Speech To My Ears: Coaching Parents on Using Wireless Technology With Their Very Young Child March 13, 2016

Transcription

1 Speech To My Ears: Coaching Parents on Using Wireless Technology With Their Very Young Child March 13, 2016 Valeri V. Le Beau, MS-CCC-SLP Consumer Education & Rehab Manager Advanced Bionics Meghan Crimmins, Au.D., CCC-A Clinical Specialist, Southwest Region Advanced Bionics

2 FALSE True or False? As experts, our job is to provide families with really good information that will fix a child s hearing. Smith, M., Smith, J., Elder, T. and Wolfe, J. (2015). How to be an effective influencer for good. The Hearing Journal,

3 Valeri V. Le Beau, MS, CCC,SLP, Consumer Education and Rehab Manager at Advanced Bionics brings a lifetime of personal and professional expertise to the field of hearing impairments. Working as a teacher for the hearing impaired and a speech language pathologist, she has trained, mentored, and lectured locally and internationally. Financial Disclosure: Valeri Le Beau joined Advanced Bionics in 2012 as the Consumer Education & Rehab Manager. Advanced Bionics is the manufacturer of the HiResolutionBionic Ear System, including the Naída CI and Neptune sound processors. Non-financial Disclosure: No relevant non-financial relationship exists.

4 Financial Disclosure: Meghan Crimmins, Au.D., CCC-A is an audiologist with ten years of experience providing direct services to individuals with hearing loss. She has worked for Advanced Bionics since 2014, recently transitioning to a clinical specialist role in October She provides on-site clinical support, product training, initial activations, and assistance with clinical management of difficult cases as part of the Southwest regional team. Prior to joining Advanced Bionics, Meghan worked at Ann & Robert H. Lurie Children s Hospital of Chicago where she accrued 6 years of programming experience, specializing in programming recipients with atypical anatomy, i.e., CHARGE syndrome. Meghan received her Doctorate of Audiology degree from Rush University in Chicago, IL. Meghan Crimmins is a full-time employee of Advanced Bionics. Advanced Bionics is the manufacturer of the HiResolutionBionic Ear System, including the Naída CI and Neptune sound processors. Non-financial Disclosure: No relevant non-financial relationship exists.

5 Learning Objectives 1. Be able to describe to a parent the benefits of using wireless technology with very young children enrolled in EI. 2. Be able to support/teach a family how to connect and use Roger TM technology. 3. Generate practical ideas/tools to coach families on appropriate use of Roger TM across everyday environments.

6 Homes are pretty quiet places.

7 Homes are pretty quiet places. Baby s cry (100dB) Food processor (95dB) Lawn mower (90dB) Food blender (88dB) Dishwasher (80dB) Living room music (76dB) TV audio (70dB) Shower (70dB) Background music (60dB) Air conditioner (60dB) Refrigerator (50dB) Computer (40dB)

8 What does the research say?

9 Noise disturbances in daycare settings Gerhardsson, L. and Nilsson, E. (2013). Noise disturbances in daycare centers before and after acoustical treatment. Journal of Environmental Health, 75:7, The World Health Organization (WHO) Guidelines for Community Noise: a maximum background noise of 35dB in preschools, lower for hearing impaired children Not to exceed 55dB from external sources for outdoor playgrounds

10 Listening environments for infant/toddler & pre-schoolers Crukley, J., Scollie, S. and Parsa, V. (2011). An exploration of non-quiet listening at school. Journal of Educational Audiology, 17, Background noise: Any sound that interferes with or impedes what a listener wants or needs to hear.

11 Listening environments for infant/toddler & pre-schoolers Crukley, J., Scollie, S. and Parsa, V. (2011). An exploration of non-quiet listening at school. Journal of Educational Audiology, 17, Room characteristics of daycare: Tile floors, windows Wide variety of non-instructional listening situations encountered daily Gymnasiums most reverberant rooms children spend time in Learning environments less reverberant than gym

12 Listening environments for infant/toddler & pre-schoolers Crukley, J., Scollie, S. and Parsa, V. (2011). An exploration of non-quiet listening at school. Journal of Educational Audiology, 17, Throughout the day, children encounter a wide variety of reverberant environments and rooms with changing listening demands: competing noise within a classroom: active ventilation systems, fan noise from computers, children s voices and lessons from the same and adjacent rooms Competing noise outside classroom: traffic noise from outside, activity in hallways outside of the classrooms

13 Listening environments for infant/toddler & pre-schoolers Crukley, J., Scollie, S. and Parsa, V. (2011). An exploration of non-quiet listening at school. Journal of Educational Audiology, 17, Throughout the day, children encounter a wide variety of reverberant environments and rooms with changing listening demands: toddlers experience highest levels, followed by pre-school children Both toddler and pre-school rooms experience maximum of 90dB or higher 71dB in the pre-school daycare when children engaged in indoor activities Daycaredata show more sustained and higher levels than the elementary or high school settings

14 Listening environments for infant/toddler & pre-schoolers Crukley, J., Scollie, S. and Parsa, V. (2011). An exploration of non-quiet listening at school. Journal of Educational Audiology, 17, Most of the day is spent in speech in noise environments: 80% of total time spent in environments classified as speech in noise and seldom in situations classified as quiet, speech alone, or noise alone In daycare setting no time spent in quiet (no background noise or an overall level below 50dB)

15 Take away messages: Very young children are moving throughout their day in environments that have varied listening demands and challenging listening demands Very young children have substantial listening needs outside of classroom instruction or speech dominated environments During a typical day, children regularly experience loud situations with levels in excess of 80dB and well as moderate-level situations with poor SNRs

16 How does this impact early language learning? Hart, B. & Risley, T. (2003). The early catastrophe: The 30 million word gap by age 3. American Educator, 27 (1), 4-9. Infancy is a critical time of neurological development because early sensory experiences stimulate the central nervous system These experiences help advance the cognitive development of a child Experiences during infancy shape later schemas for categorizing and thinking about experiences Differences in children s experience are strongly linked to children s language accomplishments at age 3

17 Effects of Noise Distance, noiseand reverberationcan cause reduced audibility in normal hearing individuals Distance Noise Reverberation

18 Effects of Noise Children with normal hearing are at a greater disadvantage to adults Speech in noise is a challenge compared to adults Neural maturation Coping skills requesting repetition asking for clarification Using context cues

19 Effects of Noise Children with all degrees of hearing loss struggle in noisy environments Challenges can be overcome by assistive listening device (ALD) such as and FM/DM system FM/DM can overcome distance, reverberation and poor signal to noise ratio Signal to noise ratio?

20 Signal to Noise Ratio (SNR) Comparing the level of the talker to the level of the noise in the environment Audibility improves as the signal-to-noise ratio is increased Audibility improves -5 SNR 0 SNR +5 SNR

21 -5 SNR 0SNR +5 SNR Talker Noise Talker Noise Talker Noise

22 Dr. Carol Flexerexplains

23 Group Activity Review Good & Not So Good Sounds in your folder. At your table outline a way that you could use this educational resource with a family on your caseload. You have 5 minutes!

24 Assistive Technology Devices or technologies that are beyond the function of a conventional hearing aid or cochlear implant processor help a person with hearing loss to function better in challenging listening environments To improve the signal to noise ratio (SNR) Considerations for use Noisy and reverberant environments Multiple talkers Listening at a distance

25 FM/DM What is FM/DM? Wireless system Improves listening in noisy environments and over distances Better access to the speech and language in all listening environments Signal-to-noise ratio (SNR) Better or worse? Consistent

26 Child hears the speaker s words directly in their ears Distracting background noise is reduced Distance removed Improved audibility

27 FM/DM Technology Progression of the technology Traditional Dynamic Digital Frequency Modulated (FM) to Digital transmission (DM) Evolution Body worn, audio shoe INTEGRATED Easier to use Easier to check input

28 Benefits of Digital Completely wireless Searches for the best channel No interference Easy to use Connecting the microphone and the receiver(s) If you can press a button, you can use Roger. Compatibility

29 A day in the life of a toddler

30 Toddler Life What do you notice the children doing throughout the day? Car Story time Walk outside in the stroller What do you notice about these environments?

31 Toddler Life Infants and toddlers face challenges of poor acoustic environmental conditions (Nozza et al. 1990) Require a better SNR to understand speech in a noisy environment Infants and young children with normal hearing required up to +25 db SNR What can provide an improved SNR?

32 FM/DM for Toddlers Would you agree that very young children are in noisy, challenging listening environments on a daily basis? Would you agree that an ALD, like a Roger system (DM) could be a solution to improve the ability to hear in noisy environments?

33 Pick a partner Partner Share One is the parent and the other an EI provider EI provider, please explain to the parentwhy his/her child could benefit from assistive listening technology in addition to hearing aids/cis Explain what DM technology means

34 Benefits of FM Use With Very Young Children Encourages interaction with parents & imitation of parent s speech (Benoit, 1989) Observed increase rate of acquisition of language, but not statistically significant (Moeller et al, 1996) Attentionto speaker, attention in noisy environments, consistent ability to hear on the go and in noise (Gabbard, 2003) Improvements in situational listening using FM over time for: noise, quiet, distance and auditory only (Mulla, 2011)

35 Benefits of FM Use With Very Young Children Use of FM technology increased hearing aid use (Mulla, 2011) Perceived benefit in the classroom for: improved attention, speech and language development, academicperformance, behavior(nelson et al, 2013) Recommended for improved ease of communication, during speech instruction and assessment, integral component to optimizing instruction in classroom (Nelson et al, 2013)

36 How is FM Used With Very Young Children? Average age of FM fitting: 17 m (Gabbard, 2003) 32% of preschool age children use FM at school and 13% use at home (Munoz et al, 2013) Regular use of FM in a variety of settings (Mulla, 2011; Nelson et al, 2013) Use of FM in home, nursery (school), car, shopping and outdoors were most popular of 7 environments (car, meals, shopping, outdoors, home, TV) (Mulla, 2011)

37 How is FM Used With Very Young Children? Average FM user per day: 3 h, 2 m (Mulla, 2011); 2-12 h (Gabbard, 2003) 97% of total hours (2801 h) with benefit ; 2 h 30 m no benefit ; 70 h 45 m not sure of benefit (Mulla, 2013) Use of personal FM increased with increased age (Nelson et al, 2013; Mulla 2011)

38 Perception/Experiences using FM With Very Young Children Parent/caregiver/early intervention providers perspectives of early FM use (Gabbard, 2003; Mulla 2011) FM system is easy to operate FM system remained in good working order FM system comfortable for child to use *anecdotal concerns of many professionals needs to be addressed regarding families not being able to cope with technology

39 Perception/Experiences using FM With Very Young Children Professionals in DHH programs reported FM systems as advantageous with preschool children (Nelson et al, 2013) Improving student s attention Improving speech and language development Improving academic performance Improving behavior

40 Perception/Experiences using FM With Very Young Children Professionals in DHH programs reported FM systems to have little or no disadvantage (Nelson et al, 2013) Distracting to students Uncomfortable to wear Unable to hear classmates Having technical difficulties

41 Perception/Experiences using FM With Very Young Children Professionals in DHH programs reported reasons FM systems are not used (Nelson et al, 2013) Preschool children may be too young to report difficulties (39%) Funding/cost (30%) Preschool children will receive insufficient benefit (27%) 71% would recommend personal FM systems to other educators (Nelson et al, 2013)

42 Perception/Experiences using FM With Very Young Children Professionals in DHH programs reported desire for additional educational information on the benefits of hearing assistive technology use in the classroom and technology training (Nelson et al, 2013)

43 What is happening in your state?

44 What is happening in your state? Talk to you partner prepare to share What barriers do you perceive or have experienced? What about the families you work with? How about as you listened to the research?

45 Cost/Funding Cost $$$ High cost for personal use $$$ Funding Limited research makes it difficult to prove necessity to private insurance Solutions Take time to demonstrate and explain the effects that noise has on hearing Datalogging-to demonstrate noisy environments

46 Child s Feedback Child can t report about the signal Solutions Coaching parents on listening check and a behavioral listening check

47 Proper Use/Training What environments to use the system? Inappropriate use Parent overwhelmed with the use of technology Solutions Coaching families on effects of noise and distance Providing a team of support around the family

48 Technology Difficult to use; complicated systems Pairing/syncing Wires, cables and audio shoes oh my! Microphone placement Poor signal, possibly intermittent signal Solutions System has been simplified as technology has improved Digital Integrated system

49 Setting Up Successful Programs

50 Center Based Program with Home Based Services 3 Audiologists, 6 Parent Educators 69 children enrolled in 0-3 program 25 enrolled in toddler program Betsy Moog Brooks, Executive Director bbrooks@moogcenter.org

51 Funding Missouri provides funding for hearing aids, Roger and therapy

52 Parents as Partners Upon enrollment, assigned to a Parent Educator Weekly home based sessions with Parent Educator Parent Educator acts as audiology assist

53 Starting Early Families exposed to other children using Roger during appointments at the center Families requesting Roger will receive a system by 2 years of age Team approach starting with Audiology and supported in the home by Parent Educator Further supported during topics offered at Informational Meetings 3x/month

54 Parent Support & Education Weekly home visits Monthly audiology visits Enter Toddler Program 18m Discussion Group 3x/month

55 Family Centered Practice Exposure to other families Conversations & answering questions Printed education pieces Home follow up to reinforce learning, answer questions, guide families in decision making Simulations/Demos Establishing confidence in use (daily listening checks)

56 Coaching for Success Use case scenarios out of real life events When mouth to ear distance changes Outside the speech bubble Not appropriate to use scenarios (intercom system, muting the mic)

57 Center based program Provides comprehensive diagnostic and therapy services Children and adults Joanna Smith, CEO/Executive Director MS, CCC-SLP, LSLS Cert. AVT

58 Funding Raised funds privately to purchase 25 kids fit with Roger

59 Starting Early Consistent use verified with Datalogging Therapist submits request Parent buy-in using simulation experience in the booth with noise and Roger mic

60 Parent Support & Education All children followed by the center to support and educate beyond audiology Listening for Littles(Toddler Group) Parent group Self-contained preschool with hearing children Tele-practice after confidence in fitting

61 Coaching for Success Facilitating Audition In The Home (FAITH) Parent support program to create a language rich environment in the home with the integration of technology

62 Medical Collaboration Model Eileen Rall, AuD, PASC Program Coordinator Assessment and Treatment Implementation Program for Infants and Toddlers with Hearing Loss Enhancing Rehabilitation (CATIPIHLER)

63 Funding Loaner program for FM

64 Parent Centered Program Center based audiologist EI providers are community-based DHH teachers providing home visits and members of the CATIPILER team EI provider is the link between medical center, home and community (daycare)

65 Starting Early Severe-Profound SNHL begin discussion and fitting at 6 m Less severe loss is fit a little older with consideration for environments child is in Dataloggingused to confirm percent of time spent in noise

66 Keys to Success Sign releases for direct communication among team members Don t use the parent as the mule for information Invite EI provider to appointments with family Don t be territorial, be open to suggestions from the team members Use datalogging to reinforce appropriate use

67 Counseling & Coaching Teach appropriate use and inappropriate use: Be aware of when you WANT to teach overhearing Using FM as an intercom is a boo, boo (not fair to child) Do you want your parent s voice inside your head 24/7?

68 Want you to know Use dataloggingand functional listening to prove benefit or need and advocate for funding Takes time to change a system take time to explain the benefit and impact of noise to decision makers and the value for preschool use Train proper use

69 Fit, Validate, Verify Want you to know Have loaners available Families are vulnerable, hear their fears and address them Every minute you don t have access is a minute of lost language

70 Roger is the new digital standard Acompletelywireless system Sophisticated technology-ability to adapt to the environment Roger is also hassle free!

71 Research on Roger and CIs* Research on Roger and cochlear implant systems Improvement over traditional and Dynamic FM technologies Significant improvements in speech understanding at high noise levels (70, 80 db) * For more details, please refer to Field Study News: Roger and Cochlear Implants.

72 Roger Receivers Roger mylink Roger 17 Roger X* * Roger X is compatible with Naída CI via Phonak ComPilot

73 Roger Microphones Roger Pen Roger Clip-On Mic Roger Inspiro* *Roger 17 (03) compatible with Roger Pen and Clip-On Mic *Roger 17 (02) compatible with Roger Pen, Clip-On Mic, and inspiro

74 Wireless Analyzes noise Adaptive microphones Roger Pen Multi-Talker Bluetooth connectivity TV connectivity Audio input for listening to multimedia

75 Roger Clip-On Mic Wireless Analyzes noise Multi-Talker Network Audio cable to connect to TV and other audio devices No Bluetooth connectivity

76 Hands on Roger

77 Tips and Tricks Fitting by the audiologist Prepare families for the need for testing Programming parameters Assessment and verification important Assess effectiveness Demonstration of benefit Goal-Optimize the use of the Roger system

78 Assessing FM/DM Function Functional Listening Check Use Naida CI listening check with earbuds Listen without and with the FM/DM system attached Assessment of the microphone Clear Static present Intermittent Behavioral Listening Checks Repeat Ling sounds Point to learning to listen toys

79 Assessing FM/DM Benefit Speech perception testing Quiet versus Noise Closed-set versus open-set testing Learning to listen toys Early Speech Perception (ESP) test low verbal or standard NU-CHIPS WIPI PBK

80 Assessing FM/DM Benefit Questionnaires FM Listening Evaluation for Children (C. DeConde-Johnson) Example: Children responds to his/her name when spoken to: Seldom Sometimes Usually A. In a quiet room, within 3ft NA B. In a quiet room, at 10 ft NA C. in a noisy room, within 3 ft NA D. in a noisy room, at 10 ft NA E. without visual cues NA F. From another room NA G. Outside/in the community NA

81 Group Share

82 Q&A