Aural Rehabilitation for Adults: Addressing Central Auditory Processing

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1 Aural Rehabilitation for Adults: Addressing Central Auditory Processing Raymond H. Hull, PhD, FASHA, FAAA Professor of Communication Sciences and Disorders, Audiology/Neurosciences Wichita State University College of Health Professions

2 THE PERIPHERAL ASPECT IS, OF COURSE, SENSORINEURAL OR 8 TH NERVE IN NATURE, GENERALLY EXHIBITING A DOWNWARD AUDIOMETRIC CONFIGURATION INTO THE HIGHER FREQUENCIES.

4 THE RESULT BEING A REDUCTION IN SENSITIVITY TO HIGHER FREQUENCY CONSONANT PHONEMES OF SPEECH.

5 A CNS AUDITORY DECLINE APPEARS TO BEGIN AT AROUND AGE 36 YEARS, AND PROGRESSES THROUGHOUT THE REMAINDER OF LIFE.

7 FACTORS OF CNS AUDITORY 1. Sorting behaviors; DECLINE 2. Attending behaviors auditory vigilance; 3. Transitional Storage (holding for analysis); 4. Alerting, pre-analysis, and refinement of the acoustic/linguistic/semantic content; 5. Speed and accuracy of CNS processing of auditory/linguistic information;

8 Neural distortion within the CNS

9 Decline of speed of neural processing at the brain stem, auditory cortex, and association areas of the brain.

10 Failure of central fusion (auditory closure) when there is incomplete auditory/linguistic information.

11 Auditory Memory

12 MEMORY Primary memory- Described as the ongoing holding rather than storage of information as it being used. Secondary memory Refers to the storage of information, and the use and organization of that information when compared with general knowledge and vocabulary stored over-time.

13 Semantic Activation refers to the processing of linguistic information over-time, and the time required for CNS priming to occur auditorily and/or visually in other words the retrieval and identification of information from long-term memory. Auditory/Linguistic Continuity The psychoacoustic/linguistic phenomenon by which our CNS will fill in the gaps between what is heard and what is not heard, for example in noisy, reverberant or otherwise auditorilly distracting environments.

14 Categorical Perception We do not listen to discrete phonemic categories, but rather from one perceptual category to the next. To accomplish this task, primary and secondary memory must be intact, along with other cognitive functions, with the speed necessary for encoding and re-encoding for CNS processing to occur.

15 The Crux of the Problem In Summary, then, the two primary areas of consideration include: 1. Speed and precision of processing auditory/linguistic elements of speech at the brain-stem and auditory cortex; 2. Speed of auditory synthesis and closure at the brain-stem and auditory cortex.

16 SO-- When faced with a reduction of intrinsic redundancies at the peripheral and central levels of the auditory system

17 And a Reduction of Extrinsic Redundancies

18 WE MUST COMPENSATE FOR THOSE FACTORS THAT COMPLICATE THE AUDITORY DIFFICULTIES.

19 We can Compensate for the Combined Effects of the Peripheral and Central Components of Presbycusis Through Environmental Design and Modification of the Characteristics of Speech of Speakers.

20 One avenue involves improvements in the speech of those who communicate most often with the person who possesses impaired auditory function whether it be peripheral in nature, central, or a combination of both.

21 We Can Enhance The Characteristics of Speaker s Speech. For Example--Remember MR. ROGERS?

22 At age 3 years, the typical child s CNS can process linguistic codes at the rate of approximately 120 WPM.

23 At ages 4 10 years, the normal CNS can process linguistic codes well at the rate of approximately 126 WPM.

24 Young adults ages can process speech accurately when it is spoken at rates in the range of WPM

25 The average adult at age 70 years can process speech most efficiently when it is spoken at a rate of approximately 124 WPM. However, the average speaking rate of the majority of U.S. adults ranges from WPM, with some timed at WPM! Where is Mr. Rogers when we need him!

26 And, family members wonder why their older parent does not seem to comprehend what they are saying, or does not appear attentive-- Dad just doesn t listen! Why doesn t he get a hearing aid! How many times do I have to say it before he understands! I told him four times that we were leaving for the restaurant, and he was still asking me to repeat it! Why doesn t he listen?. --not realizing that it was speed of speech and accompanying lack of precision of articulation on their part that was the primary cause of the comprehension problem.

27 ENVIRONMENTAL DESIGN FOR OLDER ADULTS WITH IMPAIRED HEARING

28 ENHANCE THE LISTENING ENVIRONMENT

29 Change The Acoustical Characteristics Of The Room Which does not always mean adding carpet!

30 Most clinics, churches, meeting rooms are filled with reflectant and reverberant elements Rooms are square or rectangular Floors are covered with reflectant tile Ceilings are covered with acoustical tile Blackboards Exposed windows Wooden desks and/or polyethylene chairs

31 Elements To Account For Signal--The primary signal (the speaker); Noise-- Usually around 0 to +10 db S/N; Reverberation (most classrooms are nothing more than reverberation chambers); Modes Room resonance

32 Muffle Irrelevant Noise

33 Plot Noise Producers-- Find Sources of Acoustical Distraction As Per The Following Examples Absorb sound Reduce echoes Insulate extraneous noise

34 Alter hard surfaces in places where communication is to take place; Modify square and rectangular rooms by simple modifications; Improve poor or unused PA systems by making change and by coaching the presenters here are some examples! Alter speakers rate of presentation at meetings and church. Hearing impaired listeners can coach the presenters by giving simple requests.

35 Make use of the PA system mandatory when there are more than sex in the audience.

36 Avoid background music or MUSAK in places where presentations or communication are to take place. Imagine an elegant dimly lit restaurant, candlelight, good wine, background music cool romantic jazz, a French waiter dressed in black tuxedo, and a spoken menu.

37 ENVIRONMENTAL DESIGN AT HOME

38 At Home-- Auditory distractions must be reduced Turn down (or off) the TV or radio when talking with an older adult with impaired auditory function; Do not speak unless the person can see your face; in other words, not from another room or while walking away from the listener. While churches and meeting rooms are generally reverberation (echoic) chambers, homes are anechoic chambers as a result of soft carpeting, drapes, soft furniture, and so on. Therefore, speech does not travel well in a home environment 6 ft. maximum for adequate auditory perception. Nor, does speech travel well around corners, down or up stairs, or through doors!

39 ENHANCE THE VISUAL ENVIRONMENT

40 Light and Color Perception In The Aging Eye Color of lens Glare Speed of dilation/contraction of the iris

41 Lighting and Patterns Must Therefore Be Considered

42 Avoid exposed light fixtures in bathrooms, bedrooms, diagnostic rooms, therapy rooms activity rooms results in television camera effect.

43 *Uncovered windows Other reflectant surfaces including: desk tops metal window blinds white boards Use incandescent lightening whenever possible

44 Avoid Fluorescent Light Fixtures Tearing Inattentiveness Headaches Seizures Use incandescent lighting wherever possible!

45 AVOID Mood lighting Wall lights Spot lights Corner illumination

46 Bright spots play havoc with attention, concentration, visual perception, and particularly mobility

47 Other reflectants to avoid White bathroom fixtures; Glass covered wall hangings; Patio doors w/sun exposure in work areas; Non-shaded windows on sunny exposures; Waxed floors, or other shiny floor surfaces polished hardwood, polished tile, polished linoleum

48 Avoid decorative wall-mounted mirrors. They can result in: Glare Faulty depth perception Falls

49 Avoid vividly patterned wall paper can cause visual confusions!

50 1. Avoid dark floor coverings with dark furniture; 2. Consider light floor coverings with dark furniture avoid dark floor coverings with light furniture due to visual confusions the shadowing effect.

51 Avoid Pastel blues Lavenders Pinks Salmons Light rose Beige

52 Consider DARKER SHADES OF: Navy Browns Charcoal Red Dark purple Dark blues Burgundy

53 We are talking about Supportive Architecture Preventing unnecessary impairments of *Vision *Hearing *Mobility *Social competence *Mental competence

54 Adults with impaired hearing and aging visual systems do not, of course, desire to appear as though they are demented, or impaired to a greater degree than they truly are in relation to hearing, vision, and their ability to communicate. But, many of the environments that we offer them where listening or communication is intended to take place result in what may be relatively minor impairments becoming unnecessarily amplified.

55 THE END

Contents THINK ACOUSTICS FIRST NOT LAST WHO BENEFITS FROM IMPROVED ACOUSTICS?

Contents THINK ACOUSTICS FIRST NOT LAST WHO BENEFITS FROM IMPROVED ACOUSTICS? CONSIDER KEY LEARNING ENVIRONMENT CRITERIA Background Noise Reverberation Signal-to-Noise Ratio HOW TO CONSIDER FOR HEARING