1Postlingual Hearing Loss
Adult Cochlear Implant
Home-Based Auditory Training Manual
Postlingual Hearing Loss
Recipient’s name: ......................................................................................
Adult Cochlear Implant
Home-Based Auditory Training Manual
Postlingual Hearing Loss
Authors
Belinda Henry
PhD, DipAud, BSc (Hons), MAudSA (CCP)
Current Position (from December 2014)
Audiologist – Clinical Leader
Hearing Implant Program
Lady Cilento Children’s Hospital
Queensland, Australia
Audiologist
Mater Cochlear Implant Clinic
Mater Health Services
Queensland, Australia
and
Academic Title Senior Lecturer
School of Health and Rehabilitation Sciences
University of Queensland
Queensland, Australia
Karen Pedley
MSc (Aud), BSc (Hons), MAudSA (CCP)
Audiologist
Manager, Attune Hearing Implant Centre
Queensland, Australia
and
Academic Title Senior Lecturer
School of Health and Rehabilitation Sciences
University of Queensland
Queensland, Australia
Qian-Jie Fu
PhD
Professor
Department of Head and Neck Surgery
David Geffen School of Medicine
University of California, Los Angeles
California, USA
and
Scientist III
House Research Institute
2100 West Third Street, Los Angeles
California, USA
Acknowledgements
Some of the exercises in the Adult Cochlear Implant Home-Based Auditory Training
Manuals are from the Cochlear Adult Auditory Rehabilitation Guide (Pedley, Lind &
Hunt, 2005) and were originally included in the Cochlear Adult Rehabilitation Manual
(Mecklenburg, Dowell & Jenison, 1982).
The authors wish to thank the cochlear implant recipients at the Mater Cochlear Implant
Clinic, Queensland, Australia, and the Attune Hearing Implant Centre in Queensland,
Australia, who trialled and provided valuable feedback on an earlier version of the manuals,
as well as Mater Health Services audiologists Barb Plath and Anika Batros, for providing
valuable feedback on an earlier version of the manuals and Guide for Clinicians.
Contents
2 About auditory training
6
3 Essential tips for auditory training
7
4 Auditory Training Exercise Plan
8
Section A: Getting started 11
Practice working out the sound and speech from a list of possibilities,
and repeating speech
8 Module 1: Environmental sounds checklist
12
10 Module 2: Environmental sounds training
14
11 Module 3: Identifying speech sounds (vowels and consonants)
15
17 Module 4: Recognising words (known topics)
21
19 Module 5: Recognising sentences (known topics)
23
22 Module 6: Recognising link sentences
26
24 Module 7: Text following – passages read aloud
28
28 Module 8: Recognising common phrases
30
Section B: Making it more challenging 31
Practice repeating and understanding speech in quiet and
noisy backgrounds
Part 1: Practising in a quiet background
32
28 Module 9: Recognising sentences (no topics)
32
32 Module 10: Recognising words (no topics)
36
34 Module 11: Interactive stories
38
36 Module 12: Information transfer – complete the missing information
40
37 Module 13: Information transfer – describe, perceive, draw
41
38 Module 14: Role play
42
39 Module 15: Scripted conversation
43
40 Module 16: Quest?ar
44
Part 2: Practising in background noise
46
Part 3: Practising on the telephone
49
Appendix 1: Extra exercise copies
51
Appendix 2: Tips for using the Angel Sound™ program
59
6 Postlingual Hearing Loss
About auditory training
Why do we do auditory training?
Listening with a cochlear implant enables you to hear
sound. However, this sound is very different from natural
hearing. Also, for some people it may be some time
since they have heard sound or the full range of sounds
in speech. In order to get the most out of your cochlear
implant, it is important to practise listening. Auditory
training helps you learn to understand the speech you
hear with your implant and improve your communication.
Listening practice should start in the weeks following
switch-on of the cochlear implant.
How do we do auditory training?
This manual contains auditory training exercises for you to
complete at home. You will be guided through the manual
by your clinician. Everyone differs in how much they
can hear initially and how quickly they learn to use their
cochlear implant. Therefore, this manual includes a range
of exercises covering abilities from identifying sound and
speech to recognising and understanding speech. As you
move through the manual, the exercises become more
challenging. By the end of the manual, the exercises are
done in background noise to make the task challenging
and more like the environments in which we often find
ourselves communicating.
How do I know which exercise to complete?
Included in this manual is an Auditory Training Exercise
Plan. At each appointment your clinician will discuss with
you which exercises you might like to try and will provide
guidance about how to make the most out of this manual.
Together with your clinician you can write your plan each
session, and there is plenty of room for you to write notes
about your successes and challenges on the exercises
completed. The plan will be reviewed and updated each
session as you progress.
Hard-copy exercises or computer-based exercises?
This manual includes a wide range of auditory training
exercises. Computer-based training is also a good way
to practise your listening skills. Some of the exercises
in this manual can alternatively or additionally be done
using a computer-based training program called Angel
Sound™. While most of the Angel Sound exercises are
different from the exercises in this manual, they can be
used to train on the same skills. We have provided notes
throughout the manual to let you know when Angel
Sound exercises would be appropriate and which ones to
do, for those who have access to a computer and wish to
do exercises in this manner.
The hard copy exercises look like this:
Exercise
The Angel Sound exercises look like this:
Angel Sound™ Exercise
Angel Sound™ program
The Angel Sound computer program is an interactive
auditory training program especially designed for cochlear
implant recipients to practise hearing and recognising
sound and speech. The level of difficulty is automatically
adjusted to match the user’s developing listening skills.
The program provides feedback, highlighting areas the
user can continue to practise. The training and testing
results can be shared with your clinician, who can provide
further advice on the auditory training.
The Angel Sound program can be downloaded and
installed onto your computer. Alternatively, you can
request to have a CD version mailed to you, which
can then be installed on your computer. Information
about Angel Sound, as well as the download link, is
available on the following website: http://angelsound.
emilyfufoundation.org. Refer to Appendix 2 for some
tips on using Angel Sound.
How long do I need to continue doing
auditory training?
This manual is aimed primarily at people who have just
received their cochlear implant, to use during the first few
months. The length of time that you need to do auditory
training varies, depending on how long you have been
with limited hearing, whether you were still able to use a
hearing aid in your implanted ear in the period before your
cochlear implant, and the availability of opportunities
for listening and conversation with your cochlear implant
in your everyday life. Regular auditory training during
the first few months after you get your cochlear implant
is beneficial.
1
Scientific studies have also indicated
that auditory training is beneficial for some cochlear
implant recipients who have been using the devices
for many years.
2
Are there things you would like to be
able to do but don’t feel confident enough to try? There
may be times when you will want to do some refresher
training as well. Your clinician will guide you on using
this manual and which exercises would be appropriate.
7Postlingual Hearing Loss
Tips for the training partner (speaker)
The clinician will guide you in the use of this manual.
Below are also a few tips that may be helpful:
• It is a good idea to practise the listening exercises each
day at home at the same time, so it is part of your
regular routine.
• Initially find a quiet part of the home to do the training.
• Auditory training is mostly done with hearing alone
(without lip reading). The best way to do the training
is for the listener to look down so they can’t see the
speaker’s face. Avoid covering the speaker’s mouth as
this changes the sound of the speech.
• Confirm the parts of the recipient’s response that are
correct.
• The speakers should give positive feedback. Good
alternatives to saying “no, that was wrong” are:
“listen again”, “nearly right, listen to the end of the
sentence again”, or “it sounds a bit like that word but
it’s a different word”.
• If the recipient has difficulty with the exercise, the
speaker may need to modify it using the tips provided
in the manual. For example, the speaker can give a
clue word, slow down their rate of speech, emphasise
particular words or, if needed, let the recipient see the
speaker’s face. However, the speaker should always
end by saying the word or sentence by hearing alone
(without lip reading).
• Over time, as the recipient’s listening skills improve, the
speaker can make the exercises more challenging by:
• increasing the distance between the recipient and
the speaker (for example, by sitting across a table) or
sitting on the non-implanted side
• offering less repeats – encourage more guessing
• gradually increasing the noise in the environment by
turning on the radio “off station” with static noise in
the background, or to a station with music or talking,
increasing the volume of the noise as you progress
• speaking a little faster.
Essential tips for
auditory training
• Auditory training will be the most beneficial if you:
• concentrate on using listening alone (unless
instructed to also use lip reading in the exercise)
• listen with your cochlear implant alone (if you use
a hearing aid in the other ear, turn it off during the
training time)
• practise in a quiet room at first
• check that you are using the speech processor
program and settings you hear best with before
you start
• use a conversational level voice
• practise regularly – about 30 minutes a day on five
days each week
• practise when you are feeling fresh and relaxed
8 Postlingual Hearing Loss
Auditory Training Exercise Plan
Exercises to complete
– completed by clinician and recipient
– note module/exercise and/or page number
Recipient notes
– completed by recipient
Remember to look at the “Essential Tips” (page 7) before you start each session
Date: ___ / ___ / ___
Time since switch-on: _______
Date: ___ / ___ / ___
Time since switch-on: _______
Date: ___ / ___ / ___
Time since switch-on: _______
9Postlingual Hearing Loss
Auditory Training Exercise Plan
Exercises to complete
– completed by clinician and recipient
– note module/exercise and/or page number
Recipient notes
– completed by recipient
Remember to look at the “Essential Tips” (page 7) before you start each session
Date: ___ / ___ / ___
Time since switch-on: _______
Date: ___ / ___ / ___
Time since switch-on: _______
Date: ___ / ___ / ___
Time since switch-on: _______
10 Postlingual Hearing Loss
Auditory Training Exercise Plan
Exercises to complete
– completed by clinician and recipient
– note module/exercise and/or page number
Recipient notes
– completed by recipient
Remember to look at the “Essential Tips” (page 7) before you start each session
Date: ___ / ___ / ___
Time since switch-on: _______
Date: ___ / ___ / ___
Time since switch-on: _______
Date: ___ / ___ / ___
Time since switch-on: _______
11Postlingual Hearing Loss
Section A
Getting started
Practice working out the sound and speech
from a list of possibilities, and repeating speech
12 Postlingual Hearing Loss
Module 1: Environmental sounds checklist
Why?
To help you develop an awareness of the sounds around you in the environment and learn to
identify these environmental sounds. There are some sounds that you may not have heard for
a long time and you will need to re-learn them, and other sounds may sound quite different
with a cochlear implant.
How?
Spend some time each day listening to the sounds around you and see if you can identify the
sounds. Complete the following list as you go.
Exercise
Lower pitched (deeper) sounds
fridge humming kettle boiling
man’s voice air conditioning
car engine from inside the car wind
fan
a zipper
Higher pitched (squeakier) sounds
birds child’s voice
car indicators clothes rubbing together
cicadas
wire coat hangers on a metal
rod
tapping on computer keyboard
microwave or washing
machine beeps
frying food light switch
rubbing hands together
Rhythmic sounds
phone ringing road crossing beeps
footsteps knocking at the door
tap dripping clock ticking
Continuous sounds
fridge motor vacuum cleaner
rain on roof waves at the beach
shopping centre clothes dryer
13Postlingual Hearing Loss
Very soft sounds
own breathing ice cubes melting
chopping apples or onions rustling of tissue paper
pet drinking from a bowl cat purring
gas escaping from a drink can scissors opening and closing
spray from perfume or
deodorant container
shuffling a pack of cards
Distant sounds
traffic in distance waves at the beach
neighbour coming and going children at a playground
car coming down the road aeroplane flying overhead
Louder sounds
cutlery being placed in drawer running water into the sink
toilet flushing own chewing
cup on bench motor bike passing by
dog barking
stirring a cup of liquid with a
spoon
plastic bags or packaging jangling keys
traffic
List some sounds you heard in the first week with your cochlear implant that you
had forgotten
14 Postlingual Hearing Loss
Module 2: Environmental sounds training
Angel Sound
™
Exercise
Basic Module – Environment Sounds
Why?
You can use this task to practise identifying common everyday sounds, such as the
sound of a bird, a car horn or a doorbell. Being able to associate particular sounds
with objects or events in your surroundings may assist you in developing your
auditory memory abilities. You may find that sounds may be quite different with the
cochlear implant and that you may need to re-learn some sounds.
How?
• On the main module screen, click on “Basic Module”, and then on the left hand side
of the screen click on “Environment Sounds”. Refer to Appendix 2 (Tips for using
the Angel Sound™ program) if needed.
• Click on the “Preview” button to practise listening to the environmental sounds.
There are 100 different sounds, with 12 sounds on each page. You can access the
next group of sounds by clicking on the “Forward” button.
• Click on the “Training” button to do the training task. In each task, a sound is
presented and you choose which one you thought it was.
• There are four levels ranging from easier to harder:
• Level 1: choose from two sounds (in quiet)
• Level 2: choose from four sounds (in quiet)
• Level 3: choose from six sounds (in quiet)
• Level 4: choose from six sounds (in background noise)
• Your clinician will guide you on which levels to practice. You can also select the
recommended training level if you have performed a test.
• Run a test (click on the “Test” button) every now and then so the program can
recommend the appropriate training level for you.
• You can click on the “Result” button to see the previous test results, the amount of
training time, and the training progress.
15Postlingual Hearing Loss
Module 3: Identifying speech sounds
(vowels and consonants)
Why?
Using your cochlear implant throughout the day gives you lots of practice and helps your
brain learn to recognise speech. However, some speech sounds may remain difficult to tell
apart and identify with the new and different sound heard through the implant. Recent
research indicates that it may be helpful to do exercises to train the brain to learn to
tell apart and identify speech sounds. This training involves actively listening to pairs of
words that differ in one particular speech sound (for example, the middle vowel “ee” in
“theme” vs “u” in “thumb”) and learning to tell the sounds apart. Some types of vowels
and consonants are harder to hear with a cochlear implant than others. Therefore, there is
a range of exercises progressing from easier to more difficult.
How?
The speaker will say the two words, pointing to each, and then repeat one of the words.
You then point to or say the word. If you are unable to work out which word was said, the
speaker will then say the pair of words several times, pointing to the word as they say it.
This will help to train you to hear the differences between the sounds.
Vowel identification – Level 1
*
Exercise 1
1 theme thumb
2 sharp ship
3 teach touch
4 barn bin
5 leak luck
6 carp cup
7 port put
8 peep pip
9 mast must
10 wall wool
* Adapted from Plant, G. (1984). Commtram:
A communication training program for profoundly deaf adults.
Sydney: National Acoustics Laboratories.
16 Postlingual Hearing Loss
Vowel identification – Level 2
*
Exercise 2
Exercise 3
1 bath booth 1 tea too
2 spark speak 2 pit put
3 tar too 3 cap cup
4 parch peach 4 pit pet
5 tart toot 5 beat boot
6 fast feast 6 kid could
7 hard who’d 7 bat but
8 barn bean 8 bid bed
9 bars booze 9 feed food
10 park peak 10 pill pull
* Adapted from Plant, G. (1984). Commtram: A communication training program for profoundly deaf adults.
Sydney: National Acoustics Laboratories.
Consonant identification – Level 1
*
Exercise 4
1 rip rib
2 cap cab
3 mop mob
4 pick pig
5 duck dug
6 lack lag
7 lock log
8 cod cot
9 card cart
10 hard heart
* Adapted from Plant, G. (1984). Commtram:
A communication training program for profoundly deaf adults.
Sydney: National Acoustics Laboratories.
17Postlingual Hearing Loss
Consonant identification – Level 2
*
Exercise 5 Exercise 6
1 pea me 1 match batch
2 pop mop 2 man ban
3 pie my 3 morn born
4 peel meal 4 mail bail
5 pet met 5 me be
6 pen pet 6 hen head
7 seen seat 7 moon mood
8 ban bat 8 bun bud
9 bean beet 9 pan pad
10 mean meet 10 corn cord
Exercise 7
1 sum numb
2 sea knee
3 sap nap
4 sit knit
5 seed need
6 moose moon
7 horse horn
8 mass man
9 case cane
10 dice dine
* Adapted from Plant, G. (1984). Commtram:
A communication training program for profoundly deaf adults.
Sydney: National Acoustics Laboratories.
18 Postlingual Hearing Loss
Consonant identification – Level 3
*
Exercise 8
Exercise 9
1 lip nip 1 chew shoe
2 law nor 2 chin shin
3 lap nap 3 chip ship
4 lit knit 4 chewed shooed
5 let net 5 chore shore
6 mean meal 6 cheer shear
7 fine file 7 chose shows
8 coin coil 8 chop shop
9 spin spill 9 cheers shears
10 skin skill 10 chair share
* Adapted from Plant, G. (1984). Commtram: A communication training program for profoundly deaf adults.
Sydney: National Acoustics Laboratories.
19Postlingual Hearing Loss
Consonant identification – Level 4
Exercise 10
Exercise 11
1 boat goat 1 peer tier
2 bub dub 2 peak teak
3 big dig 3 pour tore
4 dad gad 4 pair care
5 bet get 5 tool cool
6 lab lad 6 hop hot
7 bag bad 7 bat back
8 big bib 8 map mat
9 bust dust 9 cape cake
10 wed web 10 lip lit
Exercise 12 Exercise 13
1 fought short 1 mail nail
2 fine sign 2 mine nine
3 few shoe 3 sum sun
4 lass lash 4 gum gun
5 fell shell 5 meet neat
6 fit sit 6 boom boon
7 sam sham 7 more gnaw
8 frill shrill 8 game gain
9 buff bus 9 lime line
10 fail shale 10 beam been
20 Postlingual Hearing Loss
Angel Sound
™
Exercise
Basic Module – Vowel Recognition and Consonant
Recognition
Why?
In these exercises you gain practice in telling the difference between and identifying
both vowels and consonants. With your cochlear implant you may be able to hear the
vowels and consonants better than before, but some of them may still be difficult to
recognise. Improving your vowel and consonant recognition may help to improve your
ability to understand words and sentences.
How?
• On the main module screen, click on “Basic Module”, and then on the left hand
side of the screen click on “Vowel Recognition” or “Consonant Recognition”.
Refer to Appendix 2 (Tips for using the Angel Sound™ program) if needed.
• Click on the “Preview” button to practise listening to the words with different
vowels and consonants.
• Click on the “Training” button to do the training.
• There are five levels ranging from easier to more difficult. Within each level, there
are also a number of steps which get progressively more difficult.
• Level 1: is a discrimination task where you listen for differences between the
sounds. There are three buttons on the screen, one for each of the three words you
will hear. Two words are the same, one is different. Choose which word is different.
• Level 2: is a combination of discrimination and identification tasks. There are
two words on the screen. You will hear the two words, and then one of the
words again (spoken by a different speaker). Choose the word you heard.
• Level 3: is an identification task. There are two words on the screen initially. You
will hear one word, and you choose the word you heard. The number of choices
increases (from two to nine for vowels and from two to six for consonants) as you
progress through the steps.
• Level 4: is similar to Level 3, except that the differences between the vowels and
consonants are more difficult to hear. The number of choices increases from two
to four as you progress through the steps.
• Level 5: is an identification task and is the most difficult of the vowel and
consonant training exercises. This time the words are played in a noisy
background. Training on this task may help you hear speech in noise during
conversation. To do this task you need to have made good progress on the
exercises in quiet. The level of noise increases as you progress.
• Your clinician will guide you on which levels to practise.
• When your answer is incorrect, the words will be played so you can listen for
the differences.
• Run a test (click on the “Test” button) every now and then so the program can
adjust the difficulty of the exercise.
• You can click on the “Result” button to see the previous test results, the amount
of training time, and the training progress.
21Postlingual Hearing Loss
Module 4: Recognising words (known topics)
Why?
To gain practice in recognising words when you know what the topic is.
How?
You do not see the list of words. The speaker tells you the topic and you repeat the topic.
The speaker then says each of the words and you repeat them. If you cannot repeat the
word after three attempts, the speaker will say the word with lip reading and then
with hearing alone. You can also try having the words in front of you if you are having
difficulty initially.
Exercise 1 Exercise 2
Topic: Animals Topic: Months
1 tiger 1 September
2 snake 2 March
3 kangaroo 3 July
4 dog 4 February
5 chimpanzee 5 October
6 bear 6 April
7 elephant 7 August
8 spider 8 June
9 cat 9 December
10 hippopotamus 10 May
You can also make up your own sets of topics and words. Here are some ideas: colours,
vehicles, foods, bicycle parts, days of the week. Fill in the topics and associated words in
the tables at the end of the manual (Appendix 1).
22 Postlingual Hearing Loss
Angel Sound
™
Exercise
Basic Module – Word Discrimination
Why?
This exercise helps you to listen to common words used in everyday speech, such as
words for animals, foods and colours. In this module you will listen to whole words,
as opposed to training to hear small differences between words in the Vowel and
Consonant Recognition modules. This training may help you to recognise some of the
commonly used words in everyday life.
How?
• On the main module screen, click on “Basic Module”, and then on the left hand side
of the screen click on “Word Discrimination”. Refer to Appendix 2 (Tips for using
the Angel Sound™ program) if needed.
• There are six different topics (Animal, Food, Colour, Family, Number, Time).
• Click on the “Preview” button to practise listening to words in each topic. A number
of words are shown on each page and you can access the next group of words by
clicking on the “Forward” button.
• Click on the “Training” button to do the training. Then select a topic. There are four
buttons on the screen, each for a different word. You will hear one word and you
choose the word you heard.
• When your answer is incorrect, the words will be played so you can listen for
the differences.
• Run a test (click on the “Test” button) every now and then so the program can track
the training progress for you.
• You can click on the “Result” button to see the previous test results, the amount
of training time, and the training progress.
23Postlingual Hearing Loss
Module 5: Recognising sentences (known topics)
Why?
To gain practice in recognising speech when you know what the topic is but you don’t
know what the possible sentences are.
How?
You do not see the sentences. The speaker tells you the topic and you repeat the topic. The
speaker says the first sentence and you repeat the sentence. The speaker confirms which
words you got right and encourages you to use strategies to clarify the sentence, such as
“repeat” or “did you say…?” or “can you say it a different way?” If you have not been
able to repeat the sentence after three attempts, the speaker will provide an important
word in the sentence using lip reading cues, then repeat the entire sentence using hearing
alone. If you are unable to repeat the sentence, the speaker will say the sentence with
lip reading cues and then hearing alone once more. Another option if you are having
difficulties is to put the list in front of you so you can see what the options are.
Exercise 1
*
Topic: At a restaurant
1 How would you like your steak cooked?
2 You have a choice of soup or salad.
3 Good evening. May I take your order?
4 Would you care to dine at this restaurant again?
5 Would you like to use a credit card or pay cash?
6 Thank you. Do come again.
7 Would you like a table for two?
8 Is there anything else I can get for you?
9 You have potato on your chin.
10
Would you like pie, cake or ice cream for dessert?
* Pedley, K. Synthetic training. In: Pedley, K., Lind, C., & Hunt, P. (2005) Adult Aural Rehabilitation: A guide for
cochlear implant professionals. Sydney: Cochlear Ltd. Based on concept of Plant, G. (1984). Commtram: A
communication training program for profoundly deaf adults. Sydney: National Acoustics Laboratories.
24 Postlingual Hearing Loss
Exercise 2
*
Topic: At the bank
1 Do you have an account at this branch?
2 Would you like to open a new account?
3 The teller at window number one will help you.
4 Is this a deposit or a withdrawal?
5 You forgot to sign this cheque.
6 This cheque has not been cleared.
7 Would you like to order a statement?
8 Your account is overdrawn.
* Pedley, K. Synthetic training. In: Pedley, K., Lind, C., & Hunt, P. (2005) Adult Aural Rehabilitation: A guide for
cochlear implant professionals. Sydney: Cochlear Ltd. Based on concept of Plant, G. (1984). Commtram: A
communication training program for profoundly deaf adults. Sydney: National Acoustics Laboratories.
You can also make up your own topics and sentences. Here are some ideas: at the post
office, your last holiday, your favourite hobby, going to the beach. Fill in the topics and
sentences in the tables at the end of the manual (Appendix 1).
25Postlingual Hearing Loss
Angel Sound
™
Exercise
Basic Module – Everyday Sentences
Why?
In this exercise you will practise recognising sentences, rather than identifying isolated
words (Word Discrimination training) or recognising small differences between
words (Vowel or Consonant Recognition training). While you may not hear all of
the sentence, you may still be able to hear words you are familiar with and fill in the
missing parts. Reading the sentences on the screen will help you to familiarise yourself
with the possible responses. Some of the exercises are done in a noisy background.
Developing your ability to recognise the spoken sentence while excluding the
background noise is good practice for real-world listening situations.
How?
• On the main module screen, click on “Basic Module”, and then on the left hand side
of the screen click on “Everyday Sentences”. Refer to Appendix 2 (Tips for using the
Angel Sound™ program) if needed.
• Click on the “Preview” button to practise listening to the sentences.
• Click on the “Training” button to do the training.
• There are four levels of difficulty:
• Level 1: The sentences are presented in quiet.
• Levels 2, 3 and 4: The sentences are presented in background noise. The noise
gets louder as you progress through the levels. Start with Level 1 and then try
Level 2 and higher as you become more practised.
• There are four sentences on the screen. You will hear one sentence. You choose the
sentence you heard.
• When your answer is incorrect, the correct and incorrect sentences will be played so
you can listen for the differences.
• Run a test (click on the “Test” button) every now and then so the program can
adjust the difficulty of the exercise.
• You can click on the “Result” button to see the previous test results, the amount of
training time, and the training progress.
• For an extra challenge, try not to look at the response choices before the sentence
plays; after the sentence finishes playing, look at the response choices to help you
work out which sentence was said.
26 Postlingual Hearing Loss
Module 6: Recognising link sentences
*
Why?
To gain practice in identifying sentences when you know what the possible options are.
This exercise is more difficult than the previous sentences as the topics are not known and
there are many possible options.
How?
You have the table in front of you. The speaker starts by saying one of the sentences
across a row. The recipient should try to identify which sentence you said. The recipient
may be able to identify the sentence from hearing one or two words correctly, thus
building confidence. Once the recipient can do this easily from the whole table without lip
reading, the speaker can create new sentences by selecting one word from each column,
for example, Bill bought eight yellow jackets. If the whole sentence was not correct,
the speaker confirms which words you got correct and says the sentence again. If the
response is still incorrect, the speaker says the sentence again, pointing to the words as
they are spoken. If needed, you can reduce the number of items in the list (reduce the
number of rows in the table).
Exercise
*
Name Verb Number Adjective Noun
Peter owns ten old jackets
Bill sends two red boxes
John sees seven good roses
Gary bought three new birds
Steven won six green windows
Nicole gets twenty lovely cars
Rachel sold eight pretty shirts
Barbara gives thirteen big dogs
Michelle chose twelve yellow gifts
Cathy made eleven funny balls
* Based on concept of Hagerman, B. (1982). “Sentences for speech intelligibility testing in noise,”
Scandinavian Audiology, 11: 79-87. Words adapted from Angel Sound.
27Postlingual Hearing Loss
You can also make up your own link sentences. Follow the format in the previous table and
write the words into the table below.
Exercise
Name Verb Number Adjective Noun
Angel Sound
™
Exercise
Openset Module – Concatenated Sentences
Why?
To practise identifying sentences when the topic is not known but the possible words
that make up the sentence are known. Each sentence includes five words in the
following order: noun, verb, number, adjective and noun. This is the same type of
training as the Link Sentence task above.
How?
• On the main module screen, click on “Openset Module”, and then on the left hand
side of the screen click on “Concatenated Sentences”. Refer to Appendix 2 (Tips for
using the Angel Sound™ program) if needed.
• Click on the “Preview” button to practise listening to all the words.
• Click on the “Training” button to do the training. Select the appropriate training
level (Quiet, 10 dB, or 0 dB). Choose the quiet condition first. Once you are more
practised you can try it in a noisy background (10 dB first, then 0 dB, which is the
loudest background noise).
• You will see all the words in a table on the screen. You will hear one sentence, made
up from words in the table (one from each column). You select each of the words
you heard to make up the complete sentence.
• When your answer is incorrect, the correct and incorrect sentences will be played
so you can listen for the differences.
• Run a test (click on the “Test” button) every now and then so the program can adjust
the difficulty of the exercise.
• You can click on the “Result” button to see the previous test results, the amount of
training time, and the training progress.
28 Postlingual Hearing Loss
Module 7: Text following – passages read aloud
Why?
A good way to learn to hear the rhythm and pattern of sentences and individual words and
then to identify the speech is to listen to text being read aloud. You can do this by listening
to someone reading aloud from a passage, or by listening to an audiobook (see next
section) and following along with the text on the printed copy.
How?
Choose a passage from a book, newspaper, magazine or one of the passages on the
following pages. You will need two copies of the passage – one for yourself and one for
your training partner. The speaker will read the passage aloud. You follow along pointing
to each word as it is spoken. The speaker then stops at a random place and you stop at the
same word. If you don’t stop at the correct word, the speaker will show you.
Some handy tips:
• When you start this task, practise in a quiet room using materials that are easy to
follow (for example, reading from children’s books, or passages where content is easy
to follow and you know the topic).
• The speaker should start by speaking slowly and stopping in places that are
predictable, such as at the end of sentences or phrases. Passages can be read
several times for practice.
• As you gain more experience with this task, you can use more difficult materials with
longer sentences and where you are not familiar with the topic.
• When you start to find the task easier, listen in a room with background noise. To do
this you can turn on a fan, or turn on the radio “off station” with static noise in the
background, or to a station with music or talking, increasing the volume of the noise
as you progress.
• You can also practise listening by reading aloud to yourself.
Exercise
*
Australia
The continent of Australia is about 7000 miles southwest of California. It is both a
continent and an island and is almost exactly the same size as the mainland United
States. The Nullarbor is the second largest desert in the world and means “no trees”
in Latin. Because of this huge desert, most of the population live around the coastal
borders. There are seven states, including the island of Tasmania.
One of the most interesting features of this country is the animals. The most well-
known is the koala bear, of course. In fact, the koala is not really a bear, because it has
a pouch in which it carries its young. The koala lives in a special kind of eucalyptus
tree, because the koala will eat only the leaves from this tree.
Another animal is the wallaby. This is a miniature kangaroo. It has very big eyes
and very long claws and is more friendly than a kangaroo. There are several kinds of
kangaroos: grey ones, red ones and brown ones. They have very large hind feet and a
long tapered tail that make it possible for them to leap great distances. They can move
faster than fifty miles per hour. In the north of Australia, kangaroos can be found in the
wild very easily. However, wild Australian animals are not usually found wandering the
streets of any major city.
There are many other interesting things in this land called “Down Under”.
* Hunt, P. Analytic training. In: Pedley, K., Lind, C., & Hunt, P. (2005) Adult Aural Rehabilitation: A guide for
cochlear implant professionals. Sydney: Cochlear Ltd.
29Postlingual Hearing Loss
Audiobooks (recorded books)
Why?
A good way to learn to hear the rhythm and pattern of sentences and individual words
and then to identify the speech is to listen to text being read aloud. You can do this by
listening to someone reading aloud from a passage (see section above) or by listening to
an audiobook and following along with the text on the printed copy.
How?
Listen to the audiobook and at the same time follow along on the text in the written
book. Listen to the patterns in the speech and try to identify what the words are. If you
find it difficult at first, you can repeat the passage several times to practice.
Some handy tips:
• It’s a good idea to start with the clearest and quietest signal possible.
• Audiobooks are available at most libraries, and also for sale at bookshops and online
(CDs to buy or MP3/iPod files to download online).
• It’s a good idea to start with easier books and build up to harder books as you get more
practise. Starting with children’s books may be easier. Then as you get more practise,
listen to books for adults, starting with topics that you are familiar with and are of
interest to you – perhaps a book you have read before and enjoyed.
• Some talkers are easier to hear than others, so it can be helpful to experiment with this.
• You can make the task more difficult by listening to the audiobook alone without
reading along.
• Another way of challenging yourself is to add in background noise by opening windows
if there is noise outside, turning on a fan, or turning on the radio “off station” with static
noise in the background, or to a station with music or talking, increasing the level of the
noise as you progress.
30 Postlingual Hearing Loss
Module 8: Recognising common phrases
Why?
To gain practice in recognising commonly heard phrases.
How?
You do not see the list of sentences. The speaker will say the sentence without lip reading.
Try to repeat as many words as you can. If you are not sure, fill in the missing words with
your best guess. Remember, these are sentences that you hear every day. The speaker
confirms which words you got right and encourages you to use strategies to clarify the
sentence, such as “repeat” or “did you say…?” or “can you say it a different way?”
If you have not been able to repeat the sentence after three attempts, the speaker will
provide a key word in the sentence using lip reading cues, then repeat the entire sentence
using hearing alone. If you are still unable to repeat the sentence, the speaker will say
the whole sentence with lip reading cues and then hearing alone once more. For further
practise you can also try making up your own phrases which are relevant to you.
Exercise
1
What time is it?
2
I’ll see you later!
3
How was your day?
4
Would you like a cup of coffee?
5
Wait just a minute.
6
What’s the weather like?
7
Have a nice day.
8
What are we having for dinner?
9
You are looking well today.
10
Do you need a lift?
11
Would you like some help?
12
Please close the door.
13
Are you warm enough?
14
What would you like for breakfast?
15
Happy Birthday!
16
Let’s go to the movies.
17
Pass the bread and butter please.
31Postlingual Hearing Loss
Section B
Making it more challenging
Practice repeating and understanding speech
in quiet and noisy backgrounds
32 Postlingual Hearing Loss
PART 1: Practising in a quiet background
Well done on reaching the section for practising recognising and repeating speech when
the topics and possible options are not known, and for practising understanding the
message. This is getting more challenging!
Module 9: Recognising sentences (no topics)
Why?
To practise recognising speech when the topic and possible options are not known.
How?
The speaker says a sentence. You repeat the sentence. The speaker then confirms which
words you got right and repeats the sentence two more times if needed. If you are having
difficulty, the speaker can try providing a related topic or providing one of the words in the
sentence with lip reading cues. If you can’t repeat the sentence after three attempts, the
speaker will say the sentence with lip reading cues and then again hearing only.
Exercise 1 (Level 1)
*
1 We must vote next Tuesday.
2 Press the pedal with your foot.
3 Pour the stew into the bowl.
4 She saw a cat in the house.
5 The sky was clear and bright.
6 Take the winding path to the lake.
7 Will you please answer the phone?
8 The fish swam in the tank.
9 The boy missed the boat.
10 The house was built of brick.
* Adapted from IEEE sentences. Institute of Electrical and Electronic Engineers (1969) IEEE recommended practice
for speech quality measurements. IEEE Transactions on Audio and Electroacoustics, 17: 225-246. New York: IEEE.
33Postlingual Hearing Loss
Exercise 2 (Level 1)
*
1 Always close the barn door tight.
2 After the dance they went straight home.
3 She was waiting at my front door.
4 Her dress was trimmed with a gold sash.
5 He found a pink shell on the beach.
6 The grapes were pressed into wine.
7 A break in the dam almost caused a flood.
8 The red apple fell to the ground.
9 The corner store was robbed last night.
10 Cut the pie into eight equal portions.
Exercise 3 (Level 2)
*
1 The man went to the woods to gather sticks.
2 Next Sunday is the twelfth of the month.
3 Plant a bush near the front steps.
4 She called his name many times.
5 She sewed the torn coat quite neatly.
6 The sun came up in the eastern sky.
7 The term ended in June that year.
8 Use a pencil to write the first draft.
9 Come quickly when you hear the bell.
10 Wood is best for making toys and blocks.
* Adapted from IEEE sentences. Institute of Electrical and Electronic Engineers (1969) IEEE recommended practice
for speech quality measurements. IEEE Transactions on Audio and Electroacoustics, 17: 225-246. New York: IEEE.
34 Postlingual Hearing Loss
Exercise 4 (Level 2)
*
1 A small creek cuts across the field.
2 Pencils with black lead are good for sketching.
3 Movie tickets cost five dollars on Mondays.
4 The round mat covered the mark on the floor.
5 A frog and a toad are hard to tell apart.
6 The night alarm woke him from a deep sleep.
7 The crew lost their lives in the raging storm.
8 The bomb raid left most of the town in ruins.
9 The curtain rose and the show began.
10 Drive the screw straight into the wood.
Exercise 5 (Level 3)
*
1 Pick a card and place it under the pack.
2 The plant grew large and green in the window.
3 Raise the sail and steer the ship northward.
4 She danced like a swan, tall and graceful.
5 The salt breeze came across the sea.
6 There was the sound of dry leaves outside.
7 Turn on the lantern for light.
8 Twist the valve and release hot steam.
9 Watch the log float in the wide river.
10 We now have a new warehouse for shipping.
* Adapted from IEEE sentences. Institute of Electrical and Electronic Engineers (1969) IEEE recommended practice
for speech quality measurements. IEEE Transactions on Audio and Electroacoustics, 17: 225-246. New York: IEEE.
35Postlingual Hearing Loss
Exercise 6 (Level 3)
*
1 Canned pears lack full flavour.
2 A dash of pepper spoils beef stew.
3 The grey mare walked before the colt.
4 Boards will warp unless kept dry.
5 The rent was paid every third week.
6 The beetle droned in the hot June sun.
7 Bail the boat to stop it from sinking.
8 The copper bowl shone in the sun’s rays.
9 The black dog crawled under the fence.
10 A rod is used to catch pink salmon.
* Adapted from IEEE sentences. Institute of Electrical and Electronic Engineers (1969) IEEE recommended practice
for speech quality measurements. IEEE Transactions on Audio and Electroacoustics, 17: 225-246. New York: IEEE.
Angel Sound
™
Exercise
Openset Module – Sentences
Why?
To gain practice in recognising speech when the topic and possible options are
not known.
How?
• On the main module screen, click on “Openset Module”, and then on the left hand
side of the screen click on “Sentences”. Refer to Appendix 2 (Tips for using the Angel
Sound™ program) if needed.
• Click on the “Preview” button to practise listening to the sentences.
• Click on the “Training” button to do the training. Start by choosing “Quiet”
underneath the training button. See Part 2 – Practising in background noise, when
you are well practised in quiet.
• The screen shows a keyboard. You cannot see the possible answers on the screen.
Listen to the sentence and type in what you heard on the screen keyboard or on
your computer keyboard.
• When your answer is incorrect, the correct sentence will be played so you can listen
for the differences.
• Run a test (click on the “Test” button) every now and then so the program can
adjust the difficulty of the exercise.
• You can click on the “Result” button to see the previous test results, the amount of
training time, and the training progress.
36 Postlingual Hearing Loss
Module 10: Recognising words (no topics)
Why?
To gain practice at recognising speech when the topic and possible options are not known.
How?
The speaker starts by saying the first word. You repeat the word. If you do not get the
word completely correct, your speaker can give you tips, such as “nearly; listen to the
last letter again”, or “almost right, but this word doesn’t begin with p”. After three
attempts, the speaker should then write down the test word and the word that was said
and then say them several times, pointing to each in turn. Also, make a note of the error so
that your audiologist can give you exercises to work on this.
Exercise 1
*
Exercise 2
*
1 dip 6 shed 1 jam 6 rough
2 can 7 chop 2 leg 7 talk
3 boot 8 verse 3 caught 8 yes
4 cheese 9 notch 4 can 9 zoom
5 jug 10 fib 5 bath 10 pave
Exercise 3
*
Exercise 4
*
1 mesh 6 path 1 fuss 6 them
2 him 7 weave 2 reef 7 latch
3 term 8 dawn 3 save 8 nil
4 thought 9 hook 4 daze 9 sheep
5 girl 10 sheep 5 wash 10 sage
* Adapted from Angel Sound.
37Postlingual Hearing Loss
Angel Sound
™
Exercise
Openset Module – Words
Why?
To gain practice in recognising speech when the topic and possible options are
not known.
How?
• On the main module screen, click on “Openset Module”, and then on the left hand
side of the screen click on “Words”. Refer to Appendix 2 (Tips for using the Angel
Sound™ program) if needed.
• Click on the “Preview” button to practise listening to the words.
• Click on the “Training” button to do the training.
• Start by choosing “Quiet” underneath “Training”. See Part 2 – Practising in
background noise, when you are well practised in quiet.
• The screen shows a keyboard. You cannot see the possible answers on the screen.
Listen to the word and type in what you heard on the keyboard.
• When your answer is incorrect, the correct word will be played so you can listen for
the differences.
• Run a test (click on the “Test” button) every now and then so the program can
adjust the difficulty of the exercise.
• You can click on the “Result” button to see the previous test results, the amount
of training time, and the training progress.
38 Postlingual Hearing Loss
Module 11: Interactive stories
Why?
To gain practice in understanding the message rather than just repeating what is heard.
How?
The speaker reads out the paragraph without lip reading (you do not see the paragraph
or the topic). The speaker then asks you questions about the paragraph. If you are having
difficulty, your speaker could give you the topic clue, or you can start by reading the
paragraph with lip reading and then asking the questions with hearing alone.
Exercise 1 (Level 1)
*
Story 1: Breakfast
Breakfast is probably the most important meal of the day. It gives us energy to
go through the morning. Most people eat breakfast at about seven o’clock in the
morning. I like cereal, toast and juice for breakfast. On Sundays, it’s nice to go out to a
restaurant for breakfast.
1 What was I talking about?
2 What time do most people eat breakfast?
3 What time do you eat breakfast?
4 Do you like eggs for breakfast?
5 What do you like best for breakfast?
6 Do you ever go to a restaurant for breakfast?
* Pedley, K. Synthetic training. In: Pedley, K., Lind, C., & Hunt, P. (2005) Adult Aural Rehabilitation: A guide for
cochlear implant professionals. Sydney: Cochlear Ltd.
Exercise 2 (Level 2)
*
Story 2: The disappointed cat
One day, a little bird sat in a tree and looked around. He wanted something to eat and
saw a piece of bread on the ground. He flew down and began to eat it. An old black cat
saw the bird and crept up behind him. She almost caught him, but the little bird heard
her and flew back into the tree. The cat was disappointed. She lay down on the steps
and went to sleep. Then the little bird flew down again and ate the bread.
1 How big was the bird?
2 What did the bird see on the ground?
3 Did the cat catch the bird?
4 What colour was the cat?
5 Where did the cat fall asleep?
6 Did the bird get to eat the bread?
* NSW Department of School Studies (1990). Courtesy of the NSW Department of Education and Training.
39Postlingual Hearing Loss
Exercise 3 (Level 3)
*
Story 3: Garlic
The simple bulb of garlic as we know it is certainly nothing special. However, garlic has
a long and fascinating past. The Babylonians and ancient Greeks called it the “stinking
rose” and believed it had peculiar powers. People rubbed it on their bodies, buried it
with their dead, and wore it round their necks.
The Egyptians went so far as to pray to garlic. They maintained that it possessed the
secret of physical strength. When garlic supplies ran short for the workers building the
Great Pyramid, they reportedly went on strike. Big servings of garlic were also fed to
soldiers for strength in battle and to athletes for better performance.
It was also believed that garlic had many therapeutic values. Remedies have been
recorded for snakebite, measles, colds and cholera, to name but a few. A more bizarre
practice was to string it around the neck to repel vampires.
While garlic is certainly not a cure for all sickness, it is a powerful antiseptic. It has also
been used with good results as a pesticide. At the present time, the real value of garlic
is in cooking. For some time, though, it was frowned upon as something smelly that
only people from the Mediterranean ate. This view is changing, and no chef, who takes
pride in cooking, would be without it.
Since most people worry about bad breath, it should be remembered that this only
occurs with raw garlic. It is perfectly safe to eat when cooked. A final reassurance
comes from the Japanese, who are presently working on a strain of odourless garlic.
This breakthrough should win over many who refrained from eating garlic previously
because of fear of bad breath.
1 What was garlic called in the time of the Babylonians?
2 Name two ways that garlic was used in the past.
3 Why were soldiers and athletes fed so much garlic?
4 What were the garlic remedies supposed to cure?
5 What do we use garlic for in modern times?
6 What is the major shortcoming of garlic?
7 What is in the process of happening to garlic to make it better to eat?
* Pedley, K. Synthetic training. In: Pedley, K., Lind, C., & Hunt, P. (2005) Adult Aural Rehabilitation: A guide for
cochlear implant professionals. Sydney: Cochlear Ltd.
40 Postlingual Hearing Loss
Module 12: Information transfer –
complete the missing information
*
Why?
To gain practice in understanding the message rather than just repeating what is heard.
How?
The speaker’s copy of the exercise is below and your copy is in Appendix 1. You and the
speaker both have the same table, but you each have different and complementary
missing details. The task is to fill in the missing information on both of your sheets by
taking it in turns to ask and answer questions. For example, you may ask the recipient:
“What street is the house on?” The recipient may ask you: “Is the condition of the flat
modern, quite modern or not very modern?” When the recipient hesitates, encourage
them to request clarification.
Exercise
Detail Flat House
Street King Street
Size big
quite big
small
big
quite big
small
Condition
modern
quite modern
not very modern
modern
quite modern
not very modern
Number of
rooms
three downstairs –
upstairs –
List of
rooms
a living room
a kitchen
a bedroom
Central
heating
Yes
Near the
shops
No
Distance
from town
centre
1 km
Rent $1600 a month
Any other
information
You share the toilet and
bathroom on the first floor.
* Watcyn-Jones, P. & Howard-Williams, D. (2001). Grammar games and activities, Book 1. London: Penguin,
Reproduced by permission of Penguin Books Ltd.
41Postlingual Hearing Loss
Module 13: Information transfer –
describe, perceive, draw
*
Why?
To gain practice in understanding the message rather than just repeating what is heard.
How?
The speaker gives you a set of verbal instructions to draw or write objects and symbols on
a blank rectangle (see Appendix 1) to form a pattern. Example patterns for the speaker are
shown below. You carry out the instructions, using clarification strategies whenever you
are unsure of any details. Once you have completed the exercise, the speaker will show you
the correct pattern and discuss any errors.
The following presentation tips may be useful for the speaker:
• Use a number of short sentences initially, building up to longer, more detailed
instructions when the recipient is achieving the task.
• If the recipient is reluctant to ask for clarification, encourage them to repeat or
paraphrase each instruction to ensure it has been correctly perceived.
• Do not automatically repeat the instruction if the recipient hesitates. Wait for
them to question details so they begin to take responsibility for repairing the
communication breakdown.
7
9
5
1
* Adapted from Plant, G. (1991). Syntrex: Synthetic training exercises for hearing impaired adults, Part 1 Therapist’s Handbook.
Sydney: National Acoustics Laboratories.
42 Postlingual Hearing Loss
Module 14: Role Play
*
Why?
To gain practice in understanding the message rather than just repeating what is heard.
How?
You will pretend to be in a specific place with a task to achieve. Your speaker will give
you basic information about the conversation context and purpose, and an introductory
sentence with lip reading. Your speaker will then ask you questions related to the situation
without lip reading. To play your part, try to give appropriate answers. If needed, ask your
conversation partner to repeat the question, or use prompts such as “Did you say…?” or
“Are you asking…?”
Exercise 1
Situation: Purchasing a train ticket at the ticket office
1 Where would you like to go?
2 When would you like to go?
3 What time of the day would you like to travel?
4 How many people will be travelling with you?
5 Would you like a one-way or a return ticket?
6 Will you be returning on the same day?
7 How would you like to pay for the ticket?
Exercise 2
Situation: Obtaining a replacement cable for a speech processor
1 Was your speech processor fitted at this clinic?
2 What model is your speech processor?
3 Would you like the cable posted to you?
4 How long have you had this speech processor?
5 What length of cable would you like, 6 cm or 8 cm?
6 What colour would you prefer: beige, brown, grey or black?
7 Do you need any other spare parts?
* Watcyn-Jones, P. & Howard-Williams, D. (2001). Grammar games and activities, Book 1. London: Penguin,
Reproduced by permission of Penguin Books Ltd.
43Postlingual Hearing Loss
Module 15: Scripted conversation
Why?
To gain practice using prediction and topic cues to anticipate what your speaking partner
is saying.
How?
You will start the conversation about the preparation for an imaginary trip you will both
take for a picnic. Below are the sentences and questions that you will say. Your speaking
partner will make the appropriate responses. Try to repeat back what your partner says
before moving on to the next sentence.
Note to your speaker: Encourage the recipient to guess. If the recipient cannot correctly
repeat the information, provide assistance as follows:
• Repeat the whole answer.
• Repeat the answer emphasising the incorrect part.
• Repeat only the incorrect part.
• Confirm the parts correctly repeated.
Adjust the predictability and complexity of your replies to suit the skill level of the
recipient (for example, embed the answer, use proper nouns) so the exercise remains
challenging but manageable.
Exercise
Topic: Organising a picnic
1 Let’s go for a picnic. Where shall we go?
2 Who should we invite along?
3 Which day will we go?
4 Whose car shall we take?
5 How long do you think it will take to get there?
6 What food should we take?
7 What other activities shall we do at the picnic site?
8 What shall we do if it rains?
9 How long shall we stay there?
10 Do you want to take anything else with you?
44 Postlingual Hearing Loss
Module 16: Quest?ar
*
Why?
To gain practice in understanding the message rather than just repeating what is heard.
How?
Your speaker (conversation partner) will decide on a topic to discuss (see topic examples
below). You and your conversation partner can both see the list of questions (see page 56
for copy of questions). You ask each question, and your conversation partner will answer.
The conversation partner asks the recipient to repeat what they have understood of
the response. Encourage the recipient to request clarification, and for the recipient and
conversation partner to work together to clarify what was said.
Topic examples:
museum restaurant post office shopping camping
doctor zoo beach airport swimming
mountains picnic music lesson supermarket
Exercise
1 Where did you go?
2 Why did you go there?
3 When did you go?
4 How many people went with you?
5 Who were they? (give names)
6 What did you take with you?
7 Where is (the place that you went)?
8 How did you get there?
9 What did you see on the way?
10 What time did you get there?
11 What did you do first?
12 What did you see?
13 How many? What colour?
14 What happened at (the place where you went)?
15 What else did you do?
16 What were the other people doing at (the place where you went)?
17 What was the most interesting thing that you saw?
45Postlingual Hearing Loss
18 What was the most interesting thing that you did?
19 What did you buy?
20 What kind? What flavour? What colour?
21 How much did it cost?
22 Did anything unusual happen? What?
23 How long did you stay?
24 What did you do just before you came home?
25 When did you leave?
26 How did you get home?
27 What happened on the way home?
28 What time did you get home?
29 How did you feel then?
30 When are you going back
31 Do you think that I should go sometime? Why?
* Adapted from Erber, N. (1996). Communication therapy for adults with sensory hearing loss (2nd ed).
Clifton Hill: Clavis.
46 Postlingual Hearing Loss
PART 2: Practising in background noise
Well done on reaching the section for practising in background noise. Now it’s getting
quite challenging. Many of the everyday environments in which we communicate are
noisy. The noise may be steady such as an air conditioner or fan, or may be loud and
variable such as traffic noise, and often it is a background of other people talking or of
music. As you know, it is much more difficult to communicate in a noisy background.
So when you are well practised at recognising speech in quiet, it is important to practise
listening in noisy backgrounds.
You can start with low levels of noise and increase the noise level as you progress. This
practice will help your brain sort out the message you want to hear from the noise and
help you learn to fill in the gaps when you don’t hear all of the message. You can practise
listening in background noise with both the hard-copy exercises and Angel Sound™
exercises. Below are the instructions for how to practise in background noise.
Exercise
• All of the exercises in the manual can be practised in noisy backgrounds.
• You can create background noise by opening windows if there is noise outside,
turning on a fan or air conditioner, or turning on the radio “off station” with static
noise in the background, or to a station with music or talking.
• Increase the level of the noise as you progress:
• Start with the noise at a level where you are just aware of it until you can get
> 90% correct on your chosen exercise.
• Next, increase the noise level so that you have to really concentrate on the
speaker but the speaker is still louder than the noise. Practise until you can get
> 80% correct.
• Increase the noise so that it is the same level as your speaker. At this level,
sentence-type exercises work best. Remember to listen for meaning rather than
every word.
47Postlingual Hearing Loss
Angel Sound
™
Exercise
Why?
To practise listening in background noise.
How?
• Follow the general instructions for the Angel Sound exercises throughout the
manual and add in background noise using the instructions below.
• As for the other Angel Sound exercises:
• Click on the “Preview” button to practise listening to the words.
• Click on the “Training” button to do the training.
• When your answer is incorrect, the correct word will be played so you can listen for
the differences.
• Run a test (click on the “Test” button) every now and then so the program can
adjust the difficulty of the exercise.
• You can click on the “Result” button to see the previous test results, the amount of
training time, and the training progress.
• Refer to Appendix 2 (Tips for using the Angel Sound™ program) if needed.
Noise Module – Medial Vowels and Initial,
Medial and Final Consonants
How?
• In the main module screen, click on “Noise Module”, and then on the left hand side
of the screen click on “Medial (middle) Vowels”, “Initial Consonants”, “Medial
Consonants” or “Final Consonants”.
• These exercises are similar to the Vowel Recognition and Consonant Recognition
exercises in the Basic Module, except that these training exercises are done in
background noise.
• You will see four words on the screen. You will hear one of the words – choose the
word you heard. As you go through the exercise, when you get the answer incorrect
the noise will get softer and when you get it correct the noise will get louder. This
way you will be training at the point where you find it challenging. There are three
types of noise: speech babble, low-pass noise and white noise. Select speech babble
to practise hearing speech in a background of other talkers, and low-pass or white
noise to practise hearing speech in steady noise backgrounds.
Noise Module – Numbers
How?
• On the main module screen, click on “Noise Module”, and then on the left hand
side of the screen click on “Numbers”.
• You will see four numbers on the screen. You will hear one of the numbers – select
the number you heard. As you go through the exercise, when you get the answer
incorrect the noise will get softer and when you get it correct the noise will get
louder. This way you will be training at the point where you find it challenging.
Select speech babble to practise hearing speech in a background of other talkers,
and low-pass or white noise to practise hearing speech in steady noise backgrounds.
48 Postlingual Hearing Loss
Openset Module – Words and Sentences
How?
• On the main module screen, click on “Openset Module”, and then on the left hand
side of the screen click on “Words” or “Sentences”.
• Click on the “Training” button to do the training.
• Under “Training” choose first the softer noise background (10 dB) and then try the
louder noise background (0 dB).
Openset Module – Recognition Threshold
How?
• On the main module screen, click on “Openset Module”, and then on the left
hand side of the screen click on “SynSent” (this is the same type of exercise as
Concatenated Sentences).
• Click on the “Training” button to do the training.
• As you go through the exercise, when you get the answer incorrect the noise will
get softer and when you get it correct the noise will get louder. This way you will be
training at the point where you find it challenging.
49Postlingual Hearing Loss
PART 3: Practising on the telephone
Most recipients who were able to use the phone with their hearing aid learn to use the
phone again with the cochlear implant. Success depends on how much you understand
without lip reading with your cochlear implant, how you manage the conversation when
you are unsure of what is said, and how well you manage the speaker at the other end of
the line.
Voices will sound different on the telephone through the cochlear implant, as not all the
tones available in your speech processor are transmitted down the phone line. It is also
less clear and natural than talking with someone in person with your cochlear implant.
You may not always identify the caller. If you begin by initiating the calls yourself, you can
remove one source of “telephone-stress”.
Getting started
Before trying any exercises over the phone, your audiologist will show you the different
ways to use your technology: for example, you can use the phone on speaker, or hold the
receiver against the microphone of your processor, or use the telecoil inside your processor.
Using your chosen method, start with an exercise you can already do easily with your
speaking partner without lip reading. Try to repeat back what is said. Remember to listen
for the key words and aim to get the gist.
Exercises that work well over the phone include:
• Sentences people say every day like those in Module 8.
• Words with a common theme like your family names, months of the year, similar to
Module 4.
• Sentences on a specific topic such as booking a restaurant or arranging a trip to the
movies or a picnic, similar to Module 5.
• Following and repeating a passage of text over the phone, such as Module 7. Material
that works well includes recipes, children’s stories, a description of a TV program in a TV
guide. You could email a piece of familiar text to your phone buddy and ask them to read
it to you over the phone, so that you can become accustomed to their voice.
• Ask your speaker to say 10 things about themselves and repeat back each item, for
example, I have brown hair, I am 6 ft. 2 inches tall, I work on a farm, I ride a motorbike,
my favourite hobby is football.
• Try information transfer exercises like that in Module 12. Ask your phone buddy to look
out of the window and describe the house across the road, while you repeat back.
What to do when you are unsure what the speaker says
• Always try to repeat back as much as you can to check understanding using “Did you
say…?”
• If you still can’t get a word or phrase after two repeats, ask the speaker to use a different
word or say it a different way – this is the fastest way to get back on track.
• Ask the speaker to spell the word – it’s easier if you have pen and paper near the phone.
Managing the speaker
It’s important to be very specific when asking your speaker to help you. Saying “I can’t
understand you”, or “I can’t get that” or “sorry?” is likely to result in the speaker talking
more loudly, which may sound distorted in your cochlear implant processor. Ask your
speaker to use a normal level voice, to speak more slowly and to make it clear when
they change the subject, for example, “Can we talk about the arrangements for dinner
next week?”
50 Postlingual Hearing Loss
Tips
1. Practise, practise, practise – most recipients who are confident phone users speak on
the phone every day.
2. To get a good receiver-to-cochlear implant position quickly, practise listening for the
dial tone. Replace and re-position over and over.
3. Once you have a good position with the receiver against the microphone at the top of
your speech processor, keep the receiver still!
4. Start with a “phone buddy” – someone in the family whose voice you know you
understand quite well. It helps if the person has observed your audiologist work with
you on the phone.
5. Keep the first phone calls short. Chalking up a few successes will do a great deal for
your confidence.
6. When you first start, it helps if the speaker at the other end is in a quiet place. If you
can hear a lot of background noise, explain to the caller that you will ring them at
home later.
7. Landlines can be clearer than mobiles and hands-free devices. Initiate your first calls to
a home phone line. This also means the person is in a quiet situation at the other end.
8. If you are using the telecoil, you may reduce interference by moving away from
electronic items such as computers and fluorescent lights.
9. If you are still struggling on the phone, talk to your audiologist about changing the
balance of sound between your microphone and your telecoil, and discuss direct
auditory input and Bluetooth
®
options.
10. If you wear a hearing aid in the other ear, use the phone on speaker so that you can
listen with two ears.
51Postlingual Hearing Loss
Appendix 1:
Extra exercise copies
52 Postlingual Hearing Loss
1. Extra exercise tables
Exercise
Topic:
1
2
3
4
5
6
7
8
9
10
Exercise
Topic:
1
2
3
4
5
6
7
8
9
10
53Postlingual Hearing Loss
2. Recipient copy of Module 12: Information transfer –
complete the missing information
*
How?
You and the speaker both have the same table, but you each have different and
complementary missing details. The task is to fill in the missing information on both of
your sheets by taking it in turns to ask and answer questions. For example, the speaker
may ask you: “What street is the house on?” You may ask: “Is the condition of the flat
modern, quite modern or not very modern?”
Exercise
Detail Flat House
Street Park Road
Size
big
quite big
small
big
quite big
small
Condition modern
quite modern
not very modern
modern
quite modern
not very modern
Number of
rooms
three downstairs – two
upstairs – three
List of
rooms
a living room
a kitchen
two bedrooms
a bathroom/toilet
Central
heating
No
Near the
shops
Yes
Distance
from town
centre
2 km
Rent $250 a week
Any other
information
There is a large garden and a
garage.
* Watcyn-Jones, P. & Howard-Williams, D. (2001). Grammar games and activities, Book 1. London: Penguin,
Reproduced by permission of Penguin Books Ltd.
54 Postlingual Hearing Loss
3. Recipient copy of Module 13: Information transfer –
describe, perceive, draw
*
How?
Below is an empty box. Your speaker is going to help you to draw a pattern of objects and
symbols in the box by telling you what to draw and where to draw it. Listen carefully and
then draw the items in the box. If you are not sure, use one of the following strategies for
clarification, but do not look at the speaker’s drawing:
• Ask the speaker to repeat the whole instruction.
• Repeat back what you think the instruction was, for example, “Did you say the top left
hand corner?” Your speaker will provide feedback as to which parts you heard correctly.
• Ask your speaker to clarify any parts you are not sure of, for example, “I heard you say
‘circle’, but I am not sure where to draw.”
When you have finished, compare your drawing to the speaker’s drawing.
* Adapted from Plant, G. (1991). Syntrex: Synthetic training exercises for hearing impaired adults, Part 1
Therapist’s Handbook. Sydney: National Acoustics Laboratories.
55Postlingual Hearing Loss
4. Recipient copy of Module 14: Role play
*
Exercise 1
Situation A. Railway ticket office
Task: To obtain a train ticket for your journey home/to visit family.
Introductory sentence: “I would like to buy a train ticket please.”
Exercise 2
Situation B. The reception area at your cochlear implant clinic
Task: To obtain a replacement/spare cable for your speech processor.
Introductory sentence: “I would like a new cable for my speech processor, please.”
* Pedley, K. Synthetic training. In: Pedley, K., Lind, C., & Hunt, P. (2005) Adult Aural Rehabilitation: A guide for
cochlear implant professionals. Sydney: Cochlear Ltd.
56 Postlingual Hearing Loss
5. Recipient copy for Module 16: Quest?ar*
Topic examples:
museum restaurant post office shopping camping
doctor zoo beach airport swimming
mountains picnic music lesson supermarket
Exercise
1 Where did you go?
2 Why did you go there?
3 When did you go?
4 How many people went with you?
5 Who were they? (give names)
6 What did you take with you?
7 Where is (the place that you went)?
8 How did you get there?
9 What did you see on the way?
10 What time did you get there?
11 What did you do first?
12 What did you see?
13 How many? What colour?
14 What happened at (the place where you went)?
15 What else did you do?
16 What were the other people doing at (the place where you went)?
17 What was the most interesting thing that you saw?
57Postlingual Hearing Loss
18 What was the most interesting thing that you did?
19 What did you buy?
20 What kind? What flavour? What colour?
21 How much did it cost?
22 Did anything unusual happen? What?
23 How long did you stay?
24 What did you do just before you came home?
25 When did you leave?
26 How did you get home?
27 What happened on the way home?
28 What time did you get home?
29 How did you feel then?
30 When are you going back
31 Do you think that I should go sometime? Why?
* Adapted from Erber, N. (1996). Communication therapy for adults with sensory hearing loss (2nd ed).
Clifton Hill: Clavis.
58 Postlingual Hearing Loss
59Postlingual Hearing Loss
Appendix 2:
Tips for using the Angel Sound™ program
60 Postlingual Hearing Loss
Once you have installed Angel Sound, there will be an Angel Sound icon on your computer
desktop. Follow these instructions and further instructions throughout the manual to use
Angel Sound.
Step 1: Start the program
Click on the Angel Sound icon, then click on the following banner on the screen.
Step 2: Select session
A “Select Session” box appears – if this is your first time using Angel Sound, at the top left
of the box select “Session” then “New” and “Create a new session” (note that you can
use any text as your session name), click “Save” and you will then enter the program. If
you have created a session before, simply double click the session name you want to use.
Step 3: Select module
There are a number of modules to choose from. Click on the module you want to use
(as instructed in this manual). The modules used in conjunction with this manual include
Basic, Noise and Openset.
61Postlingual Hearing Loss
Step 4: Select training group
The “Introduction” screen tells you a bit about the module. Each module has several
different training groups (or training types); these are listed on the left side of the screen.
Click on the training group you want to do (as instructed throughout this manual).
62 Postlingual Hearing Loss
Step 5: Select preview, training, test or result
Across the top of the screen it says:
Select one of these, as instructed in this manual. Further
instructions are given in the manual for each particular
exercise.
• Introduction: Gives brief information about the exercise.
If you would like more detailed information about the
exercise, please click the “Learn More” button in the
top right corner of the screen.
• Preview: Gives you some listening practise to familiarise
yourself with the materials that are used in the exercise.
Click on any item and the sound will play.
• Training: This is where you do the training exercises.
There are several training tasks in each group. The
difficulty of these training tasks varies. In general, the
task in Level 1 is easiest, and the higher the level, the
more difficult the training task.
• Test: Monitors your progress and adjusts the difficulty
of the training task. You should run a test every now and
then. You will hear a word or sentence and you respond.
No feedback is given during the test session. You will
see the results at the end of the test. According to your
score, the program will then automatically recommend
the appropriate training level (indicated in green).
• Result: Contains all the training and test results.
• If you are interested in reading more detailed
information about the program, click the “Help”
button in the top menu of the screen. The program
will load the “Quick Start” section of the Angel Sound
website (http://angelsound.emilyfufoundation.org/
angelsound_help.html).
• Volume: Click on the “Preview” button and then click
on any item on the screen to play sounds. Adjust the
volume of your computer or external speakers to be
comfortably loud.
Example: Basic Module, Environment Sound training.
You will hear one of these four sounds and you choose
the sound you heard.
Example: Basic Module, Vowel Recognition
training. You will hear one of these four words
and you choose the word you heard.
Example: Basic Module, Consonant Recognition
training. You will hear one of these two words and you
choose the word you heard.
Example: Basic Module, Word Discrimination
training. You will hear one of these 12 words and
you choose the word you heard.
63Postlingual Hearing Loss
References
1. Fu QJ, Galvin JJ 3rd. Maximizing cochlear implant patients’ performance with advanced speech
training procedures. Hear Res. 2008 Aug;242(1-2):198-208.
2. Oba SI, Fu QJ, Galvin JJ 3rd. Digit training in noise can improve cochlear implant users’ speech
understanding in noise. Ear Hear. 2011 Sep-Oct;32(5):573-81.
ACE, Advance Off-Stylet, AOS, AutoNRT, Autosensitivity, Beam, Button, Carina, Cochlear, コクレア, Codacs,
Contour, Contour Advance, Custom Sound, ESPrit, Freedom, Hear now. And always, Hybrid, inHear, Invisible
Hearing, MET, MP3000, myCochlear, NRT, Nucleus, 科利耳, Off-Stylet, SmartSound, Softip, SPrint, the elliptical
logo and Whisper are either trademarks or registered trademarks of Cochlear Limited. Ardium, Baha, Baha Divino,
Baha Intenso, Baha PureSound, Baha SoftWear, BCDrive, DermaLock, Vistafix and WindShield are either trademarks
or registered trademarks of Cochlear Bone Anchored Solutions AB.
Angel Sound™ is a trademark of the Emily Fu Foundation.
Apple and iPod are trademarks of Apple Inc., registered in the U.S. and other countries.
© Cochlear Limited 2015
N585130–585133 ISS2 JUL15
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As the global leader in implantable hearing solutions, Cochlear is dedicated to bringing
the gift of sound to people with moderate to profound hearing loss. We have helped over
400,000 people of all ages live full and active lives by reconnecting them with family,
friends and community.
We give our recipients the best lifelong hearing experience and access to innovative future
technologies. For our professional partners, we offer the industry’s largest clinical, research
and support networks.
That’s why more people choose Cochlear than any other hearing implant company.
