Unit 3 Flashcards
Joint Committee on Infant Hearing (JCIH)
has published guidelines for monitoring Universal Newborn Hearing Screenings.
Who performs the test?
Nurses but they actually prefer AuDs and SLPs
Early Hearing Detection and Intervention (EHDI)
1-3-6 Rule
Individuals 3 years and younger identified with HL should be evaluated every 3 months
Recommend that infants with risk factors for HL be reevaluated in 9 months
1-3-6 Rule
Evaluated by 1 month
Diagnosed by 3 months
Intervention by 6
UNHS Protocol
All states have universal newborn hearing screening but protocol
Varies by state
Otoscopy and tympanometry are not required
ABR, OAEs (or both)
-To have ideal specificity and sensitivity, BOTH tests should be performed.
Auditory Brainstem Response (ABR)
Measures brain waves in response to sound
for those that can not responds behaviorally
Any pathologies of the OE or ME can affect ABR
Just a screening
Great objective test for patients who cannot respond behaviorally
Does not assess all necessary frequencies and cannot determine degree of HL
Otoacoustic Emissions (OAEs)
Measure of outer hair cell function
Normal OAEs suggest no worse than a mild HL
Diagnostic protocol: 750-8000 Hz (likely shortened in the hospital)
-OAE screeners likely have a shortened protocol
Greatly objective test for patients who cannot respond behaviorally
Does present OAEs mean the patient has normal hearing?
NO!
Certain configurations of HL
ANSD
Absent auditory nerve
What are Cochlear Implants?
Prosthetic devices that is surgically implanted to electrically stimulate the cochlea
Multiple components
It does NOT restore acoustical hearing (it is now electrical hearing)
cochlear implants are devices that are surgically implanted into the cochlea, activate the auditory nerve, and provide sensitivity to sound.
Components of the CI
Microphone
Speech processor
Transmitter
Electrode array
process of CI
- microphone picks up the sounds from the surrounding environment.
- speech processor changes the sound from the microphone into electrical sound signals and sends them to the transmitter.
- transmitter is held in place with a magnet behind the ear and sends the sounds through the skin to the receiver. This receiver then transmits the signals into electrical impulses and sends them to the electrodes placed within the cochlea.
- These electrodes send the impulses to the nerves in the scala tympani and then to the brain through the auditory nervous system (Battey, 2013).
CI Manuracturers
Advanced Bionics
Cochlear
MED EL
Advanced Bionics
California
Waterproof
MRI compatible
Phonak
Cochlear
Australia
Wireless accessories
ReSound compatible
MED EL
Austria
Single unit processor (Rondo)
(not recommended for children)
CI Evaluation
Will have a HA trial -Must show minimal benefit from hearing aids -Must have a referral Type of evaluations to determine candidacy Determine brand and accessories Surgery Activate CI’s 2-4 weeks later Initial visit Follow-up visits & therapy
initial visit
Activation
Determine baseline
May not UNDERSTAND language
Type of evaluations to determine candidacy
- Medical evaluation
- Physical examination
- Audiometry
- Contra-indications vs. candidacy
- Absolute contraindications
medical evaluation
General health Age of onset of hearing loss Etiology of hearing loss Auditory memory (use of hearing aids, use of oral communication) Duration of deafness
Physical examination
Cochlea present? Surgical planning (Michel’s Aplasia, temporal bone fracture, Otosclerosis, Small IAC, EVA
Absolute contraindications
Ossification of the cochlea Absence of the cochlea and/or auditory nerve Active otitis media Radical mastoidectomy cavity CNS disease that prevenst benefits Medical contraindications for surgery
FDA Audiological Criteria for Adults
Moderate to profound SNHL bilaterally
Patient receives minimal benefit from appropriately fitted amplification
<50% sentence recognition in ear to be implanted (aided)
<60% in contralateral ear and binaurally (aided)
-Medicaid: <40% in aided communication
High motivation and appropriate expectations
Children CI Candidacy (12-24 months)
Profound SNHL
Limited benefit from binaural amplification based on the MAIS/IT-MAIS
Children CI Candidacy (2-17 years)
Severe to profound SNHL bilaterally
Limited benefit from binaural amplification trial
Speech discrimination scores <30%
Candidacy
See power point
Tests utilized for Pre & Post measures
Open set tests: CNC words, AZBio Sentences, BKB-SIN Test, HINT sentence test
Closed set-tests: 4 choice spondee, vowel identification. Consonant identification
WIPI
Speech reading abilities
Family education is critical!
open set
provides an unlimited number of stimulus alternatives. These are more difficult. Monosyllabic word lists are the most widely used materials in speech recognition testing
close set
limits the number of response alternatives to a fairly small set (usually between 4-10) Word Intelligibility by Picture Identification (WIPI) is commonly used as it requires only the picture pointing response and has a receptive language vocabulary that is as low as about 5 years
Two Ears are Better Than One
An individual who meets candidacy criteria in both ears should be considered for bilateral CI.
If not, consider fitting non-implanted ear with hearing aid.
CI Benefits for Children
Development of spoken language -Expressive and receptive Environmental awareness Classroom benefits -Awareness of sound -Hearing music -Better classroom participation -Better communication -Hearing the teacher more easily
Different variables affect S&L in children with CI
Age of implantation Length of time utilizing device Language abilities prior to implantation Bilateral vs. bimodal Social interactions
When does our critical language learning occur?
first year
Study done by Conner et. al.
“Burst of Growth”
According to a study performed by Conner et.al., “Children who had received their implants before the age of 2.5 years had exhibited early bursts of growth in consonant-production accuracy and vocabulary and also had significantly stronger outcomes compared with age peers who had received their implants at later age” (2006). This study goes on to explain that this “burst of growth” begins to diminish with increasing age of implantation.
Catching Up
Implanted prior to 24 months old (Szagun & Stumper, 2012).
-Some research has suggested that if a child receives a cochlear implant by 24 months old they are more likely to make linguistic process and can be expected to catch up to their normal hearing peers by preschool age
Sensitive period (when their brain is more like a sponge)
-First 2 years of a child’s life
The duration of time for heightened sensitivity for language learning in children (Szagun & Stumper, 2012)
-Begins to diminish around 4 years old
Why is age of implantation vital for language acquisition?
The maturation of our central auditory pathways is one explanation as to why age of implantation is vital for language acquisition but language skills prior to implantation as well as a child’s social environment also play a role in language learning after implantation.
Language & Cognition Major goals
Development of speech perception
Development of spoken word recognition
Development of language skills Being able to UNDERSTAND conversational speech is essential for children to produce language correctly.
Academic Success
Better phonemic awareness
Better phonological skills resulting in better reading abilities
-Later onset hearing loss = better reading abilities (Marschark, Rhoten & Fabich, 2007).
Prior language experience
Mainstream school/changing rooms
-Mainstream: allow child to experience spoken language from multiple speakers
Fatigue
-Treatment plans
Bimodal hearing
One ear utilizes CI, other ear utilizes hearing aid
Why would we use this type of hearing?
Only 1 ear is a candidate for CI
Resources
Surgery on one ear vs. two
Studies have been conducted to determine if children perform better with bimodal hearing or cochlear implants
having brief period of bimodal stimulation earlier in life increased the rate of language learning
phonologial processing
important for language acquisition
reduced oral language abilities that leads to problems in reading, writing, and vocabulary deficits
Prevalence
12,000 with significant permanent hearing loss born each year in the United states
impacts 17/1000 children under 18 years of age
97.4% passed the newborn hearing screening
1.6% did not pass (2009)
-8.9% of those had a hearing loss
68.4% with hearing loss were diagnosed before 3 months of age
conductive
outer or middle
temporary
ear infection (otitis media)
medications used to treat
sensorineural
damage to the inner hair cells of cochlea
damage to the auditory nerve (#8)
mixed hearing loss
combination of both conductive and sensorineural
DB
loudness or intensity of sounds
measured across 250-8000 hz
to see severity of a hearing loss
documented on audiogram
0-35
soft sound
35-70
moderate
70-110
loud sound
severity of hearing loss normal
1-13 decibels in children
1-25 in adults
severity of hearing loss mild
15-31
severity of hearing loss moderate
31-60 the greater the HL the greater the language problem
direct relation to severity and language acquisition
language issues start at the moderate level–poor vocabulary, metalinguistic abilities, grammatical morphemes, figurative language (all 5 domains of language)
severity of hearing loss severe
61-90 DB HL
greatest variation of speech and language abilities
will need intense speech and language therapy
have hearing aid or cochlear implant
severity of hearing loss profound
91-120 DB HL
will need help in all domains of language
people without hearing aids
will develop slow receptive language
language issues related to hearing loss
consonants will be in error more than vowels (because they can’t hear it)
substitute voiced sounds for voiceless
nasal vocal quality
difficulty with regular and irregular nouns and verbs
problems with grammatical morpheme especially the plural s
reading and writing will be most challenging area
choppy speech
compromise of vocabulary development
difficulty with conversational management (presuppositional problems)
areas to work on
grammatical morpheme
word recognition
phonological awareness
phonological awareness, syntax, reading, written language, narrative, conversation
other ways to label hearing loss
unilateral
bilateral
auditory perceptual problems
refer to central auditory processing disorder
(not a hearing loss)
can hear, but it makes no sense
risk factors for hearing loss
reduced babbling
reduced consonants and CVC
with profound- discontinue babbling altogether- management needed within first year of life
after 4 years
tends to be more long-lasting negative outcomes
test that can be used
peabody picture vocabulary test expressive vocabulary test (ex and rec) CASTL OWL Test of problem solving Test of narrative language test of pragmatic language CELF phonological awareness test nonword repetition *best-- criterion reference language sample
intervention for Hearing Impairment
hearing aids cochlear implants sound awareness- phonological awareness develop language skills provide amplification as soon as possible (by 6 months of age) teaching awareness of sound (auditory training) speech recognition other aspects of language
speech recognition
auditory discrimination between words
understand that people are talking and that speech has meaning
other aspects of language
common vocabulary in their environment
build semantic development morphosyntactic (word order, prefixes, suffixes, etc.)
phonological development (errors in phonological patterns)
phonological awareness
foundational ability
problems that need addressed
reading and writing
problem solving
figurative language
antonyms/synonyms, idioms, etc.
aphasia
loss of language, typically caused by stroke
-not due to IQ or intelligence
acquired language disorders refers to
childhood aphasia
traumatic brain injury
type and severity of injury characterize
language impairments
localized brain damage
damage that occurs in specific area of the brian
i.e tumor, gunshot wound, stroke
diffuse brain damage
damage over large area of brain (right or left hemisphere
e.g. shake baby syndrome, car accident
traumatic brain injury
assault to the brain due to some physical force
impairments can be in: language, cognition, physical/motor functioning- can also see behavioral and socio-emotional deficits
communication disorder can be devastating
brain neuroplasticity
other parts of the brain compensate for the injured area
there is a better chance for the brain to compensate for the initial impact of the disability
for children this will occur between 3-6 months post injury- due to spontaneous recovery
younger children have a better prognosis than older individuals
prevalence of TBI
14 years and younger
-2685 deaths due to TBI
-over 37,000 hospitalized
4% of kindergarten- 12th graders will have some form of head trauma within that developmental period
Galscow Coma Scale
measures ability to open eyes, motor responses, verbal responses
GCS eye opening
receive 4- if they can open 3- when asked in loud voice 2- open when pinched 1- no opening
GCS motor responses (6 point scale)
6- follow simple commands
5- pulling examiners hand away when pinched
4- pulls part of body away when pinched
3- flexes body inappropriately to pain
2- body becomes ridges when examiner pinches
1- no motor response
GCS verbal responses
5- caring on a conversation 4- confused or disoriented 3- can talk but makes no sense 2- makes sounds 1- makes no sounds at all
GCS totals
total points for brain injury severity 3-8 severe 9-12 moderate 13-15 mild designed for adults
modified GCS
not as good as original version for children the more points that you have the greater the significance of the problem 12-15- severe brain damage 8-11- ventilation support 6- monitoring inter cranial pressure
hemiparesis
paralysis of one side of the body
left brain damage= right paresis (vise versa)
hemianopsia
visual field cut
can occur on right or left side
(results in neglect of one side of the body)
can occur in child or adults
apraxia speech or limb
loss of ability to execute or carry out skilled movements
difficulty sequencing movement to complete task or speech sounds
the greater the complexity of a word, the greater difficulty a person will have sequencing that word
ataxia
jerky movements in motion
Characteristics of TBI
hyperactivity and inattention impulsivity poor judgement emotional problems -excessive crying, laughter behavioral problems -depression auditory comprehension problems -focus on following simple directions and understanding what is being communicate to child pragmatic deficits- ability to socially interact will demonstrate perseverations -saying these words overs and over again will demonstrate frequent maxes, repetitions, false starts, word retrieval problems poor confrontational naming abilities difficulty with naming items -circumlocution poor vocabulary diversity or TTRE smal MLU problem solving/ making inferences oral language written communication deficits sensory processing deficits phonological sys te deficits reduced gestural communication narrative problems
too much or too little details story
impaired suppositional abilities
long shower and working memory problems
difficulty with orientation to time, place, and person
pg 397 table 10.2 (review before test)
infants and toddlers will hurt themselves due to fall or assault
school-age due to sport accident
adolescents due to vehicle accident
2 boys to 4 girls more likely to have TBI
anomia
inability to name objects in environment (word finding deficits)
dysarthria speech
strength and coordination of articulators
causes slurred speech
can have goth apraxia of speech and dysarthric speech
characteristics of injury will vary based on
time of acquisition
younger usually means better in terms of a prognosis
strokes
1/3 occur during 1st two years of life
can be caused by hemorrhage, blockage of cerebral artery or trauma
non fluenet aphasia
halting speech
speech compression relatively good
damage associated with frontal lobe
fluent aphasia
speech contains errors
speech produces without any significant effort
poor language- speech comprehension
characteristics of acquired language disorders
affects reading, righting, talking and listening
dysarthria
apraxia
word recall
working memory
trouble with metalinguistic abilities na dmetacognrtion
poor self monitoring of language and communication
behavioral snd emotional problems
academic problems- will need addressed in intervention process
difficulty producing narratives
-poor summarization abilities
-difficulty identifying main ideas
-disorganized language
inappropriate remarks
lack of flexibility in thinking
assessments
limited amount or taste available for acquired language disorders
pediatric test of traumatic brain injury
most highly regard within field ages: children K-12 measures: orientation following commands word fluency memory digit span word recall (naming) story retelling receptive narrative understanding picture recall ability to proceed signature for visuo-spacial and graphomotor criterion referenced and standardized norm referenced
porch index or communicative ability in children
ages 3-12 developed by Bruce Porch Verbal communication auditory comprehension writing gestural communication lacks data for validity
Neurosensory center comprehension examination for aphasia
Age 6-13
1975
no good validity reviews
models of assessment
multiple disciplinary, trans disciplinary, and inter disciplinary
want multiple professionals to work with client
-impulsivity
-lack of motivation
-aggressiveness
-problems with inhibition
-inappropriate comments
intervention process
compensatory strategies strategies for teacher buddy universal designs for learning meaningful communication AAC demands of the environment
compensatory strategies
use both at home and at school visual schedules memory books calendars picture books
strategies for teacher
verbal and written instructions provided to students
buddy
peer student to demonstrate appropriate behavior
focus on
concentration, and socialization
start small and work up
