HEARING DISORDERS

DR. ASHOK KUMAR SINHA

DIRECTOR

ALI YAVAR JUNG NATIONAL INSTITUTE OF SPEECH AND

HEARING DISABILITIES MUMBAI

THE RIGHTS OF PERSONS WITH DISABILITIES ACT, 2016

•  2016: WINTER SESSION

•  MSJE: 19.4.17

•  RULES : 15.6.17

•  GUIDELINES: 05.1. 18

•  21 CATEGORIES

A : LOCOMOTOR DISABILITY

•  LEPROSY CURED/ CEREBRAL PALSY

•  DWARFISM/ MUSCULAR DYSTROPHY

•  ACID ATTACK VICTIM

B: VISUAL IMPAIRMENT

•  BLINDNESS/ LOW VISION

1. PHYSICAL DISABILITY

C. HEARING IMPAIRMENT

•  DEAF/ HOH

D: SPEECH AND LANGUAGE DISABILITY •  LARYNGECTOMY / APHASIA

RPWD ACT, 2016

2. INTELLECTUAL DISABILITY

•  SPECIFIC LEARNING DISABILITY,

•  AUTISM SPECTRUM DISORDERS

3. MENTAL BEHAVIOUR: MENTAL ILLNESS

RPWD ACT, 2016

4. CHRONIC NEUROLOGICAL CONDITIONS

•  MULTIPLE SCLEROSIS •  PARKINSON'S DISEASE

BLOOD DISORDERS •  HAEMOPHILIA/ THALASSEMIA •  SICKLE DISEASE

5. MULTIPLE DISABILITIES : DB

6. ANY OTHER

RPWD ACT, 2016

LEARNING TO SPEAK

n  DYNAMIC PROCESS

n  PREREQUISITE: WITHIN CHILD

n  ENVIRONMENTAL FACTOR

n  VOCAL PLAY/ FIRST WORD

n  ADULT-LIKE SPEECH: 5 YEARS

EAR

COCHLEA

AUDITORY NERVE

AUDIOLOGY

n  CONDUCTIVE/ SENSORINEURAL

n  MIXED/ RETROCHLEAR PATHOLOGIES: CAPD/ AN

n  MALINGERING

n  BALANCE DISORDERS/ TINNITUS

DIAGNOSIS

n  SUBJECTIVE:

n  TUNING FORK/ DISTANCE

n  PURETONE/ NOSIE/ SPEECH

n  OBJECTIVE:

n  IMMETANCE/ ABR/ ASSR/ OAE

GOLDEN TEST

AUDIOMETER

IMMITTANCE AUDIOMETERS

INSTRUMENTATION

NORMAL TYMPANOGRAM

ABR/ ASSR

OAE

IMPACT

o  LANGUAGE AND SPEECH DEVELOPMENT

o  EDUCATION/SOCIAL AND EMOTIONAL

o  VOCATIONAL

o  FUNCTION BELOW POTENTIALS

ELIMINATION OF COMMUNICATION BARRIER

n  RULE 1 - 3 - 6

n  AUTOMATED

n  UHSP

n  INTERVENTION

n  SUCCESS

MANAGEMENT

n  PERSONAL HEARING AIDS

n  COCHLEAR IMPLANTS

n  ASSITIVE LISTENING DEVICES

n  CLASSROOM DEVICES

n  SIGN LANGUAGE

PHA

n  BODY WORN HEARING AIDS/ MOULDS

n  BTE/ ITC/ CIC/ RIC

n  CROS

n  DIGITAL

n  PROGRAMMABLE/ TRIMMER

ADIP n  BWHA

n  BTE

n  < 15000/ PER MONTH

n  DISABILITY CERTIFICATE

n  125000 PER ANNUM

GWR

COCHLEAR IMPLANTS

n  1980: SURGICAL PROCEDURE

n  SINGLE ELECTRODE

n  FOR ADULTS ONLY

n  CHILDREN BELOW ONE YEAR

n  ONLY FOUR MANUFACTURES

INTERNAL DEVICE

n  Casing of the receiver: titanium/ceramic

n  Length and structure of electrode array/ current flow: 25mm/Bipolar

n  Channels: 12-22

n  Dimensions :30mm

n  Weight:10g/ Frequency band:63

n  Speed of stimulation: 24000 pps

EXTERNAL COMPONENT

•  MICROPHONE

•  SPEECH PROCESSOR: Sp. Coding

Strategies(formants/compressed

analog/neural firing

•  CONNECTING CABLES

•  TRANSMITTER COIL

COST

n  PRE OPERATIVE: ASSESSMENT

n  COCHLEAR IMPLANT

n  MEDICAL AND SURGICAL

n  POST OPERATIVE REHABILITATION

n  MAINTENANCE

PRESENT STATUS

•  PRIVATE

•  SPONSORED

•  STATE GOVERNMENT

•  DEFENCE

•  MSJE-DEPwD- ADIP

ADIP

n  NODAL AGENCY

n  TARGET: 500/ 1000

n  ASSISTANCE: 6.00 LAKHS/ CHILD

n  PRE AND POST INTERVENTION

n  CI PROCUREMENT: ALIMCO

CANDIDACY

n  BILATERAL SEVERE TO PROFOUND

n  UPTO 5 YEARS

n  NO ASSOCIATED DEVELOPMENTAL DELAYS

n  NO MENTAL RETARDATION/ UNILATERAL IMPLANTATION

LAUNCH

n  3RD DECEMBER 2014

n  ASHOK D RANSHUR : 2.1 Yrs / Male

n  BYL NAIR HOSPITAL, MUMBAI

HospitalsEmpanelledforCochlearImplantSurgery

Telangana

ADIP CI

n  172 HOSPITALS

n  FIVE ZONES/ 1050 CI SURGERY

n  POST OPERATIVE REHABILITATION

n  AICs / ZCs

n  www.adipcochlearimplant.in

CSR

•  PFCL

•  AAI

•  SBI

•  MDSL

•  OTHERS

POR

n  AIC (POR) / ZCS

n  SWITCH ON/ MAPPING/ THERAPY

n  TELEPHONIC/ E MAIL/ POST

n  PROGRESS FORMAT/ FEEDBACK

n  TRAINING OF PARENTS

OUTCOMES

n  AUDITORY AWARENESS/ PERCEPTION OF SOUND

n  COMPREHENSION OD SIMPLE COMMANDS

n  EXPRESSION: 1/2 WORDS SENTENCES

n  PARENTS SATISFACTION

OUTCOMES n  NEW SET UPS/ SURGEONS

n  REHAB PROFESSIONALS

n  LOWERING OF COST

n  STATE PARTICIPATION

n  NATIONAL STRATEGY

CHALLENGES •  DISTRICT

•  HOME BASED THERAPY

•  ACCESSORIES/ UPGRADATION

•  BATTERY/ LOST PROCESSOR

•  ICT/ TELE- REHAB/ MAPPING

BACKGROUND ROOM NOISE

n  AUDITORY DISTURBANCES

n  SNR

n  +15dB SNRs OR GREATER n  < 35 dB A n  NO STANDARDS

REVERBERATION

o PROLONGATION OF SOUND

o  DEGRADES SPEECH PERCEPTION

o  RT > 1.0 SECOND

o  SNHL < 0.4 TO 0.5 SECOND

o  NOISE AND REVERBERATION

DISTANCE

n  DECREASE IN SOUND

n  INVERSE SQUARE LAW: 6 dB SPL

n  EARLY SOUND REFLECTION: 50msec

n  CRITICAL DISTANCE: 6- 12 FEET

ACOUSTIC MODIFICATION

n  SNR >15 dB, AMBIENT NOISE < 35dBA

n  ACOUSTIC TILES/CARPETING THE FLOORS/

n  ACOUSTIC FURNITURE TREATMENT

n  COST/ STANDARD/LEGISLATION

SNR-ENHANCING TECH.

o  D-MICROPHONE/ BEAMFORMERS

o  ASP TECHNOLOGY

o  BILL/TILL/NR/ CROS

o  CLASSROOM AMPLIFICATION DEVICES

SOUND–FIELD FM AMPLIFICATION

n  8- 10 dB UNIFORM AMPLIFICATION n  BENEFIT ALL CHILDREN

n  COST EFFECTIVE

n  LESSEN BURDEN ON RESOURCE ROOM

n  LESS VOCAL STRESS AND STRAIN

HARDWIRED SYSTEM

n  NOT SPECIFIED AS MEDICAL DEVICE-FDA

n  NO SPECIFICATION

n  EAC AND REAL EAR

n  RESTRICTED MOBILITY

ELIS

n  1938

n  1999: 3 D LOOP SYSTEM n  EMBEDDED IN MAT

n  30 dB REDUCTION

n  US ACCESS BOARD

ALDs

• VOICE AMPLIFIERS

•  TELEPHONE HEADPHONES

•  TELEPHONE/ TELEVISION ADAPTERS

HAT

FLASHING / VIBRATING

HAT

o  LIGHT FLASHERS

o  DOORBELLS

o  SMOKE /FIRE ALARMS

o  TTY/ TELECOMMUNICATION DEVICE FOR THE DEAF (TTD)

o  SMS

TV VIEWING

n  CAPTIONED MEDIA

n  CLOSED, REAL, AND OPEN

n  (TELEPHONE DECODER CIRCUITRY ACT, 1990)

COMMUNICATION STRATEGIES

n  CLEAR PRONUNCIATION

n  SLIGHT LOWER RATE OF SPEECH

n  HIGHER INTENSITY

n  FACE-TO-FACE COMMUNICATION

n  LACE

SIGN LANGUAGE RECOGNITION AND TRANSLATION

n  TEXT TO SPEECH

n  SPEECH TO TEXT

n  SIGN TO SPEAK- SIGN

AIC

n  24.9.15

n  BUILT IN INFRASTRUCTURE

n  TRANSPORTATION

n  ICT

n  NATIONAL PROGRAM

LOOKING FORWARD

n  BIS SPECIFICATIONS

n  UNDER ADIP SCHEME

n  INDIGENOUS DESIGN AND DEVELOPMENT

n  ASSESSMENT AND TRIAL/ PRESCRIBTION

NEW INITIATIVES n  RPWD ACT 2016

n  EARLY IDENTIFICATION

n  STATE PARTICIPATION

n  NATIONAL/ STATE FUNDS

n  SPEECH AND LANGUAGE DISABILITY

SPEECH

LARYNGECTOMY/

GLOSSECTOMY

BILATERAL VOCAL CORD PARALYSIS

MAXILLOFACIAL ANOMALIES

DYSARTHRIA/ APRAXIA OF SPEECH

% OF SPEECH DISABILITY = 2 X UR OF SIA + UR OF OVCA 3 •  BENCHMARK SPEECH DISABILITY: 40%

•  SLP AND ENT SPECIALIST

•  SPEECH SAMPLE •  DIGITAL PLATFORM

LANGUAGE DISABILITY: APHASIA

n  WESTERN APHASIA BATTERY (WAB)

n  INDIAN LANGUAGES/ SPONTANEOUS SPEECH/ NAMING

COMPREHENSION/ REPETITIONS/

n  SLP AND ENT/ NEUROLOGIST

n  APHASIA QUOTIENT (AQ)

AQ

n  MAXIMUM AQ: 99

n  AQ OF 94 ONWARDS : 0% LANGUAGE DISABILITY

n  AQ OF 0: 100% LANGUAGE DISABILITY

n  AQ OF 56: 40% ( 1% INCREASE)

n  READY RECKONER : AQ

TENS

PLACE IN AQ

UNIT PLACE IN AQ

0 1 2 3 4 5 6 7 8 9

0 100 98.9 97.8 96.8 95.7 94.6 93.6 92.5 91.4 90.4

1 89.3 88.2 87.2 86.1 85.0 84.0 82.9 81.8 80.8 79.7

2 78.6 77.6 76.5 75.4 74.4 73.3 72.2 71.2 70.1 69.0

3 68.0 66.9 65.8 64.8 63.7 62.6 61.6 60.5 59.4 58.4

4 57.3 56.2 55.2 54.1 53.0 52.0 50.9 49.8 48.8 47.7

5 46.6 45.6 44.5 43.4 42.4 41.3 40.0 39.2 38.1 37.1

6 36.0 34.9 33.9 32.8 31.7 30.7 29.6 28.5 27.5 26.4

7 25.3 24.3 23.2 22.1 21.1 20 18.9 17.9 16.8 15.7

8 14.7 13.6 12.5 11.5 10.4 09.3 8.3 07.2 06.1 05.1

9 4.0 2.9 1.9 0.8 00.0 00.0 00.0 00.0 00.0 00.0

ADIP SCHEME

n  BTE/ CI/ ALDS/ I PAD/ ELECTRO LARYNX

n  UHSP: OAE/ABR

n  RESEARCH: SPEECH PROCESSORS

n  MANUFACTURING

THANKS

n  HAPPY NEW YEAR 2018 n  HAPPY SARASVATI PUJA n  HAPPY REPUBLIC DAY

n  HAPPY REPUBLIC DAY