Student 6 is a young adult female with a profound sensorineural hearing loss. She is a second year student at RIT, majoring in Business Administration. She is third generation deaf in her family and all family members prefer to communicate using ASL. She has had minimal speech therapy and has unintelligible speech; she exclusively uses ASL or writing to communicate. Voice is characterized by moderate to severe tension and a pitch much above optimal level. She has not worn hearing aids since elementary school. Student 6 made the decision to enroll in speech therapy to explore her potential to develop functional speaking skills for specific situations and possibly for her future job.
Profound sensorineural loss/PTA Right: 103 dB Left: 103 dB
Hereditary
Birth
She has not worn hearing aids since elementary school. She is interested in exploring the possibility of purchasing new aids.
Minimal speech therapy, only until age 8.
Student 6 began her education at Texas School for the Deaf (TSD). From 4th through 9th grade she was mainstreamed in a public school for half a day and attended TSD for the other half. For high school she attended TSD full time. She began her college education at Gallaudet, but transferred to NTID after 3 semesters. After her first year at NTID, she was admitted to the RIT Saunders College of Business and is majoring in Business Administration-Marketing.
American Sign Language; she does not use her speech at all for communication.
NTID Voice Evaluation: Pitch level is much above optimal level with noticeable breaks of moderate to large magnitude, phonations are weak and breathy, loudness is below the appropriate intensity level and there is inadequate breath support for speaking. Vocal resonance includes a combination of hyper and hyponasality and there is moderate to severe laryngeal tension. With such low intelligibility, prosodic characteristics could not be judged.
Using KayPENTAX Visi-Pitch IV:
Mean pitch sustained on /oo/ = 356 Hz, /ah/ = 246 Hz, /ee/ = 375 Hz
Habitual Pitch (counting 1-10) = 322 Hz.
The student's speech is unintelligible and she is unaided. She has a very limited phonologic repertoire, moderate to severe vocal tension and a very high pitch register. She shows some stimulability skills, but until therapy begins it is difficult to ascertain her potential to develop speaking skills for functional purposes.
Student 6 has completed all her English requirements and has college-level reading and writing skills.
Long Term
• To build a phonetic repertoire
• To reduce pitch level
• To improve intelligibility for functional communication
Short term - 1st ten weeks of therapy
• To enhance awareness of English phonology including manner and placement features of consonants and vowels
• To explore potential for improving respiratory support for speaking, reducing vocal tension and lowering pitch level to 285 Hz on vowels, consonant-vowels and consonant-vowel-consonant words
• To explore her potential for producing consonants and vowels
• To explore her potential for using speech for a set of functional words
Short term - 2nd ten weeks of therapy
• Reinforce articulation accuracy for front and back vowels in words and 2 word phrases
• Improve articulation and co-articulation for bilabials /p, b, m/, fricatives /f, th, s, sh/, and tip-dentals /t, d, l, n/ in single and bisyllabic words and two-word phrases
• Monitor and reinforce pitch level at no higher than 275 Hz for words and phrases
• Improve intelligibility for a set of functional words and phrases
• Highlight and reinforce basic English pronunciation rules
Prognosis for continuing to attain intelligible speech for functional purposes is good after 40 hours of instruction. Improvements were noted in articulation, pitch and respiratory support. Student 6 is looking into purchasing new hearing aids for the coming academic year, which may also affect her gains. Significant improvement has been made because the student is highly motivated and she is able to benefit from verbal instructions, computer-aided feedback, visual modeling and tactile feedback. She also developed more self-confidence in her ability to make changes in her speech. Student 6 will be continuing in therapy to reinforce the changes she has made and to explore additional improvements particularly with the possibility of acquiring new hearing aids.
When this student began speech therapy, she was extremely shy about vocalizing, even in front of the instructor and was unsure about her decision to work on her speech.