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This thesis investigated lexical representations of children who stutter (CWS) and children who do not stutter (CWNS) using a duration-blocked gating task. This thesis tested the hypothesis that children who stutter have underspecified phonological representations for words, are less sensitive to incremental and segmental information for lexical items, and therefore require more acoustic-phonetic information to activate words in their lexicon. Pilot data collected from fourteen children (ages 5;6 to 10;1): 7 CWS and 7 CWNS matched on age were included in this thesis. Results showed that children in both talker groups required relatively equal amounts of acoustic-phonetic information to identify target words. A regression model revealed that age in months predicted performance on the gating task for CWNS, but that age in months did not predict performance on the gating task for CWS suggesting a difference in the developmental maturity of lexical representations in CWS. Possible conclusions from these pilot data are presented along with recommendations for future research. / text

Tittle: Speech fluency and motor system relations as the outcome of physiotherapy in comprehensive stuttering treatment Objectives: The aim of this thesis is to summarize the accessible literary sources about functional and structural etiology of developmental dysfluency and its effects on motor system. The next aim of this paper is to research current position of physiotherapy in comprehensive stuttering therapy. Methods: The thesis used literature research method, the specific criteria for the selection of literary sources were stated. The first part contains theoretical ground regarding general issues of dysfluency. The second, descriptive and analytical part contains several chapters describing many studies dealing with functional and organ cause of stuttering, features of stutter motor system of stutterers and the current state of physiotherapy in the issue of stuttering. Results: The thesis points out the fundamental meaning of motor system, particularly motor planning in the ethiopathogenesis of stuttering. Certain variations in the structure and function of the CNS of stuttering people have been described. These deviations are specifically manifested on the motor system effectors. The research shows that physical therapy in the complex treatment of stuttering has no clearly defined role so...

INTRODUÇÃO: O presente estudo seguiu a premissa que o controle neuromotor da fala é influenciado por sinais externos em todos os falantes. Visando compreender melhor a interferência dos sinais externos da fala, antes e após o tratamento fonoaudiológico, o objetivo do estudo foi (1) comparar as diferentes tarefas de fala em indivíduos gagos e em indivíduos fluentes; (2) verificar se houve algum impacto na diferença entre as tarefas de fala no póstratamento; (3) comparar os resultados do pós-tratamento quantitativamente e qualitativamente. MÉTODO: Os participantes deste estudo foram 20 adultos, 10 com gagueira (8 do sexo masculino e 2 do sexo feminino - idade média de 30,5 anos) e 10 controles, pareados por gênero e idade com o grupo pesquisa. O estudo comparou a performance dos participantes em seis diferentes tarefas de fala no pré e no pós-tratamento. As tarefas de fala analisadas foram: monólogo, conversação, leitura individual, leitura em coro, fala automática e canto. Os resultados obtidos também foram comparados quanto à auto percepção da funcionalidade da fala, por meio do ASHA NOMS. RESULTADOS: Houve diferença significativa (p < 0,001) entre algumas tarefas de fala no grupo pesquisa e no grupo controle. As tarefas de fala indutoras de fluência - leitura em coro, fala automática e canto - aproximou o grupo pesquisa do grupo controle. No pós-tratamento a única tarefa que apresentou diferença significativa foi o monólogo. Não houve diferença significativa entre o ASHA NOMS no pré e no pós-tratamento para nenhum dos grupos estudados. CONCLUSÕES: Os resultados indicaram que o controle neuromotor da fala é influenciado por sinais externos em todos os falantes. Houve diferença nas tarefas de fala no pós-tratamento, principalmente no monologo. Não houve diferença nos dados do ASHA NOMS no pré e no pós-tratamento no grupo pesquisa e no grupo controle / INTRODUCTION: This study followed the premise that the neuromotor control of speech is influenced by external signals in all the speakers. To better understand the interference of external signals in speech before and after speech therapy, the aim of this study was (1) to compare the different speech tasks in stutterers and fluent individuals; (2) to verify if there is any impact on the different speech tasks in the post-treatment; (3) to compare the results of post-treatment quantitatively and qualitatively. METHODS: Participants were 20 adults, 10 with stuttering (8 male and 2 female - mean age 30.5 years) and 10 controls matched for age and gender with the research group. The study compared the performance of the participants in six different speech tasks in the pre and post treatment. The speech tasks that were analyzed was: monologue, conversation, individual reading, chorus reading, automatic speech and singing. The results were also compared for self-awareness functionality of speech through the ASHA NOMS. RESULTS: There was a significant difference (p < 0.001) among some speech tasks in the research group and the control group. The speech tasks that induced fluency were chorus reading, automatic speech and singing, and approached the research group to the control group. In the post treatment the only task that presented significant difference was the monologue. There was no significant difference between the ASHA NOMS in the pre and post treatment for any of the groups. CONCLUSIONS: The results indicated that the neuromotor control of speech is influenced by external signals in all the speakers. There were differences in speech tasks in the post treatment, especially in the monologue. There was no difference in ASHA NOMS data in the pre- and post-treatment in the study group and the control group

Made available in DSpace on 2016-04-27T18:11:53Z (GMT). No. of bitstreams: 1 Audrey Vendramini de Carvalho.pdf: 3298911 bytes, checksum: 729d595701605b0f4740c710ddcc9680 (MD5) Previous issue date: 2011-12-14 / Introduction: Studies about the characteristics of the scientific production of a field of knowledge are important because they provide an overview of the past and present trends within a determined area of knowledge and thus highlight the boundaries that remain to be crossed as a guideline for future research. Aims: Our aim was to analyze the international scientific literature relating to stuttering published between 2005 and 2010 in order to identify current trends in reporting progress towards understanding and management of this complex speech disorder. Method: Our approach involved the selection and analysis of online, peer reviewed publications. We examined the publication frequency over yearly intervals and organized the data to highlight the following characteristics: publication period; number of publications per period; the theme addressed; the methodological procedure used, the epistemological affiliation of contributor(s), and the age range of the subjects studied. Results: A total of 339 articles from 76 international journals were analyzed. Prior to 2005 the average number of publications per year was 49(14,3%). However, we identified a total of 72(21,22%) publications in 2010. The Journal of Fluency Disorders, which is specialized in stuttering, was the most frequent contributor (94; 27,73%) in the studied interval. Next, was the Journal of Speech Language and Hearing Research (42; 12,39%), followed by the International Journal of Language and Communication Disorders (29;8,55%). Two themes stood out: Characteristics of Stuttering, with 150(44,25%) articles, and Treatment of Stuttering, with 106(31,27%) articles. The research method most used was Survey (157;46,31%), followed by Experiment (118;34,8%). The majority of research featured the Positivist (324;95,57%) paradigm. The age group most studied was adult (174;45,31%), followed by children (120;31,25%).Conclusion: The analysis of the international scientific production about stuttering presented a discreet growth which, from an epistemological perspective, is predominantly within the positivistic science paradigm. Due to the presence of a lesser number of studies in the phenomenological and historical dialectic features; the fact that the positivistic feature starts to present studies that actually quantify qualitative data perceiving stuttering as a multifactorial phenomenon; the fact that the same aspects were treated either as characteristic or as cause of stuttering; we conclude that stuttering is a complex theme which represents a challenge to researchers, pointing the need of searching through new epistemological paradigms in order to unveil it. Our findings suggested there is need for more research on stuttering for preventive health and wellness promotion, as well as to use the clinical case study as method of investigation, and also to focus on adolescents. These aspects may direct decisions about further research on stuttering / Introdução: Os estudos sobre as características da produção científica de uma área são importantes porque fornecem uma visão geral das tendências passadas e atuais do que se tem estudado em determinado campo do conhecimento e destacam assim as fronteiras a serem cruzadas como diretriz para a pesquisa futura. Objetivos: Levantar e caracterizar a literatura científica internacional sobre gagueira produzida entre 2005 e 2010. Método: Trata-se de pesquisa de caráter documental em que se analisaram artigos online, considerando-se os seguintes aspectos: 1- distribuição da freqüência por período; 2) temáticas abordadas; 3) vertente epistemológica; 4) procedimento metodológico utilizado; 5) faixa etária dos sujeitos estudados. Resultados: A produção científica sobre gagueira no período considerado perfez um total de 339 artigos distribuídos em 76 revistas. O Journal of Fluency Disorders apresentou maior número de publicações (94;27,73%); seguido do Journal of Speech Language and Hearing Research (42; 12,39%). As temáticas mais freqüentes foram: Características da Gagueira (150;44,25%) e Tratamento da Gagueira (106;31,27%). O método de pesquisa mais utilizado foi o Levantamento (157;46,31%), seguido pelo Experimento (118;34,8%). A maioria das pesquisas pertenceu à vertente epistemológica positivista (324;95,57%). As faixas etárias mais estudadas foram adultos (174;45,31%) e crianças (120;31,25%). Conclusão: O levantamento e a caracterização da produção científica internacional sobre gagueira mostraram que ela está em discreto crescimento, o qual, do ponto de vista epistemológico, está preponderantemente dentro do paradigma positivista. O fato de a produção apresentar, embora discretamente, pesquisas nas vertentes fenomenológica e dialético-histórica; o fato de a vertente positivista começar a apresentar pesquisas que quantificam dados qualitativos para olhar a gagueira como fenômeno multifatorial; o fato de termos encontrado os mesmos aspectos tratados ora como característica, ora como causa da gagueira; apontam: para a complexidade do tema; para o desafio que a compreensão da gagueira tem representado para os pesquisadores; para a necessidade de buscar novos caminhos epistemológicos para decifrá-la. As temáticas encontradas indicaram a falta de pesquisas sobre prevenção e promoção de saúde. Os procedimentos encontrados indicaram falta de pesquisas com delineamento de estudo de caso clínico. As faixas etárias estudadas indicaram a falta de pesquisas sobre adolescentes. Estes aspectos podem nortear as decisões sobre futuras pesquisas a respeito da gagueira

Producing speech is a highly complex task, involving the integration of sensory and linguistic information, with the precise, high-speed, co-ordination of muscles controlling breathing and the movement of the vocal folds and articulators. In spite of this complexity, producing fluent speech - moving smoothly from one speech sound to the next - can appear effortless. Speech fluency is highly socially valued, and the personal and societal costs of living with a disorder of fluency, such as developmental stuttering, are considerable. The outcomes of behavioural therapies to increase fluency are limited, however, especially for those seeking treatment in adulthood. The overarching aim of this thesis was to investigate how anodal transcranial direct current stimulation (A-TDCS) can be used to increase speech fluency, with a particular focus on the potential application to developmental stuttering. A-TDCS is a noninvasive brain stimulation technique that can enhance the effects of motor, speech, and language training. First, in a series of single-session experiments in typically fluent speakers, I demonstrated that applying A-TDCS over the left IFC increased speech motor learning relative to a sham control, but did not improve consolidation of this learning (chapter 2). Furthermore, I found that neither increasing stimulation intensity from 1 mA to 2 mA, nor changing from a unihemispheric to a bihemispheric configuration, had an additional effect on learning. Next, in single-session study with adults who stutter, I assessed the feasibility of using A-TDCS to improve fluency (chapter 3). Fluency was temporarily induced, by speaking in unison with another person, but the concurrent application of 1-mA unihemispheric A-TDCS over left inferior frontal cortex did not significantly prolong this fluency. Nevertheless, a trend towards stuttering reduction gave some indication that fluency might be increased using a multiple-session approach. Furthermore, I gained a number of important insights from these single-session studies, which I used to inform the design of the final multiple-session trial. In this final study, I completed a randomised controlled trial in 30 adult males with moderate to severe stuttering. Participants were randomized to receive either 1-mA A-TDCS or sham stimulation over left inferior frontal cortex combined with temporary fluency inducing behavioural techniques, for 20 minutes a day over 5 days (chapter 4). A-TDCS significantly reduced disfluency for at least 5 weeks following this intervention. The effect was specific to the speech impairment of development stuttering, as measures of the psycho-social consequences of stuttering were not modulated by A-TDCS. The findings of these studies offer significant promise for the future application of non-invasive stimulation as an adjunctive therapy for adults who stutter. In the concluding chapter, I discuss the important implications of my findings for the future use of this technique.

INTRODUÇÃO: Visando compreender quais são os possíveis efeitos do uso de dispositivos de alteração de feedback auditivo (AFA) sobre a fala, principalmente no que diz respeito às habilidades neuromotoras e à naturalidade de fala, o objetivo deste estudo foi verificar, por meio da análise acústica, as possíveis variações nas habilidades motoras da fala em adultos com gagueira e fluentes com o uso do SpeechEasy. MÉTODOS: Os participantes deste estudo foram 20 adultos, 10 com gagueira (9 do sexo masculino e 1 do sexo feminino - idade média de 30,9 anos) e 10 controles fluentes (9 do sexo masculino e 1 do sexo feminino - idade média de 25,2 anos). O estudo comparou o desempenho dos participantes em quatro tarefas: fala espontânea, diadococinesia alternada, diadococinesia sequencial e emissão de frase alvo, em duas situações distintas: uma sem o dispositivo e uma com o dispositivo. Os aspectos analisados acusticamente foram: (1) para as tarefas de diadococinesia: duração das sílabas, período médio entre as sílabas, pico de intensidade e taxa de diadococinesia, (2) para a tarefa de emissão da frase alvo: tempo de reação, duração do VOT, duração total da emissão, frequência fundamental e intensidade, em cada uma das condições de teste. RESULTADOS: Com relação à comparação entre grupos, apenas a tarefa de fala espontânea apresentou diferença significativa (p < 0,001). Com relação à comparação intragrupo do desempenho entre as duas condições de teste, novamente foram observadas diferenças significativas somente na tarefa de fala espontânea. Nesta tarefa, o uso do dispositivo de AFA resultou em melhora significativa da fluência de fala, medida pela porcentagem de sílabas gaguejadas (p=0,014), para o grupo com gagueira. Por outro lado, para o grupo de fluentes, o dispositivo produziu o efeito oposto (ou seja, aumento significativo - p=0,046 - na frequência de rupturas gagas com o uso do dispositivo). A análise estatística dos aspectos acústicos das tarefas de diadococinesia e emissão da frase alvo não indicou diferença significativa nas comparações intra e intergrupos. CONCLUSÕES: Os resultados indicaram que, para o grupo de adultos com gagueira, o uso de dispositivo SpeechEasy ocasionou em melhora na fluência, sem interferir na naturalidade de fala / INTRODUCTION: In order to understand the possible effects of the use of altered auditory feedback (AAF) devices on speech, especially with regard to neuromotor skills and speech naturalness, the purpose of this study was to use acoustic analysis to investigate possible changes on speech motor skills with the use of SpeechEasy, in adults who stutter and fluents. METHODS: Participants for this study were 20 adults, 10 with stuttering (9 males and 1 female - mean age 30.9 years) and 10 fluent controls (9 males and 1 female - mean age 25.2 years). The study compared the performance of participants in four tasks: spontaneous speech, alternate motion diadochokinesis, sequential motion diadochokinesis and utterance of a target sentence, in two different situations: one without and one with the device. The aspects acoustically analyzed were: (1) for diadochokinesis tasks: syllable duration, syllable periods, peak intensity and diadochokinesis rate, (2) for target sentence task: reaction time, VOT duration, total duration, fundamental frequency and intensity, in each of the tested conditions. RESULTS: Between group comparisons indicated significant differences only when considering the spontaneous speech testing condition (p < 0.001). For the group of stutterers, within group comparisons (i.e. without versus with device) also indicated significant differences only for the spontaneous speech task. In this task, the use of AAF device resulted in a significant improvement of speech fluency, as measured by the percentage of stuttered syllables (p=0.014). On the other hand, for the control group, the device produced the opposite effect (i.e. a significant increase in the percentage of stuttered syllables - p=0.046). Statistical analysis of the acoustic aspects of both diadochokinesis and the target sentence indicated no significant difference for between and within group comparisions. CONCLUSIONS: Our results indicated that for the group of stutterers the use of SpeechEasy device caused an improvement in speech fluency without interfering in speech naturalness

Background: Fluent speakers and people who stutter manifest alterations in autonomic and emotional responses as they view stuttered relative to fluent speech samples. These reactions are indicative of an aroused autonomic state and are hypothesized to be triggered by the abrupt breakdown in fluency exemplified in stuttered speech. Furthermore, these reactions are assumed to be the basis for the stereotypes held by different communicative partners towards people who stutter. Aims: To examine the autonomic and emotional reactions of graduate student clinicians in speech–language pathology as they viewed fluent and severe stuttered speech samples. Methods & Procedures: Twenty-one female graduate student clinicians in speech–language pathology participated in this study. Each participant viewed four 30-s video samples (two fluent and two stuttered speech samples) while their autonomic responses (skin conductance response (SCR) and heart rate (HR)) were concurrently captured. Furthermore, emotional responses to stuttered and fluent speech samples were captured using the self-assessment manikin (SAM) and a rating scale with nine bipolar adjectives reflecting one's feelings. Outcomes & Results: An increase in SCR and deceleration in HR was observed as graduate clinicians viewed stuttered speech samples versus fluent speech samples and the differences were statistically significant. In addition, results from the self-rating scales showed that participants had negative feelings (e.g., emotionally aroused, unpleasant, embarrassed, uncomfortable, etc.) while viewing stuttered speech. Conclusions & Implications: Findings suggest that graduate student clinicians in speech–language pathology demonstrated altered autonomic and emotional responses similar to those manifested by fluent and stuttered speakers as they viewed stuttered speech samples. Collectively, these findings support the contention that the inherent nature of stuttered speech triggers a visceral reaction in a listener, irrespective of their background and knowledge about the disorder.

I föreliggande studie undersöktes samtal där tre personer som stammar deltog i interaktioner med olika deltagarstrukturer; med en annan person som stammar, med en närstående person samt med en person i en institutionell kontext. Studien syftade till att analysera likheter och skillnader mellan samtal med olika deltagarstrukturer, med avseende på fenomenen samkonstruktion, blickkontakt vid samkonstruktion och uppbackning. Sammanlagt medverkade tolv personer, i totalt nio dyader. De nio samtalen, som var mellan 35 och 55 minuter långa, spelades in och analyserades enligt principer från Conversation Analysis (CA). Även beräkningar utfördes på fenomenen verbala uppbackningar, samkonstruktion och blickkontakt vid samkonstruktion. Av resultatet framkommer att det genomförs färre samkonstruktioner i de institutionella samtalen, och en tendens till att det görs fler samkonstruktioner i närståendesamtalen. Personerna som stammar gör färre samkonstruktioner i de institutionella samtalen, och gör flest samkonstruktioner i samtalen mellan två personer som stammar. Närståendesamtalen är den deltagarstruktur där det förekommer lägst antal stamningsrelaterade samkonstruktioner. Vid samkonstruktion har deltagarna vanligtvis blickkontakt. Genomgående gäller att samtalspartnern gör fler verbala uppbackningar än personerna som stammar. Det förekommer fler verbala uppbackningar i de samtal där samtalspartnerna inte känner varandra, än i de samtal då de känner varandra. Det är relativt ovanligt att verbal uppbackning förekommer i samband med stamning. / In the present study recordings of three people who stutter in interaction with different interlocutors were analysed. The participant frameworks were the person who stutters with another person who stutters, with a close friend and with an unknown person in an institutional context. The aim of the present study was to analyse similarities and differences among the interactions with different participant frameworks, regarding acknowledgement tokens, joint productions and eye contact in joint productions. In all, there were twelve participants taking part in nine dyads. The nine interactions were between 35 and 55 minutes long, and analysed according to the principles of Conversation Analysis (CA). Calculations were performed on the phenomena verbal acknowledgement tokens, joint productions and eye contact in joint productions. The result shows that there are fewer cases of joint productions in the institutional conversations and that there is a tendency that joint productions are most frequent in the conversations with a close friend. The people who stutter perform fewer joint productions in the institutional conversations and the most joint productions in the conversations between two people who stutter. The conversation with a close friend is the type of conversation with the lowest prevalence of joint productions related to stuttering. The participants mainly have eye contact when participating in joint productions. A consistent feature in all conversations is that the conversational partner produces more verbal acknowledgement tokens than the people who stutter. There are more verbal acknowledgement tokens in the conversations where the interlocutors are not acquainted. It is rather uncommon that verbal acknowledgement tokens appear in instances of stuttering.

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No. of bitstreams: 1 cerqueira_av_me_mar.pdf: 1327513 bytes, checksum: 97b978fcab23f3500bec70de9e145775 (MD5) Previous issue date: 2018-05-25 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A gagueira é um transtorno multifatorial e com manifestações que não são comuns a todos os gagos sendo assim a caracterização das habilidades auditivas desta população pode ser um importante instrumento para o processo diagnóstico e terapêutico deste distúrbio. Diante disso, o objetivo geral deste estudo foi caracterizar o desempenho dos indivíduos com gagueira nos testes que avaliaram as habilidades auditivas. Trata-se de um estudo transversal, prospectivo e comparativo realizado no segundo semestre de 2017. A amostra foi então constituída por 31 indivíduos com gagueira, de ambos os sexos, com idade entre 7 e 26 anos. Todos os participantes realizaram os seguintes procedimentos: questionário de triagem do comportamento auditivo (Scale of Auditory Behaviors- SAB), avaliação audiológica básica e comportamental do processamento auditivo central (teste dicótico de dígitos, teste de padrão de frequência, teste de padrão de duração, Randon Gap Detection Test- RGDT e Masking Level Difference- MLD). O desempenho dos indivíduos nos testes foi analisado de forma descritiva e inferencial. Na análise inferencial aplicou-se o teste ANOVA de Friedman e Coeficiente de Correlação de postos de Kendall, para comparar e relacionar as variáveis comportamento auditivo e o desempenho nos testes que avaliaram as habilidades auditivas e, a gravidade da gagueira com as variáveis comportamento auditivo e desempenho nos testes que avaliaram as habilidades auditivas. Adotou-se o nível de significância de 5% (0,050). Os resultados mostraram que a maior parte dos indivíduos apresentaram alteração nas habilidades de ordenação temporal (51,61% no Teste de Padrão de Frequência e 35,48% no Teste de Padrão de Duração) e de resolução temporal (29, 03% no RGDT). A comparação entre as variáveis escore final do SAB e desempenho nos testes que avaliaram as habilidades auditivas e, gravidade da gagueira, comportamento auditivo e desempenho nos testes que avaliaram as habilidades auditivas mostrou diferença significante, respectivamente, p= 0,00001 e p= 0,00000. Ao relacionar a variável comportamento auditivo e o perfil do desempenho nos testes que avaliaram as habilidades auditivas identificou-se uma correlação positiva fraca (r = 0,1587) e; a gravidade da gagueira com as variáveis comportamento auditivo e desempenho nos testes que avaliaram as habilidades auditivas, constatou-se uma correlação positiva moderada (r = 0,4391). Pode-se concluir que a maioria dos indivíduos desta população apresentou alteração nas habilidades auditivas, principalmente relacionada aos aspectos temporais da audição. / Stuttering is a multifactorial disorder with manifestations that are not common to all stutterers and thus the characterization of auditory abilities of this population can be an important instrument for the diagnostic and therapeutic process of this disorder. Therefore, the general objective of this study was to characterize the performance of individuals who stutters in tests that evaluated the auditory abilities. This is a cross-sectional, prospective and comparative study carried out in the second semester of 2017. The sample consisted of 31 stuttering individuals of both genders, aged between 7 and 26 years. All participants performed the following procedures: Scale of Auditory Behaviors- SAB, basic auditory evaluation and behavioral assessment of central auditory processing (Dichotic Digit Test, Frequency Pattern Test, Duration Pattern Test, Random Gap Detection Test- RGDT and Masking Level Difference- MLD). The performance of the individuals in these tests was analyzed in a descriptive and inferential way. In the inferential analysis Friedman's ANOVA and Kendall's Correlation Coefficient were used to compare and correlate the variables auditory behaviors and performance in the tests that assessed the auditory abilities and, the severity of the stuttering with the variables auditory behaviors and performance in tests that assessed auditory abilities. The level of significance was set at 5% (0.050). The results showed that the majority of the individuals presented alterations in temporal ordering (51.61% in Frequency Pattern Test and 35.48% in Duration Pattern Test) and temporal resolution abilities (29.03% in the RGDT). The comparison between the variables auditory behaviors and performance in the tests that assessed the auditory abilities and severity of the stuttering, auditory behaviors and performance in the tests that assessed auditory abilities showed significant difference, respectively, p = 0.00001 and p = 0.00000. A weak positive correlation (r = 0.1587) was identified by correlating the variable auditory behaviors and performance in the tests that assessed auditory abilities; and a moderate positive correlation (r = 0.4391) was observed between the severity of stuttering and the variables auditory behaviors and performance in tests that assessed auditory abilities. It can be concluded that the majority of the individuals in this population presented alteration in auditory abilities, mainly related to the temporal aspects of hearing.