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Author: Jack Slemenda Converse College, SC Date submitted to deafed.net – March 20, 2008 To contact the author for permission to use this PowerPoint, please To use this PowerPoint presentation in its entirety, please give credit to the author.
Auditory Verbal Therapy Jack Slemenda Converse College
Slide Contents I. Auditory Verbal Therapy (3-23) II. Cochlear Implants (24-32) III. Maintenance/Trouble Shooting for Cochlear Implants (33-40) IV. Speech, Language, Cognitive and Audition Evaluations (41-46) V. Expectations for a Child with a Hearing Loss (47-55) VI. Lesson Plans/Treatment Goals (56-87)
All children have residual hearing that can be molded for functional use History and Philosophy of Auditory Verbal Therapy
What is AVT and where did it originate? AVT was established as an approach to therapy in the mid 20th century by pioneers Ling, Beebe, and Pollack. Auditory Verbal International established ten principles to guide the field and foster understanding of Auditory Verbal Therapy.
First AVT Principle Supporting and promoting programs for the early detection, identification, and diagnosis of hearing loss and the auditory management of infants, toddlers, and children identified along with Auditory-Verbal Therapy.
Second AVT Principle Providing the earliest and most appropriate use of medical and amplification technology to achieve the maximum auditory stimulation benefit.
Third AVT Principle Seeking to integrate listening as well as maximal acoustic stimulation into the childs total personality in response to the environment by guiding/coaching caregivers without the use of sign language or emphasis on speechreading.
Fourth AVT Principle Supporting the view that communication is a social act, and seeking to improve spoken communication interaction within the typical social dyad of infant/child with hearing loss and primary caregivers including use of the parents as primary models for spoken language development and implementing one-on-one teaching.
Fifth AVT Principle Seeking to establish the childs integrated auditory system for the self-monitoring of emerging speech.
Sixth AVT Principle Using natural sequential patterns of auditory, perceptual, linguistic and cognitive stimulation to encourage the emergence of listening, speech, and language abilities.
Seventh AVT Principle Guiding and coaching parents to create environments that support listening/spoken language through the childs daily activities and to integrate listening and spoken language in the childs life.
Eighth AVT Principle Guiding and coaching parents to help their child self-monitor spoken language production.
Ninth AVT Principle Making ongoing informal/formal diagnostic evaluation and prognosis of the development of listening skills as an integral part of the rehabilitative process.
Tenth AVT Principle Supporting the concepts of mainstreaming and integration of children with hearing loss into regular education classes with appropriate support services and to the fullest extent possible.
Why does AVT work???? Existing Evidence Supporting the AVT practice The majority of children with hearing loss have useful residual hearing… a fact know for decades ( Bozold and Slebenmann, 1908, Goldstein, (1939); Urbantschitsch, 1982).
Why AVT cont… When properly aided, children with hearing loss can detect most if not all the speech spectrum (Beebe, 1953;Goldstein, 1939; Johnson, 1976; Ling and Ling, 1978; Pollack, 1970, 1985; Ross and Calvort, 1984).
Cont…. Once all available residual hearing is accessed through amplification technology (eg. Binaural hearing aids and acoustically tuned earmolds, FM units, cochlear implants) in order to maximum detection on the speech spectrum, then a child will have the opportunity to develop language in a natural way through the auditory modality. A child with a hearing loss need not automatically be a visual learner. Hearing, rather than being a passive modality that receives information, can be the active agent of cognitive development (Boothroyd, 1982; Goldberg and Lebahn, 1990; Robertson and Flexor, 1990; Ross and Calvert, 1984).
Cont… In order to benefit from the critical periods of neurological and linguistic development, then the identification of hearing loss, use of appropriate amplification and medical technology, and stimulation of hearing must occur as early as possible (Clapton, and Winfield, 1976; Johnson and Newport, 1989; Lenneberg, 1967; Marler, 1970; Newport, 1990).
Cont…. If hearing is not accessed during the critical language years, a childs ability to use acoustic input meaningfully will deteriorate due to physiological (retrograde deterioration of auditory pathways), and psychosocial (attention, practice, learning) factors (Evans, Webster, and Cullen, 1983; Merzenich and Kass, 1982; Patchett, 1977; Robertson and Irvine, 1989; Webster, 1983).
Cont…. Current information about normal language development provides the framework and justification for the structure of Auditory-Verbal practice. That is infants/toddlers/children learn language most efficiently through consistent and continual meaningful interactions in a supportive environment with significant caretakers (Kretschmer and Kretscher, 1978; Lennenberg, 1967; Leonard, 1991; Ling, 1989; MacDonald and Gillette, 1989; Menyuk, 1977; Ross, 1990).
Cont… As verbal language develops through the auditory input of information, reading skills also develop (Geers and Moog, 1989; Ling 1989, Robertson and Flexor, 1990).
Rationale Cont… Parents in Auditory-Verbal programs do not have to learn sign language or Cued Speech. More than 90% of parents with children with hearing loss have normal hearing (Moores, 1987). Studies have shown that over 90% of parents with normal hearing do not learn sign language beyond the basic preschool level of competency (Luetke- Stahlman and Moeller, 1987). Auditory-Verbal Practice requires that caregivers interact with a child through spoken language and create a listening environment which helps a child to learn.
Cont… If a severe or profound hearing loss automatically makes an individual neurologically and functionally different from people with normal hearing (Furth, 1964; Myklebust and Brutton, 1953), then the Auditory-Verbal philosophy would not be tenable. The fact is however, that outcome studies show that individuals who have, since early childhood, been taught through the active use of amplified residual hearing, are indeed independent, speaking, and contributing members of mainstream society (Goldberg and Flexer, 1991; Ling, 1989, Yoshinaga-Itano and Pollack, 1988).
ADVANCED BIONICS Platinum BTE S-Series and Platinum Speech Processor (body worn) All Rechargeable Batteries
Platinum Sound Processor
Platinum BTE Processor
Maintenance and Trouble Shooting for Hearing Aids and Cochlear Implants
What to do if there is no sound? Battery may be dead Battery may be in backwards Hearing aid may be turned off Sound outlet may be plugged with ear wax
What to do if there is weak sound? Weak battery Sound outlet or inlet may be plugged with ear wax Current hearing condition may have changed
What to do if there is a crackling or frying sound? Volume may be set too high Object may be covering inlet such as a hat, scarf, or coat collar Excessive wax present in the ear Instrument may not be fitted correctly in the ear (contact audiologist)
Trouble Shooting for Cochlear Implants is Product Specific
If the problem with the hearing aid persists, it is important to call the audiologist right away!!
General Maintenance for Hearing Aids Cleaning Storage Daily living
General Maintenance for Cochlear Implants Small children Moisture Batteries Static electricity
Speech, Language, Cognitive, and Audition Evaluations
Testing with Hearing Impaired Children Areas of testing: –Language- Receptive and Expressive –Articulation/Phonology –Auditory Skills
Language Testing may include comprehensive language tests, such as the CELF-P2, CELF-4, PLS-4, CASL, CREVT-2,, TELD:3,TOLD-P:3, or TOLD-I:3. Tests of expressive language and vocabulary, such as, EOWPVT, EVT, SPELT-3 or SPELT-P.
Language Tests of receptive language, such as ROWPVT or PPVT-3. Screening tests: Rossetti Infant- Toddler Language Scale or the REEL- 3. Concept testing may also be completed, using a test such as the Bracken-R.
Auditory Tests Tests that focus on use of audition in language: –TACL –TARPS –TAPS-R and TAPS-UL –ESP –APT-HI –IT-MAIS –MUSS –TAC
Expectations for a Child with a Hearing Loss
Chronological Age vs. Cochlear Age Chronological age begins at birth Cochlear age begins when the implant is activated Cochlear age used as tool Speech and language expectations/development should be based on cochlear age
Progression of Development Normal speech and language development can be expected on a delayed time scale Speech and language goals should follow the natural progression of normal speech and language development
Auditory Expectations with AVT & 12 months Respond to a variety of environmental and speech sounds at various distances Imitate vowels and some consonants Imitate motions of nursery rhymes Identify nursery rhymes when sung
AVT & 12 months cont. Respond to familiar phrases Identify and imitate learning to listen sounds
Auditory Expectations with AVT & 24 months Identify a picture that is part of a simple story Identify an object with descriptors Recall 3 critical elements Answer questions about a picture, book, or set of objects
Auditory Expectations with AVT & 36 months Answer questions & recall details about a story with the topic revealed Answer questions without pictures Recall four critical elements Answer questions about a familiar topic
Auditory Expectations with AVT & 48 months Repeat easy sentences Process information (by live voice or on tape) at sentence and conversation level with background noise Follow a conversation with an unrevealed topic
AVT & 48 months cont. Retell a story recalling many details in the correct sequence Expectations taken from the Auditory Learning Guide (ALG) developed by Beth Walker, 1995
Lesson Plans and Treatment Goals
Sample Lesson Plan GOALACTIVITY PROCEDURE Sample target items Materials Rationale Supporting Research STRATEGIES (To promote auditory learning) HOME IDEAS EVAL/NEXT GOALS Audition: Speech: Language & Cognition: Other:
Audition Goals & Activities Detect/identify sounds of the Ling 6/7 Sound Test s m oo ee ah sh fff –Fish in a fish bowl with water –Seeds in a flower pot –Animals in sand –Cars down a ramp
Audition Goals & Activities Identify/imitate approximations of Learning to Listen to Sounds –Scavenger hunt –Grab bag, surprise box –Open the presents –Guessing game with cups
Audition Goals & Activities Follow directions by recalling three critical elements –Barrier game –Coloring activity –Feed the people –Build a castle
Auditory Strategies Move closer to the implant Vary the prosody and intonation Sing a song Put the key word at the end of the phrase Pause before saying the key word Whisper voiceless sounds Prolong fricatives and nasals /hausssss/ Repeat stops /kkkkeik/
Auditory Strategies Vary the number of syllables Decrease background noise Ask what did you hear? Auditory sandwich technique Present two choices Use the parent as a model
Speech Goals & Activities Imitate consonants varying by manner with the same vowels ex: ssss vs tutummm vs bubu –Microphone –Basketball, bowling, soccer –Balloon toss –Marbles –Make a puzzle
Speech Goals & Activities Produce /m/ in the initial position of words –/m/ magnets –Hide /m/ objects in rice, beans, or sand –Make a book
Language Goals and Activities A Review: Normal Language Development Checklist 6 Months Repeats self-produced sounds Imitates sounds Vocalizes to others Uses about 12 different phonemes
Language Goals And Activities 1 Year Old Communication Development First true words months Use of jargon months Expressive Vocabulary 50 words-18 months Gestures and vocalizes wants and needs Develops object permanence
Language Goals and Activities 1 Year Old Vocabulary Turns to name Jabbers Loudly Waves bye bye upon request Plays peek-a-boo Often over-generalizes meaning (ball, dog)
Language Goals and Activities 2 Year Old Jargon almost completely dropped out Pronouns are used often and correctly Vocabulary may have grown from words Average sentence length 2.5 words
Language Goals and Activities 2 Year Old Vocabulary Understands words Points to five body parts on command Responds to y/n questions appropriately Knows and uses prepositions in and on Names and produces sounds of common animals Follows simple directions
Language Goals And Activities 2 Year Old Grammar Speaks in 2-3 word utterances 25% of two-word combos consist of noun + verb (Open-Pivot) construction (Daddy go) Asks Whats that? Uses rising intonation with other questions
Language Goals and Activities 3 Year Old Talking in multi-word utterances Vocabulary is extensive and long Comprehensive of more complex directions Concrete in regard to subjects they can discuss The why question phenomenon
Language Goals and Activities 3 Year Old Vocabulary/Concepts Understand the meaning of Who?, Why? and How many? Able to answer AGENT + ACTION?s Knows own gender Understands basic adjectives big and little Counts up to 3 but only understand concept of one. Follows 2-4 part commands
Language Goals and Activities 3 Year Old Grammar Speaks in 3-4 word sentences Articles a the and copula/auxiliary is are beginning to be included. Use of word tense are present Use of pronouns I, me, you, my, mine Yes/no questions are developed Is this a horse? Over generalizes grammar rules
Language Goals and Activities 4 Year Old Begin to play with words Elaborates simple responses into long narratives Comments with approval on his/her own behavior and criticizes that of others
Language Goals and Activities 4 Year Old Vocabulary/Concepts Identifying and Expressing understanding of colors Counts to ten by rote, understands concept of 3. Can perform simple analogies fire is hot, ice cream is ____ Understands basic prepositions Understands adjectives of size and quantity:
Language Goals and Activities 4 Year old Grammar 4-5 word sentences, on average. Sentences are complete Grammatical overgeneralizations continue Uses third person singular Use of conjunctions Modal verbs
Language Goals and Activities 5 Year old Has a sense of social standards and limitations. (pragmatically appropriate given then situations) Mastered number concepts thru 10 Can name and describe use and function of everyday objects Grammatical and articulatory errors are eliminated
Language Goals and Activities 5 Year old Vocabulary Concepts Can group objects by category Aware of the function of senses (eyes, ears, nose, mouth) Understands prepositions behind and ahead of Understands first and last Understands the concept of time
Language Goals and Activities 5 Year old Grammar Sentences are from 5-6 words in length Can understand almost any type of sentence spoken Speaks in grammatically complete, correct sentences. Begins to develop metalinguistic awareness
Language Goals and Activities 6 Year Old Sentence Length- 6-7 words Vocabulary words Number concepts- rote counting up to 30 Asks meaning of words Complete analogies
Language Goals and Activities Bloom and Lahey Overview Phases Content Categories
Language Goals and Activities HOW DO I TEACH LANGUAGE?.... Language Teaching Hierarchy
Language Goals and Activities Language Temptations: **** Reminders: Do's Remember Children need opportunities to communicate Deal with the child in a sensitive way Be aware of the childs message Plan activities that mean something to the child through his or her daily activities Involve other people in the interaction Remember having fun is a part Allow wait time … typically seconds; for those significantly impaired up to 30 seconds
Language Goals and Activities Dont s Dont rush the childs attempts to communicate Dont overload the childs ability to see, hear, and move. Dont set the child up to fail Dont waste valuable time doing things with child that will not help him or her in life Dont assume you know what the child is trying to communicate Expectations taken from Wetherby and Prizant 1989 Communicative Temptations and Pamela Talbot 2002 Topics in Auditory Verbal Therapy See Communicative Temptations Handout
Language Goals and Activities Handouts: See sampling of activities following phases 1-3 content categories of Bloom and Lahey. Note: Each activity can be modified to accommodate learners at varying phases of Bloom and Lahey.
Auditory Strategies Ask the child what did they hear; not are you listening??? Use the hand cue Move in closer Repeat whole phrase Acoustically highlight; not over-articulate Rephrase Whisper the key sound Model on the parent first