Communication Assessment
Chapter 3
Perry C. Hanavan, Au.D.
Goals of Initial Assessment
Determine communication demands in
everyday life
Evaluate impact of hearing loss
Identify settings where problems arise
Document social activities in which
person engages
Assess effective use of communication
strategies
Chronicle employment responsibilities
Conversational Fluency
Definition:
– how smoothly conversation unfolds
Conversational Fluency Factors
Time spent repairing communication
breakdowns
– if need for clarification is low, then
fluency is high
Exchange of information and ideas
– is conversation easily and successfully
share information, then fluency is high
Speaking time shared
– equal time, few silences, few
interruptions, then fluency is high
Index of Sharing Speaking Time
Conversational turn:
– period participant delivers a
contribution to a conversation
Mean length (speaking) turn (MLT)
– average number of words spoken
during a set number of conversational
turns
Mean length turn ratio (MLT ratio)
– ratio of two speakers in a conversation
Example 1: Conversational Fluency
Teacher: Is Sarah studying at home, much?
Parent: Yes, and I’m thrilled with her.
Teacher: You said several weeks ago she only
watched TV and used her PlayStation after school.
Parent: Yes, but we have been following your
suggestions of turning off the TV.
Teacher MLT = 10.5 words (21 words/2 utterances)
Parent MLT = 9.5 words (19 words/2 utterances)
MLT ratio: 1.1 (1.0 = equal length of speaking time)
Example 2: Conversational Fluency
Sue: Has your new furniture arrived yet?
Tom: Huh?
Sue: Your new furniture!
Tom: Yup. (looks around and shakes head)
Sue: How are you doing? How is your wife? Mary?
Tom: Fine.
Sue’s MLT=6 words (18 words/3 utterances)
Tom’s MLT=1.0 words ( 3 words/3 utterances)
MLT ratio: 6.0 (1.0=equal length speaking time)
Traditional Audiologic vs
Conversational Fluency Measures
Most audiologic test lists present unrelated
speech stimuli (spondees, PB words, etc.)
Clients usually must repeat what they hear
verbatim (Say the word _____)
No interaction with communication
partners
Problems Measuring
Conversational Fluency
Varies with the conversational setting,
situation, and communication partner
Varies with the topic of discussion
Communication breakdowns may not arise
in the clinical setting
No one evaluation adequately measures
conversational fluency
Assessment Procedures
Interview
Questionnaire
Daily Log
Group Discussion
Structured Communication Interaction
Unstructured Communication Interaction
Interviews
The client provides subjective
impressions of conversational fluency
in various settings
Advantages
– client specific information
Disadvantages
– difficult to quantify information
Example interview
Questionnaire
 Questions that probe
subjective information about
conversational fluency
 Advantages
– quick, easy to administer
 Disadvantages
– may miss client-specific
information
Questionnaire/Inventory/Survey
Adults
 HHI-S / HHI-A Questionnaire
 SAC / SOAC Questionnaire
 GHABP
 SSQ
 APHAB
 IOI-HA
 ECHO
 SADL
K-12 students
 Listening Inventories For Educators
(L.I.F.E.)
 Children’s Auditory Performance
Scale (CHAPS)
 SIFTER
 CHILD
 ELF
Go to
www.hear2learn.com
for additional surveys

There are a variety of outcome measures used by audiologists. An outcome measure may be address one or more outcome
domains: impairment, activity, participation, satisfaction, and health-related quality of life. Some outcome measures such as pure
tone thresholds, insertion gain, and audibility index (AI) are used every day and provide objective evidence of patient status.
These are outcome measures in the impairment domain.
Speech recognition scores (W-22, NU-6, SPIN, HINT, etc.), the Abbreviated Profile of Hearing Aid Benefit (APHAB; Cox and
Alexander, 1995), Client Oriented Scale of Improvement (COSI; Dillon et al. 1997), and the Glasgow Hearing Aid Benefit
Profile (Gatehouse, 1999) are examples of outcome measures in the activity domain. The APHAB, for example, asks the patient
to rate the frequency he/she has problems in a specific situation: 'I have difficulty hearing a conversation when I’m with one of
my family at home.'
The Hearing Handicap Inventory for the Elderly (HHIE; Ventry and Weinstein, 1982), the Hearing Handicap Inventory for
Adults (HHIA; Newman et al. 1991), the Abbreviated Profile of Hearing Aid Benefit (APHAB; Cox and Alexander, 1995), the
Client Oriented Scale of Improvement (COSI; Dillon et al. 1997), and the Glasgow Hearing Aid Benefit Profile (Gatehouse,
1999) are outcome measures in the participation domain. For example, the HHIE asks the question 'Does a hearing problem
cause you to avoid groups of people?'
The Satisfaction with Amplification in Daily Life (SADL) and the ASHA Consumer Satisfaction Measure are examples of
outcome measures in the satisfaction domain. For example, the SADL asks the question 'Does wearing your hearing aid(s)
improve your self-confidence?'
The HHIE, the Communication Profile for the Hearing Impaired (CPHI; Demorest and Erdman, 1986), the Sickness Impact
Profile (SIP; Bergner et al. 1981), the MOS-36 Short Form Health Survey (Ware and Sherbourne, 1992), and the Health Utilities
Index (HUI; Feeney et al. 1995) are examples of outcomes measures in the health-related quality of life domain. For example, the
SF-36 asks the question 'Compared to a year ago, how would you rate your health in general now?'
There are also a number of outcome measures that address the economic aspects of clinical treatment choices. Cost analysis
simply measures the cost of treatment (e.g. labor, equipment, supplies, space, utilities, depreciation, overhead). It does not
measure 'benefit'. Cost-benefit analysis compares dollars spent against dollars gained or saved by a treatment option. Dollar
values are assigned to both the cost of treatment (cost analysis) and the costs saved, or avoided, by the treatment. For example,
improved quality of life, reduced family strife, and improved employability are economic benefits to the patient. Willingness to
pay analysis is a special category of cost-benefit analysis. Willingness to pay analysis obtains data on the amount individuals are
willing to pay for treatment (with or without benefit). Cost effectiveness measures the cost per unit of outcome. For example, how
much it cost for each percent change on the APHAB? Cost-utility analysis relates cost to changes in quality of life. One costutility measure is the cost per quality-adjusted life year. This measure compares cost against benefit calculated over a patient’s
life expectancy.
Daily Log/Diary
Self-reports of behavior used by
respondents for self-monitoring
Advantages
– quantitative information
Disadvantages
– can be a reactive process
Example daily diary
Group Discussion
A forum for members to discuss
communication issues
Advantages
– introspection and reflection
Disadvantages
– reluctance to participate
Examples: Active Communication
Education
– discussion topics
Structured Communication
Interaction
Simulated communication
interactions
Advantage
– good face validity
Disadvantage
– can be time consuming to
score
Structured Communication
Interaction
TOPICON
 Each participant independently examinees a list of topics and
indicates topics of personal interest or familiarity
 One participant selects a topic for conversation from the list–
reflecting personal interest, that of the other participant, or both
 The client and the partner conduct a brief conversation on the chosen
topic--2 to 5 minutes while the clinician evaluates the conversation
(example)
– Background noise, visual distractions, and/or speech and language
difficulties may be introduced during the conversation, while the
clinician monitors and assesses events
 The participants and the clinician discuss the content and fluency of
the conversation, considering avoidance or resolution of difficulties.
– (Erber, 1996)
Structured Communication
Interaction
Quest?AR
 Conversation-based communication
therapy procedure that provides interactive
practice with common question-answer
sequences.
 The client asks a series of questions and
learns to anticipate and accurately receive
spoken messages
 Provides person with hearing loss
confidence in asking response-limiting
questions
ASQUE (yes/no; choice; wh questions, etc.)
– (in Erber, 1996)
Unstructured Communication
Interaction
 Spontaneous interaction with few external
constraints
 Free flowing conversation between patient
and communication partner
 Advantage
– good ecological validity—mimics real-world
interaction
 Disadvantage
– results may vary as a function of the
communication partner
– Example: Dyalog, ratings, transcription
analysis
Unstructured Communication
Interaction
 DYALOG
 Software with computer to objectively measure the
fluency of conversation before, during, and after
communication therapy
 Observe the client in conversation (live or
videotaped). Press the "space bar" on the computer
keyboard whenever misunderstanding occurs during
conversation and "repair" (e.g., repetition, clarification)
is needed. Release the space bar when fluent
conversation is restored. At the end of the conversation
(or after a pre-selected interval), the computer will draw
a graph of conversational fluency as a function of time,
and also will display:
– amount of conversation time (sec) that contained
breakdown/repair percent of conversation time that
contained breakdown/repair number of
breakdown/repair events average time (sec) per
breakdown/repair
Unstructured Communication
Interaction
Ratings of conversations
Transcription analysis of
conversations