Severe to profound bilateral hearing loss.  Pure tone average 88dB in the left ear with hearing to 8000hz.  Pure tone average 93dB in the right ear with hearing to 4000hz.

Hereditary.  Family history of deafness.

The student was born Deaf and it was detected in early infancy.

The student reports using hearing aids on a fairly consistent basis during elementary and high school.  She stopped using aids about two years ago.  She is interested in resuming the use of amplification and a hearing aid evaluation has been scheduled.

The student received minimal speech-language therapy during elementary school.  No instruction during her high school years.

Attended a non-residential school for the Deaf from kindergarten through high school.

The student prefers to use American Sign Language.  She can however communicate very clearly using signed English.

The student was scored as 44% intelligible on the NTID Write-Down Speech Intelligbility Test (sentences). This is a profile 2.6 on a 1 (low) to 5 (high) scale.  Her spontaneously produced speech is somewhat lower (rated 2.0 by the instructor). 

The student's voice quality, pitch and resonance are all appropriate.  She has a slightly slow rate of speech both when reading and speaking spontaneously.  She has moderate problems with stress and inflection, and also with blending and co-articulation.

The student's speech is mostly unintelligible.  She has numerous articulation errors and a great deal of difficulty with consonant blends and co-articulation.  Her voice quality is appropriate, and she is quite stimulable for the correct production of many consonants and vowels.

The student scored 77% consonant error and 75% vowel error on the Fisher-Logemann Test of Articulation Competence (word).  The student had a 66% error rate on stop consonants, all of which were omissions.  She scored 84% error on fricatives and affricates, all of which were distortions.  She omitted all of the nasal consonants and had significant difficulty with consonant blends and co-articulation.

The student is bilingual.  She is a native user of American Sign Language and has English language skills consistent with a very bright college junior. 

Student 5 was scheduled for two hours of speech instruction per week.

Long-term objectives

1.  The student will adopt spoken English (with or without signs)  as a means of

      communicating with hearing people.

2.  The student will become more confident in her ability to use spoken English.

3.  The student will improve her speech intelligibility.

Short-term objectives

1. The student will understand the role of the features stop and frication in consonant

     production.

2.  The student will understand the concept of co-articulation and blending in speech

      production.

3.  The student will produce /k/, /g/, and /ch/ correctly in words and short phrases.

4.  The student will produce /p/, /b/, /t/ and /d/ correctly in words and short phrases.

5.  The student will produce /s/, /sh/, /m/, and /n/ correctly in words and short phrases.

Student 5 has received thirty four hours of speech instruction to date.  Over this period she has made significant improvement in her speech production.  Her speech intelligibility has improved from 44% (profile 2.6) to 68% (profile 3.3).  Recent articulation testing showed that she is able to produce all of the stop sounds correctly in read words.  She self-corrected her production of final /k/ and final /g/ during the testing.  Her production of /s/ /sh/ and /ch/ remain mildly distorted but the distortion does not seriously effect intelligibility.  Over the thirty-four hours of instruction vowel production was not specifically addressed.  However, during articulation training and practice the correct production of vowels and diphthongs was modeled and practiced along with the target phonemes.  As a result, vowel production improved from 75% error to 25% error. 

Pre-therapy sample test sentences:

1. The snowman looked funny after the rain.

2. The girls at the meeting had a party.

Post-therapy sample test sentences.

1. A cat went to sleep under a big tree.

2. The baby played with the little puppy.

Since beginning instruction the student has purchased new binaural hearing aids.  She is using them most of the time during the day.  Audition has become an integral part of the instructional process.  Print has been completely eliminated, and the use of sign laguage is minimal.  The student and the instructor are able to successfully engage in a spoken conversation using repetition, self correction and clarifying questions to ensure comprehension. 

While both the student and the instructor are pleased with the progress that has been made, the student has not yet been able to overcome her fear of using speech outside of the instructional setting.  She is fully aware that "real life" practice is an important part of developing and maintaining her speech skills, but she has been unable to bring herself to attempt it.  Two strategies are currently being used to help the student transition to the use of speech.  First, she has begun to use simultaneous communication with her Deaf and hard-of-hearing roommates, and second she has started to communicate words and short phrases using mouth movement without voice.  She has utilized this second strategy successfully in restaurants and stores, and hopefully will soon realize that the addition of voice will make her communication more clear. 

Until such time as the student is able to make the transition to using speech outside of the instructional setting the prognosis for spoken English to become a viable option for her is guarded.

This student recognizes the fact that having spoken English as a communication option may prove to be beneficial in the future.  She is struggling in her attempt to use her voice with others.