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Hearing Is the
Foundation of Listening—
and Listening Is the
Foundation of Learning
Douglas L. Beck and Carol Flexer
◆ Introduction
Known and Unknown: A Memoir is the title of a new book by Don- ald Rumsfeld (2011). Politics aside, the premise of the title is that there are things we know, there are things we don’t know but that we are aware of, and—digging deeper—there are important things that, frankly, we don’t know and we are not aware of. Rumsfeld refers to these three categories (respectively) as “known knowns,” “known unknowns” and “unknown unknowns.” In communication disorders (admittedly a universe somewhat distant from politics) these three categories are also of importance. For example, we know we are very likely accurate when we dis- cuss tympanograms, auditory brainstem response (ABR), acoustic reflexes, and otoacoustic emissions (OAEs). In Rumsfeld’s terms, these clear and objective measures of auditory phenomena, grounded more or less in indisputable facts, might be considered “known knowns.” Of course, there are things we don’t necessarily know with respect to each child or adult, yet we are aware of their importance. Such “known unknowns” might include ear canal resonance, outer and inner hair cell population integrity, possibly speech-in-noise ability, and perhaps how closely a specifi c hear- ing aid fi tting approximates the real-ear “target.” Taking the anal- ogy to completion within the communication disorders universe, “unknown unknowns” might include processing speed, auditory processing disorders, listening skills, working memory, and atten- tion—all of which signifi cantly impact the child’s listening ability and ultimately the child’s learning ability. The purpose of this chapter is to discuss the neurological and experiential basis of hearing, listening, and learning as impacted by acoustic accessibility in children and adults.
10 Handbook of Acoustic Accessibility
◆ Hearing and Listening
Audiologists generally measure hearing. Specifi cally, audiologists tend to measure “objective” and sensory-based percepts of pure tones, beeps, clicks, words, phonemes, and more. These test proto- cols effectively approximate human hearing acuity and help reveal the gross status of the peripheral auditory nervous system with respect to the stimuli used. However, and signifi cantly, these mea- sures do not reflect our formative ability to listen. Frankly, there is much more to listening than hearing. For hu- mans, the ability to listen is one of the many cognitive processes that separates us from all other animals, including those whose hearing is superior to that of humans. Indeed, “listening is where hearing meets brain” (Beck & Flexer, 2011). Beck and Flexer (2011) noted that dogs have much better hearing (perhaps 50 to 40, Hz) than humans (generally stated as 20 to 20,000 Hz). If cogni- tion and learning were actually based on hearing, dogs (and cats, dolphins, whales, and many other animals) would be way above humans on the food chain. They are not. Dogs hear better than we do, but they cannot actually listen. For example, some dogs work tirelessly for years and years to learn to obey the command “sit.” Their performance really is not about hearing; their performance is all about listening. (And don’t get us started on cats.) Specifi cally, although hearing is the means through which sound reaches the brain, listening is what separates people from all other beings. Humans with normal hearing and normal cognitive ability learn to listen. That is, humans apply meaning, context, concepts, ideas, thoughts, and more to spoken (and written) words to communi- cate and share ideas and concepts and to travel backward and for- ward across time and space. Our words and listening skills allow us to describe things beyond the here and now. We can describe things we have never seen, and we can even describe sounds we have never heard. The task of normally functioning ears and hearing systems is to transmit acoustic information to the brain. However, hearing is a sense and hearing is passive. Listening is a learned skill and lis- tening is active. At the moment speech sounds are perceived by the brain, listening occurs, and the skills of the listener are of sig- nifi cant importance. When hearing meets brain, “listening” occurs (Beck & Flexer, 2011); that is, we hear with our brains! Unfortu- nately (or perhaps fortunately), measuring the sensory capacity of a particular person to hear sounds (as represented on an audio- gram) is just a small fraction of what matters (i.e., listening). Active
12 Handbook of Acoustic Accessibility
Ashcraft and Klein (2011) recently stated that “attention is a process that involves a fi nite commodity.” Craik (2007) reported that outcomes with respect to hearing aid amplifi cation are gener- ally dependent on the allocation of attentional processes. Again, where you pay attention “is how you will do.”
◆ Working Memory
Working memory is more or less what we used to refer to as “short term memory... typically no longer than 30 seconds.” The term “short term memory” has been judged essentially inadequate with regard to defining its role in cognition and has been replaced (for more than a decade) with the term “working memory” (WM). WM allows us just enough time to rehearse the material or per- form some other mental operations on the material. Boudreau and Costanza-Smith (2011) note WM impacts a vast quantity of cognitive processes, including learning rate for new vocabulary, language comprehension, literacy skills, reasoning, and problem solving, as well as overall academic success. Further, they state that WM controls attention and information processing.
◆ Bottom-up and Top-down Systems
Many of these issues (and related ones) have been discussed in the audiology and hearing aid literature using the terms “bottom-up” (to represent sensory information transmitted from the peripheral auditory nervous system to the brain) and “top-down” (to repre- sent how the brain interprets the perceived acoustic information). Beck and Clark (2009) stated that when bottom-up and top-down systems function optimally, “precise and extraordinary meaning” is extracted from the “cacophony of sounds” in the acoustic en- vironment—and this occurs virtually without effort. They report humans are unique in their ability to “apply cognitive processes (knowledge, memory, attention, and intelligence) to sensory input, to communicate, to learn, and to share thoughts and ideas.” Madell (2009) reports that audiologic measures of physiological events (ABR, ASSR, OAEs) are highly correlated with hearing, but cautions that they are not direct measures of hearing and, further, that people (i.e., children) with hearing loss have damaged audi- tory systems. People with hearing loss cannot achieve maximal auditory competence without specifi c training and, of note, even
2 Hearing is the Foundation of Listening 13
with appropriate amplifi cation they need to learn to listen and to maximally use auditory information. Children taught to maximize their auditory skills develop signifi cantly better speech and lan- guage skills than those who do not undergo auditory habilitation and rehabilitation (Osmond, 2011).
◆ Aural Rehabilitation: Not Just for Kids
When listeners have been trained to maximally employ the bot- tom-up (sensory-based) stimuli available to them, extraordinary things have occurred. Gordon-Salant and Friedman (2011) reported a particularly il- lustrative example with regard to 10 older blind adults, 60 through 80 years of age, compared with two groups of 10 normally sighted younger (ages 18 through 30 years) and older (ages 60 through 80 years) adults. Using 40 to 60 percent time-compressed speech as a rather challenging listening task, the authors reported the blind adults recognized time-compressed speech better than their age- matched peers, and indeed, the blind adults performed similarly to the much younger, sighted adults. Of note, 8 of the 10 blind adult participants had trained themselves via time-compressed “books on tape” recordings to maximize their listening skills through mo- tivated, dedicated, and conscious practice. Specifi cally, hearing is a sense and listening is a skill—and skills can be taught to help com- pensate for sensory defi cits (i.e., blindness) and to help improve listening (“where you attend is how you will do”). Martin (2007) presented interesting observational data based on hundreds of patients fi tted with hearing aids. One hundred and seventy-three of her hearing aid patients were given a software- based aural rehabilitation (AR) program (Listening and Commu- nication Enhancement, LACE); 452 hearing aid patients were not given the software. In general, the LACE program requires a total time commitment of 10 hours over a 30-day period. Of the patients who underwent AR training, only 3.5 percent returned their hear- ing aids. Of those who had no AR training, 13.1 percent returned their hearing aids. Martin reports that statistical analysis revealed the only variable in the two groups was the AR training. One pos- sible interpretation of these data is that patients trained in listen- ing skills were better able to successfully employ hearing aids. Stacey and colleagues (2010) reported on the effectiveness of a computer-based, self-administered AR training program for adult users of cochlear implants (CIs). Despite each of the 11 adults hav-
2 Hearing is the Foundation of Listening 15
Implications for Children
Indeed, if the bottom-up signal is missing, distorted, or impover- ished (due to noisy classrooms, for example), the top-down sys- tem must work harder to make sense of the acoustic information (Allen et al., 2003). For children, fi lling in the blanks (a top-down process) is a remarkably difficult task because children require a very high signal-to-noise ratio to perform as well as adults with re- spect to acoustics. Further, and of enormous importance, children do not have advanced knowledge as to how conversations are likely to unfold, nor do they have the vocabulary required to “fill in the blanks.” In addition, their ability to predict conversational twists and turns is much less than that of a mature adult.
◆ Summary
Typical mainstream classrooms are auditory-verbal environments where instruction is presented through the teacher’s spoken com- munication. Children in a mainstream classroom, whether or not they have a hearing loss, must be able to hear, attend to, and listen to the teacher and each other in order for learning to occur. If the brains of children cannot consistently and clearly receive spoken instruction, the major premise of the educational system is under- mined. This is what “acoustic accessibility” is all about. Acoustic accessibility is critical because in environments re- lying on spoken language instruction, sounds have to reach the brain—the bottom-up feature—in order for learning to occur—the top-down feature. Therefore, we need to consider the environ- ment of the classroom to enable us to provide the brain access to spoken instruction. The following chapters in this text will discuss the details of speech perception, room acoustics, and the use and efficacy of classroom audio distribution systems (CADS) as ways of understanding and managing the classroom learning environment.
References
Akeroyd, M. A. (2008). Are individual differences in speech reception relat- ed to individual differences in cognitive ability? A survey of 20 experi- mental studies with normal and hearing impaired adults. International Journal of Audiology, 47 (Suppl. 2), S125–S143. Allen, N. H., Burns, A., Newton, V., Hickson, F., Ramsden, R., Rogers, J., et al. (2003, March). The effects of improving hearing in dementia. Age and Ageing, 32 (2), 189–193.
16 Handbook of Acoustic Accessibility
Ashcraft, M. A., & Klein, R. (2011). Attention. In D. J. Levitin (Ed.), Founda- tions of cognitive psychology: Core readings (2nd ed.). Boston, MA: Allyn and Bacon. Beck, D. L. (2010). Where you attend is how you will do. Paper presented at the California Academy of Audiology (CAA) annual meeting, October 2010, San Francisco, CA. Beck, D. L., & Clark, J. C. (2009, March/April). Audition matters more as cog- nition declines: Cognition matters more as audition declines. Audiology Today (American Academy of Audiology). Beck, D. L., & Flexer, C. (2011, February). Listening is where hearing meets brain... in children and adults. Hearing Review. http://www.hearingre- view.com/issues/articles/2011-02_02.asp Boudreau, D., & Costanza-Smith, A. (2011, April). Assessment and treat- ment of working memory deficits in school-age children: The role of the speech-language pathologist. Language, Speech, and Hearing Ser- vices in Schools, 42 (2), 152–166. Craik, F. I. M. (2007, July-August). The role of cognition in age-related hearing loss. Journal of the American Academy of Audiology, 18 (7), 539–547. Dehaene, S. (2009). Reading in the brain: The science and evolution of a hu- man invention. New York, NY: Penguin Group. Flexer, C. (2005). Rationale for the use of sound field systems in classrooms: The basis of teacher in-services. In C. C. Crandell, J. J. Smaldino, & C. Flexer (Eds.), Sound field amplification: Application to speech perception and classroom acoustics (2nd ed.). Thomson Delmar Learning. Gladwell, M. (2008). Outliers: The story of success. New York, NY: Little, Brown. Gordon-Salant, G., & Friedman, S. A. (2011, April). Recognition of rapid speech by blind and sighted older adults. Journal of Speech, Language and Hearing Research, 54, 622–631. Hart, B., & Risley, T. R. (1999). The social world of children learning to talk. Baltimore:, MD: Brookes. Hart, B., & Risley, T. R.(2003). The early catastrophe: The 30 million word gap by age. http://www.aft.org/newspubs/periodicals/ae/spring2003/ hart.cfm Kamhi, A. G. (2011, July). What speech-language pathologists need to know about auditory processing disorder. Language, Speech, and Hear- ing Services in Schools, 42 (3), 265–272. Levitin, D. J. (2006 ). This is your brain on music: The science of a human obsession. Plume Books. Lucker, J. (2007). History of auditory processing disorders in children. In D. Geffner & D. Ross-Swain (Eds.), Auditory processing disorders assess- ment, management and treatment. San Diego, CA: Plural Publishing. Madell, J. R. (2009, March/April). The challenges ahead in pediatric audiol- ogy. ENT and Audio News, 18 (1), 66–68. Martin, M. (2007, August). Software-based auditory training program found to reduce hearing aid return rate. Hearing Journal, 60 (8), 32–35.
