Aural Rehabilitation

-Presbycusis

"The decline in hearing associated with various types of auditory system dysfunction (peripheral and/or central) that accompany aging and cannot be accounted for by extraordinary ototraumatic, genetic, or pathological conditions." (Willott, 1991) -Usually characterized by a high frequency hearing loss, progressing over time. (cochlear loss) -Also may have problems related to dysynchronous firing of the auditory nerve and changes in the blood supply to the stria vascularis.

dynamic range

The dif. Btwn the T and the c level.

Benchmarking

comparing a single patient's performance to EBP and normative outcomes

Speechreading

• The listener uses visual cues by observing the speaker's mouth, facial expressions, and gestures to help perceive what is being said. • Visual perception of oral communication. • Speech recognition using all available information including auditory signal, lipreading, contextual cues, facial expressions and body language

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• The prevalence of HL in the well baby nursery is 1 in 1000 births BUT in the NICU it is 1 in 100 births (10 x more common!!!)

1997: PL 105-71: IDEA 1007 Amendments

(IEP must have functional goals, etc.) Individual Education Plan (goals need to be realistic, applicable and functioning... LRE!!!-least restrictive environment. Procedural safeguards!!!!-Parents have rights . zero reject

History of Cochlear Implants

* 1970's- first wearable single channel implants * 1983 - first implant for post-lingually deaf * 1990 -profound 2 > 1995- pre-lingually deafened adults w/ severe. 1998- deaf as young as 18 months. * 2000-12 months

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* 90% of children born with profound HL implanted before 18 months obtain intelligible speech * 80% of children born with profound HL implanted between 2-4 obtain intelligible speech. In contrast about 20% of children born with profound HL who wear hearing aids obtain intelligible speech

Auditory Brainstem Implants

* ABI for individuals with neurofibromatosis who have bilateral VIII nerve tumors causing deafness. * The Nucleus 24 ABI approved by FDA in Nov. 2000 for those aged 12 years and older.

Adult Candidacy-

* Age 18 or over * Moderate-profound hearing loss in the low freq; severe to profound in the mid-highs * Receive little or no benefit from appropriate hearing aids (a score of 50% or less on aided speech recognition tests in the ear to be implanted; 60% or less in the unimplanted ear.) * Desire to be part of the hearing world. * No medical contraindications. (this means that their bone is not too thin, or that there is no other medical reason they cannot implant). * Appropriate expectations

How is a hearing aid different from a cochlear implant?

* Hearing aids amplify sound. * Cochlear implants do not make sounds louder. * Cochlear implants provide useful information by directly stimulating the surviving auditory nerve fibers, allowing the individual to perceive sound.

Ar and CI programs for children

* Listen, Learn and Talk * SoundScape * Nucleus: Here We Go * The Listening Room * Sound and Beyond * Listening Room

Pediatric Candidacy 12 to 24 months (CI)

* Profound sensorineural hearing loss bilaterally * Receive little or no benefit from hearing aids over 3-6 month period. * Are in a therapy program that emphasizes the development of auditory skills. * High motivation and appropriate expectations * Have no medical contraindications.

Pediatric Candidacy 2 to 17 years old

* Severe to profound s/n loss in low frequencies; profound in the mid to highs. * 30% or less in aided speech recognition test * Educational/therapy program that emphasizes the development of auditory skills. * No medical contraindications * Highly motivated parents and child * Appropriate expectations.

Why do we assess Auditory Progress?

* To evaluate the clients progress * Assists SLP and AuD with evaluating the CI recipients MAP and their intervention program, consistency of use and functionality of the CI * Compare CI patient performance to peer who are appropriately matched by age of implantation, quality, type and amount of auditory experience prior to implantation

Acoustical/electrical stimulation:

- If usable hearing in the low/mid frequencies, but not in the higher. CI electrode array only placed in the basal portion (high frequencies) of the cochlea and the low/mid frequencies are amplified by a hearing aid • Acoustical/electrical stimulation: If usable hearing in the low/mid frequencies, but not in the higher. CI electrode array only placed in the basal portion (high frequencies) of the cochlea and the low/mid frequencies are amplified by a hearing aid

Listen, Learn and Talk

- an auditory learning kit (videos and activities) for children with HL identified before 12 months

The Listening Room

- free web resource for therapy materials * Depending on the age of onset of HL, adults may benefit from some AR after CI * Programs focus on listening and audibility * Speech tracking -read material to CI client then they repeat in different presentations (without CI, with speechreading and CI, with CI only...not visual cues) * Audiotapes, DVD's, CD's

Nucleus: Here We Go

- software program for teenagers that SLP or AuD can use to create custom workbooks based on the teens interest.

3 fda approved manufactures?

-Cochlear america -advanced bionics -med el

1990: PL 101-476: Individuals with Disabilities Education Act (IDEA)

-First one to say that people are people before they are disabled. Took out handicapped and put in disability. People first. FAPE- Zero-Reject ensures the right of the parent and the children are protected.

1975: PL 94-142: Education of All Handicapped Children Act

-Free and appropriate public education (FAPE) (ALl children have a right to free and appropriate education. Started at school age). CFR300.303,

1986: PL 99-457: Education of Handicapped Act Amendments

-Joint committee on infant hearing had it including services to children from birth to age 5. IFSP-Individual family service plan was created, which helped bridge the gap between the two gaps. Btwn. part b (5 and up) and part c (birth to 5). -introduced aural rehab to early intervention.

Rehabilitation for CI

-adults do nor require formal aural rehab if later defined. -children must have auditory therapy.

Cochleostomy

-drilling of a hole through the basal turn of the cochlea to insert the electrode array (older technique) -Newer technique is to have the electrode array go through the oval window to preserve more of the residual hearing of the client

Coping: Behaviors typically fall into two categories • Controlling the social scene: • Avoiding the social scene:

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Hearing aids + Audiologic Rehabilitation EQUALS Overall Higher Quality of Life

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Special Ed. Legislative Acts

1975: PL 94-142: Education of All Handicapped Children Act 1986: PL 99-457: Education of Handicapped Act Amendments (including services to children from birth to age 5) 1990: PL 101-476: Individuals with Disabilities Education Act (IDEA) 1997: PL 105-71: IDEA 1007 Amendments (IEP must have functional goals, etc.) 2004: PL 108-446: IDEA Improvements Act (aligns IDEA with NCLB) public law-pl

Cochlear implants

A surgically implanted cochlear prostheses that bypasses the damaged peripheral auditory system to directly stimulate the VIII nerve for hearing.

Individual Education Plan

Accommodations at school, mainstreaming... etc... that is coming up with a plan at school, goals.

2004: PL 108-446: IDEA Improvements Act (aligns IDEA with NCLB) public law-pl

Aligns no child left behind and idea.

Bilateral cochlear implants-

Implants in both ears * becoming more popular for recipients * sequential or simultaneous implantation * Research: Bilateral CIs provide improved localization and improved hearing in noise.

Phonemic Regression

In some elderly individuals, presbycusis is characterized by a more severe word recognition ability than would be expected on the basis of the pure-tone audiogram. - Simply making speech louder will not usually help because phonemic regression is generally attributed to auditory processing disorder.

Individual family service plan

Includes everything from when they are diagnosed, including all the family and plans before they even enter school... what kind of therapy.... goals... what they will do at home...

Otoacoustic Emissions (OAE)

OHC and COCHLEAR FUNCTION- DON'T HAVE TO BE STILL • Recording of sounds that the ear produces itself. • Generated in the outer hair cells of the cochlea • OAEs only occur in a normal cochlea with normal or near normal hearing. • If there is damage to the outer hair cells producing mild hearing loss, then OAEs are not evoked • OAEs are usually present if hearing is 30 dB or better

People who wear CI are called?

Recipients.

Personal and Environmental Factors

Ronch and Van Zanten (1992) described lifestyle changes that typically occur with age. • Physical condition: poorer health • Emotional life: loss of significant others reduction in activity • Members of the family of origin: Parents and siblings die. • Marital relationships: Strain due to death or illness of spouse, empty-nest syndrome, pressures due to retirement. • Peer Group: Friends die or relocate • Occupation: Retirement • Recreation: Lessens due to physical limitations • Economics: Reduced income due to retirement

Auditory Brainstem Response Test (ABR)

STILL/SLEEPING • Evaluation of how the auditory nerve conducts impulses from the peripheral to auditory brainstem pathway in response to an acoustic stimuli • ABR can acquire more information about the severity of hearing loss and the integrity of the auditory pathway from the nerve to the brainstem. ( Neurological and threshold seeking. Neurological-acoustic neuroma (tumor). Can get frequency specific. The test takes about an hour. If you were trying to rule out hearing loss for a child you would do clicks and sounds).

Gen Xers-

The space race, the challenger explosion, This is a generation where the mothers went to work. This was the generation that there were more kids letting themselves in at the end of the day (Call themselves "Latch key"). Think globally, value diversity, family is still numb 1 but divorce rates started to climb and higher then ever. Came up with an ideal of perfectionism. And realizing that parenting is not perfect. It is imp when you are counseling a client that you understand that generation becaue it is going to change the way you talk to them....etc.... • Consider the values and world events of each generation

Hybrid CI Fitting Range

This fitting range allows for clients with better low frequency hearing to be fit with cochlear implants

true or false- ALL states have implemented newborn hearing screenings.

True

Type I- Type II- Type III- Type IV-

Type I -strong positive attitude towards HA's and AR Type II—essentially positive attitude toward HA's and AR but has some complicating factor (previous unsuccessful user, difficult fit) Type III- essentially negative attitude but willing to consider audio evaluation (usually in denial about loss) Type IV- strongly negative attitude about HA's and AR (may be member of Deaf community, do not want assistance)

Peple who wear hearing aids are called?

clients or patients.

Controlling the social scene:

giving verbal and non-verbal instructions to communication partners, using technology, and adjusting seating or lighting. While all laudable, if the attempts fail repeatedly, the person begins to feel helpless.

SoundScape

interactive listening activities for different age groups

Sound and Beyond

interactive software program (with speech, environmental sounds, male or female voices, music)

C-level

is the loudest level than can be listened to comfortably for a long period of time.

Avoiding the social scene:

minimize the loss, joke about it, may avoid challenging communicative situations, and choose not to use conspicuous technology. Initially, some of these behaviors may actually help "ease" into acceptance. If prolonged, may lead to social isolation and feelings of incompetence.

Procedural safeguards

parents have rights, to call meetings, being able to call meetings, looking at childs IEP...

Least restrictive environment

putting them into the most effective environment. (e.g. mainstreaming, private school, separate class,etc.... ).

Hybrid CI

simultaneously provides acoustic input through a HA for the low frequencies and electrical stimulation of afferent auditory nerve fibers to the higher frequencies via a CI to the same ear

T-level or minimum stimulation level

softest electrical current that produces an auditory sensation 100% of the time.

Bimodal Stimulation

this is when the recipient wears a CI on one side and a hearing aid on the opposite ear. 2 different modes of stimulation. Electrical and Acoustical.

neurofibromatosis

tumor, on cranial nerve 8

Listening Room

with conversation practice, discrimination activities , music appreciation and speech tracking exercises.

Cued Speech

• A manual Communication • Hand cues used to reduce confusion produced by speechreading homophenous phonemes • The handshapes are not signs but indicate place of articulation for sounds in words • Four hand positions and eight handshapes made near the mouth to represent syllables while speaking. • Can be learned through classes and follow up practice • Not widely used, but beneficial for literacy learning.

American Sign Language

• A manual communication that is distinct from spoken English • ASL is NOT based on English grammar and syntax • Extensively used within and among the deaf community • English is taught as a second language • Prepares a child for access to the deaf community • Use of amplification is not a requirement for success with ASL • Very often not learned from parents, but from peers, other deaf adults/teachers. • Signs are meaning based- consists of words, but not a corresponding sign to represent each English word. • Many signs are iconic.

2 out of 3 of every 1000....

• About 2-3 of every 1000 children are hard of hearing or deaf

Communication Options-

• Auditory Verbal Approach • Auditory Oral Approach • Cued Speech • American Sign Language • Total Communication

Psychosocial Well-Being (60+)

• Erickson's Stages Integrity vs. Despair (60+) • Sense of satisfaction, acceptance with oneself and station in life vs despair and anger • Goal of this stage is to be SATISFIED • HL= loss of independence • Also this is a time of reversal of roles for children and their elderly parents • May have difficulty with daily tasks while struggling for personal dignity • Possible that a well meaning child can overmanage their parent

Baby Boomers

• Experienced Vietnam, civil rights movement.... Have a tendency to question authority. Tend to say hm.... Is this really my best option? Believe in family. But they also believe in dignity and self worth. Who they are with what they do. Believe hard work = success.

High Risk Factors

• Family history • In utero infections such as cytomegalovirus (CMV) • Anomalies of head or face • Low birthweight • Hyperbilirubinemia requiring transfusion • Ototoxic medications • Meningitis • Low Apgar scores • Mechanical ventilation of 5 days or longer • Findings associated with a syndrome

Hearing loss in adults

• Hearing loss since birth • Late-deafened • Sudden loss • Noise-induced loss • Illness

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• Include those with minimal or unilateral s/n hearing loss and those with conductive losses, total could reach up to 10 million children.

Auditory Oral Approach

• Oral/Aural program supported by AG Bell Association • Encourages the use of residual hearing with the aid of amplification but stresses the use of speechreading • This is very appropriate for young children before the age of 2 with CI...because of the use of residual hearing and the neural plasticity of the brain (the ability of the brain to form new connections and reorganize itself through processing of sensory information provided by auditory experiences) • Child will learn to speak through a combination of early, consistent and successful amplification and speechreading • It is not encouraged to use a formal manual communication but natural gestures may be supported

Effectiveness of Intervention: Family and Child Outcomes

• Reduce familial stress • Support parental self-confidence • Promote or support responsive communicative interactions

Manual Modes of Communication

• Sign Language (ASL and Signed English) • Fingerspelling • Cued Speech

Greatest Generation

• Sometimes they just want it simple, don't always need all the bells and whistles.

Zero Reject

• The school cannot refuse to provide a program for a child regardless of the disability • The public agency must provide educational programs for all children regardless of child's disability severity or type. The school cannot refuse to provide services because they don't have it.

Auditory Verbal Approach

• This is a Unisensory Approach...Audition only • The goal is to have the child function in a hearing world • Considerable parent involvement...we teach the parent the skills to incorporate listening situations into the child's everyday life...to make listening a meaningful part of the child's experiences • The parent must create language rich environments • It is discouraged that the child use visual cues with this approach...hand covers the mouth or sit side by side • This has become a very viable option for children to use their listening skills given the advancements in hearing aid technology. • Widely used with CI clients • This is very appropriate for young children before the age of 2 with CI...because of the use of residual hearing and the neural plasticity of the brain (the ability of the brain to form new connections and reorganize itself through processing of sensory information provided by auditory experiences) • This approach focuses on listening which leads to the natural development of speech and language • With optimal access to sound, learning to listen and talk can begin immediately and can occur during all waking hours • The A-V approach embraces the view that children learn language most easily when actively engaged in relaxed, meaningful interaction with supportive parents and caregivers

Total Communication

• This method supports the use of all communication means...formal sign simultaneous fingerspelling, gestures, speechreading, body language, oral, speech and amplification • The idea is to communicate and teach vocabulary and language in any manner that works • Goals: development of language through this combination and also the ability to participate in either the hearing or deaf communities. • Use of personal amplification is encouraged • Family is primary language facilitator

Psychosocial Well-Being (35-60)

 Erickson's Stages 35-60 Generativity vs. Stagnation  Mentoring, guiding new generations, nurturing vs. self absorption and preoccupation  This is the stage where your identity is associated with their role in families...ie...mother, wife, etc. ...in the workplace...through their community, hobbies, etc  Patient will grieve...because of the difference between who they were and who they will become  They can associate HL with getting old  Hearing loss represents a psychological trauma for this group they see it as a loss of self  Acquired loss—the client may go through the grief process and grieve the loss of self, loss of who they were.  May benefit from counseling or peer groups  Effects on their quality of life

Physical and Mental Health and the Aging Process

 Much variability, but according to the U.S. Bureau of the Census (1990), approximately 9 percent of adults 65-69 years old need assistance with everyday activities, and this increases to 45 percent for those 85 and over.  If older people have difficulty hearing, they may become disadvantaged when performing cognitive tasks such as remembering information that has been heard. May appear "senile".

Sociological Status:

 Physical environment (living arrangements)  Social environment (support network and daily activities)  Financial Status ($$) Psychological Status:  Mental Status (cognition and it's decline...dementia, Alzheimer's)  Depression  Motivation, Attitude and Expectations (attitude types...) Type I -strong positive attitude towards HA's and AR Type II—essentially positive attitude toward HA's and AR but has some complicating factor (previous unsuccessful user, difficult fit) Type III- essentially negative attitude but willing to consider audio evaluation (usually in denial about loss) Type IV- strongly negative attitude about HA's and AR (may be member of Deaf community, do not want assistance)

Psychosocial Well-Being (18-35)

 Remember Erickson's stages...Intimacy vs. Isolation (18-35) Goals Include:  Trust, sharing vs distancing from others  This is the time in life when we seek a mate, marry and settle down ...which requires trusting another enough to share themselves  For people with low self esteem ...they may not reach out to others, may not take risks  They may not have succeeded academically which limits their vocational options  Deaf adults who associate with the Deaf community may have higher self esteem than peers with hearing loss as they may not feel part of either the hearing or deaf worlds.  95% of deaf people select deaf spouses  Also, deaf adults who attended a residential school may have had exposure to peers and adult role models who are deaf. However, they were away from family and friends and may have had limited academic offerings.  Mainstreamed settings generally have better academic offerings

Sudden Hearing Loss

 This is a rapid loss of hearing that occurs over a period of 1-3 days  Medical management is recommended  In most cases the hearing loss is unilateral  There can be spontaneous recovery. This is where there is no medical intervention and the hearing recovers over a period of several days  Most will recover some hearing over time (1-2 weeks)  This affects about 4,000 people a year (US)  Most often for clients 30-60 years old  Over 100 causes...most are unknown etiologies (infectious disease, trauma or head injury, toxic causes...snake bites, ototoxicity, neurological disorders...MS, Meniere's Disease)  Treatment...medical treatment ...fast