Audiogram of Familiar Sounds

Transcription

1 TM AUDIOGRAM OF FAMILIAR SOUNDS Audiogram of Familiar Sounds Frequency in Cycles per Second (HZ) z v Hearing Level in Decibels (db) p j mdb n ng ci u i oar f s th h s ch sh k Advanced Bionics For questions or additional information: Toll Free TTY Monday through Friday, 5am to 5pm PST Web AdvancedBionics.com CustomerService@AdvancedBionics.com ToolsforSchools@AdvancedBionics.com 027-M Advanced Bionics AG and affiliates. All rights reserved.

2 TM BEHAVIORAL LISTENING CHECK Form for recording a child s responses to the Ling Six sounds Child s Name: Age: Date: Cochlear Implant (CI): Right Ear Left Ear Both Ears Hearing Aid (HA): Right Ear Left Ear HA Settings: CI Settings: Technique Used: Detection Discrimination Identification Response Used: Behavioral Conditioned Play Pointing Repeating Presentation Level: Whisper Normal Voice Loud Voice Distance: 3 feet 6 feet 12 feet Reliability: Good Fair Poor Ling Sound Monday Tuesday Wednesday Thursday Friday Saturday Sunday AH EE OO SH S M Silence Note: Remember to present the Ling Six sounds in random order and to vary your length of presentation so that the child does not provide false positives. Advanced Bionics For questions or additional information: Toll Free TTY Monday through Friday, 5am to 5pm PST Web AdvancedBionics.com CustomerService@AdvancedBionics.com ToolsforSchools@AdvancedBionics.com 027-M Advanced Bionics AG and affiliates. All rights reserved.

3 TM TRACKING AUDITORY PROGRESS IN CHILDREN WITH COCHLEAR IMPLANTS By Amy McConkey Robbins, MS, CCC-SLP, LSLS Cert. AVT What are the auditory benchmarks for average progress in children with cochlear implants (CI) during the first year of implant use? Auditory benchmarks have been established independently for three groups of children, based upon research findings and clinical experience. 1-5 These groups are: Group 1: Children implanted in the preschool years (age four or earlier). Group 2: Children implanted at age five or later who have some residual hearing/speech perception skills, have consistently worn hearing aids, and communicate primarily through speech. Group 3: Children implanted at age five or later who have little or no residual hearing/speech perception skills and are highly dependent on sign language and other visual cues for language learning. The benchmarks shown for each of the three groups in Tables 1, 2, and 3 are based on data collected and reported by the investigators cited above. Tracking Auditory Progress in CI Children Note: Child is credited only for skills in listening-alone conditions. "Spontaneous" means without prompting or modeling and when not in a listening set. Time post-implant child should demonstrate the skill Table 1 Group 1 Children implanted at age four years or earlier Skill 1 mo. 3 mos. 6 mos. 9 mos. 12 mos. 1. Full-time use of CI 2. Changes in spontaneous vocalizations with CI use 3. Spontaneously responds to name 25% of time 4. Spontaneously responds to name 50% of time 5. Spontaneously alerts to a few environmental sounds 6. Performance in audio booth consistent with what is reported at home 7. Evidence of deriving meaning from many speech and environmental sounds 8. Major improvement in language

4 TM TRACKING AUDITORY PROGRESS IN CHILDREN WITH COCHLEAR IMPLANTS Table 2 Group 2 Children implanted at age five years or older (Some residual hearing, consistent HA use prior to CI, primarily oral) Skill 1 mo. 3 mos. 6 mos. 9 mos. 12 mos. 1. Full-time use of CI 2. Understands some words or phrases, closed-set 3. Understands many words or phrases, closed-set 4. Spontaneously responds to name 50% of time 5. Understands familiar phrases in everyday situations when listening, auditory alone 6. Spontaneous recognition of own name versus names of others 7. Knows meaning of some environmental or speech signals when heard, auditory only 8. Major improvement in language Table 3 Group 3 Children implanted at age five years or older (Limited or no residual hearing, limited or no HA use, heavily reliant on visual cues or signs) Skill 1 mo. 3 mos. 6 mos. 9 mos. 12 mos. 1. Full-time use of CI 2. Begins to discriminate patterns of speech (syllable number, stress, length, etc.) 3. Understands some words in closed-set 4. Begins to spontaneously respond to name 5. Reports when device is not working (e.g., dead battery) 6. Understands many words or phrases in closed set 7. Understands a few things, open-set 8. Major improvement in language Note: Full-time implant use is an unconditional prerequisite to auditory development. If a child is not wearing the implant during all waking hours at home, school, and other activities these benchmarks are not applicable. Children who fail to bond to their device and wear it full-time within a few weeks of initial stimulation may exhibit insufficient progress and are at high risk of becoming nonusers of their implants. References 1. Robbins, A.M. (2003) Communication Intervention for Infants and Toddlers with Cochlear Implants. Topics in Language Disorders, Vol. 23, no. 1; Osberger MJ, Zimmerman-Phillips S, Barker MJ, Geier L. Clinical trial of the Clarion cochlear implant in children. Annals of ORL. Suppl ;108(4): Waltzman SB, Cohen N. Implantation of patients with prelingual long-term deafness. Annals of ORL. Suppl ;108(4): Robbins AM, Koch DB, Osberger MJ, Phillips SZ, Kishon-Rabin L. Effect of age at implantation on auditory skill development in infants and toddlers. Archives of Otolaryngol Head Neck Surg. 2004;130: McClatchie A, Therres MK (2003) AUditory SPeech & LANguage (AuSpLan). Washington, DC:AG Bell.

5 TM IDENTIFYING RED FLAGS By Amy McConkey Robbins, MS, CCC-SLP, LSLS Cert. AVT Why identify Red Flags? The acquisition of listening is a developmental process that involves a sequence of cumulative skills each subsequent skill depends on the acquisition of earlier skills. For this reason, delays early in listening development often lead to long-term delays, and long-term delays usually lead to lifelong deficits. Clinicians should be familiar with the range of progress in typical children with implants so they are comfortable raising a Red Flag when a child s performance lags behind that of his/her peers. However, it is important to note that what we term a Red Flag is not a diagnosis of a problem or a statement of permanent disability, but a notice to pay attention to the skill. What is considered a Red Flag? Based on the auditory benchmarks provided on the front side of this card, a Red Flag is a delay in a particular skill of three months or more. It is important to remember raising a Red Flag is an expression of mild concern. The number of Red Flags raised is based on the length of the delay and the number of skills delayed. Therefore, the greater the number of skills that are delayed at an interval, the more substantial the concern. What do we do about Red Flags? There is little value in raising a Red Flag for a listening skill unless we can suggest ways to monitor and improve that skill. Remember that a clinical Red Flag is not a diagnosis of a problem but an indication that increased attention needs to be given to a specific skill area. Below is a table that provides you with tips on how to respond to Red Flags. Responding to Red Flags Table 4: How to respond to one Red Flag þ Share ideas with child s parent þ Confirm child wears CI during waking hours þ Contact CI center regarding possible equipment/ programming changes þ Assess that home/school environment creates a need for child to use the skill þ Verify that prerequisites to a skill are adequately established þ Break down skill into smaller steps and teach those steps þ Use different materials/teach the skill in another way þ Increase the intensity of training toward the skill þ Write plan of action/check every month for three months Table 5: How to respond to two Red Flags þ Share concern with child s parent þ Confirm child wears CI during waking hours þ Contact CI center regarding equipment/ programming changes þ Utilize any one-flag response þ Change teaching methods/techniques þ Add sensory modality þ Consult with a colleague for new ideas þ Refer for learning profile testing þ Refer to specialists to rule out additional disabilities Reference: Robbins AM. Clinical Red Flags for slow progress in children with cochlear implants, Loud & Clear. Valencia, Calif.: Advanced Bionics; 2005:1. Advanced Bionics For questions or additional information: Toll Free TTY Monday through Friday, 5am to 5pm PST Web AdvancedBionics.com CustomerService@AdvancedBionics.com ToolsforSchools@AdvancedBionics.com 027-M Advanced Bionics AG and affiliates. All rights reserved.

6 TM THE LING SIX SOUNDS Advanced Bionics For questions or additional information: Toll Free TTY Monday through Friday, 5am to 5pm PST Web AdvancedBionics.com 028-M Advanced Bionics AG and affiliates. All rights reserved.

7 Maximize Your Hearing Potential with fun, effective rehab tools from Advanced Bionics Are you ready to start your rehab now? 1. Register for TheListeningRoom.com to access free lessons to build listening skills, language skills and music appreciation. 2. Find lessons for any age and any point along your hearing journey.

8 Ready for more? Download unique rehab Apps, explore resources and seek support at AdvancedBionics.com Education and Support for All Ages Babies & Toddlers Connect with the BEA services or call HEAR (4327) BabyBeats early intervention resource Contact an AB representative Online Education Resources are available under the Support tab on AdvancedBionics.com My Child s Hearing Adventure Contact an AB representative HearingJourney HearingJourney online forum HearingJourney.com Tools for Toddlers AdvancedBionics.com/tfs Pre-School & School-Aged Children Adults and Teenagers AB Listening Adventures Available for purchase in the App store CLIX able CLIX ipad app Available for free in the App Store AB Vocab Scenes Available for purchase in the App store Musical Atmospheres Click on the link under Related Sites in the footer of AdvancedBionics.com Tools for Schools program AdvancedBionics.com/tfs mynaída CI app Download the free App for Apple and Android devices from itunes or Google Play digital distribution platforms TuneUps Available for purchase by calling customer service at If you would like more information or have questions, please contact an AB representative at HEAR (4327) or hear@advancedbionics.com 028-M Advanced Bionics AG and affiliates. All rights reserved. itunes and ipad are trademarks of Apple Inc. Google Play is a trademark of Google Inc.

9 AH EE OO SH S M Silence TM THE LING SIX Sound Check What is the Ling Six Sound Check? The Ling Six Sound Check is an easy-to-use tool that evaluates how well children are hearing with their cochlear implant and/or hearing aid. The test is a behavioral listening check that uses simple sounds to detect changes in the quality of a child s hearing. The test should be completed at the start of each school day or therapy session and any time you suspect a child is not hearing as well as they normally do. The sounds used for the Ling Six Sound Check are ahh, eee, ooo, mmm, shh, and sss. These sounds approximately cover sounds ranging from Hz and represent speech in the low, mid, and high frequencies. The chart below describes how these sounds broadly represent the sounds needed to hear spoken language. If the child has the ability to hear: Up to 1,000 Hz Up to 2,000 Hz Up to 4,000 Hz They should be able to detect: ahh eee and ooo sh s How do I Complete the Ling Six Sound Check? Verify the child s equipment is on and set at the appropriate settings. Sit beside the child. Younger children can be seated in a high chair. Always position yourself on the child s better hearing side. If you are using an auditory screen, hold it about four inches in front of your mouth so your mouth is completely covered. Using a normal speaking level, say each of the sounds so that they can be discriminated through listening alone. Make sure you are not providing any visual cues such as raising your eyebrows or other facial movements and that the child cannot lip-read. Each of the sounds should be presented for the same length of time without rising or falling pitch. After presenting each sound, wait for the child to respond in a manner that is appropriate for their age (see the Considerations for Different Ages section below for further information). Present all six sounds at least three times in random order. Vary the length of your pauses. Occasionally make no sound at all, allowing nothing to be an appropriate response. Keep track of the child s responses so you can compare performance over time. BEHAVIORAL LISTENING CHECK AB Makes it Simple For Schools: AB Makes it Simple For Schools: Form for recording a child s responses to the Ling Six sounds Child s Name: Age: Date: Cochlear Implant (CI): Right Ear Left Ear Both Ears Hearing Aid (HA): Right Ear Left Ear HA Settings: CI Settings: Technique Used: Detection Discrimination Identification Response Used: Behavioral Conditioned Play Pointing Repeating Presentation Level: Whisper Normal Voice Loud Voice Distance: 3 feet 6 feet 12 feet Reliability: Good Fair Poor Ling Sound Monday Tuesday Wednesday Thursday Friday Saturday Sunday Note: Remember to present the Ling Six sounds in random order and to vary your length of presentation so that the child does not provide false positives. Download the Tools for Schools Behavioral Listening Check tracking form to record responses to the Ling 6 Sound Check. Visit AdvancedBionics.com/TFS Make your own auditory screen. Visit The Listening Room rehabilitation website at TheListeningRoom.com and search for The Ling Six Sound Screen Assembly Instructions Advanced Bionics For questions or additional information: Toll Free TTY Monday through Friday, 5am to 5pm PST Web AdvancedBionics.com CustomerService@AdvancedBionics.com ToolsforSchools@AdvancedBionics.com 027-M Advanced Bionics AG and affiliates. All rights reserved.

10 Considerations for Different Ages The Ling Six Sound Check can be used with children of different ages and various auditory skill levels. Babies and very young children will provide responses that allow you to confirm detection and possibly discrimination. Older children will provide responses that allow you to confirm identification. Keep in mind that a child who is a new recipient of a cochlear implant or hearing aid will begin with detection tasks and then progress to discrimination and identification tasks as appropriate. Below is a description of the auditory skill levels you can test with the Ling Six Sound Check: Auditory Skill Level Description Detection Recognizing the presence or absence of sound Discrimination Discerning if two or more sounds are the same or different Identification Reproducing a sound or pointing to a picture of the sound heard Babies (Detection Task) When babies hear one of the Ling Six Sounds presented, they may respond through a behavioral cue such as eye widening, turning their head, or displaying a change in sucking behavior if using a pacifier or having a bottle. Keep in mind the baby must be able to consistently repeat these types of behavioral responses when sound is presented for the response to be considered valid. Young Children (Discrimination and Identification Task) You Very Young Children (Detection Task) Very young children can be taught to respond each time they hear by dropping a block in a bucket, pointing to their ear, or raising their hand. These methods are called Conditioned Play. Instructions on how to train children to complete a detection task using a Conditioned Play response are below. Older Children (Identification Task) Older children can respond can help young children respond using a higher-level discrimination or identification response with the use of toys. It is easy to find toys to represent each of the Ling Six Sounds. For example, an airplane for the ahh sound and a snake for the sss sound. Instructions for how to train children to complete a discrimination or identification task are below. by pointing to a picture card that represents each sound or by simply repeating what was heard. AB Makes it Simple For Schools: Download the Tools for Schools Ling Six Sound Flash Cards or Ling Six Sound Flyer Visit AdvancedBionics.com/TFS

11 Training Children to Complete the Ling Six Sound Check Training for Detection Conditioned Play can be used to teach children how to complete a detection task. To begin teaching children how to complete Conditioned Play, do the following: Sit beside the child. Younger children can be seated in a high chair. Always position yourself on the child s better hearing side. Allow the child to use lip reading and visual cues while you complete training. Hold a block next to the child s ear or help get the child in the correct posture for listening and responding appropriately for the task you are training. Each time you say one of the Ling Six Sounds, help the child drop the block in the bucket, raise their hand, or complete the desired conditioned play response you are training the child to do. It is often helpful to present the sound, pause, and look expectantly at the child. Use an excited facial expression, point to your ear and say I heard that! After several rounds of helping the child to respond in the appropriate way, say the sounds, look expectantly at the child, and see if the child will perform the required task on their own. Continue to allow the child to use lip reading and visual cues during this stage of training. Remember to train the child that no sound is possible and nothing can be an appropriate response. You can model how to indicate nothing by shaking your head back and forth and saying I don t hear a sound. Use the Auditory Sandwich to help transition the child to an auditory only task (Instructions below). Once the child is consistently responding you should eliminate all visual and lip reading cues. You are ready to complete the Ling 6 Sound Check. Training for Discrimination and Identification To begin teaching children how to complete a discrimination and identification task, do the following: Gather the appropriate toys or picture cards to represent the Ling 6 Sounds. Sit beside the child. Younger children can be seated in a high chair. Always position yourself on the child s better hearing side. Allow the child to use lip reading and visual cues while you complete the training. Start with two objects such as an airplane for ahh and a baby for shh. Point to or hold up the object and say the corresponding sound. Hold up the other object and say the corresponding sound. Do this several times. While teaching each sound, use lots of intonation in your voice to highlight the sounds. As you hold up the object, encourage the child to make the corresponding sound with you. It is often helpful to hold the object in front of you, say the sound, and then put the object in front of the parent who will model the sound, then in front of the child, pause, and allow the child a chance to say the sound. Eventually say the sound without holding or pointing to the object and see if the child will point to or pick up the corresponding toy or picture card on their own. Continue to allow the child to use lip reading and visual cues during this stage of training. Add in additional sounds and their corresponding toy or picture as the child gets comfortable with the task. If the child is not ready for a set of six choices, keep the set size small and continue to train the child on how to complete the task. Gradually increase the set size to 6. Remember to train the child that no sound is possible and nothing can be an appropriate response. You can model how to indicate nothing by shaking your head back and forth and saying, I don t hear a sound. Use the Auditory Sandwich to help transition the child to an auditory-only task (Instructions below). Once the child is consistently responding, you should eliminate all visual and lip reading cues. You are ready to complete the Ling 6 Sound Check.

12 It is important to pause when doing the Ling 6 Sound Check and allow children to indicate they do not hear any sound. Training children that no sound and nothing are appropriate responses is an important part of the Ling 6 Sound Check. Helping Children Transition to an Auditory-Only Task Using the Auditory Sandwich: LISTEN ALONE LISTEN WITH SUPPORT LISTEN ALONE Listening Alone (Top Slice of Bread) - Present the Ling Six Sounds initially auditory-only with no visual information or cues. Listening with Support (Meat and Veggies) - If the child is unable to provide the correct response, present the information again using visual cues such as lip reading, or pointing to the corresponding toy or picture card. Listening Alone (Bottom Slice of Bread) - Present the information again auditory-only with no visual information or cues. Test Tips It is very easy for children to pick up on patterns so always vary your presentation order. Use an auditory screen or make sure your mouth can not be seen by the child. Be careful about providing any visual cues such as raising your eyebrows or other facial movements. Watch for children who respond sss when they hear nothing. Some children compensate for not hearing soft sounds and guess sss. You can use the Ling Six Sounds Check to evaluate the benefit of assistive devices such as Roger or FM systems. Assistive devices each have their own operating range so be sure to complete the test from an appropriate distance for the assistive device with which you are working. Vary the distance of presentation for older children who identify Ling sounds through identification. Train children that no sound and nothing are appropriate responses. You can model how to indicate nothing by shaking your head back and forth and saying I don t hear a sound. What to do if the Ling Six Sound Check Indicates a Change in Hearing Ability Confirm the child s cochlear implant processor and/or hearing aid is set to the appropriate program and settings. Complete basic troubleshooting to determine if any part of the child s equipment is not working appropriately. Complete a listening check to confirm the sound quality from the child s cochlear implant and/or hearing aid is clear. Contact the child s parent or audiologist to report there has been a change in hearing. AB Makes it Simple For Schools: Download the Cochlear Implant Referral Form to report changes in a child s hearing to the child s audiologist. Visit Advancedbionics.com/TFS AB Makes it Simple For Schools: Download equipment troubleshooting guides. Visit Advancedbionics.com/TFS 028-M Advanced Bionics For questions or additional information: Toll Free TTY Monday through Friday, 5am to 5pm PST Web AdvancedBionics.com CustomerService@AdvancedBionics.com ToolsforSchools@AdvancedBionics.com 2016 Advanced Bionics AG and affiliates. All rights reserved.

13 Literacy Strategies for the Very Young Child By Krista S. Heavner, MS, CCC-SLP/LSLS Cert AVT When you begin planning therapy for the infant with hearing loss, the first thought may be that books are not appropriate due to a baby s lack of maturity and attention. However, the opposite is actually true. You can and should begin introducing books to children when they are in the womb and certainly as soon as the child is born. Below are several charts designed to provide you with strategies on how to facilitate pre-literacy development in the very young child. Therapy for the Infant (0 6 Months) The Adult The Child Book Features Modeling (for parents) Exposure to print Familiarity with books Familiarity with adult voice Listen and observe Bonding with the adult By 6 months of age, the child wants to hold/touch/eat the book Simple, large pictures Bright designs Chunky/board books Fold-out books Point to pictures Increased interest in pictures, Cloth/vinyl books bright and bold colors Use books with bright colors and tactile properties Interest in pictures of faces parentese (acoustic highlighting with the voice) Read a few pages at a time Watch for cues to turn the page Use simple phrases Make up your own words Therapy for the Infant (6 12 Months) The Adult The Child Book Features Continue with parentese Follow child s lead opportunity to explore turning pages Talk about pictures Keep books on low shelves Offer a teething toy! Make up story Attends to pictures Recognizes familiar objects Turns pages with help Vocalizes in response to reading Pats pictures Prefers pictures of faces listens and observes with increased attention, yet continues to have short attention span for long books Board books Pictures of babies Familiar objects Bath books Small plastic photo albums Nursery rhymes Books about routine events Multisensory books TOOLS for Toddlers by Advanced Bionics 1 Cochlear Implants in the Classroom

14 Therapy for the Toddler (12 18 Months) The Adult The Child Book Features Point out author name/illustrator Use rhyme Continue to expand on the vocabulary in the books Turn pages Holds book may be too mobile to stay interested Books that label Sturdy books Books of familiar routines Rhyming Choose books with topics familiar points to and names familiar repetition (same books over to the child (relevancy) objects in book and over) Enjoys familiar routine Repetitive phrases May ask to be read to Therapy for the Child (18 24 Months) The Adult The Child Book Features Use props/finger puppets Choose relevant books Encourage participation Continue to model for the parent Encourage participation Offer an occupying toy Relate books to child s life Fills in words for familiar phrases Reads aloud Child s attention fluctuates expect it! Recites familiar passages Board books Simple rhymes simple stories about familiar routines and animals Bedtime stories Character books Predictable books Books with flaps Repetitive Large Print TOOLS for toddlers by Advanced Bionics 2 Literacy strategies for the VeryYoung Child OCT10_ A 2010 Advanced Bionics, LLC and its affiliates. All rights reserved.