Transcript Determining Need and Benefit of FM Use: Measurement of

Karen Anderson, PhD
[email protected]
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Probe microphone measurements
Using electrophysiological data to infer hearing
thresholds for early hearing aid fitting
Hearing aid fittings on babies 1-3 mos old!
Fitting programmable and digital hearing aids
rather than familiar analog aids
Letting go of relying on behavioral measures of
hearing until a child is 5-6 months old
Etc.
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Match the gain and output to DSL targets
Earmolds fit snugly so no feedback
Parents understand that they need to return for
new earmolds when feedback occurs
Parents have been instructed in earmold insertion
and the care and operation of the hearing aids
◦ THESE ARE ALL THINGS THAT THE AUDIOLOGIST DOES
 The
child wears the hearing aids
consistently!
 Parents
make an appointment for new
earmolds as soon as they notice
feedback
 Parents have a real understanding of
the child’s hearing loss and its affects
TRY TO DO
AVOID
1. Describing hearing loss
1. Talk about how the
by using labels (mild,
hearing loss affects speech
moderate, Deaf, HOH)
perception
2. Teaching parents about
2. Describe hearing in terms
the audiogram, they can
of daily listening situations
learn it later
(listening range,
3. Giving the impression
communication access)
that amplification will
3. Encourage parents to
fully take care of the
observe their child’s
child’s hearing problems
responses to sound
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Slight Hearing Loss or Unilateral Hearing Loss
◦ May miss some consonants; mild difficulty with auditory language
learning, listening at a distance and in noise
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Mild Hearing Loss
◦ Only hears louder speech sounds; difficulty with auditory learning,
some speech/language delays, inattention
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Moderate Hearing Loss
◦ Hears almost no speech sounds at normal levels; articulation
differences, language delay, learning dysfunction related to
language delays, inattention
Assume communication from 6 feet
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Severe Hearing Loss
◦ Hears no speech sounds at normal levels; very
reduced speech intelligibility, verbal language
delay, learning dysfunction related to language
delay, inattention to verbal communication
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Profound Hearing Loss
◦ Hears no speech or other sounds; little or no
speech intelligibility, little or no verbal language,
learning dysfunction related to language delay,
learns by visual cues or manually coded language
systems, inattention to verbal communication
English and Spanish handouts at:
 www.kandersonaudconsulting.com
Hint: use to help describe effect of hearing loss in
reports, parent counseling, teacher inservice
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True management of hearing loss goes
beyond diagnosis and hearing aid fitting
Interpreting hearing loss in a way that the
parent can integrate the knowledge into
their daily lives and share it with other
people who care for the child
Ongoing consultation, information, support
to the family
Listening NOT advising
Buy-In or recognition that:
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The hearing loss is
It WILL affect the child’s development if it is not addressed
Communication access is JOB #1 in preventing delays from
developing
They – the daily caregivers – are the people who must be
involved most in helping their child learn language --parents are the magic
The prognosis for normal or near-normal development is
good but it requires their investment of time and energy
1. Suggest some ways in which people who work with
children with hearing loss can involve parents so
that they will develop a higher level of buy-in
2. Discuss ways in which we can validate the degree of
benefit experienced with their choice or adjustment
of hearing instrument
3. Discuss birth to five, but also present tools for schoolage and adolescents when teacher buy-in is critical
to the child’s success
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The key to successful development and learning is
effective access to speech from as early as possible
Regular screening of functional ability in typical
environments assures that children will not develop
or increase gaps in learning
School accommodations, including FM, are
necessary to maximize learning and performance in
school
The ‘age of accountability’ requires documentation
beyond the audiogram to support a child’s need for
S/N enhancing technology
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Test instruments involve the parent or teacher in
thinking about the child’s behavior and making a
judgment
By involving them we are showing that we respect
their opinion – that they have valuable insights to
offer
Auds set hearing aids for audibility of speech at
different levels of input but people who are with the
child everyday observe his or her functional use of
hearing
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Hearing loss and audiograms do not make much
sense to most people, especially soon after a
diagnosis
Parents cry and then go home and bang pots
Audiologists can recognize the parent’s need to
understand the hearing loss in terms of the child’s
listening/communicating at home
We need to ask parents to participate in the
discovery process to foster their understanding and
buy-in to the diagnosis and amplification use
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Educational audiologists are not in all school
districts and often are not involved at length with
any one child
Use of instruments completed by parents and
teachers is more efficient and may provide
valuable and different information than obtaining
full academic assessment
Parents involved early in recognizing their child’s
hearing needs have the power to influence their
educational program
ELF
Early Listening Function
Why: Hearing is a distance sense. A child with a hearing
loss will have a reduced hearing range, or a smaller
listening bubble, than a child with normal hearing.
Audiologists test to find out what tones a child can
detect, but only someone who is with the child for hours
everyday can observe how the child is using hearing in
daily situations.
Hearing instruments will improve the size of the
listening bubble. With use of amplification during all
waking hours, auditory skills will usually improve over
time.
6 inches, 3 feet, 6 feet, 10 feet, 15+ feet
12 Activities:
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4 quiet, 4 typical loudness, 4 loud
Loudness calibration is not critical – parent participation
in typical environments is critical
Quiet and noise: develop awareness of how having the
TV always on limits the child’s perception of other
sounds
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Gives the parents something “to do” to feel like they are
helping their child
Can be a first activity with early intervention
Motivating for following through with hearing aids or new
earmolds
Tuning into auditory development over time
Involve all caregivers
Provides parents with a clear way
of
describing the hearing loss
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Each activity has a point value do a possible
score out of 100 can be obtained
Audiologist scores and compares over time
Reveals improvements in perception of quiet
input or across distance
Separate form for parents to complete 1-2
weeks after new amplification is fit
May be beneficial to family compliance
(Example: Dad’s who get involved in
‘measuring’)
Parents circle 1-5 scale: Agree, No Change, or Disagree
My child appears to:
1. Be more aware of my voice
2. Be more aware of environmental sounds
3. Search more readily for the location of my voice
4. Have an increased amount of babbling or talking
5. Have more interest in communicating
During ELF listening activities, the size of my child’s listening bubble:
1. Has improved for quiet sounds voices
2. Has improved for typical sounds and voices
3. Has improved for loud sounds and voices
4. Has improved for listening in background noise
Describe specific situations when you noticed improvements in listening
ability:
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Developmental sequence of listening skills for children
with normal hearing
Helpful for parents of children with “little hearing
losses”
Underscores that children’s listening skills aid in the
development of socialization and verbal development
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Interview format – 10 questions for parent to
answer
Oriented to speech use and intelligibility
Good format for discussion
Good back-up if family does not follow through
completing the ELF
Also available: MAIS and MUSS
◦ Advanced Bionics – call customer service to request copies
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Takes over where the ELF begins
Assesses the functional auditory skills within a
sequence of development – not just detection
Each skill rated as not present, emerging, in
process, or acquired
Could be an integrated part of early intervention;
assistance to parents in observing and completing
Update on a regular basis (i.e., monthly)
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The following instruments can be used to:
◦ Involve the parent or teacher to improve buy-in and
understanding of the child’s abilities and need for
accommodations
◦ Screen classroom performance to determine if educational
assessment, change in services or accommodations need to be
considered
◦ Provide an indication of the need for a trial period with a personal
FM system or other assistive devices
◦ Provide a pre-test/post test format following implementation of
FM, new hearing instruments, improved accommodations
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Available from Oticon
3 worksheets: child’s needs, parent’s needs, teacher’s
needs
3 or 4 very general situations with blanks to add 1 or 2
more situations
Judgment is made “Because of the new hearing
instrument, I now hear…’
Second judgment is made “I can hear satisfactorily, 1095% of the time”
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For ages 3 years to approximately 12 years (plays with
others, not parallel play)
Provides 15 listening situations typical of the home
environment
Understand-o-meter
2 Forms:
◦ Parent completes items
◦ Child completes items (age 7-8+)
Can compare parent and child responses; use as a means
to discuss need for home FM, assistive devices, changes
in family communication dynamics
 FEW
– Family Expectation Worksheet
◦ Child is successful in this situation…
◦ Parents list goals in order of priority
◦ Rate the level of child’s success (pre/post-test)
 Pediatric
Profile
Hearing Demand, Ability, and Need
◦ Descriptions of communication activities
◦ Parents rate if a communication problem is present if the hearing
aid is on or off
◦ Parents check if problem is due to hearing, noise, distance,
visibility and the current compensation
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Typically a child will enter preschool or
kindergarten and the educational audiologist or
speech language pathologist may be informed
that they have a hearing loss or hearing aids
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Their role is to make recommendations on if the
child requires any accommodations to be able to
access verbal instruction
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Increasingly, children with hearing loss are in full-time regular
education settings
504 accommodations are often more difficult to obtain than
special education services from an education specialist
Children with hearing loss will continue to require acoustic
accommodations, regardless of their early intervention
successes
Parents who are knowledgeable of their child’s auditory needs
and who have the documentation to advocate for
appropriately intense accommodations are empowered
If a school does not provide accommodations and the child’s
performance decreases over time, the school could
potentially be held liable for providing insufficient
accommodations
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Acoustic signals degrade with distance
Integrity of the speech signal is compromised by
background noise and reverberation typical of
classrooms
Children with auditory disorders are at greater risk
for speech perception difficulties under adverse
listening conditions
FM technology addresses conditions of distance
and background noise and provides benefits to
speech perception of the primary signal for persons
with normal and impaired hearing
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Ignorance by school administrators of FM
Concern over school budgetary expense
Only required to provide an appropriate program, not
the most appropriate
Aim is for “average” achievement (within the range of
the classroom), not optimal
Definition of “need” for FM – varies widely
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Quoting research helps get the attention of teachers and
administrators but is not child specific
Looking at academic grades or asking the teacher or parent
“how the child is doing” is too vague
The audiogram does not provide a complete picture of a child’s
speech perception, listening in noise abilities, and coping skills
Speech in noise tests in the sound suite provide a
2dimensional indication of speech perception, functional
listening evaluation is more “realistic”
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How well does the child perform in different
typical communication situations
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Verbal instruction
Class discussion
Peer conversations
Home situations
Quiet and noise
Relatively near and far
PURPOSE
 Compare students functioning to peers
(Is there a functional deficit in any area?)
 Determine areas of non-strength (Based on these, what
accommodations or assessments are indicated?)
 Monitor functioning over time (Do the
accommodations/services meet the child’s speech
perception needs and deficit areas so that level of
functioning is improved/maintained?)
 Determine degree of benefit of classroom technology on
overall function after an extended period of use (Are there
improvements?)
Preschool SIFTER – age 3- kindergarten
 SIFTER – grade 1 – grade 5 / 6
 Secondary SIFTER grade 6-12
 CHAPS – kindergarten – grade 5 / 6
OTHER BROADBASED SCALES
 Psychological Scales: Social Emotional Function
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Behavior Assessment System for Children
Achenbach Scales (Teacher Rating Form)
Burk’s Behavior Rating Scale
Connors’ Rating Scale
Behavior Evaluation Scale
Listening Instrument For Education
 Collects information on child’s function with and
without amplification (hearing aids, new hearing
aids, CI, FM, compare FM types) and indicates
need for accommodations (504)
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Student LIFE – self report; grade 3+
Teacher LIFE – pretest and post-test
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Observation study performed in the classroom: time
on task without amplification device and again when
student is using device of interest
Functional Listening Evaluation with and without
device of interest
Teacher observation of following typical directions in
the classroom setting
Word discrimination in classroom
◦ Spelling tests
◦ Wepman Auditory Discrimination Test
◦ California Consonant Test in classroom
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TEAMS make decisions on children’s needs based on
information
The more compelling and reality based the information the
better the chance that appropriately intense
accommodations will be provided for the child
Documenting auditory needs related to noise and distance
early will create valuable track record supporting avocation
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Defined procedure to determine how listening
abilities are affected by noise, distance, and visual
input
Not a sound booth test; done in a “typical
environment”
Verbal language response required; 3-word
sentences (common phrases and nonsense
phrases)
8 lists of words or phrases needed
Can use to show benefit of any type of FM use
A “staple” in educational audiology
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The SIN Test audio compact disk is required for test
administration.
On this CD, test sentences were recorded at "soft" and
"loud" levels 30 dB apart.
Each of these levels is presented at four signal-to-noise
ratios (SNRs) with multi-talker babble as the
background noise.
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An intense look at auditory attention
Difficult and time consuming for teacher (or parent)
to complete, but good information
Especially useful for obtaining indepth information
on children with unilateral, minimal, mild, or cookiebite hearing loss
Scoring grid shows abilities that fall into normal and
at-risk performance categories
Can do following a trial period with sound field
amplification in the classroom or personal FM use at
home/school
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To be completed by the preschool teacher
Teacher must be aware of what is developmentally
normal for the child’s age
15 questions: preacademics, attention,
communication, class participation, school behavior
Scoring: pass or at-risk for expressive communication
or socially appropriate behavior
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Very similar to Preschool SIFTER
15 questions, 5 content areas
Scoring grid results in pass, marginal or fail
Valuable for parents of children with hearing loss who are
concerned about school progress; audiologist can assist them
in determining if concern is warranted
Parent can bring to teacher and return to audiologist (or
provide SASE)
Recommendations for FM can be made based on SIFTER
results
Valuable to use May SIFTER to inservice new teacher in
September
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15 common school listening activities
Best for elementary, but can use in secondary
Student appraisal: child judges if a listening situation
is always easy, mostly easy, sometimes difficult,
mostly difficult, or always difficult
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Pretest (or any time) and Post-test following trial with
a new or adjusted amplification device (any type of
FM, digital aids after having worn analog)
15 common classroom situations
Teacher rates student’s apparent degree of listening
challenge in the different situations
Total appraisal score plotted on a continuum
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By the time a child is about 10, they should be fully
independent with checking their hearing aids and advocating
for classroom accommodations
The LIFE provides a format for the child to develop an
awareness of how classroom environments affect listening
and understanding and what he or she should do to make it
better
Secondary SIFTER can screen for functional classroom
performance
Even students who are academically successful are entitled to
504 accommodations such as written assignments,
appropriate acoustics, seating, FM, etc).
In Determining the Need and
Benefit of FM Use….
DOCUMENTATION
is the
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ELF, CHILD, SIFTERs, LIFE : www.kandersonaudconsulting.com
CHAPS: www.edaud.org (not free)
DIAL: edaud.org; Members; downloadable reference items
COWS: Oticon –
http://otikids.oticon.nl/eprise/main/Oticon/com/SEC_AboutHe
aring/LearnAboutHearing/Products/SEC_OtiKids/Parents/Netw
orking/91180310cow_counsellingtool.pdf
Functional Listening Evaluation and FAPI:
http://www.colorado.edu/slhs/mdnc/assessment.html
IT-MAIS: from Advanced Bionics
http://www.bionicear.com/professionals/rehabmaterials.asp
Speech in Noise Test: information at
http://www.ausp.memphis.edu/harl/rsin.html