Audiologic Rehabilitation for Children

• Differ according to type of hearing loss and when the loss was identified.

• Differs according to age groups (preschool, school-age)

Rehabilitation Settings and Providers

WHAT IS A COCHLEAR IMPLANT?

• Electronic prosthetic device• Surgically implanted in the scali

tympani of the cochlea• Bypasses damaged hair cells in the

cochlea• Electronically stimulates auditory

neural elements that do not respond to acoustic stimulation with hearing aids

BASIC COMPONENTS • External Microphone• Speech Processor• Battery Component• Coil/transmitter• Receiver/Stimulator• Magnet for Retention• Implanted Electrode array

HOW DOES IT WORK?• External microphone converts

incoming sound into electrical signal

• Speech processor converts electrical signal into a digital code (speech processing strategy)

• Signal is transmitted across the skin

HOW DOES IT WORK?• Implanted cochlear stimulator receives the

coded signal and delivers it to the electrode array

• Electrodes stimulate cochlear neurons• Bypasses damaged hair cells• Nerve impulses are sent along the

auditory pathways to the cerebral cortex• Allows the brain to perceive sound

MAPPING• Term utilized for programming external

device• Occurs approximately 4 weeks after surgery• Laptop computer utilized• Objective measures utilized• Progressive maps• Plateau/stabilization• Regular maintenance schedule

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A A

CI CI CI CICI

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NR NR NR

FREQUENCY IN HERTZ (Hz)

PREDICTIVE FACTORS• Medical conditions• Communication strategies• Language development• Mode of education• Family support/dynamics• Developmental delay• Adolescents – poorer prognosis• Variability exists

TEAM APPROACH• Surgeon• Audiologist• Auditory Verbal Therapist• Speech/Language Pathologist• Nurse/O.R. Staff• Educator• Early Interventionist• Coordinator/Case Manager• Administrative

Yes! SLPs Need to Know• Pre-CI

Audiograms are Important

• Always get most the most updated audiogram!!!

Communication, Communication, Communication

• You and the audiologist will work together to get the best program for your client.

• You can help with ease of programming and adjustment to new programs with young children.

• You provide valuable information to the audiologist about your client’s functional use of his/her implant.

Adjusting to the Cochlear Implant

• You are usually on the “front line”.• Advising parents about saturation.• Talk about realistic expectations.• You provide lots of encouragement and

education!!! – Pointing out the gains in auditory skills that

you see.– Letting them know what is typical “tolerance

issues”.

Remember!!!!

Every client is different and comes to you will a diverse

background (language, social environment, hearing,

personality, family).

Keep in mind that a your client’s ability to receive the sounds of speech is only the

first step…….

Why do we address auditory skills in therapy?

• In both children and adults, we use it to fully develop their use of available sounds.

• In children, effective listening becomes their foundation for the development of spoken language.

Auditory Skills? You need to know where your client’s

auditory skills fall in the hierarchy.Each therapy session will be diagnostic in

nature.

Basic Stages of Auditory Development

ComprehensionIdentification

DiscriminationDetection

DetectionThe awareness of whether a sound is

present or not

Detection activities should be…

MotivatingSimple and quickAge appropriateVaried

• Also work on generalizing auditory attention.• Must be established as a foundation for

learning to listen• Timers• Name calling• Eventually the child will alert to

environmental sounds and speech without cues

Auditory Attention

• Should be…– Motivating– Simple and quick– Age appropriate– VariedActivity SuggestionsBalls, puzzles, mechanical banks, stacking toys,

peg boards, black towers, beanbag or ball toss, stringing beads, letters in a mailbox…..

Detection: Conditioned Response Activities

Discrimination• Distinguishing differences

between sounds• The listener's ability to tell

whether two sounds are the same or different.

Keep in mind the Acoustic Contrasts within the Discrimination Task

From Easiest to Most DifficultSuprasegmentals Syllable LengthVowel Differences (bat, bet, boot) Manner of Production Differences

(t vs. sh)Voicing Differences ( p vs. b)Place of Production Differences (k

vs. t)

IdentificationA person's ability to

recognize a sound and then label it

Comprehension• A person’s ability to understand

the meaning of the spoken message

• This level requires that the person have a certain degree of semantic and syntactic language development

• Also work on generalizing auditory attention.• Must be established as a foundation for

learning to listen• Timers• Name calling• Eventually the child will alert to

environmental sounds and speech without cues

Auditory Attention

Always keep in mind the variables that affect how challenging a therapy task is for your client.

What is your Listening Set?

ClosedBridgeOpen

What are the contents of your set?

Keep in mind….• The familiarity of the vocabulary• How the items acoustically contrast each other• The number of key words being used and where

they are place• The linguistic complexity of what you are

presenting

How are you presenting the stimulus items?

• What is your rate of speech? • Are you using acoustic highlighting?• Is there background noise?

Ling 6 SoundsWhat are they?

Why do I need to use them?When do I use them?

Ling 6 Sound TestOO EE AH

S SH MM

Also….absence of sound

• These are used to teach the skill of listening to the younger child

• They differ greatly in terms of duration, intensity and pitch.

Sound-Word Associations

• Many of these associations are commonly used in traditional, early language therapy

• Once the child learns the associated sound then the true word is given

Sound-Word Associations

• Auditory Information• Visual Clarifier• Auditory Information

Transitioning Between Visual and Auditory

• These are used to teach the skill of listening to the younger child

• They differ greatly in terms of duration, intensity and pitch

• Many of these associations are commonly used in traditional, early language therapy

• Once the child learns the associated sound then the true word is given

Sound-Word Associations

Some Examples of Sound-Word Associations

Up, up, up, weeee Mooooo

Ahhhhhhhhh(rising and falling intonation)

Listening for Littles,1997

• Imitation is not identification• Closed versus open set

– Complex closed sets may be easier than single word in a open set

– A “bridge set” may be used to connect between closed versus open sets

– Content and presentation determine the level of challenge

Keep in mind…….

• Acoustically highlight the key word

• Model a similar question with another person

• Use familiar information and vocabulary to introduce word

• Use descriptions

When they don’t get it the first time….

• Instructions on assembly provided

• Materials needed– Embroidery hoop– Stereo speaker cloth

Listening Hoop

Lots of great stuff is on the internet now!!!!!!

Therapy MaterialsFree On-line Training

Therapy Materials and Ideas