Aural Rehab, SLP Praxis

Implant hearing aids

1. Esteem: surgically implanted inner ear stimulator, for sensorineural hearing loss, uses natural ear as microphone 2. BAHA System: Bone Anchored Hearing Aid, option for middle ear dysfuntion, bypasses outer & middle ear, stimulates cochlea through bone conduction, titanium implant surgically placed into the bone behind the ear and transfers vibration

Parts of Hearing Aid

1. Microphone: converts acoustic energy to electrical signal 2. Power source: batteries 3. Amplifier: increases magnitude of electrical signal= increasing loudness of output sound 4. Receiver: transforms amplified electrical signal back into sound energy

Optional Parts of Hearing Aids

1. Telecoil: allows wearer to bypass phone ear piece, blocks out background noise, signal comes directly from phone. Can be used with BTE, ITE, some ITC. CICs are too small. 2. Tone Control: switch to adjust emphasis of frequency response (boosts high frequencies) 3. Ear Molds: used with BTE, custom, supposed to be comfortable. If poorly fit, sound will leak causing feedback, screeching sound.

Auditory oral (aural rehab)

Oral method Maximizes residual hearing & speech reading, facial expressions, gestures

Auditory verbal (aural rehab)

Oral method Maximizes residual hearing by denying visual/tactile input

Cued speech (aural rehab)

Oral method Supplements speech reading. Cues listener to which PHONEME is spoken

Analytic Approach to Language Remediation

Part to whole approach Target broken into component parts, each part taught separately, then put together

Time of onset of hearing loss

Pre-lingual: before language Post-lingual: after language Adventitious: acquired

Speech Characteristics of Hearing Impaired Individuals- Rate

Severe-Profound HL: described as "too slow" which affects speech intelligibility, may extend pauses or insert pauses where they don't belong

Speech Characteristics of Hearing Impaired Individuals- Suprasegmentals

Severe-Profound HL: errors include reduced variability in pitch and intensity, making speech sound monotonous; abnormal stress patterns (eg: stress on wrong syllable), abnormal junction, throwing off rhythm of speech, abnormal loudness

Model of Parent-Infant Program Delivery- Simulation Home

Situation (usually clinic setting) that looks like baby's home environment with crib, high chair, changing table, baby bathtub SLP models language stimulation techniques using natural daily routines/objects from baby's life

Auditory Training following Cochlear Implant

Training begins as soon as the speech processor has turned on and implant is "mapped" Individualized Length of training depends: few months for post lingually deafened adults to long term for prelingually deaf children Assessment of auditory skills includes: awarenss, attention, discriminiation, identification, memory, sequencing, closure. Speech= stimuli for training Begin training with auditory visual modes, move to auditory only

Synthetic Approach to Language Remediation

Whole to parts approach Target= whole utterance, client taught to derive meaning first then broken into components.

Hearing aid- body

Worn on the body Not seen much anymore Large, box, unnatural location of microphone

Primary goal of communication strategies training for adults with hearing loss

enhance client's conversational fluency

Digitally Programmable hearing aids

very popular available for BTE, ITE, ITC more precise fittings/greater satisfaction Lets AuD control listening paradigms

Acoustics of vowels & consonants

vowels: low frequency + high energy consonants: high frequency + less energy Nasality/voicing: low frequency range (about 500 Hz) Info about place of articulation: mid frequency range (1000-1500Hz) Info about manner: high frequency range (2000 Hz+)

Total Communication (Aural rehab)

Manual method Combines SEE and spoken language

SEE (aural rehab)

Manual method Signed Exact English English syntax with every word & word ending signed

ASL

Manual method of aural rehab American Sign Language. Has own grammar, does not follow English syntax, difficult to carryover to reading skills Language of Deaf community

Speech Characteristics of Hearing Impaired Individuals- Voice/Resonance

Mild-Moderate HL: usually no effect Severe-Profound HL: cul-de-sac resonance, posterior tongue carriage resonance too far back in pharyngeal cavity, may have breathy vocal quality *HI population may have hyperfunctional voice disorders- increased laryngeal tension, vocal nodules, breathy voice, abnormally high pitch

Hearing Aid- ITE

In the Ear small can be hard to manage- tiny pieces attractive to adults

Cochlear Implant Candidates

Adult Candidates: post lingually deafened, bilateral profound sensorineural hearing loss, little/no benefit to hearing aids, psychologically motivated/ready for adjustment Pediatric: team of otolaryngologist, AuD, SLP, psychologist, educators, and FAMILY decide, ages 5 months+, encourage educational programs with auditory/oral communication

Hearing Aid- BTE

Behind The Ear most commonly worn by babies/children microphone located at ear level= more natural sound/speech reception Have custom ear mold (prevents sound leakage, feedback)

Speech Characteristics of Hearing Impaired Individuals- Articulation

Characteristic vary depending on degree of hearing loss (HL) Mild-Moderate HL: single sound articulation errors, particularly high frequency, low intensity consonants (voiceless fricatives) Severe-Profound HL: final consonant deletion, initial consonant deletion, stridency deletion, stopping, cluster reduction, incorrect syllabication, vowel distortions (neutralized to schwa)

Model of Parent-Infant Program Delivery- Clinic Based

Clients come to clinic for 2-3 sessions (30-60min) sessions/week Clinician models language facilitation techniques for caregivers NOT to teach language to baby

Hearing Aid- CIC

Completely in the Canal completely hidden small pieces/hard to manipulate attractive to adults

Signal-independent information

Conveyed to listener without reliance on speech signal Can be conveyed in many forms and contributes to comprehensibility of the message Eg: providing listener with knowledge/awareness of topic, contextual cues, alphabet board, semantic predictability

Model of Parent-Infant Program Delivery- Correspondence

Course where parents send lesson plans to therapist through mail and receive feedback eg: John Tracy Clinic in LA

Parent Infant Programming

Early ID of hearing loss is critical OAEs = used for newborn hearing screening SLPs provide unbiased counseling/information on methods of communication/educational choices, link to support groups Directly intervention with family- empower family to become primary language facilitators

Hearing Aid- ITC

In the Canal more hidden small pieces, hard to manipulate attractive to adults

Cochlear Implant

Functional replacement of ear Parts: microphone, speech processor, external receiver, internal electrode array Surgical implant whihc converts acoustic energy into electrical energy which directly stimulates CN VII to give sensation of hearing Treatment option for adults and children with severe to profound bilateral sensorineural hearing loss Electrode array (22-24) electrode bands "mapped" by AuD several weeks after surgery, can be adjusted

Assistive Listening Devices-Loop Induction Systems

Goal: improve signal to noise ratio Listeners must have telecoils Rooms/individual spaces can be wired, electromagnetic leakage from loop is picked up by telecoil Inexpensive system, subject to interference from other systems

Assistive Listening Device-Infa Red System

Goal: improve signal to noise ratio Transform acoustic signal to infra red light, transmit it through the light waves from speaker to listener Most common type of system in large theaters/churches Receiver must be in direct line of sight to the transmitter

Assistive Listening Device-FM Systems

Goal: improve signal to noise ratio Transmit acoustic signal over FM radio waves No interference if different frequencies are used Used in schools, personal sound fields

Assistive Listening Device- Bluetooth

Goal: improve signal to noise ratio Wireless technology to listen to computers, iPods, cell phones, MP3 players, etc.

Assistive Listening Device- Hard Wired Systems

Goal: improve the signal to noise ratio System where speak and listner are directly connected Inexpensive, good for ERs and SNFs, can be used in noisy environments

Model of Parent-Infant Program Delivery- In the Home

Ideal provision of service Uses baby's actual items, real life environment to demonstrate language facilitations Cuts down on missed appointments