Innovative Tools and Technology to use during Aural Rehabilitation Therapy Jodi Creighton, M.S.,CCC-A,LSLS Cert. AVT Cincinnati Children s Hospital Medical Center As one parent I know said, You are not eased into the world of hearing loss, you are thrown into it head first when your child is diagnosed. For many people, it is quite overwhelming. But it is also a critical time for decisionmaking. The best thing you can do for your child, yourself and your family is to learn as much as you can. Be informed. Don't rely on the professionals to tell you how to educate your child. Have high goals and expectations. Your outlook can and will have a direct impact on the life of your child. (Paula Rosenthal) What is the Aural Rehabilitation Program at CCHMC? It is a comprehensive program for children with hearing impairments and their families, which emphasizes the child s useable hearing through the appropriate amplification device. Activities are designed to teach the parent how to develop auditory skills and create the optimum listening environment for their child. The main objective is to enhance listening skills by progressing through an auditory skills hierarchy. This goal is intended to enable the child to function to his/her maximum auditory potential. Speech/Language Pathology Program at CCHMC The SLP works with the families to establish an early communication system (i.e., verbal, gestural, alternative) Pre-linguistic skills, speech production, vocabulary and language skills are targeted. As the child progresses in communication development, the parents and SLP decide together what mode of communication appears to be most appropriate. Aural Rehabilitation (AR) Therapy Parent based program 80% attendance Appropriate amplification Weekly progress reports Weekly progress reports Diagnostic testing 1
An AR Audiologist should: support prompt medical and audiologic management, including selection, modification, and maintenance of appropriate amplification provide individualized sessions with active parent participation help children integrate LISTENING into their development of communication and social skills use a hierarchy of listening skills An AR Audiologist should: continuously assess and evaluate the child s auditory development maintain adequate records of professional services rendered be a team player interacting with other professionals make ongoing evaluations and prognosis of the development of listening skills an integral part of the rehabilitation process Detection the ability to determine the presence or absence of sound Dropping a block in a bucket or putting a peg in a pegboard only when sound is present Raising i your hand when you detect t a sound The Ling Six Sound Test (m,ah,oo,ee,sh,s) can be used as speech stimuli Discrimination the ability to distinguish the difference between sounds Being able to tell if two words are different Being able to distinguish your name versus other names Identification the ability to listen to a word or phrase and point to the object or picture requested The words such as ball, apple, cup, shoe, bear, dog, and cat are frequently used words in the child s everyday environment Comprehension the ability to understand what is being said Following one step directions ( open the door ) and two step directions ( Go get your shoes and your coat. ) Answering questions in closed or open set task Adapted from Erber, N. (1982) 2
Factors Affecting the Development of Communication Skills etiology/age of deafness attend speech-language and/or aural rehabilitation therapies age at implantation family involvement cognitive status consistent device use Auditory Skills Checklist (ASC) The ASC was developed to track auditory skills development in children with hearing impairments at CCHMC. The checklist evaluates children s responses to sound stimuli over a continuum from detection to comprehension (Erber, 1982). ASC The checklist is currently used to monitor progress for individual children enrolled in AR therapy. The child s skill level is compared to his/her previous skill level rather than using standardized measures based on other children s performance. The ASC is administered: at an initial evaluation to gain baseline information regarding a child s current auditory skills at intervals to monitor a child s progress and attainment of therapy goals usually at 3 month intervals, but can be given more frequently if there are concerns about a loss of skills or progression of hearing loss Administration & Scoring of the ASC The method to obtain information can be by history (H) elicited by parent report to by direct observation (O) by the therapist. Each question has an answer characterized as D (does not have the skill), E (emerging skill), and S (has skill) with the potential of 0,1,2 points respectively. 3
ASC Skills Detection wear the amplification device during waking hours? uses body language to indicate when something is heard? (ex. turns head, and/or eye widening, quiets, stops action, changes facial expressions) shows awareness of loud environmental sounds? shows awareness of soft environmental sounds? ASC Skills Detection shows awareness of voices? detects the Ling Six Sounds? detects the speaker s voice when background noise is present? search to find where a sound is coming from? localize to the correct sound source? ASC Skills Discrimination notice a difference or respond differently between someone talking vs. a common environmental sound? notice a difference or respond differently between different environmental sounds? notice a difference or respond differently between a speaker using a soft voice ( a whisper) and a speaker using a loud voice (above conversational range)? ASC Skills Discrimination notice the difference (discriminate) between a person singing from a person having a conversation? notice the difference between family members voices? notice the difference between minimal pair words (similar sounding words such as pat, bat, and mat)? Similar sounding phrases/sentences? ASC Skills Identification identify if the speaker is happy, angry, or surprised by the change in vocal tones? respond to his or her name when called? identify an object or item with an associated sound d( (a train goes choo choo, a dog goes woof woof, a cat goes meow? Identify one syllable word versus a two syllable word versus a three syllable word? ASC Skills Identification identify or recognize words used in the child s natural environment (these words may vary with age and exposure)? identify the Ling Six Sounds? Identify familiar songs (ex. Happy Birthday, Itsy Bitsy Spider, Old McDonald )? 4
ASC Skills Comprehension understand frequently heard phrases/sentences (ex. It s time for bed. and Brush your teeth and get ready for bed. )? follow one step directions (Get your shoes.)? follow two step directions (Get your shoes and open the door.)? follow three step directions (Get your shoes, open the door, and walk outside.)? ASC Skills Comprehension have an auditory memory phrases/sentences (ex. I see the dog or The girl jumped over the fence to get the ball. )? have an auditory memory for items? auditorily sequence events of a story? understand WH question forms in phrases and sentences? ASC Skills Comprehension understand concepts in phrases and sentences? understand the use of negatives in phrases and sentences? obtain information incidentally through audition/hearing alone? through audition/hearing alone, understand most of what is said? My World understanding of a child s hearing loss from their point of view The child becomes their own advocate. The tool includes three environment boards, moveable figures, and everyday objects that the child can use to describe their environment. The tablet version Parents and professionals glean a better understanding of the child s everyday interactions. My World - continued Session Documentation Form 1. What did you learn about the child? 2. How does the child manage communication at: school, home, and other 3. Provide some examples of effective strategies used and some challenges to be addressed. 4. What goals did you agree upon? Video of a child using My World 5
Why use Apps in therapy? Apps are highly motivated for children and adults Interaction with apps are rich in tactile experiences Apps are portable. Apps need to be used as a supplement in therapy and not as the main focus. Turn taking When apps consider the following: Can voices be recorded? Try the app first before using in therapy. How flexible is the app? Background music and other sound effects that play continuously while the app is being used. Ability to manipulate the timing of the action in the app Apps that have been beneficial in AR therapy My Play Home Hope Words Old MacDonald Rule the School apps Peekaboo Little Finder I Like Books Little Explorers ABC ABC Music ABC Go ABC Wildlife ABC Play Popple notion Apps continued Learning through listening needs to reflect a team approach which honors the unique personalities of each child, family, and expectations of the family s everyday environment. Speech Pathology Social Work Occupational Therapy Clinical Aural Audiology Rehabilitatio n Parents Physical Therapy 6
The AR Audiologist will need to listen to the child and family just as the child learns to listen to others. 7