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"

Wednesday, February 11, 2015

Golidlocks and The Three Bears in Auditory-Verbal Therapy

How many Auditory-Verbal goals can you think to target when including the Goldilocks and the Three Bears in therapy?

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)

Monday, February 2, 2015

FEBRUARY: Listening and Spoken Language Calendar

Here is a month's worth of language suggestions that you can incorporate into

AUDITORY VERBAL THERAPY activities with your child.

Click HERE to download your own printable copy.

Children's Literature for Auditory Development - Brown Bears and Polar Bears

Children, Children What Do You Hear?  is a classic Auditory Verbal article by Nancy Caleffe-Schenck, M.Ed., CCC-A, LSLS Cert. AVT 

Click HERE to read an updated version of this article on the Listen Foundation website entitled: How Do Parents and Practitioners Use Children Literature for Auditory Development?

There is much to be said about the satisfaction of a parent and child reading, talking, and looking at a beautifully illustrated and well-written book for children. Children’s literature is one of the most powerful tools to enrich a child’s auditory development while integrating listening with talking, thinking, and communicating.

Brown Bear, Brown Bear, What Do You See? (Martin & Carle, 1968/1983) is a popular book found in many homes and in therapy sessions around the world. The text of the book is repetitive, with the same question and answer combination being reiterated throughout the book: “What do you see?” “I see a [color + animallooking at me.”

This book may be adapted for use with children at different stages of auditory development. For younger children, the parent or listening and spoken language professional will use toy props representing the animals in the book. These props assist in maintaining the child’sinterest and promote the integration of audition, speech, language, and cognition. For example, a large stuffed yellow duck is related to a real duck, a realistic plastic duck, pictures, and stories about ducks. For an older preschooler, a cork can be used to represent the duck. The ultimate goal is that the phrase “yellow duck,” which is learned through listening, represents to the child a wide array of impressions ranging from something the child sees on a pond to something the child later discusses in a conversation with a peer or adult.

Following the principles of auditory-verbal practice, the listening and spoken language professional will use diagnostic teaching, a process of individualized interactions used to assess a child’s present levels of functioning in audition, speech, language, communication, and cognition to establish appropriate long-term goals and session targets. Parents incorporate these goals into their child’s daily life. The sequence of presenting auditory information while reading a book might be as follows:

• The child listens while the adult reads the text.
• The child imitates or comments on what was read.
• Props or pictures reinforce the text.
• Parents expand their child’s language by commenting on the story and related books or experiences.
• The child later takes the lead and spontaneously uses the spoken language prompted by the book.

Pollack, Goldberg, and Caleffe-Schenck (1997) present a hierarchy of auditory development that has been used successfully in auditory-verbal therapy and education. To assist teachers, therapists, and parents in program planning and diagnostic teaching, listening and spoken language professionals use Brown Bear, Brown Bear as an example for explaining specific auditory expectations using a storybook. The name “Sam” is used rather than the generic term “child.”

The following subsections provide a sample of the hierarchy based on the various stages of auditory development.

Auditory Awareness (Sam indicates presence or absence of sounds) 
Dad makes the barking sound of a dog while holding a stuffed dog under the table. Sam indicates that he hears something. Dad shows him the toy dog and hands it to Sam to explore and attach meaning to the sound. The toy is associated with the picture of the white dog in the book.

Distance Hearing and Localization (Sam hears at increasing distances and turns to the source of the sound) 
While walking in the park, Dad hears a dog barking a few feet away. He calls attention to this barking and shows Sam the dog frolicking in the field. (Distance hearing and localization are incorporated into each level of auditory learning once close-range hearing has been demonstrated.)

Auditory Discrimination (Sam judges whether sounds are the same or different) 
Mom reads, “Red bird, red bird, what do you see?” and whistles like a bird. Sam indicates by pointing to the red bird that he hears, discriminates, and remembers the differences in the whistle and the words “red bird” versus “quack, quack” and “yellow duck.”

Auditory Self-Monitoring (Sam modifies speech to match what was heard) 
Sam demonstrates the beginning stages of auditory self-monitoring when he imitates the sounds for the animals in the book. His imitation of “ruff ruff” for the dog is different from “meow” for the cat (low pitch, short, abrupt duration vs. high pitch, long, long duration). An example of a higher level of auditory self-monitoring is when Sam substitutes /g/ for /d/ when imitating the word dog. Mom acoustically highlights /d/ or uses auditory stress by babbling /da da dog/. Sam changes his speech production from /gog/ to /dog/.

Auditory Identification (Sam labels what he heard) 
The props or pictures used for the book are placed in front of Sam. Now it is time to put them away. Mom tells Sam, “Give me the frog.” Sam picks up the frog. Then the roles are reversed, and Sam asks for the goldfish. A more advanced auditory level would be identifying “frog” versus “dog” because they are similar-sounding words.

Auditory Memory (Sam remembers what he heard)
If Sam has an auditory memory for three items, he hears, listens, and remembers what he heard and picks up the “fish, sheep, and horse” from the toy props. He may be remembering and saying the repetitive phrase, “I see a ___” and beginning to transfer this phrase to real life by imitating or spontaneously saying to his brother, “I see a cat,” as the neighbor’s cat sleeps in the sun.

Auditory Sequencing (Sam remembers in correct order what he heard) 
Instead of Sam picking up the toy props in random order, he hands them to his Mom in the order in which she said them. He may verify or change the order in which he heard the animals by naming the animals as he picks them up. Another demonstration of sequential memory is when he recites the book from memory. Perhaps he is ready to listen to, understand, and act out a scenario such as, “Put the green frog on the rock and the goldfish in the water.”

Auditory Processing (Sam thinks about what was heard and makes a cognitive judgment) 
At this level, just imitation, identification, or memory of what Sam heard will not be adequate for him to understand and complete the activity. He must draw upon his pastexperiences and knowledge of the world and use his spoken language to be an active communicator. A description game might be played, such as “I want something with f ins that swims.” Sam chooses the fish rather than the frog.

The concepts and language structures that Sam learns through active listening evolve from simple to complex over time. The listening and spoken language professional and the parents are wise to incorporate an abundance of previously learned language targets, such as plurals, verb tenses, pronouns, conjunctions, component parts, and adjectives. More complex processing and strategies are required to understand questions such as, “What does a brown bear do when winter arrives?” Auditory closure and categorization activities encourage auditory processing. The parents and the practitioner may present incomplete statements such as, “Dogs, cats, and goldfish are pet animals. Bears, deer, and moose are wild animals.” Other auditory closure tasks involve using component parts of animals, such as “A dog is covered withfur. A fish is covered with scales. A bird is covered with feathers.” The possibilities for Sam to develop and practice auditory processing are limitless.

Auditory Understanding (Sam comprehends auditory information in a variety of settings with many different people)
Dad and Sam are taking a walk when they notice a white dog running down the road. It reminds them of the white dog in Brown Bear, Brown Bear, and they discuss where the dog might be going in such a hurry. They make up their own story about the white dog. It might be a continuous story where each person tags onto what the previous person said. At home, Sam and his parents read a variety of books about dogs and compare and contrast these stories and characters.
The activities and ideas presented in the above subsections are just examples of how listening and spoken language skill levels can be developed and enhanced through use of an interesting children’s book.

The listening and spoken language professional’s successful use of children’s literature as the basis of auditory development depends upon the following factors:

• Adhering to developmentally appropriate stages of auditory development to provide for and enrich successful auditory experiences for a child
• Incorporating several auditory levels within the same activity
• Integrating audition, speech, cognition, and communication at all levels
• Using books and other literary materials in creative and satisfying experiences that are motivating to a child and to the parents
• Empowering a child’s parents to incorporate meaningful auditory interactions throughout the day

Martin, B., & Carle, E. (1983). Brown bear, brown bear, what do you see? New York, NY: Henry Holt and 
Company. [First published in 1968]

Pollack, D., Goldberg, D. M., & Caleffe-Schenck, N. (1997).  Educational audiology for the limited-hearing infant and preschooler: An auditory-verbal program (3rd ed.). Springfield, IL: Charles C Thomas, Publisher.