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Case #1:

Case #1:. Age 4 years, 1 month History of chronic otitis media beginning in first year of life; PE tubes precluded further OAE testing Play skills appropriate Fine and gross motor skills appropriate. No apparent developing phonological system in place

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Case #1:

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  1. Case #1: • Age 4 years, 1 month • History of chronic otitis media beginning in first year of life; PE tubes precluded further OAE testing • Play skills appropriate • Fine and gross motor skills appropriate

  2. No apparent developing phonological system in place • Could combine 2-3 ASL signs with verbalizations • Verbalizations seemed to preserve prosodic qualities of speech • Had had SLP intervention for 2 ½ years

  3. Imitation and/or approximation of speech sounds when looking at the clinician • Significantly better imitation/ use of motor actions, including sign

  4. Behavior very similar to a child with a significant hearing impairment • Normal peripheral hearing sensitivity confirmed through conditioned play audiometry/OAEs

  5. Recommendation: • Electrophysiologic evaluation to rule out auditory neuropathy or similar disorder • ABR normal bilaterally

  6. Pre-training MLRAge: 4 years, 2 months C4; R & L Ears Pa C3; R & L Ears Na

  7. Normal Cortical Potentials in Children From: Sharma, Kraus, McGee, & Nicol (1997). Electroenceph. Clin. Neurophys., 104, 540-545.

  8. Pre-training Corticals (C3) P1 (C4) N1b

  9. Conclusions and Recommendations: • Results suggested abnormal neurophysiologic representation of acoustic stimuli, consistent with (C)APD • Recommended intensive computer-based auditory training, 45 minutes per day, 5 days per week throughout 8-week summer session • Auditory training to focus on both perception and production of auditory stimuli

  10. Earobics training daily; Target = verbal imitation of stimuli, mouse controlled by clinician • Goals: • Improve phonological awareness (discrimination, synthesis, etc.) and phoneme production/ imitation skills simultaneously

  11. Immediate Post-Training (4 years, 4 ½ months) • Spontaneous eye contact during conversation 100% of the time • Turned to voice 100% of the time • Imitation of vowels, CV syllables with 100% accuracy • Approximation of CVC words with some final phoneme deletions or appropriate inflection, but incorrect phonemes

  12. At 4 years, 6 months • Significant improvement in auditory comprehension • 100% imitation of sounds, words, gestures • Dozens of new words, including verbs, nouns, adjectives • Semantic relations with 90% accuracy

  13. Plural /s/ and progressive /ing/ with 80% accuracy • Use of “in” and “on” with 100% accuracy • Imitation of multi-word sentences

  14. Post-training MLR4 years, 9 months Pa Ipsilateral (C4/A2) C4; R & L Ears Pa Pa Contralateral (C3/A2) C3; R & L Ears Pa Na Na Na Na

  15. Post-training Corticals (C4) P1 N1a P1 N1b (C3) N1a N1b

  16. By 4 years, 10 months • Spontaneous use of multi-word sentences with appropriate syntax • Kahn Phonological Analysis: • Phonological development at approximately 3.5 years of age • Errors developmental in nature

  17. Conclusions • Intensive auditory training combining perception with production resulted in significant, rapid improvement in auditory comprehension and expressive skills.

  18. Behavioral observations were accompanied by a concomitant improvement in the neurophysiologic representation of acoustic stimuli.

  19. Case #2

  20. P300 reduced, other electrophysiology normal • Auditory fusion, speech and nonspeech discrimination probably normal, though some inconsistency in performance • Continuous performance (auditory and visual) – high error rate • Impression: Higher-order, likely attention-based disorder

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