Thursday, February 19, 2015

Auditory Rehabilitation- What to Expect.

Today's post can be found at:  Med-El

Nothing is most important to realizing the benefits of having a cochlear implant than auditory rehabilitation therapy. Improvements following initial programming sessions tend to happen quickly, but further improvements can surface for many months and even years. The involvement of your family and friends in the therapeutic process greatly enhances success.
You can expect therapy programs to include some or all of the following components:
    Auditory training, including analytic skill development
    Communication skills training
Conversational techniques - Repair strategies
Assertiveness training - Interpersonal skills
Coping mechanisms 
    Voice therapy
Articulation - Voice and resonance
Rhythm - Timing
    Speech production training
    Speech reading
Information on the auditory system 
and hearing loss
The effects of hearing loss on communication
The impact of background noise and 
poor listening conditions
The importance of visual input, audiovisual 
integration and attending behavior
The impact of talker differences 
and social conditions
Benefits and limitations of speech reading
Benefits and limitations of assistive devices
The use of community resources
Self-help groups

Depending on individual needs, therapy goals 
may include:
    Development of realistic expectations
    Systematic auditory and auditory-visual training 
    Communication skills training

Wednesday, February 18, 2015

Learning Listening and Spoken Language Through Daily Routines at Home

This printable handout can be found HERE. It is from John Tracy Clinic's blog with Ideas and Advice for Parents of Children with Hearing Loss. I often share this article with my AV families and many have found it a great reminder in the midst of their day to day lives.

Sunday, February 15, 2015

I'm looking forward to being the presenter at the 
Illinois 10th Annual Early Hearing Detection & Intervention Day 
on Friday, March 20th,
 at the Chicago Hearing Society.

Hope to see you there!

How's Your Foundation? - The Auditory Brain

My friend and colleague Dave Sindrey, M.Cl.Sc. LSLS Cert. AVT made this graphic, "How's your foundation?" that was inspired by a webinar  he watched by Carol Flexer on Audiology Online - "The "Auditory Brain:" Conversations for Pediatric Audiologists"

Understanding Audiograms, The Speech Banana and It's Impact of Speech

Today's blog  was reposted from Source: Leah Lefler, 2011

Understanding Hearing Loss Levels

Hearing is not an all-or-nothing proposition: the levels of hearing loss can vary immensely from person to person. The levels of hearing loss are typically defined as:
15dB-25dB Hearing Loss: This level of hearing loss applies only to children. Children who have hearing in this range are defined as having a "slight" hearing loss. These children will not need hearing aids, but should be monitored on a frequent basis to verify the hearing loss is not progressing.
25dB-40dB Hearing Loss: This is a mild hearing loss. For children, a "mild" hearing loss is not a slight difficulty: a mild hearing loss can cause major difficulties with articulation and some language acquisition skills. People with a mild hearing loss often miss the softer consonant sounds like s, t, th, and f. Hearing becomes even more difficult in the presence of background noise. Children with hearing in this range benefit from the use of hearing aids.
41dB-55dB Hearing Loss: This is a moderate hearing loss. The newborn hearing screening program is designed to pick up hearing losses in the moderate range (or greater). Individuals with hearing loss in this range will require hearing aids for conversational speech, and children will need intervention with auditory therapy to obtain age appropriate speech and language skills.
56-70dB Hearing Loss: This is a moderately severe hearing loss. Individuals with this level of hearing loss cannot hear any of the sounds of speech at typical conversational levels without hearing aids. Children will require auditory therapy and hearing aids to obtain age appropriate speech and language skills.
71-90dB Hearing Loss: This is a severe hearing loss. Hearing aids begin to lose effectiveness as the degree of hearing loss increases, due to sound distortion (caused by the amplified signal and the missing inner hair cells in the cochlea). Powerful hearing aids are beneficial to some individuals, while others will use cochlear implants to obtain access to sound. Hearing aids or cochlear implants, along with auditory rehabilitation therapy are necessary to develop age-appropriate speech and language skills in children. If an auditory-oral pathway is not selected, children can develop language through the use of sign language (such as American Sign Language, among others).
Greater than 91dB Hearing Loss: This is a profound hearing loss. Hearing aids are generally not effective for obtaining all of the sounds of speech with this level of hearing loss. Some young children will wear hearing aids to stimulate the auditory nerve until a cochlear implant is obtained. Cochlear implants are able to provide access to all of the sounds of speech, so that many children who obtain implants and have early auditory rehabilitation therapy are able to develop age-appropriate speech and language skills. If an auditory-oral pathway is not selected, children can develop language through the use of sign language (such as American Sign Language, among others).

Audiograms: Charting Hearing Ability

An audiogram: the lower frequency sounds are on the left, and the higher frequency sounds are on the right. Sound volume increases down the vertical axis
An audiogram is a graph of an individual's hearing ability.
  • The frequency, or pitch of the sound, is along the horizontal axis. Lower pitched sounds are on the left-hand side of the chart, and higher frequency sounds are along the right-hand side of the chart. A deep, bass drum would be a low frequency sound, while a shrill, chirping bird would be a high frequency sound. For the purposes of human speech, the important frequencies are from 250Hz - 8,000Hz. For reference purposes, Middle C on a piano is at 250 Hz.
  • The volume of the sound is along the vertical axis. Sound volume increases down the length of the chart. Sound is measured in decibels (dB), which does not increase in a linear fashion. 50dB is much, much louder than 10dB. 
  • The "speech banana" is the figurative area on an audiogram where individual speech sounds take place. The speech banana superimposed on the audiogram on the right is an English speech banana: each language has its own sounds of speech, and its own speech banana. Low frequency sounds like "M" and "Z" are on the left, and high frequency sounds like "F" and "S" are on the right. 


Example of an Audiogram

An example of a person's hearing loss charted on an audiogram.
This individual cannot hear the sounds highlighted in red.

The audiogram on the right is of a typical sloping moderate hearing loss. This person can hear low frequency sounds better than high frequency sounds: men would seem to have clearer voices than women or children for this individual.
This person can hear the soundsbelow the line: sounds like "J" and "B" are audible. This person cannot hear sounds above the line (highlighted in red). Sounds like "P," "CH," "F," and "S" are not audible. This person would have difficulty hearing birds chirping and vacuum cleaners, but could hear lawn mowers, dogs barking, and babies crying.
As this audiogram indicates, hearing levels can vary across the different frequency ranges. A person might have a mild hearing loss at one frequency, and a more severe hearing loss at another frequency. 

The Best Hearing Loss Simulator

Hearing loss simulations are very useful for educating parents, teachers, and friends about what a hearing loss "sounds" like. The NIOSH hearing loss simulator is extremely helpful, as it allows a person to input any audiogram and listen to what the hearing loss sounds like. The user can select a woman's voice or a man's voice to hear the difference in sound quality for a specific hearing loss. This simulator is also capable of running a simulation of hearing ability based on a person's age or for years of noise exposure (noise-induced hearing loss).

Types of Audiograms

Each person with a hearing loss has an individual hearing profile, but audiograms can be classified into general groups based on the shape:
The various types of audiograms . Source: Leah Lefler, 2011
Sloping: This is the most common audiogram. A person can hear low frequency sounds better than high frequency sounds.
Reverse-Slope: This is a rarer type of audiogram. People with conductive hearing losses often have a rising audiogram, though it is possible for sensorineural hearing losses to have a rising shape, too. In a very rare type of reverse-slope hearing loss (extreme reverse-slope), an individual may not be able to hear thunder, but can hear whispers across the room!
Cookie-Bite: This audiogram looks like someone took a bite right out of the middle of the graph. A person with this hearing loss hears low and high frequency sounds better than the mid-frequency sounds. This type of hearing loss is usually genetic, and may progress over time.
Tent-Shaped: This type of hearing loss is not very common. The individual with this type of hearing loss can hear the middle frequencies the best, but has difficulty with the high and low frequencies. Sometimes a tent shaped hearing loss develops when a person with a reverse-slope loss ages and begins to lose the high frequency sounds due to presbyacusis (age-related hearing loss).
Flat: The person with this type of hearing loss hears at about the same level across the speech frequencies. Both conductive and sensorineural hearing losses may take this shape.
Corner: When a person has a small amount of residual hearing in the low frequencies, but no recordable hearing on the rest of the audiogram, the person has a corner audiogram. A person with this type of audiogram would be a candidate for a cochlear implant.

The Flintstones Simulate Hearing Loss Levels

Other Hearing Loss and Cochlear Implant Simulations

The Effects of Noise Induced or High Frequency Hearing Loss

Hearing Loss Simulation By Frequency

Wednesday, February 11, 2015

Tuesday, February 10, 2015

Plug-in an Individuals Hearing Thresholds - Hearing Loss Simulator

Here is a hearing loss simulator, where you can plug in an individual's thresholds.

 NIOSH Hearing Loss Simulator

The NIOSH Hearing Loss Simulator is a software training and communication tool for promoting hearing loss prevention. It allows a user or trainer to demonstrate the effects of noise exposure on hearing without experiencing an actual noise-induced hearing loss.
HLSim is a Windows®-based program that displays a "control panel" for playing sounds while adjusting the simulated effects of noise and aging. A simulated individual's age (in years) can be entered along with the years of exposure to noise (in A-weighted decibels). The effects are shown visually on the frequency band control panel and sound level display screen while the user listens to the audio playback.
This completely rewritten version of HLSim adds compatibility with the latest 32 and 64-bit Windows® operating systems and now supports mp3 sound files and other popular audio file formats.
  • Windows Installer 3.1 or later;
  • Pentium 1 GHz or higher with at least 512 MB RAM;
  • Minimum disk space: 32 bit version - 850 MB, 64 bit version - 2 GB
Installation instructions:
  • Download the appropriate ZIP archive (32 bit or 64 bit)
  • Unpack it into a temporary folder and run Setup.exe.
The software can be downloaded from this page, or ordered on CD. The download archive also includes the NIOSH Hearing Loss Simulator Instruction and Training Guide.
Audience: Trainers, workers, and hearing loss professionals

Amazing Apps for Auditory Rehabilitation

Thank you for attending my presentation Amazing Apps for Auditory Rehabilitation at ILAA 2015.

 I  hope that you found the information shared worthwhile. 

Auditory Rehabilitation Why is it important?

Not every patient may be inclined to participate in AR, but at the very least our patients should be counseled regarding the important role it plays in their success, and it should be provided as an option.

Read this article in full at: 

Wednesday, February 4, 2015

Strategies For A Listening and Spoken Language Environment At Home

Today's blog post source was written by my friend and colleague Pamela J. Talbot, M.Ed., CCC-SLP, C.E.D., Cert. AVT 
Talbot, P. (2002) Topics in Auditory-Verbal Therapy, p. 43 - 44. 

 Creating A Communicative Environment

One of the parents' primary roles in the therapy process is to create a communicative environment in which the child wants and needs to learn language for her/himself. Basically this involves setting up situations and a style of interaction that facilitates language learning in everyday events. With some basic guidelines in mind, you should be able to determine if the environment challenges language learning.
A communicative environment has real reasons for the child to want and need to learn. The child needs and wants to learn, to talk, to listen, and to comprehend. The child is not doing it to please the adult; the child is doing it because s/he needs to for his/her own purposes. When the child communicates for real reasons, s/he becomes internally motivated to communicate. The more unnatural performance demands we place on the child the less likely the child will recognize the personal value of the skills we are trying to teach. What is a real reason? If you ask a yes/no question such as "Do you want a cookie?" does the child really need to talk? Since the answer is "no" why do we encourage the child to say "I want a cookie?" The answer to that one is harder to admit, because it's purely selfish desire. If the child effectively communicated by nodding, then s/he doesn't need to say it. Pleasing an adult does not qualify as a real reason to communicate. Consider another example; if you offer a choice and the child can communicate by pointing then why should the child speak. It's important to ask yourself "Why should the child say this?"

A communicative environment has natural consequences to the child's communicative attempts. The reward is successful communication rather than applause or a sticker. It is important to encourage and reinforce small steps of progress along the way to a bigger goal. If you hold out for perfection the child might not bother to try.

A communicative environment challenges the child to think for her/himself. If someone is always jumping in to provide the words or assist, the child learns to look for help rather than try to solve the communication breakdown for his/herself. Likewise, if the adults take full responsibility to figure out what the child is trying to communicate, the child learns to take a passive role rather than attempting alternative strategies to communicate his/her intent. The adults in a communicative environment do not anticipate the child's needs before the child has attempted to communicate them for his/herself. In addition, the adults keep their expectations moving higher as the child shows progress. If the child is easily successful at the current level, there is no reason for the child to move to the next level. Although challenge is important, it should not cross the line of total frustration.

A communicative environment provides rich language models. Rich language is redundant because there is frequent rephrasing and elaborating of key concepts and new words. Rich language is at and slightly above the child's level. 

It is a challenge to find ways to create needs for the child to learn to listen, to learn to talk, and learn to handle communicative breakdowns. However, the effort is worth the valuable lessons that emerge from a communicative environment.

Strategies to Create Needs for Communication
      Provide choices rather than ask a yes/no question.
      Try to respond to what the child said, not what she/he meant.
      Allow the child time to think for himself/herself before providing the words.
      Look expectantly at the child when he/she should verbalize so he/she learns to verbalize during the pause time.
      Keep your expectations moving higher. If the child is easily successful, he/she may not recognize the need to move to a higher level.
      Don’t anticipate the child’s needs before he/she has tried to communicate them to you.
      Encourage the child to repeat himself/herself or provide clarification to others rather than doing it for him/her.
      Use sabotage techniques (setting up situations which require the child to communicate with others).
      Make silly mistakes and break routines.
      Set the child up for others to have something to comment about. T-shirt with pictures, unusual lunch bag, pin, special hair clips.

   Maintain an interesting auditory environment.
   Balance talking with quiet to reduce auditory clutter.
   Reduce the amount of meaning available through visual cues. There’s no need to listen if the meaning is clear from the visual clues.
   Provide natural consequences when the child is not listening or attentive so she/he learns the consequence may be missing out on things.
   Model language that meets and exceeds the child’s level.

© 2002 Pamela J. Talbot, M.Ed., CCC-SLP, C.E.D., Cert. AVT. All Rights Reserved (with permission)