unit 2 Flashcards
conversational fluency (CF)
how smoothly conversation unfolds
-high and low fluency
factors that define CF
-time spent repairing communication breakdowns
-exchange of information and ideas
-sharing of speaking time
-time spent in silence
procedures for measuring CF
interviews, questionnaires, daily logs, and group discussion
interviews
basic assessment procedure used to elicit specific information about an individual’s hearing related communication difficulties
-prepared with specific questions
-want your provider to “know” you
questionnaires
open ended questions - elicit qualitative data
closed ended questions - used to gather quantitative data
daily logs
self reports of behavior used by respondent for self monitoring
-can give insight into strategies, difficulties, and overall conversational fluency
group discussions
provides a forum for patient to discuss communication ideas
-patients make the syllabus
development of communication strategies training (CST)
a quality AR training program should be tailored to accommodate a patients : expectations, age, socioeconomic background, lifestyle, communication problems
-making printed materials available
-presenting a weekly program
creation of a program of CST
program length (12-40 hours), intensive instruction or spread over time, develop objective, assessment materials, one-on-one, couples, group
benefits of CST
-studies may have reported a reduction in perceived hearing loss related disability
-research suggesting benefits generally show : good patient participant, change in communication strategies usage, change in perceived hearing related disability, reduced rate of hearing aid returns, reported benefit by frequent communication partners
-enhancing self-efficacy
models for CST
formal instruction, guided learning, real-world practice, individual training
formal instruction
participants learn various types of communication strategies and other listening and speaking behaviors, and are exposed to examples
-can suggest strategies they have found to be helpful
-group leader can share specific suggestions
-courtesy, explanation, and direction
guided learning
patients are encourage to use conversational strategies in a structured setting
-modeling
-role playing
-analysis of videotaped scenarios
-attention
real world practice
includes activities that participants have performed successfully in the classroom/clinic and also some activities that require them to communicate in a setting that is highly motivating (such as office of social gathering)
-report success and problems
individual training
includes difficulties associated with patient specific hearing loss
training for communication partners
training may foster empathy for the difficulty of the speechreading task, and encourage behaviors that will reduce communication breakdowns
-generally provided at the same time, and sometimes in the same class
-may also receive support and counseling about adjusting to the changes in life quality
group programs
provides the opportunity for the individual with hearing loss, their spouses, children or caregivers to participate in understanding the larger effect of quality of life caused by hearing loss
counseling
help patients understand and solve their hearing related problems
-acceptance of hearing loss
-understanding of hearing loss and effects
-decreased stress
informational counseling
professional instructs, guides, and gives expert information in the format of give and take dialogue
GOAL : patient learns about hearing loss, listening, device technology, and services
DESIRED OUTCOMES : patient has an understanding of hearing loss and knows more about technology and available services
personal adjustment counseling
GOAL : patient works through negative feelings about hearing loss and self worth and learns to accept the permanency of hearing loss
DESIRED OUTCOME : patient begins to regain positive self image and becomes willing to engage in aural rehabilitation intervention plan
psychosocial support
help patients achieve long term self sufficiency in managing the psychological and social challenges that result from hearing loss
GOAL : focus on the permanency of the hearing loss and on psychological, social, and emotional acceptance
cognitive approach
modify thought process
GOAL : eliminate misunderstandings and assumptions by replacing them with positive thoughts and positive perspectives
-rational emotive behavior therapy (REBT) : replacing the irrational belief with a rational one
behavior approach
modify behavior
-desensitization : reduce negative reaction through repeated exposure
-identify physical systems of stress
-introduce relaxation techniques
affective approach
modify emotions
-phenomenological : patient changes how they view themselves and their place in the world, even though their circumstances remain the same
-the clinician : utilized congruence with self, used unconditional regard, employs empathetic and understanding
assertiveness training
teaching patients to express themselves assertively in their communication interactions and to state negative and positive feelings directly
-enhance communication between patient and communication partner
targeting counseling
ensuring that the counseling addresses the patient’s particular concerns
reframing
provides the patient with an alternative frame of reference from which to view a problem
normalizing
patient realize their feelings are normal and helps decrease negative emotion
cost benefit analysis form (CBAF)
benefits of not taking action, costs of not taking action, costs of taking action, benefits of taking action
problem solving model
-problem identification
-problem exploration through creating scenarios
-problem exploration through reading self profiles
-problem resolution
patient centered approach
-treats patients with dignity and respect, promoting control, and independence
-dictates that highly successful aural rehab plans : best determine patients background, needs, and wants ; accommodates those through the design and delivery of appropriate interventions
patient centered approach includes
effective treatment, patient involved decision, respect for patient preference, gives clear information, empathy, involvement of family, continuity of care
prevalence of HL in adults
age 21-34 - 3%
age 34-55 - 6%
age 45-54 - 11%
age 55-64 - 22%
-onset is gradual
-typically mild to moderate SNHL
-mild to high frequency loss is most common
individual factors to think about
family life circle, life factors, community factors, socioeconomic factors, culture, psychosocial well being, stigmatization, emotional state, gender, home/social/vocational hearing related difficulties
AR journey in six steps
pre-awareness, awareness, movement, diagnosis, rehabilitation, and resolution
-diagnosis, rehabilitation, and resolution sometimes move backwards as a result of the resolution (give and take and overlap)
pre-awareness
“i’m not the issue, you are”
-can last longer for younger adults
-family or friends point out issues first
-may be frustrated with issues
awareness
“yeah I might have a problem”
-knows about it but won’t do anything
-occurs gradually
-shift in blame from others onto self
movement
“i think i need help”
-reaches the tipping point when they decide to consult a professional
-psychological costs (acceptance of hearing problem, anxiety of getting old, awkwardness from having to ask for time away, embarrassment)
diagnosis (and action)
knows what is causing the hearing loss, going to get help
-may expect rapid solutions, treatment, or complete cure
-anxiety common for those with permanent loss
rehabilitation
-some will be successful and some will need more help
-patients can shift between rehabilitation and resolution
resolution
-exit or relapse
-patients can shift between rehabilitation and resolution
american with disabilities act (ADA)
equal opportunity law which guarantees people with disabilities the same opportunities as other americans
-title 1 : employment
-title 2 : public services and transportation
-title 3 : public accommodations and commercial facilities
-title 4 : telecommunications
-title 5 : miscellaneous provisions
who is covered by ADA
protects people who :
-have a physical or mental impairment that substantially limits one or more major life activities
-have a record of such an impairment
-or are regarded as having such an impairment
presbycusis
age related hearing loss
-central auditory pathways decline due to age related (loss of neural connections are thinning of myelin sheath)
-neural : loss of sensory and supporting cells, nerve fibers, and neural tissue
-metabolic : change in the blood supply to the cochlea
circular chain of events
-social withdrawal : patients may withdraw from social interactions
-negative reactions : family and friends may perceive the person with hearing loss as unsociable, forgetful or preoccupied with health matters
-perceptions may lead to person with hearing loss mistakenly being labeled as demented, confused
-emotional distress : person with hearing loss may increasingly experience anger, frustration or may cause further withdrawal
hearing loss and dementia
with untreated hearing loss, there is a higher risk for decline in cognitive abilities
-identified as a risk factor for dementia
-hearing aids may help delay cognitive decline and even dementia
hearing aids and dementia
cascade theory - if you get HA, you are more social involved, reduced depression, promote self-efficacy, promotes physical activity which helps promote cognitive function
neurobio theory - reduce adverse effects of sensory deprivation because you can engage with their surroundings
atrophy theory - slow the decline in brain function or degeneration of the brain (neural connection and brain on level of muscle)
visual impairment
cannot be compensated through corrective lenses
-speechreading may not be an option
-communication strategies training may emphasize the environment and how individuals arrange themselves
-patient cannot see smaller components or visual indicators of hearing aids
arthritis
inflammation of joints, connective tissue, or surrounding tissue
-chronic condition seen in about 20% of individuals 75 and older
-reduced fine motor control, decreased sensitivity, loss range of motion, pain, stiffness
the vestibular system
provides information to the CNS for control of skeletal muscles for postural adjustments
-provides CNS with spatial information about linear and angular acceleration
balance problems
sensory component : loss of hair cells in the vestibular part of the inner ear, vision decrease, decreased sensation
motor component : muscles get weaker, joints get stiffer
dizziness
used to describe a range of sensations : unsteadiness, feeling faint, feeling weak, increases risk of falling and injuries
vertigo
false sensation that the individual or the environment is moving
-increases risk of falling and injuries
considerations for elderly adult patients
economic status and retirement, living environments
focus of AR for elderly adults
-continued hearing aid/sensory aid orientation
-adjustment to life with hearing loss and sensory aids
-assessment of communication abilities
-intervention for communication abilities
who is on the team for AR with elderly adults
audiologist, speech pathologists, counselors or social workers or medical personnel
within a nursing home or assisted living many face challenges with
-managing hearing loss and dementia
-preventing hearing aids from being lost
-proper hearing aid care and maintenance
-training staff about hearing aids
-frequency in service
group setting addresses
hearing and hearing loss, sensory aids, speechreading training, communication strategy training
group setting advantages and disadvantages
advantages : produce gains in speechreading, allows for group sharing of feelings, provides an emotionally safe environment
disadvantage : some training may be too general for certain clients
tinnitus
-it is a symptom
-1-2% of population experiences severe tinnitus that negatively impacts sleep, work, concentration or quality of life
-prevalence increases with age
-can be a variety of different noises/sound
-there is no cure, but we can help manage the response
transient tinnitus
temporary reduction in hearing sensitivity that resolves in a few minutes
persisten or chronic tinnitus
lasts longer than 5 minutes, occurs more than once a week or is constant
oddities of tinnitus
-can occur without damage to the cochlea
-persons with profound hearing losses don’t always have tinnitus
-some tinnitus suffered can control intensity and pitch
-tinnitus and phantom limb syndrome share similar neural characteristics
loudness of tinnitus
-70% report loudness at less than 6 dB SL at matched pure tone frequencies
-22% say equally loud in both ears
pitch of tinnitus
-half report one sound, half report two or more
-97% report ringing or clear tone
spatial lateralization of tinnitus
34% report one side, more often than not left ear
effects of tinnitus
quality of life : unable to enjoy quiet time, sleep deprivation, cognitive impairment, emotional responses, chronic stress
psychological disorder : annoyance, anxiety, depression, sleep disorders
tinnitus intake
interview and/or questionnaire
-tinnitus handicap inventory (THI) - will answer based on yes, sometimes, or no
audiologic assessment or medical assessment for tinnitus
standard test battery : may need to be mindful of loud inputs
medical assessment : necessary when tinnitus is unilateral and/or pulsatile
tinnitus psychoacoustic assessment : loudness and pitch matching
what is unilateral tinnitus a redflag for?
vestibular schwannoma
what does pulsatile tinnitus mean
blood supply
hearing aids as tinnitus treatment
tinnitus maskers are available in most hearing aids
-can be used with and without hearing loss
-masking sounds option vary greatly to personalize for the patient
cognitive behavioral therapy for tinnitus
addresses the negative responses towards their tinnitus
-referral to a specialist
sound machines
-will help mask noise in the background
-will help mask on the day to day (to some degree)
general counseling tips for tinnitus
-avoid high levels of noise
-avoid situations that cause excessive anxiety
-get adequate sleep
-limit alcohol, caffeine, nicotine
tinnitus retraining therapy (TRT)
GOAL : reduce or eliminate the annoyance of tinnitus
-addresses emotional reaction and inappropriate beliefs
universal newborn hearing screening (UNHS)
signed into law in 1999
-97% of babies receive screening
-screening is a pass or refer protocol
early hearing detection intervention
funded to provide resources to aid in establishing and operating UNHS programs and to connect them to early intervention services
importance of early detection of hearing loss
birth to 3 years is a critical time for speech and language development
why the need for early intervention
to have better language outcomes
-there is evidence for having better outcomes
1998 study for early intervention
150 deaf and hard of hearing infants and toddlers
-found those that had EI would have speech development at or near normal to those normal hearing peers when compared to children without EI
1, 3, 6 month approach
at 1 month : if you do not pass, you will come back at 3 months
at 3 months : there will be a diagnosis unless they pass
at 6 months : there will be intervention approaches that begin
GOAL : identify early, enhance development, enhancing accommodation of child needs
typical protocol for screening
if the baby does not pass on the first screening in at least one ear, they will get screened a second time
-if they do not pass on that second time, they will be referred for evaluation
objective tests
otoacoustic emissions (OAEs) and automatic auditory brainstem response (AABR)
otoacoustic emissions (OAEs)
only captures a certain range of frequencies
-2,000 to 5,000 Hz
-present or absent
-looking at hair cell function
automatic auditory brainstem response (AABR)
putting stickers on the forehead and sounds in the ear to watch sound go to auditory nerve
-if it is received there, there is more likely that it is heard
-sound will start at the cochlea then will go to the auditory nerve
-can capture auditory neuropathy disorder (one thing OAEs cannot)
behavioral evaluations
behavioral observation, visual reinforcement audiometry (VRA), conditioned play audiometry (CPA)
GOLS STANDARD : have to recognize the sound and decide what to do with it
-use these to assist in programming hearing aids or hearing loss levels
behavioral observation
birth to 6 months
-depends on if the baby can give consistent responses
-looking for a change in breathing, eyebrow movement, and eyes looking in a specific direction
visual reinforcement audiometry (VRA)
6 months to around 3 years
-child is in the center of a sound booth with puppets on both sides (with or without headphones)
-looking for reflex of looking the right way of sound
-if they look the right way, the puppet will light up
-if they look the wrong way, nothing will happen
conditioned play audiometry (CPA)
around 3 years to 5 years
-conditioning them to ask
-every time they hear a sound, they can do something with a toy
-determines ear specific and frequency specific hearing sensitivity
hearing care follow up
parent counseling (stages of grief can occur any time), referral to otolaryngologist, enrollment in early intervention, audiologist counsels parents about test results
referral to otolaryngologist
-medical evaluation
-assessment of other debilities
-genetic testing
-medical clearance for HA or CI
why is there a need for a medical clearance for HA or CI?
need for up to the age of 18 to investigate if there are other reasons for needing a HA or CI
-they go back to receive a new one when needed
follow up schedule with audiologist
testing is every 3 months for babies and every 6 months after age 3
hearing loss causes in children
genetic (50%) - syndromic is 30, non syndromic is 70
idiopathic (25%)
non genetic (25%) - infections
-most common is non syndromic genetic
early intervention programs
programs and services for children from birth to 3 years who have been identified as having a developmental delay or who are at risk for developing a delay
why are early intervention programs designed
to meet physical, intellectual, language, speech, social, and emotional needs
who qualifies for early intervention?
-having a delay in one or more areas
-having a diagnosed condition with high probability of developmental delay
family centered approach
intervention approach that places the family as central to a child’s well being
-using families strengths and weaknesses
-patterns of communication and interaction affect one another
-infants and toddlers learn best through everyday interactions
-work to support families and caregivers
how is early intervention funded
provided under IDEA part C
-screening, evaluation, and assessment procedures
-individualized family service plan
early intervention services for birth to 3 years
an intensive stage of listening, language, and speech development
-family approach care
questions to ask for early interventions for child with hearing loss
-who can provide services
-what is medical home (approach to provide healthcare that is accessible and family centered)
services provided with early intervention
-family, training, counseling, and home visits
-special instruction
-audiology
-speech pathology
-physical and occupational therapy
-psychological services
-case management
effective early interventionist
-provides unbiased information and instruction
-provides empathetic listening and unconditional positive regard
-IFSP : ready to enter plan (before IEP plane)
what do parents desire?
according to hands and voices
-wish for choices
-wish for information
counseling for families
-support and guidance
-the adjustment of having a child with hearing loss
-family support with developing and implementing AR plans
-parent support groups !
things needed for early intervention
-normal development
-understanding ramifications
-understand how to read audiograms and explain results to families
-have knowledge of communication modes and pros/cons for each
-know laws pertaining to service provision in early childhood
-know local services available in the community
early identification outcomes with expressive and receptive language
-no difference between aural/oral mode and ASL mode
-mode of communication was not a predictor of outcomes
-significant relationships were found in preschool-age children
early identification outcomes and speech production
-mild to severe HL was small discrepancies in speech production
-severe to profound HL was 2/34 children developed intelligible speech
early identification outcomes and language
-children with mild to severe HL performed better on reading, academic achievement, and language when compared to sever to profound HL
-children with hearing loss had similar language development in the first 3 years of life
facilitative learning strategies for infants and toddlers
coaching and communication techniques
coaching of parents
parents are the experts of their children
-work with family
-emphasis is placed on child family interaction, function of communication, embedding learning within ongoing routine interactions
auditory training for infants and toddlers
goal with hearing loss and goal with cochlear implants
AT goal for children with HL
due to having residual hearing, children are processing a degraded speech signal. auditory training may begin with more difficult tasks
AT goal for cochlear implants
accelerate auditory learning and to raise level of speech recognition
pyramid directional representation of AT
-awareness (easier)
-discrimination
-identification
-comprehension (more difficult)
-with small children, there is no specific timeline for when they move between levels
informal training for children
incorporated into everyday routines to encourage and enhance language enrichment
formal training for children
in person, computerized or web based programs
-moments of positive reinforcement and possible a reward system for in person
activities for sound awareness
peek a boo, musical chairs, marching to beat of a drum
activities for sound discrimination
play a game with toy animals, respond to commands, repeat what you hear
activities for identification
play game candy land and listen for name of colors, play with postcards or stickers
activities for comprehension
listen to read aloud story then answer questions
why is there a wide age range for school age children (3-22 years)
-no child left behind act
-IDEA part B focuses on the idea that everyone has access to free and public education
least restricted environment
kids should be placed in a classroom with equal peers if they have a disability
-will be placed that best supports the child
individualized education plan (IEP)
legal binding document that will travel with the child and will have goals/services that will need to be met
members of an IEP team
-parents/caregivers
-audiologist
-SLP
-teacher of child
-teacher of DHH children
-psychologist
-interpreter (depending on language of family and child)
push in model for teaching
will work with student in general education classroom one on one or a small group
pull out model for teaching
remove the child and take them to a quiet location to review and go over work
hearing impaired eligibility
hearing acuity that interferes with child’s performance in the educational environment and requires the provision of special education and related services
-starts with child find (around 2- 3 years)
-can they see or can they hear?
hearing impaired eligibility involves what aspects
audiological evaluation, evaluation of communication/language proficiency, academic performance, and observation from parents and school staff
IEP timeline
takes about 60 days from time of referral
-initial evaluation
-determination
-IEP creation
-re-evaluation
initial evaluation of IEP
review of existing evaluation data (RED)
-review existing evaluation data, information or evaluations
-determine need for further evaluation
IEP creation
development of measurable goals, how they will be delivered, and where will it occur
-direct services : working on those goals (routine)
-related services : things that need to occur but not as routine
re-evaluation of IEP
annual IEP meeting : within 1 year of last meeting
3 year reevaluation : complete assessment, determine eligibility, develop goals based on assessment
types of eligibility
a child who is at least 3 years but under 22 who :
-have been evaluated and found to have at least one disability
-because of their disability, needs special education and related services
accommodations vs. services
accommodations are not services, they are things that are done to help improve the child’s environment
-examples include : technology, seating arrangement, visual support, allow extra time
evaluation of communication and language proficiency
speech skills : speech intelligibility, speech testing
language skills : formal testing of language, receptive and expressive language
literacy evaluation : reading and writing
types of classroom placement
self contained, part time self contained and mainstream classroom, part time mainstream and resource classroom, and mainstream
what needs to be decided with a mainstream classroom
-direct vs. indirect services
-accommodation
-no services
advantages of a inclusion classroom for children with disabilities
improved academic achievement, social competence, communication skills, opportunity for skills and abilities, positive self concept
advantages of a inclusion classroom for children with no disabilities
wider social acceptance and understanding of disability, increased awareness of and respect for diversity, increased tolerance and social cognition, enhanced self concept
speech/language impairment
an evaluation by a certified speech language pathologist or speech language technician
504 plan of rehabilitation act of 1973
designed to eliminate discrimination on the basis of handicap in any program or activity receiving federal financial assistance
-with respect to public school services, a handicap person of any age
-with respect to postsecondary and vocational education services
what does 504 plan of rehabilitation act cover
-evaluation results
-504 plan
-used for primary, secondary, and post secondary education
-evaluation procedures
-placement decision
-re-evaluation
team members of a 504 plan
parents, child, general education team, counselor, audiologist
evaluation procedures for a 504 plan
-tests have been validated and tailored to specific areas of need
-review academic achievement performance
-teacher recommendations
-documentation of physical or mental condition
acquisition of speech skills depends on
auditory input from surroundings, auditory articulatory loop, information from other modalities
auditory input from surroundings
kids with HL : there is not input from auditory system
auditory articulatory loop
kids with HL : bubbles from sounds around you will get smaller
-ex. hearing the door open you will not hear so you will not know anyone came in
information from other modalities
kids with HL : will use other systems to gain information from what is occurring around them
-such as visual, proprioceptive input
what is considered when describing a child’s speech
overall intelligibility, segmental production, and suprasegmental production
factors affecting speech development
-age of identification
-degree or type of HL
-secondary disabilities
-family support
-speech and language therapy
-multi language learners
-age of amplification
-aided hearing levels
-consistency of device use
-acoustic environment
early speech development in infants with HL
-pre speech vocalizations (range is similar, but become less frequent over time)
-consonants (smaller inventory, does not expand over time)
-vowels (reduced F2 ranges)
suprasegmental characteristics of speech in children with HL
-poor breath control
-strained or tense voice
-hypo or hyper nasality
-poor prosody (ex. inappropriate rate)
what factors affect intelligibility
breath control, prosody, voice quality, and resonance
summary of speech characteristics for D/HH children
-may have suprasegmental errors affecting intelligibility
-shows delay in phonological development compared to same age peers
-have difficulty producing full range of consonants accurately
summary of speech skills and cochlear implants
-higher levels of intelligibility
-speech acquired at a faster rate
-improved vowel production
-good consonant acquisition
intelligibility rating
based on % of words understood
-# of words understood/total # of words
-controlled by breath control, prosody, voice quality, and resonance
language characteristics
form, content, and pragmatics
form issues
-simple structure with few words (overuse of nouns, omit function words)
-poor understanding of various sentence structures (the cat was chased VS. the cat chased)
content issues (words and meanings used during communication)
-limited vocabulary
-cannot identify synonyms or idioms
-understanding of words limited to subtle meaning
-learn more concrete than abstract words
-more general than specific
pragramtics issues (use of language in context)
-incorrect language use
-inappropriate asking of questions
-lack of initiation skills
-absence of communication breakdown skills
-poor turn taking
reasons for lack of pragmatics
-unfamiliar with language structure
-reduced vocabulary
-few conversational partners
-unable to overhear conversations
-lack of instruction on rules
incidental learning
SES status impacts the total variety of words young child were exposed to, resulting in a estimated 30 million word gap
-approx. 80% of new words are learned from incidental learning
summary of language skills for cochlear implant users
-accelerated language acquisition
-higher rated of acquisition of grammar
-syntax may catch up with normal hearing
-increased vocabulary development
-before 5 years of age, growth of 4 years in 3 years
reasons for literacy deficits
-reading and writing difficulties
-limited development of an auditory basis for mapping sound
-deficits in experience and world knowledge
reading
delays are common
-with consistent HA use, they can correct the normal lag that occurs compared to their peers
-with consistent CI use, they will be able to read better than impaired peers but worse than normal hearing peers
writing
writing samples often contain errors, such as omission or inappropriate use of certain words
-CI improve the prognosis
summary of literacy in D/HH children
-language and literacy development occurs simultaneously
-development follows those of their normal hearing peers
three reasons for speech and language assessment
-determining the need for intervention
-developing intervention goals
-evaluating progress of intervention
what to consider when testing speech and language of children with hearing loss
-task type
-communication mode
-rapport
-procedures for testing
-test norms
assessing speech skills
-can be informal or standardized
-will be measured as a percent correct score
-provides measures of intelligibility, segmental speech, and suprasegmental production
assessing language skills
can be standardized or can feature a collection of spontaneous or structured language samples
-using a story re-tell task or play session followed by sample analysis
literacy evaluation importance
-helps with classroom placement and need for services
-shows a child’s strengths and weaknesses
advantages and disadvantages of having the same literacy assessment for normal hearing and hearing loss
advantages : comparisons to children with normal hearing in a mainstream classroom
disadvantages : difficult test items
what do D/HH children need
-appropriate technology plus acoustic accessibility
-enriched auditory ecposure
what do the needs of D/HH children result in
auditory brain development
listening bubble
within certain bubbles around the child, they will hear acoustic information and in other bubbles they will not hear that information
-beyond the range of listening speech will not be caught
best practice for speech recognition abilities
word recognition scores :
-average speech is 45/50 dB HL
-soft speech level is 30/35 dB HL
if the child cannot hear soft speech, they will
-not hear peers in the classroom
-not overhear conversations
-have reduced language and literacy skills
the string bean
-top portion of the speech banana
-functional gain
-aided hearing at 0 dB HL is not the goal because it can cause distortion
speech audibility audiogram
tool to improve the professional’s ability to estimate listening under varying speech loudness conditions present in typical classrooms
classroom noise
-can impact speech recognition
-can lead to annoyance, learned helplessness, isolation, and identity and self concept
role of audiologists, SLPs, and D/HH teachers
-provide interventions to minimize classroom listening and learning barriers
-educate members of the school team
-establish efficacy of improvements made of classrooms
types of intervention or therapy
speech therapy (auditory training), language therapy, and pragmatics and social skills training
speech and language therapy
-children with HL benefit from receiving speech and language therapy
-long term attention must be placed on developing skills if a child is to develop
approaches for therapy
uni-sensory approach and multi-sensory approach
uni-sensory approach
auditory only cues OR visual only cues
multi-sensory approach
combines auditory and visual cues
goals of speech therapy
-increase vocalizations
-expand phonetic and phonemic repertoires
-establish link between audition and speech production
-improve suprasegmental aspects of speech
-increase speech intelligibility
hearing vs. listening
hearing : is acoustic access to the brain
listening : is attention to acoustic events with intentionality
-hearing must be made available before listening can be taught
the skill of _________ must be learned
listening
-“for a child with HL, listening is often hard without proper training” (CDC)
auditory training is defined as
instruction designed to maximize an individuals use of residual hearing or electrical hearing by formal and informal listening practice
-auditory skills can be developed with informal or formal training
goals of AT
-improves persons ability to utilize sound
-use auditory signal to recognize speech
-develop meaningful auditory integration
auditory integration
use listening skills in real world environments
auditory listening promotes
-phonetic development
-underlying development of linguistic structure for language acquisition
-child’s knowledge of phonology
principles of auditory development and training
auditory skill level, stimulus unit, activity type, difficult level
auditory skill level
detection, discrimination, identification, comprehension
detection
aware of sound
-easier
discrimination
can tell one sound if different from another
identification
understands what a word or sentence represents
comprehension
understands the meaning of connection speech
-more difficult
speechreading and AT
build association between auditory and audiovisual representations of speech
GOALS : recognize and understand spoken language, achieve increased reliance on using auditory signal to recognize speech
goals of language therapy
-increase communication between parent and child
-promoting complex concepts
-enhancing vocabulary growth and use of language syntax
-develop narrative skills
structured language therapy
teacher modeling and student imitations
naturalistic language therapy
taking any opportunity to explain or make meaningful connections using language
techniques for developing a child’s listening skills
-acoustic highlighting (the difference between incorrect and correct)
-auditory sandwich
-auditory bombardment
-parentese (changing duration,pitch, or intensity)
-leaning in
-hand cues
-turn taking
-self talk
-experience books/storytelling
auditory sandwich
emphasis auditory input without sacrificing comprehension
-present information with auditory first
-add visual cues if the child does not understand next
-restate with only auditory presentation
pragmatic auditory skills training
training introduces facilitative and communication repair strategies
-want to play different scenarios and have them practice social interactions
communication strategies training for children
formal instruction, guided learning, real world practice
-practice communication with images or pictures
receptive repair strategies for children
assess how much knowledge they have take in
-tailor questions to how much they understood
communication strategies training for parents
receive instruction on ways to repair communication breakdowns when they are the talking
-rephrasing, simplifying, elaborating, and building from the known
self advocacy specific areas
-self-knowledge
-preferential seating
-secure accommodations
-equipment management
-communication repair
