Aural Rehab Final
MODULE 4:
Atypical hearing can impact speech production, language development, psychosocial development, and educational progress.
Two pieces of federal legislation have had a significant impact on the education of children who are Deaf and/or hard of hearing:
No Child Left Behind Act (NCLB)- seeks to improve the education of all children - with an emphasis on children from low-income families (this was replaced by the Every Student Succeeds Act in December of 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.
role of an educational audiologist
role of SLP
The Rehabilitation Act first signed into law in 1973 and recently reauthorized in 2004, supports and promotes the rights of individuals with disabilities.
The Americans with Disabilities Act or ADA is the major legislation that protects the rights of individuals with disabilities against discrimination on the basis of their disability in employment settings.
Sections 504 and 508 of the Rehabilitation Act give 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 in order to make adequate progress in the curriculum. Those specific services are known as related services and supplementary aids and services, and the IEP team must decide which services each student needs.
The IEP team is made up of
Parents or guardians
General education teacher
Special education teacher or provider
School district representative
Results interpreter
Outside specialists or advocates
Transition services expert
The Deaf and Hard of Hearing Students Bill in Florida
recognizes the unique communication needs of children who are deaf and hard-of-hearing.
encourages the development of a communication-driven and language-driven educational delivery system in the state.
In the state of Florida, it requires the Department of Education to develop a communication model to become part of the individual education plan process for students who are deaf and hard-of-hearing.
Florida’s Communication Plan
Legislation added subsection (6) to Section 1003.55, Florida Statutes which require the DEP to develop a Model Communication Plan which should be used during the development of an IEP for a student who is deaf or hard-of hearing.
The Communication Plan (MCP) is a REQUIRED component of the IEP process for students who have been identified as having the Deaf or Hard of Hearing (DHH) exceptionalism. The MCP helps to gather all data to guide the IEP team discussion on supports and services needed in the areas of language, communication, reading, assistive tech, listening, etc.
2019 Florida Statutes
Outlines requirements for programs and options for families.
Allows the parent of a child who is DHH (who meets requirements by the state), to enroll the child in an auditory-oral education program as a school of choice in order to focus on listening and spoken language skills.
Adds points when calculating the matrix of services for children who are DHH.
Encourages collaboration with Listening and Spoken Language Specialists.
Role of the SLP in schools:
Help students meet the performance standards of a particular school district and state by assuming a range of responsibilities.
Work in partnership with others to meet students’ needs.
Provide direction in defining their roles and responsibilities and in ensuring appropriate services to students.
One of the primary goals of the SLPs working with children who are DHH in the public schools is to facilitate speech, language, and literacy skills to access the general school curriculum.
The role of the Educational Interpreter is:
Convey both what hearing people say and what the student with hearing loss signs (if applicable)
Ensure that the student can fully and effectively access all info.
To provide communication access to students who are DHH by faithfully and accurately representing the classroom instruction, teacher/student dialogue, and relevant sound info in the mode of communication used by the student.
Interpreting: The process of transmitting spoken English into American Sign Language and/or gestures for communication between deaf and hearing people.
Transliterating: The process of transmitting spoken English into any one of several English-oriented varieties of manual communications between deaf and hard of hearing people.
A comprehensive evaluation is critical to develop an effective plan of intervention.
SLP must assess speech, language, and auditory.
Diagnostic Assessment: The professional interventionist needs to
understand speech perception, etc., to ensure effective/treatment with a child who has not acquired listening skills “developmentally.”
When adequate early intervention does not occur, the focus should then shift to “remediation” to fill the gaps.
Assessment tools: language sample, articulation, language (syntax, global measures).
Educational tools: auditory skills, classroom behaviors/observation, Sign language proficiency, bilingual proficiency, reading/writing, speechreading.
Assessment Instruments:
Early Speech Perception Test (ESP)
Auditory Perception Test for the Hearin Impaired (APT/HI-3)
A Language Processing Skills Assessment (TAPS-4)
Management and Service Delivery:
We must use the most appropriate communication modality for the individual.
Everyone should expect typical social linguistic models with high expectations.
Instructional intensity- practice!
Families must be involved if sufficient instructional intensity is to be obtained.
All collaborators must be on the same page.
Keep in mind children with
Auditory processing disorder: impairs the understanding of the meaning of incoming sounds.
Auditory Neuropathy: a disorder of the timing of the auditory nerve also known as Auditory Dysynchrony.
Tinnitus
Dual Sensory
Foundation of Listening Development:
Listening training, assessment, language, and auditory-based speech.
The three P’s of TYPICAL development
Perception Stage (Auditory Perception Learning)
Oral Speech and Language
Processing Stage (Cognitive Operations)
Auditory processing
Speech Programming
Language/Cognitive Planning
Production Stage
Intelligible Speech and Oral Language`
The 4 Levels of Listening:
Detection
Discrimination - telling one thing from another
Identification - able to label: that sound is a cow
Comprehension
Early phases are detection
Top to bottom (easier to harder)
Foundations of Listening Development
Appropriate Amplification
S.G. Allen’s 3 P’s (perceive, process, produce)
Behavioral Conditioning
Speech Banana/String Bean
Ling 6 Sounds
Sound-Object Association (learning to listen sounds)
Factors in developing spoken language:
Early identification and appropriate intervention
Use of appropriate and optimal tech
Establishing a strong auditory foundation
Consistent exposure to spoken language
Optimal listening environments
Parent/caregiver participation in therapy and at-home
Communication between professionals and parents
Age of onset and cochlear implantation
Prior benefit from hearing aids
Consistent use of cochlear implant
Additional Disabilities and Medical Issues
Motivation
Auditory Verbal Techniques and Strategies:
Create a listening environment
work on “best hearing” side/positioning
make it easier to listen
Give the child a reason to listen/communication - and expect an answer
Use Mother/Parent
Expand and extend the child’s utterance
Beyond the Here and Now/Model target behaviors you wish the child to develop
Acoustic Highlighting:
modify acoustic info to highlight particular feature/whispering is also an option
Hear it before they see it/Audition first
Direct the child’s attention to auditory info before showing toy/action
Be a Birddog
Point to ear saying, “I hear that!”
Wait time
Expectant look
Auditory sandwich (auditory- visual-auditory) to “put it back into hearing”
Auditory closure
Sabotage
Help me but don’t tell me!
Develop a listening attitude
In the early stages: Alert the child to listen throughout daily activities
Interact with the child as if he/she can learn through listening
Later: encourage the child to monitor his own environment through hearing
Encourage the child to “listen the first time”
Serve and return
Develop confidence in listening abilities
Use Auditory Feedback mechanism for speech imitation
ASK ‘what did you hear?” vs. What did I say?
Let the child be the teacher
Module 5: Multicultural Issues
What do we know about second language acquisition?
Children with profound hearing loss typically exhibit deficits/delays in mastering one spoken language
For this reason, clinicians have been reluctant to recommend bilingual language environments for children with CI.
In the U.S., parents of children with CI often were discouraged from using a language other than English in the home.
What are indicators for successful development for children learning more than one spoken language via a CI?
Parent proficiency in both languages
most implanted before age 2
Excellent perception skills
Intensive AVT
Cultural/religious opportunities
Therapy or school in other language
Mother tongue- language of the heart
Parent Proficiency:
Parents fluent in the languages they used.
Children exposed to native speakers of the language.
Most adults used rich and complex forms in natural convo.
Continuum of proficiency in 2nd language appears to mirror natural exposure.
When to Recommend Bilingual/Multilingual Exposure for Child in Bilingual/Multilingual Home
Early age of CI - before 2 years
Good speech perception skills with CI
English skills progressing adequately
Parent motivation
Child exposed to natural and complex models of the languages
Opportunities to use in meaningful situations
All things being equal: The earlier the better
Possible Contraindications for Second Language Exposure
Family Support Issues
Additional diagnosis
Other clinical findings
Child struggling with language acquisition
Poor speech perception skills with CI
Partial Insertion of electrode
Late age at ID/Intervention
Late age at CI (after ¾ years?) with limited hearing experience or benefit pre-CI.
What is cultural competence? involves understanding and appropriately responding to the unique combination of cultural variables- including ability, age, beliefs, ethnicity, experience, gender, gender identity, linguistic background, national origin, race, religion, sexual orientation, and socioeconomic status - that the professional and client bring to interactions.
Assessment and Intervention: AUDITORY SKILLS, SPEECH, LANGUAGE (RECEP & EXP), LANGUAGE PROFICIENCY.
even home environment, parent proficiency in a second language, cultural considerations, and parent motivation.
Paper Acceptable Interpreters
Bilingual SLPs
Professional interpreters
Bilingual professionals other than SLPs
Family and friends of the client
All should have native or near-native proficiency in both languages
Briefing: The clinician and interpreter meet before the session to discuss intervention goals and make interpretation decisions
Interaction: SLP and interpreter work together with patient
Debriefing: clinician and interpreter review outcomes of session and make follow-up plans.
Responsibilities of SLP:
interpreter skills and knowledge
interview techniques
confidentiality considerations
tech terminology
objectives of intervention
sensitivity toward culture and speech community
tone of intervention, diagnosis, recommendations, outcomes & follow-up care
without training, an interpreter might unintentionally change results without monolingual SLP awareness
MODULE 6: Adult
An increasing # of adults in their 40s and 50s are experiencing hearing loss
15% of American adults (37.5 million) aged 18 and over report some trouble hearing.
It is estimated that by 2050, over 700 million people will have hearing loss.
reasoning include noise exposure from loud music, use of ear buds, workplace sound hazards, and power engines/vehicles (sensorinueral in nature)
Hearing loss is the third most prevalent chronic health condition facing older adults in the US.
Men are almost twice as likely as women to have hearing loss among adults aged 20-69.
Presbycusis (age-related hearing loss), comes gradually as one gets older.
Tinnitus is common and is described as ringing in the ears, but also sounds like roaring, clicking, hissing, or buzzing.
Hereditary can also cause HL. ex: otosclerosis
Some ototoxic medications used to treat cancer and heart disease can cause HL.
28.8 million adults could benefit from using hearing aids.
About 80% of hearing loss cases can be treated with hearing aids, but only 1 in 4 who could benefit, use them.
16% of 20-69 yr olds who could benefit from hearing aids have ever tried them.
People with hearing loss wait an average of 7 years before seeking help.
Characteristics of Adult-onset Hearing Loss:
most often the hearing loss is gradual
higher frequencies are impacted more than lower freq.
conversations become more challenging, esp when background noise is present
day-to day interactions become difficult
facial coverings negatively impact conversations
Factors to consider that would influence our clinical decision making
Patient’s age, stage of life, and lifestyle
work and family environment
financial wellbeing
cultural background
support system
self image and mental health
Women are more likely to acknowledge a hearing loss and implement helpful communication strategies than men.
Untreated hearing loss has been linked to accelerated cognitive decline in older adults.
Using hearing aids may slow the rate of cognitive decline, show reduced depression symptoms, and improved QoL.
The risk of dementia may be up to five times greater and risk of falling three times greater among people with untreated hearing loss
The Aural Rehabilitation Plan typically consists of: Assessment, Counseling, Development of Plan as a team, Implementation, Outcomes, and Follow-Up.
Assessment of an Adult should include a full audiological eval, baseline speech perception testing, comprehensive case history, structured and/or unstructured interview, eval of conversational fluency, and questionnaires or other self-rating measures.
Informational counseling should include a client-centered approach, discussion of audiological and auditory perception tests, discussion of motivation, expectations, and support system, confirmation and understanding of the individual’s hearing loss, consideration of hearing technology, discussion of indvidual’s comfort level with hearing tech, and affirmation of person’s feelings.
Communication strategies for adults:
Good listening environment (positioning)
consider complexity and distance
reason to communication
auditory sandwich
acoustic highlighting
role reversal/role playing
wait time
expectant look
ask the client, what did you hear?
sabotage
develop a listening attitude - providing feedback on progress
Training should include:
minimizing difficulties - partner, environment, etc.
use of strategies and implementation of appropriate behaviors
potential role-playing
Communication PARTNER strategies:
conversations within the same topic/within context
decreasing background noise/distractions/ distance/ same room
ensure that you are face to face
ensure comfort
appropriate conversational turn-taking
using a topic board/white board
visuals when appropriate
counseling family members
including the individual in conversations
When do you discharge from individual Aural Rehab services?
when goals are met/progress is achieved
individual feels confident using strategies
communication partners are confident using strategies
plateau in skills/other med issues
transition to group services
individual is comfortable with hearing tech and using it daily
self-advocacy skills have been enhanced
skills can be maintained via home program
Home programs: Advanced Bionics RehAB portal