Aural Rehab SLP401
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| Prevalence of Loss | 10 - 40 in every 1,000 children - bilateral, greater than 20 dB HL hearing loss. 1 in 1000 deaf.
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| 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.
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| 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)
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| 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.
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| 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).
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| 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
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| NIDCD CI study | Data from 6 sites. Expand the evidence base that guides the management of children with HL
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| Habilitation vs Rehabilitation | Never had hearing vs. replacement of info due to gradual loss.
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| Profile of the Client | -Hearing Loss -Age -Other Disabling Conditions
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| Hearing Loss age | Congenital, Prelingual, Peri-lingual, Postlingual (Even mild losses can have an educational impact
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| Hearing Loss type | Conductive, Sensorineural, Mixed
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| Hearing Loss | Permanent, Transient
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| Client Age | Divisions: 0-5 (0-3, 3-5) (EI). 5-18 (IEP), 18+ (transition progs)
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| Other Disabling Conditions | Estimated 40% other conditions. 30-50% another estimate Impact - multidisciplinary approach
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| Rehabilitation Settings | Home. Preschool. School. Transition or Vocational Programs.
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| Rehabilitation Providers | Differ from setting to setting.
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| Identification and Assessment Procedures with Children | Early Identification. School Screening. Medical and Audiologic Assessment.
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| Risk factors | Caregiver concerns. Fam history. 5+ days NIC/ototaoxic drugs. In utero infections. Craniofacial anomalies. HL associated syndromes. Postnatal infections. Trauma/chemo.
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| Assessment before AR | 1. medical examination (ear infections common), 2. audiologic evaluation
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| 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
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| Frequency of audiologic assessments | 1.Birth to 3 years: 3 month intervals 2.Preschool years: 6 month intervals 3.School-age: every year
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| Rehabilitation Assessment (EI for parent-infant and preschool) | -Communication and developmental status -Overall family and child participation variables -Related personal factors - Environmental coordination
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| 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.
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| 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
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| Family-Centered Practice |
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| Family-Centered Practice |
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| Home-based intervention |
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| 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
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| Specialized knowledge and skills of AR specialist (Science) | -Infant dev. -fam.systems. -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
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| 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
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| 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
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| Information Provider | Adapt to the learning needs of individual families and provide information in objective ways – help parents to become independent advocates and learners.
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| 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
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| 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
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| 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.
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| Partner in Play | Demonstrate a strategy or a new skill for parents
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| 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
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| 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.
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| Cole and Flexor (2011): Phase I | becoming aware of sound Alerting, lateralizing, localizing, sustaining attention, demonstrating a learned response
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| 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
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| 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
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| 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
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| Auditory Skill Development Koch (1999): I | Auditory Attention – spontaneously alert to the presence of sound – are HAs/CIs working?
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| Koch (1999): II | Perception/Production – actively listening and imitating the spoken model
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| Koch (1999):III | Sound/Object Association – closed set listening tasks – use of visual cues; # of choices
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| Koch (1999):IV | Language and Listening Association – incorporating listening skills in the child’s natural environment
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| 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.
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| School Years: Rehabilitation Assessment: IEP Meeting | -Communication and developmental status -Overall family and child participation variables -Related personal factors -Environmental coordination
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| School Years: Management | -Amplification, CI, or FM systems -Children benefit from: Regular monitoring; Encouragement to wear devices during waking hours; Opportunities to listen
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| School Years: Management | -Child Learning Environment (Classroom Management) -Foster Social Skills -Hearing Conservation -Self-Advocacy
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| School Years: Management Resources | 1.Listening and Spoken Language Knowledge Center – AGB Association (quick cards to give to teachers) 2. successforkidswithhearingloss.com (Oticon HAs) ELF
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| 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 5.dev of study skills
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| Classroom considerations | -Personal vs. sound field systems -Reverberation time -Background noise (Typical classrm=60-65dB; Cafeteria= 70-90 dB; gym=45dB; Goal=30-35dB).
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