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AUDITORY LEARNING & TELEPHONE TRAINING FOR TEENS & ADULTS

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Presentation on theme: "AUDITORY LEARNING & TELEPHONE TRAINING FOR TEENS & ADULTS"— Presentation transcript:

1 AUDITORY LEARNING & TELEPHONE TRAINING FOR TEENS & ADULTS
WITH COCHLEAR IMPLANTS Ellen A. Rhoades, Ed.S., CED, Cert. AVT Auditory-Verbal Training & Consultations International Sonja Jovanovic, Dip.CCS, R.SLP, Cert. AVT Founder & Executive Director Auditory-Verbal Centre of Calgary, Alberta - Canada Auditory Verbal International 2003 Convention, Baltimore

2 A COMPREHENSIVE AURAL REHABILITATION PROGRAM
> Pre-Ops > Counseling & Self-discovery > Equipment > Social Interaction Strategies > Education (information) > Aural Rehabilitation Approaches (synthetic & analytic) > Therapy Activities > Listening-Speech Techniques > Telephone Training Strategies > Resources

3 REHABILITATIONIST’S ROLES
FACILITATOR EDUCATOR COUNSELOR ENABLER MOTIVATOR TEMPTRESS PUSHER THERAPIST The Brass Ring The Beacon The Holy Grail

4 PSYCHOSOCIAL CANDIDACY
Has the teen/adult ‘accepted’ deafness….or still grieving or in denial? Who is the main player – the teen/adult or the parent/spouse? Why does the teen/adult want the implant? Are the teen/adult’s friends Deaf or culturally hearing? Does the teen/adult wear hearing aids, intermittently/permanently? Is hearing or speaking a priority in the teen/adult’s daily life? Are the teen/adult’s CI hoped-for outcomes realistic? Therapist listens for: What kind of language does the person use to describe the current situation due to deafness? What is the severity of the person’s language dysfunction, if any? How does the person describe the CI? Can the person give a fairly good description of how it works? Is the person’s speech intelligible? Is voice quality within normal limits? To what degree does the candidate rely on signs? “I hate being deaf” Are you hearing the teenager, or the parent: “I hate that my son is deaf”. Look at the whole situation: history of deafness, was it sudden or progressive? How much has the teen/adult worn a hearing aid? It may be on…but is it ON? Doctors, audiologists and finally parents, come around to the idea that it’s time to get a CI…but the time may NOT be right for the teenager. What has changed? Why now? We cannot take charge and assume we can ‘convince’ the teen of their needs. The consequences of this can be devastating. (Eg. HS)

5 ASSESSMENT TOOLS Preliminary Questionnaire: provides information on the person’s history, self-perception of hearing loss and hearing aid benefits Expectations Questionnaire: for the CI candidate and a parent/spouse/friend; often accompanied by an oral interview “Why I Want A Cochlear Implant”: a one-page essay written by the candidate provides insight into person’s language and expected outcomes of CI Functional Auditory Discrimination Assessment: informal evaluation of candidate’s listening skills; provides a pre-implant baseline of person’s use of residual hearing Adapted from Cochlear, these give a good indication of understanding what the device can do, and also of language ability. There are 3 in total, for both candidate and significant other. Language issues may go unnoticed by other professionals especially if parents or friends are there to help ‘interpret’. Teens and young adults MUST be in charge of their own destiny. Check they understand by having them write a page about what they want from the device and what they think will happen. If nothing else it sparks off discussion!

6 AUDITORY DISCRIMINATION ASSESSMENT
high - low (pitch) loud - soft (intensity) long - short (duration) emotional content (angry, happy, sad) number of syllables sentence length variations sentence suprasegmentals (statement, query, exclamation) high vs low frequency speech sounds auditory tracking Determine Auditory Weaknesses: move from GROSS SUBTLE in follow-up listening activities (auditory discrim) activities

7 ASSESSMENT FINDINGS Preferred Mode of Communication
Speech Production Skills & Voice Parameters Language Skills Social Skills Psychosocial Issues Motivation & Expectations Reliability in attendance Attendance can be an important indicator of motivation or priority accorded to hearing. Avoidance, no shows, excuses, or lateness can be significant factors, particularly if a behavior pattern. Each of these findings may be interrelated and mutually reciprocal with other findings.

8 BEFORE HEARING Surgery is scheduled Counseling continues
A. Social interaction strategies B. Education (information) CI candidate starts the road to self-discovery Discuss what will happen during surgery Discuss what will happen during initial stim or “turn-on” Review of CI equipment

9 WHY SOME ANALYTIC STRATEGIES?
Allows the CI user to analyze and visualize the basic sounds of speech Gives meaning to CI user’s descriptions of perceived ‘noises’ interfering with speech Encourages self-monitoring of the CI user’s own speech Indicates some of the difficulties with speechreading & the benefits of listening Provides some success at listening to motivate and encourage.

10 SYNTHETIC STRATEGIES (Discrimination of total units:
personalized sentences & connected discourse) Meaningful w/ general comprehension (pointing/imitation) acceptable Rhythmic auditory-speech tracking w/ timely reading material (e.g., cupacoffee) Poems, songs, rhymes (Three blind mice, Frere Jacques)  a la ronde (in the round) Sentences varied in length, vowels, syllables, intonation Numeral confusions  repair strategies include counting to correct # Sound confusions  repair strategies include code wds and reciting alphabet string Alphabet-word association list Topical (related  unrelated)

11 DON’T FORGET THE MAP Quarterly mapping initially
At least annual maps thereafter Watch out for indicators that upgrades may be needed in between: headaches bad moods fatigue not wearing the processor at all times

12 “I hear constant echoes and buzzing!”
HEARING COMPLAINTS “I hear constant echoes and buzzing!” Use both synthetic and analytic strategies to determine specific speech perception errors or interference occurrences. Work with CI audiologist to adjust settings and reduce effects Are high frequency phonemes clear enough or do they sound like noise? Do T or C levels, IDR, RF, or gain need to be adjusted? Does CI user need to re-learn what soft-loud-too loud (perception of intensity gradients)?

13 THE INQUIRING THERAPIST
Ask questions: Did the homework assignment provide stress for you? Do you still have problems understanding others? How do you awaken each morning when you travel? Which listening situations are hardest for you? What do you think of your mother interpreting for you? Why does that make you angry? How do you feel about people exaggerating when they talk to you? Who helps you the most? How did you do with your homework this past week? Did you learn anything today? LISTEN LISTEN LISTEN LISTEN LISTEN

14 Lurk on a CI online group for 6 months.
THERAPISTS SHOULD... Lurk on a CI online group for 6 months. Hear their concerns. Listen to their voices.

15 Always put it back into hearing!
THE AUDITORY SANDWICH First, listen. HEAR Visual cues: lip-reading printed word cued speech signs Then, if need be, watch or say it. SEE - SAY Then, listen again (no visual cues) HEAR-UNDERSTAND Always put it back into hearing!

16 ALL-INCLUSIVE THERAPY
Use both analytic AND synthetic approaches Employ global conversational skills Daily rhythmical activities; use metronome as needed Somewhat easy AND difficult training exercises per session Daily listening sessions: the ‘auditory sandwich’ Daily informal listening activities Develop effective hearing tactics too! Listen to client: practice-progress-perspectives (counseling) Intellectualize the program; ‘force’ teen to “think” the word Interweave the development of speech, listening skills, & psychosocial skills

17 BASIC TRAINING Practice taking messages for other family members Simple content (phone numbers only) More difficult content (addresses and extended messages) More difficult speech delivery (force use of repair strategies) Listen repeatedly to recorded messages, e.g. calling movie theatres, weather, answering machines Practice calling parents and selected friends with pre-written sentences General conversation!

18 COMMON CHARACTERISTICS
OF “GOOD COPERS” BE DOMINANT: show assertive behavior; act on your own best interests; promote equality in relationships; stand up for yourself; exercise personal rights while respecting others. BE EXPEDIENT: use whatever is necessary to achieve a specific goal...any means to the end. BE FORTHRIGHT: be unpretentious, open, direct, straightforward with others. Be DEF Research findings of L. Glass & H. Elliot

19 MINIMAL HOMEWORK AUDITORY TRACKING (live speech with newspapers; audiotaped library books; web sites) ALPHABET WORD LIST (family/friends) CLOSED SETS (phone: questions & answers) TOPICAL SENTENCES (family/friends) TELEPHONE PRACTICE! Use videotapes, partners, notes, phone calls for carryover. Whatever works is effective!

20 READINGS Biderman, B. (1998). Wired for sound
Farley, C. (2003). Bridge to sound with a ‘bionic’ ear Romoff, A. (2000). Hear again Weber, D. T. (1999). Journey out of silence Erber, N. (1996). Communication therapy for adults w/ sensory loss Koch, M. (1999). Bringing sound to life Plant, G. (1999). Hear at home: A home training program for adults with hearing loss Rezen, S. & Hausman, C. (2000). Coping with hearing loss: Plain talk for adults Tye-Murray, N. (1997). Communication training for older teenagers and adults: Listening, speechreading, and using conversational strategies Wayner, D. & Abrahamson, J. (2001). Learning to hear again with a cochlear implant Some professional researchers: Gagne, Owens, Trychin, Caissie

21 CI@yorku.ca (online forum)
MORE RESOURCES (online forum) SHHH CIAI ALDA A.G. Bell AVI


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