Overview. Each session is presented with: Text and graphics to summarize the main points Narration, video and audio Reference documents Quiz

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1 TAVS Online Certification Course 2014 Advanced Brain Technologies All Rights Reserved Overview Each session is presented with: Text and graphics to summarize the main points Narration, video and audio Reference documents Quiz Build your own TAVS profile 1

2 Comprehensive Training Provide an overview of auditory processing Ensure you are comfortable offering a TAVS assessment Self-paced Around 7 hours for course completion Session Topics TAVS Overview Auditory Processing Skills APD Assessment and TAVS The Pre-test TAVS Quick Auditory Screening Options Extended Screening Options Adjusting TAVS Testing Parameters Case Studies 2

3 Online Learning Success 1. Set time aside 2. Make a regular schedule 3. Completion date 4. Talk about it 5. Celebrate successful completion of modules 6. Ask questions 3

4 TAVS Online Certification Course 2014 Advanced Brain Technologies All Rights Reserved Overview The Test of Auditory and Visual Skills TAVS Pre and Post testing tool Low level auditory and visual processing Assesses areas concerned with timing, intensity, sequencing and frequency Quick and easy Suitable for age 5 upwards 1

5 The TAVS package The Test of Auditory and Visual Skills TAVS TAVS machine including headphones Prompt cards PDF Download: - User Guide - TAVS screening sheets TAVS subtests There are 9 main areas that TAVS covers Temporal Order Fusion Threshold Motor skills Pitch Discrimination Duration Pattern 2

6 TAVS subtests There are 9 main areas that TAVS covers Gap in Noise Sequence Order Pitch Pattern Crossmodality Hearing Before Listening Check hearing is within normal ranges Full audiological assessment if necessary The results available are based on normal hearing thresholds 3

7 Seeing Before Looking Check vision is within normal ranges Any glasses or contact lenses should be worn as normal. Eye test recently? TAVS Screening Options No specific exclusion criteria Youngest 5 years old Assess how well a child can respond to the Pretest Quick Auditory Screening Extended individualized screening options 4

8 TAVS Online Certification Course 2014 Advanced Brain Technologies All Rights Reserved Sound Music Language Auditory Processing Sound is a wave One wave per second is one Hertz (Hz) Our normal hearing range is 20-20,000Hz Most sounds we hear are complex tones, not pure tones. Sounds are complex combinations of many frequencies Trumpet: Hz Trombone: Hz Flute: 130-2,093Hz Oboe: 293-1,047Hz Violin: 98-1,568Hz Cello: 32-1,047Hz 1

9 Three Instruments - Spectrum Understanding Auditory Processing FREQUENCY How high or low? AMPLITUDE How loud or soft? SPACE Where does it come from? TIME How long does it last? 2

10 Understanding Auditory Processing Courtesy of Uwe Minning Understanding Auditory Processing Option Option Option Option 4 Audio courtesy of Uwe Minning 3

11 Frequency How high or low? Tonotopic Organization Sources: Neuroscience: An Outline Approach, Anthony Castro icg.harvard.edu/~psy1-s/ lectures/06sensation/ 4

12 Amplitude How loud or soft? Small changes in volume help us to identify rhythm Steady beat competency has been shown to be one of the keys to academic success Awareness of volume is important for hearing, listening and speaking Space Where does it come from? Spatial location of sound helps us to concentrate and focus in any environment. Important for survival. It works from a combination of timing and volume between both ears. 5

13 Time How long does it last? How long a sound lasts and the gap between one sound and the next is crucial to the processing of language. Beginning (Onset) and ending (offset) of sound vital for listening. Many children with autism are known to experience timing and frequency problems in the brain stem. Auditory Processing Skills Amplitude Perception - To perceive the loudness or intensity of sounds. This is measured in decibels (abbreviated db ). Frequency Perception - To perform a frequency analysis; for example, the ability to split sounds into various frequency bands. Frequency is measured in Hertz (abbreviated Hz ). Auditory Attention - To attend, focus, or listen to sound. Sound Localization - To identify the source of a sound in your environment. 6

14 Auditory Processing Skills Auditory Discrimination - To distinguish between sounds or words that are similar or different in the way they sound. Auditory Closure - To fill in the missing pieces of sounds or words. Auditory Anticipation - To expect what sound is coming next. Auditory Temporal Processing - To analyze the timing and pattern of sounds. Auditory Processing Skills Auditory Memory - To sequence sounds, words, or other meaningful combinations. To receive, store, process, and recall auditory information. Auditory Cohesion - To understand the meaning, abstraction, and intention of verbal communication and music. Auditory Figure Ground - To perceive speech or other sound when other competing sounds are present. Auditory Scene Analysis - To separate sounds when a large mixture of sounds is present. 7

15 TAVS Online Certification Course 2014 Advanced Brain Technologies All Rights Reserved Overview Using TAVS Working with the Pretest Interpreting the Pretest TAVS User Guide pages 2-6 Pretest Record Sheet and Quick Screening Record Sheet (appendix 1 and appendix 2) 1

16 TAVS Overview You should have the following available TAVS machine including headphones TAVS User Guide pp3-6 Pretest Record Sheet and Quick Screening Record Sheet Using TAVS Easy to navigate Left and right buttons Headphones ports Switching on Press buttons with your thumbs Automatic switch off! 2

17 TAVS Pretest Checks suitability for testing Inattention Impulsivity Slow processing TAVS Pretest 2 minutes long Consists of white noise with gaps Gap with a tone press button Silent gap no press High tone, low tone or silence within gap 3

18 TAVS Pretest Put on headphones Switch on TAVS Choose <pretest - left button Take the Pretest TAVS Pretest Press left button < Results + and - scrolls through the 5 categories Write down results on Pretest Record Sheet Appendix 1 hit lov High tone/low volume lot lov Low tone/low volume hit hiv High tone/high volume lot hiv Low tone/high volume Gap Err Silent Gap 4

19 Quick Screening Record Sheet Pretest results Pretest Record Sheet hit lov High tone/low volume lot lov Low tone/low volume hit hiv High tone/high volume lot hiv Low tone/high volume Gap Err Silent Gap Ideal result is 0% error and 0 event errors Worst result is 100% error TAVS Pretest Press on or menu button to return to the results options Press right button for events > Write down events on Pretest Record sheet Appendix 1 For hit lov, lot lov, hit hiv and lot hiv, each error response will be 20%, i.e. 1 in 5 5

20 Pretest Record Sheet appendix 1 Left hand columns list type of event 33 different events 20 events tone in gap, 13 events silent gap Right hand columns Answer time and Response, OK or Err Only complete if % errors are above 40% Understanding the Pretest Errors on low volume events Errors in high tone events Errors in low tone events Silent gap errors High errors for tone / low errors for gap High general error rate 6

21 TAVS Online Certification Course 2014 Advanced Brain Technologies All Rights Reserved Overview Recommended testing for APD Introduce main auditory screening areas Discuss how the individual screening areas link to functional skills 1

22 APD Test Battery At present, there is no universally accepted audiological APD test battery, nor any general consensus regarding the extent of the nonaudiological assessments that need to be conducted *British Society of Audiology Practice Guidance An overview of current management of auditory processing disorder (APD) August 2011 In fact APD is not included in DSM-V so is not universally accepted as a diagnosis in itself. APD Test Battery American Speech Hearing Association (ASHA 2005), American Academy of Audiology and the British Society of Audiology recommend an audiological test battery that includes Dichotic listening Temporal Processing Auditory Pattern Processing Binaural interaction Monaural low redundancy Auditory discrimination Sound localization Performance in competing acoustic signals Performance with degraded acoustic signals 2

23 APD Test Battery Dichotic listening This type of test uses two words delivered simultaneously to the left and right ears you are asked to say both words or focus on the left or right ear to respond It is primarily a test of auditory laterality and the functioning of the corpus callosum (Westerhausen and Hugdahl (2008)) SCAN 3 is the most extensively used dichotic test around the world APD Test Battery Temporal Processing The processing of the time structure of sounds Includes temporal integration, temporal resolution and temporal sequencing Much research shows poor temporal resolution is linked to poor reading, e.g. Ahissar et al (2000), perception of speech in noise, e.g. Snell et al. (2002) and speech perception deficits 3

24 APD Test Battery Auditory Pattern Processing The processing of the changes in volume and frequency to enable recognition of patterns. Binaural Interaction How the auditory signals coming into both ears are combined to form a 3D auditory map. Important for sound localization and listening in background noise. APD Test Battery Monaural low redundancy How well we can listen in a reduced quality listening environment. Usually tested through either Low-pass filtering time compression adding reverberation to the signal Auditory discrimination A general term to describe the ability to differentiate the many auditory signals in the environment. 4

25 APD Test Battery Sound localization This is a product of volume and time differences between the two ears. It describes how we can locate sound within the 360 of our environment. Performance in competing acoustic signals The ability to perceive speech or other sounds when another signal is present such as speech or background noise. Performance in degraded acoustic signals The ability to perceive a signal in which information is missing. Problems in this area are often manifested as difficulty hearing in background noise. TAVS screening areas TAVS screens the following areas: Temporal Processing Auditory Pattern Processing Binaural Interaction Auditory Discrimination Sound Localization 5

26 TAVS screening options TAVS screens the following areas: Temporal Processing Temporal Order Processing, Fusion Threshold, Duration Pattern, Noisegap Auditory Pattern Processing Pitch Pattern, Duration Pattern Binaural Interaction Fusion Threshold, Directional Hearing TAVS screening options TAVS screens the following areas: Auditory Discrimination Pitch Discrimination, Duration Pattern, Pitch Pattern Sound Localization Directional Hearing 6

27 TAVS Online Certification Course 2014 Advanced Brain Technologies All Rights Reserved Overview Introduce the Auditory Quick Screening Examine the 5 areas involved Understand how to record and interpret results 1

28 Overview Before the screening ensure you have The TAVS machine and headphones Spare headphones if required TAVS User Guide Prompt cards Quick Screening Record Sheet Appendix 2 Overview Before conducting screening complete Pretest Ensure quiet environment No right or wrong answers Not a race! Headphones comfortable Left on left / right on right ear 2

29 Auditory Quick Screening Conduct the Pretest Explain they will hear noise with gaps Press when they hear a tone in the gap 2 minutes long Notice behavioral clues during Pretest TAVS (Auditory) Quick Screening Options Auditory Quick Screening option includes Auditory Temporal Order Auditory Fusion Threshold Auditory Motor Pitch Discrimination Duration Pattern See TAVS User Guide p 7-9 3

30 Auditory Temporal Order Sequencing sound Lateral presentation either LEFT RIGHT Or RIGHT LEFT See User Guide page 10 and 11 for more information Auditory Temporal Order You will hear 2 clicks, one in each ear. They are close together! Where did the first click come from? Left ear or right ear? Press the button on the side you heard the first click. 4

31 Auditory Temporal Order Understanding the results End of test evaluation start Note best value on record sheet Compare to norm value on page 15 Lower the score better the result Auditory Fusion Threshold One click or two Adult responses achieved by age 8 Affects listening and language See User Guide page 11 for more information 5

32 Auditory Fusion Threshold Fusion Threshold - Auditory You will hear either 1 click or 2 clicks. They are really close together! Press left button 1 click Press right button 2 clicks See User Guide page 11 for more information Auditory Fusion Threshold Understanding the results End of test evaluation start Note best value on record sheet Compare to norm value on page 16 Lower the score better the result 6

33 Auditory Motor Assesses steady beat competency Press left and right buttons in time to the beat Linked to literacy, language, phonological development Will be affected by motor ability See User Guide page 11 & 12 for more information Auditory Motor You will hear clicks in the left and right ear that make a rhythm. Press the left and right button in time to the beat Take a few seconds at the beginning to hear the beat before pressing the buttons See User Guide page 11 & 12 for more information 7

34 Auditory Motor Understanding the results End of test evaluation start Note best value on record sheet Compare to norm value on page 16 Lower the score better the result Auditory Motor Understanding the results Thomson and Goswami Poor motor skills will be a factor Tierney and Kraus adolescent humans who demonstrate less variability when tapping to a beat, have auditory brain stem responses that are less variable as well 8

35 Pitch Discrimination Assesses frequency perception Adults ideally can discriminate 0.5 semitone maximum result! Phonological development and reading See User Guide page 12 for more information Pitch Discrimination You will hear 2 sounds One sound is higher than the other Which sound is higher, 1 st or 2 nd? 1 st sound left button 2 nd sound right button See User Guide page 12 for more information 9

36 Pitch Discrimination Understanding the results End of test evaluation start Note best value on record sheet Compare to norm value on page 16 Lower the score better the result Duration Pattern 3 tones presented - 2 of the 3 are the same length - 1 is longer than the other two Ability to discriminate duration of note Evidence suggests a specific neural mechanism See User Guide page 12 for more information 10

37 Duration Pattern You will hear three sounds One sound is longer than the other two Which sound is longer, 1 st, 2 nd or 3 rd? 1 st sound longer left button 2 nd sound center menu button 3 rd sound right button See User Guide page 12 for more information Duration Pattern Press left OR Press center See User Guide page 13 for more information 11

38 Duration Pattern Understanding the results End of test evaluation start Note best value on record sheet Compare to norm value on page 17 Lower the score better the result Overview Auditory Quick Screening Delay or damage? Auditory Quick Screening highlights areas of difficulty Excellent pre and post intervention 12

39 TAVS Online Certification Course 2014 Advanced Brain Technologies All Rights Reserved Overview How to access other data on: Individual left and right side accuracy Average response times for each side Have a copy of the Full Screening Record Sheet 1

40 Auditory Temporal Order Sequencing sound Lateral presentation either LEFT RIGHT Or RIGHT LEFT See User Guide page 10 and 11 for more information Auditory Temporal Order End of test evaluation start Note best value on record sheet Press the + button - correct L - correct R - Time (total time of test) - av. time L - av. time R Press center button Menu or on to finish 2

41 Auditory Temporal Order Compare correct left and right ear results If similar not significant Investigate large differences e.g. correct L 70%, correct R 97% av. time Left 0.7s, av. time Right 1.2s Hearing loss? Motor problems? Developmental delay? Impulsivity? TAVS Deeper Results Last screening results remain on TAVS Potential to collect results later Your results from Auditory Quick Screening are still available 3

42 Auditory Fusion Threshold Switch on TAVS Choose test and find Fusion Threshold Press menu to choose Fusion Threshold Press and hold menu for 3 seconds When start shows, press menu button Auditory Fusion Threshold Use + button to move through the information and record on the Full Screening Record Sheet Best Value Correct 1 Correct 2 Time av. time L av. time R 4

43 Auditory Motor Find AUDITORY MOTOR Note responses on Full Screening Record Sheet Best value Correct L Correct R Time Difference L Difference R Pitch Discrimination Find PITCH DISCRIMIN Note responses on Full Screening Record Sheet Best Value Correct HL Correct LH Time av. time L av. time R 5

44 Duration Pattern Find DURATION PATTERN Note responses on Full Screening Record Sheet Best Value correct L correct M correct R Time av. time L av. time M av. time R Review See Full Screening Record Sheet 12 subtests give slightly different results Best value or threshold Deeper level information better interpretation of challenges 6

45 TAVS Online Certification Course 2014 Advanced Brain Technologies All Rights Reserved Overview Interpretation of results Case studies Combine with other information: checklists behavioral observations other assessment measures 1

46 Overview Results in 6 areas: Pretest Auditory Temporal Order Auditory Fusion Auditory Motor Skills Pitch Discrimination Duration Pattern Interpreting the Pretest 1. hit lov High tone/low volume 2. lot lov Low tone/low volume 3. hit hiv High tone/high volume 4. lot hiv Low tone/high volume 5. Gap Err Silent Gap Ideal result is 0% error and 0 event errors Worst result is 100% error and 100% event errors For hit lov, lot lov, hit hiv and lot hiv, each error response will be 20%, i.e. 1 in 5. 2

47 Case Study 1 Male age 10 Poor hearing until age 8 Poor handwriting and fine motor Sensory seeking and impulsive Good reader with comprehension Many trips and falls due to poor proprioception and motor integration Referred for OT and Physiotherapy Case Study 1 Male age 10 Results Summary by category Total No. Of Events Error % achieved No. of Event Errors hit lov lot lov hit hiv lot hiv Gap Err Strong results Slightly impulsive Continue to screening 3

48 Case Study 1 Male age 10 TAVS results Auditory Temporal Order Auditory Fusion Auditory Motor Pitch Discrimination Duration Pattern 91msec 5msec 391msec 4.0 ST 200msec Case Study 2 Female age 11 History of ear infections from age 2-4 Grommets fitted age 5 Hearing now normal ranges Reading average with poor comprehension Speech and Language Therapy input up to age 8 Challenges with listening and concentration 4

49 Case Study 2 Female age 11 Poor auditory short term memory Motor coordination weak SCAN results Auditory Closure AFG Competing words Competing sentences 5 th centile 2 nd centile 1 st centile 1 st centile Case Study 2 Female age 11 Results Summary by category Total No. Of Events Error %age achieved No. of Event Errors hit lov lot lov hit hiv lot hiv Gap Err Strong results Continue to screening 5

50 Case Study 2 Female age 11 TAVS results Auditory Temporal Order Auditory Fusion Auditory Motor Pitch Discrimination Duration Pattern 145msec 7.22msec 500msec 8.5 ST 87msec Case Study 3 Female age 12 Unremarkable history Hearing normal across all ranges Assessed as dyslexic Challenges with listening and attention Recent speech and language therapy assessment Delayed language comprehension Avoids eye contact when listening Copes much better with one friend 6

51 Case Study 3 Female age 12 SCAN results Auditory Closure AFG Competing words Competing sentences 1 st centile 9 th centile 1 st centile 1 st centile Case Study 3 Female age 12 Results Summary by category Total No. Of Events Error %age achieved No. of Event Errors hit lov lot lov hit hiv lot hiv Gap Err Sufficient results Continue to screening 7

52 Case Study 3 Female age 12 TAVS results Auditory Temporal Order Auditory Fusion Auditory Motor 117msec 9.50msec 500msec Pitch Discrimination Duration Pattern 10 ST 64msec 1 st 100% 2 nd 62% 3 rd 69% Overview TAVS screenings can be invaluable Baseline screening and progress measure Interpretation is the key 8

53 TAVS Online Certification Course 2014 Advanced Brain Technologies All Rights Reserved Overview Many other screening options Auditory and Visual screening options Visual options are Visual Temporal Order Visual fusion threshold Visual motor Have a copy of appendix 3 Full Screening Record Sheet 1

54 Visual Temporal Order Magnocellular Theory of Dyslexia John Stein Emeritus Professor at Oxford University, UK Magnocells track movement Impaired magnocells in Dyslexia The first sensory trace is not erased Signals appear fused Visual Temporal Order Sequencing visual stimuli Lateral presentation either LEFT RIGHT Or RIGHT LEFT See User Guide page 10 and 11 for more information 2

55 Visual Temporal Order Screen shows Temporal Order Press center button - start val: 250ms Press center button - stimuli auditory Press + button stimuli visual Press and hold center button - < start > See User Guide page 10 and 11 for more information Visual Temporal Order You will see two lights flash. They are close together! Where was the first flash? Left light or right light? Press the button on the side where the first flash was. 3

56 Visual Temporal Order Understanding the results End of test evaluation start Note best value on Full record sheet Compare to norm value on page 15 Lower the score better the result Visual Fusion and Visual Motor Visual fusion lower for Dyslexics Interesting to gain pre and post results Visual system more attuned spatially Visual motor results may be much larger than auditory motor results 4

57 Other testing options Noisegap Directional Hearing Sequence Order Pitch Pattern Duration Pattern / Pitch Pattern 3 responses Crossmodality Noisegap Test of temporal resolution Consists of either one band of noise two bands of noise with a small gap Adult levels reached by around age 7 Around 4 milliseconds average result See TAVS User Guide, page

58 Directional Hearing Measure of sound lateralization Important for Stress levels Concentration and attention Listening in background noise Microsecond differences in presentation in left and right ear signals See TAVS User Guide, page 13 and prompt cards Directional Hearing Take the Directional Hearing test Are you happy navigating TAVS now? If not here is a reminder 1.Switch on TAVS with the center button 2.Choose test by pressing the right button 3.Find Directional Hearing by pressing the + and - buttons. 4.Press the center button 5.Press and hold the center button until < start > is displayed 6.Press the left or right button to begin Record your results and check norms 6

59 Sequence Order Replicates consonant and vowel Consonants higher frequency and shorter Vowels lower frequency and longer Tone replicates the vowel Click replicates the consonant Norms currently from age 8 upwards Pitch Pattern Widely used in APD and dyslexia screening Children who are poor readers Poor pitch pattern skills Poor duration pattern skills Adults who are poor readers Poor duration pattern skills only 3 tones, 2 the same pitch, 1 higher Respond to the highest tone 7

60 Pitch Pattern Press left OR Press center See User Guide page 12 for more information Duration Pattern 3 / Pitch Pattern 3 Variation on a theme! More complex responses required E.g. Duration Pattern 3 - short tone Left button - Long tone Right button SSL LSL Left, Left, Right Right, Left, Right 8

61 Duration Pattern 3 / Pitch Pattern 3 Pitch Pattern 3 - Low tone Left button - High tone Right button E.g. HHL Right Right Left LHLLeft Right Left Crossmodality There is little information available on the interplay of visual and auditory input If assessing visual function it is usual to only use visual stimulus If assessing auditory function it is usual to just use auditory input Assess the interplay of auditory and visual 9

62 Crossmodality Auditory input mechanical 1msec Visual input photochemical 40-50msec What strategy do you employ? primarily visual or auditory? Auditory or visual dominance? Crossmodality Take the Crossmodality test No norms for this subtest 10

63 Overview Wide range of screening options Understand how auditory and visual information is being processed Help to guide towards appropriate interventions 11

64 TAVS Online Certification Course 2014 Advanced Brain Technologies All Rights Reserved Overview Look at how to adjust the testing parameters See page 20 of the User Guide Parameters that can be altered are Start Value Stimulus Volume Test time 1

65 Adjusting Parameters Subtests have preset values shown on page 21 of the User Guide Suitable for most people If necessary you can alter the settings for:- Slow processing speeds Younger children Hearing loss Limited screening time Adjusting Parameters 1. Switch on your TAVS machine 2. Choose test > by pressing the Right button 3. Find the Temporal Order subtest using the - and + buttons as usual 4. Choose Temporal Order by pressing the center Menu button 5. Default value of 250 milliseconds 6. Alter default value to 400 milliseconds using + 2

66 Adjusting Parameters Press Menu again Moves to Stimuli option Menu again moves to Volume option Menu again moves to Test Time option Menu again moves to <start> screen Adjusting Parameters Returning to factory settings Press and hold - and + buttons Briefly press centre Menu button Screen will show new device 3

67 Technical and Troubleshooting Troubleshooting guide on page 22 Reset button inside casing Batteries Technical specifications page 23 Overview Focus initially on the Auditory Quick Screening option Powerful screening tool Screen everyone to become comfortable with using TAVS 4