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Goal of auditory training

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To improve perception of speech or sound through the auditory modality

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For directions/explanations...

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Use clearest mode of communication for your client, whatever his/her best mode of communication is

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For auditory training, assessment and therapy tasks should be...

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Auditory only; cover mouth with your hand, turn face away/have client turn away, use a fabric covered hoop or piece of paper, work on the telephone, or use pre-recorded material with no visual

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Background information needed before assessing your client for auditory training

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Audiogram, age, onset of hearing loss, age of implantation or amplification, info about client's language skills (if any), results of an APD eval if indicated

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APD

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2-7% of children and 10-20% of adults; sometimes as a result of traumatic brain injury (TBI), and incidence increasing in veterans from blast injuries

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Who is not a good candidate for auditory training?

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Individuals with no hearing and no benefit from amplification/implants; culturally Deaf individuals who prefer not to use spoken language

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Who is a good candidate for auditory training?

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Children with peripheral hearing loss of any degree or type or auditory processing deficits; adults with peripheral hearing loss, esp. those with changes hearing status (e.g. new hearing aids, new implanted device, sudden hearing loss), ASL users who want to use/improve spoken language, adults with APDs

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Reduction of a clear signal can be caused by...

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Endogenous issues (peripheral hearing loss, APDs); exogenous issues (low S/N ratio, high reverberation time)

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Auditory skill level hierarchy

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Awareness (detection), discrimination, identification, comprehension; sometimes useful to work on lower-level tasks with a client who has achieved identification or comprehension, but can't skip ahead

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Awareness (detection)

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Client is aware of sound

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Awareness tasks

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Raising hand in response to tone/other sound, turning head in response to tone or other sound (in VRA), playing musical chairs or other awareness games, Ling sounds

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Discrimination

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Client can discriminate variations in all auditory parameters but cannot understand spoken language (at least auditory-only)

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Auditory parameters

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Intensity (soft/loud); frequency (high/low); time, including duration (long/short), rate (fast/slow), and envelope cues

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Discrimination tasks

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Two or more alternative forced-choice tasks (which one?), same/different tasks (same or different?); only change parameter that you're working on at the time

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More ideas for therapy at the discrimination level

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Frequency (pitch) training: use a musical keyboard or sing (for high/low); intensity training: bang a drum softer/harder; temporal training: clap or tap the table to illustrate or test discrimination of rate, duration, envelope temporal cues

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Desired responses

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Client mimics the stimulus/stimuli; client describes the difference

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Identification

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Client can identify a word or phoneme and relate sounds to meaning

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Identification tasks

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Select the word spoken by clinician (from printed list, group of pictures, group of manipulables), identify some or all of Ling sounds

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Ling sounds

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Test whether children can hear across the frequency spectrum; /a/ /u/ /i/ /s/ /sh/ /m/ / /

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Comprehension

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Client can understand and respond to a stream of (auditory-only) connected speech

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Comprehension tasks

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A story is read to client and client answers questions about the story; client can follow directions given auditorally; fill-in-the-blank sentences

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Principles for auditory training

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Analytic (bottom up, at sound/phoneme/syllable/word level) vs. synthetic (top down, at phrase/sentence/message level -- for clients as comprehension level); formal (drills, structured practice, computer programs) vs. informal (exercises in the clinic and at home)

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Select stimuli based on...

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Client's auditory skill level, cognitive level, age, individual interests

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General rule of thumb for therapy

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Poorer than 50% correct may be too frustrating; better than 80% correct may not be challenging enough

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To manipulate difficulty using only task structure...

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Change the possible number of responses (set size): closed sets/limited and smaller sets easier than open sets/unlimited and larger sets

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Neighborhood density

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Words from sparser neighborhoods are recognized more quickly than words from denser neighborhoods

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Analytic training: vowels

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Differences in formant frequencies determine how vowels sound; vowels with similar formant frequency characteristics sound more similar than vowels with very different formant frequencies

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First formants

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Determined by size of the mouth opening; differences in first formant may be easier for hearing impaired clients to distinguish than differences in second formant, as they are lower in frequency and may be more salient

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Second formants

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Affected by the tongue position (how far forward or back the tongue is in the mouth)

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Vowel chart

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Vowels closer together sound more similar than vowels further apart

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Analytic training: consonants

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Using knowledge of phonetic features (place, manner, voicing); 3 features different is easiest, 2 features different and 1 the same is middle, and 1 feature different 2 the same is hardest

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Which cues generally provide stronger auditory information?

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Voice and manner generally stronger than place cues

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Note about auditory training

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Some sounds may be impossible for your client to discriminate in the auditory-only mode; plot the aided thresholds on the audiogram of familiar sounds to help you determine whether a specific sound is likely to be audible to your client

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Analytic omputer-based auditory training (children)

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Fast ForWord, Earobics; generally require comprehension level and are somewhat controversial in their claims about what they can do; provide practice with intensity training, frequency (pitch) training, temporal training, speech recognition training

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Synthetic computer-based auditory training (adults)

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LACE: Listening and Communication Enhancement; provides practice with discriminating speech in background noise, auditory working memory

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Ideas for other projects and stimuli for auditory training therapy

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Enjoyment of music (lyrics, instrumental passages); enjoyment of other sounds (environmental tapes, soundscapes); homework (daily logs, TV or radio training); books on tape; work on the telephone

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Beyond auditory-only

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Link with articulation therapy (work on production of sounds that are difficult to discriminate) and speechreading training (how sounds look)

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