CSD Communication and Aural Rehabilitation

Auditory-Verbal Therapy

Guide, counsel, & support parents as primary models for spoken language. Help children integrate listening into the development of communication and social skills. This is through 1-to-1 teaching. Families are expected to develop listening and language-rich environments for children. This is used often for people with cochlear implants.

Auditory-Oral Approach

Encourages maximum use of residual hearing and hearing technologies. Auditory learning focus. Visual supports (speech reading) to aid communicative development. Families are encouraged to create an optimal oral learning environment. High expectations for spoken language.

Total Communication

Combines all means to communicate with the child - signs (English-based signing system), listening (speechreading), natural gestures (body language).

Encourages simultaneous use of speech and sign to promote access to spoken language. Families must gain sign fluency and consistently sign when speaking.

Bilingual-bicultural (bi-bi)

Deaf children learn ASL as the primary language. English is learned as second language once ASL is mastered (typically in written format), Prepares child for social access to the Deaf community. Family learns about Deaf culture; invest in learning ASL; provide child access to fluent users of ASL. Devices may or may not be emphasized.

This approach is commonly used in schools for the Deaf

Sign-Supported Speech (sim-com)

Signing and spoken English used simultaneously. Does not use ASL grammar but English Grammar instead. This can lead to misunderstandings because you are cueing and spelling each word rather than focusing on meaning.

Cued Speech

A visual mode of communication that uses handshapes and placements in combination with mouth movements of speech to make phonemes of a spoken language look different from each other. Because cueing is the visible counterpart of speaking, cued language is the visible counterpart of spoken language.

Helpful for phonemic awareness and literacy.

Outcomes Affecting Variables

Age at diagnosis, etiology, device use and effectiveness, auditory learning abilities, health status of child, personal-social adjustment of family, family involvement, skills of the service providers, parenting skills, child’s temperament and learning styles, intellectual abilities, secondary disabilities, cultural values, and socioeconomic issues.

Factors for Determining Communication Method

Hearing level, caregiver’s values, preferences, and resources, evidence of linguistic dominance, evidence of efficacy, and additional diagnoses/disabilities.

Multiple

The brain works best when it uses _________ sense, thus employing more areas to process the signal.

Benefits of Using MSI

Increased acuity in one of the modalities (increase in processing and learning)

Reduction of detection thresholds

Decreased response time

Increased target detection accuracy

Neocortex

_________ processes information in a multi-sensory way

Sight-sound

Infants who are just a few hours old can learn __________ pairings

HB199

Lead-K: Language Equality and Acquisition for Deaf Kids.

Proposes to establish a task force of professionals to recommend a framework to assess the language milestrone of Deaf and Hard of Hearing children ages 0-5 for both English and American Sign Language. This is the first step forwards towards collecting valuable data to end the language deprivation epidemic among Deaf and Hard of Hearing Children.

Language Deprivation

Def children are at high risk of _________ __________.

Parent Counseling

Age - Infants/Toddlers

Most parents know very little about hearing loss, so they get informed. With the advent of universal hearing screening, babies are identified at younger ages. Parents may feel overwhelmed with being new parents, in addition to the stress of hearing loss. While the majority of parents were glad the hearing loss was identified early, some parents report that they wish they had not found out so soon. Parents typically will feel shock, denial, and grief (some may also feel guilt and anger)

Social Support

We should put families in contact with other families of children with hearing loss. This kind of support is important for both the hcild and the afamily members.

Corrective

Parents need to know that hearing aids are not _________, the importance of full-time use, to have a positive attitude when the baby is putting on the hearing aids, to associate wearing the hearing aids with fun activities, and how to care for and troubleshoot the hearing aids.

10 hours

Wear time for hearing aids matter. Language increases over time with exposure of at least _________ a day.

Individualized Family Service Plan

Child’s present level of functioning, family’s resources, priorities, and concerns, major goals for child and family, and specific services needed to meet the goals.

These for babies with hearing loss often include auditory training, providing parental support, communication strategies, and encouraging participation in parent groups.

Early Intervention Programs

Home-based vs. center-based programs

 Family-focused

 Parents are trained to...

 respond to child’s communication attempts

 provide speech/language models

 provide language stimulation (“self talk”)

 use conversational strategies

 use facilitative strategies:

 signal expectations (waiting for a response) via pausing, raising eyebrows and looking at child

 expansion and modeling

 parallel talk (talking about what the child is doing)

 labeling

 do informal auditory training:

 encourage detection of environmental sounds (e.g., doorbell, telephone, dog barking)

 target certain vocabulary words and use them often

 evaluate child’s progress

 Reading 10 books a day!

Family and Client Centered Intervention

Parents are experts on their child and emphasis should be placed on this relationship.

Parents/clients and professionals are members of a team, and it should be balanced in the decision-making.

The needs and desires of the client/family drive the intervention program (professionals adapt)

Intervention utilizes the client/family’s resources so that learning strategies can be incorporated everyday.

Intervention is guided by regular monitoring.

Should connect them to support systems.

Deficit vs Difference

How things are worded will have a huge impact on how information is received. The wording can also effect the feelings of the parents and self-efficacy.
Ensure you use appropriate language during counseling and in your reports.

Attitudes

People are not born with negative ______ to hearing devices. _________ are influenced by the language use and behavior associated with hearing.

Serve and Return

_________ _____ _________ interactions are best for shaping the brain; therapy activities need to support brain development. This approach results in more turns.

Aural Habilitation

Awareness/detection → discrimination → identification → comprehension (requires vocabulary, grammar, and auditory skills)

Teenage

As we age, our self-esteem fluctuates. It is typically at its lowest during our ___________ years.

Peer Attitudes

Children perceive peers who wore hearing aids as having. less physical competence and less peer acceptance than those who did not use hearing technology

Environmental Modifications

Well-lit, ensuring visual access to teacher, preferential seating, tennis balls on the bottoms of chairs, door closed to hallway, installation of acoustic tiles, carpet, modification of HVAC system, and classroom selection.

School Placement Options

Residential school for the deaf, day school for the deaf/HOH, regular school

FM

Children with hearing loss may benefit from the use of an ______/remote microphone system, speech and language intervention, CART or C-Print, ASL interpreter, or notetaker

IEP

for children with hearing loss need to consider the child’s access to sound not only for learning,

but also for communication with peers

Educational Audiologist: an audiologist who works in schools

Audiologists’ roles:

 evaluate hearing and speech recognition

 assess auditory processing

 select, fit, and manage hearing technology

 analyze listening environments and make recommendations

 provide hearing rehabilitation

 consult to parents and other professionals

Teacher Training

Use of visual information, limitations of the child’s technology, gaining child’s visual attention before talking to them, allowing the child to move their seat as needed, realize that child cannot take notes while lipreading, help socialize child within the classroom, importance of keeping noise levels down.

Language

Children with severe/profound hearing loss...

 tend to have restricted vocabulary, especially for abstract words

 use words in only one way and/or don’t know multiple meanings of words

 use simplified language structure (subject-verb-object)

 may rarely use adverbs, pronouns, prepositions, past tense

 may omit morphemes that mark plurality and possession

 difficulty comprehending compound or complex sentences

 may have difficulty with pragmatics (e.g., turn taking, initiating

conversations)

 often have delayed literacy skills (reading and writing)

Speech Production

Children with severe/profound hearing loss who use hearing aids tends to have multiple

abnormalities:

 distortion/omission of vowels and consonants

 problems with pitch control

 breathiness

 inappropriate pausing within and between words

 inappropriate syllabic stress

 lack of coarticulation

 Children who use cochlear implants tend to have many fewer abnormalities

Adult Hearing Rehabilitation

Audiologic evaluation measures hearing loss does not measure reactions to hearing loss, hearing needs, real-life listening performance, and how the hearing loss affects day-to-day activities.

This is designed to help resolve communication problems brought on by the hearing loss.

Including communication partners in therapy.

Hearing Rehabilitation

Components: skills training (auditory, visual, auditory-visual), problem-solving, and counseling.

Benefits of Group Hearing Rehabilitation

Provides a supportive atmosphere, patients and communication partners can help each other, provides a safe place to practice new skills, and cost effective.

Skill Training

Activities designed to improve auditory, visual, and auditory-visual speech perception.

Auditory-only is sometimes called auditory training. Visual-only is called lipreading or speechreading.

Lipreading

Getting information from watching the articulators. This can sometimes be improved with training. This can improve people’s ability to make good guesses.

However, some sounds are visible and some sounds look the same.

Speechreading

Includes multimodality information: gestures, expressions, postures, and environmental cues.