Profile of Phoneme Auditory Perception Ability in Children with Hearing Impairment and Phonological Disorders

ByManal Mohamed El-Banna (MD)Unit of Phoniatrics, Faculty of Medicine,Alexandria University

Cairo 8/3/2012

Introduction

•Receptive language impairment is related to:▫Audiometrically low hearing sensitivity ▫Audiometrically sensitive hearing it may be

due to: Non speech auditory perceptual deficit Linguistic problem.

Failure of phonology representation

Phonological awareness•Quality or distinctiveness of phonemic

representations in memory

Internal representation•Incorporate more segmental

information•Representations of distinct phonemes

Expressive phonology or articulation errors•Bidirectional causal relation between

articulation and underlying phonemic representations

The Relation between Perception and Production

Same linguistic representation systems. Unbalanced relationship.

A synchronize development in early language acquisition.

1. Se´ne´chal M, Ouellette, G Young L: Testing the concurrent and predictive relations among articulation accuracy, speech perception, and phoneme awareness J. Experimental Child Psychology 89 (2004) 242–269 2.Warker JA, Xu Y, Dell GS, Fisher C. Speech errors reflect the phonotactic constraints in recently spoken syllables, but not in recently heard syllables.Cognition 112 (2009) 81–96

Children’s articulation accuracy

Preexisting differences in phonological

representations

Perceive, discriminate, manipulate

speech sounds

Production

Perception

Speech Perception Phoneme Specific Tasks:•Attempt to measure implicit phonological

representations.•Provide a sensitive test of the association

between variables.•Confound speech perception ability with

memory and vocabulary skills by involving word, pseudoword.(1)

1. Boada R., Pennington B.F. Deficient implicit phonological representations in children with dyslexia Journal of Experimental Child Psychology 95 (2006) 153–193

Similarity and confusability of phonemes•The similarity between phonemes and

confusability in short-term memory influence:▫Speech errors ▫The strength of phonotactic constraints▫The overall similarity between whole

words.

•Important for many psycholinguistic contexts.Bailey MT, Hahn U. Phoneme similarity and confusabilityJournal of Memory and Language 52 (2005) 339–

362

Aim of the work

•Study the phoneme auditory perceptual profile in children with hearing impairment and phonological errors.

▫Highlight the relation between the ability to interpret the acoustic characteristics of the phoneme as represented by phoneme auditory perception assessment results and the speech production errors.

Subjects:

•32 children, age range 6-12 years. Average intelligence. ▫Group A: 12 children Med-El cochlear

implant.▫Group B: 8 children moderate severe and

moderate SNHL.▫Group C: 6 children with phonological

disorders.▫Group D: 6 normally language developing

children.

Methodology

•Protocol of language disorders▫Audiological evaluation▫Profile of Speech errors (Phonology test)(1)

▫Psychometry

•Phoneme Speech auditory Perception evaluation

1. Abou-Ras et al. 27th Alexandria International Combined ORL Congress, April 8-10,2009

General Testing Instructions:• Room: Quiet room with minimal distractions.�• Position : Behind and to the side.�• Examination condition: life sound by use sound �

level meter at 60 dB.• Responses according to each task and level.�• Reinforcement is providing at the beginning of �

each task.• Patient should understand the instructions first �

before proceeding.

1) Vowel perception testing:• Recording of the number of correct response

according to total number of stimuli & calculation of %.

• Identify vowels using pictures of facial gestures representing/a/,/i/,/o/. (CVC)

• Discrimination of pairs of monosyllabic words:▫Vowel height▫Vowel place ▫Vowel length

Vowel Identification

CVC syllables

Vowel Identification (monosyllabic words)

Discrimination of vowels

2) Consonant perception testing:

Low frequency phonemes

Low frequenc

y fricative

s

High frequen

cy fricative

s

Consonant perception testing• Consonants are introduced listwise in syllabic form

(VCV) with vowel stabilization.• Score of correct identification:

▫ Low frquency Fricatives▫ High frequency fricatives▫ Low frequency phonemes

Stops Nasals Glides Laterals

• Score of correct discrimination:▫ Voicing▫ Place of articulation▫ Manner of articulation▫ Emphatic

اتا ابا

Results

Group A: Cochlear Implant

•Common speech production error:▫Distorted vowels▫Imprecision of consonants (manner and

place of articulation)▫Devoicing▫Fricatives were easier to acquire than rest

of consonants. ▫Difficulties to perceive voicing cues and

vowels with close acoustic features.

Group A: Cochlear Implanted discrimination of vowels

1 2 3 4 5 6 7 8 9 10 11 120%

10%20%30%40%50%60%70%80%90%

100%

Vowel Length1 2 3 4 5 6 7 8 9 10 11 12

0%10%20%30%40%50%60%70%80%90%

100%

Vowel Place

1 2 3 4 5 6 7 8 9 10 11 120%

10%20%30%40%50%60%70%80%90%

100%

Vowel Height

Group A: Cochlear Implanted Consonants Identification

0 2 4 6 8 10 12 140.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

StopsNasalsGlideslaterals

Group A: Cochlear Implanted Consonants Identification

0 2 4 6 8 10 12 140.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

Low frequency phonemes High Frequency Fricatives Low Frequency fricatives

Group A: Cochlear Implant Discrimination of consonants

1 2 3 4 5 6 7 8 9 10 110%

10%20%30%40%50%60%70%80%90%

100%

Voicing

1 2 3 4 5 6 7 8 9 10 11 120%

10%20%30%40%50%60%70%80%90%

100%

Place of articulation

1 2 3 4 5 6 7 8 9 10 110.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Manner of articulation

1 2 3 4 5 6 7 8 9 10 11 120%

10%20%30%40%50%60%70%80%90%

Emphatic

Group B:Hearing Impaired

•Degree of hearing loss▫6 Moderate severe▫2 Moderate

•Configuration of hearing loss:▫6 High frequency hearing loss (sloping)▫2 Flat configuration

Group B: Hearing Impaired

•Common speech errors:▫Difficulty of production of high frequency

fricatives.▫Substitution

Stopping Devoicing

Group B: Hearing Impaired Discrimination of vowels

1 2 3 4 5 6 7 80%

10%20%30%40%50%60%70%80%90%

100%

Vowel Length1 2 3 4 5 6 7 8

0%10%20%30%40%50%60%70%80%90%

100%

Vowel Place

1 2 3 4 5 6 7 80%

10%20%30%40%50%60%70%80%90%

100%

Vowel Height

Group B: Hearing Impaired consonants identification

0 1 2 3 4 5 6 7 8 90.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

StopsNasalsGlideslaterals

Group B: Hearing Impaired consonants identification

0 1 2 3 4 5 6 7 8 90%

20%

40%

60%

80%

100%

120%

Low frequency phonemes High Frequency Fricatives Low Frequency fricatives

Group B: Hearing Impaired Discrimination of consonants

1 2 3 4 5 6 7 80%

20%

40%

60%

80%

100%

Voicing

1 2 3 4 5 6 7 80.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Manner of articulation

1 2 3 4 5 6 7 80%

10%20%30%40%50%60%70%80%90%

Place of articulation

Group C: Phonological errors

•Common speech production errors:▫Substitution

6 (Devoicing) 2 (Fronting)

•100% accuracy of vowel perception•100% accuracy of consonants perception•Difficulty encountered with discrimination

tasks, were not consistently detected on repetition of testing.

Comparison between Group A, B, C and D: Vowels

CI: Cochlear implant, HI: hearing Impaired, Ph: phonological errors

Comparison between Group A, B, C and D: Consonants low frequency phonemes identification

CI: Cochlear implant, HI: hearing impaired, Ph: phonological errors

Comparison between Group A,B,C and D : Consonants Identification

CI: cochlear implanted, HI: Hearing impaired, Ph: phonological errors

Comparison between Group A, B, C and D: Consonants Discrimination

CI: Cochlear implant, HI: hearing impaired, Ph: phonological errors

Conclusion

•Cochlear implantees encounter perceptual difficulties in interpretation of temporal feature (vowel length, stops, voicing) that is not necessarily related to their production difficulty.

•Hearing Impaired difficulty were more related to spectral nature of the sound (vowel advancement, high frequency fricatives, emphatic)

Conclusion

•Phonological errors encountered may not be related to error of acoustic interpretation of phoneme signals, but could relate to attention or central perceptual difficulty easily corrected by repetition.

Recommendation for Further Research•Extension of the number of studied

subjects.•Study of influence of variable stimuli on

speech perception results.

Thank you for your attention