Candidature for and delivery of audiological services: special needs of older people.
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Aged↗
Biomedical subjects
N P Erber
Publications and source records attributed to N P Erber.
Communication perceptions of older adults with sensory loss and their communication partners: implications for intervention.
INTRODUCTION: Vision and hearing loss are prevalent disorders in older adults although their effects on communication are not well documented. METHOD: The purpose of this study was to investigate the perceptions of older adults with sensory loss and their communication partners with regard to their communication, situational difficulties and conversational needs. RESULTS: Questionnaire results revealed that the sensory loss group experienced a range of functional vision and hearing difficulties. Over two-thirds of subjects reported frequent conversational difficulty, particularly in background noise and group conversations. Most subjects used clarification requests (mainly non-specific clarification and repetition requests) to overcome misunderstandings. By contrast, the communication partners reported few communication difficulties and claimed that they proactively eliminated or controlled environmental, speaker and listener variables to optimize conversation. The most frequently reported strategy was repetition. CONCLUSION: The findings suggest that older adults with sensory loss experience communication disruptions, which in many instances are not resolved. To optimize communication efficacy in this population, a communication training programme for people with sensory loss and their communication partners is highly recommended.
Adaptation, Psychological↗
Communicating with elders: effects of speaker-listener distance.
As the distance between two communicators increases, weaker sounds of speech become inaudible, conversation becomes more difficult and there is a greater need to resolve communication difficulties. This study investigated the effects of distance on face-to-face social conversation by 27 older adults with hearing impairment, under three listening conditions (without amplification, with personal hearing aids, with a small portable amplifier). Each participant was rated on a 1-5 scale of conversational fluency at distances between 0.5 and 3.0 metres. Results indicate that the subjects conversed more fluently with amplification and at short communication distances. Use of a portable amplifier resulted in high conversational fluency regardless of distance.
Aged↗
Conversation as therapy for older adults in residential care: the case for intervention.
Social isolation resulting from sensory loss tends to reduce life satisfaction in older adults. Residence in a long-term care facility such as a nursing home does little to alleviate their communication needs. Potenial communication partners are available (e.g. other residents, family and friends, nursing staff, volunteers, health-care workers), but many need instruction, counselling and feedback to become therapeutically effective. The speech pathologist's experience as both communication therapist and social facilitator can enhance consultation and staff training in this area.
Aged↗
Communicating with elders. Effects of amplification.
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Aged↗
Adaptive screening of sentence perception in older adults.
An adaptive procedure was used to screen adult sentence perception by means of hierarchical compensation for previous errors (original acoustic stimulus greater than repetition greater than clarification greater than partial auditory-visual greater than all auditory-visual). The screening procedure yields not only percent correct scores, but also suggests minimal perceptual conditions under which hearing-impaired older adults can identify sentences. After screening in nursing homes, staff are observed to adapt the findings, devising strategies to enhance communication with residents. Typical client response patterns and consequent recommendations to caregivers are summarized.
Acoustic Stimulation↗
Simulation of sensorineural hearing impairment.
A hearing loss simulation system (HELOS) was designed and constructed to simulate various aspects of sensorineural hearing impairment. The theoretical bases for HELOS were several threshold and suprathreshold auditory phenomena typically exhibited by people with sensorineural hearing losses. In addition to providing differential attenuation of acoustic signals across the frequency range, HELOS simulated loudness recruitment, loudness discomfort thresholds, reduced dynamic range, and reduced frequency selectivity. Three basic audiometric configurations were chosen to investigate the effects of the aforementioned components of a sensorineural hearing impairment on the auditory perception of speech. They were: (1) a sloping high-frequency hearing loss; (2) a flat, severe hearing loss; (3) a severe/profound hearing loss. The battery of tests administered to a group of normal-hearing adults consisted of pure-tone audiometry and PB-word recognition tests, as well as vowel and consonant identification tests. For comparable audiometric configurations, the results from the speech-perception tests were in good agreement with the published results of similar tests administered to persons with sensorineural hearing losses.
Adult↗
Auditory, visual, and auditory-visual perception of vowels by hearing-impaired children.
The vowels (foreign letters in text) were presented through auditory, visual, and combined auditory-visual modalities to hearing-impaired children having good, intermediate, and poor auditory work-recognition skills. When they received acoustic information only, children with good word-recognition skills confused neighboring vowels (i.e., those having similar formant frequencies). Children with intermediate work-recognition skills demonstrated this same difficulty and confused front and back vowels. Children with poor word-recognition skills identified vowels mainly on the basis of temporal and intensity cues. Through lipreading alone, all three groups distinguished spread from rounded vowels but could not reliably identify vowels within the categories. The first two groups exhibited only moderate difficulty in identifying vowels audiovisually. The third group, although showing a small amount of improvement over lipreading alone, still experienced difficulty in identifying vowels through combined auditory and visual modes.
Adolescent↗
Use of the auditory numbers test to evaluate speech perception abilities of hearing-impaired children.
A simple auditory test has been developed to assist in determining whether a young hearing-impaired child can perceive spectral aspects of speech or only gross temporal acoustic patterns. This live-voice test requires the child to identify counted sequences and individual numbers. It has been administered by two talkers to 39 children, three-eight years old, with mean hearing levels (500, 1000, 2000 Hz) at 60-130 bB. Resulting scores were bimodally distributed for both talkers, indicating effective separation of the subjects on the basis of minimal auditory function. Scores were related to mean HL, although a range from chance to maximum was obtained for children with audiograms at 100-113 dB. The test is recommended for rapid evaluation of speech perception in young hearing-imparied children to aid in the planning of an aural habilitation program.
Auditory Threshold↗
Speech perception by profoundly hearing-impaired children.
This article reviews the limitations of defining profound hearing impairment solely by reference to pure-tone audiograms. Instead, profoundly hearing-impaired children may be described as those whose ability to distinguish spectral features in speech is extremely poor, and for whom the gross intensity variations in the waveform envelope are the principal acoustic cues. Examples of pattern cues that are available to profoundly hearing-imparied children are presented through an optical analog, and the usefulness of these cues is shown with regard to vowel and consonant identification, word stress-pattern perception, and distinction among sentences that differ in number of syllables, pattern, intensity, or rate. Perception of speech material through vision (lipreading) and also through combined auditory and visual modes are described, with a discussion of articulatory and language factors that influence intelligibility. Instructional strategies are briefly reviewed as they relate to educational improvement of speech-perception abilities of profoundly hearing-impaired children and to the development of special sensory aids.
Acoustic Stimulation↗
Auditory-visual perception of speech with reduced optical clarity.
Optical cues for visual and auditory-visual (A-V) perception of speech were varied by placing a sheet of rough-surfaced Plexiglas between talker and lipreader and systematically changing the distance between Plexiglas and talker. This distorts the optical environment in a way that is analogous to masking or filtering in the acoustic domain. In studies with normal-hearing adults and with hearing-impaired children, speech (words, sentences) was presented live under different degrees of optical distortion, and observers attempted to identify the stimuli. Visual-along (lipreading) scores dropped abruptly to the chance level as Plexiglas distance (blurring) was increased. A-V scores were relatively high for clear conditions but diminished gradually as Plexiglas distance (blurring) was increased. Under extremely poor optical conditions, A-V scores reached a plateau. This represents essentially auditory perception without meaningful optical cues for speech. Results parallel those of previous acoustic studies that compared auditory with A-V perception of speech as a function of S/N ratio or sensation level, demonstrating a reciprocal aspect of optical and acoustic cues for speech perception. Optical distortion seems to have potential as an auditory training technique to shift attention of hearing-impaired observers to non-dominant acoustic cues during A-V perception of speech.
Adolescent↗
Vibratory perception by deaf children.
Audiologists and educators of the deaf have become interested in vibratory perception of speech because: (1) research suggests that profoundly deaf children feel rather than hear amplified speech through their ears, and educators must help them to use this acoustic (vibratory) speech information; and (2) vibratory transducers already are used in many classrooms for deaf children to provide supplementary speech input, and educators must learn how to present vibratory stimuli most effectively for perceptual learning. Vibration provides mainly the gross time-intensity information in speech. This paper describes the variety of speech cues that are available through the vibratory sense, for example, number of syllables; syllable rate, stress, and onset/decay; pause; and roughness. An optical analog (tracings from a storage oscilloscope) is used to show the type of information available to deaf persons through vibration. Deaf children are able to perform not only closed-set recognition tasks but also can learn to identify general characteristics of vibratory speech patterns. Although vibratory perception alone is limited for communication, vibratory input can serve as a supplement to lipreading and also as a speech-training aid for profoundly deaf persons.
Bone Conduction↗
Voice/mouth synthesis and tactual/visual perception of /pa, ba, ma/.
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Adult↗
Effects of stimulus intensity on speech perception by deaf children.
Ten monosyllabic, 10 trochaic, and 10 spondaic words were presented monaurally to 10 severely (70-95 dB HTL) and 10 profoundly (larger than 95 dB HTL) hearing-impaired children at sensation levels (SL) ranging from near detection to near discomfort. Two methods were used to evaluate word perception as a function of stimulus intensity: the percentage of words recognized correctly and the percentage of words categorized correctly as to stress pattern. Both word-recognition and categorization scores reached maxima at 24-36 dB SL for the severe group, supporting previous result. For the profoundly deaf group, word-recognition scores were low regardless of SL, but their perception of the stress patterns of words improved as a function of increasing intensity, reaching maxima at 12-30 dB SL. The procedure and results described in this paper may be used by audiologists to help select optimal hearing aid volume settings for young hearing-impaired children.
Acoustic Stimulation↗
Auditory/vibratory perception of syllabic structure in words by profoundly hearing-impaired children.
Sixty monosyllabic, disyllabic, and trisyllabic words were recorded and presented at different times through earphones and vibrators to 20 normal-hearing adults and to 20 profoundly hearing-impaired children to evaluate their perception of number of syllables. Vibratory perception by the profoundly hearing-impaired and normal-hearing subjects and auditory perception by the profoundly hearing-impaired subjects all were similar. Their responses could be predicted by counting the number of prominent energy bursts displayed on the screen of a storage oscilloscope. The subjects' responses obtained under these conditions differed considerably from normal auditory perception, which could be predicted by "dictionary criteria" for syllabification. These findings suggest the need for a special perceptual viewpoint in teaching stress or prosody to profoundly hearing-impaired children.
Acoustic Stimulation↗
Audiologic evaluation of deaf children.
This paper describes an audiologic test battery for hearing-impaired children which includes otoscopic examination, tympanometry, pure-tone audiometry, speech perception testing, and hearing aid evaluation. Several of the procedures and modifications to apparatus have been developed specifically for use with deaf children. Clinical data are presented from 160 hearing-impaired children (age range three-16 years). Eighteen percent of their ears were found to contain excessive cerumen and to require ear canal irrigation. The incidence of abnormal tympanograms was high for young children but decreased with increasing age. A simple auditory speech perception test designed for use with both severely and profoundly deaf children is described, which provides for evaluation of a child's ability to recognize words, categorize them into stress patterns, or both. The children's word recognition and word categorization scores were found to relate to their audiometric averages. The overall test battery is easy to administer and also is efficient, in that considerable audiologic information can be obtained quickly.
Adolescent↗
Effects of sentence context on recognition of words through lipreading by deaf children.
Twenty monosyllabic nouns (10 animate, 10 inanimate) were presented in isolation and in three different positions in sentences to 15 profoundly deaf children to determine the effect of context on word intelligibility through lipreading. Isolated words were more intelligible (80%) than were words in sentences (46%). Animate nouns were more intelligible (70%) than inanimate nouns (33%) when used in initial position (as subjects) in sentences. Teacher ratings of children's "general lipreading ability" were correlated more highly with their recognition of words in the test sentences (r = 0.93) than with their recognition of words presented in isolation (r = 0.53). The results indicate that teachers of deaf children could enhance the intelligibility of important words by isolating them from sentences. The results also suggest that some speech-perception difficulties of deaf children could be diagnosed through lipreading tests which are scored on the basis of correctness of "key words" in sentences.
Adolescent↗
Auditory-visual perception of speech.
Hearing-impaired persons usually perceive speech by watching the face of the talker while listening through a hearing aid. Normal-hearing persons also tend to rely on visual cues, especially when they communicate in noisy or reverberant environments. Numerous clinical and laboratory studies on the auditory-visual performance of normal-hearing and hearing-impaired children and adults demonstrate that combined auditory-visual perception is superior to perception through either audition or vision alone. This paper reviews these studies and provides a rationale for routine evaluation of auditory-visual speech perception in audiology clinics.
Auditory Perception↗