Introduction PURPOSE OF THE GUIDE

Transcription

1 Introduction PURPOSE OF THE GUIDE There are four purposes for developing A Speech Guide for Teachers and Clinicians of Hearing Impaired Children: 1. To consolidate information currently available for teaching speech to hearing. impaired students 2. To organize the information in a concise and easily accessible format 3. To collect auditory, visual, and tactile strategies for each phoneme 4. To facilitate staff training programs. The rationale for consolidating sources resulted from frustration on the part of teachers and clinicians in having to search through various texts. This activity required a great deal of time because many texts are organized by theory presentation. In A Speech Guide for Teachers and Clinicians of Hearing Impaired Children, the material is organized by phoneme. This format was adapted and developed so that instructors could quickly find the following information for each phoneme: 1. A picture demonstrating articulator placement 2. Phoneme transcription in three symbol systems (I PA, Thorndike, and Northampton) 3. Classification by manner, place, and voicing 4. General comments pertinent to each phoneme 5. Acoustic, visual, and tactile/kinesthetic characteristics 6. Progression of skills 7. Methods of teaching from sound approximations 8. Auditory, visual. and tactile teaching strategies 9. Common problems and solutions 10. Words to assist during initial phonologic transfer In order to develop a more rational choice of strategies by teachers and clinicians. the teaching strategies are listed in auditory, visual, and tactile categories. We hope that instructors will begin with auditory strategies and. if necessary, progress through visual and tactile strategies. The final purpose of this guide is to assist in staff training programs. We hope it will serve as a resource for development, remediation, and infusion of speech into concept-based programs of if")terdisciplinary instruction. 3

2 4 A SPEECH GUIDE CONSIDERAllONS FOR TEACHING SPEECH 1. We cannot overemphasize the importance of having hearing impaired students use full-time amplification. It plays a vital role in the acquisition of phonetic and phonologic speech, language, and auditory learning. 2. Hearing impaired students receive not only a less intense auditory signal but also a signal that is distorted. When hearing people plug their ears, the reduced hearing that results is not the same as the distorted signal that hearing impaired students with sensorineural hearing losses receive. For most hearing impaired children, increasing the loudness of sound beyond a certain decibel (db) level does not improve the clarity of speech. 3. Ability to detect, discriminate, and identify the phonemes is dependent on factors other than the student's unaided puretone audiogram, such as: a. Distance of sound source from listener b. Intensity at which phoneme is produced c. Background noise d. Hearing aid's frequency range e. Student's ability to maximally use residual hearing 1. Quality of speaker's voice (gender, age, etc.) g. Student's health (colds, allergies, ear infections, etc.) 4. In addition to each student's personal amplification system, auditory trainers should be used during all possible situations. Auditory trainers help improve speech intelligibility in environments where competing background noise is present. Further, auditory trainers maintain the strength of the speech signal despite increased distance within a classroom. 5. Auditory equipment should be checked in the morning and periodically throughout the day to ensure proper functioning. 6. Speech phonemes should be taught through audition first. Students who gain insufficient information from audition alone may benefit from teaching strategies that incorporate audition with other sense modalities, such as visual or tactile. 7. It is important to understand the context in which you ask the student to produce the target sound. The context may hinder or help, depending on surrounding vowels and consonants. If It! is being produced dentally rather than tip-alveolar, ask the student to produce consonant-vowel (CV) syllables with back vowels: Ita! instead of Iti/. B. Auditory learning and speech should be kept as interesting as possible. In addition to specific communication therapy, speech and listening activities should be infused throughout the day in content areas (math, science, and others) and in other natural situations. Specific exercises or drills including speech at the phonologic level should be infused in the students' daily life, not only by the school personnel but also by each student's family. 9. If exaggeration is used as a teaching strategy, importance must be placed on the immediate transfer of the phoneme to appropriate phonological speech.

3 INTRODUCTION 5 RELATIONSHIP OF DEGREE OF HANDICAP TO EDUCATIONAL NEEDS Effect of hearing loss on the understanding of Educational needs and programs language and speech when the child is not wearing appropriate amplification!!aildhearin.g loss (26 to 45 db) Child may have difficulty hearing faint or distant speech. Difficulty experienced in school situations will depend upon noise in classroom, seating, and configuration of hearing loss. Child will miss consonants even if average loss is mild but with a high frequency impairment. Child understands conversational speech at a distance of 3 to 5 feet (face-to-face) only if structure and vocabulary are controlled. Child may miss as much as 50% of class discussion if voices are faint or not in line of vision. Child may exhibit limited vocabulary, immature syntax, and reduced speech intelligibility. Child may hear only loud voices, may be able to identify environmental sounds, and may be able to discriminate vowels but not all consonants. Speech and language will not develop spontaneously if loss is prelingual in onset. Speech and language are defective and likely to deteriorate if hearing loss is of recent onset. Quality of speech is atonal. Child may hear some loud sounds, but is aware of vibrations more than tonal pattern. Child may rely on vision rather than hearing as the primary avenue for communication. Speech and language wi II not develop spontaneously. Speech and language will be severely delayed. Adapted from Bernero and Bothwell 1966 Student: 1. Will benefit from a hearing aid as loss approaches 25 db. 2. May need hearing aid orientation. 3. Needs auditory skill building. 4. Requires attention to vocabulary development. 5. May need speech remediation. 6. Needs favorable seating and lighting. Moderate hearing loss (46 to 65 db) Severe hearin.g loss (66 to 85 db) Profound hearing loss (86 db or greater) Student: 1. Should be referred to special education for language evaluation and for educational followup. 2. Needs auditory training and skill building. 3. May need speechreading instruction, depending on score on a sentence lip reading test. 4. Requires attention to oral language development, reading, and written language. 5. Needs speech remediation as indicated by test results. 6. Needs favorable seating and possible special class or resource placement, particularly for primary children. 1. Initially, most students will need full-time special aural/oral program for hearing impaired children, with emphasis on all language skills, concept development, auditory training, speech reading, and speech. 2. Program needs specialized supervision and comprehensive supporting services. 3. Student needs full-time individual hearing aid, supplemented by group amplification in classrooms, with limited acoustic treatment. 4. Mainstream in regular classes only as indicated by ongoing assessment. 1. Student will need a program for hearing impaired children with emphasis on all language skills, concept development, speech reading, speech, and auditory training. 2. Program needs specialized supervision and comprehensive supporting services. 3. Student requires continuous appraisal of needs in regard to oral and total communication. 4. Student needs auditory training with group and individual aid. 5. Mainstream in regular classes only for carefully selected children.

4 6 A SPEECH GUIDE THE SPEECH BANANA The speech banana represents a spectrum of formants for many of the phonemes and indicates the frequency and intensity at which they occur. This type of spectrum provides useful and important information in reference to auditory training and speech. Teaching a specific speech sound is facilitated when that sound is within the student's auditory capabilities. When the student's unaided individual audiogram is compared to the spectrum, it allows the teacher or clinician to predict which phonemes the student should be able to detect and/or identify when wearing appropriate amplification. By taking note and comparing the first and second formants of two specific phonemes, a possible explanation may be found as to why a student may not be able to accurately discriminate those two sounds. By transferring the information provided on the speech banana to the school audiogram, it is possible to make a transparency to layover the student's audiogram. The speech spectrum will shift up or down in decibels (db) depending on the intensity or loudness of the speaker's voice. The average intensity level for vowels falls around SOdB. A quiet speech level is considered to be at 35dB, while a loud intensity level is 6SdB. In addition, this banana is calibrated based on a distance of 3Y2 feet between the speaker and the listener. As that distance increases, the banana will change to a position similar to that of quiet speech. Therefore, distance from the speaker is important when considering phoneme audibility. Further, the speech spectrum will shift to the right or left depending on whether the speaker is male or female. For a male, the banana will shift to the left, or lower frequencies. The banana will shift to the right, or higher frequencies, for a female speaker.

5 HEARING EVALUATION Name' -- Age Date' frequency IN HERTZ (Hz) AUDIO(iRAM KEY I (j( '" ~ Vi z..: '" Oil :E. 50 <I'>... '" 60 u C! 70 \.J!.....: '" :r AIR BONE 80 go Effedlve maski. level in non-test ear Speech AWlIrenftl Speech Reception Speech Threshold Threshold DlKrlmln.-.1ion Rlpl.... d....hl... d %I... d 1lIP left d. Left... d. left... %/..... left... d. Aided... d' ~... d. AIded... % L... db ~._...d. Comments: _/:..!i.:.../..::b~e:..:::a:..::.t.:../.::.i/...:b:::..:i~t RIGHT "ir Conduclion Unmasked 6 I LEfT Ai, Conduction Masked t:::. 0 Bon. CondUClion UlVllasked Bon.. Conduction Muked Sound field "ided No Rl!SpOfIR INR) < > C S I A /? I 1'\ COULD NOT TEST.. CNT DID NOT TEST.. DNT PURE TONE AVE'tA(iE (PTA) RIGHT db LEfT db 0-10 No.", Borderline 3-45 Mild *-r'5 Mod...",., Sever., Over" Profound T...1dIty Kcepeable Any ella,.. tine.. I.. _ lui boot lell bake Ia! hot lrel bat. Y" Yes IN" No lei bet IAI but R HEARIN(i AID INFORMAnON J L Man Model s.w Na. H.A. Style RIGHT LEfT Tester: v",,-setd,. FIGURE 1 The Speech Banana

6 8 A SPEECH GUIDE PHONEME AUDIBILIlY Frequency characteristics often are thought to be the only factor influencing the audibility of phonemes. See Figure 2, Intensity Rating of Phonemes. This chart emphasizes the importance of phoneme intensity as it relates to the audibility of vowels and consonants when they are produced in syllables. High-frequency phonemes are typically less audible to hearing impaired students than low-frequency phonemes. However, phoneme intensity interacts with frequency to determine phoneme audibility. For example, if /9/ is taught using auditory strategies, it is important to consider the influence of vowels that surround it (such as, /09/ vs. /i9/). - In this situation, the low intensity, high frequency /9/ is made less audible by the intensity of /0/. When /9/ is combined with /ii, the /9/ may be more audible to the hearing impaired student. In a second example, the frequency characteristics associated with /a! are higher than those associated with iii. However, /a! often is more audible to the student due to its greater intensity.

7 Vowels Consonants ~.... _ <0,....,. >"... ~ ~ '", '" {. ~ l ". I,. ~-.,~.," :." : ~> ~. ~,: ".., IPA Thorndike 1. I:JI 6 2. lal a 3. IAI u a 5. Iall I 6. laul au 7. Irei a 8. lei e 9. lui u 10. lui u 11. leii a 12. III I 13. Iii e 14. IfI r 15. III I 16. IfI sh 17. IIJI ng 18. Itfl ch 19. Inl n 20. Iml m~ 21. Id31 j rh 23. It I t 24. Ikl k 25. IfI f 26. Igl lsi s 28. Izl z 29. Ivl v 30. Ipl P 31. Ibl b 32. Idl d th FIGURE 2 Intensity Rating of Phonemes From loudest (1) to quietest (33)

8 Imitation/ Demonstration Known to Unknown: Context Sound Approximation Analogy Verbal Instruction Analogies Manipulation Prompting Vocal Play Explanation of Component Skills FIGURE 3 Strategies for Eliciting Sounds

9 STRATEGIES FOR ELICITING SOUNDS INTRODUCTION. 11 Strategies may have auditory, visual, and tactile components. However, some strategies may be exclusive to one modality. For example, manipulation is primarily a tactile strategy with a possible visual component. Phonemes should be taught first through audition. When discussing auditory strategies, it is important to discuss the four levels of auditory skills: detection, discrimination, identification, and comprehension. Detection is simply determining whether sound is present or absent. Through detection tasks, we can check whether hearing aids are working and set appropriately, alert students to the listening task, and determine which sounds are audible to the child. The response may be yeslno or a conditioned response (such as dropping a block in a bucket). The second level of auditory skill, discrimination, is determining the similarity or difference between speech sounds. Instructors often use this level as remediation or a check when the student makes an identification error. It is important to realize that sameldifferent discrimination tasks are difficult or impossible for children who are unable to categorize or make generalizations. The third level of auditory skill, identification, means providing a name or a label for what the student has heard. The student may respond by repeating the word. writing the word or sentence, or pointing to the stimulus being presented. The highest level of the auditory skill hierarchy is comprehension. Comprehension tasks require that the student understand the meaning of auditory messages. It also requires the student to acquire new information through hearing, and then react appropriately. Unlike an identification task, the student must not only label the stimulus, but also must demonstrate understanding with a response that differs in content from the stimulus but is closely associated in some way (Erber 1982). After using auditory strategies, visual strategies should be considered before moving to tactile strategies. Because the strategy employed is dependent upon the student's abilities, diagnostic results should be reviewed carefully. This will allow you to move quickly to strategies that will provide the student with success. Many times, strategies are used simultaneously. The most widely used strategy is that of imitation or demonstration. Imitation requires the student to repeat a target sound after one or more examples have been provided. Imitation is easily and naturally combined with other strategies when evoking sounds. For example, a sound may be presented without allowing the student to see your face. The student is required to produce the sound after one or two presentations. If the student is unsuccessful, the phoneme may be presented again, this time allowing the student to See your face. If this strategy is unsuccessful, imitation through tactile stimulation may be the next modality attempted. The tactile modality is usually the last teaching strategy used. Students can feel the tongue position for most vowels by placing a finger on the instructor's tongue, then placing a finger of the other hand on their own tongue. Another widely used strategy is moving from a known sound oruset" to an unknown. This is accomplished through use of context, sound approximation, and analogy. Use of context means that facilitating contexts may be used as a beginning point for a lesson or in combination with other techniques to develop intelligibility. For example, if a student can produce IJI in a few contexts (such as IJul and IJaI) but cannot imitate it in other contexts (ljii orlju/), the instructor should indicate the words where the sound is correctly produced, then provide practice on the available facilitating contexts. Teaching through sound approximation is another technique of progressing from a known sound to an unknown sound. In this method, the instructor uses a phoneme the student can correctly produce as a point of departure for teaching the target sound. For

10 12 A SPEECH GUIDE example, say the target sound is If! and the student can produce lsi. Have the student gradually move the tongue back until If! is produced. The use of imitation plays an important role during sound approximation strategies (Secord 1981). For approximations to be successful, the strategy of analogy also must be applied. An analogy is a resemblance or comparison in some particulars between things otherwise unlike. Ling (1976) summarized analogies in this statement: Analogies can be auditory, visual, or tactile, depending on the child's sensory capacities and on the natu re of the behavior to be taught. For example, an auditory analogy might be used to show the commonality of nasality in sounds such as 1m/ and In/, or Ibl and Id/; a visual analogy, using one hand to represent the palate and the other the tongue, might be used to demonstrate relative points of occlusion for It! and Ik/; or a tactile analogy, using the fingers on the chin to feel vibration, might be used to indicate that both Ivl and I'zJ are voiced. The most effective use of analogy is to show that a sound or behavior that is known shares a particular characteristic with the sound or behavior that is being learned (p. 288). Prompting is another effective strategy used to evoke sounds. Prompting activities involve the association of a particular manner of production with specific objects or actions (Ling 1976). For example, you might touch your chest to cue the student to lower pitch register. This technique should be used when an auditory presentation is unsuccessful and only after the phoneme can be consistently produced. The prompt should be discontinued as soon as possible, since its continued use may impede the development of coarticulation skills (Ling 1976). Vocal play is a recommended strategy for eliciting sounds. Encouraging the child to generate sounds spontaneously in the course of play establishes the use and control of the speech organs (Ling 1976). Once the sound is produced during vocal play, the instructor is challenged to bring the child to a consistent imitation stage. It may be necessary to probe for imitation during vocal play for a substantial time before the child is able to imitate consistently. This strategy is one of the most effective for evoking sounds in young children. Direct verbal instruction is another effective strategy. Instructions must be concise; for example, "Close your lips for Im/" or "I want to see your teeth." This ;strategy is more successful with older students and adults. Verbal instruction is most effective when combined with imitation and sound approximations. Another strategy used to teach hearing impaired students is explanation of component skills. When using this strategy, first explain to the student what component parts are needed to produce the sound (for example, "I want you to say lau/. Say Ia! and the lui together. Blend them smoothly on one breath"). This strategy is less effective in the early stages of speech acquisition because most hearing impaired children do not have the language to understand the explanation and apply it. However, thoughtful use of this strategy can produce positive results. The final strategy is that of manipulation. This strategy is primarily a tactile strategy with a visual component. Manipulation may be defined as the shaping of a speech behavior through gentle force imposed on one or more of the speech articulators (Ling 1976). The most preferred type of manipulation is that in which the student adjusts the articulators by using a finger or tongue depressor. Manipulation is the last strategy used and is usually not necessary. The strategies of manipulation and tactile imitation are closely associated and are considered by some to be one and the same. Once the student can reliably imitate, manipulation is unnecessary, and some form of auditory or visual cues may be more appropriate.

11 TONGUE. AND PALATE. INTRODUCTION 13 Figure 4 shows the place of articulation on the palate and parts of the tongue. This diagram provides a reference as you read through the text, particularly when studying classification and visual and tactile/kinesthetic characteristics for the individual phonemes..,......' , I....'" '." '.' '.... ' : ' ":.-.'..'...'.... ' :...'...' -., ". '.. -.,.' '.,...,....".. '..... '...'.... '..',.., ' '".'. 1/1' " '...' ' ':',... tit " '. '... '.'......,., '.'-.-..',.'...". '. ' '.....'.."..,.-.. '...'.'. ".. '.,. '... '..... '..:. '. '.'.'". Tongue Palate 1. tip 6. alveolar ridge 2. blade 7. prepalate 3. front 8. palate 4. center 9. velum 5. back 10. uvula FIGURE 4 Tongue and Palate

12 14 A SPEECH GUIDE VOCAL FOLD VIBRATION Figure 5 is a simplistic drawing of vocal fold configuration during phonation. The voice quality of sound can be altered through various glottal configurations. For example, a strained, harsh quality is produced when vocal folds are inappropriately adducted. A breathy voice quality results when vocal folds do not abduct properly. For an in-depth discussion of vocal fold vibration and remediation of abnormal vocal qualities, see Boone The phonation cycle begins when the vocal folds come together at the midline. Air pressure below the vocal folds builds up until the folds are forced open, creating voice. The folds then quickly assume their closed position until air pressure builds up again. + + =1 cycle (vibration) Vocal fold vibration occurs at the rate of approximately 213 cycles per second (cps) for women and 128 cps for men. Vocal fold configuration during whisper Vocal fold configuration during inhalation and exhalation FIGURE 5 Vocal Fold Vibration