development and standardization of staggered spondaic word...

Asia Pacific Journal of Research

ISSN (Print) : 2320-5504

ISSN (Online) : 2347-4793

www.apjor.com Vol: I. Issue XLI, July 2016

162

DEVELOPMENT AND STANDARDIZATION OF STAGGERED SPONDAIC

WORD (SSW) LIST IN BANGLA

SAYANI BARI1 & MR INDRANIL CHATTERJEE

2*

1 Audiologist and Speech Language Pathologist, ICMR Project, Dept. Of ENT, North Eastern Indira Gandhi

Regional Institute of Health and Medical Science, Mawdiangdiang, Shillong, Meghalaya-793018

2 Lecturer, Ali Yavar Jung National Institute for the Hearing Handicapped, Eastern Regional Center, B.T. Road,

NIOH Campus, Bonhooghly, Kolkata-700090.

*Corresponding Author

ABSTRACT

Staggered Spondaic (bisyllabic equal stress) Word (SSW) is a dichotic test. The Dichotic listening tests is a behavioural test

battery to assess the hemispheric function, inter-hemispheric transfer of information, and development and maturation of auditory

nervous system. Staggered Spondaic Word (SSW) is more sensitive for brainstem and cortical lesion. The current investigation

was aimed to develop and standardize staggered spondaic word (SSW) list in Bangla for assessing the central auditory processing

of native Bengali listener. In this regard 200 sets of Bangla bisyllabic words were collected where each set contained a pair of

spondee words: first syllable of first spondee word and last syllable of second spondee word made another spondee word. Based

upon this concept sets of the staggered spondee words were fixed. Then familiar staggered spondaic word sets had been selected

and stress pattern was judged. From where finally 40 sets bisyllabic equal stress words were selected. The final SSW list was

recorded in a sound recording studio by an adult female standard native Bengali speaker. Each word was fitted into a separate

track and then track had been overlapped and stimulus had been modified. The developed test stimulus was standardized on 30

male and 30 female normal native Bengali listeners (18-40 years). Error scores and pattern of error had been analyzed. These

were not significantly present on normal (P> 0.05).There was no significant gender effect and laterality effect on SSW test

(P>0.05) on SSW test performance scores. Test- Retest reliability was obtained. The Pearson moment correlation coefficient

showed there was a strongly positive correlation between test and retest trial. The standardized test was validated on six age

matched native Bengali language learning disability (LLD) patients. There was a significant difference between performance on

normal listeners and LLD listeners (P<0.05).

Key Words: Staggered, Spondee, Dichotic, Hemisphere, Brainstem, Cortex, Language learning disability.

INTRODUCTION

Auditory processing stated simply is “what we do with what we hear”33

. It is the abstraction of meaning from an acoustic

signal and the retrieval of that meaning12

. According to American Speech-Language and Hearing Association (ASHA) census in

the year 19962, an auditory processing disorder (APD) was defined as an observed deficiency in one or more of the following

behaviours: i) Sound localization and lateralisation ii) Auditory Discrimination iii) Auditory pattern recognition iv) Temporal


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aspects of Auditions, including temporal resolution, masking, integration and temporal ordering v) Auditory performance with

competing acoustic signals vi) Auditory performance with degraded acoustic signals. An APD was defined more broadly a deficits

in information processing specific to the auditory modality. It may be associated with difficulties in listening, speech

understanding, language development and learning58

. Therefore it is conceptualized purely as a deficit in processing of auditory

input29. APD‟s are primarily based on deficits in hierarchical processing of acoustic signal in the afferent nervous system and the

evoked nerve pulses, and neural activities53

. Adults with an APD complain difficulties in speech understanding especially in

adverse listening conditions for instance in a room with background noise61

. Other symptoms are explained like difficulties in

following oral instruction, difficulties with rapid/ degraded speech and with auditory closure, inattention and distractibility5.

Auditory Processing Disorder or APD has been erroneously confused with other disorders such as dyslexia, learning

disabilities, and attention deficit disorders. Fortunately, recent developments show a growing awareness of the disorder on the part

of professionals, parents, educators, and the general public. Numerous sites have emerged on the internet with reference to CAPD.

Clinical programs, addressing auditory processing and its disorders are being developed, focusing on interdisciplinary

collaboration between speech-language pathologists, neuroscientists, neuropsychologists, and professionals and scientists in

countless other disciplines. They are united in their quest to define, understand, diagnose, and treat auditory processing disorders6.

Investigators have attempted to document the heterogeneous nature of APDs by sub-grouping APD or describing the

characteristics in terms of commonalities7, 33, 48

. Although this may be beneficial in management, no sub-grouping system or

model is universally accepted.

The Buffalo Model37

focuses on the relationship between patterns of performance on one particular test of auditory

processing, and learning difficulties in children. This model contains four subtypes: (i) decoding (ii) Tolerance- Fading Memory

(iii) Integration and (iv) Organization. Decoding describes individuals who “have difficulty keeping up with the flow of

communication, have poor phonemic skills, are slow responders, often have articulation errors, have difficulty following

directions, and have weak oral reading and spelling skills”61

. Persons with tolerance-fading memory have difficulty understanding

speech with competing background noise and have short-term memory problems1.

These individuals are often described as impatient and are easily over-stimulated. They tend to have poor reading

comprehension and may have handwriting difficulty. Persons with integration problems have difficulty integrating the auditory

modality with other nonverbal aspects of speech such as word finding, morphological and syntactical errors, or an expressive

language disorder17

. Organization describes persons who have difficulty sequencing events and have sequencing errors 55

. These

individuals are often disorganized at home or school. Often a person will exhibit characteristics of more than one sub-type.

Auditory Processing Test

Many tests have been proposed in order to diagnose central auditory processing disorder. American Speech and Hearing

Association (ASHA) CAPD taskforce in 19962 stated that assessment of APD should consist of: i) gathering information about the

patient‟s history; ii) non-standardized but systematic observation of auditory behaviour; iii) several audiological test procedures

(behavioural tests, possibly supplemented with electrophysiological tests); iv) Speech-Language pathology measurements.

Behaviourally auditory processing disorders are based on the principle of reducing the redundancy of speech material.

Accordingly, a division can be made into two categories: those that add information to the signal and those that remove

information from the signal8. A test battery must stress the central auditory nervous system at various levels to identify areas of

weakness. Although use of a test-battery is recommended for the diagnosis of APD33, 49

there is no statistically compelling

evidence indicating which tests should be included in the battery, which tests correlate with other tests, or the cost-effectiveness of

each test60

. However, the authors had used Staggered Spondaic Word Test amongst the various central auditory test battery test

materials to assess the same.

Staggered Spondaic Word Test

Staggered Spondaic Word (SSW) is a dichotic test30, 31

. SSW test offers the diagnostician many sources of information

regarding individual‟s ability to respond to and cope with complex speech stimuli29

. Before development of SSW the earliest

speech tests for diagnosing central auditory disorder were a gradual trend to include stable materials31. „Stable materials‟ was

meant familiar speech containing considerable redundancy 13, 25, 38, 33

. These materials are less likely to be affected by peripheral

hearing loss except distorted speech materials. In order to challenge nervous system, complex presentation of materials came into

use and therefore, primary auditory system was investigated perhaps areas of secondary auditory functions perhaps areas of

secondary functions. In SSW test speech stimuli are presented in both competing and noncompeting conditions. This procedure

assesses more abstract functions rather earlier developed tests for CAPD33

. This test has been shown to be sensitive to brainstem

and cortical lesions1.


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During presentation of SSW, for each test item a couple of spondaic words are presented with staggered onset, one to

each ear. There are three separate sequential events: i) the first half of the first spondaic word (monosyllabic word) is presented in

isolation to one ear ii) followed by the second half of the first spondaic word (monosyllabic word) to the same ear simultaneously

with the first half of the second spondaic word (monosyllabic word) in the other ear iii) followed by the second half of the second

spondaic word (monosyllabic word) in that ear. The first event with the monosyllable in the first ear is a noncompeting event

(NC); the second event with different monosyllables in each ear is the competing event i.e., right competing (RC) and left

competing (LC); the third event with monosyllable in the second ear is also a noncompeting event (NC). The spondaic words are

familiar words. When the noncompeting segments of each item are combined, they also form familiar, spondaic words58

. There

are 40 sets of spondee words that mean total 80 spondees. Spondees are presented at 50dBSL threshold with reference to three

frequency average as pure tone average. The participant is asked to repeat both the spondees. The following figure (Figure: 1.)

shows right Noncompeting (RNC) - Up; right competing (RC) - stairs; left competing (LC) -down; left non competing (LNC) -

town.

Figure-1: The Block diagram of Staggered Spondaic Word presentation

Substitutions, omission, and additions and incorrect repetition are considered as error response. At the end of the test the

total numbers of error response are noted down for each condition. The total no. of errors in every condition is listed down. From

each error score Raw SSW (R-SSW) % scores are obtained. Corrected SSW (C-SSW) % scores are obtained by subtracting

discrimination loss at peripheral level. Discrimination Loss is the difference between when 100% and the % of word of a

phonetically balanced (PB) list that a listener repeat correctly when a list is presented at an intensity level that is so high that

further increase in intensity will not increase the articulation28

. Adjusted SSW score (A-SSW) % is obtained from the response

biases are like ear effect, order effect, response reversal, pattern effect. Response bias refers to any one of a number of unlikely

responses that persist in patients test performance. Usually it is presumed that a normal cooperative subject will make random

errors when the items are presented right ear first or left ear first. If the subject makes consistent errors when the left ear was

leading then this is a type of response bias called ear effect. Therefore, ear effect, is a type of response bias, represents a tendency

to make more errors on items when the right- ear is first (REF) than when the left is first (LEF) or vice versa. If the score of ear

effect is more than five than it will be said that ear effect is said to be present significantly. Order effect is a type of response bias

where the participants have a tendency to make more errors on the 1st spondee than on 2nd spondee or vice versa per item. If the

error score will be more than five, the order effect is said to be considered as significantly present. When the participant repeats

2nd spondee word instead of 1st spondee, the reversal response is said to be considered. Two different configurations of error will

be exhibited if for the right ear first items as opposed to the left ear first item.

In Indian context SSW was developed and standardized in Kannada language known as staggered paired word test50

. In

Kannada language as there were lacks of bisyllabic spondee word hence paired words were used.

NEED OF THE STUDY

Any lesion at the level of central auditory system disrupts auditory processing skills5. As consequences, the whole

communication process gets affected. Therefore, the areas related to communication like academic background, social interaction

and vocations are also got affected1. The result can affect the individual potentiality. Hence, such conditions have to be identified

as early as possible and appropriate remediation strategies must be provided. Sometimes, various subtle changes in neural

structure may not be detectable even by the sophisticated radiological/ neurological techniques. Such conditions may include

various degenerative disease (particularly in the initial stages), biochemical alterations of the brain and a host of minimum

neurological deficits 18

.


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There are very few tests available in Indian Languages regarding CAPD. Language is an important issue for developing

and standardization of a test battery. It has an important influence on the outcomes in the tests which are linguistically loaded.

Very few tests have been standardized in Indian population. Population specific criteria are crucial for interpretation of the results

obtained from such tests because the normative differs in different populations. There is a need for developing assessment and

remediation tools which are not appropriately and unduly influenced by western thought, practice and materials.

Near about 230 million total speakers speak Bangla24

. Bangla is the very primary spoken language in Bangladesh and

second most spoken language in India69

. Inspite of having such a wide use of Bangla language no such work have been reported in

the area of Auditory Processing skills among native Bangla speakers.

SSW has been preferred because the dichotic technique in SSW test appears to be highly sensitive to the presence of

lesions in many parts of the central nervous systems. The test is particularly powerful when all of its qualitative and quantitative

indicators are used. The raw score and the corrected score of SSW are the quantitative indicators, where as the response biases

give the most sensitive localizing information of qualitative indicators. Corrected SSW score helps in neutralizing peripheral

hearing distortion. The particular response bias pattern has also diagnostic significance in indicating various sites of brain

dysfunction. This test has been used in conjunction with competing environment sound for the purpose of improving the

prediction of involved hemisphere. On average the time required to administer the test is approximately 10 minutes as compared

to other tests.

SSW test has been standardized and developed first in English language30, 31

in order to diagnose central auditory

processing disorder. Then SSW has been developed and standardized in Spanish language54

and French version56

and Australian

SSW 72

. In Indian context SSW test is available in Kannada known as Staggered paired word test50

. In fact, there is no specific

data for SSW in Bangla language.

Hence, an attempt has been made in order to develop and standardize staggered spondaic word list in Bangla which

would serve as a test for assessing auditory processing skills. Thus, the present study attempts to investigate the auditory

perception abilities for Staggered Spondaic Word among adult native Bangla speakers.

METHODOLOGY

Participants

The participants were categorized among two groups:

I. 60 participant including 30 males (Mean age-26.3; Standard Deviation- 4.96) and 30 females (Mean age-22.63; Standard

Deviation-3.19) with age range 18-40 years.

II. Six diagnosed Language Learning Disability (LLD) patients with age range 18-40 years (Mean age- 23.67; SD-1.21 ;)

Inclusion Criteria for the Group-I:

The selected participants were native Bengali speaker. All the participants were right handed. Right-handedness was

confirmed by administering the Edinburgh Handedness Inventory51

, which is a simple 10-item questionnaire that provides a

quantitative assessment of handedness. Individuals selected for the present study scored ≤ 20 on the questionnaire to ensure the

subjects right-handedness. The participants had hearing sensitivity within normal limits i.e., 25dBHL at pure tone thresholds at

octave frequencies 250-8000 Hz. All the individuals should have word discrimination score (WDS) more than 90%. All

participants had normal otoscopy findings comprised of a clear external ear canal, a healthy tympanic membrane, and no sign of

structural anomalies. Ear, Nose and Throat (ENT) specialist opined the same as well. Tympanometry results were within normal

limits, and all individuals were health during testing with no complain of illness which might affect the performance of hearing

speech. Minimum qualification should be higher secondary education and these participants should have Bangla as first and

English as second language. Misarticulation, Dysarthria or any neurological impairment, Cognitive impairment, Language

Learning Disability were excluded from Group-I Participants.

Inclusion Criteria for the Group-II:

The selected participants from this group were also native Bengali speaker, right handed, normal hearing, normal

otoscopic findings, normal tympanometric findings and minimum qualification was higher secondary education with Bangla as

fist language and English as second language. Individual having Dysarthria or other neurological or cognitive impairment were

excluded from the study. But there was an exceptional finding for participant-1 of Group-II.


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Participant –I was having hearing sensitivity within normal limits as per pure tone audiometry but as per speech

audiometry very poor WDS, which was a symptom of Auditory Neuropathy Spectrum Disorder (ANSD). So for further

confirmation he was referred for Otoacoustic emission (OAE) and auditory brainstem response (ABR) assessment. The Transient-

Evoked OAE and The Distortion Product OAE showed bilaterally PASS indicative of outer hair cells were functioning normally

and hearing sensitivities were expected to be within 30dBHL (tested in ERO.SCAN TM OAE). But as per ABR peak-V was not

obtained up to 95dBnHL bilaterally having click rate 11.1 and 39.3, indicative of hearing problem at Central level rather

Peripheral level (tested in Nicolet® and TECA® Supplies and Accessories ABR). So, these findings were strongly support the

diagnosis of ANSD.

Instrumentations

An otoscope (Heine Beta ® 200) was used for ear external ear examination. The participants were tested in a double

room Audiological testing suite at the Department of Audiology, in AYJNIHH, ERC using the MAICO MA 53 Dual Channel

Diagnostic Audiometer. The stimulus (both pure tones and speech) were delivered monoaurally through the Telephonic TDH-39

supra-aural headphones. Prior to data collection, the equipment was calibrated using ANSI S3.6-2004 specifications. The

earphones were calibrated using a Bruel & Kjaer (type 2235) sound level meter. Calibrated Immittance (GSI 38) meter was used

to assess the status of middle ear. A Samsung laptop (Model no. RV411) with Pratt- 5.2.01 and adobe audition version 3.0

software were used for sound recording and sound monitoring respectively. Nuendo (version 4.0) software was used for sound

editing at sound recording studio. The recorded sound was burned into a CD by Nero Express. Recorded material was played by a

Sony CD player (Model No. D-88). The responses of the individuals were recorded by a Sony digital tape recorder (Model No. -

ICD-PX720).

Test Environment

A two room setup audiometric room was used. The environmental state of the test room was met with the current

American National Standard Institute for background noise (ANSI S3.1-1999, R2003).

Procedure

Development of Test Material:

200 sets of Bangla bisyllabic words were collected from the corpus of news papers, story books, magazines, periodicals,

and text books of West Bengal Board of Secondary Education and West Bengal Council of Higher Secondary Education. Each set

of word contained a pair of bisyllabic words and its staggered bisyllabic words. No rhyming and reduplication words were

included.

The each sets of words were distributed among ten adult professional native Bengali speakers to judge the familiarity by

five point familiarity rating scale which was consisted of 1- unfamiliar, 2- doubtful, 3-not very familiar, 4- familiar, and 5- most

familiar. For each set, its two bisyllabic words were rated along with its staggered word. For each set, each bisyllabic words and

its staggered bisyllabic word was rated minimum 3 or more than 3, was considered as a familiar bisyllabic word set. In this way

familiar word sets were extracted from the word set which were rated by at least nine individuals out of 10 individuals. In this way

total 144 familiar word sets had been selected based upon frequency distribution.

Homogeneous stress pattern was formulated based on two intercorrelated measures: a) the each set of familiar Bangla

bisyllabic word along with its staggered bisyllabic words were distributed among two linguists. In standard Bangla language stress

is predominantly at initial syllable. Bangla words are virtually all trochaic; the primary stress falls on initial syllable of the word,

while secondary stress falls on thereafter the odd-numbered syllable. However, in words borrowed from Sanskrit, the root syllable

has a stress, out of harmony with the situation with native Bangla words16

. In any case, Word-stress does not alter the meaning of

a word, and is always subsidiary to sentence-stress16

. Thus, apart from linguistic view in Bangla language, true spondee words are

not available. Therefore, compound words in Bangla were taken into considerations because, the process of compounding make

several words into a single system of accentuation. Thus, the uniformity in accentuation becomes responsible for bringing ease in

pronunciation of compounds, which is hardly available in sentences21

. Therefore, out of 144 familiar sets 60 sets of familiar

Bangla compound words were selected by the linguists. b) The talker had presented the bisyllabic words with equal stress on both

the syllable. Pratt (Version-5.2.01) software was for recording and visual analysis of stress pattern by means of frequency,

intensity and duration analysis. After visual analysis finally total two staggered spondaic word (SSW) lists were made. Each list

contained 20 sets of SSWs. Two word lists were added in order to make it randomly 40 sets of SSWs and four practice items were

also added30, 31

. Figures 2, 3 and 4 are exemplifying visual analysis of symmetries in each syllable of three spondees. Thus, the

two measures, one by the linguists and other by the Pratt Software (version 5.2.01) were strongly correlated at P=0.05.


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Figure- 2: Pratt window for the word d inkhɔn in English it means „Particular time of a day‟

Figure- 3: Pratt window for the word /k lr t in English it means „One of the post-weeding Rituals in Bengali Community‟

Figure-4 Pratt window for the word d inr t in English it means „day-night‟


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Recording Parameter

The final SSW list was recorded in a sound recording studio. An adult female standard native Bengali speaker was

considered as the speaker. The stimulus was recorded into the computer containing Praat (version-5.2.01) and Adobe Audition

(version 3.0) software. The speaker was asked to speak at her best quality and instructed to maintain equal stress in each syllable

with equal loudness during recording of the whole wordlists. The microphone was placed at a distance of six inches away from the

mouth. The signal was digitized at sampling rate 44100Hz using 16 bit analogue to digital (A-D) and digital to analogue (D-A)

converter housed within a computer. Each word was recorded in a separate file and then edited by Nuendo software version-4.

Each word for a particular set was fitted into a separate track and then overlapped at last syllable of the first word and the first

syllable of the second word. From this overlapped manner, sound output was simultaneously presented in both ears at second time

sequence. Whereas, at first and third time sequence, the first syllable of first word and last syllable of second word in each set was

presented into right ear first and left ear first in alternating manner. Figure-5 describes the overlapped spectral envelop of two

spondaic words. The overlapping of competing two words was done perceptually30, 31

. The recorded words were carried to edit the

noise and the hiss reduction filter by Nuendo software. For some stimuli amplitudes were balanced by Adobe Audition version 3.0

and Nuendo software. Inter stimulus duration was five seconds along with carrier phrase before each stimulus27

. After editing the

complete prepared stimuli, it was burned into a digital versatile disc (DVD) at a bit rate of 16.

Figure-5: The overlapped spectral envelop of two spondees in two separate track.

Standardization of the newly developed test:

As per test protocol 500Hz, 1 KHz, 2 KHz, frequencies average pure tone threshold and word discrimination errors were

recorded and percentage of scores for correct responses were obtained.

Staggered Spondaic Word Test: A list consisting 40 pairs of item was presented by a Sony CD player (Model no. - D-

88). The CD player was connected with the dual channel MAICO MA 53 audiometer. The stimuli were presented at 50dBSL with

reference to pure tone average15

. Each individual heard the whole list along with four practice items. Therefore, individual heard

for practice items 16 monosyllable and 160 monosyllables for test items.

Each item was introduced by the carrier phrase, / pn i pro t ut t en t o . In English it means “Are you ready ” Items

were arranged in this way so that the ear getting the first word was alternated.

A diagram of the time sequence was shown in Figure-6. It can be seen that each ear receives stimulation in

isolation as well as in competition with other. For example there are total two paired words /d ɔ d ik means „ten-sides‟, hin d ɔn /

means „guilt-feeler‟. d ɔ means „ten‟ in English, is heard as a right non competing R-NC condition while d ik means „side‟ is

hard in right competing (RC) and simultaneously /hin means „absent‟ is hard in left competing LC conditions. Finally, d ɔn /

means „individual‟ is hard as left non competing LNC condition. The words were paired in such a way that the non competing

words formed yet a third meaningful familiar spondee word as /d ɔ d ɔn means „ten-individuals‟. As illustrated, the ear stimulated

first changes from item to item. Therefore, the second item was presented at left ear first. The two paired of spondaic words were

d ɔrbe means „name of a sweet in Bengal‟ and ɔrk r means „government‟. The word in LNC condition d ɔr means „corridor‟ ,

in LC condition / be means „dress‟, in RC condition ɔr means „layer of milk‟ and in RNC condition k r/ means „whom‟ were

presented. The third spondee was d ɔrk r means „needed‟. Attempt was done during construction of the items. Subjects were

required to repeat both the spondee words, and a time gap of five seconds was allowed between each item for the participant to

respond.


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Figure-6: The time sequences of SSW items.

The test was administered as 50dB above the pure tone average. Four practice items were used before the test stimuli. If

the subject failed consistently three times on practice session he was not taken up for the study.

Scoring: SSW scoring was done based on calculating no. of errors which was included incorrect repetition, substitution,

omission, addition. Each half of the spondaic error would carry one mark. The participant had to respond by repeating the test

items in the same order as they hard them. The response was monitored and recorded on a score sheet. An example of a score

sheet is abbreviated on Table-1 by giving the practice items.

A: Right Noncompeting (RNC), B: Right Competing (RC), C: Left Competing (LC), D: Left Non Competing (LNC), E:

Left Non Competing (LNC), F: Left Competing (LC), G: Right Competing (RC), H: Right Noncompeting (RNC). A, B, C, D, E,

F, G, and H, these are called cardinal numbers; „Rev‟ stands for reversal response. So, there are total eight cardinal numbers. Here,

/ph kt ɬ means „absent of rhythm‟ and rɔ hin means „dry‟. Again d eɓr d means „king of Angel and mon ok/ means

„mentally sad‟.

Table-1: Example of SSW list illustrating the practice items

A B C D Reversal Wrong E F G H Reversal Wrong

1 d ɔ

d ik hin d

ɔn

2 d ɔr be ɔr k r

3 ph k t ɬ rɔ hin 4 d eɓ r d roɠ ok

There are total 40 test items with four monosyllabic words in each item. Each word has been considered. If an item was

said (regardless of order) it was correct. Nothing was done for this item. If a word was not responded by any reason, a horizontal

line was drawn through it. To indicate error on the printed word of the score sheet, the person‟s utterances was noted for

substitution, addition and distortion. If the items were said in incorrect sequence, 1-4 numbers were used below the printed words.

For example most common error in sequence was 3, 4, 1, and 2. No number was used for omission word. For entire correct items

a dot (.) was entered into the wrong column. If there were errors in the item number of error was put into the wrong column.

Items were totalled in five ways:

i) Total monosyllable missed The total percentage of correct responses indicate an individual‟s overall success on this

test. There were 160 possible errors for each condition.

ii) Right ear non-competing errors (R-NC): These monosyllables were hard in the right ear when there were no stimulus

in the left ear. There were 40 possible errors.

iii) Left ear non-competing errors (L-NC): These monosyllables were hard in the left ear when there were no stimuli into

the right ear. There were 40 possible errors.


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iv) Right ear competing errors (R-C): These monosyllabic words were hard in the right ear where simultaneously a

monosyllable was hard in left ear. There 40 possible errors.

v) Left ear competing errors (L-C): These words were hard in the left ear while simultaneously a monosyllable was

hard in right ear. There were 40 possible errors on this.

In this way Raw-SSW (R-SSW) scores were calculated in each condition. Table-2 is representation of R-SSW % calculation.

Table-2: The R-SSW score calculation

R-SSW

Conditions RNC RC LC LNC

Total Errors

(TE)

TE TE TE TE

Multiplier × 2.5 × 2.5 × 2.5 × 2.5

R-SSW %

Score

Ear RE LE

R-SSW % error

Total

From R-SSW% Error Corrected SSW (C-SSW) was calculated by subtracting discrimination loss. Discrimination loss

was calculated from Word Discrimination Score (WDS). By subtracting obtained discrimination scores from the total

discrimination scores. Table-3 is showing C-SSW % error calculation. For Group-I participants R-SSW scores and C-SSW scores

were obtained.

Table-3: The C-SSW Score calculation

C-SSW

Enter the R-SSW % error

Conditions RNC RC LC LNC

R-SSW % error

-discrimination loss - - - -

C- SSW % Error

Ear RE LE

C-SSW % Error

Total

Test-Retest reliability has been measured after one week of first time testing by randomly selecting five males and five

females participants from the Group-I.

The concomitant validity is an extent to which a cause and an effect occur together in the way predicted by the

hypothesis under consideration43

. SSW lists in Bangla was validated in six diagnosed native Bengali language learning disability

(LLD) (Group-II) having age range 18-40yrs (Mean-24; Standard deviation- 1.2). Pure tone average, immittance test, Speech

Recognition Threshold and Word Discrimination Scores (WDS) were administered. Discrimination losses in each participant were

also measured with reference to WDS. Standardized SSW list was administrated at 50dBSL (ref: three frequency pure tone

average). Responses were recorded in the digital tape recorder. R-SSW score, Corrected SSW (C-SSW) score, Adjusted SSW (A-

SSW) score were measured along with response biases.

Response Bias (RB) was originally thought to be idiosyncratic responses, but later it was found in people with brain

lesions, that RBs were consistent with their site-of-lesion (Katz, 1984). The similar patterns were seen in those with CAPD having

no history of brain damage. RBs were calculated in order to get Adjusted SSW (A-SSW) score. Therefore, A-SSW score was

calculated in clinical population. There are four types of response biases:

Ear Effect: An ear effect, a type of response bias, represents a tendency to make more errors on items when the right-ear

is first (REF) than when the left ear is first (LEF) or vice versa. When the score of ear effect was more than the cut off value it

would be said that ear effect would present significantly. If REF is significantly greater it is referred to as Ear effect High/Low

(REF has Higher). If LEF is significantly greater it is Ear effect Low/High (LEF is greater). Also in scoring with High/Low, REF


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minus LEF gives positive value, and with Low/High, REF minus LEF gives negative value. If sum of errors of even number

columns minus sum of errors of odd numbers columns score would greater than the standardize value than ear effect would

considered significantly present.

Order Effect: Order effect is a type of response bias where the participants have a tendency to make more errors on the

1st spondee than on 2nd spondee or vice versa. If the error score will be more than five, the order effect would be considered as

significant. If 1st spondee has more errors than the 2nd it is Order Effect High/Low (first spondee more errors than second

spondee) and vice versa. Order Effect High/Low when subtracted gives a positive value because the 1st spondee has more errors

than the 2nd. Table-4 is showing calculation of order effect. If sum of errors of first spondee minus sum of errors of second

spondee would be greater than the standardized value, order effect would be considered significant.

Table-4: The calculation of order effect

Order Effect

1 2 3 4

(A+E) (B+F) (C+G) (D+H)

Total

1st Spondee

Total

2nd

Spondee

Significant Not Significant

Reversal Response: When the words of the item are repeated out of sequence and there is not more than one error it is a

Reversal Response. The most common reversal is saying the second spondee first that is shown as 3, 4, 1, 2 below the printed

words on score sheet.

Type-A Pattern: The eight Cardinal Numbers were considered on score sheet. For example errors for columns F vs. B

were compared. The larger of the two columns were chosen and if it was „F‟. Then from the remaining columns the one with the

largest number of errors were chosen and if it was „X’. If F minus X is > the normal limit it is a Type-A pattern. The diagnostic

significance of Ear/Order Effects were ignored if Type-A significant.

When highly positive C-SSW score were obtained and response biases were present, the Adjusted SSW score were

obtained by lowering the C-SSW score by the magnitude of response bias. A-SSW score calculation has been shown on Table-5.

Table-5: The calculation of adjusted score

A-SSW

Enter least Biased Score

Condition RNC RC LC LNC

Least biased

errors (LBE)

LBE LBE LBE LBE

Multiplier ×5.0 ×5.0 ×5.0 ×5.0

Least Biased %

error

-WDS % Error - - - -

A-SSW % Error

Ear RE LE

A-SSW % Error

Total

In the current investigation A-SSW score were not taken into consideration as this study did not intake participants

having known site of lesion.


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Statistical Analysis

The raw data was subjected to statistical analysis. Mean and standard deviation were calculated by using Statistical

Package for Social Science (SPSS) Software (Version- 16.0). For hypotheses testing, R (Version- i386 3.0.1) software was used.

One sample Wilcoxon sign rank test was performed for the judgement of pattern effects, reversal, ear and order effect because the

outcomes of the distributions were not known. Two sample paired t test was performed to judge the gender effect and laterality

effect where outcomes were assumed to be normally distributed. „Welch two sample t test‟ was performed to estimate the

difference of performance scores between normal and language learning disables where unequal sample sizes were present

between the two variables under study.

RESULT

The results for the present study were explained under the following headings:

Development of the test material

Standardization of test materials

Test retest reliability

Validity

Development of the test material

200 sets of Bangla bisyllabic words had been selected then these had been rated as familiar staggered spondaic words set

based upon frequency distribution.

Figure-7:‘Box Plot‟ for frequency distribution of next 1-200 sets based upon each sets minimum, maximum, 1st quartile and 3rd

quartile value. „X‟ Axis represents frequency distributions in average by means of Sets Minimum S_MIN , Maximum S_MAX ,

1st Quartile (S_Q1) and Third Quartile S_Q3 Values with respect to Set No.‟s in „Y‟ Axis.

For the selected sets the frequency distribution lay within 7 to 15. These are the minimum and maximum value

respectively and Box Plots upper whisker and Lower Whisker value. The Out liar values sets were also taken as familiar sets but

below lower whisker values sets were not taken as a Familiar Sets.


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Figure-8:‘Box plot‟ of Selected Sets based upon frequency distributions. „X‟ Axis represents frequency distributions in average

by means of Sets Minimum (S_MIN), Maximum (S_MAX), 1st Quartile (S_Q1) and Third Quartile (S_Q3) Values with respect

to Set No.‟s in „Y‟ Axis

Then from these selected sets stress pattern had been judged both qualitatively by experienced linguists and

quantitatively by Pratt software in terms of frequency, intensity and time. Finally, 40 sets of staggered spondaic words had been

selected.

Standardization of test materials

The first objective of the study was to study the performance of normal native Bengali Listeners on SSW and to establish

the mean of the corrected SSW scores for the same. Table- 6 would representative of the normative of the C-SSW error scores of

males and females.

Table: 6 Descriptive Statistics of average C-SSW error scores for 30 Normal Native Bengali Female and 30 Normal Native

Bengali Male listeners

Gender N Minimum Maximum Mean Standard

Deviations

Female 30 1 29 12.83 8.76

Male 30 1 31 16.03 7.49

The table-6 represented mean C-SSW error scores of female was 12.83, and the standard deviation was 8.76 and mean C-

SSW error scores of male was 16.03, and standard deviation was 7.49.

Next major concerns were to investigate pattern effects, ear effects, order effects and response reversals on normal

listeners and to obtain the normative beyond that cut off value where pattern effect, ear effects, order effects and response reversal

were significantly present. In this concern of pattern effect, ear effect, order effect and reversal the responses were not normally

distributed. As response‟s distributions patterns were not known, exponential distribution was followed for each pattern of error

response. In this regards it had been tested that for pattern effect the error score difference between „F‟ one of the eight cardinal

number versus „X‟ the next lesser value of the previous cardinal number, F column value was „five‟ as the value covers 95%

confidence interval. Hence, the normative for pattern effect was „five‟. Different error scores between right ear (first) and left ear

first the cut off value „six‟ covered a 95% confidence interval. Hence, the normative for ear effect was „six‟. The error score

difference between first spondee and second spondee the cut off value 12 covers 95% confidence interval. Hence, the normative

for order effect was 12. The cut off value for reversal response was „two‟ covers 95% confidence interval. Hence the normative

for reversal was „two‟.


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Table- 7: “One sample Wilcoxon sign rank test” for Response errors of SSW test on normal listeners.

Participants Response Errors Wilcoxon statistic P value. Interpretation

Normal

60 (30 male and 30

female) native

Bengali Listeners

Pattern Effect 2.5 1 1>.05, Pattern

Effect was not

present significantly

across normal

participants.

Ear Effect 12 1 1>.05, Ear Effect

was not present

significantly across

normal participants

Order Effect 0 1 1>.05, Order Effect

was not present

significantly across

normal participants

Reversal 58.5 1 1>.05, Reversal

Responses was not

present significantly

across normal

participants

Hypotheses were computed regarding the objective was there would not be significant pattern effect, ear effect, order

effect and reversal effect observed on SSW performance of normal native Bengali listeners. In order to prove the hypothesis as

the responses were not distributed normally and distribution patterns were unknown non parametric test was performed for each

condition that is one sample Wilcoxon sign rank test. Here Null hypothesis for pattern effect was µ=5 (Pattern effect would not

present significantly) against alternative hypothesis was µ> 5 (Pattern effect would be present significantly). Null hypothesis for

ear effect was µ=6 (Ear effect would not present significantly) against alternative hypothesis was µ> 6 (Ear effect would be

present significantly). Null hypothesis for order effect was µ=12 (Order effect would not be present significantly) against

alternative hypothesis was µ>12 (Order effect would be present significantly). Null hypothesis for reversal response was µ=2

(Reversal responses would not present significantly) against alternative hypothesis was µ>2 (Reversal responses would be present

significantly).

The next major concern was to investigate gender effect, whether the SSW scores would be significant between male

versus female. The responses were assumed to be normally distributed. Hence, paired t-test was performed to draw the inference

between gender differences.

Table: 8- “Paired t-test” and Comparison between C-SSW scores of Adult Male and Female normal native Bengali listeners:

t df P value Interpretation

Adult male - Adult

female

/-1.33/=

1.33

29 0.1935 0.1935> 0.05; Performance scores of Adult

males and performance scores of adult

females would not differ significantly.

Here, the null hypothesis was there were no significant difference on SSW test performance between male and female

against alternative hypothesis was there was significant difference on SSW performance between male and female. Table-8

clearly depicted that the alternative hypothesis is rejected at α=0.05 level of significance 95% confidence level . t calculated

value is -1.33. The modulus of that negative value should take i.e., positive value was considered. Therefore, t calculated value

was 1.33, lesser than t tabulated value that was 2.0452 at degree of freedom (df) 29. As, tcal 1.33< ttab 2.0452 and also p > 0.05


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hence, alternative hypothesis was rejected. Therefore, Performance scores of Adult males and performance scores of adult females

would not differ significantly.

Then laterality effect was investigated, whether right ear performance and left ear performance would differ significantly

or not. Responses were assumed to be normally distributed. Hence, paired sample t-test was performed to draw the inferences

regarding laterality effect.

Here, the null hypothesis was there were no significant difference on SSW test performance between right ear and left ear

of normal native Bengali listeners against alternative hypothesis was there was significant difference on SSW performance

between right ear and left ear. Table-9 clearly depicted that the alternative hypothesis was rejected at α=0.05 level of significance

(95% confidence level). t calculated value was 1.080. Therefore, t calculated value was 1.33 is lesser than t tabulated value that

was 2.0010 at degree of freedom (df) 59. As, tcal 1.080< ttab 2.0010 and also p > 0.05 hence, alternative hypothesis was rejected.

Therefore, Performance error scores of right ear and left ear of normal native Bengali Listeners would not differ significantly.

Table: 9- Paired Samples Test for Laterality Effect on SSW test of Right Ear Performance Error Scores and Left Ear Performance

error Scores of Normal Native Bengali Listeners.

t df P Value Interpretation

Right Ear

Performance Error

Scores and Left

Ear Performance

error Scores of

Normal Native

Bengali Listeners

1.080 59 0.284 0.284>0.05;

There would no

significant

difference between

error scores of

right ear and left

ear performance

The typical errors on the performance of the SSW test of normal native Bengali listeners had been investigated. It

represented here in the total sets of SSW words in which sets the participants performed well and in which sets they made more

errors. Figure 8 represents a „Box Plot‟ of the typical sets of words with respect to mean of errors in each item. Each set had

separate mean which also varied individual to individual. But the values lied within a range. Therefore, based upon mean,

maximum error score, minimum error score, 1st quartile and 3

rd quartile value of all candidates in each set were distributed in the

„Box Plot‟.

Figure: 8- the Box Plot with respect to participants means quartile deviations with respect to each set.


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The Box plot represented more errors on Set no.-1, 2, 3, 7, 10, 12, 15, 20, 23, and 24. The figure represented that all

candidates‟ performance error in each set ranged within lower and upper whisker but at set no. 3 one participant‟s error response

lied at extreme outlier value that is greater than to upper outer fence.

The SSW test was administered to 18 participants (9 males and 9 females) randomly selected from the original sample

for second time, one week after the first test to measure the test retest reliability. The results were compared with the results

obtained during the first test. For male, the Pearson moment correlation coefficient (r) was 0.88 and for female 0.92 suggested that

there was a strongly positive correlation between test and retest trials. However, variation was observed in terms of the individual

items on which errors were seen. This later findings probably indicated that individual made committed errors randomly on the

test though his/her total errors score was constant.

SSW lists in Bangla were validated on six diagnosed native Bengali language learning disability (LLD) having age range

18-40yrs (Mean-24; Standard deviations- 1.2). Mean of C-SSW percentage was 54 and standard deviation was 3.30. In the

validation the main objective was to investigate the performance of C-SSW error scores of normal native Bengali listeners as

compared to performance of language learning disability listeners would significantly differ or not. Welch Two Sample t-test was

performed as responses were assumed to be normally distributed and unequal sample size between two variables.

Table: 10 -“Welch Two Sample t-test” to compare the performance of C-SSW scores of normal native Bengali listeners and

Language Learning Disability Listeners.

t df P Value Interpretation

Normal native

Bengali listeners

and Language

Learning Disability

Listeners

2.5706 5.062 0.03251 0.03<0.05; Performance scores of Normal

native Bengali listeners and Language

Learning Disability Listeners differed

significantly

Table- 10 clearly depicted that the alternative hypothesis is accepted at α = 0.05 level of significance 95% confidence level ,

since p value is less than 0.05 (p < 0.05). Thus, the error scores obtained by disordered participants on the developed test were

comparatively better than those obtained by the normal participants.

The final concern was to investigate response biases (pattern effect, ear effect, order effect and reversal) on

Language learning disability participants. Response biases could not be judged on disorder population in order to present very less

sample size and in presence of tie rank exact P value could not be obtained although the pattern of distributions were unknown.

Hence, inferences could not be drawn regarding response biases of disorder population. A-SSW score was not taken into

consideration as any site of lesion patient was not taken to judge the performance of SSW test in Bangla.

DISCUSSION

Bangla language is rich in rhyming and reduplicated words. Therefore, the performer might guess the word and the

outcome might be over estimated. The more that one is acquainted with the stimulus, the more readily one recognizes it

(Lyregaard, 1997). Familiarity of a word depending upon listener‟s exposure to that which in turns approximated by the frequency

of occurrence of that word materials (e.g., literature, magazines). The most familiar words by means more high frequency words.

Familiarity was also explained based on the effect of intelligibility. Prior knowledge of test vocabulary yields the threshold of the

participants67

. As the spondaic words were presented in staggered onset both in competing and in non competing situation,

participants were likely to be missed out the competing word. Hence, familiar sets were taken rather familiarity weightage based

on most familiar and most unfamiliar were excluded. Katz also had paired the familiar spondaic words through this assumption to

increase the likelihood of the subject‟s missing one or both competing words31

. In Bangla language it is difficult to get bisyllabic

words have equal stress on both syllables. In standard Bangla language, stress is predominantly present at initial syllable of the

word16

, while secondary stress often falls on all odd numbered syllable16

thereafter, giving syllable string such as /ʃɔm-bɔɽ-dho-

ni-o „cultivation‟, where boldface represents primary and secondary stress. The first syllable carries the greatest stress, with the

third carrying a somewhat weaker stress, and all following odd-numbered syllables carrying very weak stress. However, when

words were borrowed from Sanskrit, the root syllable has stress, out of harmony with the situation with native Bangla words16

.

Adding prefixes to the root word typically shift the stress to the left; for example while the word / ʃɔmbhɔb means „possible‟


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carries the primary stress on the first syllable /ʃɔm/, adding the negative prefix /ɔ/ creates /ɔ ɔmbhɔb means „impossible‟, where

as the primary stress is now on the newly added first syllable /ɔ/. In any case, Word stress does not alter the meaning of a word,

and always subsidiary to sentence-stress16

. Thus it is cleared that in Bangla language true spondee words are not available. The

talker has to present bisyllabic word with equal stress on both the syllable in defining spondee words. Linguist has considered

compound word as bisyllabic word having equal stress perceptually because process of compounding brings several words into a

single system of accentuation. Thus, the uniformity in accentuation becomes responsible for bringing ease in pronunciation of

compounds, which is hardly available in sentences21

. Judgement of homogeneous stress pattern was judged through

spectrograph70

. They had judged acoustic properties of speech stimuli especially for spondee words in order to measure auditory

thresholds. They judged pressure waveform, variation of sound pressure that occurs with time and intensity level of steady state

speech signal having highly variable sound pressure level.

In this study the erroraneous raw SSW score was given less importance. Because, the raw SSW error score might be

contaminated by peripheral distortion31. But the test aimed to quantify the patient‟s difficulty at the central level. As a

consequence, the corrected SSW score would be able to judge the performance at central level by reducing the peripheral

distortion, might present within the raw error score.

However, from the present investigation total mean C-SSW error score for male was 16.03% and in female 12.83%.

There was a supportive findings incorporated by the preparation of SSW tape using 24 sets of Spondaic words to standardize in

Indian population on 60 normal hearing Indian listeners (30 male and 30 female, age range 16-29 years). The mean C-SSW error

score of this investigation were for 15.25% in females and 13.27% for males15

. In this investigation knowledge of 1st language

and 2nd language exposures were not taken into consideration. But an important fact that for a learning process, the listener‟s

selected input structure should be transferred and remodelled as they progress in the development of their linguistic knowledge

across the languages. Therefore in the process of production, the transfer process is involved of the learner‟s retrieval of this

knowledge and in their effort to bridge those gaps linguistically based on their knowledge which cannot be side-stepped by

avoidance 39

. In the current investigation the participants educational background of where had till XIIth

standard Bangla as 1st

language and English as 2nd language. But at graduate level participants had English as first language and Bangla as second

language. Therefore as per previous explanation of learning the error score might vary with respect to present status of linguistic

knowledge where as the materials were collected from magazine, news papers.

During the qualitative analysis the normative was found for „pattern effect‟ was „five‟ was supported by Katz‟s study31

where pattern effect was not found significantly on normal individuals. Pattern effects represented the highest amount of mistakes

occurring in the second word, both when the test began in the left ear as well as in the right ear respectively52

. Qualitatively

pattern effect represents the integration disorder. As per Buffalo model37

on SSW test, patter effect might have significantly

present in which the left competing condition for the left-ear-first items was significantly poorer than any other columns

(especially in right-handed individuals). The lesion involved for pattern effect was tumor in Corpus Callosum 36

.

The normative found for „Ear Effect‟ was „six‟. Ear performance was generally a more accurate indicator of central

auditory function that either the SSW conditions or total score31

. Defective performance in one ear suggested the dysfunction in

contralateral hemisphere. However, ear effect were absent in normal listeners on SSW test. There was another investigation done

on 86 normal listeners where mean C-SSW was consistent with Katz‟s findings31

and also there were no prevalent Ear effect3. So

present study finding were consistent with these supportive studies.

The normative for „order effect‟ was „12‟ which was quite greater in the current investigation rather the English SSW

word test31

where it was „five‟. In English language when spondaic words were paired it did not follow any phonetic content31

.

Through acoustic analysis the physical properties of spondees along with its homogeneity was judged 70

. In Bangla language there

was no true spondaic words; attempt had to be made in order to produce stress in both the syllable. Therefore, when the two words

were paired, as these did not follow phonetic content, the acoustic properties of these two spondaic words might vary with respect

to homogeneity in terms of frequency, intensity and time. As their physical properties of these two spondaic words might differ

the outcome also might differ in terms of detectability and intelligibility. If the spondaic words were homogeneous with respect to

recognition, then each word would become recognizable. Also familiarity is an important factor in determining degree of

intelligibility. Better performance is achieved when the performer knows the stimulus materials for which he/she is listening67

.

There were two steps of familiarity measures. The first was how familiar the individual is in general with the target word i.e., the

more the listener uses the target word, the more familiar with it. The second was whether or not the listener knew that the target

word was a member of the same set of test items. Based upon this concept it might be judged that Bangla SSW words were rated

based upon each set where each set consisted of two paired bisyllabic words and its staggered bisyllabic words. Therefore, each

paired word set each bisyllabic word might have different familiarity levels. Suppose, one word was rated most familiar another

word was rated doubtful. Therefore, for that particular set in between two paired spondaic words itself heterogeneous. Again, the

single syllable of words was presented in competing manner that was on complex situation. For these reasons the score might

differ. In English language, in order to make SSW EC-list and ED-list spondees were taken and paired where each spondaic word


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had separate familiarity31

. But in Bangla language, an average familiarity of the each set was computed including all words, rather

separate word in the set. Therefore, heterogeneity in terms of acoustic properties of two paired spondee words and familiarity the

score between 1st spondee and 2nd spondee error score might have more difference. If 1st spondee had more errors than the 2nd it

was Order High/Low (first spondee more errors than second spondee) and vice versa. Order Effect High/Low was that when

subtraction might give a positive value because the 1st spondee might have more errors than the 2nd

52

. According to Buffalo

model37

qualitatively order effect High/Low represents tolerance fading memory and Low/High represents decoding function.

Tolerance Fading Memory signs were associated with anterior portion of the brain 23, 41

; therefore, the connection among them

might be anatomical. Anatomically, phonemic decoding of speech was uniquely associated with the auditory cortex of the brain.

The middle-posterior portion of the superior temporal lobe was responsible for phonemic discrimination, phonemic memory, and

phonemic synthesis-analysis40, 41

. In the current investigation order effect would not differ significantly among normal listeners.

The result of the current investigation was supported by Katz‟s findings31

and Arnst study3.

Reversal response revealed the phoneme sequencing. Reversal might present as one or might be absent31

. Present

investigation finding regarding reversal response was supported by Arnst study3. According to Buffalo model

37qualitatively it

analysed the phoneme organization. Auditory sequencing error lesion is located in fronto-temporal and fronto-temporo-parietal

regions41, 23

.

The findings regarding gender effect was supported by Chandrasekhar‟s study15

. A part from findings of dichotic

listening test there was an investigation to establish the normative on adults and children10. In adult‟s score there was no

significant difference between genders. So, the current investigation finding was supported by this study finding regarding gender

effect on dichotic test.

The findings regarding laterality effect was supported by Katz‟s study31

. There was another SSW test which was

developed in French version 56

French version of SSW had also got similar findings like this investigation. The SSW is essentially

free from laterality effect caused by the hemispheric dominance in terms of speech 56

.

In the current investigation few typical error were observed. When Katz finalized the 40 items clinical version of SSW

list EC 31

, he found that in some sets the rate of error was high for normal and also they appeared relatively unfamiliar.

Participants had greater difficulty on some items. Probably this was either due to the improbable nature of these words appearing

on a test such as these, or indeed the words might not be appeared in the vocabulary of the subjects 68

. Familiar word retrieves

faster 22

and less familiar word become fade out 57

.

Figure: 9- Item wise total error in descending order.

45 44 43 41

38

29

24

20 17 16 15 15 14 14 13 12 11 10 9 8 8

6 6 6 5 5 4 4 3 3 3 2 2 2 1 1 1 1 0 0 0

5

10

15

20

25

30

35

40

45

50

3 24 2 1 20 15 27 40 11 5 21 38 19 34 13 6 37 28 31 8

No

. o

f E

rro

rs p

er I

tem

Set Number

Total Error


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However, these responses would be explained since they probably differ qualitatively from other types of responses.

These typical responses probably indicated that prior knowledge of lexical, semantic and syntactic rules of the language, which

has influenced their performance. The SSW items were probable „complex linguistic context‟ since the listener would be getting

speech stimuli in a time sequence which staggered the words that were being presented. Hence, the performance in this complex

linguistic context might be influenced by the abstractions of the linguistic rules on the part of the listener. Top-down processing of

language 20, 46

had confronted with the recipient‟s former knowledge and expectations facilitate comprehension and made

influences on target stimuli. Any act of perception is intimately tied up with perceiver‟s background i.e., the anterior experience,

their memory and their attitudes 44

. Again the typical error pattern might occur due to presence of heterogeneity in terms of

dissimilar acoustic properties of two paired words70

. Same thing might be explained by „Analysis by Synthesis‟ model63

. This

model represented a process of specifying an unknown sign in terms of the best match selection from a standard inventory; it

might be possible to explain these unique error responses observed in the normal Bengali listeners in the present investigation.

A part from test retest reliability there was strongly positive correlation. This finding was supported by Chandrasekhar

study15

However, variation was seen in terms of the individual items on which errors were seen. This later findings probably

indicated that individual made committed errors randomly on the test though his/her total errors score was constant. In the

supported study also scores were consistent but the item errors were varied. This study was also performed on Indian context.

A test‟s validity varies according to the purpose for which its results are used and the types of individuals tested. The

mean C-SSW error score was 54% and standard deviation was 3.30 for Bengali Language learning disability listener. This value

should not be taken as a norm of Adult language learning disability because the sample size was so less and heterogeneous in

terms of variability like first patient was diagnosed as auditory neuropathy, others were diagnosed as dyslexia in terms language

learning disability but whether it was dysphonetic or dysedietic were not ruled out. The chief characteristic of dyslexia in

adulthood is difficulty with reading. A dyslexic adult may be slightly slow in reading but otherwise competent. The chief

characteristics of dyslexia in adulthood are usually weaknesses in auditory short-term memory (working memory) and visual

processing skills47

. There was an experimental short form of SSW test on 40 learning disability subjects including male and

female with age range 7-11 years along with age matched peers 73

. The normative obtained for learning disabled subject at 7 years

25.16% with standard deviation 10.50%, at 8years 25.6% and standard deviation 10.50%, at 9 years 15.58% with standard

deviation 10.50 %, at 10 years 8.21 % with standard deviation 10.50% and at 11yrs 13.25% with standard deviation 10.50%.

Although the normative values did not support the current investigation but the e study had also mentioned that when they were

considering individual score the error scores were more with respect to the normative in presence of wide range of standard

deviations. In this point of view individual scores would be discussed along with response biases.

Table: 11- The individual performance of six adult LLD patients on SSW test

Patient’s Serial

No.

C-SSW Score Pattern Effect Ear Effect Order Effect Reversal

1. 113 Insignificant Significant Significant Absent

2. 46 Insignificant Insignificant Insignificant Absent

3. 23 Significant Insignificant Insignificant Absent

4. 25 Significant Insignificant Insignificant Significant

5. 52 Insignificant Insignificant Significant Significant

6. 65 Significant Insignificant Insignificant Insignificant

It was discussed that LLD subject no. 1 had been diagnosed as Auditory Neuropathy Spectrum Disorder. A rare but

severe form of CAPD called auditory neuropathy74

. Individuals with auditory neuropathy have normal cochlear function, usually

identified by otoacoustic emission tests, but have abnormal auditory brainstem responses. Therefore, the C-SSW error score has

matched with the statement. The client was also having significantly ear effect (High/Low) and order effect (Low/High). Both of

the findings related to ear and order effect suggestive of affected decoding function with respect to Buffalo Model 37

.

Anatomically, phonemic decoding of speech is uniquely associated with the auditory cortex of the brain. The middle-posterior

portion of the superior temporal lobe was responsible for phonemic discrimination, phonemic memory, and phonemic synthesis-

analysis40, 41

. Lesions to this region of the brain demonstrated large error peaks on the SSW test in the contralateral ear 30

, as well

as significantly greater number of errors at the end items compared to the beginning (i.e., Order Effect low/high) 71,

45. The indicator might be associated with slow processing, as seen in those with auditory decoding problems. Similar findings

were noted in other types of speech analyses 11, 64

.

Pattern effect was significant for LLD subject 3, 4 and 6. Qualitatively pattern effects represented the integration function

as per Buffalo Model 37

. The lesion associated to pattern effect is corpus callosum 35

. Pattern effect was commonly seen in those

with severe reading and/or spelling problems and who are sometimes labelled Dyslexic34

.


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LLD subject 5 had significant order effect (High/Low) along with significant numbers of reversal responses. Therefore,

qualitatively these were the indication of tolerance fading memory as well as organization problem as per Buffalo Model 37

. The

word "tolerance" refers to understanding speech in noise and "fading memory" refers to auditory short-term or working memory.

"Various" related characteristics such as attention66

are also combined into the TFM category. These appeared to be no functional

connection between these factors. However, blocking out noise, short-term/working auditory memory, attention, and other TFM

signs are associated with anterior portion of the brain23, 40

therefore, the connection among them might be anatomical. Order Effect

high/low is associated with limited short-term memory (a primacy error) 34

.

LLD subject 2 had only increased C-SSW error score might be in presence of dysphonetic dyslexia where other response

biases were absent significantly. The poor readers have difficulty detecting rapidly presented acoustic changes as complex

condition 64 14, 26, 19

.

The final major concern was whether the performance of C-SSW scores differs significantly between normal and

language learning disability listeners. The performance of normal listeners and language learning disability listeners would differ

significantly. The finding was supported by Young‟s study73

. It was an experimental short form of SSW test on 40 learning

disability subjects including male and female with age range 7-11 years along with age matched peers. In the study normal age

matched control group and experimental group performance differed significantly. Another study was performed in 93 normally

achieving children and 97 children referred to a learning disabilities clinic9. All subjects were 8-11 years of age. The SSW test

was found to differentiate between the normally achieving children and those experiencing classroom learning difficulties.

Further, it was found that the performance of the normally achieving group was generally better than current test norms would

imply.

Therefore, from the current investigation for experimental group individual performance could compared both

qualitatively and quantitavely. But statistically qualitative responses could not be judged on disorder population in order to

presence very less sample size and in presence of tie rank exact P value could not be obtained although the pattern of distributions

was unknown. Hence, inferences could not be drawn regarding response biases of disorder population. Further study by increasing

sample size will be able to draw a conclusion regarding the facts.

In the current investigation A-SSW was not taken into consideration because, any site of lesion cases was not taken

where hemispheric asymmetry might be observed along with problem in central auditory processing.

CONCLUSION

The SSW is an efficient, reliable and valid tool to be used among native Bengali speakers between the age ranges of 18-

40 Years in order to detect Central Auditory Processing Disorder. The test may also provide qualitative informations about the

presence of central non auditory dysfunction. It may also be included as a part of routine speech test to differentiate cochlear and

retrocochlear pathology. Same study can be used for development of speech perception research materials. It will further enrich

the field of Audiology.

Limitations of the Study

1. Less number of sample sizes in order to establish a normative and to validate disorder population such as Learning

Disability.

2. To develop a more valid tool few heterogeneous stimulus pattern may be excluded from the final list.

3. Qualitative analysis is not inferential into the study to establish disorder norms.

Future Directions

1. Measurement procedure of adjusted score in SSW test may be further studied to confirm the site of lesion and the amount

of (C) APD.

2. SSW test material may be further developed and standardized in other Indian languages.

3. The study may be incorporated to see the therapeutic improvement in adverse listening condition for (C) APD and that

may formulate a prognostic matrix.

4. SSW test performance in normal listeners and in different (C) APD subjects may be further validated with the help of f-

MRI or other advanced radiological studies can pinpoint the site of lesion.

5. Practice effect study on SSW test may be further documented as an evidence of understanding of adaptive learning.


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181

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