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Section 5 - Using Facilitator Speech-Voice Amplification
When the Facilitator is turned on, it functions as a
speech-voice amplifier. The real-time amplification has a
pass-band focus of 70–7800 Hz. Such amplification is
designed to amplify primarily the speech-voice of either the
clinician or the client/patient. The instrument was not designed
as a hearing aid with the amplification of environmental sounds
along with speech amplification. Rather, the microphone,
earphones, and amplifier all offer an improved signal-to-noise
ratio, permitting the Facilitator to be used for speech
amplification purposes at relatively low and safe intensity
levels.
Amplification of teaching models and the child’s spoken
response have become important parts of many phonologic
intervention programs. The use of real-time, low-level
amplification appears to direct the client’s attention to
the phonologic target. Normal hearing children with learning
disabilities and/or attention span deficits are using
amplification and FM assistive listening devices as part of their
school and home training programs. Children with stuttering or
voice disorders may profit from amplification as they attempt to
take the "work" out of voicing, learning to use
soft-contact, easy-onset speech patterns.
Many adults with communication disorders may benefit from
receiving speech-language pathology services with some
amplification of their own speech-voice. The non-fluent aphasic
patient, for example, may profit from greater auditory awareness
of his own speech with greater emphasis given to the spoken
signal. Dysarthric patients and people with voice disorders
sometimes seem to produce clearer voice signals as they listen to
their own real-time amplified speech.
A trial use of amplification with children and adults with
various communication problems can be part of diagnostic
evaluations. Does amplification increase accuracy or desirability
of response? Responses under amplification can be compared to
non-amplified response, using various electronic devices, such as
the Visi-Pitch or the Computerized Speech Lab (CSL). If real-time
amplification is found to be facilitative, it can then be used in
therapy and in self-practice.
Clinicians and teachers using auditory amplification with
normal hearing children and adults should be aware of some of the
concerns of ASHA’s Committee on Amplification for the
Hearing Impaired, as cited in Section 1 of this manual. The settings recommended using the
amplification of the Facilitator should not exceed a level that
is "comfortable" for the client using the instrument.
For clients with normal hearing, this is probably in the
75–85 dB intensity range. As the clinician, you should make
volume adjustments with each client so that he/she is comfortable
with the amplitude provided (i.e., not too soft or too loud). The
benefits from using amplification appear less related to
intensity and more to the focus given to the auditory signal that
such headphone-directed amplification provides.
Danny, age 7, was found to have learning disabilities
primarily related to attention span deficits. In his public
school classroom, he was found to be easily distracted by
competing auditory and visual stimuli. In special out-of-class
tutoring sessions, it was found that he could read aloud with
second-grade-level accuracy. However, he would only attend to the
task of oral reading for about 90 seconds. Wearing headphones and
receiving about 75–80 dB of speech level amplification, he
would continue to read aloud in excess of five minutes (under
amplification, he would often need to be asked to stop the
reading task). Further, his oral reading with amplification
seemed to increase his voice loudness and his speech would become
totally free of articulation errors. Oral reading with real-time
amplification of what he says continues to be an important
component of his total educational program.
Christeen, a 39-year-old hospital administrator, experienced
unilateral left vocal fold paralysis, secondary to a
neurosurgical procedure that corrected a ruptured cervical disc
by fusing the left cervical 6-7 vertebrae. She was first seen by
the SLP some three months after onset of the paralysis. Her
whispered "rough" voice was barely audible, sounding
typical of a patient with the paralyzed vocal fold in the
paramedian position with the normal fold not making much of a
midline compensation. As part of our diagnostic procedure, she
was asked to continue voicing wearing headphones with real-time
amplification of about 80 dB. The effect of amplification on her
voice was immediate: Visi-Pitch readings showed an elevation of
fundamental frequency, greater loudness, and a marked decrease in
jitter ratio. Subsequently, as part of her voice therapy and
everyday use of voice, she wore a portable voice amplifier with
microphone and headphones. Self-amplification of voice seemed to
produce the Lombard effect, creating greater voice loudness (with
a concomitant increase in voice quality). Six month post-surgery,
innervation of the left recurrent nerve returned and she
experienced normal laryngeal function. Voice therapy continued to
use amplification as the patient worked to re-establish easy,
ongoing prosodic voicing patterns.
1. The use of amplification
in the clinic using the Facilitator, should begin after
an explanation to the patient, such as "Let’s
see how you sound when you hear yourself speak through
these headphones." The clinician then places the
headphones on the patient and attaches the lapel
microphone, indicating that the patient will now hear
both the clinician’s voice and his own on the
headphones. Trial loudness levels should be established
by adjusting the volume control button.
2. When the Facilitator is turned on, the amplifying
mode is on. The instrument may be plugged in and
used in the clinic, either on a desk or table or placed
inside the wearable carry case and worn as a portable
device. The in-clinic usage offers the clinician a
separate microphone and headset, enabling direct teaching
or modeling with the patient listening on his or her
headset. Or the Facilitator can be used strictly
as a portable, battery-driven instrument (without the
clinician’s headset and mike).
3. Diagnostically, amplification can be used as a
specific step in the evaluation of a child or adult with
a speech-language-voice-learning problem. It is an
add-on procedure that may be coupled with other
diagnostic tasks. For example, if a phonetic inventory is
administered, amplification could be used during part of
the exam. This permits the testing of sounds under both
amplified and non-amplified conditions.
4. Use amplification as part of a diagnostic probe.
When amplification is added to a diagnostic task, does it
make a difference? Different loudness levels should be
tried.
5. The use of amplification in therapy and in training
sessions is highly individualized. If it has been found
to increase correct response rate, improve speech and/or
voice, or improve learning through greater focus on
auditory stimulation, amplification via headphones should
be an important part of therapy. Within the therapy or
training sessions, different levels of amplification
should be tried, using the lowest levels of amplification
that are still facilitative.
6. The portability of the Facilitator makes
amplification possible out of the clinic. The child or
adult may select to wear the phones with amplification
only in self-practice sessions out of the school, clinic,
or studio. Some people elect to use the benefits of
amplification on their speech-voice by wearing the
amplifier with headphones at school, at home, or at work.
7. More often, continuous wearing of the Facilitator
in out-of-the-clinic situations is found in those people
who elect to use other features of the instrument, such
as looping, DAF, masking, or pacing.
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