CSD 5400
REHABILITATION
PROCEDURES FOR THE
HARD OF HEARING
Language and Speech of Deaf and
Hard-of-Hearing
Characteristics and Concerns
Speech Development
Some Preliminary Remarks
The first intelligible word
usually occurs at 1 year
Discrimination of important
phonetic contrasts occur
much earlier (receptive)
Normal speech development
occurs concurrently with
language development
Consistent exposure to
conversations with adults is
necessary
Normal hearing is necessary
Newborns
Primary form of
communication is
through their cry
Newborn Communication
Communication intents
though crying:
 Pain or discomfort
 Hunger
 Overload
Newborn Speech Skills
Primarily reflexive
sounds at birth
Oral reflexes
Crying
Changes in Speech
Increased development and use of
non-distress sounds
 Some productions of vowel sounds
and back consonants /g/ and /k/
 By 3 months, vocalization in response
to caregiver’s vocalizations

Babbling




Emerges at around 4
months
Random sound play
Extremely important
landmark of infant
development
Single syllable units of CV
or VC construction
Changes in Speech





By 6 months, see evidence of more complex
sound combinations
Labial sounds like /m/ and /p/ are
produced more often
Stop consonants (p,t,b,k,g,d), nasal
consonants (m, n, ing) and vowels comprise
about 80% of sounds produced
Evidence of reduplicated babbling
Emergence of imitative behavior
In Summary…
By six months, most babies:
 Make a lot of different sounds
 React appropriately to different voices
 Turn and look for sounds
 Babble with purpose
 Respond to their name
 Try to imitate sounds and vocalizations
Landmarks in Speech
Development by One Year
The use of one or more words
with meaning
Typical first words include
“mama”, “dada”, other
nouns important in the
child’s life
Concept words come next
Babbling development gets
the child to this point
Stages of Babbling
During this Time
Echolalia--imitation
Varigated babbling--syllables aren’t
identical
Jargon
Phonetically consistent forms
Representation
Affect of Hearing Loss on Early
Speech Development and Behavior
The effects of hearing
loss on speech
development are very
subtle
Generally, even subtle
differences sometimes
aren’t apparent until
after the first birthday
Emergence of canonical
babbling is a major
clue
Variables Affecting Later
Speech Intelligibility
Age of identification/remediation
We already talked about this
Degree of impairment
Focus more on aided thresholds
Communication mode
Oral programs tend to develop speech
intelligibility best
Speech Characteristics and
Therapy Goals
Children with mild/moderate degree of
impairment
Children with profound impairment
Acquired hearing loss
Speech Characteristics With
Mild/Moderate Hearing Loss
What’s normal
Vowel production, voice quality,
suprasegmental features
Intelligibility
What’s not normal
Articulation of single consonants and
consonant blends
Substitutions, distortions, omissions
Speech Characteristics with
Mild/Moderate Hearing Loss
Phonologically, these
children look like
normally-hearing kids
of a younger age
These children develop
and use speech sounds
in the same order as
normally hearing kids
Speech Management of
Mild/Moderate Hearing Loss
Amplification is a must
Clear understanding of the child’s aided hearing
thresholds
Articulation and phonological management
can generally be approached in the same
way as a normally hearing child but
Don’t rely on auditory feedback cues
Rely more on visual, tactile, and/or kinesthetic
cues
Be mindful of the developmental order of
speech sound acquisition
Speech Characteristics of
Deaf Children
What’s normal
Nothing
What’s not normal
Respiration, phonation, resonance,
articulation, and suprasegmentals
Intelligibility averages about 20%, but
extremely variable on a case-by-case
basis
Characteristics of
Respiration
Basic problems related to
a general incoordination of
respiration and
phonation
Few syllables/breath
Inhalation at inappropriate
times
Abnormally high airflow
rates during phonation
Breathy quality
Characteristics of Resonance
Hyponasality
Hypernasility
Characteristics of Phonation
Inadequate vocal fold adduction
Breathy voice quality
Voiceless sound substitutions for voiced sound
Inadequate control of vocal fold vibration
Abnormally high pitch
Pitch change is restricted across utterances
Inadequate control of laryngeal activity
Speech intensity too high or too low
Lack of loudness variation and control across
utterances
Breathiness or glottal resistance
Characteristics of
Articulation
Individuals are extremely variable in the
number and type of articulation errors seen
Vowel errors
Vowel neutralization, diphthong and vowel
confusions, nasalization of vowels
Consonant errors
Errors of voicing, omission and distortion of
consonants, omission of consonant blends,
nasalization of consonants
Impaired coarticulation movements
Characteristics of
Suprasegmentals
Slower than normal speaking rates (1.52 times)
Individual phonemes prolonged
Lengthy pauses within utterances
Pauses are more numerous and longer
than normal
Abnormal intonation patterns
Increasing Speech
Production and Intelligibility
Maximizing residual hearing
Appropriate amplification is a must
Anatomical and pictorial monitoring
Picture representations of tongue
placement during phoneme production
Visual stimulation and feedback
Mirrors
Feedback devices
Visipitch, SpeechViewer, palatometers
Speech Characteristics of
Acquired Hearing Loss
Extremely variable effects
Usually the degree of hearing loss has to be
very significant, especially in the high
frequencies
Decline in intelligibility is gradual and due to
loss of auditory feedback
Typical errors
Production of siblants, final consonants, voice
quality, loudness control, rhythm
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