Training Transcripts

Transcript for Auditory Skill Development Training Part 1

– [Instructor] The purpose of this tutorial is to serve as a general guideline for early interventionists working on auditory skill development with Wyoming children who have moderate to profound hearing loss and who are primarily using cochlear implants. However, interventionists working with children with lesser degrees of hearing loss and that use hearing aids may also find this information useful. The intended audience includes, speech language pathologists, childhood special education teachers, and other interventionists who have experience working with the birth through five population. This tutorial will cover the following topics, the role of the early interventionist, the role of technology, and auditory hierarchy, including detection of sound, discrimination of the suprasegmental aspects of speech, discrimination of segmental aspects of speech, connected speech, and intervention strategies. We will also discuss factors affecting auditory discrimination skills. The appropriate and effective use of technology is fundamental to the child’s development of auditory skills and hence his or her ability to reach his or her auditory potential. Technology including hearing aids, cochlear implants, and FM systems, combined with the effective use of that technology is truly the foundation upon which listening, speech, and language skills develop. We will now briefly discuss hearing aids and cochlear implants. A hearing aid is basically a small amplifier that children with hearing loss can wear to make speech and everyday sounds louder. Typically, children are fit with behind the ear hearing aids as compared to in the air hearing aids. The basic goal of hearing aids is to make speech sounds loud enough for a child with hearing loss to hear them. It is important to remember that wearing hearing aids is not comparable to putting on a pair of eyeglasses. Hearing aids, amplify sounds but do not necessarily make all sounds clearer. A cochlear implant is a surgically implanted device that works by directly stimulating the auditory nerve in the inner ear. Sound enters the microphone and travels through a chord to the speech processor, the processor digitally codes important components of the sound and sends this digitized information to the transmitter, FM radio transmission sends the information from the transmitter to the receiver, the electrodes stimulate the auditory nerve fibers, which carry the sound message to the brain, the brain then interprets the sound. Just like hearing aids, receiving a cochlear implant is not comparable to putting on a pair of eyeglasses, a child with a cochlear implant must be taught to interpret the signals that he or she receives from the cochlear implant. The appropriate and effective use of technology is fundamental to the child’s development of auditory skills and hence his or her ability to reach his or her auditory potential. Technology including hearing aids, cochlear implants, and FM systems combined with the effective use of that technology is truly the foundation upon which listening, speech, and language skills develop. We will now briefly discuss hearing aids and cochlear implants. We will now review the role of education as it applies to the role of technology, the use of technology, knowledge of hearing loss, the adverse effects of hearing loss, full-time amplification, and incidental learning. As the early interventionist, you’ll share the responsibilities and role of educating the deaf, hard of hearing child’s parents regarding use, maintenance, troubleshooting, and care of the equipment with the child’s audiologist. In addition to the child’s parents, it is important that the early interventionists educate the adults who spend prolonged periods of time caring for the child, including, but not limited to, caregivers, teachers, and grandparents. Technology can only benefit a child with a hearing loss if it is used appropriately. It is vital that the child’s parents are knowledgeable about their child’s hearing loss and their child’s device. One can never assume that the child’s parents have a firm understanding of their child’s hearing loss, listening device, and the use and care of the device. Reviewing the child’s hearing loss on a familiar sounds audiogram and discussing the potential impact of the loss on the child’s development, as well as reviewing the benefit of the child’s listening device is essential. An excellent resource titled, “The Relationship of Hearing Loss to Learning and Listening Needs,” is available on the Wyoming EHDI website. This is a valuable tool to use when discussing the potential adverse effects of a child’s hearing loss with parents. By asking open-ended questions and having the parent demonstrate specific tasks such as checking the battery, you gain valuable information regarding the extent of the parent’s working knowledge of the device. Demonstration is also a valuable tool for the early interventionists to use when teaching parents and caregivers. It is best to avoid asking yes/no questions when discussing the maintenance and care of the child’s listening device. An excellent resource for specific information regarding a child’s cochlear implant is the user manual. When a child receives a cochlear implant, a user manual specific for that implant is provided. User manuals and troubleshooting guides for specific cochlear implant models are also available online. Reference the child’s implant user manual for troubleshooting, maintenance, and other information. Beyond educating the child’s parents regarding the child’s hearing loss and listening device, the early interventionist must dedicate time to educate the parents regarding the need for full-time amplification, the parameters of full-time amplification, and the potential consequences of inconsistent use of amplification. It’s important to address the parameters of full-time amplification with parents and caregivers. Full-time amplification is defined by, “The use of amplification during all waking hours with the exception of water activities.” By asking the parent to describe the child’s daily routine, the early interventionist may discover that the child’s hearing aids are being inserted after the family eats breakfast instead of directly after the child wakes up. Incidental learning is a key topic to discuss with parents. Incidental learning occurs when the child hears something that is not specifically directed towards him or her, such as mom talking to dad on the phone, dad reading to another sibling or truly any auditory input in his or her environment. Full-time amplification is necessary to expose a child with hearing loss to incidental learning. Incidental learning takes place throughout the child’s day, in fact, the majority of what we learn, we learn incidentally. Parents must have a firm understanding of the need for full-time amplification and the critical role of incidental learning. Parents may have the misperception that learning occurs during specific times during the child’s day, such as when he or she is being read to, talks to or during the early intervention home visits. It is the responsibility of the early interventionist to address this misconception and discuss the critical impact of incidental learning. Parent support and training is an ongoing process. Reviewing and updating the parent’s understanding of their child’s hearing loss and the implications for intervention is a central component of effective early intervention. The early interventionist needs to be prepared to review information frequently with the child’s parents. This review will help solidify the parent’s understanding of the child hearing loss and the implications of that loss. Typically, the review will occur during the initial portion of the session, this initial check-in discussion should consist of leading questions that will reveal specific topics that need to be readdressed or that have not yet been addressed. The previous week’s strategies and the success of those strategies should also be reviewed during this initial check-in portion of the session. The check-in period of the visit is vitally important, it provides the early interventionist with valuable insight that may directly affect or shape the content of the current session, as well as provide direction for future visits. The early interventionist must remain flexible and be prepared to change the content of the session in response to information obtained during the check-in period. Establishing and maintaining a working relationship with the child’s audiologist is essential to the child’s success. The child’s audiologist may prove to be a valuable source of information and vice versa, the early interventionist can provide valuable information to the audiologist regarding the child’s functional use of his or her amplification. The involvement of the early interventionist in the cochlear implant mapping process is extremely beneficial. Information from the early interventionist regarding the child sound production errors and auditory responses is extremely valuable to the cochlear implant center audiologist during the mapping process. Creating a network of communication between other professionals who also work with a child can strengthen early intervention efforts. Attending audiology appointments with the family can also prove to be beneficial. In addition to exchanging technical and functional information with the audiologist, the early interventionist can help clarify information for the parents. Finally, it’s also constructed to encourage the parents to invite the child’s audiologist to participate in the child’s individual family service plan or individual education plan meeting. Many audiologists are willing to participate by a conference call if unable to attend the meetings in person. It is crucial that the child’s parents actively participate in the early intervention sessions. Through the inclusion of the parent as a partner and active participant in the early session, the early interventionist empowers the parent to assume the role of primary facilitator of their child’s auditory, speech, and language development. Remember, parent observation is not active participation. When the early interventionist assumes the role of a teacher without actively involving the parents in the therapy sessions, the parent’s opportunity to practice and learn new skills is inhibited. The parent is not empowered to actively teach their child during normal daily activities by simply observing the sessions. Active parent participation in the intervention process is non-negotiable.