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AUDE 6140 - Pediatric Audiology > Conditioned Play Audiometry (CPA) > Flashcards

Conditioned Play Audiometry (CPA) Flashcards

1
Q

What is conditioned play audiometry?

A

A method of testing hearing in toddlers and preschoolers through conditioned motor responses to sound using game activities

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2
Q

Why is VRA an issue with those 36 months and older?

A

Habituation is too fast, only do it for a few minutes

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3
Q

When was CPA introduced?

A

The 1950s
Protocol has only been modified slightly since

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4
Q

What is the target population for CPA?

A

30 months to 5 years of age
Cognitively older than 3 years but challenging for children younger than 2 and a half

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5
Q

What is the first task before CPA is performed?

A

Determine the child’s cognitive age through case history, normal motor and language development milestones, and absence of significant development issues

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6
Q

What is the goal of CPA?

A

To determine if the child have sufficient hearing to develop speech and language

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7
Q

When can children begin to cooperate voluntarily during hearing testing?

A

About 30 months cognitive age

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8
Q

What is a challenge in CPA?

A

Keeping the child entertained for long enough to complete the tests
Be creative
The audiologist needs to be the one who makes the decision of when to continue or end a testing session

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9
Q

What transducer should you start with in CPA?

A

Headphones/inserts
Ear specific information

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10
Q

What are some pros of supraaural headphones in CPA?

A

Easier to be placed
Easier to be removed

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11
Q

What are some cons of supraaural headphones in CPA?

A

Can be heavy for a small head
Needs to be positioned directly at the opening of the ear canal

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12
Q

What are some pros of inserts in CPA?

A

No need to monitor for position
Provides the best test results

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13
Q

What are the cons of inserts in CPA?

A

Requires more effort and more convincing to be inserted

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14
Q

What are the different transducers that CPA testing can be accomplished with?

A

Earphones
Bone conduction
Hearing aids
CIs
FM systems

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15
Q

What test stimuli should be used for CPA?

A

Warble tones or narrow bands of noise will provide frequency specific information

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16
Q

Can other test stimuli be used for CPA too?

A

Yes, such as broadband stimuli
But will not provide frequency specific information

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17
Q

Should you start with speech stimuli during CPA?

A

Yes, if they respond to speech
May make it more interesting for the child
Condition to listen and drop task
Speech awareness (detection threshold)

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18
Q

What should you do after the child is conditioned to the listen and drop task with the speech stimuli?

A

Change the stimulus to tones or narrowband noise to obtain an audiogram

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19
Q

What stimuli can you try with children that are developmentally delayed?

A

Tones
Narrow band noise
Music

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20
Q

What should you start testing with?

A

A task that requires the least amount of cooperation and them move on to more difficult tasks once the child becomes more comfortable

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21
Q

What should you do if the child is resistant to earphones?

A

Begin testing in the sound field, obtain two or three thresholds, then try using earphones again

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22
Q

What is a good protocol for CPA?

A

A good protocol is to start at 2,000 Hz in one ear and then move to 2,000 Hz in the other ear
Then repeat at 500 Hz

23
Q

How do you determine a starting level for testing CPA?

A

Case history and interaction with the child will give you some information regarding the level at which the child should be hearing sounds

24
Q

What level should you train the child?

A

Train the child at a level they hear
If a child responds at normal conversation levels, then we can probably start training around 40 to 50 dB
If the child does not respond a normal conversation levels but seems to be developing otherwise in a normal manner (e.g. Motor skills) the child may have a hearing loss, then start your training at a high intensity level

25
Q

Is it better to have one person in the room and one running the test?

A

Yes, but it can be done with only one person

26
Q

Do we have to teach the child to respond at the onset of the auditory stimulus?

A

Yes

27
Q

Is a period of pre-play beneficial?

A

Yes
It helps comfort them in the new environment and puts them at ease with unfamiliar faces
You can also see what toy the child is naturally drawn to

28
Q

What is an example of a behavioral response (targeted response)?

A

The child holds a toy up to his ear and drops it in a bucket when he hears a sound

29
Q

What is the conditioning process?

A

Auditory stimulus
Behavioral response
Reinforcement

30
Q

Should you be careful to suggest activities that need good dexterity?

A

Yes

31
Q

What is a response defined as for conventional and play audiometry?

A

Performance of the desired motor behavior within 3 seconds of the stimulus onset
No later than 4 seconds

32
Q

What is a false responder?

A

Responding when they don’t hear anything

33
Q

How do you manage a false responder?

A

The audiologist can place an open hand just in front of or resting against the child’s hand holding the response peg or block. The child then has to go around or through the audiologist’s hand to complete the task once the sound is heard

34
Q

What is a reluctant responder?

A

These children frequently wait until they are visually prompted to complete the task despite numerous training trials and reinforcement

35
Q

How do you manage a reluctant responder?

A

The audiologist might want to identify if there is a definite facial response or reaction when the tone is presented and can then assist the child in completing the play task and watch for the child’s reaction to the next stimulus

36
Q

What is an off responder?

A

These children prefer to wait until the stimulus has stopped prior to completing the task

37
Q

How do you manage an off responder?

A

Using a continuous tone can often assist them in feeling more confident in responding because there is a definite “off” to the signal

38
Q

How do you train a child for CPA?

A

The assistant shows the task (hold toy near ear, “I hear that”, drops toy in bucket)
Assists the child (holds child’s hand with the toy next to the child’s ear, “we hear that”, moves the child’s hand and directs them to drop it in the bucket
Child attempts on their own

39
Q

What can you do if the child is hesitant to do it themselves?

A

Encourage the parents to try
Guide them by saying “you heard it, you can put it in”

40
Q

What happens after several training trials?

A

Probe trials are done to determine if conditioning has been establishedIf successful, move to phase 2 (threshold exploration)
If unsuccessful, increase intensity level and present additional conditioning trials
If still unsuccessful, consider other important factors (physical, cognitive, social) and use VRA

41
Q

What are some common forms of positive reinforcement?

A

Verbal praise - “that’s good”; “good listening”
Social reinforcement - pat-on-the-back; a smile and nod of the head; applause
Tokens that can be traded for small toys or stickers at the end of the test session, unsweetened cereal, or a changing computer display screen

42
Q

Should you start with 100% reinforcement?

A

Yes
Then gradually shift to an intermittent reinforcement schedule
When in doubt, don’t reinforce (reinforcing a false response can confuse the child)

43
Q

What should you do if you’re uncertain that the child has heard the sound even at loud levels?

A

Try conditioning with the bone oscillator
They will feel the stimulation and then learn the task from that
Resume with air conduction after

44
Q

Will a variety of interesting toys increase the probability of keeping the child’s attention?

A

Yes

45
Q

What are some activities used in CPA?

A

Toss a ball in a basket when the sound is heard
Place a puzzle piece in the puzzle when the sound is heard
Put a ring on the cone when the sound is hear
Place a peg in the pegboard when the sound is heard
Give mom/dad a high-five when the sound his heard
Place a block on the castle when the sound is heard

46
Q

Do children with mild to moderate hearing loss require special test adaptation?

A

No

47
Q

What is the test adaption that might be needed with severe to profound hearing loss?

A

The probe from the insert earphones can be attached directly to their personal earmolds
If the child does not respond at the audiometric limits, it may be possible to obtain a response using a bone vibrator held either in the child’s hand, on the knee, or on the mastoid
Once the child responds consistently to the tactile stimulus, begin testing with earphones at 250 or 500 Hz

48
Q

When does bone conduction need to be performed?

A

Concern about conductive component
Hearing loss

49
Q

What is the challenge when testing young children with bone conduction?

A

Placing the transducer
Two or three thresholds may be sufficient if attention is an issue
Conductive HL :250, 500 and 2000 Hz are more critical to obtain
Sensorineural HL: 500, 2000 and 4000 Hz are more critical to obtain

50
Q

What is computer assisted testing?

A

Child has a mouse
Adds features to a screen (hat added to a clown)
The child clicks the mouse
Audiologist controls the mouse from the control room

51
Q

What should you do if you have a difficult child?

A

Don’t offer options that are not really options (“do you want to put the headphones on?”)
Do not try switching to different testing technique (immediately)
Try short breaks, new toys, new assistant, parent as assistant, new stimulus, bribery
Allow the child to sit on parent’s lap
Give some indication of how long the test will be

52
Q

What are some benefits of using CPA?

A

Accurate responses possible at threshold level
Can be conducted in soundfield or with earphones, with bone oscillator, hearing aids, or cochlear implants

53
Q

What are some challenges of CPA?

A

Keeping the child entertained and involved long enough to obtain all the necessary information

54
Q

When can conventional audiometry be used on children?

A

When they are older than 5
The child raises a hand or presses a button in response to the auditory stimuli rather than completing a play task

AUDE 6140 - Pediatric Audiology (15 decks)

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