Functional Listening Evaluations: How to complete them and how to use the Data Presented by: Samantha Rogers, Au.D., CCC-A District Audiologist for Fayette County Schools

Present Level Areas Health, Vision, Hearing, and Motor Abilities Section is taken from the Guidance Document For IEP Development.

Functional Hearing and Listening Functional Hearing, Listening Assessment and Functional Communication Assessment are completed for a student who is deaf or hard of hearing. The Present Levels summarize the status of the student in these areas. The purpose of the Functional Hearing/Listening and Communication Assessment section is to: provide information about how a student is able to understand and process linguistic information through hearing as well as how a student uses his/her hearing in the educational environment. This may include how well a student is able to access verbal instruction and to what degree visual input, distance and noise affect performance.

Some of the Guiding Questions Does the child require visual supports and/or speech reading? To what degree does the distance from the speaker and or background noise affect the student’s ability to understand auditory information? What noise reducing supports or accommodations are needed to enhance access to auditory information? Does the student need an enhanced signal to noise ratio?? How does the student's hearing loss impact auditory function in the school/classroom setting? -Taken from the Guidance Document For IEP Development P. 26 and 27

How are we going to answer some of these questions….? That’s where Functional Listening Evaluations come into play.

Purpose of a FLE? Determine how listening abilities are affected by noise, distance, and visual input in the student’s natural listening environment Demonstrated abilities in the real world as opposed to measurements made in a sound booth

The results may … Show the need for amplification Demonstrate need for sign support Justify amplification is not necessary Provide evidence to teachers, students, and parents regarding the impact of the hearing loss Help justify accommodations needed Provide information to include in the Functional Hearing Section on the IEP

FLE Protocol It is Free and online Protocol with word lists http://www.handsandvoices.org/articles/education/ed/func_listening_ev al.html

Materials Needed CD Play/Computer Sound Level Meter Multi Talker Noise CD/ audio file Test stimuli (I.e. words/phrases/sentence lists) Tape Measure Speech hoop

Testing environment Student’s Natural listening environment (IE classroom) Use while empty A room that closely approximates size, ambient noise level and acoustic surfaces of the child’s classroom.

Physical Set-up of Testing Environment Close Condition: Noise source and examiner 3 feet in front of student Student Noise Source Examiner

Distant Condition Student Noise Source Far Condition: Noise source stays at 3 feet in front of the student and examiner moves 12-15 feet away from the student. Student Noise Source

Types of Evaluation Materials Word Level PB-K NU-6 W-22 Phrases/Sentences Common Children’s Phrases Common Children’s Non-Sense Phrases BLAIR Sentences SPIN Sentences HINT-C

Considerations for picking materials Students age Language Abilities/Vocabulary Memory Skills Speech intelligibility The sentence material should remain the same through the evaluation. The only variables that should be manipulated are distance, noise level, and visual inputs.

Presentation Levels Protocol is set up to approximate +5 decibel signal to noise ration with close condition and -5 dB with distant condition Examiner’s voice: 71 dBA at 18” from mouth Noise: 60 dBA at student’s ear *Use sound level meter to determine the loudness of the stimuli. Then adjust as necessary.

Sound Level Meter Measures decibels (dB) of noise typically in Sound Pressure Level (SPL) You want to use the A weighting scale (dBA).

Presentation Protocol Use the child’s typical hearing mode If the child usually wears amplification it should be worn during the evaluation When Used as a validation tool to demonstrate improvement in listening ability with FM or other hearing assistance technology, the examiner should repeat the far conditions to demonstrate the benefits of the technology.

Testing Conditions Auditory Visual Close Quiet 2. Auditory Close Quiet 3. Auditory Visual Close noise 4. Auditory Close noise 5. Auditory Visual Far Noise 6. Auditory Far Noise 7. Auditory Far Quiet 8. Auditory Visual Far Quiet *** Modifications can be made to test protocol as needed. In this order it balances the difficulty across conditions.

Scoring -

Step 1: Record results on scoring sheet while administering the evaluation

Step 2 Transfer percentages to Scorebox and Interpretation Matrix

Step 3 Calculate Averages

Step 4 Summarize results Interpret Data Make Recommendations

I have all the data.. Now what? Data can show need for accommodations FM System Sign Support Preferential seating Data can be used as a counseling tool Show need for amplification Show need for FM system Information can be added to IEP to demonstrate Functional Hearing abilities

Case Studies

Who do you expect to perform better? Student 1 Student 2 11 y/o female Born with profound hearing loss in 1 ear, normal hearing other ear Not using amplification English is used to communicate 9 y/o female Born with profound hearing loss in 1 ear, normal hearing in the other ear Not using amplification English/Spanish are used to communicate at home.

FLE Results Student 1 Student 2

Student 3 14 year old female, Diagnosed with a unilateral hearing loss at birth Has worn amplification consistently for about 8 months Right Side: Borderline Normal hearing Left: mild sloping to severe sensorineural hearing loss Reason for referral: To assess the need for FM or other assistive technology

Student 3 Test Results- Auditory Only Amplification Stimulus % correct 3’ quiet % correct 3’ noise % correct 12’ quiet % correct 12’ noise Hearing aids Common Children’s Phrases 100% 95% Hearing Aids Plus FM DNT

Student 4 Age: 15 Amplification: Cochlear Nucleus 5 Activated at age 3 Bilateral Profound Sensorinerual hearing loss Reason for Evaluation: Student stopped wearing FM

Student 4 Results– Auditory Only Amplification Stimulus % Correct at 3’ quiet %correct at 3’ noise % correct at 12’ quiet % correct at 12’ noise Cochlear Implant no visual cues Common children’s phrases 80% 50% 0% Cochlear Implant with Visual cues DNT

Student 5 5 year old male Fit with hearing aids 3 months ago Mild to moderate sensorineural hearing loss bilaterally Reason for referral: Eligibility for HI services, new special education referral

Student 5 Results Amplification Stimulus 3’ quiet No visual cues With visual cues 12’ quiet NO visual cues Hearing Aids PB-K Words 20% 80% Hearing Aids Plus FM 85% * Did not Test

Contact Information Samantha Rogers Audiologist Fayette County Public Schools Phone: 859-381-4080 Email: Samantha.Rogers@Fayette.kyschools.us