laying the foundation for listening - infant hearing me to death bader 1999 i see it = i hear it...

Laying the Foundation for Listening

VELVET BUEHLER, M.A. CCC-SLP/A

UNIVERSITY OF TENNESSEE HEALTH SCIENCE CENTER

EHDI CONFERENCE 2015

Disclosure StatementFinancial: I receive a salary as a clinical professor at the University of Tennessee Health Science Center.

Non-financial: As part of my work with the UTHSC, I serve on two cochlear implant teams that provide pre/post cochlear implant evaluations. I have recently served a 6 year term as an ASHA steering committee member for SIG 9.

Velvet Buehler, M.A. CCC-SLP/A

Overview

• Expecting a Cochlear Implant

• Laying the Foundation for Listening

• Treatment Objectives and Strategies: What to expect prior to implantation and one and two years following CI activation

• Lesson Plan and Activities: What to do in treatment for the first year or two following CI activation

Expecting a Cochlear Implant“What? Treatment begins tomorrow?”

Parent Education, Counseling, and Participation

Evaluations

Pre-Literacy

Cognition

Conditioned Play

Learning to Listen Sounds Warren Estabrooks

Intervention Strategies

Expecting a Cochlear Implant“OH! You have a lot to learn, Mama!

But, there is still time for fun!”

Intervention Strategies◦ Yardstick and Yardstick Level◦ Where You Lead I Will Follow◦ Radio Commentator Bader

◦ Cheap Hotel Bader

◦ Three Ring Circus Bader

◦ Bore Me To Death Bader 1999

◦ I See It = I Hear It◦ Pace Yourself◦ “Listen! What did you hear?” Warren Estabrooks 2000

What to Expect During the First Year of Listening

Factors to Consider:

◦ Hearing Age

◦ Adequate Access to Sound

◦ Full time Use of CI

◦ Focus on Audition

◦ Develop the Auditory Skills Hierarchy


Hearing Age must be considered◦ Time with adequate exposure to sound◦ The first year of listening is for INPUT◦ Build listening hours for first words to emerge◦ Babies with normal hearing “listen” for one year before first

words emerge…expect similar results for child with hearing loss


Adequate access to sound◦ Hearing all sounds of speech within the speech banana◦ Hearing at distances


Full time use of CI ◦ Access to sound for four hours/day is not enough◦ This would take two years to acquire the same listening

experiences as a one year old hearing child


Focus of intervention is on audition for the first year of listening◦ Speech is for later, focus on audition “deliberately”


Listening Hierarchy◦ Auditory Awareness: “I hear that”◦ Auditory Discrimination: “That sounds different”◦ Auditory Identification: “That means This”◦ Auditory Comprehension: “ I understand conversation and I

answer questions and take my turn”


Learning to listen takes a while◦ Hearing age and language age are similar the first year of

listening◦ Language age will become similar to chronological age after the

first year of listening

What to Expect During the First Six Months of Listening

Treatment Objectives

Intervention Strategies

CI Activation: CA 12-18 mos.“WOW! I can hear! What’s all this talk about listening?”

Treatment Objectives◦ Full-time use of CI

◦ Level 1 on Listening Skills Scale Estabrooks and Marlowe

◦ Conditioned play: detects Ling 6 Sounds (structured detection)

◦ Spontaneously alerts to environmental and speech sounds

◦ Meaningful Auditory Integration A Robbins◦ Changes in vocalizations with CI◦ Vocalizes when spoken to◦ Develops auditory feedback loop◦ Alerts to name 50-100% of time◦ Derives meaning from speech and

environmental sounds

CI Activation: CA 12-18 mos.“Listening is fun!”

Treatment Objectives◦ Identifies Learning to Listen Sounds and Songs Warren

Estabrooks

◦ Understands a few common phrases and responds to “no”◦ Waves bye-bye◦ Matches and identifies suprasegmental features paired

with vocabulary labels and common expressions for exposure◦ Transportation◦ Animals◦ Clothes◦ Food◦ Body parts◦ Verbs◦ Common expressions◦ Concepts

CI Activation: CA 12-18 mos.“Daddy, you still have more to learn!”

Intervention Strategies◦ Make Your Point Bader◦ 1-2-3 Bader

◦ The Brass Ring Bader 1999

◦ Observe Wait and Listen Manolsen 1985◦ Sing and Talk… Before You See Estabrooks

◦ Say It Back Estabrooks

◦ Hand Cue Estabrooks

◦ Acoustic Highlighting Estabrooks

◦ Auditory Sandwich Rhoades

◦ Sabotage Estabrooks

What to Expect During the Second Six Months of Listening

Treatment Objectives

A Lesson Plan for the First Year of Listening

The Listening Journey Continues CA 18-24 mos.

“The first six months went well, what’s next?”

Treatment Objectives◦ Identifies the Ling 6 Sounds ◦ Spontaneously alerts to name in noise and discriminates name

from others◦ Identifies and produces more Learning to Listen Sounds and

Songs◦ Identifies the name of the object for the Learning to Listen

Sounds in larger sets◦ Receptive and expressive vocabulary in the following

categories: animals, food, clothing, toys, vehicles, body parts, family names, people, furniture, places

◦ Group these in categories

The Listening Journey Continues

Treatment Objectives◦ Receptive ID and expressive use of concepts in the

following categories: ◦ Position: in, out, on, off, under, together, up◦ Quality: hot, cold, dirty, clean, happy, sad, soft, heavy,

fast, same◦ Quantity: big, little, tall, all, none, all gone, more, empty,

give me one, two, or three items, rote count to 5◦ Temporal: wait, now, later, in a minute


Treatment Objectives◦ Understands and emerging use of questions: where, what’s

that, who, what doing, how many, what color, what happened, yes/no?

◦ Understands pronouns: I, my, mine, you, me, yours, your◦ Emerging use of present progressive and a few past tense

verbs◦ Emerging use of 2-3 word combinations◦ Enjoys being read to and reading◦ Points to objects named in book


Treatment Objectives◦ Receptive understanding and Expressive use of Common

Expressions and Semantically Potent Words◦ Protection: don’t, stop, ow, no◦ Attention: look, watch, hey, help, uh-oh◦ Refusal: no, yes, want, more◦ Location: there, this, that, here◦ Social: please, thank you, fine, hi, bye◦ Action: push, pull, hit, go, stop, run, walk, fall, climb,

open, close, throw, roll, bounce, eat, sleep, drink, sit, give it to __, go get the ___


Treatment Objectives◦ Selects two learning to listen sound objects or pictures

(memory for two units)◦ Comprehends simple directions with and without objects◦ Pairs pictures that are associated◦ Emerging understanding of object-functions◦ Identifies object by descriptions◦ Uses jargon◦ Approximates words and uses a variety of CV, VC, and CVC

combinations◦ Refers to self by name, says name on request

A Lesson Plan for the First Year of Listening“My brothers help me learn! But, sometimes I don’t want to listen to them.”

Knock-Knock-Knock,

Who’s that a knockin’? Barton◦ Supra-segmentals◦ Knock-knock, Open◦ Who is it? What do you hear?◦ Learning to Listen Sounds◦ Come out◦ Boo!◦ Hi, Bye-bye◦ More◦ Look◦ Where? Yes/no◦ Under/on◦ Match object with pic◦ I found it, run, sit down

A Lesson Plan for the First Year of Listening“My SLP sure has fun. She makes me laugh!”

Greeting Song◦ Hello◦ How are you?◦ I’m fine.

Common Songs/Rhymes◦ If you are happy and you know it◦ Head knocker◦ Ride a little horsey◦ Peek-a-boo

Name Song Barton◦ Boy, girl◦ What’s your name?◦ Recognize written name◦ Recognize letters◦ Colors, under◦ Not mine/yours

Listening Walk◦ Book Paul Showers◦ Role-play◦ Stuffed animals◦ Family members◦ Environmental sounds

Movement Time and Song◦ Circle◦ Hold hands◦ Do you? I want to ___ ◦ Yes, no◦ Walk, run, jump, sit down◦ Fast, slow◦ This way, that way◦ Ready?◦ 1-2-3 Go, stop

A Lesson Plan for the First Year of Listening“I just love to sing and move and listen!”

Blocks and Boat◦ Sabotage/Cond. play◦ I hear it! Oh!◦ In, On, Wait, No

Airplane◦ AHH.◦ Rising and falling intonation◦ Up, down◦ Open, close◦ In, out

Bus◦ Rhythm and number◦ BUH BUH BUH◦ Mama, Daddy, Baby

Hear & Listen! Talk & Sing!Estabrooks & Birkenshaw-Fleming

Fire Truck◦ Rhythm and pitch◦ WahOOH◦ Puppy WOOF◦ Fireman WALK◦ Up, down◦ In, out◦ Uh-oh!

Car◦ BEEP BEEP◦ Mama, Daddy, Baby◦ Go, stop◦ Wait◦ Uh-oh! ◦ Turn around◦ Vroom Vroom

Songs for Listening! Songs for Life!

Estabrooks & Birkenshaw-Fleming

A Lesson Plan for the First Year of Listening“This is fun! Let’s keep playing!”

Train ◦ Voiceless consonant◦ CHOO CHOO◦ Come back◦ How many?◦ In, out, stop◦ Animals/Sounds

Box of Vehicles◦ Loud, shhh!◦ Knock knock◦ Open, close◦ Out, in◦ Make a choice

Box of Fish◦ Voiceless consonants◦ SWISH◦ Swim◦ OOWah and Laugh◦ Blow a kiss, kiss

Pinwheel◦ Around and around◦ Blow◦ Give it to ___◦ My/your turn

Bubbles◦ POP POP POP◦ Blow◦ Uh-oh◦ More?◦ Yes, no◦ All gone

Book◦ Turn the page, point◦ The endListen for your name!

Listen to Me!

My SLP knew what to do prior to implantation!

My SLP knew what to expect the first year or two after implantation!

My SLP knew how to plan fun, fun, fun treatment activities for the first year or two after implantation!

What comes next? Age appropriate language AND…

The fun continues, right?

What We Have Learned

What can be accomplished when a child is expecting a cochlear implant?

What factors need to be considered in order to lay a good foundation for listening?

What are appropriate intervention objectives and strategies before and after cochlear implant activation?

How do we make lesson plans “Fun” for the first year or two of listening?

laying the foundation for listening - infant hearing me to death bader 1999 i see it = i hear it...

Documents