Determining Functional Outcome of Hearing Amplification: The Case for Language Sample Analysis

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1 Determining Functional Outcome of Hearing Amplification: The Case for Language Sample Analysis Patrick R. Walden, Ph.D., CCC-SLP & Maryrose H. McInerney, Ph.D., CCC-A Session Code: 1147; McCormick Place, Room: W187BC November 14, 2013; 4:30-5:30 pm

2 Amplification Outcome Measures Historically, benefit of amplification has been measured through: Self-report of hearing QoL Self-report of communication ability Adherence to use (data logging) Functional gain (speech discrimination testing in noise) Willingness to pay for hearing aids Yueh, Souza, McDowel, et al. (2001)

3 Aural Rehab Approach Research on conversational aural rehabilitation models has traditionally used: Speech perception tasks Storytelling (unstructured conversation) Focus is usually on repair strategies Clinically, hearing handicap is often evaluated through use of questionnaires rather than using an aural rehabilitation model. This provides little information about how to analyze breakdowns and to repair the breakdowns using communication strategies. Lind (2011)

4 Language Sample Analysis (LSA) Long history in SLP literature Has become the gold standard for diagnosis and intervention of communication disorders across the lifespan. The purpose of language sample analysis is to demonstrate how an impairment affects a client s communication function. It has the highest ecological validity of all other assessment methods typically used in CSD. Jacobson & Walden(2013); Walden, Gordon-Pershey, & Paul (in press)

5 Benefits of LSA Flexible (same sample, various uses) Repeatable Valid (direct measure of variables of interest) Accountable (meets ASHA EBP standards) Yet, LSA is rarely employed to determine functional outcomes of amplification. Miller, Andriacchi, and Nockerts (2011)

6 How to perform LSA Choose a naturalistic communication activityanything will do as long as it is something that might occur naturally. Audio- or video-record the communication interaction. Transcribe the interaction. For aural rehab, breaking the transcript up by turns will meet the assessment needs. Look over the transcript for breakdowns in communication as well as whether these were repaired, by whom and how. In-vivo analysis may be possible

7 Coding Communication Breakdowns Hearing breakdowns: I did not hear you speak. Utterance breakdowns: I heard you speak but I did not recognize the words. Reference breakdowns: I heard what you said but did not know what you referred to. Intent breakdowns: I know what you referred to but did not understand what you meant. Lind (2011), Clark, (1999)

8 Diapix Task Van Engen, Baese-Berk, Baker, et al. (2010)

9 Diapix Task Van Engen, Baese-Berk, Baker, et al. (2010)

10 What do you code? Total number of turns Number of Breakdowns Type of Breakdown Number Repaired Breakdowns Number Unrepaired Breakdowns Number of turns to repair breakdown Patient Clinician

11 Examples of Coding C: Do you have a cat by the tree? P: I have a cat. C: You have a cat right above the tree? By the pet shop? P: Yes, I have a green bench. C: What else do you have? P: I have a sheep dog. C: On the pet shop? P: I have a pet shop?

12 Hints for a better experience Find short, simple activities which can be transcribed quickly Use family-members/caregivers as communication partners for clients Use a digital recorder that easily plugs into a computer for storage and transcription A transcriber (foot pedal) makes the process much easier

13 Evaluating the Use of an Assistive Listening Device for Communication Efficiency Using the Diapix Task: A pilot Study Methods Subjects: 22 subjects (19 F, 3 M) mean age years (70-93 yrs) Inclusion Criteria : MMSE= > 24 score HL= >40 db BPTA (Jupiter,2009) HHI-E (Weinstein, 1986) ALD were randomly distributed. McInerney and Walden, 2013 Group 1: No HL with ALD Group 2: No HL No ALD Group 3: HL with ALD Group 4: HL No ALD

14 Findings Mann Whitney U Results for Groups by Total Breakdown, Repaired Breakdown, and Unrepaired Breakdown *=p<.05; **=p<.01

15 A rehabilitative approach to the validation of hearing aids Subjective and objective documentation of hearing aid outcomes, particularly in the area of speech perception performance is essential for determining the efficacy of our treatment outcomes in hearing aid fitting (i.e., whether the hearing aids are beneficial). (Mendel, 2009) Communication, the ultimate objective for our patients, encompasses not only hearing, but also listening skills, cognitive-based interpretation and communication strategies. (Sweetow, 2009) (Kiessling et al 2003)

16 A rehabilitative approach to the validation of hearing aids Although data from multiple studies suggest hearing aids significantly reduce problematic behaviors (i.e. forgetfulness, negative statements) and isolation in subjects. Thirty percent of individuals who purchased hearing aids attributed their non-use of hearing aids to poor benefit. ( Kochkin, 2002) A review of the literature indicated that there are no evidence based studies that focus on the effect different rehabilitation programs may have on a person s decision to obtain amplification. (Knudsen, Oberg, Nielson, et al., 2010)

17 Case Study: How to Use LSA 74 year old female, HA user for 15 years Moderate sloping to profound SNHL bilaterally Fair speech discrimination bilaterally Issued state of the art hearing aids bilaterally 3 weeks ago. REM speech mapping was completed. Patient notes significant subjective benefit supported by HHIE results.

18 Communication Breakdowns Hearing breakdowns: I did not hear you speak. Utterance breakdowns: I heard you speak but I did not recognize the words. Reference breakdowns: I heard what you said but did not know what you referred to. Intent breakdowns: I know what you referred to but did not understand what you meant. Lind (2011), Clark, (1999)

Sample of LSA- Unaided Clinician J- Jerry C- Ok, so I m here with Jerry and we re going to be looking at um the picture together. So, how are you today Jerry? J- I m fine, thank you. C- That s good.

19 Sample of LSA- Unaided Clinician J- Jerry C- Ok, so I m here with Jerry and we re going to be looking at um the picture together. So, how are you today Jerry? J- I m fine, thank you. C- That s good. Ok, so we have these pictures and we re going to try to figure out which ones. So, let me see um do you have chickens in your picture? J- Do I have chickens on mine? C-Yes. J- Yes. C-And um are they J-Little chicks. C-I have little chicks too. I have three little chicks. Right. Do you have three little chicks? J- Yep. C- My chicks say chirp chirp chirp. J-Mine says peep peep peep. C- K, so that would be one thing that s not right, right? That was the one thing that s different? Uh J- Ok. C- Let s J- I heard one word you said. (Type 2- Repaired) C- You heard one word. What word did you hear? J- Kitchen. C- Kitchen. Ok. That s- what I said was, that would be one thing that was different. J- What would be the one thing that was different? That doesn t even sound like kitchen. C-And J- On on the chicks? C- Yea, so it s chirp verses beep beep beep, cause remember we re J- Peep peep peep C-Cause remember we re trying to find ten things that are different J- With the chicks? (Type 3- repaired) C- With the whole picture.

Types of Breakdowns Unaided Auditory Only Condition 188 Turns Number of Breakdowns 14 12 10 8 6 4 2

20 Types of Breakdowns Unaided Auditory Only Condition 188 Turns Number of Breakdowns Total Repairs Unrepairs 0 Hearing Breakdown Utterance Breakdown Reference Breakdown Intent Breakdown

Sample of LSA - Aided C- Ok, so now we re going to record it, still not looking at um there s no lip-reading. J- Right. C- And, we re going to have the hearing aids on. J- Yea.

21 Sample of LSA - Aided C- Ok, so now we re going to record it, still not looking at um there s no lip-reading. J- Right. C- And, we re going to have the hearing aids on. J- Yea. C- Ok, so this is picture s a lot different than the last picture. J- Right. C- Um so I have a lady, and she has red shoes on. J- I have a lady with green shoes. C- So, that s one difference. J- And a blue purse C- My lady has a blue purse too. J- Ok, and a light pink dress. C- Yes, so so does mine. How bout um it this looks like a picture of stores, doesn t it? J- Right. C- So, my first store um is a pet shop. J- That s on that s on the right. C- Yes. J- Ok. OK. Pete s Pet shop C- Yes. Mine just says Pet shop. It doesn t say Pete s Pet Shop. J- Ok. C- And I have a picture of a cat in mine. J- I have a picture of uh a lamb uh next to Pete s Pet Shop, on top. C- Oh, so mine just has a picture of cat next P..Pet Shop. And then, on the bottom, do you have another picture? J- Yea. I have a picture of a sh sheep dog. C- So do I. I have a picture of a sheep dog too. J- Ok. C- With a yellow door. J- Yea. C- With paws on it. J- No. Nothing on the door. C- Oh. So, mine has paws on it, like um dog paws J- right. C- You don t have any paws? J- Nope. C- Mm. Ok. And then, the next shop I have is a grocery store. J- Right. C- My grocery store has a man outside of it. He does not look happy. (Phone rings) Uh you have a phone call. Do you want to take that? J- No.

22 Types of Breakdowns Aided Auditory Only Condition Total Turns- 109 Hearing Breakdown 1 repaired Utterance Breakdown 1 repaired

23 Group Exercise Read through the handout we provided. Mark each breakdown. Code each breakdown by type. Determine whether the breakdowns were repaired or unrepaired. How many turns did the repair take?

24 QUESTIONS 24

25 References Clark, H. H., & Schaefer, E. F. (1987). Collaborating on contributions to conversations. Language and Cognitive Processes, 2(1), Jacobson, P. F., & Walden, P. R. (2013). Lexical diversity and omission errors as predictors of language ability in the narratives of sequential Spanish/English bilinguals: A cross-language comparison. American Journal of Speech- Language Pathology, 22, Lind, C. (2011, October). Conversation repair and acquired hearing impairment: Research and clinical perspectives. Presentation at the 2011 Aging and Speech Communication Conference at Indiana University in Bloomington, IN. Retrieved September 21, 2011 at McInerney, M., & Walden, P. (2013). Evaluating the use of an assistive listening device for communication efficiency using the Diapix task: A pilot study. Folia Phoniatrica et Logopaedica, 65(1), Mendel, L.L. (2007). Objective and subjective hearing aid assessment outcomes. American Journal of Audiology, 16, Miller, J. F., Andriacchi, K., & Nockerts, A. (2011). Assessing language production using SALT software: A clinician s guide to language sample analysis. Middleton, WI: SALT Software, LLC. Van Engen, K.J., Baese-Berk, M., Baker, R.E., Choi, A., Kim, M., Bradlow, A.R. (2010). The Wildcat Corpus of native- and foreign accented English: Communicative efficiency across conversational dyads with varying language alignment profiles. Language and Speech, 53(4), Weinstein, B.E., Spitzer, J.B., & Ventry, I.M. (1986). Test-retest reliability of the hearing handicap inventory for the elderly. Ear and Hearing, 7(5), Walden, P.R., Gordon-Pershey, M., & Paul, R. (in press). Communication sampling procedures. In R. Paul & P. Cascella (Eds.). Introduction to clinical methods in communication disorders (3rd ed). Baltimore, MD: Paul H. Brookes Publishing. Yuen, B., Souza, P. E., McDowell, J. A., Collins, M. R., Loovis, C. F., Hedrick, S. C., Ramsey, S. D., & Deyo, R. A. (2001). Randomized trial of amplification strategies. Archives of Otolaryngology-Head & Neck Surgery, 127(10),

Critical Review: Does the participation of a significant other in aural rehabilitation classes reduce perceived hearing handicap for older adults?

Critical Review: Does the participation of a significant other in aural rehabilitation classes reduce perceived hearing handicap for older adults? Christine De Luca M.Cl.Sc. (Aud) Candidate School of Communication