Question

Your 62-year-old client in the audiometric sound-treated booth is non-verbal due to cerebrovascular accident (CVA, aka stroke). The speech-language pathologist in your speech and hearing department has indicated in his report that the client's CVA resulted in expressive aphasia (cannot verbalize aloud), but receptive abilities are intact (so the client understands what is asked of her). The client’s case history also has notations from the physical therapist and occupational therapist that fine-motor skills were affected by the CVA, but gross-motor skills are largely intact. There is suspicion of undiagnosed hearing impairment that was present prior to the CVA.

1.) In your response to this, please provide specific examples of how you, as an audiologist, could adjust the audiometric testing procedure to obtain the audiometric results you need. You may use peer-reviewed sources (e.g., professional journals) to answer the question.

2.) How might the client respond to the pure-tone stimuli being presented during air-conduction testing? (Hint: Think of the different responses a client can use to indicate that the stimulus was heard.)

Answer 1

Audiometric testing in a stroke patient with aphasia requires pure tone audiometry, speech recognition threshold, word recognition score, and immitance measures (tympanometry and contra-lateral acoustic reflex) along with a standardised questionnaire where the patient is allowed to choose his responses from a visual scale format and picture album.

Different responses from the client to the pure tone stimuli:

As the client is aphasic and fine motor skills are affected the response can be noticed by instructing the client to raise his hands depends on the ear where he receives stimuli for example if he receives stimuli in left ear raise left hand and vice versa.