Case Study - Student 3
8/24/04 4:05 PM
Introduction
Student 3 is a young adult male with a profound sensorineural hearing loss. He received a cochlear implant in July 2002 and is very satisfied with it. His speech is better than semi-intelligible in a face to face situation, however, some new listeners have difficulty understanding him and comprehensibility is further reduced without visual cues. Impacting intelligibility are articulation and prosodic errors. This student is comfortable using all modalities of communication and uses his speech when communicating with non-signing hearing people. His spoken and written English skills are strong. He was a direct admit to RIT and is currently a fourth year student. He expects to graduate with a B.A. in May 2004. He has an excellent academic record and has been involved in many extracurricular activities.
This student did not request speech services until his final year at RIT. His current motivation to work on his speech results from his desire to compliment his aural rehabilitation instruction with speech therapy and utilize the listening benefits he derives from his cochlear implant for speech improvement. He is presently completing his third quarter of speech therapy and his sixth quarter of aural rehabilitation. Speech therapy has been twice a week for two fifty-minute sessions. After 43 hours of individual instruction significant changes were achieved in all skill areas that were targeted.
Background Information:
Student Age: 22 years
Degree of Deafness: Profound sensorineural hearing loss;
received a cochlear implant for his right ear in July 2002; his most recent
mapping on 1/19/04 shows hearing thresholds are between 20 dB-35 dB.
Etiology: Usher’s Syndrome Type I; student also
has an older sister who is profoundly deaf.
Age of onset/date of detection: birth/one month of age
Use of amplification: Aided binaurally at 6-8 months
and used hearing aids consistently except in high school. He is currently
very satisfied with his cochlear implant.
Speech-language therapy history: Had therapy from elementary
school through his junior year of high school, but therapy was less intense
in high school; did not request any speech services in college until his
senior year; he is now completing his sixth ten week session of aural
rehabilitation (View report: PDF | Word
Document)
Educational history: Attended Central Institute for the
Deaf through the fourth grade and then was mainstreamed in public school
with an interpreter through high school; was a direct admit to RIT in
September 2000.
Preferred mode of communication: Comfortable with both
speech and sign and has a lot of experience in all modes of communication.
Foreign language in home: None
Other medical conditions: Usher’s Syndrome Type
I
Evaluation Results:
Intelligibility: NTID Write-Down 72%, (3.4 on a 1-low to 5-high scale)
Rated by this instructor as 3.5 in reading the Rainbow Passage
(audio) (reference: Fairbanks)
Voice:
NTID Voice Evaluation: pitch register appropriate for age and sex, normal
loudness but inadequate vocal inflection, air expenditure moderately excessive
and truncated breath groups revealed in oral readings and conversation,
mild to moderate hypernasality and mild vocal tension,
speaking rate moderately fast in conversation, moderate problem with stress
and blending
Articulation:
Fisher-Logemann Test of Articulation Competence (words), 57%
total error, 57% consonant error, 56% vowel error. 68% of the errors were
in the fricative and affricate categories and the remaining 32% were across
all the other categories with the highest concentration in the stops.
Error pattern included voiced/ voiceless confusions, lack of airflow and
voicing, mild to moderate distortions, reduced affricates and four omissions.
The oral reading reflected similar errors and additionally difficulty
with inclusion of final sounds and correct number of syllables for more
complex words.
Language:
Written language and spoken language are both very strong and college-age
appropriate. Excellent pragmatic skills.
Therapy goals and objectives:
Long Term:
1. To improve productions of selected consonants and vowels
2. To improve listening skills for articulation targets
3. To improve prosodic features
4. To improve overall intelligibility for conversational contexts
Short Term -1st ten weeks: (two hours per week, attended
17 hours)
1. Improve productions of back-velars, fricatives, and affricates in
words, sentence and conversations
2. Reduce voiced/voiceless errors on stops and fricatives
3. Improve productions of frontal vowels and diphthongs
4. Reinforce listening skills for articulation targets
5. Reinforce co-articulation skills at the syllable and word to
word level
6. Enhance conversational intelligibility
Short Term – 2nd ten weeks: (two hours per week,
attended 12 hours)
Same goals as 1st quarter with an additional goal of improving
suprasegmental and temporal features including pausing, blending
and rate in structured contexts.
Short Term – 3rd ten weeks: (two hours per week,
attended 14 hours)
1. To continue to improve and maintain voiced/voiceless distinctions and
the productions of fricatives, affricates and blends
2. Reinforce improved productions of diphthongs and frontal vowels
3. Reinforce listening for correct productions of target sounds
4. Reinforce suprasegmental and temporal features in connected speech
5. Increase conversational intelligibility for specific contexts designated
by the student
Therapy Progress
Student 3 has just completed his third quarter of instruction and accumulated 43 hours of instruction. The results of instruction are summarized below.
1) Articulation: Improvements have been achieved and
are evident in both
formal tests and instructor and student observations.
At the end of the 3rd quarter of instruction, test results are compared
with the intake assessment scores. The Fisher-Logemann Test of
Articulation (words), results were as follows: 31% consonant
error (26% improvement); 12.5% vowel error (54%improvemnet); 28% total
error (29% improvement). Compared to the error patterns on the intake
exam, Student 4 has made significant changes across all the phoneme categories
including sounds that were not targeted. There was only one omission,
40% fewer voiced/voiceless errors and generally minor distortions that
do not significantly impact on intelligibility.
Changes were also revealed on the NTID Write-Down:
Intake score: 72% (3.4)
1st quarter post: 76% (3.6)
2nd quarter post: 78% (3.6)
3rd quarter post: 82% (3.8):
(10% gain since instruction began)
Throughout instruction, this student displayed good stimulability skills and developed an excellent understanding of the distinctive features of his target sounds. This knowledge facilitated the changes he was able to achieve. The Real-Time Spectrogram program on the Kay Computerized Speech Lab (clip) was frequently utilized to enhance instruction as it provided important visual feedback. Therapy materials were generated from various sources, including some designed by the instructor and the student, and some generated from news magazines and commercial workbooks. Phonemes were practiced in phrases and sentences and in conversational contexts. Listening training was employed during all sessions and attempts were made to work on the same targets that were focused on in aural rehabilitation. In structured contexts, the student made significant progress and achieved closer approximations particularly with the fricatives, affricates and vowels. He was also able to achieve voiced/ voiceless distinctions for stop sounds. The back-velar sounds, however, proved to be more challenging even in the drill exercises. Less success was achieved on the stops, affricates and several vowels and diphthongs when practice shifted to a less controlled context.
Therapy conversations often generated words that were important to the student’s everyday communication needs and interests. Select words and phrases were practiced and improvements in intelligibility were observed. The student also reported more success in being understood outside the therapy sessions.
2) Prosody: Features such as linking words, employing appropriate syllable and word stress and pausing were practiced. Listening training was also employed to reinforce appropriate temporal patterns. Improvements were evident in structured practice and in several oral readings (audio), {link to rb_s…_A_02_04.WAV). More work in this area is needed to reinforce carryover to spontaneous speech.
At the end of instruction, Student 3 participated in a videotaped interview conducted by this instructor. During the interview the student reflected on his own progress and the gains in intelligibility that he was able to achieve. The student’s comments revealed very positive perceptions of the benefits of therapy including being understood more by people outside of RIT and having a better understanding of his speaking skills. He attributed his satisfaction to a variety of factors including his involvement in the therapy process and goal establishment. He also felt that taking therapy concurrently with aural rehabilitation was very helpful.
This interview also served as an additional efficacy measurement for the instruction provided. [view interview]
Discharge Status:
Student 3 was discharged since he was graduating. He could still benefit from further intervention to monitor and reinforce the changes he has achieved and to work on additional improvements in his articulation and prosody that still might be achieved. His motivation remains very strong and he plans on continuing therapy wherever he resides in the future.
