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University of Toronto Mississauga
Stuart Kamenetsky

PSY345 FINAL STUDY PACKAGE Chapter Six: Exceptionalities & Families What is the Social Ecological System consist of? - Purpose - Cultural Beliefs - Parent/Child Roles - Exceptions - Socio-economic circumstances The stages in finding out your child has a disability 1. Shock – This is where parents may blame themselves and/or reassess the meaning of their lives for the present challenges 2. Realization – This is where the parents come to understand the actual demands and constraints when raising a child with a disability 3. Defensive Retreat – The parent will either place the child in a clinical or residential setting because they believe that it would be a safer and less demanding environment 4. Acknowledgement – This is where the parents will accept that the child has a disability What is respite care? It is assistance provided by individuals outside of the immediate family to give parents and other children time away from the child with the disability Does having a child with a disability affect their marital state? There is a small negative impact on marital adjustment • Spina Bifida – A developmental defect in the spinal column • Down Syndrome – A condition caused by a chromosomal abnormality that results in physical characteristics and varying degrees of mental retardation The Parent-Child Relationship as a Developmental Sequence 1. Parent learns or suspects that the child may have a disability  Diagnostic Period 2. Parent makes plans regarding the child’s education  School Period 3. Individuals with the disability has completed his or her education  Post-school Period 4. Parents are older and unable to care for their adult offspring • Dyadic Relationship – Two individuals who develop and maintain a significant affiliation over time. For example, the child may use the mother as an exclusive channel of communication. Important Notes on the Family Dynamics: - Fathers of sons with mental retardations are more concerned about their future and are more likely to be involved with the child if they can speak and interact - 6.5 million children in the USA have a sibling with a disability - There is a strong correlation between grandparents support and positive paternal adjustment - Millions of children with disabilities live with their grandparents as the primary care givers PSY345 FINAL STUDY PACKAGE What is Primary Behaviour Support (PBS)? An approach to developing behaviours that “facilitate and promote comprehensive lifestyle changes for enhancing [the] quality of life for both the individual and his or her family COMMUNICATION DISORDERS Chapter TEN – Communication Disorders A baby says their first word between 9-14 months There are 6 stages 1. 1-2 months – crying or making other psychological sounds 2. 3-6 months – cooing and crying 3. 9-14 months – speaking their first words & babbling 4. 18-24 months – First sentence as well as words 5. 3-4 years – Basic syntactical structure 6. 4-8 years – Articulating all speech sounds in context Communication is one of the most complicated and vital processes we undertake; yet we seldom think about it unless there is a problem - We take it for granted unless there is a problem (even if the problem is mild) such as differences in intonations - Chinese intonations are recognized immediately What is communication? interchange of ideas, opinions or facts between people (exchanging information) - Nonverbal communication takes place in one direction unless you speak up - Not being able to communicate the same as everyone else is a major obstacle (greatest obstacle in belonging to mainstream society) Speech and Language Forms of communication Speech is how we communicate and language is what we communicate - Some components of communication involve language but not speech (body language, ASL, gesturing & reading and writing) - Reading and writing has become much more prominent now that we all have smartphones - We never use to write letters to one another but now it is used through emails and text messages (back in the day we would only sit down and write a letter twice a year or so to someone who lived far away) - It was once considered that people that do not have speech do not have language (deaf and dumb) - Could not speak because you are deaf (not true) and therefore, you were mute - The term of mute was called (the term for someone that cannot speak) but they certainty do have language (Story: Husband is deaf from birth communicates in ASL but does read and write and language, after 5-10 minutes writing and reading to him felt completely natural, there would be facial expressions and gestures) - It is all a matter of what we consider to be normal PSY345 FINAL STUDY PACKAGE - Speech is one means of expressing language but not the only The message we use in communication is the language - Speech is just one of the particular modalities that we use to communicate with each other The Structure of Language Phonology: The system of speech sounds (syllables, phonemes) not all of languages use all of the phonemes (we need to develop them early on in life or it will be difficult to pronounce them) - Set number of phonemes that certain languages use * Rules about what kinds of sounds that can be combined with others and what cannot A phonological disorder - This person won't be able to pronounce certain types of speech sounds (Example "L" many kids have a hard time with this and don't pronounce it) it is mild but it is still a disorder Syntax: Rules that govern sentence structure. Sequences of words are combined into phrases and sentences * word order (reversing them can get completely different meanings) * These disorder tend to be more cognitive and linguistic because they don't understand word order * It is hard to understand them if they are not using the same conventions as everyone else (Arbitrary because word order is not consistent across cultures) Morphology: Form and internal structure of the word (colder, cold, "ing") – The difference from “colder” to “coldest” * People who understand it understand the deeper meanings of the words – Problems is when people will have a hard time expressing the meanings and the different versions of the words * They will have a harder time with the tenses that are determined by the types of suffixes Semantics: Represent the understanding of language (cognitive problem) – Can take shape in many different forms: * Cannot understand the meaning of certain words – people will talk to you and you won’t understand what they are saying * Will only understand frequently used words * Hard time coming up with the right words that you want to express (intelligent but cannot express the words because you cannot attach meaning to the verbal or auditory expression of the idea) Pragmatics: Concerned with use of language in social contexts * Set the language in a certain way because you are aware of the setting and you know what that setting entails (seeing the prof during his office hours) – There is a certain format that you are going to use because you are aware of that setting and know what that certain atmosphere entails * People who understand pragmatics do understand the language differences (sending the prof an email will be different from the email that you send your friends) Tourette's Syndrome - repeat language over and over again, may swear alot, do not have that type of self-control over language (this is a type of pragmatic language disorder) - Autism may cause them to swear a lot because they do not have control over their language Overall, language structure is very complex and there are many areas that can be disrupted by disorders PSY345 FINAL STUDY PACKAGE - Some people with communication disorders can communicate well sometimes in their own ways – So a communication disorder does not mean that they cannot communicate well Language Development: The development of language is complex. Young children normally proress through several stages in developing languages - First 2 years of life they are exposed to language and gradually develop a vocabulary (speaking and understanding verbal language)  Repetition with phonemes with sounds and meanings at a very young age tell them that they are going to feed “come to the table I am going to feed you” - Classically conditioning meanings to children (telling children to come to the table - Give the phoneme meaning for the child) - Gradually the child is able to associate the sound with the meaning - Next, the child will start saying table (will be hard to understand at first) but the people that are close to the child will understand - Gradually, the caregiver will raise the bar (successive approximation) so that the child will meet the target sound, so appropriate speech will come next and then what comes after that is reading and writing (does not come naturally) the child usually has to be taught - This is the sequence but there are variations in terms of what vocabulary learns from the first year But keep in mind, this tends to be the sequence for the average child but it is not the only and right way (Dyslexia may make reading more difficult for children) - Consider variability in terms of the speed and the variation but in most part the sequence is the same - Healthier kids are better at this - Hereditary aspects on how the child will develop (genes) - Environmental influences - Expectations of you while you are developing language (TV allowing the child to learn, but parent child interaction is much more stimulating and allows the feedback loop for the child to excel) - Parents need to read to you a lot and expose you to language - Need to interact with the child so there is a greater potential for the two- way communication with the child Group of Communication Disorders 1. Language Disorders - Serious disruption of the language process, including memory, learning, message reception and processing and expressive skills Who is to say someone has a language disorder? – The disruption is sufficient enough to be noticed - CBC anchors have perfect speech and you tend to notice it - It is clear to notice when someone has a language disorder (process) and it can be told by the number of speech errors, most of us speak normal with lots of speech errors, so for us to notice a disruption it needs to be sufficient enough to be noticed * Receptive Language Disorders – This is where an individual cannot comprehend what others to say (slow to respond) - ½ language processing & half language production - High risk for other language disabilities & so they are under diagnosed PSY345 FINAL STUDY PACKAGE * Expressive Language Disorders – Difficulty in language production. This is where an individual has a limited vocabulary and uses the same arrays in language. - This can sometimes appear as immature speech - These people often use hand signals and facial expressions to communicate * Aphasia – This is the loss of the ability to speak or comprehend language due to a developmental abnormality in the brain - Classified as expressive and receptive problems - Children with aphasia begin to use words at 2 & phases at age 4 * Acquired Language Disorders – Acquired through accidents - Back of the brain  More fluent speech but lacks content - Front of the brain  Can comprehend but cannot speak ** Augmentative Communication – Forms of communication that employ non-speech alternatives Part of new technological developments: - Communication boards - Electronic Appliances • Fluency Disorders – Speech is generally fluent in speed and continuity and fluency disorders involve speech that is interrupted by repetitions, blocking, prolongations of sounds, syllables, words or phrases - 1.5% of the population have these types of disorders (lowest prevalence) 2. Speech Disorders * Delayed Speech – Speak much like a young person - Usually have more articulation errors in their speech pattern Causation: - Environment (deaf, so there is no communication at home) - Negativism – Conflict between the parent’s expectation and the child’s ability to perform (they can be irritated by the child’s attempt to communicate) - The parents will reward gestures and not actual speech 3. Articulation Disorders – Occur in 2% of 6-7 years old children - Can be because of a psychological development - Can be a result of their biological make up - Or, it can be neurological problem/ learned behaviour - Use different parts of the brain (different hemispheres) - This is because they usually develop between 2-5 years of age when language is being developed Articulation disorders are termed phonological disorders on the DSM - Substitutions - Additions - Distortions - May include transitional lisps - Prevalent problem (seen above) Functional Articulation Disorder – This is the result of either not talking to the child enough or encouraging baby talk 5. Voice Disorders – A condition in which an individual habitually speaks with a voice that differs in pitch, loudness or quality from the voices his or her peer groups PSY345 FINAL STUDY PACKAGE • Hyponasality – This is when too little air passes through the nasal cavity, it is also known as denasality • Hypernasality – This is when too much air passes through the nasal cavity and the individual develops a twang in their speech Cleft Palette (Cleft on the lip or palette or both) – There is a gap on the soft palette of the roof of the mouth, sometimes extending throughout on to the top lip. This condition thereby reduces the division between the mouth and the nasal cavities influencing the movement of air. Occlusion – Meshing of teeth on the upper and lower jaw  Malocclusion is the abnormal meshing of the upper and lower jaw Group of Communication Disorders 1. Language Disorders – When there is a serious disruption of the language process, including memory, learning, message reception and processing and expressive skills - Learning opportunities are disruptive - Language is receptive (relate to all these different aspects) - Remember language that we already have • Language delays – Sequence of development is intact but the rate is interrupted (listening and acquiring vocabulary but more slowly) - Start speaking at 3-4 years of age • Language Disorders – The sequence of language acquisition is interrupted - Children may miss a step - Major interruption in the sequence of language acquisition • Receptive Language Disorders - Difficulty in receiving the message which is contained in language • Expressive Language Disorders - Difficulty in formulating and using language (difficulty coming up with the words that we want to use to express our ideas) • Aphasia – Impairment of language comprehension, reception and formulation - Neurological problem associated with the structure of the brain (improper development, disease, gunshot wound or any other strong blow to the head) - The person had perfect language before but after the even they did not develop language properly - Can be expressive and receptive language disorder but in Aphasia we understand the causes of the language disorders Causation of Language Disorder Issue #1: Defective or deficient sensory systems (eyes that do not work well or ears to not work well) - For example, if a child cannot hear the words they will have issues with learning them (English is a phonetic language) so they will not be able to associate the word with the object - If they are blind they will not develop an understanding of concepts (i.e.; table) Issue #2: Neurological Disorder - If the parents do not stimulate the child they will not learn the language Issue #3: Deficient or disrupted learning opportunities PSY345 FINAL STUDY PACKAGE - Jungle Boy - They will still be able to learn the language given the opportunities Intervention Children – Address initial acquisition or learning of language Adults – Involves relearning or re acquiring language function • They make a gradual recovery, they already know the concepts but they just can’t access them Individuals with severe physical or cognitive disabilities – May involve alternative or argumentative communication • Programs or apps designed to help people with disabilities • Software at various different levels that the person at the lowest level can progress to get into a more • Input devices that involve looking at something to communicate what you want 2. Speech Disorders – Defective speech that is sufficiently deviant from normal or expected speaking patterns that it affects attention and adversely effects communication for the speaker and/or listener - Extreme diversity • Fluency Disorders – Normal speech is characterized by smooth flows of language - Most of us are sufficiently fluent (lack ugh, but and then) - Characterized by repeated interruptions (the and uhhh), above and beyond the expected number or interruptions and repeated repetitions that interrupt the flow of education • Cluttering – Quick and rapid speech and tends to be disorganized - Filled with unnecessary and unrelated words (may be some cognitive component that is related to this) • Stuttering – Flow of speech is interrupted by repetition and blocking (try to start talking again but they can’t), prolongation of words and syllables - Mostly characterized by blocking and prolongation of words and syllables - Don’t know why stuttering happens but there many different theories  Symptom of an emotional disturbance (Freud) – Suppressed feelings that are presented through stuttering - At those times they were not able to speak about these types of behaviors (were not able to talk openly about sexual abuse)  Caused by a person’s biological makeup or neurological health - Emotional disturbance resulted in brain damage and function  Learned Behavior - A child may have learned to stutter vicariously (their parents stutter) - It may be a way for the child to get attention from the parent - Related to heredity and gender (boys stutter more than girls) Intervention: Complex - If it is learned behavior we try to change it (not giving the child attention when they stutter but when they use appropriate language) - Some people stutter more in situations when they are in situations that provoke anxiety PSY345 FINAL STUDY PACKAGE (talking in front of a crowd), therefore we try to expose them more to threatening situations • Delayed Speech – May also have maturational delays Causation: - Partial or complete hearing loss (not going to speak because they never heard speech, cannot pronounce words that he or she did not hear) - Little opportunity to learn speech (sitting the child in front of the TV will not give them stimulation) - Cerebral Palsy (brain sends out mixed messages and the individual does not have the ability to control their speech and words), mental retardation, emotional disturbance (psychological, don’t speak) or brain injury - Severe conflict between parents’ expectations and a child’s ability or choice to communication – A child that is expected to speak in forum that they are not expected to speak (the child cannot speak, there is nothing else the child could do in that situation)  Just needed to get through that blockage that cause the problem with the psychological origin Intervention - Varied, but should focus on teaching appropriate speaking proficiency for the child • Surgery and/or prosthetic devices (fix the hearing for the child that cannot hear) • Behavior modification (modify what is reinforcing the child) • Direct Instruction – Speech therapy, sitting with the child and emphasizing “this is what you need to say and when you need to say it” (not speaking about themselves in the third person) - Tell the child that they need to speak properly or they are not going to get it 3. Articulation Disorders – Abnormality in the speech sound production process resulting in inaccurate or otherwise inappropriate execution of the speaking act - Not pronouncing a particular letters or phonemes, substitution (s instead of t), additions and distortions of particular sounds Two Broad Categories: • Articulation problems due to structural physiological abnormalities – Dental malformations, an inappropriate bite, cleft palette, misaligned teeth - It is a machine and if it is not working properly then you will not be able to speak properly • Functional Articulation Disorders – May be environmental and/or psychological disorders - Immaturity, especially in boys (lisp) and as they get older they tend to go away Intervention - Surgery  Surgical repairs of cleft palettes - Surgery to alter jaw structure and alignment in order to correct the jaw structure and alignment - Prosthetic appliances – Braces, dentures - Interventions to teach proper articulation  Speech therapy, real direct instruction techniques “Look at my mouth and look at how I make different types of sounds” • Direct instruction in order to get people to articulate properly PSY345 FINAL STUDY PACKAGE - Many professionals are reluctant to treat functional articulation disorders in young school children because of: • Developmental immaturity – We could ruin their self-esteem and they may not want to speak after that so we leave it alone and see if it gradually diminishes overtime • Resources for treatment – it is expensive so we reserve them for the children that may not be able to speak at all 4. Voice Disorders – Involve unusual or abnormal acoustical qualities in a person’s speech - Can feel the sounds being produced in your vocal cords when you speak • Pitch disorders – Might be too high or too low • Deviations in loudness – People may speak loud and sometimes speak quiet and do not have control over it • Quality of speech Causation - Paralysis of vocal cords or diseases of sound production system - Imitation (copying a male singer that you think you should imitate) - Organic condition (too much estrogen) Intervention - Surgical Intervention - Direct Intervention Movie: (Available on YouTube) - Look at how technology is used - How technology has changed over the 30 years - What hasn’t changed over the past 30 years and what barriers will always remain Hearing Impairments Had to do with so many things other than helping the child, political factors, advances in science, religious teachings (not using your hands to speak because animals do that), and important figures Before: People thought that people that were deaf were unreachable - Helen Keller “Blindness cuts people off from things and deafness cuts people off from people so deafness was worse” - They were band from some religious institutions because they could not read, write or follow the religious establishment Today: - We have deaf leaders in the community - Still view deafness as a dreadful faith How do we understanding hearing? 1. Acoustics of sound - Displacement of air (vibration that causes this compression and refraction of pressure) - Sound is real physical energy and is produced by some vibration that produces that type of displacement - Back and fourth movement can be represented in the shape of a sin wave - Sound has many different types of wave shapes and it has harmonics (many waves that occur at the same time) PSY345 FINAL STUDY PACKAGE Need to understand: 1. Loudness – Intensity 2. Pitch – Frequency (the number of cycles that vibrate per second) it is measures in Hz and humans typically hear between 20-13000 Hz & Sounds in the environment are usually between 300-400 Hz 3. Human Speech – 40-60dB, overall humans can hear between 0-130dB and anything louder than that will be painful • Loudness: Amplitude (dB), the greater number of dB the larger the sound, if we pluck the string very gently it would be a lower wave height (fewer dB) • Pitch: Frequency (Hz), the number of cycles per second this wavelength is taking place (large sounds = many cycles, quiet sounds = fewer cycles), average human hearing is 20Hz - You can have any combination of both of them • Timbre: Quality (wave shape), can have the same amplitude and frequency but they sound differently from each other - Same frequency and amplitude but it may be different How does the ear work? - Sound pressure comes in from the outer ear and vibrates the ear drum (according to the frequency and amplitude that it comes in from) that transports that movement through the three little bones, the last one enters the inner ear (outer part of the cochlea) and as it moves in and out it pushes the fluid, that moves the hair cells that directly stimulate the auditory nerve Problems: • Bones could be broken PSY345 FINAL STUDY PACKAGE • Swelling of the middle ear caused by infection • Hair cells death (they do not grow again) • The auditory nerve could be disrupted from brain injury Overall, it is not the case that people hear or not it might differ in many ways ** Audiograms – Determine what your hearing is like to see if you have what you need to understand speech - Want to know that you reliably say no sound when there is no sound and that there is a sound when there is a sound - They will constantly make the sound louder so you reliably say you hear it when it is there and say you don’t hear it when it is not there - A person who has a profound hearing loss will have a flat audiogram around 90 or 100dB so they hear what is underneath the audiogram (they only hear sounds above 100dB, so things need to be very loud for you to hear them such as a plane taking off) - Speech is around 40-50dB - Important for us to know what the child hears and does not hear The Banana Shape Curve - Tells us in general how loud these sounds are in speech (s is quiet, a has to be louder before we hear it) - Low frequency and high frequency sounds will be heard PSY345 FINAL STUDY PACKAGE Example: The child’s threshold is 110dB - This would be disruptive because they do not hear the language at all - We will know that in the child’s education we will have to focus on sounds that the child does not hear  We HAVE to know what it is the child hears and does not hear in order to properly educate them Difference between deaf and hard of hearing - Hard of hearing: You can make use of whatever residual hearing you have Age of loss is crucial in determining method of intervention - If you never heard a speech sound it is going to be harder for you to repeat it - The earlier the child loss hearing the more difficult it will be for the child to acquire hearing Prevalence 1/1000 at birth but half of these are not identified until age 3 - It is sad when we don’t know if the child is hearing because they missed out in opportunities to be exposed to language Deafness – Hearing of 90dB or greater and uses vision as their primary output Hard of Hearing – Hearing is deficient but somewhat functional Prelingual Loss – hearing loss before age 2 & before speech development Postlingual Loss – Occurs at any age following speech acquisition Conductive Problems – Poor conduction of sound along the passages leading to the sense organ (inner ear)  this can usually be corrected by a hearing aid and/or medical surgery Sensorneural Problems – Abnormal sense organ & damaged auditory nerve, which will distort sound and affect the clarity of human speech - This is more severe than conductive loss & people can only hear sound 70dB or greater - Will not be able to hear the tuning fork regardless of its placement PSY345 FINAL STUDY PACKAGE Mixed Hearing Loss – Combination of both and can be assessed through the use of an air bone conduction test Central Auditory Disorder – This is due to a dysfunction in the cerebral cortex - Loss in the ability of auditory perception, discrimination, comprehension of sound & language development There are 200 types of deafness that have been related to hereditary factors - Connexin 26 - Otoclerosis – Suffer from high pitch ringing or throbbing sound (tinnitus) Causes - Bacterial infections - Viral infections – Spread through close contact - Prematurity • Atresia – External auditory canal is either malformed or completely absent at birth • Meningitis – Inflammation of the membranes all over the brain and spinal cord • Otitis Media – Inflammation of the middle ear - Prenatal infections of mother • Rubella Cytomegalovirus (MV) & Toxoplasmosis [33% of infants born with this disease are deaf] • Also acquire heart disease, cataracts/glaucoma & mental retardation • Damage to the central nervous system (CNS) [seizures, hydrocephalus, microcephaly) - Excessive noise - Anoxia (deprivation of O2 at birth) - Rh incompatibility - Blows to the head - Side effects of antibiotics - Genetic Factors – Complicated, 1/6 people carry the gene EDUCATIONAL APPROACHES Important to teach babies sign language as soon as you can (see page 337) 1. Oralism – Enhancing hearing with hearing aids or cochlear implants and teaching oral English language skills in inclusive skills • Hearing Aid – comparisons from now to the past - It is a magnet with a coil of electricity (like a microphone) • FM systems – Instead of playing out through the loud speaker it plays into the student’s ear (choose where to locate the microphone and the speaker is in their ear so what the child needs is there fore there lesson) - Sound Field – Problems with sound and picking up signals because the teacher in the adjacent room could be using it too and they would pick up on the signals (need to set them on different channels) - We are increasing the amplitude of the sound waves so they get where they are suppose to be - We recognize that they are defective systems (medical model) so we fix them PSY345 FINAL STUDY PACKAGE 2. Manual – Taught American sign language and communicate with their hands, segregated into provincial schools - Take a cultural approach to deafness  American Sign Language (ASL) is their means of communication, just like other people speaking English or Arabic - Sign systems are different because they attempt to create visual equivalents of oral language through manual gestures 3. Bilingual Approach – Teaching ASL primary and English second for children who are deaf 4. Total Communication – Simutaneous presentation will make it easier to understand both signs and speech 5. Cued Speech – 8 different hand signs in 4 locations under and near the person’s chin 6. Closed Captioning – This is also known as line 21 system as of Jan2006 through the Telecommunications Act 7. Text Telephones (TT) – Send & receive print messages Otologist – Specialist concerned with the hearing organ and its diseases - Diseases of the ear, nose and throat Audiologist – Assessment in a person’s hearing ability (Emphasis on the functional impact) Hearing Impairment - Deaf – flat audiogram (100db) and cannot make use of their residual hearing - Hard of hearing – can make use of their residual hearing because there is enough over there for them to make use of their speech Educational Approaches Oralism – Enhancing hearing with hearing aids or cochlear implants and teaching oral English language skills in inclusive setting - The child will be able to be educated in an inclusive setting (the hope) • Hearing Aid – Amplifies the sound and makes it louder (30db-60db in a very simple and logical type of fashion, just like a speaker system but it will be done individually inside your ear) • VIDEO: Amplify sound to the extent that is possible and teach them oral English and classically condition sound with meaning so they are able to learn the same way we do – Filmed 20 years ago when cochlear implants were not prevalent - These people are successes in oralism - Some of these individuals do not have perfect speech and their speech is unintelligible and not easy to understand - They were able to be brought up in inclusive setting and environments • FM system – Passed around a microphone that amplified speech directly into the child’s ear (same thing as a hearing aid) but the microphone is located where the teacher speaks instead of the child’s ear - So the microphone will solve problems such as distractions or if the teacher speaks to softly PSY345 FINAL STUDY PACKAGE - VIDEO • Sound Field – A PA system that is more portable and better in terms of what they sound like (it is a speaker and an amplifier) and wherever they are, they simply use that - Simple classroom techniques (repeating student comments) we should always use - The kids speech read and lip read to a certain extent - A combination of amplifying sound using technology (maximizing dB) we are able to keep these kids and educate them in inclusive settings • Cochlear Implant - Problem with the ear drum – sound will go through the ear drum and it will not vibrate the way it should - Ossicles – can be repaired and replaced - Can all be functioning well but not strongly enough • Neurological – nerve that goes from the brain to the ear is severed PSY345 FINAL STUDY PACKAGE • Hair cells in the cochlea are missing (die from too loud noises) – if the hai
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