Aural Habilitation for School Age Children 2022/2021 PDF

Aural R/habilitation: School age children 2022/2021 Dr. Alyaa Alduhaim  Toddlers versus School age children Focus of services Focus of service Fitting with appropriate Structured auditory training amplification syste...

Aural R/habilitation: School age children 2022/2021 Dr. Alyaa Alduhaim  Toddlers versus School age children Focus of services Focus of service Fitting with appropriate Structured auditory training amplification system. Challenging listening tasks Setting a stimulating Improve challenging language environment skills Teach parents techniques to Speech intelligibility enhance the child’s Social inclusion development of active enhance educational listening skills to support the outcomes development of spoken language.  How to deliver services for school age children? Direct services Pull out Push in Small group Indirect services Consultation Observation Assume responsibility of amplification system Wear and keeps amplification on during waking hours Indicate when cochlear implant not functioning properly Become familiar with audiogram and programming process  Structured Auditory Training Refer to auditory milestone p 145, child at age 1 year old has all auditory skills to learn correct articulation and syntax. Therefore, for older children, auditory tasks need to be structured (bottom-up approach): Detection Patterning Discrimination Identification Comprehension  Detection Detecting non-linguistic (varies environmental sounds) and linguistic (name) sounds. Detecting six ling sounds Detecting sound onset and termination of non-linguistic and linguistic sounds.  Patterning Initiate discrimination between spoken message, animal sounds, and musical instrument. Associate specific familiar sounds with object in his environment  Discrimination Suprasegmental Vocal intensity (whisper, quit, loud sounds) Vocal duration (long or short and continues or repeated syllable) Rate of speech (fast or slow) Vocal pitch (high or low pitch, reflection of gender and age, and emotional content) Segmental Vowels Consonants (nasal or non-nasal, voicing, and words beginning with same sounds)  Identification Comprehension of common expression Follow direction containing multiple critical elements Make identification based on several related description Beginning to comprehend sequencing  Comprehension Identifies true and false statement describing a picture Follow an illustrated story Answering questions about a story Describe past events with fair degree of accuracy Retell a short story Carries out conversation through audition alone Paraphrase remarks of another speaker Goals  Resources for activities https://blog.medel.com/5-games-can-play-help-child-detect-sounds/ https://www.pinterest.com.au/lasenders/apps-for-auditory-processing- sound-discrimination-/ Challenging Listening Conditions  Auditory strategies Acoustic Highlighting Putting emphasis on a specific sound or word to make it stand out from the rest of the phrase or sentence. for example, “No, I would like two cappuccinos and one tea please”. Acoustic highlighting makes it easier for the child to identify the important information as it stands out in the spoken sentence. How Can I Use “Acoustic Highlighting”?  Add emphasis to the important word by changing your tone of voice.  Add a sing song quality to your voice when you say the key word to draw attention to it: sing what you say!  Say the word slightly louder or softer than the rest of the phrase: whisper it…..what shall we do?  Pause slightly before saying the key word: “I go to the pool today,” pause before the word /went/: “You went to the pool today.”  Say the word more slowly to draw out the sounds they might be missing: “Oh, you are going to for a ssswim?” https://www.youtube.com/watch?v=pxFH9eyNWrE https://www.youtube.com/watch?v=sHck1V-OLmg  Auditory strategies Auditory Bombardment Focused auditory stimulation  Auditory strategies Auditory sandwich The bread of the sandwich is listening or an auditory signal. The filling of the sandwich is whatever context is necessary for the child to understand what is being discussed. The primary concepts of the auditory sandwich include 1. audition first 2. Repetition 3. put it back into audition  Strategies to improve Auditory access in educational settings A FM system A special wireless device that helps people hear better in noisy listening situations. FM stands for frequency modulation and uses radio waves to transmit audio signals to the listener. The device is typically used in conjunction with hearing aids. The FM system can be used to pick up a single voice or placed in such a way to pick up multiple voices. This is done through a small microphone worn by the speaker. The microphone is connected to a transmitter which sends a wireless audio signal to a receiver. The receiver is worn by the listener and is often attached to a hearing aid. FM systems allow the listener to hear a speaker even if they are across the room without amplifying all the background noise. This improves the speech signal allowing the listener to hear better. For more strategies read table on page 152 of your book  Speech and Language therapy for children with hearing loss Any program directed toward children’s language and speech development starts with Assessment. Tests of either aspect can be: Norm-referenced (designed and standardized to permit comparisons, e.g., the Goldman-Fristoe test of Articulation) Criterion-referenced (designed to determine what skills a particular child has acquired). Observational test However, for children with hearing loss it is best to reduce the use of Norm- referenced test, Why?  Chronological age or Hearing age? Hearing age starts when a child’s use of technology provides access to sound and is worn during all waking hours. Another long-term goal of early intervention is to close the gap between a child’s CA and HA. Individual differences among children with hearing impairment are often greater than those among children who hear normally. Therefore, no one type of language and speech development program can possibly suit the needs of all children.  Focus on challenging language skills Vocabulary expansion Increase MLU Increase use of variety of sentence structure Pay attention to small words/ morphemes (bound and free) Improve phonological awareness skills Use of conversational convention (introduction, and ending of a conversation, interruption) Understanding tone of voice Comprehension of higher language expressions (e.g., idioms and jokes) Required reading P141-142 impact of hearing loss on listening and talking Speech perception versus speech production Audiologists usually document speech perception and SLPs usually document speech production. Speech perception is associated with the detection, discrimination, identification, and comprehension of speech or spoken language. Speech production is the development, intelligibility, and use of speech or spoken language at home and school. speech production include both the suprasegments (intensity, duration, and pitch); and the segments (consonants, vowels) that make up a child’s language.  Speech Intelligibility Issues in Hearing Impaired Children All types of hearing loss, even mild and moderate hearing losses can impact speech development negatively, particularly: Acquiring fricatives such ad /s/, /f/, and /th/ that carry important morphology and grammatical content in language: “certain verb tenses (It’s mine; She wants), as well as plurality (cat, cats) and possession (mom’s hat) on nouns” Other high pitch sounds such as /k/ and /t/. Intonational changes, for example: rising intonation signal to the listener that the speaker is asking a question.  Resolving speech Intelligibility challenges Intelligibility is impacted by familiarity with speaker, background noise, and availability of visual cues. Working on speech sounds on word-initial, word-medial, and word-final Cs, may not bridge the need for intelligible conversational speech important to the interactions with peers. Teaching children language strategies that increase successful interactions with hearing peers. SLPs to encourage speech that fits language needs and language that fits speech needs. Children can acquire optimal speech skills only when they use appropriate amplification during all waking hours. A further requirement is that the speech addressed to children relates closely to their cognitive levels, motor development, and personal and social experiences.  Goal and purposes of intervention The general goal of intervention is to effect change in communicative behaviours an individual’s potential to communicate Three basic purposes of intervention: 1. Eliminate the underlying cause e.g., articulation, voice. 2. Teach compensatory strategies e.g., AAC, study skills. 3. Modify the disorder e.g., language and phonological intervention  Planning Intervention Basic information you need to begin planning: The broad areas to be targeted are identified through the assessment process and results. The contexts in which the person needs to operate. The end of treatment. What can the client achieve, that will make a significant contribution to improving their communication or swallowing? The family’s perspective and available support system An EBP approach to intervention will be an ongoing, dynamic clinical decision- making process Intervention Goals 1. Long-term goals A long-term goal is the “best performance that can be expected of an individual in one or more targeted communication or swallowing areas within a projected period of time” (Klein & Moses, 1999) The clinician develops a group of long-term goals Long term goals represent the client’s potential achievement They are broad changes in communicative behaviour that can achieved during a course of therapy If the client has multiple issues, long term goals may then need to be prioritised. Intervention Goals 1. Short-term goals Long-term goals that are to be focused on are then broken down into short term goals Short-term goals are the building blocks towards achievement of long-term goal Dynamic assessment is a great method to help SLP choose STG Short term goals contain A “do” statement A context/condition A criterion  Goal Attack Strategies The sequence to approach the intervention goals Vertical Horizontal Cyclical Targets one goal at a Targets multiple goals Target each goal by time until the client simultaneously. itself for a specific reaches the desired Maybe 3-4 goals in the amount of time (e.g., 3- level of performance. same session until the 4 sessions) Then progress to the desired level of Regardless of progress, next goal on the list. performance is reached switch to next goal for This procedure on each goal. the same amount of continues for all goals As goals are achieved, time, then switch to targeted. the SLP may add in new next goal, etc. short-term goals. Once all goals have been targeted, a "cycle" is complete. Repeat cycle of goals. Special population of children with hearing loss 30-40% of children with sensorineural hearing loss are diagnosed with additional disabilities that cross all medical, cognitive, sensory, motor, and behavioral areas. SLP should recommend augmentative and alternative communication strategies for several children who had not progressed in either oral or sign language interventions.  Required Reading Page 149-150 (Auditory therapy- infants and toddlers, children enrolling in school) P141-142 (Impact of hearing loss on listening and talking) Optional: Article in additional resources (the ling model fixing speech intelligibility)