The main purpose of this study was to understand tonal characteristics of hearing-impaired children based on perceptual analysis and acoustic analysis.  Qualitative research and quantitative research methods were both used in this study.  Four Chinese teachers for hearing-impaired children in Shanghai area were invited to take part in the research project, and data via semi-structural intensive interviews for summarization and analysis was gathered. Three research questions were conducted to investigate tonal characteristics of hearing-impaired children. Eight severe hearing loss children with hearing aids and four normal hearing children were surveyed. The subjects were given eight monosyllabic words of Putonghua. All data was collected by custom-developed software and analyzed by Praat.

The results showed that there were significant differences between hearing-impaired children and normal hearing children. The results also showed that there were significant differences among their performance in four tone type for hearing-impaired children. Of the four tones, high rising tone was the most difficult tone for the hearing-impaired children to produce. Error patterns of level tone substitution and high rising tone distortion were most frequent. In addition, the results indicated that no particular relation between age and tonal production in hearing-impaired children could be observed.  Also tonal production of hearing-impaired children was not improved by age. Hearing-impaired children took a longer course in acquiring tones and their F0 contours were different from that of the normal hearing children. Finally, the results of the analysis lead to suggestions for tonal instruction teachers, that they should pay more attention to improving tonal production of hearing-impaired children by using effective methods.

Keywords：hearing impairment, lexical tone, speech production

Thoughts on Learning and Evidence Based Practices
1/16/2006
Jess Dancer, Ed.D., Professor Emeritus, University of Arkansas at Little Rock 

“Knowledge is power”
Sir Francis Bacon

“Skill to do comes of doing”
Ralph Waldo Emerson

(omit Formal Learning,Informal Learning,Pareto’s Principle,My “Ah-Ha” Moment)

Evidence-Based Practice:

To determine whether information is valid, reliable, important, and useful, we as scientists and professionals, realize the importance of evidence-based practices (EBPs). EBP is the “use of current best evidence in making decisions about the care of individual patients.” ⁽⁴⁾ According to Drake (2001) "Evidence-based practices are interventions for which there is consistent scientific evidence showing they improve client outcomes." ⁽⁵⁾

The process of creating EBP includes;

1. Identify the particular issue or problem at hand
   
2. Search the literature for relevant research
   
3. Evaluate the research evidence
   
4. Choose an intervention and justify its selection with the most valid evidence

Identify:

Identifying a particular issue or problem begins with asking a good question, which you can easily construct using the PICO system of analysis ⁽⁶⁾. The system consists of Problem, Intervention, Comparison, and Outcome. For example, if one were evaluating the value of gingko biloba as a treatment for tinnitus…. the “Problem” is that tinnitus affects millions of people in the U.S. The “Intervention” is gingko biloba. The “Comparsion” treatment is a placebo or no treatment. The hoped-for patient “Outcome” is a significant reduction in tinnitus.

Search:

There are many places and methods offering search assistance. The traditional paper-based libraries are always an alternative, but quicker and more efficient searches are usually accomplished online, and it is easier and more efficient than ever.

For peer-reviewed evidence on gingko biloba as a treatment for tinnitus, the Cochrane Database of Systematic Reviews at www.nelh.nhs.uk/cochrane.asp is considered a “gold standard.” By typing “tinnitus” and “gingko biloba” into the search engine, I came up immediately with a review published in 2004 by Hilton and Stuart ⁽⁷⁾ of 12 clinical trials which indicated no significant effects of gingko biloba on tinnitus. Already, I had pretty convincing evidence to advise against the use of gingko biloba for tinnitus relief.

The National Library of Medicine also has a Clinical Queries section which searches for clinically relevant abstracts of peer-reviewed research www.ncbi.nlm.nih.gov/entrez. I typed in “tinnitus and gingko biloba” into their search engine and couldn’t believe my eyes. The first study ⁽⁸⁾ in a list of 5 had the title: “Gingko biloba does not benefit patients with tinnitus: a randomized placebo-controlled double-blind trial and meta-analysis of randomized trials.”

Other search engines to be considered for information related to communication disorders include; www.askjeeves.com, www.google.com, www.yahoo.com, the AAA and ASHA websites, as well as www.audiologyonline.com and www.speechpathology.com, sumsearch.uthscsa.edu(9). and others are worthy of additional exploration and consideration, too.

Evaluate:

If you can’t find systematic reviews or meta-analysis evidence in the appropriate online databases, you may need to evaluate for yourself the available journal articles and the peer-reviewed and non-peer-reviewed resources. Evaluating research is the process of determining whether the evidence presented is valid, reliable, and useful. Some questions to ask in the evaluation process include the following;

1. Is the literature review relevant and complete?
   
2. Are the research questions/hypotheses stated in a measurable way?
   
3. Are the materials and methods used in the study suitable to answer the questions/hypotheses?
   
4. Is the sample size adequate?
   
5. Are the statistics appropriate?
   
6. Are the conclusions and recommendations justified?

Intervention Selection:

Using your scientific and analytic skills to answer the above questions will help you to “verify and validate before you incorporate.” Of course, a working knowledge of statistics is extremely useful, and many pragmatic online sources are available. ⁽¹⁰⁾

Summary:

You might consider your clinical practice a rich, everyday source of informal learning, from which you can take advantage of on-the-job and work-related resources. You don’t have to wait for a formal lecture to learn valuable, useful, and specific information. You can learn from patients, as their questions or comments spark your curiosity and inspire you to investigate and learn more about a particular subject in more detail.

Applying the principles of evidence based practices to informal learning events may provide a wealth of important clinical observations and outcomes.

[Source] http://www.irsc.org:8080/irsc/irscmain.nsf/outweb?readform&site=http://www.audiologyonline.com

LEARNING CONCEPTS OF CHANGE:
COMMUNICATION AND LEARNING

Suzanne Evans Morris, Ph.D.
Speech-Language Pathologist

Therapy is the process of assisting an individual with the concept of change. It increases the options or choices available to the child or adult in a given area. Children with sensorimotor disabilities have a limited repertoire of movement choices. Those choices are expanded through therapy, and the child is introduced to the functional advantages of different movement op tions. Therapy does not guarantee that the child's choice will be the one proposed by the handling of the therapist. In order for specific concepts and techniques to be considered and accepted, the child must be engaged as an active participant in treatment.

A therapy program that acknowledges and builds upon an understanding of change, communication, and learning will be much more successful than one that does not. The following concepts contribute to a therapy program that works well for both the child and therapist. These principles impact on the learning of the therapist as well as the child. In an interactive therapy session the therapist and child are simultaneously teachers and learners.

Communication underlies all treatment.

• All children communicate, and they communicate at every moment. When children's messages are received, understood, and respected, their level of trust deepens. Trust is built on a base of authenticity and honesty. The child knows that the therapist's communication is honest. When therapists say one thing and do another, trust does not develop. A child who trusts a herapist is more willing to risk, and learns more easily.

• Physical handling by the therapist is a powerful system of communication. A therapist's hands learn to "read" the child's message, and move intuitively to provide the support, stability, and movement that is needed.

• Communication takes many forms. A child can say "yes", "no" or "maybe" through alterations in muscle tone, through changes in body rhythms, facial expression, crying or vocalizing, or through moving with or against the therapist. A child's learning style or sensory preferences are communicated by movement toward or away from specific activities or interests. A child who knows that the therapist listens, increases the frequency or consistency of expression. Active listening provides empathy, encouragement, and a feeling of acceptance. When children feel respected and understood, they are more willing to challenge the unknown. With a greater willingness to let go of the familiar and explore change, the child discovers more options for function.

Children are their own best experts.

• Children have an inner, intuitive knowledge of their readiness for what a therapist or parent might introduce. When the adult moves with children and is in harmony with children's knowledge of themselves, they learn more rapidly.

• Observing a child's emotional and physical reaction to an activity is the best feedback of its appropriateness at each moment in time. We can observe a child's interests, activities that delight, and sensory areas that are pleasing or threatening. From these the therapist can choose appropriate activities or techniques that fit with a knowledge of the child's developmental readiness. When a child is disinterested or actively opposes an activity, it is a strong cue that the adult needs to make changes. The activity may be inappropriate for the child, or may be presented in a way that is threatening, uncomfortable, or unfamiliar. Therapy that follows a child's lead and is built on the inner expertise of the child is more successful than therapy built on the agenda of the therapist.

Change that is gradual and slow is less threatening and more acceptable than change that is rapid.

• Every child has an inner sensory feedback system that constantly compares what is familiar and "normal" with what is unfamiliar and "strange". When change occurs in small steps that are related to what is already known and accepted, the child moves more easily and more comfortably in a new direction. The therapist can expand a child's repertoire through subtle variations of patterns that are already familiar.

• Learning occurs more rapidly in an atmosphere of playfulness and fun.

• Play is the young child's access to learning. Children can be motivated by eliciting enjoyment and interest in movement, sensory exploration, oral-motor play, and sound play. Joyful learning contributes to discovery and desire. Working for toleration of handling or oral-motor exploration or any specific desire of the therapist omits this concept. Toleration implies that the child puts up with an imposed activity. As a result, children become reluctant learners without a real sense of inner desire and commitment.

Learning occurs more rapidly when therapy builds upon interests and abilities rather than focuses on disabilities and deficits.

• Children learn more easily in the areas that interest them. They learn more rapidly when they feel capable and competent. When therapists focus on the children's deficits, they communicate the child's limitations and a perception of inability. The child learns to depend upon the therapist to fix what "goes wrong", and is deprived of an inner joy in accomplishment and participation. Through effective therapy the child is encouraged to be a full participant in his change. It must engage the child as a participant and co-creator. Therapy becomes a dialogue between the therapist and child in which each is a contributor.

Learning is easier and faster in a non-judgmental atmosphere.

• When children are judged in their performance, they quickly learn to judge themselves, thus, shifting the emphasis from learning to self-praise or self-condemnation. Therapy that labels movement, feeding patterns, or voice quality as "good" or "bad" teaches children non-acceptance of themselves. In contrast, a specific movement might be explored as interfering with or assisting a functional activity desired by the child. For example, a child can discover and choose a new relaxed or differentiated arm movement because it makes it easier to turn pages in a book. The more familiar, tense movement pattern may be discarded, not because it is a "bad" way, but because it doesn't work as well in obtaining a desired goal.

Awareness increases self-knowledge, and enhances the ability to carry over a new concept or movement into daily life.

• When therapists help children focus their awareness on sensations accompanying a movement, they become more able to repeat that movement pattern independently. Knowledge and learning occur through contrasts. Children understand flexion through its contrast with extension. As awareness of movement and sensation increases, children are more able to move toward what they wish. They are less dependent upon the guidance of another person.

Children learn to adapt to their anatomical structure and physiological abilities to function.

• Therapists can observe functional changes that the child has discovered and attempt to understand how a specific movement pattern or adaptation supports current function. In the process of change some children may temporarily need adaptations such as neck hyperextension to assist breathing or a specific head position to protect the airway during swallowing. With this understanding, a therapist can explore treatment options that contribute to even greater functional abilities. If these are introduced slowly, the child may discover a better or easier way.

[Source] Expressive Communication Help Organization (ECHO)http://www.new-vis.com/fym/papers/p-lrn8.htm

Hearing and speech rehabilitation department of China Rehabilitation research Center is earliest special department for treating and research of different kinds of hearing and speech-language disorders in China. The department owns many modern devices, such as audiometers, phono-laryngograph, and hearing aid testing system, visit-pitch and different speech-language test battery. Professor Li Sheen Li and other doctors and speech therapists have a lot of experience. Aphasia, dysarthria,delayed language development,hearing disorder，speech disorder of cerebral palsy, stutter can be evaluated ,diagnosed and intevented. The patients can get best hearing aid fitting and intervention here. More than five thousands patients have been intervented since 1988.Fifteen national speech and hearing therapy courses and four speech disorder seminars have been held and more than seven hundreds speech therapists and clinicians coming from different part of China have been trained in our department.We set up speech and hearing rehabilitation international cooperation unit in 2000.We has been keeping intimate academics communication with the developed countries in this field.
Speech and hearing disorders are varied and quite complicated .But, if the patients can get formal intervention, their disorder will be improved or recovered. Therefore, Please speech and hearing disorder patients come to our department for evaluation and therapy early .They will return to their family and society early.

Source:http://www.crrc.com.cn/kfyl/ksjs08.htm

In adults, much of what is known about the organization of language functions in the brain has come from the study of patients with focal brain lesions. It has been known for hundreds of years that a left-hemisphere injury to the brain is more likely to cause language disturbance-aphasia-than a right hemisphere injury, especially but not exclusively in right-handed persons. For about a hundred years, certain areas in the adult left hemisphere-Broca's area in the posterior frontal lobe, and Wernicke's area in the temporal lobe-have been identified as centrally involved in language functions. However, researchers in the field of adult aphasia are divided over the exact role these brain areas play in language processing and production. Damage to Broca's area results in marked problems with language fluency; with shortened sentences, impaired flow of speech, poor control of rhythm and intonation (known as prosody); and a telegraphic style, with missing inflections and function words. In contrast, the speech of Wernicke's aphasics is fluent and often rapid, but with relatively empty content and many neologisms (invented words) and word substitutions. It was initially believed that the two areas were responsible for output (Broca's) versus input (Wernicke's), but research does not confirm such a simple split.

Other theories ask whether the two areas might be differentially involved in syntax versus semantics, or phonology versus the lexicon, but the picture is not clear. Some have argued that adult aphasic patients, once they are stable after their injury or stroke, employ many compensatory devices that conceal or disguise the central character of their language difficulties. It then becomes more difficult to assess what is missing or disturbed because the difficulties are overlaid by new strategies, and perhaps new areas of the brain taking over functions for the damaged areas.

Infants and young children who suffer focal brain lesions in advance of acquiring language provide valuable information to neuroscientists who want to know how "plastic" the developing brain is with respect to language functions. For instance, is the left hemisphere uniquely equipped for language, or could the right hemisphere do as well? What if Broca's or Wernicke's areas were damaged before language was acquired? Thirty years ago a review of literature on children who had incurred brain lesions suggested that, unlike the case of adults, recovery from language disruption after left-brain damage was rapid and without lasting effect. Researchers concluded that the two hemispheres of the brain were equipotential for language until around puberty, and that this allowed young brain-damaged children to compensate with their undamaged right hemisphere.

However, several studies suggested that left-brain damage caused greater disruption to language than right-sided damage even in the youngest subjects. Children known to be using only their right hemisphere for language (because they had undergone removal of the left hemisphere for congenital abnormalities) demonstrated subtle syntactic deficits on careful linguistic testing, but the deficits failed to show in ordinary conversational analysis. Almost all of these studies were retrospective, that is, they looked at the performance of children at an older age who had suffered an early lesion. Furthermore, the technology for scanning the brain and locating the lesion site, then carefully matching the subjects, was much less developed.

With the invention of new technologies including CT scans and Magnetic Resonance Imaging (MRI), several studies have been conducted to look prospectively at the language development of children with focal, defined lesions specifically in the traditional language areas. There is surprising concordance among the studies in their results: all of them find initial (but variable) delays in the onset of lexical, syntactic, and morphological development followed by remarkably similar progress after about age two to three years. Lasting deficits have not been noticed in these children. Surprisingly, there are also no dramatic effects of laterality: lesions to either side of the brain seem to produce virtually the same effects. However, most of the data comes from conversational analysis or relatively unstructured testing, and these children have not been followed until school age. Until those detailed studies are extended, it is difficult to reconcile the differing results of the retrospective and prospective studies. Nevertheless, the findings suggest remarkable plasticity and robustness of language in spite of brain lesions that would devastate an adult's system.

Further Reading

For Your Information

[Source]

http://www.findarticles.com/p/articles/mi_g2699/is_0005/ai_2699000526

To parents,

I have ever written an unpublished article and claim the government should build an integrated system, including birth history, health and medicine record, welfare and assistant equipment bulletin, special education service and so on. In fact, I've ever read a paper that a research institute in Taiwan started to study the technical possibilities. You may not hear this system so far, so do I. It takes much time to integrate current systems. But our children can't wait. So, why don't you, parents, start from yourself.

As you may read on my former blogs, parents are the ones who know their children best. If parents record each events happened in their children and it will be an integrated data including all required data.

There is no technical barrier at all. Anyone can write a blog. The best part is all related professionals, such as doctors, therapists, teachers or governmental administrative staffs, can refer the blogs, your child's profile. These data are very important for evaluating your child and make a correct diagnosis which is the basis of all special services. As all we know, children develop in diversity and a behavior/mental problem may cause by complex reasons. In the past, professionals rely on parents' fragment of memory and standard object assessments. They are surely not enough.

Write down what you observe, trust me, you'll get more than you expect.

Carol Hsu