Aural Rehab: Week 5
Hayden, a 3 year old girl has severe motor delays. What would you say to the school SLP about why Hayden might not be hearing during the assessment.
"I would recommend a different method of auditory testing for Hayden. Since she has very low muscle tone, she may not be able to physically turn around or raise her hand each time she hears a noise. Instead, you could try sitting in front of her and measuring when she looks at you, changes her facial expression, or makes a noise in response. Though she is three, the is developmentally lower than the typical three-year-old and should be taught and tested at a level more similar to an infant or young toddler."
Which of the following is not an assessment that can be used to measure children's auditory skills? Preschool Language Scale Ling 6 Sound Test APT/HI Early Speech Perception Test
Preschool Language Scale
Early Speech Detection Test
*Low Verbal Version* The ESP helps us answer "Just what does this child perceive with his hearing?" starting from a low level, prior to what is needed for listening in the classroom. Pattern Perception Training 4 different types Then you test (Pattern Perception Test) child must identify the pattern Next, word identification test *Standard Version - when vocabulary is not an issue* Picture cards pattern perception using real words *not looking for identification (during the pattern portion) then complete word identification component.
Ling 6 Sound Test
*detection and identification 6 sounds /m/ wasn't a part of the original vary based on frequency (250 Hz to 4,000 Hz) /m/, /u/=oo, /i/=ee, /a/=ah, /sh/, /s/ 7th sound = silence high frequency sounds harder for children w/ hearing loss mouth needs to be out of view from the child detection = looking for some reaction from the child no reaction, then try more environmental sounds or animal sounds
Ling Six Sound Test
-/a/, /u/, /i/, /sh/, /s/, and /m children's test to assess hearing in vowel/consonants, etc to test cochlear implant effectiveness Up to 1,000 Hz = "ahh" "eee" "ooo" and "mmm" Up to 2,000 Hz = "sh" Up to 4,000 Hz = "s"
Activities for Sound Discrimination
-Play a game w/toy animals "The cow says moo, the sheep says baa" -Respond to the command (Give me a crayon, Draw) -Play a Same or Different game (boy boy, toy boy) -Repeat what you hear (ma ma ma; pa pa pa)
listening ladder: discrimination
-basic auditory skill -ability to determine whether two sounds are the same or different (length, pitch, loudness) pattern reception: child can tell that two syllable labels are different from one syllable labels child can discriminate the difference between words by phonemes. child can discriminate the difference between words by morphemes or markers. child must attend to suprasegmental cues such as (duration, pitch, intensity, stress) & individual speech sounds
listening ladder: detection/awareness
-most basic auditory skill level -awareness of when a sound is present and when it is not -children search for the sound (turn their head) -amplification can have a dramatic effect on a child's ability to detect sound. -awareness of the presence of sound
Steps for a HA daily check
1. Check the physicial condition of the -hearing aid -earmolds -earmold tubing 2. listen to see if the hearing aid sounds: -weak -distorted -intermittent (cutting in and out) 3. check battery 4. check for wax around the ear mold 5. look at the microphone opening, see if anything is blocking sound 6. remove tone hook, and see if sound is louder after you remove the tone hook. 7. static sound = check battery contacts, clean 8. to check for internal feedback, cover the ear mold opening with your finger. If you still hear feedback remove tone hook. If you still hear feedback their may be a crack. 9. check to make sure ear mold is fit snuggly in the ear. 10. Finally, do a ling test. To make sure child is hearing all the sounds of speech.
Put the stages of Erber's hierarchy of auditory functioning in order from earliest developing to latest developing. sound identification sound detection sound comprehension sound discrimination
1. detection 2. discrimination 3. identification 4. comprehension
When should hearing aids be checked (child)?
1. every morning 2. before class 3. before speech and language therapy 4. anytime a concern comes up
12-18 months: Auditory Development
12 to 18 months: Says first words such as "more," "milk," "kitty," and "cracker"
RECD
A probe microphone is placed in the child's ear canal and the same insert phone (which has been coupled to the child's ear mold) is used to deliver the signal to the ear. The difference between the real-ear and coupler response is the Real Ear to Coupler Difference (RECD).
digital noise reduction
Amplifies speech, reduces noise
Candidacy Criteria for CI
Approximately age 12 months or older. Bilateral severe to profound sensorineural hearing loss. Limited benefit with appropriately fit hearing aids. Lack of progress in auditory skill development despite appropriate intervention.
I Spy
Auditory Training may overlap with speech & language training *Sound Identification* you can make your own game board 1. introduce each word with a flashcard (teaching moment) 2. Demonstrate how the activity works. I spy a key, then mark the word - sticker, marker, etc. 3. Think out loud. I heard a key, I need to find a key. I'm putting a sticker on the key. (Repetition of the target word). 4. Give child a turn. Bingo, Goldfish,
Describe the most common pediatric amplification devices.
Cochlear implant: 12 months or older; has severe to profound hearing loss in both ears. (3 to 6 month trial of HAs is recommended w/auditory therapy). Hearing Aid: If a child has hearing loss in both ears, two hearing aids are recommended. Mild-Moderate: BTE Hearing Aid most appropriate for children, high-frequency hearing loss Receiver In the Canal: secure for infants when appropriately designed Body Style HA: can be used on infant behaviors of lying down and drooling, for small and soft ears and small ear canals. BAHA: conductive or mixed hearing loss or single-sided deafness (complete sensorineural) Bilateral BAIs: Bilateral-Severe Conductive Hearing Loss
Be able to describe how each amplification device works to help children have auditory access
Cochlear implants: A cochlear implant is an electronic medical device that replaces the function of the damaged inner ear. Unlike hearing aids, which make sounds louder, cochlear implants do the work of damaged parts of the inner ear (cochlea) to provide sound signals to the brain. Hearing aids: The hearing aid receives sound through a microphone, which converts the sound waves to electrical signals and sends them to an amplifier. The amplifier increases the power of the signals and then sends them to the ear through a speaker. BAHA: Bone anchored hearing systems are designed to use your body's natural ability to transfer sound through bone conduction. The sound processor converts sounds into vibrations, which are then sent through your skull bone and directly on to your inner ear.
What is auditory comprehension?
Comprehension is the ability to understand the meaning of speech by answering questions, following directions, paraphrasing, or participating in a conversation.
auditory Strategies
Decrease distance to child Ling 6 Sound Test Use short phrases Repetition Ask, What did you hear? Use a closed-set Auditory Highlighting (stress, inflection) Use the "Sandwich Technique"
What is auditory detection/awareness?
Detection is the ability to respond to the presence or absence of sound. It is the essential first step in learning to listen.
Auditory assessments
Detection: Ling Six Sound Test Discrimination: Informal measures (same or different tests, Identification: Early Speech Perception Test (6 years and older) Meaningful Use of Speech Scale Meaningful Auditory Integration Scale Test of Auditory Comprehension Ling 6 Sound Test Auditory Perception Test for the Hearing Impaired-Revised
What is auditory discrimination?
Discrimination is the ability to perceive similarities and differences between two or more speech stimuli.
Discuss why objective verification of HAs is important
Ears are different so we cannot expect the hearing instruments (HIs) to perform in a predicable way in different ears. The purpose of verification in a hearing instrument fitting context is to collect objective information about the sound that the hearing instrument is producing in the ear canal of the individual client, instead of relying on estimations of the performance of the hearing instrument in an average person's ear. Verification is an objective measure to determine if the hearing instruments meet a particular standard and are performing as expected. If we are running probe microphone measures to see if we matched a prescriptive gain target, we are performing verification.
T/F: It's okay to drop function words out of a sentence when working with a child with hearing loss.
False
T/F: Subjective verification of hearing aid fit, such as patient report, is more important that objective verification, such as real-ear measurement.
False
Describe the auditory skills hierarchy.
I. Detection II. Discrimination III. Identification IV. Comprehension
What is auditory identification?
Identification is the ability to label by repeating, pointing to or writing the speech stimulus heard.
Know why outcome evaluation of HAs is important
Monitoring the hearing-related outcomes of infants and children with hearing loss can be accomplished both objectively and subjectively. One example of an objective measure is the use of Ling 6 Sound Test. One advantage of objective measures is that they provide a direct measure of the child's hearing while wearing hearing aids and can therefore be used as a way to determine the impact of the intervention. Questionnaires, diaries, and structured interviews are examples of subjective ways to assess a child's auditory behaviors in real world environments. A combination of objective and subjective outcome evaluation tools may provide a multidimensional approach to tracking a child's auditory-related performance over time.
Activities for Sound Awareness (young children)
Peek - a- boo Musical chairs march to the beat of a drum push a toy car when the clinician says, "Vrrrm"
Activities for Sound Identification
Play Candy Land and listen for the names of the colors go fish, sets of postcards or stickers (Show me the cat)
learning to listen to sounds
The Learning to Listen (LTL) sounds and associated objects or actions are hallmarks of teaching spoken language through listening. They are easy to hear for most babies wearing hearing devices, and they follow normal language development which makes playing with them fun for babies.
Plan and implement an auditory training program for young children.
The development of auditory skills depends upon the organic capability of hearing. Hearing can not be taught. Perception is a learned skill which implies that the teaching process can have a direct impact on the development of perceptual skills (lerner, 1971). The goal of education is to build the ineffective modality into a useful and productive channel for learning. learner suggests that the auditory process can be improved in this way. Tinker (1971) comments that many children learn very little about even the sounds that they hear most frequently unless they are guided in paying attention to them. The program is divided into three parts: Part One: Gross Discrimination of Sounds Part Two: Auditory Memory Part Three: Fine Discrimination of Sounds
How to determine a child's level of auditory functioning?
To determine Hayden's level of auditory function, I would like first to measure her awareness to sound. I will use informal testing via observation by looking for nonverbal or verbal responses (e.g., pointing to her ear or vocalizing) to the presence or absence of sounds. I would do this by performing the Ling 6 sounds listening check. I am able to measure listening attention and her auditory access to speech syllables. I will begin by presenting the sounds at a conversational level at a close distance. I would also like Hayden's parents to fill out the Infant-Toddler Meaningful Auditory Integration Scale to better understand what skills Hayden exhibits in a natural environment.
General principles of auditory training
To develop patients' ability to recognize speech using the auditory signal and to interpret auditory experiences. Step One: to maximize residual hearing through amplification (hearing aids, CI, assistive listening devices)
Speech Reading Training
Training speech recognition via both auditory and visual channels explicit training of articulation properties of speech sounds Goal is to gradually increase reliance on audition. *Can use a mirror for this activity *Not really common
T/F: FDA approval of cochlear implantation begins at 12 months old.
True
Hayden turns immediately when her mother opens a bottle of Sprite. What auditory skills does Hayden have?
Turning to the sound indicates localization, but otherwise most people got the other skills.
feedback management
Whistling Noise Hearing Aid creates waves that are out of sync and cancel each other out
Why do audiologists recommend amplitude compression for pediatric hearing aids?
Young children are often unable to report uncomfortable loudness or adjust volume themselves.
directional microphone
a mic with a pick-up pattern that captures sound from primarily one direction
What does feedback sound like?
a whistling sound
Auditory Training considerations
age of client (kinds of activities/motivation), pre/post lingual ability (what is the goal/expectations), degree & type of HL, language level (test/client appropriateness), formal vs informal (or combo)
Auditory Perception Test for the Hearing Impaired
assesses discrete auditory skills necessary to decode spoken language criterion-referenced (good to write goals from) - not compared to peers, but what we expect you to be able to do. ages 3+ assesses 8 major skill areas: auditory awareness (non speech sounds, # of beats in a speech sound) suprasegmental awareness prosodic perception vowel perception consonant perception other segmental perception linguistic perception communicative comprehension
listening ladder: Identification
basic auditory skill ability to identify what a speaker has named or labeled sometimes called "recognition" how can they show that they identify with the sounds -by repeating -ling 6 sound test
Auditory Training Curriculum
children must learn to attend to the auditory speech signal may be a new, scary, uncomfortable, painful sensory experience next, decipher it then gain meaning from it Program should be flexible because children's hearing loss varies widely! rate of progress is variable 4 Design Principles 1. Auditory skill level - use informal assessment, Ling 6 sound test (sound awareness, sound discrimination [same/different -Early Speech Perception Test], identification, comprehension) 2. Stimuli (phonetic-level, sentence level) 3. Activity Type (formal, informal) 4. Difficulty Level (response set, closed, limited, open, stimulus unit, words, phrases, sentences, stimulus similarity, contextual support, task structure, highly structured, spontaneous, listening conditions
Calculating Hearing Age
hearing age = child's chronological age - age at which appropriate amplification was fit Ex. Sally is 3 years, 3 months old. She received her bilateral hearing aids when she was 8 months old. What is Sally's hearing age? 12 months in a year, convert it all to months *Sally is 39 months old *HA at 8 months so subtract 39 - 8 = 31 months *convert months back to years = 12/31 = 2.7 = 2 years and 7 months
listening ladder: comprehension
higher level auditory skill -ability to understand the meaning of spoken messages integrating auditory input w/linguistic knowledge (syntactic knowledge) early: recognizing familiar expressions and instructions later: following multistep directions, understanding verbal narratives *the stages can overlap between levels!!
A ______ is an informal check of a hearing aid to ensure that it is functioning
listening check
Which of the following items are essential in a listening kit? (Select all that apply).
listening tube ear mold blower battery tester extra batteries
6-9 months: Auditory Development
localizes sounds, responds consistently to name, attentive to others' conversations, begins to comprehend words Coos and moves to music • Imitates speech with non-speech sounds • Plays with voice repetition and varied patterns; "la, la, la, la," "ga,ba,boo,ba"
What is a speech screen?
makes the sound invisible, they can't read your lip.
3-6 months: Output Speech Production
may vocalize in response to music Makes a variety of sounds "baba" and "gaga". Babbles frequently and for pleasure; initial reciprocal talking
real ear measurement
probe microphone inserted into canal with the hearing aid and measuring the hearing aid gain and frequency response
Activities for Sound Comprehension
read aloud story & answer questions about characters or plot i spy (I spy a red sweater) 20 questions (Is it bigger than a chair)
amplitude compression
reduces short-term amplitude contrasts among elements of speech and flattens the speech envelope.
Which of the following is a principle of auditory training?
repetition is key
frequency lowering
restoring high frequency sounds that would otherwise be inaudible due to severity of hearing loss by shifting them to lower frequency where less hearing loss is present
Brian and his SLP are playing 20 questions, in which he is learning to answer yes/no questions about an object that is hidden in a box.
sound comprehension
Julia's mother points out the source of sounds, such as the doorbell, in her day-to-day life.
sound detection
Mason's SLP is teaching him the difference between loud and soft using Learning to Listen sounds.
sound discrimination
Maria is learning to find objects placed around the room when her father says their names.
sound identification
speechreading
speech recognition using both auditory and visual cues
Birth to 3 months: Auditory Development
startles to loud sounds, quieted by mother's voice, capable of detecting phonemes, prefers native language
9-12 months: Auditory Development
starts to discriminate real words, loses interest in phonemes not part of native language(s), perceives word boundaries
3-6 months: Input of Auditory Development
starts to search for location of sounds, noises may make baby cry, begins to recognize name
What is a listening care kit? And what is included in it?
what you need to care for a hearing aid -listening tube/stethoscope -battery tester -ear mold tubing blower -drying kit -retention clip (so the child won't lose the HA) -extra batteries -alcohol wipes
acoustic highlighting
when a talker changes duration, intensity, and pitch to highlight a word or enhance the audibility of a message
Auditory Training Activities
• Sound awareness: Play Peek-a-boo, Musical chairs, March to the beat of a drum, Push a toy when a sound is made • Sound discrimination: Respond to a command, Play a same/different game, Repeat what you hear, Choose the correct toy that matches the sound, play a game w/toy animals (The cow says 'moo') • Identification: Play "go fish" card game, Play with sets of postcards or stickers • Comprehension: Listen to a read-aloud story, Play "I spy", Play "20 questions" *Make sure activities are developmentally appropriate. *use the learning to listen sounds, but quickly label sounds with their actual name/vocabulary. Ex. The bunny goes hop, hop, hop.