AUDITORY LEARNING & AUDITORY LEARNING & TELEPHONE TRAINING TELEPHONE TRAINING FOR TEENS & ADULTS FOR TEENS & ADULTS

WITH COCHLEAR IMPLANTSWITH COCHLEAR IMPLANTS

Ellen A. RhoadesEllen A. Rhoades, Ed.S., CED, Cert. AVTAuditory-Verbal Training & Consultations International

www.AuditoryVerbalTraining.com

Sonja JovanovicSonja Jovanovic, Dip.CCS, R.SLP, Cert. AVT Founder & Executive Director

Auditory-Verbal Centre of Calgary, Alberta - Canada

Auditory Verbal International2003 Convention, Baltimore

> 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

A COMPREHENSIVE AURAL REHABILITATION PROGRAM

REHABILITATIONIST’S ROLES

• FACILITATOR

• EDUCATOR

• COUNSELOR

• ENABLER

• MOTIVATOR

• TEMPTRESS

• PUSHER

• THERAPIST

The Holy Grail

The Beaco

n

The Brass Ring

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?

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

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 trackingDetermine Auditory Weaknesses: move from GROSS

SUBTLE in follow-up listening activities (auditory discrim) activities

ASSESSMENT FINDINGS

• Preferred Mode of Communication

• Speech Production Skills & Voice Parameters

• Language Skills

• Social Skills

• Psychosocial Issues

• Motivation & Expectations

• Reliability in attendance

• 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

BEFORE HEARING

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.

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)

SYNTHETIC STRATEGIES (Discrimination of total units:

personalized sentences & connected discourse)

DON’T FORGET THE MAP

Quarterly mapping initially

At least annual maps thereafter

Watch out for indicators that upgradesmay be needed in between:

• headaches• bad moods• fatigue• not wearing the processor at all times

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)?

LISTENLISTEN LISTENLISTEN LISTENLISTEN

Ask questions: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?

LISTENLISTEN LISTENLISTEN LISTENLISTEN

LISTENLISTEN LISTENLISTEN LISTENLISTEN

THE INQUIRING THERAPIST

THERAPISTS SHOULD...

Lurk on a CI online group for 6 months.

CI@YORK.CACI@YORK.CA

Hear their concerns.

Listen to their voices.

THE AUDITORY SANDWICH

Always put it back into Always put it back into hearinghearing!!

HEAR

HEAR-UNDERSTAND

SEE - SAYSEE - SAY

First, listen.

Then, if need be,watch or say it.

Then, listen again

(no visual cues)

Visual cues:• lip-reading• printed word• cued speech• signs

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

ALL-INCLUSIVE THERAPY

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 20-30 pre-written sentences

General conversation!

BASIC TRAINING

COMMON CHARACTERISTICS OF “GOOD COPERS”

• BE DDOMINANT: show assertive behavior; act on your own best interests; promote equality in relationships; stand up for yourself; exercise personal rights while respecting others.

• BE EEXPEDIENT: use whatever is necessary to achieve a specific goal...any means to the end.

• BE FFORTHRIGHT: be unpretentious, open, direct, straightforward with others. Research findings of L. Glass & H.

Elliot

Be DEFDEF

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!

READINGSBiderman, 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

MORE RESOURCES

http://www.AuditoryVerbalTraining.com

http://www.focusonhearing.org

http://www.saywhatclub.com

http://www.hearingloss.com

http://www.listen-up.org

CI@yorku.ca (online forum)

SHHH

A.G. Bell

CIAI

AVIALDA