Improving Prosody and Intelligibility
in Young Adult Cochlear Implant
Users
Paula M. Brown, Ph.D./CCC-SLP,
Professor, Nazareth College
Marianne S. Gustafson, M.S./CCC-SLP,
Assoc. Prof., NTID at RIT
ASHA Convention, November 22, 2008
Overview
Cochlear Implant Outcomes
y Information on 440 Students receiving
Speech Therapy
y Therapy Outcomes
y Description of Prosody Assessment and
Intervention
y Case Studies
y Conclusions and Questions
y
2
Overview of Prosody and
Cochlear Implants
3
General Outcomes of CI Users
y
CI vs. HA
y
Speech Perception
y
Speech Production
y
Language
4
Variables influencing outcomes
Access and use of sound prior to
implantation
y Age at implantation
y Quality of sound processor
y Quality of services
y Time on task
y Parent commitment and involvement
y
5
Early Access to sound is critical!
6
Outcomes of prosody assessment
and intervention with children with
cochlear implants
y
Prosody and Voice/Pitch
y
Prosody and Intelligibility
y
Prosody and Language
7
Can we do better?
8
Access to prosodic cues
y
Typically not complete.
y
Problems possibly due to lack of deep
insertion (Med-El deeper) and resultant
lack of access to lower frequencies (F0)
that equate to fundamental pitch level and
pitch changes used to convey linguistic
meaning (intonation and syllabic stress).
9
Speech Coding Strategies
Goal of the newer strategies is to better
represent the input speech spectrum:
y Offer more channels
y Capture more sound
y Faster processing rate
y Better frequency/pitch resolution for
◦
◦
◦
◦
Speech in quiet
Speech in noise
Temporal processing
Music appreciation
10
Speech Coding Strategies
y
Advanced Bionics
◦ SAS
◦ Hi Res
◦ Fidelity 120
y
Cochlear
◦ SPEAK
◦ CIS
◦ ACE
y
Med-El
◦ CIS, CIS+
11
CI Coding Strategies Demo
y
How a CI Hears.lnk
12
Speech Therapy
Students and Strategies
13
NTID population
y
1100 Deaf and hard-of hearing students
y
Enrolled in associate degree programs at
NTID or in baccalaureate programs at
other colleges of RIT
y
23% (n=255) with Cochlear Implants
14
Incoming Students: Amplification
100%
90%
80%
70%
60%
%None
%CI
%HA
50%
40%
30%
20%
10%
0%
1997
2000
2003
2007
15
All Incoming Students:
Preferences for Receiving Information
60
50
40
% Sign Alone
% Sim/Comm
% Speech/Listening
% Other/Text
30
20
10
0
1997,
n=299
2000,
n=269
2003,
n=294
2007,
n=355
16
Incoming Students w/CI’s
Preferences for Receiving Information
70
60
50
40
% Sign Alone
% Sim/Comm
% Speech/Listening
% Other/Text
30
20
10
0
1997, n=9
2000,
n=14
2003,
n=51
2007,
n=74
17
NTID Students in Speech Therapy
Over the past 5 years, 440 students have
voluntarily pursued individual speechlanguage therapy at NTID.
y 26% (n=115) of speech therapy students
have been Cochlear Implant users
y
◦ 79% graduated from mainstream HS
◦ All received some level of speech-language
support growing up
◦ The majority were late implanted
18
Intelligibility Ratings of Students
Seeking Speech Therapy
CI Users n=115; Non-CI Users n=325
60
50
40
% Intelligible
% Semi-Intelligible
%Unintelligible
30
20
10
0
CI Users
Non-CI Users
19
Outcomes
y
Brown & Weyman, 2005
y
55% of students had measurable gain in
intelligibility after 2 or more quarters.
y
87% feel their communication has
improved.
20
Intelligibility gains for CI students
y
Percent who improved
51% improved
40% stayed the same
9% scored lower
y
Average gain
Pre=71% of key words understood; 3.4
Post=82% of key words understood; 3.8
21
NTID Voice Evaluation Form –
Prosody ratings
Rate:
◦
◦
◦
◦
◦
Circle descriptor - "fast" or "slow"
Cannot control rate of syllable articulation
Much too fast or slow for efficient communication
Moderately fast or slow
Slightly fast or slow, but monitored well for clarity
Normal
Stress and Inflection:
◦
◦
◦
◦
◦
Cannot evaluate
Severe problem
Moderate problem
Mild problem
Normal
Blending and coarticulation:
◦ Cannot evaluate
◦ Severe problem
◦ Moderate problem
◦ Mild problem
◦ Normal
http://www.ntid.rit.edu/speechlangpros/assessment/discourse.php
22
Description of Prosody Problems
y
Rainbow Passage example
y
Clark Sentence example
y
Word level example
23
Initial Evaluation Prosody Ratings
70
60
50
Normal/Mild Problems
40
Moderate/Severe
Problems
30
20
10
0
CI Users
Non-CI Users
24
Speech Therapy Strategies
y
Listening to intonation and stress patterns
y
Reduction of vocal tension and/or
fundamental pitch
y
Teaching about intonation & stress
patterns
y
Using visual feedback instrumentation
25
Therapy Demos
NTID website for SLP’s
www.ntid.rit.edu/speechlangpros
y
Question Intonation
intonation 3.mov
y
y
Monitoring Intonation & Pitch
Web_Demo_of_VP_SS.mov
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Therapy Demos, cont’d.
y
Pitch Control
5_levels_of_practice.mov
y
Pitch and Amplitude
Demo_of_VP_1.mov
y
Pitch Games
Web_Demo_of_VP_2.mov
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Case Studies
3 Students with Prosody as a
Focus of Therapy
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Student DB
Speech Intelligibility 2.6
y
CI at age 16
◦
◦
◦
◦
y
Used for 5 years
Nucleus 24 3G
ACE coding strategy
Frequency Range
120 Hz – 8658 Hz
y
Pre-Therapy
y
Post-therapy
Therapy:
◦ Prosody Focus 4 Qtrs.
◦ Improvement
x Rate 2+ to 4+
x Stress/Inflection 2 to 3
29
Student DB
y
Pre-therapy:
◦ Speaks with reduced rate, syllable-by-syllable
◦ “…has poor prosody particularly blending
syllables and using correct stress”
y
Post-therapy:
◦ When verbal model given with correct word
and phrasal prosody, can learn and copy, but
doesn’t retain and incorporate into
spontaneous speech
30
Student JG
Speech Intelligibility: 3.8
y
CI at age 12
◦
◦
◦
◦
y
Used for 8 years
Clarion Platinum BTE
SAS coding strategy
Frequency range
250 Hz – 6800 Hz
Therapy:
y
Pre-Therapy
y
Post-therapy
◦ Year 1
◦ Year 2
◦ Focus on pitch control,
then prosody
◦ Improvement
x Stress/Inflection 3 to 4
31
Student JG
y
Pre-therapy
◦ Fluctuations in pitch control are disruptive to
prosody and intelligibility.
◦ Focus of therapy was on pitch control.
y
Post-therapy 1st year
◦ “He continues to use an appropriate vocal pitch
overall, but there continues to be a pattern of
pitch fluctuation wherein a sentence begins at a
lower pitch and ends at a higher level. This has
been very resistant to change.”
32
Student JG
y
Pre-therapy
◦ Fluctuations in pitch control are disruptive to
prosody and intelligibility.
◦ Focus of therapy was on pitch control.
y
Post-therapy 1st year
◦ “He continues to use an appropriate vocal pitch
overall, but there continues to be a pattern of
pitch fluctuation wherein a sentence begins at a
lower pitch and ends at a higher level. This has
been very resistant to change.”
33
Student JG
y
Therapy 2nd year- Focus on prosody
◦ Increase speech intelligibility through
improved co-articulation and intra-, intersyllable blending
◦ Listen for stress and inflection
◦ Produce sentence inflection utilizing feedback
from CSL Real Time Pitch
◦ Incorporate terminal pitch fall and
appropriate word stress in conversational
speech
34
Student MR
Speech Intelligibility 3.7
y
CI at age 16
◦ Used for 3 years
◦ Nucleus 24 Freedom
◦ Coding strategy ACE?
y
Therapy:
◦ Moderate problems
with stress & inflection
and pitch control
◦ Prosody Focus 2 Qtrs.
x Receptive/expressive
35
Student MR
y
Pre-therapy
◦ “Speech characterized by moderate
breathiness leading to problems with stress
and inflection including pitch control.”
◦ Equal stress on all words and equal pausing
between words
Receptive and expressive practice of
intonation patterns in everyday sentences
y Pitch, intensity, rhythm and rate addressed
in terms of intended meaning
y
36
Student MR
y
Resources utilized:
◦ Hear2Learn program
◦ Daily ESL online http://www.dailyesl.com/
◦ Randall’s ESL lab http://www.esl-lab.com/
37
Student MR
y
Intonation
◦ Statement
◦ Question
y
ESL conversation
y
Post-Therapy comments
◦ In structured situations could alter intonation to
match communicative intent, however minimal
carryover to spontaneous speech.
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Summary
Questions?
Contact Information:
Paula M. Brown
[email protected]
39