Presentation - Alexander Graham Bell Association

12/13/2010
Listening, Language, and Learning
for Infants and Children Who Are
Deaf or Hard of Hearing
Donald M. Goldberg, Ph.D.
AG Bell Biennial Convention
Short Course
June 2012
Donald M. Goldberg, Ph.D., CCC-SLP/A, LSLS Cert. AVT
Consultant, Professional Staff Professor, The College of Wooster
Hearing Implant Program (HIP) Department of Communication
Head and Neck Institute
Cleveland Clinic
2
Its ALL About
Learning to Listen!
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12/13/2010
Agenda
• Communication Options/”Communication
Opportunities”
• Questions to Ask of ALL Options
• Auditory-Verbal Therapy Principles
• Auditory-Verbal Education Principles
• Audiology: The Foundation of Auditory
Teaching
• Introduction to Hearing Sensory Technology
Agenda
• Assessment of Auditory Functioning
• The Auditory “Hierarchy”/Levels of Functioning
• AG Bell Academy for Listening and Spoken
Language
◦ LSLS Cert. AVT
◦ LSLS Cert. AVEd
• Research Support/Resources: Auditory Teaching
• Resources: Cochlear Implants
ESSENTIAL KNOWLEDGE AREAS OF A
LISTENING AND SPOKEN LANGUAGE SPECIALIST
Emergent Literacy
6%
Education 6%
History, Philosophy,
and Professional
Issues 4%
Strategies for
Listening and
Spoken Language
Development 18%
Parent Guidance,
Education and
Support 13%
Hearing and Hearing
Technology 12%
Auditory Functioning
16%
Spoken Language
Communication
16%
Child Development
9%
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12/13/2010
Auditory-Based Teaching Does NOT Merely Mean
Putting An Acoustic Hoop In Front of Your Mouth!
A Caveat PLEASE!
A workshop/presentation/short course does NOT
prepare one to become a fully trained
interventionist
for children who are deaf or hard of hearing!
A “jump start” perhaps – but expertise,
both academically and clinically –
in child development, parent/family counseling,
speech-language pathology, audiology, education
of the hearing impaired, teaching spoken
language through listening, among others, –
IS ALSO REQUIRED!
Opening Doors:
Technology And
Communication Options for Children With Hearing Loss
Opening Doors: Technology And Communication
Options for Children With Hearing Loss
- Your Beautiful Child
- Windows of Opportunity
- Quick Facts
- First Reactions
- Early Intervention
- Where Do I Turn?
- Groups Specializing In
Hearing Loss and Deafness
- Breaking the Sound Barrier
(Hearing Aids, Cochlear
Implants)
- Exploring Communication
Options (Auditory-Oral,
Auditory-Verbal Verbal, Cued
Speech, Sign Language)
From the U.S. Department of Education
www.ed.gov/about/offices/list/osers/reports.html.
&
www.cdc.gov/ncbddd/ehdi
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12/13/2010
Communication Modes/Options
Opportunities
• Auditory-Verbal
• Auditory/Oral
• Cued Speech
• Verbotonal
• Total Communication
• Simultaneous Communication)
• New: ASL/English Bimodal Bilingual
• Manual Communication
- MCE/Sign Systems
- ASL (Bi-Bi)
Which communication
approach is the “BEST”
for MY child?
Adapted from Schuyler & Sowers, 1998
Questions to Ask/Issues to
Consider
• Where does one start?
• What is the child’s age at time of
identification?
• What is the degree of the hearing loss?
• With amplification i -- how well does the child
“hear” spoken language?
• What early intervention & educational
resources are available in or near your
community?
• …
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12/13/2010
Questions to Ask/Issues to Consider
• If selecting ANY option -- how willing are the
primary caregivers to learn the option’s
requisite “components” (e.g., sign, cue,
“technique” fluency/ competence)?
• What is the family’s commitment to a
selected approach?
• How does a selected option work for the
family?
• What are the goals for the child?
• …
Questions to Ask/Issues to
Consider
• What educational options exist “down the
road”?
• What other factors, if any, need to be
considered?
• What are the potential benefits of each
approach?
and
• What are the potential challenges of each
approach?
CONSIDER
Look at the graduates of
each program and do
NOT only see the
“STARS”!
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12/13/2010
NO decision
a parent
makes is a
“WRONG”
decision!
Principles of A-V Therapy Practice
(AG Bell Academy for Listening and Spoken Language, 2009)
1. Early diagnosis, audiologic
management, and AVT.
2. State-of-the-art hearing
technology to obtain maximum
auditory stimulation.
3. Guide and coach parents to help
their child use hearing as the
primary sensory modality in
developing listening and spoken
language.
Principles of A-V Therapy Practice
4. Guide and coach parents as
primary facilitators of child’s
listening and spoken language
development through active
consistent participation in
individualized id d AVT.
5. Guide and coach parents to create
environments that support
listening throughout the
child’s daily activities.
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12/13/2010
Principles of A-V Therapy Practice
6. Guide and coach parents to help
integrate listening and spoken
language into all aspects of
the child’s life.
7. Guide and coach parents to use
natural developmental
patterns …
8. Guide and coach parents to help
their child self-monitor spoken
language through listening.
Principles of A-V Therapy Practice
9. Administer on-going formal and informal
diagnostic assessments to develop
individualized A-V treatment plans –
diagnostic therapy – to evaluate
clinical effectiveness
and
10. Promote education in “regular”
classrooms with peers with
“typical” hearing and with appropriate
support services from early childhood
onwards.
Principles of A-V Practice
Above PRINCIPLES were adapted from Pollack
(1970)
• An A-V Practice requires all 10 principles to be
in place.
• “Parents” also includes other caregivers who
interact with the child.
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12/13/2010
Principles of Auditory-Verbal
EDUCATION
1. Early diagnosis, followed by immediate
audiologic assessment and use of appropriate state
of the art hearing technology to ensure maximum
benefits of auditory stimulation.
2. Promote immediate audiologic management and
development of listening and spoken language for
children as their primary mode of
communication.
3. Acoustically controlled environment
throughout the child’s daily activities.
Principles of A-V Education
4. Guide and coach parents to become effective
facilitators of child’s listening and spoken language
development in all aspects of the child’s life.
5. Provide effective teaching with families and children in
settings such as homes, classrooms, therapy
rooms, hospitals, or clinics.
6. Provide focused and individualized instruction
through lesson plans and classroom activities while
maximizing listening and spoken language.
Principles of A-V Education
7. Collaborate with parents and professionals to develop
goals, objectives, and strategies for achieving the
natural developmental patterns …
8. Promote each child’s ability to self-monitor spoken
language through listening.
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12/13/2010
Principles of A-V Education
9. Use diagnostic assessments to develop individualized
objectives, monitor progress, and evaluate the
effectiveness of the teaching activities.
and
10. Promote education in “regular” classrooms with
peers who have “typical” hearing as early as
possible, when the child has the skills to do so
successfully.
The Options for “Success”…
Have never been more exciting!
Why?
- Universal Newborn Hearing Screening
- Increased survival rates of
“at risk” infants
- Increased focus on EARLY INTERVENTION &
clinical efficacy
- Advances in sensory technology, most notably,
cochlear implants!
By using today’s incredible “sensory
technology,” even children with
severe and profound hearing loss
can make use of auditory
information to develop spoken
language – through listening!
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12/13/2010
Coach the parent as the
primary model for listening
and talking
Parent guidance should be an
integral part of any EI program,
as it is the family members who
must learn to provide the child
with maximum auditory
stimulation and ...
who model meaningful verbal
communication strategies
throughout
the child’s daily activities.
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12/13/2010
Cornerstones of A-V Practice
• Early Detection/Early Identification
• Appropriate use of sensory aid/s
• One-on-one intervention
with full parent involvement
• Absence of signs & speechreading training
• Integration with hearing peers…
• On-going diagnostic therapy
Auditory-Verbal
&
Auditory-Based
Helen Hulick Beebe
Auditory-
Verbal
Pioneer
Doreen Pollack
A-V Pioneer
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12/13/2010
Give back to parents
their natural role as their
child’s first and most
important teacher
(adapted from Pollack, 1970)
The Sky’s the Limit!
Why?
• Early Identification
• Audiology
• Sensory Technology
• Auditory Learning / Early Intervention
• Professional Certification of LSLS/s
Audiology
The Foundation of
Auditory-Based Intervention
&
The KEY to auditory “success”
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12/13/2010
Let’s talk about HEARING!
Pinna
Tympanic
Membrane
Semicircular
Canals
Cochlea
Hearing
Nerve
(VIII N)
Let’s take a look ….
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12/13/2010
Auditory Brain Development
It’s all about the BRAIN!
The ears are just the way in…
1-3-6
1 Before one Month of Age:
Hearing Screening
3 Before three Months of Age:
Hearing Evaluation
6 Before six Months of Age:
Early Intervention
www.cdc.gov/ncbddd/ehdi
Tympanometry
OAEs
Air Conduction
Tonal ABRs
Air
Conduction
Click ABRs
Bone
Conduction
Click ABR
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12/13/2010
Audiologic Protocol
• Use a battery approach:
◦ Auditory Brainstem Response (ABR)
◦ Otoacoustic Emissions (OAEs)
◦ Auditory Steady State Response (ASSR)
Auditory Steady State Response (ASSR)
◦ Behavioral Observation Audiometry (BOA)
◦ Visual Reinforcement Audiometry (VRA)
◦ Conditioned Play Audiometry (CPA)
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12/13/2010
Audiologic Recommendations
On-site audiology program with the
early intervention program
Pediatric Test Assistant
(Birth to age 3-years-old)
Active parent participation
Comprehensive testing protocol
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12/13/2010
Audiograms
X
O
X
X
X O
X
O
X
O O O
Image from League for the Hard of Hearing
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12/13/2010
Hearing Technology Worn Throughout the Child
Waking Hours (www.almontpool.com/www.poolrafts.com)
Hearing Sensory Technology
Hearing Aids
FM/s and other Hearing Assistive
Technology (HAT)
Cochlear Implants
Consider Trying:
• Hearinghenry.com
• www.silkawear.com
• www.hannaanderson.com
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12/13/2010
Because EVERY dB counts!
Unaided Testing
Right Ear
Left Ear
Aided Testing
Binaural
Right HA
Left HA
CI/HA Testing
CI-Only
CI & HA
HA-Only (if possible)
Bilateral CIs
Both CIs
Right CI-Only
Left CI-Only
FM/s (IR) – NON-NEGOTIABLE!
NEGOTIABLE!
Audiology Foundation
• Aggressive assessment, including
unaided & aided thresholds, speech
perception measures, acoustic immittance
• Aggressive management of sensory
aid/s, earmold acoustics
◦ parents should complete daily listening checks
• FM /IR system/s in conjunction with CI/s
and/or HA/s.
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12/13/2010
Pediatric CI Candidacy Criteria
Ages: 12 months to 24 months
• Profound sensorineural hearing loss
in both ears
• No medical contraindications
• Lack of progress in the development
of auditory skills
• High motivation & appropriate
expectations from family
(Cochlear Candidacy Magnet)
Pediatric CI Candidacy Criteria
Ages: 25 months to 17 years, 11 months
• Severe to profound SNHL in both ears
• LNT scores of 30% or less in best-aided condition
(children, 5 years to 17 years, 11 months)
• MLNT scores of 30% or less in best-aided conditions
(children, 25 months to 4 years, 11 months)
• Lack of progress in the development of auditory skills
• No medical contraindications
• High motivation & appropriate expectations (both child &
family, when appropriate)
(Cochlear Candidacy Magnet)
Adult Candidacy Criteria
Ages: 18 years of age or older
• Moderate-to-profound sensorineural hearing
loss in both ears
• Preoperative HINT sentences recognition
scores of 50% or less in the ear to be
implanted and 60% or less in the opposite ear
or binaurally
• Pre-linguistic or post-linguistic onset of severeto-profound
hearing loss
• No medical contraindications
• A desire to be part of the hearing world
(Cochlear Candidacy Magnet)
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12/13/2010
Hammes et al. (2002; 2006)
Children implanted under 18
months demonstrated best
outcomes for
language acquisition,
speech intelligibility, and spoken
language.
Hammes et al. (2002). Early Identification and Implantation: Critical Factors for Spoken Language
Development. Annals of Otology, Rhinology and Laryngology, Suppl; 189:74-78.
It’s ALL about
communication!
Auditory Learning
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12/13/2010
Auditory Teaching Techniques
• Emphasize LISTENING
• Prompt “Listen”
• 1-on-1 Time
• Parents are Partners
• “Hand Cue”
• Use Acoustic
Highlighting
• Integrate speech/auditory
learning & language goals
• Use “Pause Time”
• Use Conversational Turn-
Taking
• “Role reversal”
• Keep High expectations
Auditory Teaching Techniques
• Pay Attention to
Acoustics
• Keep AUDIOLOGIC
MANAGEMENT a
priority
• Beware of Repetition
• Use “Sabotage”
• Listening Age/Hearing
Age
• Use Cognitive-Based
Activities
• “Teach Don’t Test”
• “Put It Back Into Hearing”
• Follow an AUDITORY
HIERARCHY
Focus on:
AUDITION FIRST
Emphasize LISTENING!
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12/13/2010
KEY:
Parents as partners and
case managers
A Parent Is
Worth 10,000000
Schoolmasters
A Chinese Proverb
Pay Attention to Acoustics
•Positioning in therapy lessons
•Use of FM systems
•Use Acoustic modifications
•Know your “speech acoustics”
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12/13/2010
Keep in mind the need for:
Aggressive audiologic
management
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12/13/2010
Major technique:
Follow an Auditory
“Hierarchy” or “Levels of
Auditory Functioning” (LAF)
How Far We Have Come!
(Erber, 1982, 2011; Boothroyd, 1978)
Comprehension:
Is there meaning to this sound?
Recognition/Identification:
Is this sound distinct from other sounds?
Discrimination:
Is this sound different from other sounds?
Detection:
Was there a sound?
Levels of Auditory Functioning
• Detection
• Auditory Awareness
• Auditory Attention
• Distance Hearing
• Localization
• Auditory Association
• Auditory Discrimination
• Auditory Feedback
• Identification…
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12/13/2010
Levels of Auditory Functioning
• Auditory/Sequential Memory
• Auditory Closure
• Auditory Analysis
• Auditory Blending
• Auditory Figure Ground
• Auditory Tracking
• Auditory Processing
• Auditory Understanding/
Comprehension
Auditory Functioning
• Detection–to indicate the presence/
absence of sound
(Alarm Clock / Wake-Up / Marching Games)
• Auditory Attention – to pay attention to
auditory signals, especially speech, for an
extended time.
• Identification – to indicate an
understanding of what has been labeled or
named or to label or name something.
(L to L Sounds // Recognition / Identification)
Auditory Functioning
• Auditory Memory / Sequential
Memory – to store and recall auditory
stimuli or different length or number in
exact order.
• Distance Hearing – to attend to sounds
at a distance. (FM Issue)
• Localization – to localize the source of
sound. (Bird Call Localization)
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12/13/2010
Auditory Functioning
• Auditory Figure Ground – to identify a
primary speaker from a background of noise.
• Auditory Tracking – to follow along in the
text of a book as it is read aloud by someone
else or in conversation.
(see De Filippo & Scott, 1978)
• Auditory Understanding / Auditory
Comprehension – to synthesize the global
meaning of spoken language and to relate it to
known information.
Learning to Listen Lesson
• Auditory-Verbal therapist as COACH
• Audition first -- so hide/wrap/
disguise/withhold materials
◦ toys, y, objects, book, etc.
• Integration of auditory/speech/
language activities
• “Ling thing” for speech
◦ at both the supra- or non-segmental and
segmental levels…
Learning to Listen Lesson
• Follow the child’s lead (up to a point of course!)
• Capitalize on all acoustic opportunities
• Use story book for auditory connected
discourse tracking or story modeling
practice
• AUDITORY LEARNING occurs inside
and out of the therapy “box”…
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12/13/2010
Learning to Listen Lesson
• Therapist pauses!
• Thinking skills are emphasized
• No teaching curriculum exists
and
• All sessions are diagnostic in nature –
guiding you to subsequent goals and
objectives
Learning to Listen with CIs
Cochlear implants
are
NOT A “PANACEA”
Learning to Listen with CIs
Cochlear implants
significantly increase
the audibility of
sound -- increase the
sensitivity of hearing
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12/13/2010
Learning to Listen with CIs
Cochlear implant
“thresholds”
are improved across the
frequency range of hearing
Learning to Listen with CIs
Cochlear implants allow for
improved listening in noise
Learning to Listen with CIs
Cochlear implants,
in general,
result in an improved
Quality of sound
&
Quality of life
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12/13/2010
Integration of
Cochlear Implants &/or Hearing Aids
and
Adit
Auditory
Intervention
A “Perfect” Marriage
Communication Assessment:
Speech
Speech Intelligibility
Receptive Language
Expressive Language
Auditory Functioning
Assessment of
Auditory
Functioning
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12/13/2010
Auditory Assessment
• Ling 6/7 Sound Test • Auditory Perception of
• Early Speech Perception Alphabet Letters (APAL)
(ESP)
• Speech Perception
• Glendonald Auditory Instructional Curriculum &
Screening Procedure (GASP)
Evaluation (SPICE)
• Test of Auditory
Comprehension (TAC)
• Auditory Numbers Test
(ANT)
• Children’s Auditory Test
(CAT)
• Auditory Perception Test for
the HI (APT-HI 2)
• Parents’ Evaluation of
Aural/Oral Performance of
Children (PEACH) Scale
Auditory Assessment
Word Recognition
• NU-CHIPS *
• WIPI *
• PB-K
• NU-6
• Gardner Lists
• California Consonant
Test
• Meaningful Auditory
Integration Scale (MAIS)
• Infant-Toddler MAIS
(IT-MAIS)
• Mr. Potato Head
• Multiple Lexical Neighborhood
Test (MLNT)
• Lexical Neighborhood Test
(LNT)
* Closed to Open Set
Auditory Assessment
• Hearing in Noise Test for
Children (HINT-C)
• Listening Skills for Kids
with Cochlear Implants
• The Functional Listening
i
Evaluation
• Listening Inventory for
Education (LIFE)
• Screening Instrument for
Targeting Educational Risk
• Preschool SIFTER
(Age 3 through K)
• Secondary SIFTER
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12/13/2010
Auditory Assessment
• Developmental Index of • The Listening
Audition and Listening (DIAL) Comprehension Test 2
• Speech Intelligibility in Noise • Children’s Auditory
(SPIN-R)
Processing Performance
Scale (CHAPPS)
• Early Listening Function (ELF)
• Fisher’s s Auditory Problems
• Children’s Home Inventory Checklist
for Listening Difficulties • Screening Test for Auditory
(CHILD)
Processing Disorders
• Children’s Realistic Index of (SCAN)
Speech Perception (CRISP)
Auditory Assessment
• Functional Auditory Performance Inventory (FAPI)
• “Learning to Listen” Checklists
• Common Children’s Phrases
• CID Everyday Sentence Test
• Children’s Abbreviated Profile of Hearing Aid
Performance (CA-PHAP / PA-PHAP)
• Hearing Handicap Inventory for Adults (HHIA)
• Hearing Handicap Inventory for the Elderly (HHIE)
Ling Six (Seven) Sound Test
ah (/a/)
oo (/u/)
ee (/i/)
sh
s
m
(Ling & Ling, 1978)
Consider
“NO SOUND”
as the
7 th Sound
(Rosemarie Drous,
Formerly of the
Helen Beebe Speech & Hearing
Center)
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12/13/2010
Ling Sounds – Low, Mid, High
/u/ and /m/
/a/ and /i/
/”sh”/ and /s/
Ling Six Sound Test
Distance for Detection/Identification
Sound 1’ 3’ 6’ 9’ 12’
/u/ oo
/a// ah
/i/ ee
/ / sh
/s/ ss
/m/ mm
Early Speech
Perception (ESP)
(Moog & Geers, 1990)
(Moog & Geers, 1990)
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12/13/2010
Auditory Assessment
• Meaningful Auditory Integration Scale
(MAIS)
◦ Robbins, Renshaw, & Berry, 1991
• If Infant-Toddler Tddl Meaningful fl Auditory Ad
Integration Scale (IT-MAIS)
◦ Zimmerman-Phillips, Osberger & Robbins, 1997
Infant-Toddler Meaningful Auditory
Integration Scale
Zimmerman-Phillips, Osberger, &
Robbins, (1997)
Available from Advanced Bionics
10 Questions
0-4 Rating Scale
(0=Never; 1=Rarely; 2=Occasionally; 3= Frequently; 4=Always)
Meaningful Auditory Integration Scale
(Robbins; Robbins, Renshaw, & Berry, 1991)
Available from
Advanced Bionics Corporation
Parent Interview
10 Questions
(1a younger than age 5 years/
1b older than age 5 years)
0-4 Rating Scale
(0=Never; 1=Rarely; 2=Occasionally; 3=Frequently;
4=Always)
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12/13/2010
PEACH
Parents’ Evaluation of Aural/Oral
Performance of Children
Ching & Hill, 2007
11 Peach Items (6 Quiet; 5 Noise)
Frequency Ratings (n=5) of Reported Behavior
(Never/Seldom/Sometimes/Often/Always)
(0%, 25%, 50%, 75%, >75%)
PEACH
Abstract
The PEACH was developed to evaluate the
effectiveness of amplification for infants and children
with hearing impairment by a systematic use of
parents’ observations.
The internal consistency reliability was .88, and the testretest
correlation was .93.
The PEACH can be used with infants as young as one
month old and with school-aged children who have
hearing loss ranging from mild to profound degree.
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12/13/2010
Test of Auditory
Comprehension
(TAC)
(Trammell, 1981)
(Foreworks Publishers)
Test of Auditory
Coomprehension (TAC)
• Ages 4-17 years
• Normative data based on age
ranges and better ear PTA
• Stimuli on audiotape
• Screening task to start
• Hierarchical
• Ceiling: 2 consecutive subtest
failures
Listening Comprehension Test 2
• Ages: 6;0 through 11;11
• Subtests
- Main Idea
- Details
- Reasoning
- Vocabulary
- Understanding Messages
(From LinquiSystems)
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12/13/2010
Videotape
REGAN
SAMPLES at C.A./s
1;4 2;8 3;1 3;9; 5;1
Activities Demonstrated
• Learning to Listen sounds – vehicles (1;4)
• Ling 6/7 Sound Test (2;8)
• Experience Book (2;8)
• NU-CHIPS in noise (multi-speaker babble) (3;1)
• “Story Modeling” (3;1)
• PLEDGE OF ALLEGIENCE (3;9)
• HAPPY BIRTHDAY song (3;9)
• More Story Modeling (5;1)
Integration of
Cochlear Implants
&/or Hearing Aids
and
Auditory Intervention
A “Perfect” Marriage
A “Sweet” Lesson
• A Roll of Lifesavers
• A Box of Dots
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12/13/2010
“It Happens At Home”
“Natural Language Teaching”
Bathe the youngster in “meaningful” spoken language
“Teaching with a shoelace”
- Let’s make toast
- Bath Time
Data Collection
• “Interventionists” should be keeping data.
• What outcomes are being measured/
monitored?
• Both “informal” and “formal” measurements
are needed.
Measure/Monitor:
• LISTENING SKILLS / AUDITORY DEVELOPMENT
• SPEECH SOUND REPERTOIRE / SPEECH
INTELLIGIBILITY
• RECEPTIVE LANGUAGE / COMPREHENSION
• EXPRESSIVE LANGUAGE
Transfer: Test Data to
Intervention Goals/Objectives
- Use “tests” that assist you in developing
intervention
- Be hierarchical
-Vary field size (closed/open set; # in set)
- Be functional
- Have fun! (otherwise – Why bother?)
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12/13/2010
Diagnostic Therapy
• Measure skills frequently
• Complete longitudinal videotape sampling
• Use “formal” diagnostic measures
addressing AUDITORY, SPEECH, LANGUAGE,
& COGNITION
• Use “informal” diagnostic tools
• Continually assess the PARENTS, as well as
the KIDDO who is deaf or hard of hearing!
“Ideal” Variables
• Early identification
• Early & consistent use of
hearing technology
(HA/s, ALD/s &/or Cochlear
Implants)
• Strong family support and
• Auditory attitude
(with an “audibility” caveat)
Are We On Course?
• Overall – What is the Auditory-Speech-
Language Progress ?
• Some other specifics:
- Wear time of CI/s?
- Progression through auditory hierarchy
(basic awareness of sound to Ling Sound
detection to Ling Sound
recognition/identification, Learning to Listen
sound associations, etc.)?
- Increases and changes in speech sound
production?
- Receptive/Expressive language growth?
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12/13/2010
Are We On Course?
Typical Benchmarks:
• “Flat” serial audiograms in the
“mild” hearing loss range
• Improving speech perception measures
(closed to open set; quiet to noise)
• Closing the auditory-speech-language “gap”
• Approximately 1 years growth in 1 years time
See Loud & Clear! – “Clinical Red Flags”
Amy McConkey Robbins (2005)
Communication is Key!
• Northeast Ohio Consortium for Children with
Cochlear Implants (NOCCCI)
- NOCCCI Cochlear Implant Center to School
Communication Form: Cochlear Equipment
Information Checklist
- NOCCCI School to Cochlear Implant Center
Communication Form
Alexander Graham Bell Association for
the Deaf and Hard of Hearing
3417 Volta Place, NW
Washington, DC 20007-2778
(202) 337-5220 (V/TT)
(800) HEAR-KID
(202) 337-8314 (FAX)
www.agbell.org info@agbell.org
40

12/13/2010
AG Bell Academy
Certification is now available from the AG Bell
Academy for Listening and Spoken Language
Listening and Spoken Language Specialists
(LSLS)
- Cert. Auditory-Verbal Therapy
(Cert. AVT)
- Cert. Auditory-Verbal Educator
(Cert. AVEd)
Want more information?
APPLICATION PACKET
• Eligibility Requirements
• Instructions for Completing the Application Form
• Application Deadline
• Application Submission Format
• Application Form (Attachments & Checklist)
www.agbellacademy.org
academy@agbell.org
(202) 204-4700
ESSENTIAL KNOWLEDGE AREAS OF A
LISTENING AND SPOKEN LANGUAGE SPECIALIST
Emergent Literacy
6%
Education 6%
History, Philosophy,
and Professional
Issues 4%
Strategies for
Listening and
Spoken Language
Development 18%
Parent Guidance,
Education and
Support 13%
Hearing and Hearing
Technology 12%
Auditory Functioning
16%
Spoken Language
Communication
16%
Child Development
9%
41

12/13/2010
Canada = 70
9
0 0
3
6
2
01 7
0
6
19
0
0
11
2
1
27
2
1
6
9
16 6
14
37
7
1 1 23 0
5
3
14
33
6
5 24
5 2
11
2
7
12 21
41 1 2
0
15
0
Family Choice:
Snapshot North Carolina
Communication Outcomes Selected by Families
6% 4%1%
Listening and Spoken
Language
g
Total Communication
American Sign Language
89%
Cued Speech
Source: BEGINNINGS of North Carolina is a non-profit agency providing an impartial approach to meeting the diverse needs of families with
children who are deaf or hard of hearing and the professionals who serve them
We have a “crisis of capacity”
A global saturation of professionals
is desperately needed for those
families who choose listening and
spoken language g to communicate.
42

12/13/2010
Your Life In Stereo
(The Bilateral Difference)
- “Movie/DVD”
- Hear From the Experts
(available from Cochlear Americas)
Features SKYE and her family – along with members of
the CCF HIP Team
“Baking therapy into every aspect of her life”!
Unilateral v. Bilateral Hearing
• Unilateral CI
• Bimodal (CI and HA)
• Bilateral Sequential CIs
• Bilateral Simultaneous CIs
Advantages of Bilateral CI/s
• Improved hearing in quiet (binaural summation)
• Improved hearing in noise (binaural squelch, head shadow
effect, and binaural redundancy)
• Improved lateralization
• Improved localization
• Assurance that the “better hearing ear” is
implanted/”captured”
• Qualitative listening improvement
43

12/13/2010
Disadvantages of Bilateral CI/s
• Increased costs (2 devices, batteries, etc.)
• Multiple pieces of equipment to manage
• Surgical and medical risks
• Future developments
• No or limited “natural” hearing remaining
• Challenge – Reimbursement (US)
• Challenge – Different processing strategies &
speech processors (with sequential bilateral CIs)
Bilateral Cochlear Implants
(adapted from HOPE 2009)
Utilization of Bilateral Cochlear Implants
• Recent Trend towards BILATERAL use of CI/s
-- 1992: 0-1%
-- 2007: 14-15%
• 70% of bilateral CI usage is among 18 years and
under age group
Bilateral % above applies to new surgeries
(not total implanted base)
(Source: Cochlear Americas estimates)
Simultaneous Bilateral CI/s
• Almost always / full-time intervention
with BOTH CIs
• Periodic -- BOTH CIs;
Left CI-Only;
Right CI-Only
Ling 6 Sound Check / Word Identification
Check (Q/N) / Tracking Check
44

12/13/2010
Sequential Bilateral CI/s
•No one generalization/rule
for intervention with patients with
sequential bilateral CIs
can
possibly be
the only answer /solution.
Bilateral CI Guidelines
“Therapy and Educational Guidelines for
Bilateral Cochlear Implantation”
By Nancy Caleffe-Schenck, M.Ed., CCC-A, Cert. AVt
- Getting Started
- Laying the Foundation
• Core Concepts
• Therapy and Educational Tips
• Activities for Auditory Comprehension
- Unique Considerations for Bilateral Implantation
• Simultaneous Implantation
• Sequential Implantation
• Therapy and Teaching Tips for Sequential Implantation
• Listening With Both Implants
(see Kuhn-Inacker et al., 2004)
Bilateral CI Therapy Guidelines
Auditory Rehabilitation Therapy Guidelines for
Optimizing the Benefits of Binaural Hearing
By Leo De Raeve
- Introduction
- Auditory Training for Binaural Hearing Skills
- Training with Softer Sounds & Speech
- Speech Perception Training with Background Noise
- Training Localization
- Examples of Localization Training Activities
- Influence of Time-Delay Between Implant Procedures on Rehabilitation
- Sequential Stimulation/Implantation
- Simultaneous Stimulation/Implantation
- Incidental Learning
- In the Classroom
- Conclusion
45

12/13/2010
Subject
Gender
Age at
Activation CI
1
Age at
Activation
CI 2
Subject
Cochlear Implant Subjects
Gender
Age at
Activation CI
1
Age at
Activation
CI 2
1 M 1;0 1;0 14 M 3;1 4;1
2 F 1;0 1;0 15 M 1;9 5;8
3 M 1;5 1;5 16 M 1;8 6;6
4 F 1;0 1;0 17 F 5;8
5 M 1;8 HA at LE 18 M 5;4 7;11
6 F 19 1;9 19 F 19 1;9 75 7;5
7 F 3;5 5;9 20 M 2;1 7;1
8 M 1;8 HA at RE 21 M 4;0 8;8
9 F 1;5 2;1 22 F 1;7 7;7
10 M 4;3 HA at RE 23 M 1;8 7;10
11 M 4;6 4;10 24 M 10;2 14;0
12 F 2;2 3;1 25 M 10;1 13;1
13 M 1;8 4;1 26 F 1;3 1;3
TAC Outcomes
(Latest Individual Test Data)
25
Number of Patients
n=26
20
15
10
5
0
< 50 50-59 60-69 70-79 80-84 85-89 > 97+
T-scores
PPVT-III Outcomes
(Latest Individual Test Data)
f Patients
23
Number of
n=2
20
16
12
8
4
0
70-
79
80-
89
90-
99
100-
109
110-
119
120-
129
Standard Scores
130-
139
140-
149
46

12/13/2010
EVT Outcomes
(Latest Individual Test Data)
20
f Patients
25
Number of
n=2
16
12
8
4
0
80-
89
90-
99
100- 110- 120- 130- 140-
109 119 129 139 149
Standard Scores
150-
159
160-
169
SPELT Outcomes
(Latest Individual Test Data)
16
14
Number of Patients
n=19
12
10
8
6
4
2
0
Below Age
Range
At Age Range
Above Age
Range
TAC: Highest Subtest PASSed!
• Subtest 5: S26 (age 3;1
• Subtest 7: S2 (age 4;1)
• Subtest 8: 11 Ss
• Subtest 9:
7 Ss
• Subtest 10 (but FAILed
Subtest 9: 3 Ss
• Subtest 10: 3 Ss
47

12/13/2010
Educational Placement Summary
(For FALL 2011)
Fully Mainstreamed n=20
Primarily Mainstreamed
w/Resource Room Support n=1
Primarily Self-Contained n=2
“Other” n=4 (2 are home schooled; S 26 is 3-years-old; and
S27 is 2-years-old)
Primary Research Study Conclusion
The majority of the children with cochlear
implants who present with bilateral, severe
to profound hearing loss, who have been
enrolled in a listening and spoken language
program and tested longitudinally,
overwhelmingly demonstrated auditory &
spoken language skills and abilities that
were at or above their
hearing peers.
Early intervention/(re)habilitation & followup/monitoring
by school and other
professionals are most important factors!
J t f th th i /f t / i bl
Just some of the other issues/factors/variables:
• Age of cochlear implantation
• Amount of “residual hearing”
• Presence of other disabilities
• Communication “method”
• Use of bilateral or bimodal hearing technology; and
• Type and amount of auditory-based (re)habilitation
48

12/13/2010
www.clwm.net
Books and Props
gabbygadgets.com
49

12/13/2010
DMG’s Therapy Boxes
DMG’s Therapy Closet
LSLS Learning Opportunities
• FIRST YEARS
(University of North Carolina –
Chapel Hill – Kathryn Wilson)
• PPCI (Mary Ellen Nevins – Project
Director)
• HOPE (Cochlear Americas)
• Children’s Hospital Symposium
(Chicago, IL – Sally Tannenbaum)
50

12/13/2010
Competing Messages / Noise
AUDiTEC, Inc.
2515 S. Big Bend Blvd.
St. Louis, MO 63143-2105
(314) 781-8890
(800) 669-9065
auditecinfo@auditec.com
LENA
www.lenafoundation.org
“Great Stuff”
• Cottage Acquisition Scales for Listening, Language, & Speech (CASLLS)
www.sunshinecottage.org
• St. Gabriel’s Curriculum
• Oh Baby, Baby, Kick Those Legs and Hello Hands www.avc-atlanta.org
• Learn To Talk Around the Clock
www.LearnToTalkAroundTheClock.com
• My Baby and Me (Moog Center for Deaf Education)
• Boys Town Handouts www.babyhearing.org
g
• Beginnings www.ncbegin.org
• Baby Talk (Central Institute for the Deaf)
• Hearing Exchange www.HearingExchange.com
• John Tracy Clinic www.johntracyclinic.org
51

12/13/2010
Cottage Acquisition Scales
for Listening, Language, & Speech
(CASLLS)
Developed by Elizabeth Wilkes
Criterion-referenced scales
(Pre-Verbal; Pre-Sentence; Simple Sentence;
Complex Sentence; Sounds and Speech)
St. Gabriel’s Curriculum
For the Development of
Audition, Language, Speech, Cognition (2001
2005)
Compiled by
J. Tuohy, J. Brown, & C.
Mercer-Moseley
IEP Writer
office@stgabriels.cfc.edu.au
Compiled by
J. Tuohy, J. Brown, & C. Mercer-Moseley
52

12/13/2010
IEP Writer: St. Gabriel’s Curriculum
Examples from the Audition category:
• Indicates when hearing aids/cochlear implants/FM system
are not working
• Identifies the Ling 6 Sounds at close range
• Identifies the Ling 6 Sounds at 1, 2, 3 meters
• Selects one item by name, using toys/pictures
(Show me the dog. Get your shoes.)
• Identifies one item in the middle of a sentence
(Put the duck in the water)
• Comprehends and expresses an action sentence by
using toys/pictures (He’s climbing the ladder.)
IEP Writer: St. Gabriel’s Curriculum
Examples from the Audition category:
• Comprehends subject-verb sentences – subject
is constant
◦ The baby is eating.
◦ The baby b is crawling.
• Selects two items using toys/pictures
◦ Give me the ball and the shoe.
◦ Get your shoes and your hat.
• Comprehends sentences using props, with one
subject – one verb
◦ The boy is sleeping.
Oh Baby, Baby,
Kick Those Legs And
Hello Hands
By Mary Ann Costin, Cert. AVT
Auditory-Verbal Center, Inc.
1750 Century Circle, Suite 16
Atlanta, GA 30345
www.avc-atlanta.org
$15.00
53

12/13/2010
Learn To Talk Around the Clock:
A Professional’s Early Intervention Toolbox
By Karen Rossi
- Thematic Units
- Video
- (available from A.G. Bell)
- www.LearnToTalkAroundTheClock.com
My Baby and Me:
A Book About Teaching
Your Child To Talk
By Betsy Moog Brooks
(available from the Moog Center for Deaf Education)
MY BABY’S HEARING: Boys Town National
Research Hospital/NIDCD Handouts
• Getting Started
• Keep It Short and Simple
• Respond to Your Baby’s
Communication
• Follow Your Child’s Lead
• Talk About What Interests Your
Bb Baby
• Comments on Objects, Actions,
and Problems
• Affirm to Support Turns and
Stretch
• Everything Can Be a Toy
• What Is Its Name?
• What Does It Look Like, Feel,
and Taste Like?
• What Do I Hear?
• How Do I Feel?
• How Can I Find Out What I Want
to Know?
• How Can I Stretch My Ideas?
• Let Me Explore
• Accomplishing Daily Routines
• Play IS Learning
• HEARING & AMPLIFICATION
– Hearing Aid Choices
• HEARING & AMPLIFICATION
– Is My Baby a Candidate for
a Cochlear Implant?
54

12/13/2010
HOPE Notes
(from Cochlear Americas by Nevins & Garber)
• Auditory Skill Development • Children from Homes With Spoken
• Spoken Language Development Languages Other Than English
• Assessment Measures
• The Experienced Cochlear Implant
User: Preschool
• Performance Outcomes
• The Experienced Cochlear Implant
• The Newly Implanted Infant/ Toddler
• The Newly Implanted Preschooler
• The Newly Implanted School-Age
Child
• The Newly Implanted Teenager
• Amount and Type of Therapy
• Issues in Mainstreaming
• Issues in Reading
• Children Who Sign
User: School Aged and Teen
• Cochlear Implants and Special
Populations
• Speech Development for Children
With Cochlear Implants
• Vocabulary Development for
Children With Cochlear Implants
•Cochlear Implant Compass Cards:
Programs 1, 2, and 3
•Listening Games for Littles
(2 nd edition with CD)
David Sindrey
Books
• Educational
Audiology For
The Limited-
Hearing Infant
And Preschooler:
An Auditory-
Verbal Program D.
Pollack, D. Goldberg, & N.
Caleffe-Schenck
55

12/13/2010
Books
We CAN Hear And Speak!
The Power Of Auditory-
Verbal Communication For
Children Who Are Deaf Or
Hard Of Hearing
www.nciohio.com
Parents & Families of Natural
Communication, Inc.
goldbed@ccf.org
&
dgoldberg@woosteredu
dgoldberg@wooster.edu
56