Management Flashcards
What is the role of the audiologist?
Evaluation and/or interpretation of test results for educational relevance
Communicate with members of multidisciplinary team
Monitoring classroom environment
Recommendation and management of FM system(s)
Auditory training
What are the four broad recommendations for management for CAPD?
Managing the auditory environment
Auditory training
Music training
Training with phonemes and words
Do children with CAPD struggle with a lot of the same things as children with hearing loss?
Yes
Have difficulty understanding in the classroom
May have difficulty understanding speech even with low level background noise
Difficulty following rapid speech, speech degraded by distance or poor acoustics, and accented speech
What are individual FM systems?
Personalized signal enhancement systems that direct the teachers voice directly to the child’s ear(s)
Often worn in conjunction with conventional hearing aids and CIs
What do you need to get a sound field or personal FM system?
Medical clearance from the student’s physician prior to a personal FM fitting
Permission from parents to use FM in the school
Trials with an FM system through an evaluation period of 30 to 45 school days (pre and post evaluation forms are recommended to be completed by the classroom teacher (CHAPS or SIFTER))
Training on FM use to teachers
How can you improve the speaker in the auditory environment?
Ask speakers to speak clearly
Teachers should speak after writing on the board or looking at notes to provide necessary visual cues
Ensure proper lighting of the speaker, no backlighting
Place the child closer to the speaker (aka preferential seating) - this without other recommendations is not effective
Decrease visual and audible distractions
What does ASHA say the ambient noise levels of an unoccupied classroom should be?
Not exceed 35 dBA
dBA is a weighted scale measured from a sound level meter based on human hearing
What are some expensive changes to achieve the 35 dBA goal?
Infrastructure changes like double-paned windows, noise control devices on heating and cooling equipment, modify lighting fixture types, or lowing ceiling levels, acoustic tiles, etc.
What are cheap modifications to achieve the 35 dBA goal?
Carpeting, curtains, cork boards, felt or rubber tips on chairs, use of bookcases, etc.
Do signal enhancement systems reduce the disadvantage of distance and improve the SNR?
Yes, reduces the cognitive load
Without this, the level of sound decreases by 6 dB SPL for every doubling of distance
What is the optimal reverberation time for a classroom?
0.3 to 0.4 s for small classrooms
~ 0.6 s for middle to large sized classrooms
Exceeding this exacerbates hearing difficulty especially in noisy classrooms
In a reverberant classroom, overall signal level may decrease less over distance because of reverberation enhancement, but excessive reverberation decreases intelligibility
What are the goals of signal enhancement systems?
To improve the SNR and reduce effects of reverberation
Optimal classroom SNR is ≥ 15 dB
For young children with normal hearing, an SNR of > 20 dB is needed in environments with interfering noise and reverberation
Difficult to achieve in a classroom
What are remote mic hearing aids?
Devices that are hybrid radio and hearing aid systems designed for children with normal hearing
The child wears the typically ear level HA receiver and teacher (parents, etc.) wear the radio transmitter mic
They are not accessories to other hearing instruments as they deliver the signal directly to the child’s ear
The remote microphone hearing aids are designed for people without hearing loss but difficulty understanding speech in noisy and adverse environments
Currently available devices include the Phonak Roger Focus II receiver and the Oticon Amigo Star receiver
What is the roger focus?
It is a discreet and comfortable behind-the-ear Roger receiver for children with normal hearing, unilateral hearing loss , ASD, and (C)APD
It delivers the teacher’s voice directly to the child’s ear
It features a SlimTube, a volume control, and uses a 312 battery (or rechargeable)
Looks like a hearing aid
All roger mics are compatible with it
What is the oticon amigo star?
The Amigo FM system comprises a microphone, transmitter, and Amigo Star receiver with 312 battery
Available in 6 colors; Water resistant
The Amigo Star FM receiver can receive input from virtually any transmitter
Looks like a hearing aid
Amigo Star is an excellent choice for schools with a FM program already in place
Teachers can choose from a clip-on mic or a head-worn mic
What are some features that assistive devices also have?
Adaptive technology that maintains a constant SNR by increasing/decreasing signal level based on environmental noise
The high-level mic input (80 to 95 dB SPL) and additional amplification, if needed, allow for ear level output levels at ~ 70 to 90 dB SPL, which can achieve the SNRs of up to 20 dB
These systems are output limited at 105-110 dB SPL when fitting ears with normal hearing to prevent noise damage
What are digital sound distribution systems?
The general goal of these systems is a uniform ≥ 10 dB SNR throughout the classroom
Fixed wireless public address systems or portable wireless sound distribution systems
How should you test HAT systems according to AAA?
At 50 dB HL (65 dB SPL), which represents the teacher’s voice level at 2 meters at an SNR of 0 dB
Why does improved SNR improve focus and attention in younger children?
Shorter attention span and greater distractibility of younger children
Developmental issues of understanding in noise and reverberation
Could hearing aids be used for children with CAPD and no hearing loss?
Could be helpful
Low gain (~ 10 to 15 dB) open fit hearing aids
Improved SNR eases the listening environment, which may benefit some children with (C)APD
Cosmetic concerns and fears of a noise-induced hearing loss may limit widespread benefit
Benefits of using open-fit low gain (10 dB) conventional hearing aids are currently not as well documented and not implemented routinely
What is amblyaudia?
An auditory disorder resistant to amplification (type of CAPD)
It is an interaural asymmetry diagnosed with dichotic testing where children may show a LEA
The interaural asymmetry remains unchanged with use of remote microphone HAs
Should first be corrected with auditory rehabilitation for interaural asymmetry (ARIA)
Involves gradual adjustment of interaural stimulus levels until the asymmetry is reduced
What are some general tips for teachers?
Gain the child’s attention (bi-sensory information, cueing)
Flexible preferential seating
Clear instructions (use routines, speak clearly, modeling, list steps, repeat)
Preview and review class lessons
Provide time (avoid fatigue, allow adequate time to respond)
Classroom modifications (avoid open classrooms, reduce hard surfaces)
What are some general tips for parents?
Learn about (C)APD
Simplify your language
Listen to and speak with the child daily
Slow down the rate of speech
Gain visual as well as auditory attention (e.g., talk to the child when in the same room)
Read aloud with the child
When implementing remediation strategies with the child, start with short sessions and gradually increase time and difficulty of tasks
Encourage the child to ask questions and clarification
Rephrase utterances if needed
What is auditory training?
A set of acoustic conditions and/or tasks that are designed to activate auditory and related systems in such a manner that their neural base and associated auditory behavior are altered in a positive way
Can be done by audiologists, but more likely done by SLPs or special ED teachers
Audiologists should obtain proper justification (evidence-based practice) before recommending and implementing remediation for (C)APD
What is the goal of preschool intervention (auditory training)?
To expose the child to experiences that require careful listening to prevent disruption of communication, learning, and social development
Some simple tasks that can be implemented with this age group:
Finding the target sound of word during a story
“Marco-Polo” type games
Listen and identify environmental sounds
Identifying song tunes
Listening to rhymes
Musical chairs
What are school-aged intervention strategies (auditory training)?
Figure-ground training (apply the skill of listening in noise in normal daily conditions because the child will not have an FM at all times)
Sound discrimination (helps with auditory discrimination, environmental sounds can be used because the differ in intensity, frequency, duration, and quality; differentiate between the highest, middle, and lowest sound made by bell, identify 3 different but familiar voices)
Read aloud (builds vocabulary, improves concept learning, practice selective listening, multisensory integration)
Following verbal instructions (helps with listening and attending)
*Focus on strategies and techniques that reduce communication and learning disabilities
What is used for adult intervention (auditory training)?
Intervention is similar to aural rehab for adults (speech reading skills, listening and communication enhancement (LACE))
*Focus is on compensation and relearning rather than recovery of function
What aspects should training tasks have?
Challenging
Repeated
Age-appropriate for the individual
Is patient motivation critical for auditory training?
Yes
Crucial for improvement
What is music training?
Stimulating the same areas of the brain as speech but it is more interesting and engaging
Requires active listening and engagement
Music and speech consist of the same elements (pitch, timing, timbre (harmonics))
How does noise affect musicians vs non-musicians?
ABRs demonstrated that noise had a greater effect on morphology, size, and timing of the response with the non-musician population
Young adult musicians had higher scores on both the HINT and QuickSIN than the non-musicians
Years of musical practice appears to correlate with speech-in-noise perception ability
Does musical training change the brain?
Yes
Children who completed two years of music training had a stronger neurophysiological distinction of stop consonants, a neural mechanism linked to reading and language skills
< 1 year of training was insufficient to elicit changes in CANS function but after one-year, greater amounts of instrumental music training were associated with larger gains in neural processing
Neural changes from music training can take longer to emerge than other forms of auditory training, such as computerized training programs but persisted for decades after training stops
Can you do musical training on people with CAPD?
Yes
In some studies, musical training, especially early in life, is proven to be beneficial to maintain good attention and cognitive skills throughout life
Playing an instrument has far greater impact than listening to music and even later in life helps with attention and cognition
Also used for a variety of developmental disorders (autism, ADHD, etc.)
What is phonemic training?
Useful for children with poor phonemic decoding, spelling, and reading skills
Most programs include computer-based auditory training (CBAT)
Are there few benefits of phonemic training?
Yes
And they are hard won
