children with abis in the classroom: what can we expect?

CHILDREN WITH ABIS IN THE CLASSROOM: WHAT CAN WE EXPECT?

CI & ABI Candidacy Device Surgery Medical & Audiological Sites Research

CANDIDACY Not a CI candidate Neurofibromatosis Type 2 Absent VIII nerve Cochlear Nerve aplasia Auditory Neuropathy Cochlear Malformation Cochlear Ossification Head Trauma Inner Ear Scarring

IMPLANTS Cochlear ImplantAuditory Brain Implant http://www.medel.com/blog/neurofibromatosis-type-ii-hearing-loss/ http://www.medel.com/image-gallery/

DEVICE COMPARISON Photographs courtesy of Cochlear Ltd.

ABI IMPLANTED Illustration courtesy of Cochlear Inc

SOME OF THE IMPLANT & MAPPING LOCATIONS Worldwide Belgium Germany Italy* Poland* Turkey* United Kingdom* USA (Clinical trials) Massachusetts Eye and Ear Infirmary University of North Carolina USC-CHLA California Singapore* (mapping) Spain Sweden *Enrolled in programs at JTC

ABIs in Children Colletti et al. (2014) Audiol Neurotol Vittorio Colletti MD First pediatric ABI In 2000 Data provided by USC, R. Shannon, et al

Categories of Auditory Performance (CAP) 0. No awareness of environmental sounds or voice 1. Awareness of environmental sounds 2. Response to speech sounds 3. Identification of environmental sounds 4. Discrimination of speech sounds without lipreading 5. Understanding of common phrases without lipreading 6. Understanding of conversation without lipreading 7. Use of a telephone with known speaker 8. Follows group conversation in a reverberant room or where there is some interfering noise, such as a classroom or restaurant 9. Use of telephone with an unknown speaker in unpredictable context

CAP Scores Children with NF2, AN, and Other 0. No awareness of environmental sounds or voice 1. Awareness of environmental sounds 2. Response to speech sounds

CAP Scores Children with VIII Nerve Aplasia 3. Identification of environmental sounds 4. Discrimination of speech sounds without lipreading 5. Understanding of common phrases without lipreading

CAP Scores Children with Ossification or Trauma 5. Understanding of common phrases without lipreading 6. Understanding of conversation without lipreading 7. Use of a telephone with known speaker

COMPLEX NEAP The Complex NEAP package is an assessment package for deaf children with complex needs which provide assessments, checklists and profiles to enable professionals and parents to assess and monitor the progress of deaf children with complex needs, in the areas of: Communication and Language Listening Speech Complex NEAP is based on the Nottingham Early Assessment Package (NEAP) and includes tools to facilitate the development of skilled observation in this special population.

AUDITORY BRAINSTEM IMPLANT NIH CLINICAL TRAIL @ USC-CHLA Auditory Brainstem Implant NIH Clinical Trial @ USC-CHLA Initial activation of the ABI is analogous to a newborn entering the world and hearing for the first time, which means these children will need time to learn to interpret what they are sensing through the device as sound, said USC Keck otolaryngology professor / study co-leader audiologist Laurie S. Eisenberg, Ph.D.. She adds that with the device, the child still needs to undergo therapy and interaction with, as their brains have to learn to map out the sounds and decode them: The incoming stimulus for a child with an ABI is completely scrambled, and as a result, children with ABI require intensive long-term therapy and very strong parental involvement. michelsonmedical.org

ABI RESEARCH

ABIS IN THE CLASSROOM Similarities Developmental Milestones Professionals to work with Methodology Reliance on Parent Participation Additional Considerations Slower progress Audiological support may not be local

JTCS CHILDREN WITH ABIS Demographics 10 Children All under 6 years old 8 Countries 5 Boys & 5 Girls 8 in the Preschool 5 Summer School 3 Summer School & preschool the next year 2 in Parent-Infant Etiology Goldenhar or Goldenhar-Gorlin Syndrome Auditory Nerve Deficiency CHARGE Cochlear Nerve Aplasia

SURGERY DATA Implant Facility Italy - 8 Turkey -1 England -1 Single Sided MedEl 5 Cochlear 3 Implanted In 2001 - 1 2002 - 1 2009 - 2 2012 - 4 2013 - 2

ABIS & EARLY OUTCOMES - SHORT TERM STUDENTS Name Country/Center & Time at JTC ABI Age Devices & Fitting Ages Etiology/Other Challenges Impact Rating Listening Performance Language Performance Speech Performance UAE SS 2011 F 7/13/05Nucleus ABI 39m Cochlear nerve aplasia Hypotonic, Oral-Motor, Torticollis 4 No Response 500-6KHome: English & ArabicVocalizing /a/ Ireland (Manchester) SS 2012 C 11/19/08Nucleus ABI 54m Premature Balance Gross motor delays; Absent auditory & vestibular nerves; Cochlear aplasia Poor audio thresholds Outside banana: 80dB Indicates env sounds Using sign language Good pragmatics Beginning vocalizations Some vowels Some plosives & nasals UK (Italy & Manchester) SS 2013 E 9/28/10Rt Medel ABI 22m Goldenhar Oral-Motor Good audio thresholds Detects all Ling 6 IDs /a/ vs /sh/ Responds to env. sound Good pragmatics Calls for attention Few vowels Few nasals CA (Italy & C3) SS 2013 A 6/26/09Medel ABI Goldenhar Gorlin cleft lip & palate, lipoma of corpus callosum, dysgenesis of splenium of the corpus callosum, bilateral colobomas; Absent auditory & vestibular nerves; Oral-Motor/Feeding Fair audio thresholds IDs all Ling 6 at 1 ft Reports ABI off Responds to env sounds Uses ASL 5-word ASL phrases Single words: English Few vowels And /m/ CA (Italy & C3) PI 2013 B 9/15/11 Rt Medel ABI 18m Lt HA CHARGE Detects all 6 IDs env sounds Puts ABI on if falls off Stops to no Mandarin/English Few single words: Bye-bye, no, come, sh Vocalizes with ABI Few vowels Few consonants UK SS 2014 O 7/31/11Rt Medel ABI 20m Auditory nerve deficiency Goldenhar Scoliosis: walks with aid No detection of Ling 6 Stills to env sounds Responds to no BSL & English Understands 10 signs Vocalizes Poland PI 2014 A March 12 CHARGE, Malformed Leg, Vision Developmentally Delayed 4 Polish/English/Sign John Tracy Clinic 2015

ABIS & YEAR LONG PRESCHOOL STUDENTS Name Country/Center & Time at JTC DOB Devices & Fitting Ages Etiology/Other Challenges Listening Performance Language Performance Speech Performance UK (Italy &C3) 2010 8/6/06Nucleus ABI 31m Absent auditory nerves Vestibular/Balance Thresholds in banana IDs all Ling 6 Two critical elements Previously used BSL 4-5 word phrases Simple sentences First me, and then you PLS Total 3;1 @ 4;8 Many vowels Plosives, nasals, fricatives Singapore 2013 9/8/10Rt Medel ABI 17m Auditory nerve deficiency Shortened frenulum Motor planning Oral-Motor/Feeding Good audio thresholds Reports ABI off 25dB across banana IDs all Ling 6 @ 3ft IDs 3 critical elements 2-3-word MLU catch me, daddy PLS 1 yr below CA Most vowels Most consonants Turkey (Turkey) 2014 1/24/12 Rt ABI 21m Lt CI 32m Oral-Motor Poor audio thresholds Detects all Ling 6 with CI IDs /a/ with CI Nothing with ABI Single words Vowels Few plosives/Stops Few nasals John Tracy Clinic 2015

SOMETHING NEW Teacher Concerns What are their needs? How are we going to accommodate their needs in an AVEd. Classroom? What are acceptable articulation parameters? How are we going to make a difference in three weeks?

SHORT HISTORY OF CHANGE Unilateral-Single channel CI Variations of Multiple channel CI Digital Aids MRI OAE Auditory Neuropathy Bi-lateral CIs ABI

LESSONS LEARNED FROM CI DEVELOPMENT You can see trends coming - Learn all you can Develop a Team Approach Communication and Reporting Observations are key to progress Outcomes Vary and Get Better Over Time Confusion, Frustration and Doubt are part of learning So are Optimism, Anticipation, and Discovery Its not magic Its work

EXPECTATIONS FOR ABI DEVELOPMENT You can see trends coming - Learn all you can Develop a Team Approach Communication and Reporting Observations are key to progress Outcomes Vary Get Better Confusion, Frustration and Doubt are part of learning So are Optimism, Anticipation, and Discovery Its not magic Its work

ACTIVITY Explorers Pioneers Settlers How do we know what each phase looks like? What are the skill sets with each level and what are the skills to nurture in each phase (parents)?

MULTIDISCIPLINARY APPROACH

HETEROGENEOUS LEARNERS: CLASSROOM AVEd. Classroom Immediate audiological management Acoustically controlled environments Parent as Effective Facilitators Provide focused and individualized instruction Collaborate with parents and professionals Promote spoken language self monitoring AVEd. Classroom + ABIs All of the AVEd. list and.. Small group lessons Higher adult-child ratio Adapt lesson for other learning needs Use sandwiching technique to build into auditory learning Integrate learning through movement

SPECIFIC CLASSROOM STRATEGIES Seating Arrangement Sandwiching Slow progress means??? For the ABI Close Proximity Environmental Acoustics Sound Field Systems Trouble Shooting In children with hearing loss

LEARNING CHALLENGES

LENA ABI OnlyABI & CI

PARENT SUPPORT GROUPS Different than in the 80s 90s Availability to stay supported through the internet Many live at the implant site Facebook Children with Auditory Brainstem Auditory Brainstem Implant Technology Facebook

COLLABORATIVE WORK

REFERENCES

children with abis in the classroom: what can we expect?

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