ROUGH EDITED COPY
EHDI
BECKHAM
WORKING ACROSS DISCIPLINES: IMPLEMENTING LISTENING TARGETS
USING AUDIOLOGICAL DATA AND FUNCTIONAL LISTENING PERFORMANCE
PRESENTERS: TRACY MEEHAN AND WENDY DETERS
3/9/15
2:00-2:30 P.M. ET
REMOTE CART/CAPTIONING PROVIDED BY:
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PO BOX 278
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(This text is being provided in a rough draft format. Communication Access Realtime
Translation (CART) is provided in order to facilitate communication accessibility and
may not be a totally verbatim record of the proceedings.)
>> So hi and welcome. I hope lunch was good. So we're going to jump right in to our
30-minute pacer. Here we go.
Go!
So why work across disciplines?
Why would Wendy, a speech language pathologist and me, an educator develop this
presentation for today's audience?
Well, there's a couple of reasons.
Number one, Wendy and I co-coordinate a grant certificate program through Illinois
State University and it's designed to increase the number of highly trained professionals
entering early intervention serving our youngest listeners.
Secondly, Wendy and I have also worked on IFSP teams serving infants and toddlers in
the birth to three program in Illinois and we worked together on IFSP teams as speech
pathologist and provider of aural rehab.
Is that not working?
We were told not to touch it, so I'm not going to touch it.
We find ourselves using this audiological data and functional listening performance or
using listening performance and audiological data, so we've had interesting dialogues
and started thinking maybe others would like to learn as Wendy and I learned from each
other.
We feel the collaboration between audiologist and provider is crucial for families,
whether the home or clinic is speech language pathologist like Wendy or deaf educator
like myself, that loop of information is just as critical as the auditory loop.
So Wendy and I coordinate.
Let's go forward.
So we coordinate courses with our partner Mary Beth Lartz at Illinois State. I have
brochures if anyone is interested. We're here for the rest of the conference and happy
to talk to you about it. We supervise and mentor students in this graduate program
through two separate practicum experiences because we expect them to take as any
good educator course work from the classroom and synthesize it and be able to use it in
a practical setting. So as we do research to better equip ourselves and our instructional
toolkit for our students in the classroom, we find a question coming up, what are the
priorities of the program? What are the priorities we want to share with our students?
These professionals come into our program with different experiences and licensure in
their discipline, but what they don't have are many or if any courses in listening skill
development. Yet alone, courses in listening skill development of the very youngest
learners.
So we know our course work has to be comprehensive and focus on listening.
We, here, know that hearing is a distant sense and our deaf and hard of hearing kiddos
have a listening bubble that is much smaller. So we need to be sure that our students
are able to actually discuss that with families that they serve in early intervention. They
need to be able to discuss listening skill development and own the material and be able
to set targets and take that diagnostic information that we get from the audiologist that
we're going to be doing a little practice with today and be able to set up those
intervention and targets. Wendy and I also feel strongly that part of that clinical lens is
being able to assess and observe functional listening performance. What does that
mean? What am I watching for? And then who am I going to share that back with?
The audiologist. Because a 12-month-old and 20-month-old can't do it as well as we
can. So that's what we're here to do today.
So hopefully this visual will let us all agree that the outcome of listening and spoken
language depends on the input of auditory signal. I think we heard that this morning
loud and clear. Clear auditory signal comes when the equipment is appropriately
programmed and worn, right? And worn. And then the outcome, the best success of
the outcome is when that intervention includes the assessment of functional listening.
That data is then shared between the audiologist and the provider. So a family that
chooses this outcome, they have a lot of steps to take. We know that. They have a lot
of players to learn and work with. So we have to be very committed to the 1-3-6
guideline and this visual plays into that as well. We know hearing aids and diagnosis
and hearing aids, amplification by three months and appropriate intervention by six
months. And so our take is that when intervention begins, that child is already
participating in routines. Rich routines full of language, full of the ability to set up the
serve and return, parent provider, parent infant, and also routines that include a lot of
repetition.
So life is full of routines.
It doesn't have to be big routines. Small routines that a family is doing with their infant.
Unpacking the groceries, finding a nursing chair to sit down in. Putting the baby down
for a nap. Getting the baby up for a nap. Predictable routines that provide repetition.
So our clinical skills are to imbed our ASL strategies into predictable routines. Why?
Because we know maximum repetition is necessary for our kids. So we need to
empower the parents to be able to do that and before I turn it over to Wendy, just think
about an example and we'll go forward.
So we know that 6 to 10-month-old infants are developing basic -- just Google it on
University of Tennessee if you want to see parents showcasing their infants or
grandchildren doing canonical babbling, do it right now as you leave the room. We
know that vocal production of the kids we're serving could match with the same listening
age.so we could use research to set up intervention targets, but we know that's an
expected target that we could expect of that age group.
So we have audio metric data on Sophia, and Sophia is eight months and we see from
the audiometric data that she detects ah. So we know clinically there are also some
basic early developing consonant sounds that Sophia also can detect. Bsand Ms. So if
we want Sophia to be able to reach that re-duplicated babbling, we have to make her
environment reach with that sounds, bah-bah-b, mah-mah-mah. Did that pretty good.
We want the basic canonical automatic. The parent takes them over to provide
maximum repetition.
>> So as home open based providers, we have this opportunity to be in the child's
home with the people who know them best, their parents or caregivers. We need to
take these opportunities to observe and evaluate how the child is moving with their
listening skills. For functional speech and language development. Hearing aids and
cochlear implants as we know are programmed in quiet environments. Infants and
toddlers do not live in quiet environments.
So young children, especially very young children also have difficulty participating in
speech perception testing due to their age and lack of vocabulary. So we as providers
and parents need to be very vigilant about observing their functional listening skills so
we can report that back to the audiologist. So in our home-based session, there are
many tasks that we work on. We build speech development. We build language,
communication, but as Tracy was saying, we really need to focus on listening as well.
And one specific piece that we're talking about today is this daily functional listening.
So, again, there are many people on the child's team that need to understand functional
listening skills. As providers we need to know this so we can set goals and also identify
red flags. Parents need to know how to do this because they need to be good
observers of their child's behavior. They need to be able to work on building listening
skills throughout the day, not within that one hour a week when we're in their home.
They also need to be -- we don't go to every audiology appointment with our kids.
Sorry, can you hear us?
>> Can you raise the mic a little?
>> WENDY DETERS: Or I can talk a little louder. Is that better now?
Is that better?
Oh, okay.
Got it. Where am I now?
Okay. Yes, parents. Parents need to know how to build listening skills throughout the
child's week, not just in that hour that we're in their home. They also need to know this
because we don't go to their audiology sessions, nor should we have to. We can go to
some but not all. They need to be reporters of their child's behaviors. Audiologists
need to know what sounds a child can detect or identify, so that they can appropriately
program devices and recommend the best technology for that child.
So, again, this is another reason why that collaboration is so important. Everyone on
the child's team needs to understand their functional listening skills.
We define functional listening skills -- we kind of came up with our own definition from
using a bunch of different sources as not what a child hears but how they use it.
So not what we see on an audiogram but how they're using their hearing for learning.
So, for example, a child could have aided thresholds around 20-decibels on an
audiogram. And they may be responding to a variety of environmental sounds, the door
slamming, somebody knocking, but after about three to four months post-activation,
depending on age of implantation and other factors, they're still not responding to their
name consistently. This would be a functional listening red flag. And not necessarily
matching up with what is reflected on the audiogram.
So the goal of the amplification as we know and you probably have heard in other
sessions is for the child to have complete auditory access to the brain so that
development of listening and spoken language can occur.
So what does appropriately fit mean? We know that children need to have access to all
phonemes throughout the frequency ranges of about 200 to 8,000-hertz. They need to
clearly hear all phonemes at varying loudness levels, so across different speakers. And
we want them to have aided thresholds of at least 20-decibels at all frequencies. As we
mentioned, children don't live in quiet environments, so we have to assess functional
listening skills in the challenging environments of distance and noise. So not just
focusing on these tasks in our you know, sitting on the floor with the baby in front of us,
mom next to us, we have to take that information and then overlay these challenging
environments of distance and noise.
>> TRACY MEEHAN: So there's a bunch of tools we all have in our toolkit and these
are the three that we reference. We're going to click through these, the castles of spice,
but the point of the overlap here of Wendy and I is that we as clinicians are required to
use those challenging factors. So we have our checklist and then we want to be aware
and cognizant. There's a slide -- the next one has an activity that we thought might be
an interesting one to take back to your teams or your professionals that you work with.
We don't obviously have time today to do it, but looking at the challenging factors of
noise and distance and varying speakers, coming up with activities and then reflecting
back and forth on how those are going and how often are you doing it and building in
the assessment piece of that to report back to the audiologist. Just some quick
resources. We all have this probably, but thought maybe on one slide maybe there'd be
one or two you haven't already heard of. So hopefully those will be helpful.
>> WENDY DETERS: So we have video examples for you of a little boy, and for the
purposes of this presentation, we're using the Ling 6 sound test for the lens we can
assess this particular child's listening skills. It's one of the many activities we use, so
don't get caught up on the fact we're doing the Ling. We all know how to do it, we're
past it, but that's the exact approximately we have here. Think functional listening skills
with this specific task.
Tracy is passing out some audiograms for you that will match up with these videos.
There's a link here to a tool that is produced by Cochlear that is very helpful to track just
to do quick LING checks over time. I've used this and given it to families to use at home
too. Just a quick check when the child puts on their devices in the morning.
Another thing to think about is when we work with students that use the LING6 in their
daily professional lives, we challenge them to think about why they're doing what they're
doing, and more importantly, what information they're taking from the child's responses.
So not just using it as a check of device functioning but really as functional listening
skills. Sometimes in very young children, before they are even able to really pair early
listening -- early learning to listen sounds with an object, they're able to -- we are able to
get some good information from this quick check.
So, for example, if a child is missing the S sound, we challenge our students to think
about what else are they missing. So think beyond the test that you're giving. Think
about an F or a TH or the second or third form of the E vowel, so not just the ling sound
itself but what other consonant and vowel information is in the frequency range they're
not able to identify? That will clue us into some functional listening skills. So before
they're able to say ish instead of fish, we know if they can't detect an S sound, we know
they're missing valuable information there in those higher frequencies.
So, again, as we're stressing here about listening in noise, our next step to the students
would be, okay, you can do this at a close distance. Now how does this child do when
you're in another room 12 feet away? Or when the TV is on? Not that we want them
watching TV at home, but to challenge them to step out of that comfort zone of being up
close in a quiet room and overlay these challenging factors, because really that's how
kids live..
So here is our little guy. He's a toddler, male, identified at birth with a hearing loss. His
initial sedated ABR indicated bilateral mild sloping to profound sensorineural hearing
loss hearing loss.
[ speaker is off microphone ]
>> Yeah, I'm just giving the background and I'll go into the audiograms.
Currently now he's -- so as you can see, there may be some progression in his loss.
We're not sure. We're not at that time.
He was aided at 8 months. He started participating in EI therapy twice a week when he
was seven months old, consistent hearing aid user, supportive family, speech and
language approach with supplemental sign.
We are not audiologists, disclaimer, but this is the information. What you have is what
we get from the audiologist. We do the best with what we have. We look at these
reports and do the functional listening and get back together as a team to put all of the
information together.
So our first video is from when this little guy was 11 months old. He had a listening age
of three months. He was wearing bilateral hearing aids. And if we look at audiogram
one, I won't make you interpret it. Very quickly I'll just do that for you. Results indicate
a moderate sloping to severe hearing loss. This is unaided in the sound field speech
awareness threshold at 60 dB. Audiologists okay there? Not an audiologist.
If you turn to audiogram two, this is actually the same child but just two weeks later. It
looks like his participation may not have been as good, being that he's 11 months old
there could have been a variety of reasons for this.
So the results on the second audiogram indicate a severe to moderately severe loss in
the left ear with a speech awareness threshold of 50 to 55 dB. And a profound to
moderate hearing loss in the right ear with speech awareness at 60 dB.
So as we pull up the video, think about what you would expect this child to detect in a
quiet environment. Then consider how you think you would do in distance and in noise.
Also we would like you to note the behavioral or functional listening responses that he
has to this task.
And then I'll share -- again, I won't make you all report back to me in a short term, but I'll
share our thoughts and if we have time we'll take some from you as well.
[ video playing ]
>> WENDY DETERS: We're just going to work with the audio here for a second.
I don't want to touch it. I'm going to blowout everybody's eardrums.
He's got his cap on.
It worked. It doesn't work with everyone, from what I've experienced, but...
[ speaker is off microphone ]
>> WENDY DETERS: That's a good idea. That's a great idea.
No, they all figure it out eventually.
It's hooked up to the speakers.
All right. It is captioned. It doesn't have the same effect.
Let's see. I'm going to play it because it is captioned. Just take a look...
[ video playing ]
>> WENDY DETERS: Clearly not the first time this kiddo has done this. I trained him
well. Mom trained him well, actually. Again, I'll share thought here. He had a nice
response to sound by looking up when he heard ah, oo, ee. Pretty clear response to
very soft noises, as I described to mom seemed to interfere with his detection of the
sound, which is telling us something.
We had already had preconceived notions just by looking at his audiogram and recent
performance that that was a difficult sound for him. Behaviorally he's looking for
acknowledgment and praise for his speech, so he's communicating nicely. Nice nonverbal communication and that good old communicative intent is observed. Wonderful
attention span and eye contact. Something else to note, because we don't have a lot of
time, I do go across the room to do it again. So, again, we're at a very close distance
and quiet environment. He doesn't have visual cues, but everything else is set up for
listening. So if he's having trouble with the high frequency sound in this environment,
what can we expect for a more challenging environment?
So we're going to show him again four months later. This is now the third audiogram. If
you take a look.
[ video playing ]
>> WENDY DETERS: And sorry we're kind of -- well' have to speed through the last
few slides here. Again, some observations, he's a little more distracted, could be his
age. He's a little bit older. Unfamiliar setting, new people. This video was him with one
of our graduate student clinicians in our summer clinical practicum that takes place at
Child's Voice. He does have a nice consistent response to ah, um and oo. A nice clear
head turn. He's looking at the student instead of dad. Could that be a localization
issue? Could it be he's just used to the student talking to him this week?
He continues to have good communication skills. Something else to note, he's saying,
ah-ha, all done, no consonant sounds whatsoever. Again, we have a listening age of
seven months and no consonant sounds are noted in his speech. He's got a limited
repertoire at home and consistent response to S and only five words expressively.
So what we're looking at is some progress here, but is it enough?
Looking at this audiogram and looking at his functional listening skills, this is where we
go back to our audiologist and work as a team to determine if -- is she confident in these
audiological results or are there programming changes or perhaps other technology that
need to be implemented so that we can see even more progress in these functional
listening speech and language skills.
So, again, what we wanted to stress today is the importance of not just looking at the
audiogram and not just operating by yourself. Really getting information from the
audiologist and your other team members and working together to pair audiological data
with functional listening and speech and language data so that the child can really make
progress.
Again, we as providers need to know this functional listening information so we can set
goals and figure out what to do next. So, for example, working with this child in quiet
and then working with him in distance and in noise to see how he really functions in a
real world environment.
We need to teach families how to observe these skills and thousand to build them so
they can be-supporters of their child's abilities. And why we're here is communication
amongst providers. Our main goal as we heard this morning and throughout the whole
conference is complete auditory access to the brain in both favorable and challenging
listening environments.
We can be out there and answer any questions. Thank you so much. Enjoy the rest of
the conference.
[Applause]