Author: Jack Slemenda Converse College, SC

1. Author: Jack SlemendaConverse College, SC Date submitted to deafed.net – March 20, 2008 To contact the author for permission to use this PowerPoint, please e-mail: slemenjc@spart5.k12.sc.us To use this PowerPoint presentation in its entirety, please give credit to the author.

2. Auditory Verbal Therapy Jack Slemenda Converse College

3. Slide Contents • I. Auditory Verbal Therapy (3-23) • II. Cochlear Implants (24-32) • III. Maintenance/Trouble Shooting for Cochlear Implants (33-40) • IV. Speech, Language, Cognitive and Audition Evaluations (41-46) • V. Expectations for a Child with a Hearing Loss (47-55) • VI. Lesson Plans/Treatment Goals (56-87)

4. All children have residual hearing that can be molded for functional use History and Philosophy of Auditory Verbal Therapy

5. What is AVT and where did it originate? • AVT was established as an approach to therapy in the mid 20th century by pioneers Ling, Beebe, and Pollack. • Auditory Verbal International established ten principles to guide the field and foster understanding of Auditory Verbal Therapy.

6. First AVT Principle • Supporting and promoting programs for the early detection, identification, and diagnosis of hearing loss and the auditory management of infants, toddlers, and children identified along with Auditory-Verbal Therapy.

7. Second AVT Principle • Providing the earliest and most appropriate use of medical and amplification technology to achieve the maximum auditory stimulation benefit.

8. Third AVT Principle • Seeking to integrate listening as well as maximal acoustic stimulation into the child’s total personality in response to the environment by guiding/coaching caregivers without the use of sign language or emphasis on speechreading.

9. Fourth AVT Principle • Supporting the view that communication is a social act, and seeking to improve spoken communication interaction within the typical social dyad of infant/child with hearing loss and primary caregiver’s including use of the parents as primary models for spoken language development and implementing one-on-one teaching.

10. Fifth AVT Principle • Seeking to establish the child’s integrated auditory system for the self-monitoring of emerging speech.

11. Sixth AVT Principle • Using natural sequential patterns of auditory, perceptual, linguistic and cognitive stimulation to encourage the emergence of listening, speech, and language abilities.

12. Seventh AVT Principle • Guiding and coaching parents to create environments that support listening/spoken language through the child’s daily activities and to integrate listening and spoken language in the child’s life.

13. Eighth AVT Principle • Guiding and coaching parents to help their child self-monitor spoken language production.

14. Ninth AVT Principle • Making ongoing informal/formal diagnostic evaluation and prognosis of the development of listening skills as an integral part of the rehabilitative process.

15. Tenth AVT Principle • Supporting the concepts of mainstreaming and integration of children with hearing loss into regular education classes with appropriate support services and to the fullest extent possible.

16. Why does AVT work???? • Existing Evidence Supporting the AVT practice • The majority of children with hearing loss have useful residual hearing… a fact know for decades ( Bozold and Slebenmann, 1908, Goldstein, (1939); Urbantschitsch, 1982).

17. Why AVT cont… • When properly aided, children with hearing loss can detect most if not all the speech spectrum (Beebe, 1953;Goldstein, 1939; Johnson, 1976; Ling and Ling, 1978; Pollack, 1970, 1985; Ross and Calvort, 1984).

18. Cont…. • Once all available residual hearing is accessed through amplification technology (eg. Binaural hearing aids and acoustically tuned earmolds, FM units, cochlear implants) in order to maximum detection on the speech spectrum, then a child will have the opportunity to develop language in a natural way through the auditory modality. • A child with a hearing loss need not automatically be a visual learner. • Hearing, rather than being a passive modality that receives information, can be the active agent of cognitive development (Boothroyd, 1982; Goldberg and Lebahn, 1990; Robertson and Flexor, 1990; Ross and Calvert, 1984).

19. Cont… • In order to benefit from the “critical periods” of neurological and linguistic development, then the identification of hearing loss, use of appropriate amplification and medical technology, and stimulation of hearing must occur as early as possible (Clapton, and Winfield, 1976; Johnson and Newport, 1989; Lenneberg, 1967; Marler, 1970; Newport, 1990).

20. Cont…. • If hearing is not accessed during the critical language years, a child’s ability to use acoustic input meaningfully will deteriorate due to physiological (retrograde deterioration of auditory pathways), and psychosocial (attention, practice, learning) factors (Evans, Webster, and Cullen, 1983; Merzenich and Kass, 1982; Patchett, 1977; Robertson and Irvine, 1989; Webster, 1983).

21. Cont…. • Current information about normal language development provides the framework and justification for the structure of Auditory-Verbal practice. That is infants/toddlers/children learn language most efficiently through consistent and continual meaningful interactions in a supportive environment with significant caretakers (Kretschmer and Kretscher, 1978; Lennenberg, 1967; Leonard, 1991; Ling, 1989; MacDonald and Gillette, 1989; Menyuk, 1977; Ross, 1990).

22. Cont… • As verbal language develops through the auditory input of information, reading skills also develop (Geers and Moog, 1989; Ling 1989, Robertson and Flexor, 1990).

23. Rationale Cont… • Parents in Auditory-Verbal programs do not have to learn sign language or Cued Speech. More than 90% of parents with children with hearing loss have normal hearing (Moores, 1987). Studies have shown that over 90% of parents with normal hearing do not learn sign language beyond the basic preschool level of competency (Luetke-Stahlman and Moeller, 1987). Auditory-Verbal Practice requires that caregivers interact with a child through spoken language and create a listening environment which helps a child to learn.

24. Cont… • If a severe or profound hearing loss automatically makes an individual neurologically and functionally “different” from people with normal hearing (Furth, 1964; Myklebust and Brutton, 1953), then the Auditory-Verbal philosophy would not be tenable. • The fact is however, that outcome studies show that individuals who have, since early childhood, been taught through the active use of amplified residual hearing, are indeed independent, speaking, and contributing members of mainstream society (Goldberg and Flexer, 1991; Ling, 1989, Yoshinaga-Itano and Pollack, 1988).

25. Cochlear Implants Companies, Parts, Features

26. Cochlear Implants • Nucleus 24 Contour • Cochlear Corporation • Clarion CII Bionic Ear • Advanced Bionics • Combo 40+ • Med-EL

28. NUCLEUS • Processors • SPrint (Body worn device) • Rechargeable batteries • ESPrit 3G (BTE) • No rechargeable batteries • Internal Device • Nucleus 24 Contour • 22 Electrodes

29. Nucleus 24 Contour

30. ADVANCED BIONICS • Platinum BTE • S-Series and Platinum Speech Processor (body worn) • All Rechargeable Batteries

31. HiRes 90K

32. Platinum Sound Processor

33. Platinum BTE Processor

34. Maintenance and Trouble Shooting for Hearing Aids and Cochlear Implants

35. What to do if there is no sound? • Battery may be dead • Battery may be in backwards • Hearing aid may be turned off • Sound outlet may be plugged with ear wax

36. What to do if there is weak sound? • Weak battery • Sound outlet or inlet may be plugged with ear wax • Current hearing condition may have changed

37. What to do if there is a crackling or frying sound? • Volume may be set too high • Object may be covering inlet such as a hat, scarf, or coat collar • Excessive wax present in the ear • Instrument may not be fitted correctly in the ear (contact audiologist)

38. Trouble Shooting for Cochlear Implants is Product Specific

39. If the problem with the hearing aid persists, it is important to call the audiologist right away!!

40. General Maintenance for Hearing Aids • Cleaning • Storage • Daily living

41. General Maintenance for Cochlear Implants • Small children • Moisture • Batteries • Static electricity

42. Speech, Language, Cognitive, and Audition Evaluations

43. Testing with Hearing Impaired Children • Areas of testing: • Language- Receptive and Expressive • Articulation/Phonology • Auditory Skills

44. Language • Testing may include comprehensive language tests, such as the CELF-P2, CELF-4, PLS-4, CASL, CREVT-2,, TELD:3,TOLD-P:3, or TOLD-I:3. • Tests of expressive language and vocabulary, such as, EOWPVT, EVT, SPELT-3 or SPELT-P.

45. Language • Tests of receptive language, such as ROWPVT or PPVT-3. • Screening tests: Rossetti Infant-Toddler Language Scale or the REEL-3. • Concept testing may also be completed, using a test such as the Bracken-R.

46. Articulation: -GFTA-2 -CAAP -Arizona 3 -SPAT-D Phonology: KLPA-2 HAPP-3 CAAP Compton Assessment IEPN Articulation/Phonology

47. Auditory Tests • Tests that focus on use of audition in language: • TACL • TARPS • TAPS-R and TAPS-UL • ESP • APT-HI • IT-MAIS • MUSS • TAC

48. Expectations for a Child with a Hearing Loss

49. Chronological Age vs. Cochlear Age • Chronological age begins at birth • Cochlear age begins when the implant is activated • Cochlear age used as tool • Speech and language expectations/development should be based on cochlear age

50. Progression of Development • Normal speech and language development can be expected on a delayed time scale • Speech and language goals should follow the natural progression of normal speech and language development