Case Studies: Student 1
Last Updated: 9/13/04 10:48 AM
Introduction
Student 1 is an unintelligible female speaker with a very limited phonetic repertoire, severe pitch and loudness problems and little residual hearing. During 12+ years of speech therapy prior to entry to NTID she had never addressed voice/pitch production. She was not using amplification when she sought speech-language services but expressed a willingness to explore the use of hearing aids and computerized visual feedback equipment to facilitate instruction, practice and self-monitoring. Student 1 made modest gains in pitch control, speech sound production and intelligibility after 20 hours of individual instruction. She remains motivated to improve speech/voice and will continue for a 3rd ten-week session of speech-language therapy.
Background information
Student Age: 23 years
Degree of deafness/PTA: severe to profound sensorineural
loss bilaterally; PTA RE 107dB, LE 108dB
Etiology: maternal rubella
Age of onset/Date of detection: birth/unknown
Use of amplification: body aids from ages 2-7; binaural BTE's
from ages 7-18; no use of amplification from ages 18-23; has binaural
BTE's and agreed to bring them to NTID for hearing aid check and potential
use in speech-language therapy classes.
Speech-language therapy history: individual speech therapy sessions
in school from ages 3.5 to 15 or 16; worked on phoneme accuracy with IBM
SpeechViewer in high school; did not work on voice (pitch or loudness)
Educational history: oral deaf school from ages 3.5 to 6; started
in special education program in mainstreamed elementary school in first
grade using SEE method; attended deaf high school using ASL and English
signs
Preferred mode of communication: simultaneous speech and signs
Lives in French-speaking Quebec, Canada, with relatives who use English
with her.
Other medical condition: has had eye surgeries; acuity
not corrected to 20/20
Evaluation Results
Speech Intelligibility
NTID Write-Down Test: 2% (1.0 on a 1-low to 5-high scale)
· Rated as 1.0 in reading the Rainbow Passage
(Fairbanks)
Voice (qualitative)
NTID Voice Evaluation: moderately high pitch with noticeable
fluctuations of a large magnitude; moderate problems with rate and vocal
tension; severe problems with stress, inflection, blending and coarticulation
Voice (quantitative)
Kay Visi-Pitch III: Mean pitch on sustained /i/ = 287 Hz, sustained /a/
= 170 Hz, read words = 207 Hz, read sentences = 216 Hz, conversations
= 272Hz; Minimum pitch = 119 Hz; Maximum pitch = 400 Hz
Speech/Voice (comprehensive)
FSST (Fundamental Speech Skills Test): total
score = 271 (out of a possible 600) for a percentile ranking below 30%
for her age and degree of hearing loss; correct number of syllables in
words = 83%; correct word stress = 39%; correct intonation = 17%; pitch
control = 35% due to frequent inappropriate pitch elevation at the end
of words and/or high average pitc
h
Articulation
Fisher-Logemann Test of Articulation Competence: 78% total errors; 82%
consonant errors; 61% vowel errors; of consonant errors 55% = deletions,
24% = manner of phonation errors, 9% = voicing errors; correct consonant
sounds = /b, d, w, f, v, l/
Language
Written language sample, a retelling of the NTID Surprise Birthday Party
Picture Series: accurate description of most story elements; errors in
the use of verb tenses, determiners and pronouns
Therapy goals and objectives
Long term
1. To lower habitual pitch level
2. To establish pitch and loudness control
3. To build a phonetic repertoire
4. To improve intelligibility of functional words and phrases
Short term-1st ten weeks of therapy:
1. To stimulate pitch awareness and control
2. To reinforce correctly articulated phonemes when they occur in therapy
3. To explore potential contributions of tactile, proprioceptive, auditory
and/or visual feedback related to pitch level and phoneme production
Short term-2nd ten weeks of therapy
1. To stabilize habitual pitch at 250Hz or below
2. To increase awareness of occurrences of inappropriately high pitch
and/or loudness
3. To stimulate awareness and correct productions of voiced vs. voiceless
consonants
4. To stimulate correct production of vowels
Therapy progress
1st ten weeks-primarily diagnostic therapy
1. Feedback: Use of Kay Visi-Pitch III for visual feedback related to pitch level/control and vowel production was effective; tactile feedback was not beneficial for pitch monitoring; auditory feedback was not used because student never brought hearing aids to therapy.2. Pitch: Able to produce low vowels in isolation and cvc's at a relatively low pitch (below 250Hz) but high and front vowels were always at an inappropriately high pitch. All utterances were terminated with a pitch rise.
3. Articulation: Consonants /h, m, s, b, d, w/ were reinforced when they occurred correctly during therapy sessions.
4. Speech Intelligibility: 6% (1.2 rating) for a gain of 4% on the NTID Write-Down Test
2nd ten weeks of therapy
1. Feedback: Use of Kay Visi-Pitch III (Real-Time Pitch) and IBM SpeechViewer II (Waveform and Spectrograms) to reinforce pitch level and air management on /s, t, sh, m, n/; hearing aids were used for several sessions with no noticeable benefit for monitoring pitch or speech sound production2. Pitch: Consistently able to maintain pitch below 300 Hz on sustained vowels, words, phrases and read sentences; unable to eliminate habituated terminal pitch rise in any context; unable to control loudness or pitch in spontaneous speech or conversations
3. Articulation: Able to recognize visual differences between voiced and voiceless consonants on spectrograms; unable to produce voiceless stops; moderate success in producing voiceless fricatives /s, sh/ in cvc words in structured drills and in some functional words/phrases the student wanted to practice.
4. Speech Intelligibility: 22% (1.9 rating) on the NTID Write-Down Test for a gain of 16% (20% total gain since instruction began)
5. Prognosis: Prognosis for attaining intelligible speech is guarded after 20 hours of instruction. Improvements in pitch level and control were achieved quickly but no further gains were made. Student 1 is stimulable to correct on very few speech sounds. Gains were made because she more consistently produced sounds from her limited repertoire and reduced the number of deletions of final sounds in words. She may be able to achieve semi-intelligibility on a set of functional words and phrases if she learns to self-monitor pitch and carryover her best sound productions into spontaneous speech.
