Audiologic Rehabilitation for Children

1. Audiologic Rehabilitation for Children

2. Rehabilitation Settings and Providers • Differ according to type of hearing loss and when the loss was identified. • Differs according to age groups (preschool, school-age)

3. WHAT IS A COCHLEAR IMPLANT? • Electronic prosthetic device • Surgically implanted in the scali tympani of the cochlea • Bypasses damaged hair cells in the cochlea • Electronically stimulates auditory neural elements that do not respond to acoustic stimulation with hearing aids

4. BASIC COMPONENTS • External Microphone • Speech Processor • Battery Component • Coil/transmitter • Receiver/Stimulator • Magnet for Retention • Implanted Electrode array

5. HOW DOES IT WORK? • External microphone converts incoming sound into electrical signal • Speech processor converts electrical signal into a digital code (speech processing strategy) • Signal is transmitted across the skin

6. HOW DOES IT WORK? • Implanted cochlear stimulator receives the coded signal and delivers it to the electrode array • Electrodes stimulate cochlear neurons • Bypasses damaged hair cells • Nerve impulses are sent along the auditory pathways to the cerebral cortex • Allows the brain to perceive sound

7. MAPPING • Term utilized for programming external device • Occurs approximately 4 weeks after surgery • Laptop computer utilized • Objective measures utilized • Progressive maps • Plateau/stabilization • Regular maintenance schedule

8. FREQUENCY IN HERTZ (Hz) 125 250 500 1000 2000 4000 8000 0 10 CI CI CI 20 CI dB HL CI 30 40 A A A 50 60 A 70 A 80 90 NR NR NR 100

9. PREDICTIVE FACTORS • Medical conditions • Communication strategies • Language development • Mode of education • Family support/dynamics • Developmental delay • Adolescents – poorer prognosis • Variability exists

10. TEAM APPROACH • Surgeon • Audiologist • Auditory Verbal Therapist • Speech/Language Pathologist • Nurse/O.R. Staff • Educator • Early Interventionist • Coordinator/Case Manager • Administrative

11. Yes! SLPs Need to Know • Pre-CI Audiograms are Important • Always get most the most updated audiogram!!!

12. Communication, Communication, Communication • You and the audiologist will work together to get the best program for your client. • You can help with ease of programming and adjustment to new programs with young children. • You provide valuable information to the audiologist about your client’s functional use of his/her implant.

13. Adjusting to the Cochlear Implant • You are usually on the “front line”. • Advising parents about saturation. • Talk about realistic expectations. • You provide lots of encouragement and education!!! • Pointing out the gains in auditory skills that you see. • Letting them know what is typical “tolerance issues”.

14. Remember!!!! Every client is different and comes to you will a diverse background (language, social environment, hearing, personality, family).

15. Keep in mind that a your client’s ability to receive the sounds of speech is only the first step…….

16. Why do we address auditory skills in therapy? • In both children and adults, we use it to fully develop their use of available sounds. • In children, effective listening becomes their foundation for the development of spoken language.

17. Auditory Skills? You need to know where your client’s auditory skills fall in the hierarchy. Each therapy session will be diagnostic in nature.

18. Basic Stages of Auditory Development Comprehension Identification Discrimination Detection

19. Detection The awareness of whether a sound is present or not • Detection activities should be… • Motivating • Simple and quick • Age appropriate • Varied

20. Auditory Attention • Also work on generalizing auditory attention. • Must be established as a foundation for learning to listen • Timers • Name calling • Eventually the child will alert to environmental sounds and speech without cues

21. Detection: Conditioned Response Activities • Should be… • Motivating • Simple and quick • Age appropriate • Varied Activity Suggestions Balls, puzzles, mechanical banks, stacking toys, peg boards, black towers, beanbag or ball toss, stringing beads, letters in a mailbox…..

22. Discrimination • Distinguishing differences between sounds • The listener's ability to tell whether two sounds are the same or different.

23. Keep in mind the Acoustic Contrasts within the Discrimination Task From Easiest to Most Difficult Suprasegmentals Syllable Length Vowel Differences (bat, bet, boot) Manner of Production Differences (t vs. sh) Voicing Differences ( p vs. b) Place of Production Differences (k vs. t)

24. Identification A person's ability to recognize a sound and then label it

25. Comprehension • A person’s ability to understand the meaning of the spoken message • This level requires that the person have a certain degree of semantic and syntactic language development

26. Auditory Attention • Also work on generalizing auditory attention. • Must be established as a foundation for learning to listen • Timers • Name calling • Eventually the child will alert to environmental sounds and speech without cues

27. Always keep in mind the variables that affect how challenging a therapy task is for your client.

28. What is your Listening Set? Closed Bridge Open

29. What are the contents of your set? Keep in mind…. • The familiarity of the vocabulary • How the items acoustically contrast each other • The number of key words being used and where they are place • The linguistic complexity of what you are presenting

30. How are you presenting the stimulus items? • What is your rate of speech? • Are you using acoustic highlighting? • Is there background noise?

31. Ling 6 Sounds What are they? Why do I need to use them? When do I use them?

32. Ling 6 Sound Test OO EE AH S SH MM Also….absence of sound

33. Sound-Word Associations • These are used to teach the skill of listening to the younger child • They differ greatly in terms of duration, intensity and pitch.

34. Sound-Word Associations • Many of these associations are commonly used in traditional, early language therapy • Once the child learns the associated sound then the true word is given

35. Transitioning Between Visual and Auditory • Auditory Information • Visual Clarifier • Auditory Information

36. Sound-Word Associations • These are used to teach the skill of listening to the younger child • They differ greatly in terms of duration, intensity and pitch • Many of these associations are commonly used in traditional, early language therapy • Once the child learns the associated sound then the true word is given

37. Some Examples of Sound-Word Associations Up, up, up, weeee Mooooo Ahhhhhhhhh (rising and falling intonation) Listening for Littles,1997

38. Keep in mind……. • Imitation is not identification • Closed versus open set • Complex closed sets may be easier than single word in a open set • A “bridge set” may be used to connect between closed versus open sets • Content and presentation determine the level of challenge

39. When they don’t get it the first time…. • Acoustically highlight the key word • Model a similar question with another person • Use familiar information and vocabulary to introduce word • Use descriptions

40. Listening Hoop • Instructions on assembly provided • Materials needed • Embroidery hoop • Stereo speaker cloth

41. Therapy Materials and Ideas Lots of great stuff is on the internet now!!!!!! • Therapy Materials • Free On-line Training