If You Could Hear What I Hea

If I Could Hear What You Hear
19 July 2013 * LSLS
Project TALK
specialists in pediatric hearing
Project TALK
2210 Encinitas Boulevard
Suite O
Encinitas, CA 92024
Phone: (760) 634-1553
FAX: (760) 634-1660
www.ProjectTALK.org
Coming to grips with the basics
Jane Madell Lecture - 2002
— Power of speech
perception testing
— Use of frequency
bands for specific
phonemes to improve
speech perception
Advanced Bionics Workshop - 2003
— Introduction to the
idea of MAPping to
live voice
— Use of phoneme
frequency allocation
charts
Trial by fire - 2003
— 2 ½ yr old congenitally
—
—
—
—
—
deaf child
Implanted at 18 months
No language developing
3 yr old congenitally
deaf child
Implanted at 18 months
No language developing
Our BIG questions
— What information do we need to ensure
children are hearing optimally?
— How do we reliably obtain that information
from children?
What does technology tell us about hearing?
— Real ear measures and CI MAPping do NOT tell what
the child is hearing!
Real ear only tells what is reaching the eardrum.
¡ CI MAPs/NRT only tell how much electrical stimulation
is being provided.
¡ Real ear and CI MAPs tell nothing about what the
auditory brain hears!!
¡
If HA and CI programs do not tell us
what a child hears, then what does?
— Children provide us with accurate and reliable
information about what they hear:
When we observe and understand their behaviors
¡ When we listen to what they say and how they say it
¡ When they complete detailed audiological testing
with an experienced pediatric audiologist
¡ When parents, interventionists, teachers, family
members, and friends are considered essential
sources of information
¡
BUT, how do we obtain
accurate and reliable information from
children with multiple disabilities?
Think INSIDE the Box!!!
How do we think inside the box?
— Apply appropriate developmental practices
— Understand the child’s auditory behaviors
— Utilize detailed evaluations of speech perception
— Capitalize on the child’s individual preferences
— Consider receptive language separately from
expressive language
— Consistently record the data
Apply Appropriate Developmental Practices
— Evaluate the child’s developmental level, not
chronological (or even hearing) age
¡
Gather information from parents prior to child’s visit
÷ “Does
your child have any other health issues in addition
to hearing loss?”
If appropriate, gather information from other
professionals prior to child’s visit
¡ Have parents complete a detailed case history
¡
Sample Case History Questions
— Age of sitting? Crawling? Walking?
— Eating habits?
— Sleeping habits? Bedtime? Time awakens? Naps?
— Child’s temperament?
— Restless or overactive?
— Behavior problems encountered?
— Method of discipline?
— Biggest frustration in communicating with child?
Sample Case History Questions
— Educational programs enrolled in?
— Areas child appears advanced?
— Areas child appears delayed?
— Services for other areas of development?
— Specific concerns about development?
— Play interests?
— Play with peers?
— Communication with peers?
Apply Appropriate Developmental Practices
— Structure the setting for the developmental age
— Create a child-friendly, not clinical atmosphere
— Minimize visual (and auditory) distractions
— Carefully consider the amount of structure
needed for child to attend to tasks
Apply Appropriate Developmental Practices
— Stokke Tripp Trap High Chair – 877-978-6553 –
www.stokkeusa.com
Understand the Child’s Auditory Behaviors
— Child:
¡ Is not bonded with HAs or CIs
¡ Refuses to wear HAs or CIs
¡ Has involuntary eye blink or facial stim with HAs or CIs
¡ Has hypersensitivity to sound
¡ Consistently removes HAs or CIs
¡ Turns up volume and/or sensitivity of CIs
¡ Does not respond or turn to close and/or distant sound
¡ Appears to be very distracted auditorily
¡ Appears withdrawn
Utilize Detailed Evaluations of
Speech Perception
— Speech perception, not sound perception
— What is the earliest developing skill which provides
significant information about the quality of a child’s
speech perception?
Utilize Detailed Evaluations of
Speech Perception
— Teach speech imitation games!
— Most basic imitation games:
Animal with animal sounds
¡ Silly, but expressive sounds
¡
÷ Aaaaaaa
choooooo
÷ Limit sounds with significant body movement
¡
Coloring game with crayons
÷ Movement
reflects the sound
Utilize Detailed Evaluations of
Speech Perception
— Imitation on demand games:
¡ Evaluate imitation of all phonemes (not limited to Ling 6)
¡ Initially use repeated syllables
¡ Move to single syllables
÷ Iowa Medial Consonant Test
÷ Individual phonemes
¡ Generalize the games to single words and sentences for
additional speech perception testing
¡ Transfer techniques to audiological speech perception
testing
Imitation on Demand
— Remember:
Visual input must be eliminated for an accurate
evaluation of speech perception.
¡ For children, it’s all about the toys!!
¡ For you, it’s all about fully engaging the child in the toy
to obtain a natural evaluation of speech perception.
¡ Toy must have sufficient number of pieces to provide a
length of engagement.
¡ Changing the toy makes the task seem new to the child
so change as often as needed.
¡
Toys for Imitation on Demand:
Developmental Age: 1 to 2 years
Toys for Imitation on Demand:
Developmental Age: 1.6 to 3 years
Toys for Imitation on Demand:
Adaptable Developmental Age: 1.6 to 5 years
Toys for Imitation on Demand:
Adaptable Developmental Age: 3 to 8 years
Toys for Imitation on Demand:
Adaptable Developmental Age: 5 years +
Capitalize on the Child’s
Individual Preferences
— Ask parents about the child’s interests
— Incorporate the interests with your toys
— Examples:
Plastic food for 3 yr old child with Down Syndrome
¡ Plastic animals (and snakes) for 3 yr old child diagnosed
with malnutrition, failure to thrive, and autism spectrum
disorder
¡
Consider Receptive Language Separately
from Expressive Language
— In our practice, ALL of our patients who have
appropriately fitted technology and auditory/oral
input develop oral receptive language.
— However, the receptive language of our patients with
multiple disabilities is affected by:
Level of cognitive functioning
¡ Processing time
¡ Intense interests
¡
Consider Receptive Language Separately
from Expressive Language
— In our practice, our patients with multiple
disabilities (who have appropriately fitted
technology) use a variety of different forms of
expressive language.
— Do not forget that receptive language development
always precedes expressive language development.
— Expressive language is affected by:
Level of cognitive functioning
¡ Processing time
¡ Intense interests
¡ Oral motor development
¡ Fine and gross motor development
¡
Consider Receptive Language Separately
from Expressive Language
— Forms of expressive language used by our patients
with multiple disabilities:
Facial expressions, gestures, vocalizations
¡ Sign language
¡ Combination sign / spoken language
¡ AAC (Proloquo2Go)
¡ Written language
¡ PECS to WECS to Proloquo2Go to spoken language
¡
— Aim should be moving toward oral expressive
language
Consistently Record the Data
— Records should include:
Modifications made for developmental age
¡ Factors which potentially affect child’s behavior
¡ Detailed results of child’s phoneme and word perception
¡ Toys / techniques which were motivating to child
¡ Specific examples of development in receptive language
¡ Successful techniques for generating expressive language
¡
Help others think inside the box!
Share your findings!
— Provide data to others, especially audiologists and
others who do not see the child as often.
Behaviors observed
¡ Phoneme perception errors
¡ Word perception errors
¡
— Confirm that your findings are consistent with
those obtained by parents and other
professionals.
Share your successes!
— If you have success, share--in detail--the factors
which elicited the success.
Specific structure?
¡ Specific toy?
¡ Specific modification?
¡
— Demonstrate the success techniques for others.
— Invite others to observe.
— Accompany the child to other appointments (such
as audiology).
Share your successes!
— If others report gains you are not seeing, obtain--
in detail--the factors they used to elicit success.
Specific
¡ Specific
¡ Specific
¡ Specific
¡
structure?
time of day?
toy?
modification?
— Observe the child with the parents or
professionals reporting the successes.
— If your expectations are too low, do not hesitate
to readjust them.
Summary
— Children with multiple disabilities can provide
reliable information about what they hear if we:
Create an appropriately structured and engaging
setting.
¡ Utilize developmentally appropriate toys.
¡ Assess as wide a range of speech perception as
possible.
¡ Facilitate receptive and expressive language
development.
¡ Consistently collaborate with other professionals.
¡
Toy Resources
— 1 to 2 yrs:
Melissa and Doug Colorful stacking blocks
¡ Haba jumbo peg board
¡ Connect Four
¡ Shapes all around us puzzle
¡
— 1.6 to 3 yrs:
Wedgits
¡ Melissa and Doug Sort and snap
¡ Haba large shape sorter board
¡ Colorforms
¡
Toy Resources
— Adaptable 1.6 to 5 yrs:
Fischer Price Barnyard bingo
¡ Duplo train
¡
— Adaptable 3 to 8 yrs:
Super sorting pie
¡ Pacific Kid Story boards
¡ Batik
¡ Zingo
¡
Toy Resources
— Adaptable 5 yrs +:
Blokus
¡ Pajaggle
¡ Perfection
¡ Pipeline
¡