Slide1: AUDITORY LEARNING & TELEPHONE TRAINING
FOR TEENS & ADULTS
WITH COCHLEAR IMPLANTS
Ellen A. Rhoades, Ed.S., CED, Cert. AVT
Auditory-Verbal Training & Consultations International
Sonja Jovanovic, Dip.CCS, R.SLP, Cert. AVT
Founder & Executive Director
Auditory-Verbal Centre of Calgary, Alberta - Canada
Auditory Verbal International
2003 Convention, Baltimore Slide2:
> Counseling & Self-discovery
> Social Interaction Strategies
> Education (information)
> Aural Rehabilitation Approaches (synthetic & analytic)
> Therapy Activities
> Listening-Speech Techniques
> Telephone Training Strategies
A COMPREHENSIVE AURAL REHABILITATION PROGRAM Slide3: REHABILITATIONIST’S ROLES
The Holy Grail The Beacon The Brass Ring PSYCHOSOCIAL CANDIDACY: 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: 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 Slide6: 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 tracking Determine Auditory Weaknesses: move from GROSS SUBTLE
in follow-up listening activities (auditory discrim) activities Slide7: ASSESSMENT FINDINGS
Preferred Mode of Communication
Speech Production Skills & Voice Parameters
Motivation & Expectations
Reliability in attendance
Surgery is scheduled
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
Review of CI equipment
BEFORE HEARING WHY SOME ANALYTIC STRATEGIES?: 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
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-word association list
Topical (related unrelated)
(Discrimination of total units:
personalized sentences & connected discourse) Slide11: DON’T FORGET THE MAP
Quarterly mapping initially
At least annual maps thereafter
Watch out for indicators that upgrades
may be needed in between:
not wearing the processor at all times
Slide12: 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)?
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?
THE INQUIRING THERAPIST Slide14: THERAPISTS SHOULD...
Lurk on a CI online group for 6 months.
Hear their concerns.
Listen to their voices.
Slide15: THE AUDITORY SANDWICH
Always put it back into hearing! HEAR HEAR-UNDERSTAND SEE - SAY First, listen. Then, if need be,
watch or say it. Then, listen again
(no visual cues) Visual cues:
signs Slide16: 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 Slide17:
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
BASIC TRAINING Slide18: 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.
Research findings of L. Glass & H. Elliot Be DEF Slide19: 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! Slide20: READINGS
Biderman, 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 Slide21: MORE RESOURCES
CI@yorku.ca (online forum)
SHHH A.G. Bell CIAI AVI ALDA