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EDITORIAL
Year : 2019  |  Volume : 25  |  Issue : 2  |  Page : 49-52

Visual speech perception


Department of ENT, Indian Institute of Ear Diseases, New Delhi, India

Date of Web Publication16-Aug-2019

Correspondence Address:
M K Taneja
Department of ENT, Indian Institute of Ear Diseases, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/indianjotol.INDIANJOTOL_67_19

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How to cite this article:
Taneja M K. Visual speech perception. Indian J Otol 2019;25:49-52

How to cite this URL:
Taneja M K. Visual speech perception. Indian J Otol [serial online] 2019 [cited 2019 Sep 21];25:49-52. Available from: http://www.indianjotol.org/text.asp?2019/25/2/49/264675



Hearing is an essential sensory sense of an individual for development of speech which is crucial for verbal communication and personality development. Hearing impairment is one of the most frequent sensory deficits in human being. It is the second most common form of disability after locomotor disability in India.[1] Deafness is like any other human deficiency, namely blindness, orthopedic problems, or any other kind of physical challenge. Disabling hearing loss is more than 40 dB hearing loss in better ear in a person more than 15 years of age and >30 dB hearing loss in better hearing ear below14 years of age. WHO estimated 360 million individuals in the world with disabling hearing loss, of which 91% are adults and only 9% are children.[2] Prevalence of disabling hearing impairment in South East Asia in children is 2.4%, and adults below 65 years is 9.5%. The prevalence of deafness is as high as 48% in population above the age of 75 years.[3]

It is a usual belief that perception of speech is an auditory function; hence, we assume in senior citizen with sensorineural hearing loss (presbyacusis), nothing significant can be done to help if hearing aid is not acceptable or does not add to clarity to speech perception.

The question in mind is can we rehabilitate these senior citizens with visual speech perception by learning lip reading, activation of nondominant brain and mid brain by generating alpha brain waves. It has been observed that a visual speech stimulus can augment the hearing in noisy environment.[4] This has been observed by functional magnetic resonance imaging (FMRI) that visual speech stimulates the cortical auditory area.[5]

The perception of visual speech stimuli varies with the individuals and can be activated by practice which is by multimodel perception, a neuroplastic effect by sensitization, or taking over of cerebral auditory cortex or by surrounding brain tissue.

The art of identifying the phonemes by vision is termed as viseme. We can explain it by example, the differentiating unit in bad/bat, d/t is phoneme and perceiving the expression on the face (lip) is visemic. The speed of sound is 343 meters per se cond while speed of light is 299,792,458 meters per se cond; hence, vision is 874,000 faster and early than sound stimulating the auditory cerebral cortex. The visual effect of lip reading and prosody (facial and body gestures) affect and influence the perception of heard speech. Interpretation of phonemes at auditory cerebral cortex is by multimodel multicenter brain activation[6] and by audio visual integration.[7] The core area for the visual speech perception are facial fusiform area in the right lateral portion of fusiform gyrus, occipital face area, and posterior superior temporal sulcus[8] These observations have been confirmed by FMRI that every psycholinguistics' speech structure visemic (phonetic features), phonemes, syllables words, and prosody may be perceived visually by visual cerebral cortex area. This has been further confirmed by electroencephalography/electrocorticography that audio visual processing and integration take place in nonprimary cortical areas.

There is two-fold impact on quality of life; one is by impairment of hearing; another is cognition which is memory attention, neural processing, and speed of processing of hearing input. Researchers have proved that hearing impairment and cognitive decline are associated; hence, we can predict a better quality of life and somewhat better speech understanding by improving the concentration power, neural network, processing speed, and working memory. This will lead to enhanced processing of auditory information. This can be achieved by focused concentration dynamic neurobics, optimizing the cerebral blood flow by cervical, other yogic exercises, and Bhramari Pranayam.[9]


  Bhramari Pranayam Top


It is a breathing exercise; a humming sound is produced during exhalation with an effort to generate the echo in the ears. In modern medicine, higher frequency sounds (ultrasound therapy) is a known modality in the treatment of tinnitus and sensorineural deafness. Apart from restoration of hearing by stimulating the hair cells and generating action potential, it is also quite effective in destressing. Bhramari releases nitric oxide in the body which acts as a vasodilator and increases tissue perfusion.

Patient is instructed to take a slow deep abdominal breath, lift the tongue and press on hard palate in Khechari Mudra, hold the breath in, blow the cheek for better echo, close both ears with thumbs of both hands keeping them on concha simultaneously blocking the ear, and both eyes are gently closed by index finger. The index finger should rest on the lateral wall of nose. Both middle fingers are put on base of ala of nose, and mouth is closed on both sides, upper lip by ring fingers and lower lip by little fingers. Both eyes are focused in Shambhavi Mudra at the Ajna Chakra in-between both eyebrows. A constant rhythmic-uninterrupted specific frequency sound (mouth closed) is generated. Spiritual concentration is focused on Dwarika Dhish (Deity). After complete exhalation, hold the breath out; Vahya Kumbhak is enforced with Jalandhar bandha and spiritual focus on Lord Shiva (Deity). Keep holding the breath out as long as possible, give a command to brain that my whole body is revitalizing with improvement in hearing.[10]

The exercise can be performed sitting comfortably in calm places, eyes closed, relaxed mood with a smile on face, place your index finger gently in the ear canal or on tragal cartilage to gently block the ear canal. Take a deep breath, and as you exhale slowly, make a loud humming sound and generate echo, and focus your attention toward the inner ears. A high pitch sound gives better results. It also helps in regaining better speech recognition.


  Greeva Chalan (Neck Exercise) Top


With the growing age, there is some degree of reduced blood supply to brain and labyrinth by compression of the vertebral artery (VA) due to stiffness of neck muscles (cervical spondylolisthesis). Compression of VA can be minimized by regular cervical (neck) exercise.

Body position – The neck exercise can be performed sitting on chair, floor, or on bed margin. Fix the upper half of body by fixing the upper limbs including shoulder by placing both palms firmly on ground, arms of chair, or on thighs so that only neck and head should move, movement below the neck keep the back straight but relaxed. It is a set of four exercises.

Neck flexion-extension exercise

Start the exercise by slow deep abdominal breath through the nose and by holding the breath in. Tuck the chin into the chest by gently bringing the head downward.

Focus physical awareness on the back of the neck and spiritual awareness on Vishuddhi Chakra. Hold the breath in and position to the maximum comfortable duration; give the command that all neck muscle are getting relaxed and there is no spasm and no pain; enjoy and feel the increase in blood flow to the ear and brain along with increased power of hearing. Now come in neutral position and exhale. Inhale deeply and slowly in abdomen. Gently band the head upward and backward, let it go to the maximum with ease. Focus your physical awareness on the back of neck muscles and spiritual awareness on Vishuddhi Chakra. Hold the breath in and position to the maximum comfortable duration; give command that all neck muscles are getting relaxed and there is no spasm and no pain; enjoy and feel the increase in blood flow to the ear and brain along with the increased power of hearing. Exhale and come into the neutral position. Repeat whole of the exercise three times.

Note – Relax by slow deep abdominal breathing, hold the breath, make sure there is no tension or stress. Give a command that you are feeling comfort and release of spasm of neck muscles with loosening of vertebral joints.

Patients of severe cervical spondylitis should start the exercise with extension only, once spasm is released, may go for flexion exercise.


  Lateral Flexion Exercise Top


Start with the slow deep abdominal inhalation, hold the breath in, and fix the shoulders. Flex (tilt) the neck to the right, try to touch your right ear to right shoulder. Do not lift the shoulder, keep the palms firmly on floor, and be gentle but do with definite stretching. Focus your physical awareness to the back of the neck and spiritual awareness to Vishuddhi Chakra. Hold the breath in and position to the maximum comfortable duration; give the command that all neck muscle are getting relaxed and there is no spasm and no pain; enjoy and feel the increase in blood flow to the ear and brain along with the increased power of hearing. Come back in the neutral position and exhale. Again take a slow deep abdominal breath now flex the neck to left and make effort to touch left ear to the left shoulder. Hold the breath in and position to the maximum comfortable duration; give the command that all neck muscles are getting relaxed and there is no spasm and no pain; enjoy and feel the increase in blood flow to the ear and brain along with the increased power of hearing. Exhale, and come back into the neutral position. Do not turn or rotate your head.


  Head Rotation Exercise Top


Start with slow deep, abdominal breathing in hold the breath in, fix the shoulders, and rotate your head on neck to the right side. Focus your awareness to the back of neck and spiritual awareness to Vishuddhi Chakra. Be gentle but try to rotate and stretch to your maximum; hold the breath in and position to the maximum comfortable duration; give the command that all neck muscles are getting relaxed and there is no spasm and no pain; enjoy and feel the increase in blood flow to the ear and brain along with the increased power of hearing.

Now, come in neutral position and exhale. Again take a deep abdominal breath, rotate your neck to be left be gentle but with definite stretching. Focus your awareness to the back of neck and spiritual awareness to Vishuddhi Chakra. Hold the breath in and position to the maximum duration, give the command all neck muscles are getting relaxed and there is no spasm and no pain, enjoy and feel the increase blood flow to the ear and brain along with increased power of hearing. Come back to the neutral position.

All these three exercises are performed to the maximum stretch and maximum duration and movement, but with ease, no overstretching or pain; remember, all yogic exercises are for relaxation, so smile and enjoy. Give a command to brain and body to act accordingly is the most vital part.


  Counter Pressure Neck Exercises Top


Second set of three exercises: performed in the same way but we do not move the head but apply the counter pressure by the hand on moving head and stretching neck muscles.

360° head rotation

It should be performed by the beginners in sitting posture to avoid giddiness and sudden fall. After slow deep abdominal inhalation and holding the breath in, smile and start by tucking the chin into the chest swinging to the left shoulder to back then going to the right side shoulder and coming back forward and downward in the initial position. Repeat 3 more times.

Again a slow deep abdominal inhalation with holding of breath in, repeat the exercise three more times start by rotating the head to the right side shoulder to back then going to the left side shoulder and coming back forward and downward in the initial position; perform at least three rotation in slow pace but keep smiling and holding the breath in and exhale. Now inhale deeply, slowly in abdomen, exhale fully by squeezing the abdominal muscles, and relax.


  Skandh Chalan (Shoulder Exercise) Top


Sit comfortably on chair or hard comfortable floor preferably in Sukhasana, put both hands on both knees, elbows just touching to the sides of body. Start with slow deep abdominal inhalation and holding the breath in. Focus your physical awareness on back between the shoulder blades and spiritual awareness on Manipura Chakra. Rotate your both shoulders first forward then upward then backward and then downward completing one cycle. Try to do it maximum time steadily in a single breath, repeat your breath if needed. Do it 21 times.

Relax by slow deep abdominal breath, hold it, and give a command that every neck and shoulder muscle is relaxing, there is no spasm, and all whole body including ear and brain is revitalized with improvement in hearing. Repeat the shoulder exercise in reverse direction after holding a deep abdominal breath. Both shoulders should go down then posterior, superior, and coming anterior and in the initial neutral position completing one cycle. Do it maximum time in a single breath, repeat your breath if needed. Do it 21 times, relax, and give a command that all neck and shoulder muscles including ear and brain are revitalized along with the increased power of hearing.

Alternate

shoulder rotation exercise

After deep inhalation and breath holding, exercise is performed; right shoulder goes up and left shoulder will go down, and when right shoulder will go forward, the left will go backward, thus completing the cycle; do it maximum time in a single breath. Repeat your breath if needed. Do it 21 times, relax, and give a command that all neck and shoulder muscles including ear and brain are revitalized along with the increased power of hearing. Now perform the exercise in reverse direction.

Note – This exercise is a powerful exercise. It revitalizes the body, builds up confidence, alleviates depression, delays aging, increases cognition power, and prevents from dementia and Alzheimer's disease.


  Hastapadasana Top


Hast mean hand and Paad means foot; hence, a union of hand and foot is termed as hastapadasana. Stand erect with both feet together, for senior citizen both legs 10 cm apart, hands by the side of the body, relax, and smile. Maintain weight equally on both legs. Join both hands by joining in pranam mudra at the level of lower chest (Anahata Chakra) smile and Chant “Om mitrayNamay.” Take a slow deep abdominal breath, hold it, stretch your trunk shoulder, both arms upward, flex the head tuck the chin into the chest, bend forward so that the trunk becomes parallel to the floor, relax the shoulders and upper arms but arms out stretched with elbow extended.

Exhale completely, squeeze your abdomen, bend further forward and downward on lower spine, do not bend your knees, and try to touch your fingers to the great toe. Practice it gradually; whole hand should touch the feet or the floor by the sides and forehead to the knees. Relax your body smile, focus your spiritual awareness on Ajna Chakra and physical awareness on lower back muscles. Hold the breath in and position to the maximum comfortable duration, give the command all back muscles are getting relaxed and there is no spasm and no pain, enjoy, and feel the increase in blood flow to the ear and brain along with improvement in hearing. Slowly return to the neutral position in reverse order. Inhale and relax.

This aasana improves (Vatadosha) digestion, alleviates flatulence, increases in blood flow to brain and hence improves concentration said to improve hearing and speech discrimination, delays aging, prevents dementia and Alzheimer's disease.


  Tratak Top


Tratak is a Sanskrit word derived from traytak that means three: first is practitioner (Yogi), second is object viewed, and third is the process of viewing when all three become one; it is called tratak which leads to dhyan, and all chittvratis are eliminated. This state can be termed as state of Samadhi. In this state, scientifically brain is calm, relaxed, and alpha brain waves are generated. These alpha waves give a command to body through the hypothalamus to calm down and healing takes place. It is a state of one point internal consciousness. Tratak procedure can be divided as VahyaTratak, AntahTratak, and adhotratak. VahyaTratak: Initially, it can be practiced by focusing the eyes on nail of thumb; later on, it is practiced on a spot called as BinduTratak.

Procedure: Sit in any comfortable position whether on floor, chair, or margin of bed but be sure that spine is erect, body is comfortable, relaxed, smile on face, squeeze the whole body, close the eyes, take a deep abdominal breath, keep the spine straight, exhale and relax the whole body give a command and make positive effort to relax the mind, open your eyes, extend your left hand at the shoulder level parallel to ground and continuously focus your both eyes on the nail of thumb, do not blink, stare uninterruptedly, till the tears start rolling. Now close the eyes, relax, and repeat the cycle. Just focus the eyes, relax the body and mind. It will lead to introversion. Always do the Tratak by left hand; it activates the right side brain.


  Dynamic Neurobics Top


It is an exercise to channelize the subtle energy from muladhara chakra onward to Anjana Chakra. Correct technique, posture, frequency of humming focused concentration along with relaxed mind is necessary to achieve result.


  Technique Top


Stand erect tall with both feet shoulder distance apart both great toe slightly facing inward, squat go down slowly and inhale simultaneously; your thighs should become just parallel to floor, lean forward with minimum arch, knees in line with the toes. Lift your toes upward and focus your eyes in front, sit on an imaginary low lying chair. Come up slowly in maximum comfortable duration along with an uninterrupted sustained pitch humming (Bhramri), during the whole exercise keep smiling, relax enjoying and keep giving command to brain that I am relaxed, my cognition power and hearing power is increasing. Repeat the squat. Young should face east which radiates predominantly violet pranic energy, activates the Ajna chakra, pineal gland, while old person should face north which radiate red pranic at energy muladhara chakra.


  Conclusion Top


Man is born with inbuilt power to correct many of the body defects and fight illness. Most illnesses start in our mindset grow when abetted by fertilizer, namely depression, tobacco, alcohol, bad food habits, environmental pollution, and modulated by genes. Depression, hostility, and anger are the key factors regarding the fighting (immunity) power which is further aggravated by questionable drugs leading to decline in cognition power. It is a myth that presbyacusis is genetic also. Gene lone cannot bring on any disease. The presence of a gene only indicates possibility. As human mind is the driving force for wellness as well for illness; hence psychotherapy, yoga, dynamic neurobics, Bhramari, good psychosocial and physical environment along with healthy diet and life style not only prevent aging deafness also lead to better rehabilitation.[11] Prolong use of mobile phone should be strictly discouraged in persons with family history of deafness.[12] Supplementation of Vitamin D and Iron in anemic patients specifically edentulous improves nerve action potential and cognitive power.



 
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Taneja MK. Role of ENT surgeons in the national programfor prevention and control of deafness. Indian J Otol 2012;18:119-21.  Back to cited text no. 1
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2.
World Health Organization Deafness and Hearing Impairment Factsheet; February 2014. Available from: http://www.who.int/mediacentre/factsheet/fs300/index.  Back to cited text no. 2
    
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WHO Fact Sheet Global Estimates on Prevalence of Hearing loss; 2012. Available from: http://www.who.int/pbd/deafness/WHO_GE_HL.pdf.  Back to cited text no. 3
    
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Calvert GA. Crossmodal processing in the human brain: Insights from functional neuroimaging studies. Cereb Cortex 2001;11:1110-23.  Back to cited text no. 4
    
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Rhone AE, Nourski KV, Oya H, Kawasaki H, Howard MA 3rd, McMurray B,et al. Can you hear me yet? An intracranial investigation of speech and non-speech audiovisual interactions in human cortex. Lang Cogn Neurosci 2016;31:284-302.  Back to cited text no. 5
    
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Kayser C, Petkov CI, Remedios R, Logothetis NK. Multisensory influences on auditory processing: perspectives from fMRI and electrophysiology. In: Murray MM, Wallace MT. editors. The Neural Bases of Multisensory Processes. Boca Raton, FL: CRC Press; 2012. Available from: http://www.ncbi.nlm.nih.gov/books/NBK92843/.  Back to cited text no. 6
    
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Nath AR, Beauchamp MS. Dynamic changes in superior temporal sulcus connectivity during perception of noisy audiovisual speech. J Neurosci 2011;31:1704-14.  Back to cited text no. 7
    
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Fox CJ, Iaria G, Barton JJ. Defining the face processing network: Optimization of the functional localizer in fMRI. Hum Brain Mapp 2009;30:1637-51.  Back to cited text no. 8
    
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Taneja MK. Deafness, a social stigma: Physician perspective. Indian J Otolaryngol Head Neck Surg 2014;66:353-8.  Back to cited text no. 9
    
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Taneja MK. Improving hearing performance through yoga. J yoga phys Ther 2015;3:194. [doi: 10.4172/2157-7595 1000194].  Back to cited text no. 10
    
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Taneja MK, Varshney H, Taneja V, Varshney J. Ototoxicity, drugs, chemicals, mobile phones and deafness. Indian J Otol 2015;21:161-4.  Back to cited text no. 11
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Taneja MK, Taneja V. Role of Vitamin D in prevention of deafness. Indian J Otol 2012;18:55-7.  Back to cited text no. 12
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  In this article
Bhramari Pranayam
Greeva Chalan (N...
Lateral Flexion ...
Head Rotation Ex...
Counter Pressure...
Skandh Chalan (S...
Hastapadasana
Tratak
Dynamic Neurobics
Technique
Conclusion
References

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