Lecture 7- Management fo HL in Children Flashcards
Why does early intervention begin with the AuD?
AuD establishes foundation with the family during 1st few weeks, often before SLP
AuD should begin the discussion of communication progress with families
- Guide families who are struggling with full-time HA use
Connect consistent HA use to development of auditory and spoken language proficiency
Continuum of families who are informed & involved with high expectation to passive families who struggle with managing their child & achieving full-time HA use
What are the principles of EI?
- Services are family centered and culturally ad linguistically responsive
- Services are developmentally supportive and promote children’s participation in natural environments (home, daycare)
- Services are comprehensive, coordinated, and team based
- Services are based on the highest quality evidence that is available
What are some possible barriers to providing EI services?
- No clinician in area trained in the chosen mode
- No clinician or interpreters who speak family’s language
- Clinicians with necessary skills have full caseloads
- Trained EI clinicians may provide center-based tx rather than home-based and aren’t authorized Part C providers
- Communication bias
- May be subtle and insidious
What is a communication bias?
Bias toward a particular communication method among members of the eligibility determination team
May be overt (families told outright that one is superior)
What are some barriers to providing services in the home?
Parents: availability, feeling self-conscious about having a professional in the home
Home could not have a conducive environment
Proof of abuse and neglect in the home
How can parents be a barrier to the service provided?
Stigmas associated with hearing loss (cultural)
Not reinforcing what is being done in therapy
Not using specified communication mode
Resources: difficulty obtaining transportation
What is the therapeutic alliance?
Collaborative problem solving, accountability, alignment of purpose
A negative and long-lasting consequence occurs when professionals do not honor parent choice
What are the barriers within EI service provision?
- Shortage of qualified interventionists with expertise in HL
- Regulations within Part C that create roadblocks & interpretation of certain regulations
- Failure to provide unbiased info
- Challenges originating in the child’s home or family
What is the “Amplification-Communication Connection”?
3-phase program (Robbins, 2002, 2007)
- AuDs can establish foundation that fosters communication development in the early period following dx of HL
- Help parents understand the role of technology and their role in communication development
- Aud may be the HL expert on the EI team
Phase I
- DX to 1st fitting of HAs
- Careful not to supply too much technical info
Phase II
- Early weeks following initial HA fitting
- Involves AuD giving family multiple opportunities to become familiar with HAs
Phase III
- AuD should get a sense of the adjustment to consistent, daily HA use
- Probe parent about their ability to manage and trouble shoot devices
- Encourage and empower parent
Describe RECD measurements.
Pediatric RECDs are significantly higher than average adult RECDs.
- Due to smaller volume of child’s ear canal
Proper placement of prove tube is critical
- Use earmold as a guide for insertion depth
- Align probe tube along bottom of the earmold so the tube extends 3 mm beyond the sound bore
Sometimes, measurement of RECDs isn’t possible
DSL 5.0 method uses normative values based on age
What are characteristics of a pediatric prescriptive method?
Implementation of auditory thresholds estimated from electrophysiological tests of hearing
Accounting for external ear canal acoustics in assessment data
Access to age-specific normative data for predicting ear canal acoustics
Methods to conduct coupler-assisted verification
Other considerations for a Pediatric Prescriptive Method
- Should be able to handle & compute targets based on partial audiometric data
- LDLs are predicted from auditory thresholds conservatively
What are some of the listening needs of infants and children with HL?
- Speech/language learning occurs through aided hearing rather than prior experience with language
- Children with HL required more speech audibility to perceive all speech sounds
- Age-related interactions with level, BW, and sensation level in the perception of fricatives or the use of context for word recognition
- Children with HL require a higher SNR and broader audible bandwidth to have a better chance at acquiring speech and language
What are some electroacoustic considerations?
- Avoid distortion
- Allow for frequency/output shaping and flexibility to provide audibility and prevent loudness discomfort
- Apply wide dynamic range compression for most HLs
- Apply output limiting compression
- Advanced signal processing schemes considered on an individual basis (frequency lowering, noise reduction, directionality)
What are some hearing aid companies that manufacture pediatric hearing aids?
Phonak Sky
Oticon Sensei
ReSound Up Smart
Widex Baby
