Exploring Collaboration And Evidence-Based Practice In Speech-Language Pathology, Alyssa K. Kuiack

Electronic Thesis and Dissertation Repository

Evidence-based practice refers to an integration between one’s clinical expertise developed through professional development and previous experience, the most current and valid scientific evidence and the unique needs of a particular clinical setting. Recently, there has been a growing expectation of speech-language pathologists to engage in the evidence-based practice process despite awareness that real-world implementation is a complex task. Implementation strategies may be helpful in moving complicated research findings into clinical practice, but there is little research examining the practical use of these strategies. The current dissertation examines how four different implementation strategies, explored through two case studies, can be …

User Preferences For Hearing Aid Features: Outcomes, Concepts, And Test Construction, Hasan Saleh

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Modern hearing aids can vary in both digital signal processing (DSP) and non-signal processing (non-DSP) features. The complexity and availability of these features can differ at opposite ends of the technology spectrum, potentially influencing aided benefit and preference. Furthermore, the amount of feature choices in modern hearing aids has led to increasing complexity in the selection process.

The first aim of this dissertation was to investigate the aided benefit and preference differences between premium and entry-level hearing aids, and to investigate the drivers of any preference differences. No significant differences were found between the entry-level and premium hearing aids in …

Practice-Based Research In Speech-Language Pathology, Meghan Vollebregt

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Practice-based research is an active and collaborative approach to clinical research that minimizes the research-practice gap. Practice-based research involves collecting data in practice to answer questions that arise from clinical practice. The findings from this research then inform future practices. Though over the past two decades there has been a significant increase in knowledge translation activities, especially the use of collaborative partnerships, the integration of these practices in speech-language pathology is in its infancy. In this thesis, I investigate the role of practice-based research in speech-language pathology. In Chapter 2, I first examine the current role of practice-based research in …

Typical And Atypical Development Of Compensation To Altered Auditory Feedback, Caitlin E. Coughler

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Auditory feedback, how we hear ourselves speak, plays an important role in the acquisition and maintenance of fluent speech. Although there is wide acceptance of the importance of auditory feedback control throughout development, little is known about how this develops or how the reliance on auditory feedback control may shift compared to other elements of speech motor control. This dissertation aimed to improve our understanding of the development of auditory feedback control and speech motor control in typically developing children and pediatric clinical populations through the exploration of responses to altered auditory feedback. In altered auditory feedback paradigms, small, often …

The Similarities And Differences Between Distortion-Product Otoacoustic Emission Testing Instruments And Accuracy Settings, Maximilian Tran-Luong

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Advanced measures of the auditory system like otoacoustic emission (OAE) testing are essential for highlighting the subtle expressions of hearing loss if clinical care is to remain up to date with current scientific knowledge. The purpose of this study was to compare distortion product OAE (DPOAE) testing across three different measurement systems (Interacoustic Titan, Bio-logic Scout and Vivosonic Integrity) to determine if there are differences in DPOAE testing. Secondly, the study will look to evaluate the effect if varying accuracy settings on DPOAE testing within the Integrity system. DPOAE tests evaluating levels, noise floor levels, probe fit check time and …

Developing A Spoken Language Outcome Monitoring Procedure For Early Hearing Detection And Intervention Programs, Olivia Daub

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Early Hearing Detection and Intervention programs are associated with improved spoken language outcomes for children who are deaf/hard-of-hearing. Best practice recommendations call for regular spoken language outcome monitoring to support decision making for all stakeholders (families, audiologists, speech-language pathologists, and program managers).

Despite the clear calls for spoken language outcome monitoring, there is no peer-reviewed guidance as to how Early Hearing Detection and Intervention programs can best accomplish this monitoring. This dissertation evaluates the assumptions underlying spoken language outcome monitoring and contributes a new procedure developed for a Canadian Early Hearing Detection and Intervention program: the Ontario Infant Hearing Program. …

Speech Language Pathologists (Slps) Enactment Of Dysphagia Education And Counselling In Tbi Inpatient Rehabilitation., Stephanie Muir-Derbyshire

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Abstract

Background

Traumatic brain injury (TBI) incidence rates are rising significantly across all age groups, often requiring complex and expensive medical care. Common causes of TBI include motor-vehicle accidents, violence, sport injuries and falls. For some individuals, inpatient rehabilitation (IPR) is used as a care pathway to provide intervention(s) for the physiological, psychological, neurobehavioural and cognitive-communication sequelae of a TBI.Many patients with a TBI will also experience dysphagia, an impairment or disorder of deglutition (swallowing). Dysphagia affects hydration, nutritional intake, respiration and can significantly impact an individual’s quality of life. It has been identified as a contributing factor in the …

Objective Measurement Optimization In Early Hearing Detection And Intervention, Matthew J. B. Urichuk

Electronic Thesis and Dissertation Repository

Following the fitting of amplification devices, outcomes need to be evaluated to determine benefit of intervention. Objective measurements, which generally require rapid acoustic or electrophysiological measurement without active participation of the individual, are one subset of evaluation methods.

This thesis aimed to improve the reliability, accuracy, and efficiency of a subset of objective outcome measurements: the speech-evoked Envelope Following Response (EFR), and the wideband real-ear-to-coupler-difference (wRECD), which are used in hearing aid validation and verification respectively.

The speech-evoked EFR, a neural response reflecting phase-locked activity to the envelope of a speech stimulus, can be detected using a variety of statistical …

Speech-Language Pathology Interventions And Ingredients That Support Social Communication And Language Of Preschoolers With Autism, Amanda Binns

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One of the best predictors of long-term outcomes for autistic children is development of language and social communication skills. Therefore, it’s not surprising that speech and language therapy is one of the most frequently accessed interventions for children with suspected or diagnosed autism. From a public health and family well-being perspective, identifying effective social communication interventions and better understanding the specific components that contribute to their effectiveness is critical. However, there is a lack of clarity about the most effective interventions. This dissertation addressed this important topic through three studies.

Study 1 examined the literature on interventions provided by speech-language …

An Exploration Of Audiologists' Readiness To Adopt Connected Hearing Healthcare For Remote Hearing Aid Fitting, Luisa Natalia Perez Velez

Electronic Thesis and Dissertation Repository

Background: Globally, the increasing prevalence of hearing loss and need for improved access to hearing healthcare services, highlights the growing need for alternative service delivery models. A Connected Health model emerges as a solution for this need, focusing on the use of telecommunication technologies. This model, extended to audiology, can help to better ‘connect’ a patient to their own care process and to their provider during audiological diagnostics, treatment, and management services, at a distance and in an effective and timely manner. The strong capacity for and underutilization of Connected Audiology within current aural (re)habilitation service models have led to …

Advanced Phenotyping Of Otosclerosis In An Ontario Population And Two Large Newfoundland Families, Matthew B. Lucas

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Otosclerosis is a relatively common hearing loss disorder characterized by abnormal bone growth in the otic capsule leading to stapes fixation. In approximately half of cases, otosclerosis is inherited as an autosomal dominant trait. Typically, gene discovery efforts rely on surgical confirmation, audiometry and occasionally acoustic reflexes to identify affected cases of otosclerosis within families, requiring that the otosclerosis was at an advanced stage to be detected. This makes it difficult to identify individuals with early otosclerosis. The use of advanced phenotyping to identify cases of otosclerosis was tested in an Ontario otosclerotic population as well as in two large …

Objective Estimation Of Tracheoesophageal Speech Quality, Yousef S Ettomi Ali

Electronic Thesis and Dissertation Repository

Speech quality estimation for pathological voices is becoming an increasingly important research topic. The assessment of the quality and the degree of severity of a disordered speech is important to the clinical treatment and rehabilitation of patients. In particular, patients who have undergone total laryngectomy (larynx removal) produce Tracheoesophageal (TE) speech. In this thesis, we study the problem of TE speech quality estimation using advanced signal processing approaches. Since it is not possible to have a reference (clean) signal corresponding to a given TE speech (disordered) signal, we investigate in particular the non-intrusive techniques (also called single-ended or blind approaches) …

Parkinsonian Speech And Voice Quality: Assessment And Improvement, Amr Gaballah

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Parkinson’s disease (PD) is the second most common neurodegenerative disease. Statistics show that nearly 90% of people impaired with PD develop voice and speech disorders. Speech production impairments in PD subjects typically result in hypophonia and consequently, poor speech signal-to-noise ratio (SNR) in noisy environments and inferior speech intelligibility and quality. Assessment, monitoring, and improvement of the perceived quality and intelligibility of Parkinsonian voice and speech are, therefore, paramount. In the first study of this thesis, the perceived quality of sustained vowels produced by PD patients was assessed through objective predictors. Subjective quality ratings of sustained vowels were collected from …

The Role Of Auditory Feedback For Speech Intensity Regulation In Parkinson’S Disease, Dona Abeyesekera

Electronic Thesis and Dissertation Repository

Hypophonia (low speech intensity) has been found to be the most common speech symptom experienced by individuals with Parkinson’s disease (PD). Previous research suggests that, in the PD population, there may be abnormal integration of sensory information for motor production of speech intensity. In the current study, auditory feedback was systematically manipulated during sensorimotor conditions that are known to modulate speech intensity in everyday contexts. Twenty-six individuals with PD and twenty-four neurologically healthy controls were asked to complete the following tasks: converse with the experimenter with varying distances between the participant and listener (near and far distances), vowel prolongation, read …

Understanding Hearing Aid Sound Quality For Music-Listening, Jonathan Matthew Vaisberg

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To improve speech intelligibility for individuals with hearing loss, hearing aids amplify speech using gains derived from evidence-based prescriptive methods, in addition to other advanced signal processing mechanisms. While the evidence supports the use of hearing aid signal processing for speech intelligibility, these signal processing adjustments can also be detrimental to hearing aid sound quality, with poor hearing aid sound quality cited as a barrier to device adoption. Poor sound quality is also of concern for music-listening, in which intelligibility is likely not a consideration. A series of electroacoustic and behavioural studies were conducted to study sound quality issues in …

An Experimental Evaluation Of Stop-Plosive And Fricative Consonant Intelligibility By Tracheoesophageal Speakers In Quiet And Noise, Sebastiano Failla

Electronic Thesis and Dissertation Repository

Despite functional levels of postlaryngectomy communication, individuals who undergo total laryngectomy and tracheoesophageal (TE) puncture voice restoration continue to experience significant communication difficulties in noisy environments. In an effort to identify and further characterize TE speakers’ intelligibility in noise, the current auditory perceptual study investigated stop-plosive and fricative intelligibility of TE speech in quiet and in the presence of multi-talker noise. Eighteen listeners evaluated monosyllabic consonant-vowel-consonant words produced by 14 TE speakers using an open-response paradigm. Our findings indicate that overall intelligibility was significantly lower in noise. Further examination showed a differential effect of noise on intelligibility according to manner …

Ipad Use To Enhance Conversations Between Persons With Dementia And Their Family Caregivers, Kelsey Dynes

Electronic Thesis and Dissertation Repository

Electronic conversational memory notebooks, a more current application of previous hardcopy versions, consist of personally relevant photographs and accompanying sentences. The notebooks help persons with dementia access memories during conversations. Person-centred communication (PCC) recognizes the individual, accommodating for personal beliefs and intentions. The purpose of the current study was to determine whether persons with dementia and their family caregivers could be educated and trained to use PCC while using an iPad-based electronic conversational memory notebook. Seven persons with mild to moderate dementia and their family caregiver completed the six-week study. Participants were educated and trained to use PCC while conversing …

Identification Of The Smallest Perceivable Interaural Time Differences, Sinthiya Thavam

Electronic Thesis and Dissertation Repository

Several studies have reported human threshold interaural time differences (ITDs) near 10 μs; however, none of these studies aimed to find the stimulus and experimental method that yields the lowest threshold. The goal of the current study is to systematically determine the stimulus and the experimental paradigm that yields the smallest threshold ITD and to provide an accurate reference value. We systematically varied seven parameters: stimulus waveform, stimulus level, stimulus duration, adaptive versus constant stimulus procedure, number of reference intervals, inter-stimulus pause duration, and inclusion versus exclusion of onset and offset ITD. The condition yielding the lowest threshold ITD was …

Exploring Associations Between Language And Working Memory Abilities In Children With Specific Or Combined Impairments In Language And Working Memory, Laura J. Pauls

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Children with disproportionate deficits in language, known as Specific Language Impairment (SLI), often demonstrate deficits in nonverbal cognitive abilities, such as working memory. Such findings have prompted much debate on the association between language and working memory functioning. The primary aim of this thesis was to examine the connection between working memory and language abilities among children with specific or combined impairments in these domains. Study 1 examined the potential of narrative retell performance to indicate impairment in language or working memory among 17 children with specific or combined impairment in language or working memory as well as 9 controls. …

Physiological And Behavioral Evidence Of Auditory Processing Deficit In Children Suspected Of Auditory Processing Disorder, Sangamanatha Ankmnal Veeranna

Electronic Thesis and Dissertation Repository

A series of studies were carried out to examine the neural and behavioral processing of acoustic stimuli in children with suspected auditory processing disorder (sAPD).

The click-evoked auditory brainstem responses recorded from children with sAPD and adults were analyzed using traditional clinical measures and detailed analysis seeking to explore the separate contributions of axonal conduction and synaptic transmission. Clinical measures revealed significant prolongation of absolute latencies and interwave intervals in children with sAPD compared to adults. Examination of responses delineating axonal vs. synaptic transmission showed frequent delays in synaptic factors and fewer instances of delays related to axonal conduction in …

Predictors Of Language Outcome For Children In The Ontario Infant Hearing Program, Olivia M. Daub

Electronic Thesis and Dissertation Repository

The Ontario Infant Hearing Program (OIHP) provides early interventions (i.e., hearing aids) to children who are hard of hearing (CHH) because research consistently demonstrates their benefit to language outcomes. The impact of pre-fitting language abilities on these outcomes are not well understood.

This retrospective cohort analysis examined the performance of OIHP children on the Preschool Language Scale-4 at the time of (n=47), and after (n=19), initial hearing aid intervention. Regression analyses revealed that, before amplification, hearing loss severity predicted language abilities. However, after amplification, severity of hearing loss did not uniquely predict language achievement, but rather …

The Application Of Clear Speech In Electrolaryngeal Speakers, Steven R. Cox

Electronic Thesis and Dissertation Repository

The present work was comprised of a series of experiments that investigated the application of clear speech (CS) in a group of electrolaryngeal (EL) speakers. Three experiments were conducted to assess the impact of CS on three important aspects of EL speech. More specifically, Experiment 1 sought to identify the impact of CS on EL speakers’ word and consonant intelligibility; Experiment 2 examined the influence of CS on the acoustic characteristics of words and vowels in EL speech; and finally, Experiment 3 sought to identify the influence of CS produced by EL speakers on auditory-perceptual ratings by naïve listeners. Results …

Exploring The Conceptual Foundations Of Social Communication In Preschool And School-Aged Children, Kristen H. R. Izaryk

Electronic Thesis and Dissertation Repository

Introduction: Social communication is a complex and dynamic construct that is an important component of human functioning. However, an agreed upon conceptual understanding of social communication within the field of Speech-Language Pathology has been a persistent challenge. Among main issues that obscure our current understanding are those pertaining to terminology, classification, and the boundaries of social communication within social skill. All three impede the advancement of knowledge and sound clinical application. Therefore, the objective of the current study was to investigate the conceptual foundations of social communication.

Method: Two approaches were taken to begin to address these issues. The Delphi …

Parent-To-Parent Support For Parents Of Children Who Are Deaf Or Hard Of Hearing: A Conceptual Framework, Rebecca Henderson

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Background: Parent-to-parent support for parents with children who are deaf or hard of hearing (D/HH) is identified as an important component of early hearing detection and intervention (EHDI) programs for children with hearing loss.

Purpose: The specific aim of this review was to identify the constructs and components of parent-to-parent support for parents of children who are D/HH.

Research Design: An extensive scoping literature review identified 39 peer-reviewed articles published from 2000-2014. Studies were selected and reviewed based on standardized procedures.

Results: Data was identified, extracted and organized into libraries of thematic and descriptive content. A conceptual framework of …

Exploring Communication Apprehension And Its Relationship To Communication Attitude And Socio-Communicative Functioning In Children With Velopharyngeal Insufficiency, Agnieszka Dzioba

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Myriad findings on children with velopharyngeal insufficiency (VPI) indicate the potential for this population of children to experience feelings of apprehension specific to communication and the potential for other psychological and social difficulties. The purpose of the present investigation was to explore the construct of communication apprehension (CA) and its potential relationship to social and communicative functioning in a diverse group of children with VPI. Potential linkages between CA and multiple socio-communicative constructs including attitude, speech satisfaction, speech and language skill, social competence, and speech severity were explored in a cohort of children with and without VPI, followed by an …

Characterizing Spoken Discourse In Individuals With Parkinson Disease Without Dementia, Angela C. Roberts

Electronic Thesis and Dissertation Repository

Background: The effects of disease (PD) on cognition, word retrieval, syntax, and speech/voice processes may interact to manifest uniquely in spoken language tasks. A handful of studies have explored spoken discourse production in PD and, while not ubiquitously, have reported a number of impairments including: reduced words per minute, reduced grammatical complexity, reduced informativeness, and increased verbal disruption. Methodological differences have impeded cross-study comparisons. As such, the profile of spoken language impairments in PD remains ambiguous.

Method: A cross-genre, multi-level discourse analysis, prospective, cross-sectional between groups study design was conducted with 19 PD participants (M_age = 70.74, M …

Role Of The Cochlea And Efferent System In Children With Auditory Processing Disorder, Sriram Boothalingam

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Auditory processing disorder (APD) is characterized by difficulty listening in noisy environments despite normal hearing thresholds. APD was previously thought to be restricted to deficits in the central auditory system. The current work sought to investigate brainstem and peripheral mechanisms that may contribute to difficulties in speech understanding in noise in children with suspected APD (sAPD). Three mechanisms in particular were investigated: cochlear tuning, efferent function, and spatial hearing. Cochlear tuning was measured using stimulus frequency otoacoustic emission (SFOAE) group delay. Results indicate that children suspected with APD have atypically sharp cochlear tuning, and reduced medial olivocochlear (MOC) functioning. Sharper-than-typical …

Evaluation Of Auditory Evoked Potentials As A Hearing Aid Outcome Measure, Vijayalakshmi Easwar

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This thesis aimed to explore the applicability of Cortical Auditory Evoked Potentials (CAEPs) and Envelope Following Responses (EFRs) as objective aided outcome measures for use in infants wearing hearing aids. The goals for CAEP-related projects were to evaluate the effect of speech stimulus source on CAEPs, non-linear hearing aid processing on tone-evoked CAEPs, and the effect of inter-stimulus intervals on non-linear hearing aid processing of phonemes. Results illustrated larger amplitude CAEPs with shorter latencies for speech stimuli from word-medial positions than word-initial positions, and no significant effect of the tone burst onset overshoot due to non-linear hearing aid processing. Inter-stimulus …

The Effect Of Botulinum Toxin Type A On Speech Intelligibility In Oromandibular Dystonia, Beatriz Ysabel Domingo

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Speech intelligibility of 10 individuals with OMD was measured before and after receiving BoNT-A injections. Intelligibility was assessed using the PIT (single-word intelligibility), SIT (sentence intelligibility), and a conversational speech task. Five listeners rated the speech intelligibility of these three intelligibility tasks via orthographic transcription and visual analogue scaling (VAS) techniques. BoNT-A was not associated with significant differences in speech intelligibility. Further analysis revealed a significant difference on the PIT VAS intelligibility ratings based on order of presentation, suggesting that listeners rated the first half of words on the PIT (words 1-29) as more intelligible than the second half of …

Reflective Practice And Professional Knowledge: A Grounded Theory Study Of Speech-Language Pathologists Working In Head And Neck Cancer Rehabilitation, Marie-Eve Caty

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Reflective practice is defined in this dissertation as a process of thinking 'about' and 'through' one's doings, such that practitioners become more skillful, and aware of the nature and impact of their performance within their professional practices. Because it is presumed to enable healthcare delivery practices that are more sensitive to patient needs and more in-line with evidence- based practices, RP is frequently noted as an essential attribute of competent clinical practice. Yet, little is known about the processes by which RP contributes to the professional learning of health-care practitioners in general, and Speech- Language Pathologists (SLPs) in particular.

This …