Aural Rehab- Final SPA 6327

Atypical Hearing can impact:

speech production, language development, psychosocial development, and educational progress

No Child Left Behind (NCLB)

Improves education of all children, with an emphasis on children from low- income families (replaced in December 2015)

Individuals with disabilities act (IDEA)

Focuses on the individual child and seeks to ensure specialized services for children with disabilities so that they may benefit from education.

Rehabilitation Act of 1973

Supports and promotes the rights of individuals with disabilities.

ADA- Americans with Disabilities Act

The major legislation that protects the rights of individuals with disabilities against discrimination based on their disability in employment settings. SECTION 504 and 508 gave children who are deaf and hard of hearing the right to full access to school and public activities and events, including after-school events.

Students who are deaf and/or hard of hearing may need specific support services known as:

Related services and supplementary aids and services

Who makes up the IEP team?

1) Special education or regular teacher

2) Parents and students

3) Psychologist

4) SLP

Deaf and Hard of Hearing Students Bill in Florida

Specific law that recognizes the communication needs of children who are deaf and hard-of-hearing. ALSO in the state of Florida, it requires the Department of Education to develop a communication plan to become part of the individualized education plan process for students who are deaf/hard of hearing.

Florida's Communication Plan

Is required in Florida, completed prior to or during the IEP, and informs all stakeholders who work with the student. Ideology and accommodations.

What is an IEP?

Individualized Education Plan; goals and who is providing the services

Primary goals of the SLPs working with children who are DHH in the public-school setting is to:

Facilitate speech, language, and literacy skills in order to access the general school curriculum.

Role of Educational Interpreters

Provide communication access to students who are deaf or hard of hearing by faithfully and accurately representing the classroom instruction, teacher/student dialogue, and relevant sound information in the mode of communication used by the student.

SLPs must assess:

speech, language, and AUDITORY!

Criterion-referenced test

An assessment that measures a student's performance against a specific set of skills, objectives, or criteria rather than comparing the student to other individuals. It evaluates whether a learner has mastered specific knowledge or skills based on predetermined standards or learning targets.

Informal language assessment may include:

CASLLS, Speech and language sample, PLS-5 checklists

Auditory Processing Disorder

This impairs the understanding of meaning for incoming sounds

auditory neuropathy

When the ear detects sound normally, but has a problem sending it to the brain.

Tinnitus

ringing in the ears

The 3 P's of Typical Development

1. Perception stage (oral speech and language)

2. Processing stage (Cognitive operations)

3. Production stage (intelligibility speech and oral language)

What are the 4 levels of listening development?

1. Detection

2. Discrimination

3. Identification

4. Comprehension

School- Age considerations:

Outcomes, (language abilities supporting literacy development, vocabulary, mainstreaming, social engagement) Self-advocacy, and Long term: post graduation

What are some considerations?

Collaborate across settings and disciplines, advocacy, building awareness: strengths and areas of opportunity

What do we know about second language acquisition?

1. Children with profound hearing loss typically exhibit delays in mastering one spoken language.

2. Clinicians have been reluctant to recommend bilingual language environments for children with cochlear implants.

3. In the U.S., parents of children with cochlear implants were discouraged from using a language other than English at home.

What are some indicators for successful development of children learning more than one spoken language via a cochlear implant?

Parent proficiency in both languages, implanted before age 2, excellent perception skills, intensive auditory verbal therapy, cultural/religious opportunities, therapy or school in other language, mother tongue: language of the heart.

When to recommend bilingual/ multilingual exposure?

The earlier the better!

Possible contraindications for second language exposure

later age of ID, late age of CI (after 3/4 years) with limited hearing experience or benefit pre- CI, poor speech perception skills, additional diagnosis, family support issues, child struggling with language acquisition.

Bilingual Family Interview (BIFI)

Frankness from family critical, self-rate speaking ability of each parent independently- in English and second language, self rate understanding ability.

What is cultural competence?

involves understanding and appropriately responding to the unique combination of cultural variables (ability, age, beliefs, ethnicity,etc) that the professional and client/patient bring to interactions.

What is briefing?

Clinician and interpreter meet before session to discuss intervention goals and make decisions

What is interaction?

SLP and interpreter work together with patient

What is debriefing?

clinician and interpreter review outcomes of session and make follow up plans

Vocational Rehabilitation (Young to Middle- Aged Adults)

Helps individuals with disabilities to find independence. Age range: 14- adulthood. Highlights skill sets early on, jobs on site work training

Prevalence of Hearing loss in Adults

About 15% of American adults (37.5 million) aged 18 and over report some trouble hearing. Reasons include but, not limited to: noise exposure from loud music, workplace, and vehicles.

Hearing loss is the 3 most prevalent chronic health condition in the US older adult population.

Men are twice as likely as women to have hearing loss

What is presbycusis?

age related hearing loss

What is the heredity hearing loss called?

Otosclerosis

How many years do some people with hearing loss wait before seeking help?

7

Characteristics of Adult-onset Hearing loss

1. hearing loss is gradual

2. higher frequencies more impacted than lower frequencies

3. conversations become more challenging especially with background noise

4. Facial coverings/masks/facial hair can negatively impact conversations.

Pre- awareness

"Nah my hearing is good"

Awareness

"yes, my hearing isn't where it used to be"

Movement

"I am going to make an appointment with my audiologist/primary care physician"

Diagnosis

Dx of Hearing loss

Rehabilitation

Hearing aids/ Cochlear implant..etc

Resolution

End of story where speech is clearer

What does Aural Rehabilitation (AR) typically consist of:

Assessment, counseling, development of a plan, implementation, outcomes, and follow up

An assessment of conversational fluency can take place during the client interview.

True

Common concerns from the client/caregivers

"I hear some things, but I don't understand everything", "conversations on the phone are challenging."

Goal writing for AR students/clients must include goals in...

Auditory skills

Therapy activities for an adult client may include:

Ling Sounds *Now LMH-10 sounds

Minimal pairs

Practice on the phone

All of the above

All of the above

Communication PARTNER strategies:

conversations with the same topic, decreasing background noise, face-face conversations, ask partner "What did you hear?" instead of "What did I say?", ensure comfort of hearing aid technology, visuals

When do you discharge AR client?

Goals are met, individual feels confident, communication partners feel confident, plateau in skills, transition to group services, self- advocacy skills enhanced, skills can be maintained via home program

TAPS-4

Test of Auditory Processing Skills. Ages 4;0- 18;11 and administered in 1 hour. Not the result of EF; it is that children will have a hard time understanding speech in noisy environments.

CASLLS

A criterion-referenced assessment because it evaluates a child's progress toward specific listening, language, and speech skills that are expected along a developmental sequence.

The CASLLS:

Lists specific auditory, language, speech, and cognitive skills in a hierarchical order

Determines which skills a child has mastered and which are emerging

Does not compare the child to a normative group of same-age peers

PLS-5

Language Assesssment- Receptive and Expressive

  Factors that may impact adult AR planning include:

Financial, Employment/vocational, Family Support, lifestyle, self advocacy

Financial

Employment

Self advocacy

Financial, Employment/vocational, Family Support, lifestyle, self advocacy

Clients can access a home program for AR using...

Constant therapy

AB RehAB portal

ABC Mouse

Orlando Sentinel

AB RehAB portal

Which of the following is a cueing strategy specific to auditory (re)habilitation?

Expectant delay

repetition

auditory sandwich

None of the above

Auditory Sandwich

Testing auditory perception would mean administering which of the following?

PLS-5

CASLLS

APT-HI 3

TAPS 4

APT-HI 3

Create a listening environment

Make the environment easier for the child to hear and focus on sound

Best Hearing side/positioning

Place the child where they can hear the best

Give the child a reason to listen/communicate

Create situations where the child needs to listen and respond

Use Motherese/Parentese

Use a slower, exaggerated, higher-pitched, expressive way of speaking to help children notice sounds

Expand and extend the child's utterance

Add words to make the child's message longer and more complex. (Child: "dog"--- Adult: "Yes, big dog!")

Beyond the Here and Now

Talk about things that are not happening right now (past/future/imaginary events)

Model target behaviors

Show the child the language or behavior you want them to learn

Acoustic Highlighting

Change your voice to emphasize important sounds or words (slower, louder, longer, stressed)

Hear it before they see it/ Audition First

Let the child hear the information before seeing the object/action so they learn to rely on listening.

Be a Birddog

Draw attention to sounds by pointing to your ear and saying things like "I hear it!"

Wait time

Pause after speaking to give the child time to process and respond.

Expectant look

Look at the child and wait, showing that you expect them to communicate or answer.

Auditory sandwhich

Say it with hearing first → show visual support → say it again without visual support. (Auditory → Visual → Auditory)

Auditory closure

Let the child finish a familiar phrase or song. (“Ready, set…” → child says “go!”)

Sabotage

Create a problem or remove something so the child has a reason to communicate. (Put toy in a container they cannot open.)

Help me but don't tell me!

Give support without giving the answer so the child has to think/listen.

Develop a listening attitude

Teach the child that listening is important and encourage them to pay attention to sounds.

Alert child to listen during routines

Remind the child to listen during everyday activities (meals, play, dressing).

Interact as if the child can learn through listening

Assume the child can learn from spoken language and provide listening opportunities.

Monitor own environment through hearing

Teach the child to notice and respond to sounds independently.

Listen the first time

Encourage the child to pay attention without needing repeated directions.

Serve and return

Take turns communicating: child responds → adult responds back.

Develop confidence in listening abilities

Give activities where the child can succeed and build trust in their hearing skills.

Work from known to unknown

Start with familiar skills and gradually introduce harder skills.

Audible to less audible

Start with easier-to-hear sounds and move toward harder sounds.

Reinforce accomplishments immediately

Praise the child right after successful listening attempts.

Auditory Feedback mechanism

Help the child listen to their own speech and adjust sounds/pronunciation.

"What did you heard?" instead of "What did I say?"

Encourage the child to rely on their listening rather than just repeating.

Reverse roles

Let the child become the teacher so they practice remembering and producing language.

Sensorineural hearing loss

hearing loss caused by damage to the cochlea's receptor cells or to the auditory nerves; also called nerve deafness

Conductive hearing loss

Hearing loss or impairment resulting from interference with the transmission of sound waves to the cochlea

Mixed Hearing loss

combination of sensorineural and conductive hearing loss

Presbycusis Hearing loss

hearing loss that gradually occurs in most individuals as they grow older. (Sensorineural) High frequencies drop more

APT- HI- 3

Measures speech perception capabilities in individuals with hearing loss

ranging from mild to profound using a closed set design

● Can be used with children aged 3 and up as well as adults in auditory

rehabilitation

● Looks at:

○ Awareness of non-speech sounds

○ Duration, intensity, and pitch changes

○ Prosodic perception

○ Vowel/consonant perception

○ Segmental perception

○ Linguistic perception and communicative comprehension

● Results can be used to measure progress in therapy