By Manal Mohamed El- Banna (MD) Unit of Phoniatrics , Faculty of Medicine,

1. Profile of Phoneme Auditory Perception Ability in Children with Hearing Impairment and Phonological Disorders By Manal Mohamed El-Banna (MD) Unit of Phoniatrics, Faculty of Medicine, Alexandria University Cairo 8/3/2012

2. Introduction • Receptive language impairment is related to: • Audiometrically low hearing sensitivity • Audiometrically sensitive hearing it may be due to: • Non speech auditory perceptual deficit • Linguistic problem. Failure of phonology representation

4. The Relation between Perception and Production Same linguistic representation systems. Unbalanced relationship. A synchronize development in early language acquisition. Production Perception 1. Se´ne´chal M, Ouellette, G Young L: Testing the concurrent and predictive relations among articulation accuracy, speech perception, and phoneme awareness J. Experimental Child Psychology 89 (2004) 242–269 2.Warker JA, Xu Y, Dell GS, Fisher C. Speech errors reflect the phonotactic constraints in recently spoken syllables, but not in recently heard syllables.Cognition 112 (2009) 81–96

5. Speech Perception Phoneme Specific Tasks: • Attempt to measure implicit phonological representations. • Provide a sensitive test of the association between variables. • Confound speech perception ability with memory and vocabulary skills by involving word, pseudoword.(1) 1. Boada R., Pennington B.F. Deficient implicit phonological representations in children with dyslexia Journal of Experimental Child Psychology 95 (2006) 153–193

6. Similarity and confusability of phonemes • The similarity between phonemes and confusability in short-term memory influence: • Speech errors • The strength of phonotactic constraints • The overall similarity between whole words. • Important for many psycholinguistic contexts. Bailey MT, Hahn U. Phoneme similarity and confusabilityJournal of Memory and Language 52 (2005) 339–362

7. Aim of the work • Study the phoneme auditory perceptual profile in children with hearing impairment and phonological errors. • Highlight the relation between the ability to interpret the acoustic characteristics of the phoneme as represented by phoneme auditory perception assessment results and the speech production errors.

8. Subjects: • 32 children, age range 6-12 years. Average intelligence. • Group A: 12 children Med-El cochlear implant. • Group B: 8 children moderate severe and moderate SNHL. • Group C: 6 children with phonological disorders. • Group D: 6 normally language developing children.

9. Methodology • Protocol of language disorders • Audiological evaluation • Profile of Speech errors (Phonology test)(1) • Psychometry • Phoneme Speech auditory Perception evaluation 1. Abou-Ras et al. 27th Alexandria International Combined ORL Congress, April 8-10,2009

10. General Testing Instructions: • •Room: Quiet room with minimal distractions. • •Position : Behind and to the side. • •Examination condition: life sound by use sound level meter at 60 dB. • •Responses according to each task and level. • •Reinforcement is providing at the beginning of each task. • •Patient should understand the instructions first before proceeding.

11. 1) Vowel perception testing: • Recording of the number of correct response according to total number of stimuli & calculation of %. • Identify vowels using pictures of facial gestures representing/a/,/i/,/o/. (CVC) • Discrimination of pairs of monosyllabic words: • Vowel height • Vowel place • Vowel length

12. Vowel Identification CVC syllables

13. Vowel Identification (monosyllabic words)

14. Discrimination of vowels

17. 2) Consonant perception testing: Low frequency phonemes Low frequency fricatives High frequency fricatives

18. Consonant perception testing • Consonants are introduced listwise in syllabic form (VCV) with vowel stabilization. • Score of correct identification: • Low frquency Fricatives • High frequency fricatives • Low frequency phonemes • Stops • Nasals • Glides • Laterals • Score of correct discrimination: • Voicing • Place of articulation • Manner of articulation • Emphatic

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20. Results

21. Group A: Cochlear Implant • Common speech production error: • Distorted vowels • Imprecision of consonants (manner and place of articulation) • Devoicing • Fricatives were easier to acquire than rest of consonants. • Difficulties to perceive voicing cues and vowels with close acoustic features.

22. Group A: Cochlear Implanted discrimination of vowels

23. Group A: Cochlear Implanted Consonants Identification

24. Group A: Cochlear Implanted Consonants Identification

25. Group A: Cochlear Implant Discrimination of consonants

26. Group B:Hearing Impaired • Degree of hearing loss • 6 Moderate severe • 2 Moderate • Configuration of hearing loss: • 6 High frequency hearing loss (sloping) • 2 Flat configuration

27. Group B: Hearing Impaired • Common speech errors: • Difficulty of production of high frequency fricatives. • Substitution • Stopping • Devoicing

28. Group B: Hearing Impaired Discrimination of vowels

29. Group B: Hearing Impaired consonants identification

30. Group B: Hearing Impaired consonants identification

31. Group B: Hearing Impaired Discrimination of consonants

32. Group C: Phonological errors • Common speech production errors: • Substitution • 6 (Devoicing) • 2 (Fronting) • 100% accuracy of vowel perception • 100% accuracy of consonants perception • Difficulty encountered with discrimination tasks, were not consistently detected on repetition of testing.

33. Comparison between Group A, B, C and D:Vowels CI: Cochlear implant, HI: hearing Impaired, Ph: phonological errors

34. Comparison between Group A, B, C and D: Consonants low frequency phonemes identification CI: Cochlear implant, HI: hearing impaired, Ph: phonological errors

35. Comparison between Group A,B,C and D :Consonants Identification CI: cochlear implanted, HI: Hearing impaired, Ph: phonological errors

36. Comparison between Group A, B, C and D:Consonants Discrimination CI: Cochlear implant, HI: hearing impaired, Ph: phonological errors

37. Conclusion • Cochlear implantees encounter perceptual difficulties in interpretation of temporal feature (vowel length, stops, voicing) that is not necessarily related to their production difficulty. • Hearing Impaired difficulty were more related to spectral nature of the sound (vowel advancement, high frequency fricatives, emphatic)

38. Conclusion • Phonological errors encountered may not be related to error of acoustic interpretation of phoneme signals, but could relate to attention or central perceptual difficulty easily corrected by repetition.

39. Recommendation for Further Research • Extension of the number of studied subjects. • Study of influence of variable stimuli on speech perception results.

40. Thank you for your attention