Proving Benefit
with
Speech Testing
Vicky Watermeyer CertMRCSLT
Speech and Language Therapist
Audiologist
Auditory Verbal Intern at AVUK
© AVUK 2015
Learning outcomes
• Identifying a range of validation tests for hearing technology.
• How best to work in collaboration with the AV therapist, SLT
and TOD to set the best possible levels for hearing aids
• Using the speech perception tests and evaluating a child’s
speech production to fine-tune technology
© AVUK 2015
Why amplification?
Why do we fit babies and young children with hearing
technology?
© AVUK 2015
The whole point of technology
to Madell, J. & Flexer, C. (2014)
•
•
•
according
Getting sound/spoken communication to a child’s brain
Children speak what and how they hear – speech is a
window into what sound is reaching their brain
Validation tests are as important as verification tests for
optimal hearing aid fitting
© AVUK 2015
Verification & Validation
•
In software engineering the V&V approach is a widely
used discipline to confirm that a product is at once wellengineered and meeting the client’s needs
•
•
Verification: are we building the system right?
Validation: are we building the right system?
(Easterbrook, S. 2010)
Validation is not about checking hearing aids but checking
what information is reaching that child’s brain.
© AVUK 2015
Validation
• Think of four assessments that can be used for validation
when fitting to validate hearing aids.
Threshold tests – VRA, BOA, Play Audiometry
Speech Perception – Ling Test, McCormick Toy Test, CCT, SII
Speech evaluation – the child’s speech output as a reflection of the
sound input
© AVUK 2015
Speech Perception Tests
• The Ling 6-sound test –
mm – oo—ah – ee – sh – s
• What useful information can be obtained from using the
Ling test?
© AVUK 2015
Ling Sound Test
• Detection is not enough, we need to start working on
discriminating the Ling sounds from very early on.
• Discrimination will give us a wider range of information
about the validation of the hearing aid fitting.
© AVUK 2015
dB
125Hz
250Hz
500Hz
1000Hz
2000Hz
4000Hz
0-10
20-30
zv
XXX
30-40
XXX
40-50
50-60
sXXX
th f
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
60-70
70-80
80-90
90-100
100-110
100+
© AVUK 2015
mm oo
250-350 Hz
FB
ah
F1
ee
sh
ss
F1
500Hz
750Hz –
850Hz
10001500Hz
2000 –
2500Hz
F2
F1
F2
F2
FB
3000Hz
4000Hz
FB
© AVUK 2015
Video of Ling sound check with a 15-month old
© AVUK 2015
Video of training a LSA to carry out the Ling
sound check
© AVUK 2015
McCormick Toy Test
cup – duck
spoon – shoe
man – lamb
plate – plane
horse - fork
key - tree
house - cow
© AVUK 2015
Consonant Confusion Task (CCT)
• Four alternative choice format
• Four pictures with similar sounding words
• Pictures can be sent home in advance for pre
teaching of vocabulary
• CCT ≥ 3yrs
• www.chears.co.uk
© AVUK 2015
Chear Auditory Perception Test (CAPT)
• Four alternative choice format
• Minimal pairs
• Pictures can be sent home in advance for pre
teaching of vocabulary
• CCT ≥ 5yrs
• www.chears.co.uk
© AVUK 2015
Vowels & Dipthongs
•
Formants = broad peaks of resonance that occur as breath stream passes
through the vocal tract.
•
1kHz to detect and 3kHz to discriminate
•
Linguistic structures
– past tense irregular (eat-ate, catch, caught, sit-sat
– Function words
• Conjunctions (or and)
• Numbers (2 and three
• Colors (blue and green)
• Articles (a, the)
© AVUK 2015
Vowel Frequency Bands (Hz)*
1st Formant
2nd Formant
Who
430
1170
would
540
1410
know
760
1250
more
840
1060
of
1030
1370
Art
1020
1750
must
850
1590
learn
580
1740
and
1010
2320
then
690
2610
take
610
2680
his
530
2730
Ease
370
3200
Vowel
© AVUK 2015
The Finer details…
Non segmentals
• Duration - Rate, rythmn and emphasis (1kHz)
• Intensity - Stress (1kHz)
• Pitch - Intonation (1kHz)
Speech Information
•
•
•
•
Manner – eg. plosive burst for /b/, /d/ (400-500Hz) /t/, /k/ (1KHz)
Place of articulation – eg. alveolar /t/, /d/ (2KHz)
Fricatives – eg. /f/, /th/, /s/, /z/ (4KHz)
Voicing – eg. /d/ vs /t/; /g/ vs /k/ (1KHz)
© AVUK 2015
© AVUK 2015
Practical practice of interpreting errors during
speech perception tests
Evaluate the following example of CAPT results
diagnostically:
Child A
calf = card
path = park
Child B
goat = coat
card = cart
Child C
red = ref
cart = calf
© AVUK 2015
How else can such information be obtained?
• Talking to parents
• Evaluation of child’s babbling/speech
(owl vs eye /aƱl/ vs /ai/)
© AVUK 2015
Babbling and auditory access
1 – 3 months – child will start responding to speech vocally
4 – 6 months
-
Vocal play – start to change pitch, intonation & intensity
Imitates intonation-this requires auditory feedback
Pre-babbling – single-syllable productions
Vocalises in response to speech, singing and pleasure
Vocalises to toys imitating some sounds
Vocalises for needs and wants
Producing vowel like sounds, squeals, growls, yells, raspberries
Oral-nasal distinction developing /m, b/
© AVUK 2015
© AVUK 2015
© AVUK 2015
Babbling and auditory access
6 – 9 months
- responds to own name being called
- understands ‘no’ & ‘bye bye’
- discriminates suprasegmentals (increased attention in
singing)
- Reduplicated babbling (ba ba ba)
- Uses a range vowels mostly (/o/(hot); /a/ (car); /ae/ (cake)
- Some consonants /p/; /b/; /m/ /d/
- Strengthening of auditory feedback loop
© AVUK 2015
Babbling and auditory access
10 – 12 months
- canonical babbling
- jargon
- vocables / protowords
- first single words appear
© AVUK 2015
Speech errors often caused by faulty perception
(Ling, D.)
• Substitution of plosives for nasals (eg. more = pore):
insufficient amplification around 300Hz
•Deaffrication (eg. juice = duce): insufficient amplification
around 200Hz
•Omission/substitution of stops for fricatives (eg. eat = eas):
insufficient amplification above 2KHz
© AVUK 2015
Speech errors often caused by faulty perception
(Ling, D.)
• Weak syllable deletion (eg. apple = pull): input levels or gain
too low
• Cluster Reduction (eg. school = cool): component sounds
outside auditory range
© AVUK 2015
Speech Intelligibility Index (SII)
• What is the relevance of the SII to HA validation?
• What is an acceptable SII?
© AVUK 2015
Questions?
© AVUK 2015
References
•
Easterbrook, S. (2010) The difference between verification and validation.
http://www.easterbrook.ca/steve/2010/11/the-difference-between-verification-andvalidation/
•
Madell, J., Flexer C. (2008) Paediatric Audiology. Diagnosis, Technology and
Amnagement. New York. Thieme Medical Publishers Ltd
•
Madell, J., Flexer C. (2014) Reviewing Audiologic test Results to Improve Management.
Presentation at the A.G. Bell Conference – Orlando
•
Ling, D. (2002) Speech and the Hearing Impaired Child. Washington, A.G. Bell Association
for the Deaf and Hard of Hearing
Ling, D. (2002) Assessment of speech. Presentation at the Auditory Verbal Learning
Institute at the University of Ottowa. Video accessed via
http://www.hearandsayworldwide.com/AboutUs/LingConsortiumVideos/
•
© AVUK 2015