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Aural Rehab SLP401

Prevalence of Loss 10 - 40 in every 1,000 children - bilateral, greater than 20 dB HL hearing loss. 1 in 1000 deaf.
Prevalence (Contd) 1–2 million school-age children are HH. Add 3–5 million min HL (15 dB or worse), unilateral HL and high-frequency HL. Add 1 – 2 million: conductive HL. Total: 10 million children in the US with HL.
Who is more likely to receive AR services? HH or Severe/Profound HL? 27% of mild HL were receiving services as compared to ~92% for severe HLs (Iowa reports)
Evidence Base Newborn screening: OAE, Aud. brainstem response. Early ID improves outcomes, but results in greater shock to parents (no chance to observe problems). Some mild HL may still squeak by the 30dB screening min.
NIDCD (subdiv of NIH) multi-site, longitudinal study 300 children with HL vs. 100 normal hearing children. Assessment factors: Audiological, S/L, Psychosocial, Academic, Family (ongoing).
NAL (Australia) 328 children with HAs, and 149 CIs (66 bilateral). 16% - mild HL; 35% moderate; 20% severe; 29% profound. Effects of provision of early access to interventions and multiple factors that influence outcomes for individual children
NIDCD CI study Data from 6 sites. Expand the evidence base that guides the management of children with HL
Habilitation vs Rehabilitation Never had hearing vs. replacement of info due to gradual loss.
Profile of the Client -Hearing Loss -Age -Other Disabling Conditions
Hearing Loss age Congenital, Prelingual, Peri-lingual, Postlingual (Even mild losses can have an educational impact
Hearing Loss type Conductive, Sensorineural, Mixed
Hearing Loss Permanent, Transient
Client Age Divisions: 0-5 (0-3, 3-5) (EI). 5-18 (IEP), 18+ (transition progs)
Other Disabling Conditions Estimated 40% other conditions. 30-50% another estimate Impact - multidisciplinary approach
Rehabilitation Settings Home. Preschool. School. Transition or Vocational Programs.
Rehabilitation Providers Differ from setting to setting.
Identification and Assessment Procedures with Children Early Identification. School Screening. Medical and Audiologic Assessment.
Risk factors Caregiver concerns. Fam history. 5+ days NIC/ototaoxic drugs. In utero infections. Craniofacial anomalies. HL associated syndromes. Postnatal infections. Trauma/chemo.
Assessment before AR 1. medical examination (ear infections common), 2. audiologic evaluation
Later assessment 1.Degree and configuration of HL 2.Type of HL and cause 3.Speech recognition ability 4.Threshold of discomfort 5.Hearing aid performance (verification) and audibility measures
Frequency of audiologic assessments 1.Birth to 3 years: 3 month intervals 2.Preschool years: 6 month intervals 3.School-age: every year
Rehabilitation Assessment (EI for parent-infant and preschool) -Communication and developmental status -Overall family and child participation variables -Related personal factors - Environmental coordination
Rehabilitation Management (EI for parent-infant and preschool) IFSP-based (family-centered, rather than child-centered). Developed based on the assmt info. Parent as a partner in the rehabilitation process.
Rationale for shift from child-centered therapy to family-based Diapering, feeding, playing – 2000 hours before 1st birthday. ~36,000 learning opportunities at home between 1 and 2. AR specialist cannot have major impact
Family-Centered Practice
Family-Centered Practice
Home-based intervention
Home-based EI (3 relationships) 1.Parent-child – most important 2.Parents and AR provider – balanced partnership 3.Child and AR provider – secondary to parent relationship and includes observation of the child to determine to guide the next steps
Specialized knowledge and skills of AR specialist (Science) -Infant dev. -HL impact on dev. -Communication, aud., speech, lang. -Communication approaches. -Amplification tech. -relationship of listening & speech dev. -Asst tech. -Appropriate dev. expectations. -Infant/family asset skills
Specialized knowledge and skills of AR specialist (Art) -Atmosphere of trust -Active listing -Responds to feelings -Effective pacing -Handles ambiguity/contradiction -Nonjudgemental -Understands grief/adjustment -Encourage self-direction -Prioritizes needs -Accept parent feedback on infant -Adapts
EI or Preschool AR Clinician Roles (6) 1.Information Provider 2.Coach / Partner 3.Discoverer 4.News Commentator 5.Partner in Play 6.Joint Reflector
Information Provider Adapt to the learning needs of individual families and provide information in objective ways – help parents to become independent advocates and learners.
Coach / Partner Shifts the focus from expert-driven ideas to “learner- focused”. Clinician provides guidance or tips that support the integration of skills by the paren
Joint Discoverer -Key ingredient in a partnership process -Families learn that any question can be addressed as an experiment -Both parties become skilled observers of the infant’s behaviors and what works to promote success
News Commentator -Promote partnership and base decisions on what works. -Objective, descriptive feedback. -Point out what is working well. Help families learn observation strategies to figure out what works. -Practice compassion instead of correction.
Partner in Play Demonstrate a strategy or a new skill for parents
Joint Reflector and Planner Work together to list key observations and successes from the previous session Helps to set the agenda for the next session
Auditory Learning and Development with HA or CI -embed listening lessons in natural communication. -meaningful, frequent opportunities that require reliance on and use of residual hearing.
Cole and Flexor (2011): Phase I becoming aware of sound Alerting, lateralizing, localizing, sustaining attention, demonstrating a learned response
Cole and Flexor (2011): Phase II connect sounds with meaning Child learns to respond in a meaningful way to sound Babbling, engaging in vocal turn taking, smiling when spoken to
Cole and Flexor (2011): Phase III Establish sound-meaning associations: -Sound/toy associations -Sound/event associations (uh-oh) -Variety of word and phrase identification -Increasingly imitate target words and phrases w audition alone -Simple directions, questions
Cole and Flexor (2011): Phase IV Recognizing and comprehending expressions through audition alone Responding to a familiar language at a distance Following complex directions Answering a variety of questions Answering questions after listening to a story
Auditory Skill Development Koch (1999): I Auditory Attention – spontaneously alert to the presence of sound – are HAs/CIs working?
Koch (1999): II Perception/Production – actively listening and imitating the spoken model
Koch (1999):III Sound/Object Association – closed set listening tasks – use of visual cues; # of choices
Koch (1999):IV Language and Listening Association – incorporating listening skills in the child’s natural environment
Preschool Management Techniques: -stimulate thinking -problem solving -active learning. Encourage mastery of question-answer routines("Why?"), because this aspect of language supports them in making discoveries about the world.
School Years: Rehabilitation Assessment: IEP Meeting -Communication and developmental status -Overall family and child participation variables -Related personal factors -Environmental coordination
School Years: Management -Amplification, CI, or FM systems -Children benefit from: Regular monitoring; Encouragement to wear devices during waking hours; Opportunities to listen
School Years: Management -Child Learning Environment (Classroom Management) -Foster Social Skills -Hearing Conservation -Self-Advocacy
School Years: Management Resources 1.Listening and Spoken Language Knowledge Center – AGB Association (quick cards to give to teachers) 2. (Oticon HAs) ELF
School Years: Management overview (5) 1.Evaluation of abilities/needs 2.functional classroom learning emphasis 3.opps for world knowledge & vocabulary 4.opps for self-expression/narratives 5.opps for verbal reasoning of study skills
Classroom considerations -Personal vs. sound field systems -Reverberation time -Background noise (Typical classrm=60-65dB; Cafeteria= 70-90 dB; gym=45dB; Goal=30-35dB).
Created by: ashea01



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