Aural Rehab Final Exam
List an example of a good reinforced for a preschooler.
-Collecting stickers -Putting features on Mr. Potato Head -Blowing bubbles -Playing a card game -Putting puzzle pieces together
How is hearing related difficulty assessed?
-Structured or unstructured interviews -Questionnaires and other self-report measures -Structured or unstructured communication interactions
True/False: ABR stands for aberrant brainwave reception.
False (auditory brainstem response)
True/False: Presbycusis is typically low frequency hearing loss.
False (high frequency)
True/False: Content is a language characteristic that refers to the use of language in social interactions.
False (pragmatics)
Babies who fail the screening test but who turn out to have normal hearing are examples of ________ results.
False-positive
According to the Department of Education and Children's Services, IEP goals must adhere to DART. What does the "R" in DART stand for?
Realistic
It has been found that children with normal hearing require a speech to noise ratio of about ___ for optimal auditory comprehension.
+6 dB
What is tinnitus?
-Affects 25-55% of kids with HL -May inflict insomnia, emotional trauma, physical symptoms
Know the difference between analytical and synthetic training and the type of activities you would do for each. Do most auditory training programs only use one or the other or incorporate both?
-Analytic training works on recognizing individual sounds, like differentiating between "top" and "pop" -Synthetic training focuses on understanding the whole utterance using context clues in order to process and understand the meaning of the information as a whole -Most auditory training programs incorporate both analytic and synthetic training - on more of a continuum
Who are the potential users of ALD systems?
-Anyone can use them now! -HA users -CI users -BAHA/Ponto users -Unilateral hearing loss -Normal hearing -Individuals with auditory processing disorder -Large groups/entire classrooms
What are some of the differences during hearing aid verification for children versus adults?
-As with adults, goal is to determine whether speech is audible -Includes electroacoustic measures using probe microphone and insertion gain protocol -Behavioral measures may be included in the verification process of older children -Provides frequency-specific information about speech audibility and estimates of real-ear aided responses
Discuss the role of the SLP in the IEP multidisciplinary team.
-Assessment of speech, language, literacy and pre-literacy skills, and speechreading skills -Conduct hearing screenings -Possess knowledge of listening devices and ALDs (be able to perform visual inspection and listening checks of amplification devices) -Provide direct speech-language therapy -Provide speech-reading and auditory training -Consultation with parents, classroom teachers, and other members of the multidisciplinary team -Sometimes provide sign language instruction to child, teacher, or parents -Act as a liaison between clinic, classroom, and home to ensure consistency of therapy objectives -Consultant to audiologist-including appropriate language levels for audiological testing
What are some of the differences during hearing aid orientation for children versus adults?
-Audiologist must instruct parents and caregivers on how to care for the device -Must also learn how to perform a listening check, monitor the child's ability to hear with the device, and troubleshoot problem -Written materials should supplement verbal instructions
Describe the action stage in becoming a successful hearing aid user.
-Clinician provides services for HA evaluation and fitting -Patient learns about appropriate HA styles, steps for acquiring an HA, and receives HA
What is LRE?
-Least Restrictive Environment -Child educated with peers without disabilities to the maximum that is appropriate
Discuss ABR testing.
-Auditory Brainstem Response -Electrophysiological response to the acoustic stimulus -Originates from CNVIII and auditory brainstem -Most comprehensive test for identifying infants -Most often used for kids birth-5 or kids who can't take behavior testing -Usually performed on sleeping child (must be still), surface electrodes placed on the child's head and neck to record neural activity elicited by presentation of tone bursts or clicks -Can also be used to determine degree of hearing loss
What are other hearing related disabilities/conditions a child may have?
-Auditory Processing Disorder (APD) -Auditory Neuropathy Spectrum Disorder (ANSD) -Tinnitus
Discuss BOA testing.
-Behavioral/Observational Audiometry -Observation of child's response to sound (i.e. change in sucking pattern, eye widening, cessation of activity, or head turn) -Does not test hearing threshold
Name a questionnaire that assesses a patient's hearing related difficulties.
-COSI -SSQ
Name one red flag for auditory development for a suspected hearing loss that you may see in a 12 month old infant.
-Cannot be quieted by familiar voice (mom or dad) 0-3 months -Does not respond to pleasant sounds by cooing 3-6 months -Is not responding to soft levels of speech and turning heads to voices at 6-9 months
What are some ways to improve classroom acoustics and background noise?
-Carpeting -Rubber tips on chair and desk legs -Acoustical panels or bulletin board on walls -Placing bookshelves or wall dividers to create quiet areas within the classroom -Angling freestanding whiteboards to reduce reverberation -Hanging curtains or shades on windows -Arranging desks and tables in a staggered formation -Reduced overall room size or rooms that are not complete squares -Low ceilings of covering ceilings in suspended acoustic tile -Conduct classroom instruction away from sound sources such as air vents
What is auditory processing disorder?
-Central cause—not peripheral -Signal from brainstem to cerebrum is disrupted due to damage or malformation (normal hearing but no acoustic reflexes) -Difficulty with localizing sound, auditory discrimination, following directions -No formal test battery
What are troubleshooting guidelines for ALDs?
-Check device battery -Ensure microphone is not muted -Ensure transmitter and receiver are on the same channel -Ensure there is no other interfering equipment -Check battery in ALD components -Clean battery and gold contacts with cleaner or alcohol -Check chargers and power outlets -Wiggle microphone cord and look for cracks and tears -Ensure microphone jack is securely connected -Swap out one piece at a time
Know how to write a goal for a school-age child.
-Child will discriminate between a closed set of like-sounding word pairs with 80% accuracy. -Child will display auditory comprehension by recalling 2 details of a story read aloud with 80% accuracy. -Child will demonstrate expressive use of possessives (girl's hat) with 80% accuracy.
Know how to write a goal for a preschooler.
-Child will discriminate between two familiar speakers differing in pitch and loudness with 80% accuracy. -Child will display auditory comprehension by following directions with 2 critical elements ("give me the brown cow") given minimal cues with 80% accuracy. -Child will discriminate adult-produced sounds differing in suprasegmental features in a closed set with 80% accuracy. -Child will imitatively use the present progressive "ing" verb form with 80% accuracy.
Know how to write a goal for an toddler.
-Child will identify environmental sounds (hair dryer, telephone, vacuum) of varying intensities with 90% accuracy. -Child will identify adult produced animal sounds (moo, quack, woof) by pointing to a picture card with 70% accuracy. -Child will imitatively produce the /p/ consonant with 80% accuracy.
Know how to write a goal for an infant.
-Child will turn to detect moderately loud environmental sounds from 1-3 feet with 90% accuracy. -Child will turn to attend to their name compared to other names in a closed set of 3 with 75% accuracy. -Child will turn to speaker for localization in 2 out of 5 attempts. -Child will demonstrate bilabial lip closure with 85% accuracy when imitating an adult vocalization such as /m/.
Discuss day program placement for children who are deaf or hard of hearing.
-Children commute to and from school on a daily basis -May enroll in a general education school or school day school specifically for children who are deaf or who have hearing loss
Why is early identification important? What are some of the benefits that have been shown?
-Children who receive intervention services demonstrate significantly better language, speech, and social-emotional development than those who don't -Early-identified children with intervention have language development similar to their nonverbal cognitive development -The better the language development, the less parental stress, and the better personal-social development
What is the mainstreaming classroom placement option in public schools?
-Children with hearing loss attend classes together with children who have normal hearing -Child is included in all or most aspects of regular classroom -There are several variations of mainstream including selective mainstream, inclusion, and co-enrollment
What are some of the difficulties associated with classroom acoustics and background noise?
-Classrooms are full of background noise which muffles and distorts speech (papers shuffling, books and desks closing, and children whispering) -Sounds also bounces from one hard surface to another (walls, floors, desks, and ceiling) -Impacts speech recognition by causing the speech signal to merge with other signals thus losing its clarity -Exacerbates already degraded word recognition/speech comprehension abilities in children with HL
Describe the preparation stage in becoming a successful hearing aid user.
-Clinician addresses and helps develop constructive values and attitudes -Patient revises self-stigmatizing beliefs, understands costs/benefits of HA, and considers how it will help achieve their AR goals
Discuss didactic instruction for parents.
-Clinician and parent jointly select strategies to be taught based on child's age and language development as well as parent's current behavior -Clinician may provide handouts with an explanation of the strategy, videotaped examples of the strategy being used, modeling of the target strategy, and simulation of the strategy when possible
Discuss other manual sign systems besides ASL (manually coded English).
-Comprised of manual signs corresponding to the words of English, sharing syntactic structures -Likely what interpreters use (speak simultaneously while singing) -Every word of English is signed -Signed English, SEE (signing exact English), and L.O.V.E
Discuss CPA testing.
-Conditioned Play Audiometry -2+ years old, usually up to age 5 -"Wait and listen" behavior, child performs an action such as placing a block in a jar or a peg on a board each time a sound is heard -Can also be used for speech testing
Discuss mixed and conductive hearing loss in children.
-Conductive: anomaly of outer and/or middle ear (most commonly caused by otitis media -Mixed: both sensorineural and conductive HL
What is the self-contained classroom placement option in public schools?
-Contained within a community school but separate from the general classroom -May contain only children with hearing loss, or they include children with other disabilities (multi-categorical self-contained classroom)
Explain the following facilitative language techniques and provide an example: expansion and modeling.
-Copies the meaning of child's utterance and adds one or more morphemes/words -i.e. Child: "baby cry", Adult: "The baby is crying."
List one of the three reasons provided for why to administer a speech language assessment.
-Determine the need for intervention -Developing intervention goals -Evaluating progress and effective of intervention
What are some of the DON'Ts of describing an audiogram to patients?
-Don't exclude people who came to the appointment unless patient requests they be excluded -Don't use jargon -Don't assume the patient understands everything you tell them -Don't tell the patient what to do
How else could the do's and don'ts of describing an audiogram be applied to informational counseling?
-Don't tell a patient what to do about their HL -Explain everything in a way that is easy for them to understand -Be empathetic, ask how client is doing -Counsel the SO/family member as well
What is the difference between an FM and DM system?
-FM system transmits sound via radio waves -DM system transmits sound via digital signals
What is a false positive and what is a false negative?
-False positive: child fails screening but passes exam, doesn't actually have HL -False negative: child passes screening but actually has HL
What is FAPE?
-Free Appropriate Public Education -Guaranteed free and appropriate education for all children with disabilities ages 3-18 -Special education provided at public's expense under public supervision
What is the role of the IFSP service coordinator?
-Helps the family during the development, implementation, and evaluation of the IFSP -Coordinates the child's evaluation and assessments -Facilitates and helps develop the IFSP -Coordinates, monitors, and assists the family in receiving appropriate services -Helps develop a transition plan to preschool services if needed
What are the difficulties associated with unilateral hearing loss?
-Historically received little/no intervention -Risk for language delay (miss out on incidental learning) -May easily fatigue because they exert increased effort in noisy/reverberant classrooms -At risk for decreased educational achievement -May be accused of inattention "selective listening" -May seem easily distracted or frustrated
Know how you can evaluate auditory skills
-IT-MAIS -SPICE
Discuss the role of the psychologist in the IEP multidisciplinary team.
-Implement psychoeducational assessment -Provide programs to promote coping skills, psychosocial adjustment, positive self-concept, and problem solving
What are the benefits of ALD systems?
-Improved Signal-to-Noise Ratio -Reduces vocal strain on speaker/teacher -Helps reduce listener fatigue -Better access to signal of interest
Briefly discuss the evolution of the research on cochlear implants. What did the research focus on in the past, what does it focus on now?
-In the past, research aimed to discover if cochlear implants lead to better performance than hearing aids -Today, the questions is, "to what extent do children with cochlear implants perform like children who have normal hearing?"
What are some of the DOs of describing an audiogram to patients?
-Include SO/family member if present -Describe type of HL but focus on what it means for them -Keep it simple (relate everything to what the client knows) -Look at how patient is reacting (confused or upset)
What is IDEA?
-Individuals with Disabilities Education Act -Mandated service for infants and toddlers and their families rather than just 3 and up -Changed "handicapped" to "disabilities" -2004 revision included PT, OT, SLP, and AuD -IEP or IFSP created for each child based on their individual educational needs
Explain the following facilitative language techniques and provide an example: interactive silence.
-Interjects a self-controlled pause to serve as wait time, think time for the child to formulate a response, expectancy, or impact -i.e. "Jack and Jill went up the...."
Explain the following facilitative language techniques and provide an example: labeling.
-Interprets the child's intended messages using context clues and expresses in words -i.e. Child vocalizes and parent says, "That's a car!"
Discuss parental support during the early intervention process.
-Intervention team will provide parental support throughout early intervention to help build a sense of self-efficacy in parenting a child with an HL -Includes training aimed at promoting language development and interactive communication -May also recommend support groups -Can promote the child's development of speech, language, cognitive, and emotional skills AND the parent's sense of self-efficacy/increase family well-being
What are joint goal setting and shared decision making? Why are these good?
-Joint goal setting: clinician and client/family create a partnership to identify meaningful goals and desired outcomes -Shared decision making: neither the clinician nor patient alone decides how the patient's goals are addressed, making all clinical decisions together -Ensures all people have a say in the development of the intervention plan
What kind of auditory training activities you would do at the level of sound comprehension?
-Listen to a read-aloud story and then answer questions about the plot and characters -Play I Spy ("I spy a red sweater"; "I spy some blue jeans") -Play 20 Questions ("Is it bigger than a chair?"; "Is it alive?")
What kinds of things could be included in a goal for a 9-month-old with hearing aids?
-Localizing sound -Attend to name by turning head -Recognizing loud, soft, and moderate environmental sounds -Discriminating adult produced vocalizations such as "mm" and "uh-oh"
What are the risk factors of hearing loss?
-Low birth weight -Family history of HL -In utero infections (CMV, rubella) -Ototoxic medications -Low Apgar scores -Craniofacial anomalies
Explain the following facilitative language techniques and provide an example: comment.
-Makes a comment to keep conversation going or to positively reinforce the child -i.e. "Yes, that's right!"
Discuss American Sign Language.
-Manual system of communication expressed by the hands -Has different syntax and grammar than spoken English (one hand gesture may represent an English phrase or concept) -Includes facial expressions and body language
Describe the circular-pathways model of grieving.
-Many of the same reactions as sequential model, but grieving experience is an enduring cyclical process -Positive pathway: incorporate hope, take on future with optimism -Negative pathway: regularly lapsing into despair or anger, protest
Discuss the non-genetic causes of hearing loss in children.
-May be prenatal, perinatal, or postnatal -Include rubella, CMV, anoxia (absence of oxygen), meningitis, measles, use of ototoxic drugs
Discuss the auditory-verbal method of communication.
-Method that teaches parents the skills to aid their Deaf child's speech and language development -Implemented through play-based therapy sessions which are transferable to everyday life activities -Provides children with learning opportunities throughout their day outside of therapy
What are the difficulties associated with mild-moderate hearing loss?
-Mild HL often not diagnosed until later in childhood -Moderate HL: difficulty understanding speech in conversational/group setting -Difficulty listening in noisy/reverberant classrooms -Deficits in speech recognition, academic learning, social skills, and self-image which may warrant aural rehabilitation -May lead to mild articulatory disorders/vocabulary delays
Discuss formal instruction for parents.
-More structured and systematic instruction for parents/caregivers -Might follow specific stages of didactic instruction, guided learning, and real-world practice
Discuss facts about otitis media.
-Most common cause of conductive HL -Most common reason a child under 15 visits a doctor -Most common reason why physicians prescribe antibiotics for kids -Affects about 50% of children by age 1 and 80% by age 3
Discuss parent counseling.
-Most parents of kids with HL have normal hearing -Some take the news as traumatic, while others take on the challenge headfirst -Parents are integral for successful AR
What are some of the challenges when looking at research on speech, language, and literacy performance of cochlear implant users?
-Much of the research included children that were implanted relatively late as compared to today's standards -Cochlear implant technology is advancing so rapidly, the literature cannot keep up
Why is follow up important?
-New problems or situations can arise -A patient's hearing predicaments can change -As one goal is met, new goals emerge
Describe the treatment options for tinnitus. Is there a cure?
-No known cure exists -Few patients pursue treatment -There are a variety of options to provide relief or some control over the sensation on tinnitus including: auditory signal masking, relaxation techniques, biofeedback, tinnitus retraining therapy
Discuss OAE testing.
-Otoacoustic emissions -Low-level sounds spontaneously emitted by the cochlea upon presentation of an auditory stimulus -Caused by movements of the outer hair cells -Vibrations can be measured by a small probe placed in the ear canal -People with normal hearing produce OAEs while those with HL of 30-40 dB do not -Quick and easy to administer, sound is presented via probe in the ear and OAE is detected by a microphone in the probe
What tests are involved in Universal Newborn Hearing Screening?
-Otoacoustic emissions (OAEs) -Automated auditory brainstem response (A-ABR)
Discuss guided practice for parents.
-Parent practices the strategy with the child as clinician observes -Prime time to use coaching rather than direct therapy -After practicing, parent and clinician may discuss other situations in which the strategy could be used -Parents may complete workbook activities about hypothetical situations
Discuss real-world practice for parents.
-Parents monitor and reflect on their own use of the strategies in their everyday interactions -Might videotape themselves while playing with their child at home and later watch themselves -May complete daily checklists or a daily journal
Describe the sequential-stage model of grieving.
-Parents pass through stages after learning about child's HL -Shock and denial -Guilt -Bargaining -Anger -Depression -Acceptance
Discuss communication strategies training for parents.
-Parents should receive instruction on the optimal ways to repair communication breakdowns both when they are the talker and the listener -As the talker: rephrasing, simplifying, elaborating, building from the known -As the listener: ask child to repeat message, encourage them to provide more info, ask them to slow down
Describe the maintenance stage in becoming a successful hearing aid user.
-Patient completes trial period with hearing aid, develops and continues appropriate use pattern -Clinician supports and encourages patient
Name 1 of the top 3 challenges experienced by parents in obtaining hearing aids for their infant or child.
-Paying for the hearing aid and related products -Dealing with their child's other health concerns -Having confidence in the audiologist/finding an audiologist who specializes in young children
Describe a family centered approach to assessment and intervention.
-Places the family as central to the child's well-being -Acknowledges parental expertise and includes family in the design and execution of the AR plan -Acknowledges the importance of emotional, social, and developmental supports
What kind of auditory training activities you would do at the level of sound discrimination?
-Play a game with toy animals ("The cow says 'moo'; the sheep says 'baaa'") -Respond to commands ("Clap your hands"; "Jump!") -Play a Same or Different game ("car car"; "car star") using pairs of picture cards where the child has to point to the correct illustration -Repeat what you hear ("Mamma," "Papa")
What kind of auditory training activities you would do at the level of sound awareness?
-Play peek-a-boo -Play musical chairs -March to the beat of a drum -Push the toy car whenever the clinician says "Vrrrrm"
What kind of auditory training activities you would do at the level of sound identification?
-Play the game Candy Land and listen for the names of the colors -Play with sets of postcards or stickers ("Show me the cat") -Play Go Fish with cards ("Give me your sevens"; "Give me your twos")
IEPs should include...
-Present level of performance -Annual goals -Short-term objectives -Special education services provided -Anticipated duration of services
Discuss the role of the teacher in the IEP multidisciplinary team.
-Provide academic instruction -Make modifications to regular education curricula -Manage learning environment -Manage student behavior and social skills -May provide daily listening checks on the child's HA and troubleshoot problems
Explain the following facilitative language techniques and provide an example: parallel talk.
-Provides commentary on what the child is doing, an object the child is looking at, or what he may be thinking or feeling - does not require the child to respond, but can elicit a response -i.e. "You're holding a teddy. Now you're feeding the bear."
What are the different school placement options for children who are deaf or hard of hearing?
-Public or private schools -Residential or day programs
Discuss private vs public school placement for children who are deaf or hard of hearing.
-Public schools: funded by the government -Private placements: funded by tuition and donations or scholarships
What factors have a positive impact on speech development?
-Raised in a favorable speech environment -Child identified early on as having hearing loss -Child begins to use a listening device shortly after identification and wears the device for most waking hours -Has motivation to speak -Child quickly begins to receive intervention services, including speech and language therapy -No other disabilities are present
Explain the following facilitative language techniques and provide an example: recast.
-Recasts the child's utterance into a question -i.e. Child: "daddy go", Adult: "Did daddy go to the store?"
What is the recommended follow up schedule for HA patients?
-Recheck at 1 month of use then visits every 2-3 months -After 1 year of use, visits every 4-6 months -Hearing is assessed and HAs are tested/adjusted if necessary (new earmold fittings)
Discuss the genetic causes of hearing loss in children.
-Represent half of congenital hearing loss -Can be dominant, recessive, or x-linked with sudden or gradual progression -Can be syndromic (Waardenburg, Usher, Alport, Treacher Collins syndrome) or non-syndromic (no other associated findings)
What is the recommended follow up schedule for CI patients?
-Return to cochlear implant center at regular intervals after first year (6-12 months) -Receive audiologic testing, speech recognition testing and speech/language testing -AR is required for kids with a CI
Discuss informal instruction for parents.
-SLPs/AuDs may shape a parent's communication behaviors in an informal manner -Provided irregularly as clinician observes parent-child interactions -Goal is to enable and empower parents to foster language growth and communication skills in their children
What are the different classroom placement options within the public schools?
-Self contained -Mainstreaming -Mixed
Know the facilitative language techniques and be able to provide an example of each.
-Signaling expectations and time delay ("Hmm, you have a block, I wonder what you'll do with it" *looks expectantly at child*) -Self talk ("I'm unpacking the groceries. I'll take out the apples. Maybe we'll make a pie.") -Expansion and modeling (Child: "baby cry", Adult: "The baby is crying.") -Parallel talk ("You're holding a teddy. Now you're feeding the bear.") -Recast (Child: "daddy go", Adult: "Did daddy go to the store?") -Comment ("Yes, that's right!") -Labeling (Child vocalizes and parent says, "That's a car!") -Interactive silence ("Jack and Jill went up the....")
What are some of the differences during hearing aid selection for children versus adults?
-Smaller ears and ear canals limit hearing aid style options (ITE, CIC, and ITC styles are usually impractical, most receive BTE hearing aids) -Babies cannot participate in the fitting process like adults can, cannot indicate when sound is too loud or take word rec tests
Know the four auditory skill levels.
-Sound awareness -Sound discrimination -Sound identification -Sound comprehension
What are some types of ALD systems?
-Sound field (benefits multiple speakers) -Personal (intended for one listener) -Fixed gain (signal strength fixed at a predetermined value, traditional FM) -Adaptive gain (strength of signal adjusts based on environment, Phonak Dynamic FM)
Why you would recommend one type of ALD or the other for a patient?
-Sound field recommended if more than one ALD user in the classroom -Personal recommended if listener needs their own channel because they use it at home and at school -Roger system recommended for noisy environments (i.e. school) b/c it allows for a larger bandwidth of audio signal
Explain the following facilitative language techniques and provide an example: self-talk.
-Speaks aloud what they are doing, thinking, and feeling - shows that language can be used to organize, analyze, and direct actions -i.e. "I'm unpacking the groceries. I'll take out the apples. Maybe we'll make a pie."
Discuss residential placement for children who are deaf or hard of hearing.
-Students live in dorms with other students who have HL -Staff is expected to communicate with students fluently in their mode of communication -School also provides comprehensive academic, health, and socialization programs
What are some factors that influence a patient's decision whether or not to get hearing aids?
-Subjective factors (patient's perception of their hearing loss and hearing difficulties, whether or not they think they need one) -Input from family members -Professional input -Patients' attitudes and values (positive/negative thoughts toward HAs and their sense of hearing self-efficacy, stigma)
What is AVT?
-Teaches children with hearing loss to communicate by listening and talking, takes advantage of the child's residual hearing -The philosophy of AVT is for deaf and hard of hearing children to grow up in a regular learning environment and be full participants in the mainstream society -Parent centered approach that encourages the use of naturalistic conversation and the use of spoken language to communicate -Teaches the child to develop self-monitoring skills
Describe telephone training. Who might benefit from it?
-Telephone training is for patients who desire to communicate more effectively over the phone -May use acoustic or wireless routing strategies (Bluetooth) -Begins with familiar speakers/familiar topics and eventually moves to unfamiliar speakers/unstructured tasks (often includes repair strategies) -Candidates: those who fear talking on the phone due to misunderstandings/embarrassment, patients who receive CI/HA, patients who haven't used a phone in many years
Discuss the role of the audiologist in the IEP multidisciplinary team.
-Test hearing and speech recognition -Assess central auditory function -Select, fit, and maintain listening device and ALDs including hearing aids and FM systems -May make recommendation for cochlear implant -Assess classroom (and sometimes home) environment and make recommendations -Consult with parents' multidisciplinary team -Serve as educational audiologist in school system -Sometimes provide direct speechreading or auditory training rather than/in addition to the SLP
The IEP should take into account...
-The family's preferred mode of communication -The child's linguistic, educational, and social-emotional needs -Child's present level of performance and academic progress -Child's strength's including abilities, skills, and talents -The impact of the child's needs on learning and interacting with peers
Discuss the oral method of communication.
-The same language that is used by peers with no HL -Child speaks messages and uses speechreading to receive those messages -Multisensory approach: using both vision and hearing to recognize speech
What is auditory neuropathy spectrum disorder?
-Thought to be related to CAPD but affects peripheral auditory system -Sound enters ear normally but is transmittal through the nervous system is impaired -Present OAEs; abnormal/absent ABR -Poor speech recognition skills
Why do we assess a patient's hearing related difficulties?
-To identify activity limitations and participation restrictions -To identify what the patient believes is important and resolve/target those problems
Discuss communication strategies training for children.
-Typically taught to children in the higher grades of elementary school/junior high school/high school -Includes formal instruction, guided learning, and real-world practice -May include review of effective listening behaviors, teaching expressive repair strategies, and practicing interacting with people in different contexts
Discuss cued speech.
-Uses phonemically based hand gestures to supplement speechreading -Talker speaks while cueing the message -Not commonly used
Discuss VRA testing.
-Visual Reinforcement Audiometry -6 months to 2.5 years -Sound is presented through audiometer and box with animated toy lights up, child learns to look at the box each time a sound is presented -Able to determine thresholds
What are some general troubleshooting guidelines for hearing aids?
-Visual inspection: look for dents or cracks -Listening check: use stethoscope -Battery check: check and replace the batteries if needed
Explain the following facilitative language techniques and provide an example: signaling expectations and time delay.
-Waits for the child's response and signals expectation to respond by tilting the head or raising the eyebrows -i.e. "Hmm, you have a block, I wonder what you'll do with it" (looks expectantly at child)
What are some things to consider when recommending ALDs for a patient?
-Will child need to change programs to access ALD signal? -Do they need a remote or press a button? -Are they able to switch out their ear hook or battery? -Are they the only ALD user in the school or classroom? -If the school has their own sound field is it sufficient enough for the personal ALD system? -Which personal ALD system is most cost effective for schools? -Which system is most appropriate for an adult who wants to purchase for meetings at work?
What is an IEP?
-Written plan that identifies goals and objectives that address the educational needs of students aged 3-21 who have a disability -Reserved for children performing below grade level or experiencing speech/language difficulties -Must be demonstrable, achievable, realistic, time-related, specific (DART)
What are the 6 steps in an aural rehabilitation plan?
1. Assessment 2. Informational counseling 3. Development of a plan 4. Implementation 5. Assessment of outcome 6. Follow-up
What are the stages in becoming a successful hearing aid user? Do all patients progress at the same rate? Does it always follow these steps?
1. Contemplation 2. Preparation 3. Action 4. Maintenance -Patients do NOT all progress at the same rate and it does NOT always follow the same steps
What are the 3 broad things that are assessed in the assessment stage?
1. Hearing loss 2. Hearing-related difficulties (activity limitations and participation restrictions) 3. Individual factors
What are the the two models of grieving?
1. Sequential-Stage model 2. Circular-Pathways model
True/False: A unilateral hearing loss is inconsequential because "one good ear provides adequate hearing for language learning and cognitive development."
False
How many children with hearing loss do not have a risk factor at birth?
50%
Which of the following is a segmental error? A. Error at the phoneme level B. Error in intonation C. Error in conveying meaning D. Error in tempo
A. Error at the phoneme level
True/False: Many errors in children's spoken language often does NOT transfer to their writing samples.
False
Which is not a characteristic consonant error? A. Voiced/voiceless confusion B. Diphthongization C. Omissions D. Distortions
B. Diphthongization
What is NOT part of a child's individualized education plan (IEP)? A. Description of the child's language and communication needs B. Description of the child's present level of performance C. Generic goals seated from a goal bank D. The means for assessment
C. Generic goals seated from a goal bank
Discuss HA vs CI user performance for overall intelligibility.
Children who use cochlear implants speak better than children with profound hearing loss who use hearing aids
In which hearing test might a child throw a key in a bucket each time they hear a tone or speech signal?
Conditioned play audiometry (CPA)
Congenital hearing losses may be: A. Idiopathic B. Genetic C. Non-genetic D. All of the above
D. All of the above
In the multidisciplinary team, the role of the classroom teacher may involve: A. Selecting and ensuring the proper use of listening devices B. Helping parents learn sign language C. Providing speech reading training D. Planning and managing the learning environment
D. Planning and managing the learning environment
Discuss cochlear implant candidacy.
Determined by -Degree of HL -Demonstration of minimal/unsatisfactory benefit from HAs after a 2-6 month trial -Absence of medical damage to cochlea/cochlear nerve
When do children undergo their most intensive stage of listening, speech and language development?
From birth to age 3
Discuss HA vs CI user performance for reading.
HA -HA users in the past had an average reading level at third or fourth grade level→ more recently, reading level has been shown at a 6.2 grade level and on the rise CI -Read better than children with HAs -Read worse than their peers with normal hearing
Discuss HA vs CI user performance for form.
HA -Impaired morphological development -Overuse nouns and verbs and rarely use function words -Simple SVO sentences with fewer words than normal hearing children CI -Enhanced development of compared to HA users -Still delays compared to normal hearing children -Performance varies widely
Discuss HA vs CI user performance for content.
HA -May have limited vocabulary (only every day, concrete words) or use words in limited ways (don't understand figurative language or abstract words) CI -CI enhances and accelerate vocabulary acquisition -Performance often still trails behind their normal hearing peers
Discuss HA vs CI user performance for pragmatics.
HA -May repair communication breakdowns less effectively -Not as strong pragmatic skills as same age level peers CI -Use more specific repair strategies than HA users -Many still experience pragmatic difficulties
Discuss HA vs CI user performance for segmental errors.
HA -Often demonstrate different developmental patterns than children with normal hearing; plateau relatively early on CI -Early implantation = prelinguistic development more like that of babies with normal hearing, acquire speech sounds in about the same order -Greater vowel and consonant accuracy as compared to hearing aid users
Discuss HA vs CI user performance for writing.
HA -Rarely achieve writing competency normal hearing peers -Often contain the same type of syntactic errors as their speech CI -Writing and spelling remains problematic for CI users
Discuss HA vs CI user performance for suprasegmental errors.
HA -Speech sounds detached/arrhythmic -Equal stress on all syllables -May speak very slowly/softly CI -Struggles with pitch perception and rising intonation (asking questions) -Able to master other suprasegmental aspects such as loudness, timing, and relatively good voice quality
What is the difference in ages served between an IEP and an IFSP?
IEP is for children 3-21 and IFSP is for children birth-3.
Name 1 type of hearing aid that is impractical for babies and WHY.
ITE, CIC, and ITC styles because the babies' ears are too small, and they grow quickly
What are some assessments to do for tinnitus/questions to ask?
Interview or questionnaire asking questions such as: -What does your tinnitus sound like? (pitch, loudness) -Is your tinnitus louder on one side? (location) -How long have you had your tinnitus? (duration) -Is It always present or intermittent? (constancy) -Describe the onset of your tinnitus.
How are the outcomes of an aural rehab program measured?
Measured in reference to the four domains (performance, benefit, usage, and satisfaction) through: -Observations -Interviews -Questionnaires -Daily logs -Self-reports -Structured or unstructured assessments
What are some of the other disabilities children with hearing loss may present with? What percentage of children will have other disabilities?
Nearly 30% of kids with HL suffer from another disability including: -Cognitive delays -Vision impairment -Learning disabilities -Autism -ADD
What is the most common cause of a conductive component of hearing loss?
Otitis media
Describe the contemplation stage in becoming a successful hearing aid user.
Patient has been informed and educated about the chronic nature of their HL and what an HA can/cannot do
What is defined as the rules of grammar that govern how linguistic units are combined into phrases, clauses, and sentences?
Syntax
Discuss total communication.
The child uses every available means to receive a message, including sign, residual hearing, and lipreading
Know generally how ALDs work.
There are two basic components to every system: 1. The transmitter (includes a microphone that is used by the speaker) 2. The receiver (receives the acoustic input from the transmitter and delivers it to the listener)
True/False: Children with significant hearing loss often experience difficulty in learning to read and write.
True
True/False: Children with significant hearing loss often have reduced vocabularies and have mastered less syntactic structures than children with typical hearing.
True
True/False: Fewer than 10% of children with a hearing loss between the ages of 6 and 21 attend a school for those who are deaf and hard of hearing.
True
True/False: Hearing loss is the most common birth defect in the US.
True
True/False: One of the most potent predictors of speech proficiency is a child's ability to recognize and understand speech.
True
