CHILDREN WITH ABIS IN THE
CLASSROOM: WHAT CAN WE EXPECT?
CI & ABI
Candidacy
Device
Surgery
Medical & Audiological Sites
Research
CANDIDACY
• Not a CI candidate
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Neurofibromatosis Type 2
Absent VIII nerve
Cochlear Nerve aplasia
Auditory Neuropathy
Cochlear Malformation
Cochlear Ossification
Head Trauma
Inner Ear Scarring
IMPLANTS
Cochlear Implant
http://www.medel.com/image-gallery/
Auditory Brain Implant
http://www.medel.com/blog/neurofibromatosis-type-ii-hearing-loss/
DEVICE COMPARISON
Photographs courtesy of Cochlear Ltd.
ABI IMPLANTED
Illustration courtesy of Cochlear Inc
SOME OF THE
IMPLANT & MAPPING LOCATIONS
Worldwide
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Belgium
Germany
Italy*
Poland*
Turkey*
United Kingdom*
USA (Clinical trials)
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Massachusetts Eye and Ear Infirmary
University of North Carolina
USC-CHLA – California
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• Singapore*(mapping)
• Spain
• Sweden
*Enrolled in programs at JTC
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
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
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
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
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
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.
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
ABI RESEARCH
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
JTC’S CHILDREN WITH ABIS
Demographics
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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
SURGERY DATA
Implant Facility
• Italy - 8
• Turkey -1
• England -1
• Single Sided
• MedEl – 5
• Cochlear – 3
Implanted In
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2001 - 1
2002 - 1
2009 - 2
2012 - 4
2013 - 2
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
7/13/05
Nucleus ABI 39m
Cochlear nerve aplasia Hypotonic, Oral-Motor,
Torticollis
4
No Response 500-6K
Home: English & Arabic
Vocalizing /a/
Ireland
(Manchester)
SS 2012 C
11/19/08
Nucleus 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
9/28/10
Rt 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
6/26/09
Medel 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/
9/15/11
Rt Medel ABI 18m
Lt HA
CHARGE
Mandarin/English
Few single words:
Bye-bye, no, come, sh
Vocalizes with ABI
Few vowels
Few consonants
UK
SS 2014 O
7/31/11
Rt Medel ABI 20m
Auditory nerve deficiency
Goldenhar
Scoliosis: walks with aid
BSL & English
Understands 10 signs
Vocalizes
Poland
PI 2014 A
March ‘12
UK (Italy & Manchester)
SS 2013 E
CA
(Italy & C3)
SS 2013 A
CA (Italy & C3)
PI 2013 B
CHARGE, Malformed Leg, Vision
Developmentally Delayed
Detects all 6
IDs env sounds
Puts ABI on if falls off
Stops to “no”
No detection of Ling 6
Stills to env sounds
Responds to “no”
Polish/English/Sign
4
© John Tracy Clinic 2015
ABIS & YEAR LONG
PRESCHOOL STUDENTS
Name
Country/Center
& Time at JTC
UK (Italy &C3)
2010
DOB
8/6/06
Devices &
Fitting Ages
Etiology/Other
Challenges
Listening
Performance
Language
Performance
Speech
Performance
Nucleus 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
2-3-word MLU
“catch me, daddy”
PLS 1 yr below CA
Most vowels
Most consonants
Single words
Vowels
Few plosives/Stops
Few nasals
Singapore
2013
9/8/10
Rt Medel ABI 17m
Auditory nerve deficiency
Shortened frenulum
Motor planning
Oral-Motor/Feeding
Turkey (Turkey)
2014
1/24/12
Rt ABI 21m
Lt CI 32m
Oral-Motor
Good audio thresholds
Reports ABI off
25dB across banana
IDs all Ling 6 @ 3ft
IDs 3 critical elements
Poor audio thresholds
Detects all Ling 6 with CI
IDs /a/ with CI
Nothing with ABI
© John Tracy Clinic 2015
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?
SHORT HISTORY OF CHANGE
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Unilateral-Single channel CI
Variations of Multiple channel CI
Digital Aids
MRI
OAE
Auditory Neuropathy
Bi-lateral CIs
ABI
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
• It’s not magic – It’s work
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
It’s not magic – It’s work
ACTIVITY
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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)?
MULTIDISCIPLINARY APPROACH
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
SPECIFIC CLASSROOM STRATEGIES
• In children with hearing
loss
• Seating Arrangement
• Sandwiching
• Slow progress
means???
For the ABI
• Close Proximity
• Environmental
Acoustics
• Sound Field Systems
• Trouble Shooting
LEARNING CHALLENGES
LENA
ABI Only
ABI & CI
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
COLLABORATIVE WORK
REFERENCES