Engaging with Sound and Optimising Listening Skills for Children and Young People with Multi-Sensory Impairment

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1 Engaging with Sound and Optimising Listening Skills for Children and Young People with Multi-Sensory Impairment

2 Seashell Trust Seashell Trust is a national charity educating and caring for children and young people with complex learning, communication and sensory needs.

3 For more information

4 How does a child or young person with complex needs and a hearing impairment make sense of their auditory world and how can we can help them to understand that sound carries meaning?

5 WHAT MAKES A COMPLEX MSI YOUNG PERSON DIFFERENT? Every student is different and probably doesn t fit any existing grouping EG. CHARGE Students lack of understanding/expectations Difficulty processing sensory information and can easily become over-loaded The need for familiar professionals and support staff? Often unable to express their needs and have them met

6 What do we think sound is like for a young person with SLD/PMLD? It has been described in the literature as a blooming, buzzing confusion PMLD -may be only a window on the world around them (unquantifiable) Auditory processing can be very inconsistent Sound may carry very little meaning May have phonophobia May have true hyperacusis (loudness intolerance)

7 Blooming, buzzing confusion

8 What challenges do we face when trying to assess the hearing of complex needs patient? Inconsistent behavioural thresholds (intra-subject variability) Poor correlation between ABR and observed behavioural responses Multi-sensory processing difficulties (competing stimuli) Cognitive processing impairment arising from neuroprocessing difficulties? Often results are very inconclusive and uncertain

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10 The speech banana

11 The Human Ear

12 The auditory pathway

13 Auditory Processing Some processing skills develop throughout childhood and may be delayed with complex needs children (neural maturation) Some processing skills are influenced by top-down cognitive processes. Deafness can affect the development of some auditory processing skills. For example, listening through hearing aids provides a degraded sound compared to natural hearing. Also, fluctuating hearing, such as with persistent glue ear or inconsistent hearing aid use, provides the brain with mixed auditory input.

14 What do we want to achieve? What are our expectations when promoting and developing auditory/listening skills (and/or fitting hearing aids) for a child with complex needs? improved communication ranging from speech to intentional vocalisations enhanced environmental awareness social interaction/awareness increased sense of 'connectedness' with the outside world? make exploration of sound and music accessible stimulate active listening eg. through sensory integration (as part of multi-sensory input)

15 WHAT CAN WE DO TO HELP for poor auditory processing and limited listening skills Motivational listening using live instruments and choice boards to develop auditory awareness Matching natural sounds to pictures/symbols Conduct listening activities in a very low distraction environment with minimal competing stimuli Check with carers about any confounding issues eg. a sleepless night, seizure activity prior to sessions/tests Allow time for processing and accept good and bad days

16 Programmes that we use to support students to make sense of sound? Provide structured listening sessions to elicit a response and try to make sound meaningful We use TLP at Seashell Trust May need to start with simple engagement such as intensive interaction Start with detection focussing on start and stop Provide a safe listening environment free from other stimuli and sensory clutter. Aurythmics with live musicians

17 Music Use music during transition to filter out unpredictable noise 2/4 time 'grabs them rhythmically Jingles to cue a certain activity Predictability of a song a distinct beginning, middle, and end. Music that is simple with clear and predictable patterns most effective in eliciting responses to joint attention in children in the severe range of functioning.

18 Suggestions for embedding listening into classroom activities and programmes Consistently use very short jingles to cue in as many different activities as possible. Suggestions:I m a pink/blue toothbrush for brushing teeth Select a favourite sensory toy and create a very short tune to identify it and prepare student prior to being given the toy EG Leona Lewis Light up, light up for a sensory light toy In a quiet environment without other distractions, intensive interaction/listening mirroring the student s own vocalisations but developing the sound perhaps into 2 notes or a short melody and develop this into turn-taking. Develop a popular short tune but with an in-built element of surprise which can be exploited EG Bibbedy Bobbity Bibbedy Bobbity /BOO/ and hold off on the /BOO/ to build up the anticipation. EG /AA/ went the little green frog one day

19 Problems of sound and transition Anxiety about unfamiliar environment Fear of unpredictable sounds Hearing aids amplify environmental and background noise Sounds may distort due to over stimulation and multisensory processing problems (overload) Out of routine Unable to filter out extraneous stimulation MSI students may have rudimentary vestibular systems and be unbalanced and dizzy in an upright position

20 What may a student do to manage their sound environment? Block ears or request ear defenders Student may make sounds to control and mask unwanted sound Remove hearing aids Ground themselves by dropping to the floor/ground or get stuck Distract themselves by visual or tactile actions

21 How can we support transitions? Visual support Allow time Preparation Sensory regulation (weighted jackets) Minimise speech (single words) Familiar support worker Music (masker) ipod and ipad

22 Background noise Most speech is heard in noise With normal hearing, communication is still possible when the signal to noise ratio is negative People vary a lot in their ability to hear well in background noise Deafness makes the problem worse Steady noise is worse than fluctuating noise ( dip listening or glimpsing makes it easier to pick up some sounds and clues) Deafness causes limited glimpsing capabilities Children aren t able to ignore another talker.

23 MULTI-DISCIPLINARY WORKING Liaison meetings with TOD s and specialist LSA with responsibility for hearing impaired students Joint sessions and planning with SALT s to look at communication systems and deliver joint aurythmic sessions Joint sessions with OT s to deliver multi-sensory programmes (planned sensory movement sessions to music or vibration)