CHILDREN WITH ABIS IN THE CLASSROOM: WHAT CAN WE EXPECT?
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CI & ABI Candidacy Device Surgery Medical &
Audiological Sites Research
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CANDIDACY Not a CI candidate Neurofibromatosis Type 2 Absent
VIII nerve Cochlear Nerve aplasia Auditory Neuropathy Cochlear
Malformation Cochlear Ossification Head Trauma Inner Ear
Scarring
DEVICE COMPARISON Photographs courtesy of Cochlear Ltd.
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ABI IMPLANTED Illustration courtesy of Cochlear Inc
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SOME OF THE IMPLANT & MAPPING LOCATIONS Worldwide Belgium
Germany Italy* Poland* Turkey* United Kingdom* USA (Clinical
trials) Massachusetts Eye and Ear Infirmary University of North
Carolina USC-CHLA California Singapore* (mapping) Spain Sweden
*Enrolled in programs at JTC
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ABIs in Children Colletti et al. (2014) Audiol Neurotol
Vittorio Colletti MD First pediatric ABI In 2000 Data provided by
USC, R. Shannon, et al
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Categories of Auditory Performance (CAP) 0. No awareness of
environmental sounds or voice 1. Awareness of environmental sounds
2. Response to speech sounds 3. Identification of environmental
sounds 4. Discrimination of speech sounds without lipreading 5.
Understanding of common phrases without lipreading 6. Understanding
of conversation without lipreading 7. Use of a telephone with known
speaker 8. Follows group conversation in a reverberant room or
where there is some interfering noise, such as a classroom or
restaurant 9. Use of telephone with an unknown speaker in
unpredictable context
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CAP Scores Children with NF2, AN, and Other 0. No awareness of
environmental sounds or voice 1. Awareness of environmental sounds
2. Response to speech sounds
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CAP Scores Children with VIII Nerve Aplasia 3. Identification
of environmental sounds 4. Discrimination of speech sounds without
lipreading 5. Understanding of common phrases without
lipreading
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CAP Scores Children with Ossification or Trauma 5.
Understanding of common phrases without lipreading 6. Understanding
of conversation without lipreading 7. Use of a telephone with known
speaker
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COMPLEX NEAP The Complex NEAP package is an assessment package
for deaf children with complex needs which provide assessments,
checklists and profiles to enable professionals and parents to
assess and monitor the progress of deaf children with complex
needs, in the areas of: Communication and Language Listening Speech
Complex NEAP is based on the Nottingham Early Assessment Package
(NEAP) and includes tools to facilitate the development of skilled
observation in this special population.
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AUDITORY BRAINSTEM IMPLANT NIH CLINICAL TRAIL @ USC-CHLA
Auditory Brainstem Implant NIH Clinical Trial @ USC-CHLA Initial
activation of the ABI is analogous to a newborn entering the world
and hearing for the first time, which means these children will
need time to learn to interpret what they are sensing through the
device as sound, said USC Keck otolaryngology professor / study
co-leader audiologist Laurie S. Eisenberg, Ph.D.. She adds that
with the device, the child still needs to undergo therapy and
interaction with, as their brains have to learn to map out the
sounds and decode them: The incoming stimulus for a child with an
ABI is completely scrambled, and as a result, children with ABI
require intensive long-term therapy and very strong parental
involvement. michelsonmedical.org
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ABI RESEARCH
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ABIS IN THE CLASSROOM Similarities Developmental Milestones
Professionals to work with Methodology Reliance on Parent
Participation Additional Considerations Slower progress
Audiological support may not be local
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JTCS CHILDREN WITH ABIS Demographics 10 Children All under 6
years old 8 Countries 5 Boys & 5 Girls 8 in the Preschool 5
Summer School 3 Summer School & preschool the next year 2 in
Parent-Infant Etiology Goldenhar or Goldenhar-Gorlin Syndrome
Auditory Nerve Deficiency CHARGE Cochlear Nerve Aplasia
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SURGERY DATA Implant Facility Italy - 8 Turkey -1 England -1
Single Sided MedEl 5 Cochlear 3 Implanted In 2001 - 1 2002 - 1 2009
- 2 2012 - 4 2013 - 2
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ABIS & EARLY OUTCOMES - SHORT TERM STUDENTS Name
Country/Center & Time at JTC ABI Age Devices & Fitting Ages
Etiology/Other Challenges Impact Rating Listening Performance
Language Performance Speech Performance UAE SS 2011 F
7/13/05Nucleus ABI 39m Cochlear nerve aplasia Hypotonic,
Oral-Motor, Torticollis 4 No Response 500-6KHome: English &
ArabicVocalizing /a/ Ireland (Manchester) SS 2012 C 11/19/08Nucleus
ABI 54m Premature Balance Gross motor delays; Absent auditory &
vestibular nerves; Cochlear aplasia Poor audio thresholds Outside
banana: 80dB Indicates env sounds Using sign language Good
pragmatics Beginning vocalizations Some vowels Some plosives &
nasals UK (Italy & Manchester) SS 2013 E 9/28/10Rt Medel ABI
22m Goldenhar Oral-Motor Good audio thresholds Detects all Ling 6
IDs /a/ vs /sh/ Responds to env. sound Good pragmatics Calls for
attention Few vowels Few nasals CA (Italy & C3) SS 2013 A
6/26/09Medel ABI Goldenhar Gorlin cleft lip & palate, lipoma of
corpus callosum, dysgenesis of splenium of the corpus callosum,
bilateral colobomas; Absent auditory & vestibular nerves;
Oral-Motor/Feeding Fair audio thresholds IDs all Ling 6 at 1 ft
Reports ABI off Responds to env sounds Uses ASL 5-word ASL phrases
Single words: English Few vowels And /m/ CA (Italy & C3) PI
2013 B 9/15/11 Rt Medel ABI 18m Lt HA CHARGE Detects all 6 IDs env
sounds Puts ABI on if falls off Stops to no Mandarin/English Few
single words: Bye-bye, no, come, sh Vocalizes with ABI Few vowels
Few consonants UK SS 2014 O 7/31/11Rt Medel ABI 20m Auditory nerve
deficiency Goldenhar Scoliosis: walks with aid No detection of Ling
6 Stills to env sounds Responds to no BSL & English Understands
10 signs Vocalizes Poland PI 2014 A March 12 CHARGE, Malformed Leg,
Vision Developmentally Delayed 4 Polish/English/Sign John Tracy
Clinic 2015
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ABIS & YEAR LONG PRESCHOOL STUDENTS Name Country/Center
& Time at JTC DOB Devices & Fitting Ages Etiology/Other
Challenges Listening Performance Language Performance Speech
Performance UK (Italy &C3) 2010 8/6/06Nucleus ABI 31m Absent
auditory nerves Vestibular/Balance Thresholds in banana IDs all
Ling 6 Two critical elements Previously used BSL 4-5 word phrases
Simple sentences First me, and then you PLS Total 3;1 @ 4;8 Many
vowels Plosives, nasals, fricatives Singapore 2013 9/8/10Rt Medel
ABI 17m Auditory nerve deficiency Shortened frenulum Motor planning
Oral-Motor/Feeding Good audio thresholds Reports ABI off 25dB
across banana IDs all Ling 6 @ 3ft IDs 3 critical elements 2-3-word
MLU catch me, daddy PLS 1 yr below CA Most vowels Most consonants
Turkey (Turkey) 2014 1/24/12 Rt ABI 21m Lt CI 32m Oral-Motor Poor
audio thresholds Detects all Ling 6 with CI IDs /a/ with CI Nothing
with ABI Single words Vowels Few plosives/Stops Few nasals John
Tracy Clinic 2015
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SOMETHING NEW Teacher Concerns What are their needs? How are we
going to accommodate their needs in an AVEd. Classroom? What are
acceptable articulation parameters? How are we going to make a
difference in three weeks?
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SHORT HISTORY OF CHANGE Unilateral-Single channel CI Variations
of Multiple channel CI Digital Aids MRI OAE Auditory Neuropathy
Bi-lateral CIs ABI
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LESSONS LEARNED FROM CI DEVELOPMENT You can see trends coming -
Learn all you can Develop a Team Approach Communication and
Reporting Observations are key to progress Outcomes Vary and Get
Better Over Time Confusion, Frustration and Doubt are part of
learning So are Optimism, Anticipation, and Discovery Its not magic
Its work
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EXPECTATIONS FOR ABI DEVELOPMENT You can see trends coming -
Learn all you can Develop a Team Approach Communication and
Reporting Observations are key to progress Outcomes Vary Get Better
Confusion, Frustration and Doubt are part of learning So are
Optimism, Anticipation, and Discovery Its not magic Its work
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ACTIVITY Explorers Pioneers Settlers How do we know what each
phase looks like? What are the skill sets with each level and what
are the skills to nurture in each phase (parents)?
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MULTIDISCIPLINARY APPROACH
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HETEROGENEOUS LEARNERS: CLASSROOM AVEd. Classroom Immediate
audiological management Acoustically controlled environments Parent
as Effective Facilitators Provide focused and individualized
instruction Collaborate with parents and professionals Promote
spoken language self monitoring AVEd. Classroom + ABIs All of the
AVEd. list and.. Small group lessons Higher adult-child ratio Adapt
lesson for other learning needs Use sandwiching technique to build
into auditory learning Integrate learning through movement
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VIDEO
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SPECIFIC CLASSROOM STRATEGIES Seating Arrangement Sandwiching
Slow progress means??? For the ABI Close Proximity Environmental
Acoustics Sound Field Systems Trouble Shooting In children with
hearing loss
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LEARNING CHALLENGES
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LENA ABI OnlyABI & CI
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PARENT SUPPORT GROUPS Different than in the 80s 90s
Availability to stay supported through the internet Many live at
the implant site Facebook Children with Auditory Brainstem Auditory
Brainstem Implant Technology Facebook