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Copy of Hearing Impairment and its Effect on Speech Therapy

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Rachel Kelly

on 22 December 2012

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Transcript of Copy of Hearing Impairment and its Effect on Speech Therapy

The number of Americans with a hearing loss has doubled during the past 30 years. General Statistics Most children with congenital hearing loss have hearing impairment at birth and are potentially identifiable by newborn and infant hearing screening. However, some congenital hearing loss may not become evident until later in childhood (9). There are four major ways in which hearing loss affects children--
1.It causes delay in the development of receptive and expressive communication skills (speech and language).
2.The language deficit causes learning problems that result in reduced academic achievement.
3.Communication difficulties often lead to social isolation and poor self-concept.
4.It may have an impact on vocational choices.

About 2 to 3 out of every 1,000 children in the United States are born deaf or hard-of-hearing. Nine out of every 10 children who are born deaf are born to parents who can hear. Three out of 4 children experience ear infection (otitis media) by the time they are 3 years old. Chronic ear infection that is a fairly common diagnosis could result in a defect ear drum and/or middle ear ossicle damages. In 2009, Centers for Disease Control and Prevention (CDC) data showed that over 97% of newborns in the United States were screened for hearing loss. Of those who were screened, 1.6% did not pass the
final or most recent hearing screening. •Of those babies not passing the hearing screening, 67.9% were diagnosed as either having or not having a hearing loss before 3 months of age •In 2009, 88.0% of the babies with diagnosed hearing loss were referred to Part C Early Intervention Services. Among the 88% of those referred, 91% were eligible
for Part C services The remaining 9% referred either were not eligible for services or their eligibility status was unknown. Causes, Risk Factors, and Characteristics •Genes are responsible for hearing loss among 50% to 60% of children with hearing loss Other causes are: Disease or Illness, Neurological Disorders, Medications, Exposure to Ototoxic chemicals, Physical trauma Assessment References Speech-Language Services for the Hearing Impaired (HI) Intervention Language Therapy Speech Therapy Auditory-Verbal Therapy (AVT) Auditory Training Aural Habilitation Articulation The purpose of aural habilitation is to help a hearing impaired child develop his or her listening skills, using a hearing device, in order to understand and use spoken language. Analytic Auditory Training Synthetic Auditory Training Analytic auditory training focuses on the isolated parameters of listening including: individual speech sounds, syllables, and words (CT). This is a bottom-up approach in which the finer acoustic distinctions are introduced and practiced (ATA). Synthetic auditory training is a top-down style approach that involves greater emphasis on the comprehension of meaningful, connected speech (ATA). Sample Objectives Recognition of phrases in routines (e.g. "Get your hat" "eat your dinner")
Recognition of statements and questions (e.g. "Whose turn?" "Look at that.")
Sentence repetition Sample Objectives Recognition of frequently occurring words (e.g. client's name, favorite toys)
Recognition of word pairs differing in the number of syllables
Recognition of contrasts of phonemically dissimilar words with the same number of syllables
Recognition of minimal pair words Sample Activities Using a picture book, take turns making up sentences such as, "I see a a boy wearing sunglasses" having the listener point to the corresponding picture.
The clinician provides a riddle or joke and the client is required to repeat what was heard before providing the answer Sample Activities Using a picture book, name an item depicted on the page and have the client point to the corresponding picture
Minimal pair bingo Principles of AVT Promote early diagnosis of hearing loss in newborns, infants, toddlers, and young children, followed by immediate audiologic management and Auditory-Verbal therapy.
Recommend immediate assessment and use of appropriate, state-of-the-art hearing technology to obtain maximum benefits of auditory stimulation.
Guide and coach parents to help their child use hearing as the primary sensory modality in developing listening and spoken language.
Guide and coach parents¹ to become the primary facilitators of their child's listening and spoken language development through active consistent participation in individualized Auditory-Verbal therapy.
Guide and coach parents¹ to create environments that support listening for the acquisition of spoken language throughout the child's daily activities.
Guide and coach parents¹ to help their child integrate listening and spoken language into all aspects of the child's life.
Guide and coach parents¹ to use natural developmental patterns of audition, speech, language, cognition, and communication.
Guide and coach parents¹ to help their child self-monitor spoken language through listening.
Administer ongoing formal and informal diagnostic assessments to develop individualized Auditory-Verbal treatment plans, to monitor progress and to evaluate the effectiveness of the plans for the child and family.
Promote education in regular schools with peers who have typical hearing and with appropriate services from early childhood onwards. Suprasegmentals & Voice Voice Quality Intensity Pitch Intonation Resonance Initial production tasks might involve production of discrete vowel vocalizations at different fundamental frequencies (e.g. high, mid, and low) followed by production of smooth transitions between these levels. (CT) When working on producing an appropriate pitch level, the use of visual aids, such as Visi-pitch or IBM SpeechViewer, can be helpful for modeling and providing a visual representation of the client's production pattern. These computer systems provide the client with model spectrogram and a real-time spectrogram of his or her production for visual comparison. Prelingual deafness is hearing impairment that is sustained prior to the acquisition of language Post-lingual deafness is hearing impairment that is sustained after the acquisition of language 1. Everyone who is deaf or hard of hearing uses sign language. MYTHS about Hearing Loss 2. People who cannot hear are not allowed to drive 3. All forms of hearing loss can be solved by hearing aids or
cochlear implants 4. All deaf/hard of hearing people are experts in Deaf Culture. 5. All deaf people want to be hearing 6. People who can't hear can't use a phone. 7. Everyone who cannot hear can lip read. 8. Most deaf people have deaf parents. Syntax Semantics (CT) (ATA) (ATA) (ATA) (ATA) Morphology Phonology Pragmatics (AGBA) Requirements for becoming an Auditory-Verbal Therapists (LSLS Cert AVT) a degree in either audiology, speech-language pathology, deaf education, or related field
a license, certification, or appropriate credential necessary to practice audiology, speech-language pathology, or education of the hearing impaired in the professional's jurisdiction
a minimum of 750-900 supervised therapy clock hours in AVT
at least 10 hours of observation under at least two different LSLS-certified professional
work with a LSLS-certified mentor for three years prior to taking the LSLS written examination
pass the written examination The general principles and procedures for improving articulation in a normal hearing child are often appropriate. However, the clinician may need to rely more heavily on visual, tactile, or kinesthetic cues to facilitate correct productions. Figurative Language Vocabulary (CT) Communicate With Me: Conversation Strategies for Deaf Students Teaching Strategies Exposure in Meaningful Contexts Connections Between the Words and the Student's Prior Knowledge Varied Information about Each Word Multiple Exposures to New Words An Active Role Taken by the Student in the Word Learning Process increase the amount of information that the student reads
focus is primarily on the meaning of what is read; individual words are seen as parts of the whole message Dialogue Journaling Think Aloud Five Finger Method Semantic Feature Analysis Semantic Mapping Semantic Associations SLP models the process of predicting word meanings and testing to see if the guess makes sense all the while thinking aloud
Student is encouraged to the attempt the same process This is a written conversation with the SLP that helps the students learn new vocabulary words related to their own experiences needs, and interests
Students can ask the SLP the meanings of words that the SLP writes
Students can write about how they figure out what new words mean
Allows SLP and student to understand vocabulary learning process Students retain new knowledge and learn at a quicker pace when they are able to relate that knowledge to an already existing schema Encourages students to discuss words that share common features Main Idea
or Topic Relate Words Related Concepts Multiple Meanings (e.g. bank can be defined as an edge of a stream or a place where money is deposited)
Grammatical Variations (e.g. boredom, bore, boring, boringly)
Antonyms (e.g. kind vs. cruel)
Synonyms (e.g. beautiful & gorgeous)
Analogies (e.g. hot:cold::dark:light)
Tools for communication assessment should consist of standardized tests, non-standardized tests (i.e. language sample), and observation within the educational context

Assessment tools used to diagnose communicative deficits in normal-hearing children may be used with hearing-impaired children as well, as long as the clinician understands the limitations imposed by the hearing loss

While test scores would be invalid for testing a child who is not included in the normative group of the test's standardization sample, the test can provide descriptive information about the child's abilities and deficits, including error patterns
Speech assessments describe not only the kinds of errors a child makes but also intelligibility of his/her speech

Consistency and accuracy of articulation is influenced by auditory perceptual skills, as well as oral-motor sequencing abilities More than one exposure to a new vocabulary word is needed before it becomes part of the student's expressive vocabulary.
Reinforcement of new words in a variety of experiences is related to effective learning If a child spontaneously produces a phoneme incorrectly but perceives it correctly when listening, hearing can be used to remediate the production by comparing the error to the correctly articulated adult model

If the child displays the same error in perception and articulation, it can be assumed the error is the result of hearing a distorted signal

Training in improving both perception and articulation would address this error most effectively word of the day have students discuss
when and where they see/hear recently learned vocabulary word Students can make their own decisions about the kind of words they choose to learn and can evaluate how often they use newly learned words. Effects on Speech and Language
The following procedures should be followed to ensure that the hearing-impaired child is not penalized for not hearing the stimuli:

The child's amplification should be checked immediately before assessment to be sure that it is functioning at optimal levels

If a child uses classroom amplification (FM Unit) that uses a microphone, the examiner should wear it to eliminate any interference from background noise

The test environment should be as quiet as possible, located away from obvious noise sources, such as the cafeteria, gym, and playground, and free of visual distractions Considerations When Administering An Assessment to a Hearing-Impaired Child Evidence indicates that individuals with HI experience difficulty with figurative language, particularly idioms. The test environment should be well lighted from overhead. If the room has a window, the child should be seated opposite the clinician, with his/her back to the window. This seating arrangement reduces glare,
which can interfere with speechreading (lip reading) the clinician's face

Instructions should be given while the child watches the clinician's face, accompanied by an explanation or demonstration

When verbal test stimuli are presented, the child should be watching the clinician's face and repeating back what was heard

Unless measuring auditory perception, the clinician may want to select assessments that permit repetition Strategies for Students Utilize prior knowledge
Use contextual clues
Predict/guess the meaning
Test the proposed meaning to see of it makes sense
Skip over the part of the text that isn't understood and come back to it after more information has been obtained Teaching Stratagies Think Aloud Activities
Identify Likenesses and Differences Between Two Objects (e.g. size, shape, color, texture, use, location)
Various Forms of Humor (e.g. jokes, puns, riddles, hyperbole, and slang)
Newspaper Headlines (especially from the sports section)

Some school districts refer students with a hearing loss aged 3 to 21 years to the NJ's Specialized Child Study Teams (SCST) for Assessment

Must be hired by the school district
No parent referral
SCST consists of 2 psychologists, LDTCs, and 2 SLPs
Conduct Initial, Re-Evaluations, and Tri-Annual Evaluations
(609) 530-3145
http://www.mksd.org/partnerships/scst.htm Journaling Glossing Peer Reading Journal Literature Journal Dialogue Journal Student's grammar and spelling is not corrected
Instead, the teacher's model of correct English grammar and spelling should gradually shape the student's entries Similar to dialogue journals, however, litreature journals are content oriented and provide a way for the SLP to gain insight into what the student needs in terms of instruction
Research has shown that when students discuss what they were reading in ASL and then write about what they were reading in a literature journal they are able to increase their understanding of what was read Students have written conversations with peers about books they have read or topics of mutual interest
The SLP may periodically join the written conversation to encourage deeper thinking about a topic or lead the conversation in a different direction
Two studies have provided solid evidence for conversational writing with no correction of syntax resulting in improvement in the use of syntax ASL has its own grammar separate from English
Students fluent in ASL may have a hard time following the rules of English grammar, substituting those of ASL
Glosses can be used to help "translate" from ASL to English and visa-verse
Glosses are English words written entirely in capital letters that are to be regarded as the ASL sign
In a sense, it's written ASL (Ross, 1991, p. 116,
Tomblin, Morris, & Spriestersbach, 2002, p. 458) Additional Assessment Resources Published program for students ages 7-15, which focuses on student-to-adult interactions to help improve conversational skills. selecting appropriate topics and communication methods
gaining attention
ending conversations
repair strategies
maintaining and changing topics
combining all the areas mentioned above (Ross, 1991, p. 136) Effects on Language Syntax Semantics Morphology Phonology Pragmatics Initial and final consonant deletion is a common process exhibited in students with HI (Pena-Brooks & Hedge) Vocabulary Vocabularies of HI students often contain fewer lexical items
HI individuals tend to have difficulty with function words (e.g. the, a, are)
Children with hearing loss learn concrete words (e.g. cat, jump, five, and red) more easily than abstract words (e.g. before, after, equal to, and jealous)
Children with hearing loss have difficulty understanding words with multiple meanings
Students appear not to see relationships between words or appriciate words as parts of larger categories (Moseley ASHA) Children with hearing loss often cannot hear word endings such as -s or -ed. This leads to misunderstandings and misuse of verb tense, pluralization, nonagreement of subject and verb, and possessives Langauge development in HI children is similar to that in normal hearing children it often just occurs at a slower pace The Verb System
Complementation (e.g. problems with infinitives)
Question Formation
Shorter Clause, Sentence, and Composition Length
Lack of Complexity
More Grammatical Errors (e.g. additions, substitutions, omissions, and inappropriate word order Effects on Speech Articulation Suprasegmentals & Voice Studies show that the suprasegmental features of speech have a greater impact on the intelligibility of HI individuals than articulation (Moores) Intensity Pitch Intonation Resonance Consonants Children with hearing loss often cannot hear quiet speech sounds such as "s," "sh," "f," "t," and "k" and therefore do not include them in their speech Vowels Figurative Language They may speak too loudly or not loud enough Pitch is often too high Poor intonation may cause them to sound mumbled Hearing is critical to speech and language development and overall communication Vowel sounds should be among the first sounds targeted because a variety of clear vowel sounds constitutes a foundation for the development of natural voice for children with hearing loss Although there are a variety of ways to model and teach speech sounds to children with hearing loss, it is recommended that a sound be presented in the following order: Auditory
Auditory & Visual
Tactile It is helpful to progress from more visible sounds such as labiodentals and bilabials to less visible sound such as velars Teaching voiced/voiceless distinctions is especially important for treating children with hearing loss SLPs need to pay close attention to stops, fricatives, and afficates as these are especially difficult for children with HI Although vowels are easier to hear, they are more difficult to differentiate visually which can cause problems for individuals with severe to profound hearing loss (Moseley & Bally) (ASHA, Pena-Brooks & Hedge) (ASHA) (ASHA) (ASHA) (Moseley & Bally) (ASHA) (ASHA) (ASHA) (AGBA) (ARB) (HLA&IA) (HLA&IA) (A&P) (A&P) (CT) (CT) (CT) (CT) (CT) It is important for the SLP to describe to the student the ways that loudness can be controlled and offer concrete strategies for increasing loudness Once adequate control is achieved for nonmeaningful vocalizations, then work may be directed toward production of these intonation patterns using increasingly meaningful speech material (e.g. single syllable words, short phrases, sentences). For example, the client may initiate speech at slightly higher lung volumes than would be used for normal conversation (CT) In beginning intervention toward reducing nasality, it is often helpful to use pictures or drawing to demonstrate to the client how nasal consonants are produced and how production of these phonemes differs from the production of oral phonemes. (CT) Not all children with hearing impairment are eligible for special education under IDEA, provided that their hearing loss does not adversely impact their educational performance
A child with hearing impairment may not be eligible for special education but accommodations for general education may be made as part of their 504 plan
Accommodations may include preferential seating, provision of notes, use of a personal or classroom frequency modification (FM) system, and provision of additional time to complete a task Hearing impaired individuals can be hypernasal or hyponasal. However, hypernasality is far more common. This is perhaps the most noticable aspects of deaf speech. (Moseley & Bally) Research suggests that breathy or tense voice patterns, or other more postural voice abnormalities should be addressed first. American Speech-Language-Hearing Association.
(n. d.). Effects of hearing loss on development.
Retrieved from
Hull, R. H. (Ed.). (1997). Aural rehabilitation: Serving
children and adults (3rd. ed.). San Diego, CA:
Singular Publishing Group, Inc.
Moores, D. F. (1987). Educating the Deaf:
Psychology, principles, and practices (3rd. ed.).
Boston, MA: Houghton Mifflin Company.
Moseley, M. J. & Bally, S. J. (Eds.) (1996).
Communication therapy: An integrated approach
to aural rehabilitation with deaf and hard of
hearing adolescents and adults. Washington, DC:
Gallaudet University Press.
Paul, R. (2007). Language disorders from infancy
through adolescence: Assessment and intervention
(3rd ed.). St. Louis, MO: Mosby, Inc.
Ross, M. (Ed.) (1994). Communication access for
persons with hearing loss: Compliance with the
Americans with Disabilities Act. Baltimore, MD:
York Press, Inc.
Ross, M., Brackett, D., & Brancia Maxon, A. (1991).
Assessment and management of mainstreamed
hearing-impaired children: Principles and
practices. Austin, TX: Pro-Ed., Inc.
Roth, F. P. & Worthington, C. K. (2011). Treatment
resource manual for speech-language pathology
(4th ed.). Clifton Park, NY: Delmar Cengage
Tomblin, J, B., Morris, H. L., & Spriestersbach, D. C.
(2002). Diagnosis in speech-language pathology
(2nd ed.). Clifton Park, NY: Delmar Cengage
Webster, A. & Wood, D. (1989). Children with
hearing difficulties. London: Cassell Educational
Limited. Breath control and controlled respiration can be improved through diaphragmatic breathing and establishing a supportive posture. (CT) A conductive hearing impairment is present when the sound is not reaching the inner ear, the cochlea A sensorineural hearing loss is one resulting from dysfunction of the inner ear, the cochlea, the nerve that transmits the impulses from the cochlea to the hearing centre in the brain or damage in the brain. The most common reason for sensorineural hearing impairment is damage to the hair cells in the cochlea. As we grow older the hair cells degenerate and lose their function, and our hearing deteriorates. Mixed hearing loss is a combination of the two types discussed above Other Considerations Hearing Threshold Level
26-40 dB Mild
41-55dB Moderate
56-70 Moderately Severe
71-95 Severe
96+ Profound Hearing Impaired Child- any child with an an auditory disorder.
Hard-of-Hearing- developed their communication skills through the auditory channel.
Deaf Child- Development of speech and language is developed through visual means. Pragmatic skills in children with HI are on par with normal-hearing peers
However, children with HI might have difficulty with initiating conversations or following rules for entering and continuing a conversation
(Paul) Ling Method (1976) Substitution of voiced for voiceless consonants
Substitution of stops for nasals, fricatives, and affricates
Cluster reduction
Substitution of schwa for other vowels (aka neutralization) (Roth & Worthington) This method consists of four major areas that build upon one another Vocalization/Voice Patterns Vowels and Diphthongs Consonants Blends More phonological process usage (Paul) Breath Vocalizations Intensity Duration Pitch Central Vowels Diphthongs Front Vowels Back Vowels Voice/Voiceless Consonant Pairs Individual Consonants Generalize a
stable production by
using different phonetic contexts and new syllable types Teach the Segmental
Speech Sounds Establish a Suprasegmental Base This should improve with the improvement of speech sound discrimination and production.
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