AUDITORY LEARNING &
TELEPHONE TRAINING
FOR TEENS & ADULTS
WITH COCHLEAR IMPLANTS
Ellen A. Rhoades, Ed.S., CED, Cert. AVT
Auditory-Verbal Training & Consultations International
www.AuditoryVerbalTraining.com
Sonja Jovanovic, Dip.CCS, R.SLP, Cert. AVT
Founder & Executive Director
Auditory-Verbal Centre of Calgary, Alberta - Canada
Auditory Verbal International
2003 Convention, Baltimore
A COMPREHENSIVE AURAL
REHABILITATION PROGRAM
> Pre-Ops
> Counseling & Self-discovery
> Equipment
> Social Interaction Strategies
> Education
(information)
> Aural Rehabilitation Approaches
> Therapy Activities
> Listening-Speech Techniques
> Telephone Training Strategies
> Resources
(synthetic & analytic)
REHABILITATIONIST’S ROLES
The
Brass
Ring
• FACILITATOR
• EDUCATOR
• COUNSELOR
• ENABLER
• MOTIVATOR
• TEMPTRESS
• PUSHER
• THERAPIST
The
Holy
Grail
The
Beacon
PSYCHOSOCIAL CANDIDACY
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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
• 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 preimplant baseline of person’s use of residual hearing
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
ASSESSMENT FINDINGS
• Preferred Mode of Communication
• Speech Production Skills & Voice Parameters
• Language Skills
• Social Skills
• Psychosocial Issues
• Motivation & Expectations
• Reliability in attendance
BEFORE HEARING
• Surgery is scheduled
• Counseling continues
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
or “turn-on”
• Review of CI equipment
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.
SYNTHETIC STRATEGIES
(Discrimination of total units:
personalized sentences & connected discourse)
 Meaningful w/ general comprehension (pointing/imitation) acceptable
 Rhythmic auditory-speech tracking w/ timely reading material
(e.g., cupacoffee)
 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 string
 Alphabet-word association list
 Topical (related  unrelated)
DON’T FORGET THE MAP
Quarterly mapping initially
At least annual maps thereafter
Watch out for indicators that upgrades
may be needed in between:
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headaches
bad moods
fatigue
not wearing the processor at all times
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)?
THE INQUIRING THERAPIST
Ask questions:
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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?
LISTEN
LISTEN
LISTEN
LISTEN
LISTEN
LISTEN
LISTEN
LISTEN
LISTEN
THERAPISTS SHOULD...
Lurk on a CI online group for 6 months.
CI@YORK.CA
Hear their concerns.
Listen to their voices.
THE AUDITORY SANDWICH
Visual cues:
• lip-reading
• printed word
• cued speech
• signs
HEAR
SEE - SAY
HEAR-UNDERSTAND
First, listen.
Then, if need be,
watch or say it.
Then, listen again
(no visual cues)
Always put it back into hearing!
ALL-INCLUSIVE THERAPY
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
BASIC TRAINING
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
General conversation!
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.
Be
DEF
Research findings of L. Glass & H. Elliot
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!
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
MORE RESOURCES
http://www.AuditoryVerbalTraining.com
http://www.focusonhearing.org
http://www.saywhatclub.com
http://www.hearingloss.com
http://www.listen-up.org
CI@yorku.ca
(online forum)
SHHH
ALDA
CIAI
A.G. Bell
AVI