AR Exam 3 Flashcards
IEP’s include:
Statement of the present level of performance
Statement of annual goals
Short-term instructional objectives
Special education provided
Participation in regular educational program
Projected date for services to begin
Anticipated duration of services
Criteria to determine if objectives are achieved
Procedures to determine if objectives achieved
Schedules for review
Assessment information
Placement justification statement
Audiologist Do:
♣ Test hearing and speech.
Select, fit and maintain listening device and ALDs, including FM units.
Assess central auditory function.
Assess classroom acoustics and make recommendations (Ambient noise level, reverberation times).
Provide direct speech perception training.
Consult with multidisciplinary team.
Serve as educational audiologist in school system.
SLP do:
Assessment speech, language, literacy, and speechreading skills.
Possess knowledge of listening devices and ALDs.
Provide direct speech-language and speech perception therapy.
Consultation with parents.
Sign language instruction.
Act as liaison between clinic, classroom, and home.
Consultant to audiologist.
Provide speech perception training.
Individuals with Disabilities Act (IDEA, 1997)
mandated services for infants and toddlers, expanded coverage to age 21
IFSP
(birth-3 years): family centered approach, build upon its strength.
Bilingual/ Bicultural Model
ASL first, spoken language taught in school
Total Communication (Manually Coded English):
manual signs corresponding to words of English, person speaks simultaneously while signing, child uses every available means to receive a message (sign/residual hearing/lipreading).
Aural/Oral Language:
same language used with normal hearing. Speaking and speechreading to receive messages. Multisensory approach (vision/hearing). Unisensory approach with some children (only residual hearing). Helps achieve better S/L performance.
Cued Speech
phonemically-based hand gestures to supplement speechreading. Talker speaks while cueing message
Ling Sounds
span the range of speech frequencies that commonly occurs in running speech
Amplification: hearing aids received as early as 4 weeks of age. 5 step process:
- Selection: size of ear/ instrument
- Verification: real ear measures
- Orientation: parents need to learn about care and use
- Validation: looking to access childs response to sounds
- Follow-Up: infants and toddlers more often than adults
Most common birth defect:
Hearing loss
Behavioral Observation Audiometry (BOA):
auditory behavior index (ABI). Observation of child’s response to sound (changes in sucking pattern, eye widening, activity cessation, head turn). Doesn’t test threshold. Habituation to sound.
Visual Reinforcement Audiometry (VRA):
acoustic signal and reinforcing head turn with a light stimulus or animated toy/video. 6 mos-2.5 yrs. Operant conditioning response based. Observe natural tendency to turn to sound.
Conditioned Play Audiometry (CPA):
child is trained to perform a task in response to a sound. 2-5 years. “wait and listen” behavior. Familiar toys. Can be used for speech testing.
Cytomedalovirus (CMV)
common, member of herpes family virus. Usually no symptoms in adults, fairly harmless. Babies at risk for active infection and complications born to women who are infected. Causes 20-30% on HL. Some children asymptomatic at first and symptoms become present later in life.
Genetic causes:
½ of congenital HL. Confirmed by physical exam/family hx/ancillary medical testing (CT and molecular genetic testing). Autosomal dominant/recessive. X-linked gene. Syndrome.
Auditory Neuropathy
affects peripheral nervous system. Mild-moderate loss. Present OAES. Abnormal/absent ABR. Poor speech recognition.
Tinnitus:
25-55% of ch with HL affected. Inflicts insomnia, emotional trauma, physical symptoms, attention difficulties and listening challenges. Lack context of normal hearing so it’s hard to detect.
Central Auditory-Processing Disorder (CAPD)
central cause. Transmission of signal from brainstem to cerebrum. May/may not know cause. Difficult to diagnose. Difficulty localizing sounds, auditory discrimination, recognizing auditory pattern and associating meaning to sound.
Detection of HL:
Ch may have failed a screening (newborn, pediatrician or school)
Ch does not respond to sound the same way as children who have normal hearing
Ch has speech and language delay
Universal Newborn Hearing Screening (UNHS) or Early Hearing Detection Intervention (EHDI)
o It’s the application of rapid and simple audiological tests to all newborn babies prior to leaving the hospital in order to identify those babies that require further testing.
Testing is done with either:
Automated Auditory Brainstem Response (ABR) Otoacoustic emission (OAE’s)
Risk factors for HL (50% of Ch have no risk factors at birth):
Low birth weight (less than 3.3 pounds) Family history of hearing loss In utero infections such as cytomegalovirus, rubella, or herpes Ototoxic medications Low Apgar scores Need for ventilator for 5 days or longer Craniofacial anomalies Physical manifestations consistent with a syndrome Bacterial meningitis Hyperbilirubinemia (severe jaundice)
Otoacoustic Emissions (OAE):
low level sound emitted by cochlea on presentation of an auditory stimulus. Inaudible sounds from outer hair cell function. Pass/refer. 2/3/4/5000 Hz.
Sequential-Stage Model Of Grieving:
shock and denial, guilt, bargaining, anger, depression/detachment, acceptance.
Circular-Pathways Model Of Grieving
sequential stage reactions, grieving experience as enduring cyclical approach, positive pathway (hope, future with optimism), negative pathway (despair/anger/protest).
Assistive Technology: FM devices are typical in classroom settings:
Personal microphones (teacher only).
Environmental microphones (whole classroom).
In personal set-up, teacher wears microphone.
Student wears receiver.
Audiologist serves as resource for teacher to ensure comfort with system.
Children in classrooms with Mild or moderate hearing loss:
May have difficulty listening in noisy and reverberant classrooms.
This can lead to deficits in speech recognition, academic learning, social skills, and self-image.
These children may need aural rehabilitation.
Children in classrooms with Unilateral Hearing Loss:
Historically, have received little or no intervention.
These children are at risk for language delay, as they miss out on incidental learning, or opportunities to overhear information from diverse sources.
Favored seating in classrooms can help.
Education For All Handicapped Children Act (1975
guaranteed free and appropriate education for children with disabilities ages 3-18 in least restrictive environment. SpEd provided at public’s expense.
Center-based programs:
children attend weekly therapy for a set number of hours
Home-based programs
early-intervention specialist visits the infant’s home and provides instruction to the parents and child.
Lesson plans: (program)
provide kinds of activities appropriate for very young children. Serve as a series of goals for the child.
Informal Instruction:
Irregularly as clinicians observe parent-child interactions. Clinicians should be tactful, provide respect for parents and avoid being overly negative.
Formal Instruction:
Didactic Instruction: teach language-stimulation strategies
Guided Learning: provides coaching on the language strategies
Real-World Practice
Four Design Principles for AT
Auditory Skill level, Stimulus Units, Activity Kind, Difficulty level
Auditory Skill level
Sound Awareness (detection) – detect presence/absence of sound
Discrimination – differentiates same/different or pattern perception
Identification – label some auditory information and suprasegmentals (vowels/consonants)
Comprehension – understanding of spoken language (answering ?s, following instructions, paraphrasing, conversation).
Stimulus Units
addresses whether the approach puts emphasis on segments of speech (analytic) and meaning of utterances (synthetic). Most use both.
Activity Kind
formal training activities occur at specific times of the day, either one-on-one in small groups (highly structured and may involve drill).
Difficulty Level – 6 ways: Four Design Priniciples for AT
a ) Varying the size of the stimuli set used for the training (closed, limited or open set)
b) Vary the stimulus unit (training exercises with words or phrases are easier than sentences)
c) Varying stimulus similarity (start with dissimilar and move to similar)
d) Context (speech stimuli that are supported by linguistic or environmental context are easier)
e) Moving from structured to spontaneous tasks
f) Altering listening environment or stimuli presentation (changing the SNR)
Vowel objectives:
discriminate vowels that differ in first format info/second formant info, discriminate words that have vowels with similar first and second formant info. Identifying words with different vowels (4-item response set/open set).
Consonant training objectives (contrast place, manner and voicing
Discriminate nasal/nonnasal voiced/voiceless consonants, and fricatives v. voiced/voiceless stops that differ in place of production. Identify words.
Synthetic Training Objectives:
Dependant upon student’s skill level, synthetic training objectives might begin with simple discrimination activities (suprasegmental). Suprasegmental aspects include intonation, stress, duration, and loudness
Speechreading training:
Some studies have found children improved their recognition of phonemes following training. Speechreading training, in conjunction with the use of a tactile aid, also appears beneficial.
Formal Training: AT
stimuli becomes challenging over time, variety of talkers for traiing items, many traiing items presented over short period, nonspeech training stimuli only to be used with prelingually deaf young students over a short time. Closed to open set response. 10-15 minutes a day of AT. Engaging and interesting.
Informal AT:
can enhance confidence in conversation ability. Can be coordinated with speechreading.
