Case study 45-year-old Kathy is 45 years old. She has had hearing loss all of her life and just got a cochlear implant. She has always used oral communication but learned some signs as an adult. Her family members are all hearing and most of the time they communicate using spoken language in the home. She has two teenage children but she is frustrated that she doesn’t understand them all of the time. They have an active, busy home and the kids bring home friends many afternoons. She loves the holidays and would love to better understand some of the Christmas songs that play on her Alexa. What are questions you have about her hearing/hearing technology? How is your hearing now with the cochlear implant versus when you had hearing aids prior? What form of communication would you prefer to use most often? What would you work on for auditory skill development? I would ask if there were conversations involving different things that are more difficult for Kathy. I would have us go through different ling sounds to see what range she is able to distinguish. I would go through different carrier phrases that practice different rates of speech. o I would also look at acoustic highlighting and the number of repetitions in different phrases. I would also look at different syllable words and sentences where she identifies how many syllables are in each word. For sentences I would have her identify sentence length when I give her a sentence to listen to. I would say two sentences that are similar and I would have her distinguish which one I asked for before I said them. I would check that she is hearing across all frequencies. Track passages read aloud to her or on the phone. I would have her listen to songs on Alexa. What would you work on for speech-language development—remember to be functional? I would have us practice which instances are most difficult for her when she is at home. Since she enjoys listening to music on her Alexa so we might practice some short songs with music and see what she is able to understand and hear. o I would also see if she could turn her Alexa up more to hear better or move it to a different part of the house when she is wanting to listen to music. o I might also suggest getting the app on her phone and hooking her phone up to headphones or speakers in her house that would let her use that verbal instructions while also being able to hear the music. She also wants to speak with her family better so we might practice situations that she could encounter at home and how she could make that situation better for her to understand. We should also work on more sign language with her so that when she is out in public in a place that has a lot of surrounding sounds, she can communicate with her family better. Since she wants to hear the Christmas music, she could print out the lyrics for the songs her family listens to so that she could make the connection of the lyrics visually and somewhat when she hears it being played. o Apple Music has an option to read lyrics while the song plays and that could be something she does more when she listens to songs so that she can better understand the lyrics and know what the singer is saying at that moment in time. How would family members be involved? It seems like her family doesn’t fully understand the extent of Kathy’s hearing loss. I would try to explain to them what she is hearing and how she still cannot hear everything perfectly with her CI’s. I would encourage her family to learn some ASL signs so that they can communicate with her in environments that have too many surrounding sounds. Have her kids read to her so that she can become more accustomed to their voice. What resources would you share? I would share videos of what people with CI’s hear and what the process was for Kathy to get her CI. I would also share resources for how family can help someone with a CI and be better understanding with what she is going through. What would interprofessional collaboration look like? I would keep in touch with the audiologist about Kathy so that if I were to find anything odd from my different tests in auditory skill development, I discuss if we need to do any further testing so that Kathy can hear to the best of her ability. Post-lecture reflection: Overall I feel pretty confident in what I had originally versus what else I should have added. I really liked the idea of having her print out lyrics to the Christmas songs because I know that when I read the lyrics while listening to a song I can better understand what it being sung rather than me guessing the word. Apple Music has a feature that highlights the phrase being sung at that moment in time so you can read with the song as you listen to it and I think that would be great for Kathy. I also liked the idea of having Kathy be read to by her children so that she can hear their voices and become accustomed to what they sound like so she can begin to distinguish their voice from others.