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 TOOLSPreliminary Questionnaire: provides information on the person’s history, self-perception of hearing loss and hearing aid benefitsExpectations 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 CIFunctional Auditory Discrimination Assessment: informal evaluation of candidate’s listening skills; provides a pre-implant baseline of person’s use of residual hearingAdapted 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 syllablessentence length variationssentence suprasegmentals (statement, query, exclamation)high vs low frequency speech soundsauditory trackingDetermine Auditory Weaknesses: move from GROSS SUBTLEin follow-up listening activities (auditory discrim) activities
7 ASSESSMENT FINDINGS Preferred Mode of Communication Speech Production Skills & Voice ParametersLanguage SkillsSocial SkillsPsychosocial IssuesMotivation & ExpectationsReliability in attendanceAttendance 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 strategiesB. Education (information)CI candidate starts the road to self-discoveryDiscuss what will happen during surgeryDiscuss what will happen during initial stimor “turn-on”Review of CI equipment
9 WHY SOME ANALYTIC STRATEGIES? Allows the CI user to analyze and visualize the basic sounds of speechGives meaning to CI user’s descriptions of perceived ‘noises’ interfering with speechEncourages self-monitoring of the CI user’s own speechIndicates some of the difficulties with speechreading & the benefits of listeningProvides 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) acceptableRhythmic 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, intonationNumeral confusions repair strategies include counting to correct #Sound confusions repair strategies include code wds and recitingalphabet stringAlphabet-word association listTopical (related unrelated)
11 DON’T FORGET THE MAP Quarterly mapping initially At least annual maps thereafterWatch out for indicators that upgradesmay be needed in between:headachesbad moodsfatiguenot 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 effectsAre 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?LISTENLISTENLISTENLISTENLISTEN
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 SANDWICHFirst, listen.HEARVisual cues:lip-readingprinted wordcued speechsignsThen, if need be,watch or say it.SEE - SAYThen, listen again(no visual cues)HEAR-UNDERSTANDAlways put it back into hearing!
16 ALL-INCLUSIVE THERAPY Use both analytic AND synthetic approachesEmploy global conversational skillsDaily rhythmical activities; use metronome as neededSomewhat easy AND difficult training exercises per sessionDaily listening sessions: the ‘auditory sandwich’Daily informal listening activitiesDevelop effective hearing tactics too!Listen to client: practice-progress-perspectives (counseling)Intellectualize the program; ‘force’ teen to “think” the wordInterweave the development of speech, listening skills, & psychosocial skills
17 BASIC TRAININGPractice taking messages for other family membersSimple 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 machinesPractice calling parents and selected friends with pre-written sentencesGeneral 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 DEFResearch findings of L. Glass & H. Elliot
19 MINIMAL HOMEWORKAUDITORY 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’ earRomoff, A. (2000). Hear againWeber, D. T. (1999). Journey out of silenceErber, N. (1996). Communication therapy for adults w/ sensory lossKoch, M. (1999). Bringing sound to lifePlant, G. (1999). Hear at home: A home training program for adults with hearing lossRezen, S. & Hausman, C. (2000). Coping with hearing loss: Plain talk for adultsTye-Murray, N. (1997). Communication training for older teenagers and adults: Listening, speechreading, and using conversational strategiesWayner, D. & Abrahamson, J. (2001). Learning to hear again with a cochlear implantSome professional researchers: Gagne, Owens, Trychin, Caissie
21 CI@yorku.ca (online forum) MORE RESOURCES(online forum)SHHHCIAIALDAA.G. BellAVI