CSD 5400 REHABILITATION PROCEDURES FOR THE HARD OF HEARING

1. CSD 5400REHABILITATION PROCEDURES FOR THE HARD OF HEARING Language and Speech of Deaf and Hard-of-Hearing Characteristics and Concerns Speech Development

2. Some Preliminary Remarks The first intelligible word usually occurs at 1 year Discrimination of important phonetic contrasts occur much earlier (receptive) Normal speech development occurs concurrently with language development Consistent exposure to conversations with adults is necessary Normal hearing is necessary

3. Newborns Primary form of communication is through their cry

4. Newborn Communication Communication intents though crying: • Pain or discomfort • Hunger • Overload

5. Newborn Speech Skills Primarily reflexive sounds at birth Oral reflexes Crying

6. Changes in Speech • Increased development and use of non-distress sounds • Some productions of vowel sounds and back consonants /g/ and /k/ • By 3 months, vocalization in response to caregiver’s vocalizations

7. Babbling • Emerges at around 4 months • Random sound play • Extremely important landmark of infant development • Single syllable units of CV or VC construction

8. Changes in Speech • By 6 months, see evidence of more complex sound combinations • Labial sounds like /m/ and /p/ are produced more often • Stop consonants (p,t,b,k,g,d), nasal consonants (m, n, ing) and vowels comprise about 80% of sounds produced • Evidence of reduplicated babbling • Emergence of imitative behavior

9. In Summary… By six months, most babies: • Make a lot of different sounds • React appropriately to different voices • Turn and look for sounds • Babble with purpose • Respond to their name • Try to imitate sounds and vocalizations

10. Landmarks in Speech Development by One Year The use of one or more words with meaning Typical first words include “mama”, “dada”, other nouns important in the child’s life Concept words come next Babbling development gets the child to this point

11. Stages of BabblingDuring this Time Echolalia--imitation Varigated babbling--syllables aren’t identical Jargon Phonetically consistent forms Representation

12. Affect of Hearing Loss on Early Speech Development and Behavior The effects of hearing loss on speech development are very subtle Generally, even subtle differences sometimes aren’t apparent until after the first birthday Emergence of canonical babbling is a major clue

13. Variables Affecting Later Speech Intelligibility Age of identification/remediation We already talked about this Degree of impairment Focus more on aided thresholds Communication mode Oral programs tend to develop speech intelligibility best

14. Speech Characteristics and Therapy Goals Children with mild/moderate degree of impairment Children with profound impairment Acquired hearing loss

15. Speech Characteristics With Mild/Moderate Hearing Loss What’s normal Vowel production, voice quality, suprasegmental features Intelligibility What’s not normal Articulation of single consonants and consonant blends Substitutions, distortions, omissions

16. Speech Characteristics with Mild/Moderate Hearing Loss Phonologically, these children look like normally-hearing kids of a younger age These children develop and use speech sounds in the same order as normally hearing kids

17. Speech Management of Mild/Moderate Hearing Loss Amplification is a must Clear understanding of the child’s aided hearing thresholds Articulation and phonological management can generally be approached in the same way as a normally hearing child but Don’t rely on auditory feedback cues Rely more on visual, tactile, and/or kinesthetic cues Be mindful of the developmental order of speech sound acquisition

18. Speech Characteristics of Deaf Children What’s normal Nothing What’s not normal Respiration, phonation, resonance, articulation, and suprasegmentals Intelligibility averages about 20%, but extremely variable on a case-by-case basis

19. Characteristics of Respiration Basic problems related to a general in- coordination of respiration and phonation Few syllables/breath Inhalation at inappropriate times Abnormally high airflow rates during phonation Breathy quality

20. Characteristics of Resonance Hyponasality Hypernasility

21. Characteristics of Phonation Inadequate vocal fold adduction Breathy voice quality Voiceless sound substitutions for voiced sound Inadequate control of vocal fold vibration Abnormally high pitch Pitch change is restricted across utterances Inadequate control of laryngeal activity Speech intensity too high or too low Lack of loudness variation and control across utterances Breathiness or glottal resistance

22. Characteristics of Articulation Individuals are extremely variable in the number and type of articulation errors seen Vowel errors Vowel neutralization, diphthong and vowel confusions, nasalization of vowels Consonant errors Errors of voicing, omission and distortion of consonants, omission of consonant blends, nasalization of consonants Impaired coarticulation movements

23. Characteristics of Suprasegmentals Slower than normal speaking rates (1.5-2 times) Individual phonemes prolonged Lengthy pauses within utterances Pauses are more numerous and longer than normal Abnormal intonation patterns

24. Increasing Speech Production and Intelligibility Maximizing residual hearing Appropriate amplification is a must Anatomical and pictorial monitoring Picture representations of tongue placement during phoneme production Visual stimulation and feedback Mirrors Feedback devices Visipitch, SpeechViewer, palatometers

25. Speech Characteristics of Acquired Hearing Loss Extremely variable effects Usually the degree of hearing loss has to be very significant, especially in the high frequencies Decline in intelligibility is gradual and due to loss of auditory feedback Typical errors Production of siblants, final consonants, voice quality, loudness control, rhythm