TechnologyAudiologic Rehabilitation for Children

&

Educational Audiology

SPA 6581 – Spring 2015

Technology

Rationale for personal hearing instruments and hearing assistive technology

Recent trends and regulatory considerations

Assessment of the personal hearing instrument and hearing assistance technology needs of children and youth

Personal hearing instruments and hearing assistance technology options

Implementation and Management of hearing technology

Other Assistive Technologies

Technology: Rationale

Well researcher and documented: Negative effects of noise, distance, and

reverberation

The above can impact any child, but are particularly deleterious to children with deficiencies in: Hearing

Auditory processing

Language

Attention

Learning

Non-native English speakers

Recent trends and regulatory considerations

Regulations IDEA

No Child Left Behind Act of 2001

Section 504 of the Rehabilitation Ac of 1973

The Americans with Disabilities Act of 1990

HAT is not classified as durable medical equipment Little regulation of performance with regards to the companies

Widespread commercial availability! May mean that audiologists are not involved in their selection, purchase,

and fitting Need to be well versed in Professional Practice Standards and Scope of

Practice

HAT fitting issues should ALWAYS be addressed as part of the IFSP or IEP so that all members of the planning team understand and are informed of the necessity for a qualified person to perform this service.

REVIEW The AAA Clinical Practice Guidelines for HAT

Technology: Assessment of HAT

needs Candidacy and Candidacy Considerations

Every child and youth with HL should be considered a candidate for personal hearing instruments*

Personal choice

Regardless of the decision to fit personal hearing instruments, the next consideration is for HAT. Should be considered for the following populations (AAA, 2008): Hearing loss

Auditory processing deficits

Auditory neuropathy spectrum disorder

Learning disabilities

Language deficits

Attention deficits

English language learners

The decision to proceed with HAT should be based on evidence that links the deficit to hearing, listening or learning problems whether in or out of school.

Technology: Assessment of HAT

needs Candidacy and Candidacy Considerations

The decision to proceed with HAT should be based on evidence that links the deficit to hearing, listening or learning problems whether in or out of school.

Technology: Assessment of HAT

needs Next step is to consider the

social emotional, functional, and support implications for use of HAT

Social-emotional

Motivation (student, teachers, child and family members)

Attention and fatigue (listening and looking)

Self-image

Self-advocacy

Social acceptance

Classroom culture

Family support

Functional

Age

Chronological and developmental

Academic

Communication skills

Home communication environment

Support

Awareness

External acceptance

Ability to use and manage technology

Financial resources

ADA obligations

Technology: Assessment of HAT

needs Device Selection Considerations for HAT

Developmental considerations Age, academic performance, and additional learning problems

The listening Environment Extends beyond school to the home and community activities

and is one of the most critical areas affecting communication access

Technology See next slide

Funding Although it should not dictate the recommendation for HAT or

the type of HAT selected, it can be a deterrent

Device Determination The decision is made after all of these considerations have

been discussed

Technology: Assessment of HAT

needs Device Selection Considerations for HAT

Technology Considerations Convenience

Wearability

Reliability

Maintenance

Ease of monitoring

Manufacturer or dealer support

Compatibility with existing amplification

Compatibility with computers, phones, and other devices

Signal interference

Multiple FM frequencies

Bluetooth capability

Electromagnetic capability

Technology: HAT technology options

Type: Air conduction, Bone conduction, Cochlear implant, Implantable bone conduction device (FDA approved for children 5 years and older)

Style: BTE, BTE open fit, BTE RITE, All in the ear

Receiver type options: ear level personal FM system, induction, targeted area audio distribution system (ADS), classroom audio distribution system (ADS)

Wireless transmitters: Location: lapel mic connected to body-worn transmitter, head or cheek boom

mic connected to body-worn transmitter, lavalier – mic and transmitter in one unit, conference – mic and transmitter in one unit that sits on a table top

Type: omni-directional, directional

Other Features: Adaptive FM

Single-fixed FM channel

Multichannel selectable

Accessories Audio input jack

Bluetooth

Technology: HAT technology options

Goals: Speech recognition that is commensurate with performance

in ideal listening conditions

Full audibility of self and others Consistent signal from the talker regardless of head

movement

Technology that will be worn consistently by the individual, parent, or teacher

Technology that will provide full audibility according to the listening group Group 1 = children and youth with hearing loss who are actual

or potential hearing aid uses. (default recommended arrangement: bilateral ear-level wireless technology and fewest equipment adjustments)

Group 2 = children and youth with cochlear implants (default recommended arrangement: bilateral wireless technology)

Group 3 = children and youth with normal hearing sensitivity who have special listening requirements (no default arrangement)

Reduced effects of distance, noise, and reverberation

Personal FM System

Page 302 Table 7-9

Page 304 Table 7-10

Technology: Implementation and

Management Fitting and Verification

Orientation and Training

The Usage Plan

Validation

Monitoring and Equipment Management

Fitting and Verification

AAA Pediatric Amplification Guidelines (2004) Addresses fitting and verification for

hearing aids

AAA HAT Guidelines, Supplement A (2008) Addresses fitting and verification for ear-

level FM

Fitting and Verification

Basic premise for HAT? All verification measures of the relationship between the FM and the

HA microphones are based on the assumption that the hearing aid portion of the system has been adjusted to provide appropriate audibility and output for the individual child!

Personal FM system should increase the level of the perceived speech in the listener’s ear by at least 10 dB relative to reception by hearing aid only.

If simultaneous use of the personal FM and hearing aid is normal for the child, the assessment of the FM And hearing aid should be performed in that condition

Assess performance electroacoustically with a speech-weighted input

True estimates of the maximum output of the system are obtained from the HA microphone, not the personal FM system microphone, because of the presence of input automatic gain control in the FM system

Fitting and Verification

Electroacoustic verification and Real-ear measurements Necessary to verify that the instrument is functioning

according to the manufacturer’s specifications

Crucial to check before fitting

Determine that there is “transparency” between devices When the same input is given to the hearing aid microphone

and to the personal FM system transmitter, the hearing aid with the FM receiver attached should perform in an identical manner

Difference? Adjustments before continuing with the verification process

Real Ear measures verify optimal audibility and maximum output for the individual user and are routinely performed

Measurements for FM verification rely mostly on the 2cc coupler

Fitting and Verification

Behavioral verification Purpose is to determine that what has been

selected and fitted functions as expected for the child or youth

Performance with the FM in an ideal listening condition should be as good as the hearing aid alone in that same condition

Testing in noise to compare the performance with a hearing aid alone to performance with the FM microphone engaged is also necessary to determine the benefit provided by the FM

Orientation and Training

As a service required under IDEA (2004), orientation and training activities for assistive devices should be included in the IEP for each child and should be provided as part of the audiologist’s consultation time Including caregivers if devices are used at

home

Should be face-to-face in addition to written information

Orientation and TrainingTopics for

children and youth

Implications of hearing loss

Basic function of device(s)

Appropriate use of device and features

Expectations: benefits and limitations, when to use and when not to use

Care and maintenance

Basic troubleshooting

Self-monitoring of function

Self-advocacy

Topics for teachers,

parents, and others

Basic implications of hearing loss

Basic function of the device

Appropriate use of device and features

Expectations

Listening check and basic troubleshooting

The Usage Plan

With leadership from the audiologist and input from the student (when age appropriate), the IFSP or IEP team needs to determine a usage plan that identifies when the HAT will be used.

Out of school events such as: therapy, education classes, organized activities should also be considered School-owned HAT would only be used if the

IEP team determined it was necessary for FAPE

Validation

Purpose? To determine that the hearing instruments audiologists

have fit, prepared children or youth to use, and trained the teachers and staff to support actually result in the intended outcomes in classrooms, homes, and other settings

Should identify strengths and limitations of HAT, and be ongoing in its evaluation LIFE

ELF

CHILD

SIFTER

IT-MAIS

etc

Monitoring and Equipment

Management Monitoring – not an option

IDEA 34CFR300.113 specifies that monitoring must occur, it does not state the frequency or procedure with which the monitoring should occur

Daily checks

Monitoring plan

Need battery testing, listening stethoscope, extra batteries, cleaning brush, wax loop, earmold puffer, diagram of hearing aids with parts labeled, directions for physical and listening checks, who to call when a problem is identified

Strategies to Implement the American Academy of Audiology Hearing Assistance Technology Guidelines

Classroom Acoustics

Audiologic Rehabilitation for Children

&

Educational Audiology

SPA 6581 Spring 2015

Acoustical Parameters in

Classrooms They change as a function of:

Time

Specific learning activity

Other factors

Measuring Classroom Acoustics

Classroom Observation

Instrumentation and Software Programs

Classroom Noise Measurements

Classroom Reverberation Measurements

Estimating Critical Distance

ANSI/ASA Standard (2010) and ASHA Guidelines for Addressing

Acoustics in Educational Settings (2005)

Specific procedures should be used: 1) Measure background noise levels in dBA

2) Measure or estimate reverberation time

3) Measure or estimate SNR

Also – estimation of critical distance should be included as part of the classroom survey and acoustical measurements

Classroom Observation

Before measuring classroom acoustics, the educational audiologist should conduct an observation of the specific learning space(s).

Subjective appraisal of noise and reverberation characteristics and information about teaching style and physical room characteristics

Observe both OCCUPIED AND UNOCCUPIED space before measuring noise and reverberation

Classroom Observation:

Referrals 1) General concern about noise and

reverberation levels

2) Student-specific concern related to hearing loss, auditory processing, or the effects of noise and reverberation on academic achievement

3) concern expressed by a teacher experiencing excessive vocal stress or fatigue

Classroom Observation: Data

Useful in making follow-up recommendations for acoustical modifications in the teaching and learning enviroment

Instrumentation and Software Programs

Sound Level Meters Type 1: integrating-averaging type capable of measuring

time-average sound levels

Type 2: conventional sound level meter capable of measuring slow time-weighted sound levels

Most educational audiology facilities supported by local education agencies? Type 2

Capable of measuring both A and C weighted filter networks is adequate for conducting classroom noise measurements

Some Sound Level Meter manufacturers offer software that allows for transfer of data for analysis. Calculation of reverberation time, etc.

Classroom Noise Measurements

See pdf

Classroom Reverberation Measurements

The average Reverberation Time of a classroom is calculated by averaging the RTs at 500, 1000, and 2000 Hz.

All classrooms with the same RT are not the same acoustically. May differ with respect to the predominant type of

reverberation or the frequency characteristics of the reverberation

What is the equipment is not available to the educational audiologist? The use of estimating software or manual calculation is a

good alternative

Applications are available on smart phones, etc.

Classroom Acoustical Screening Survey Worksheet – see pdf

Estimating Critical Distance

It is important to know what the critical distance is for a given classroom and for different learning activities.

Learners who are seated beyond the critical distance in the learning environment may experience difficulty comprehending instruction, and as a result, learning opportunities may be missed.

Critical Distance is dependent upon… The dimensions of the learning space and the Reverberation Time

(RT), and the directionality of the auditory signal.

Including critical distance information in the classroom acoustic measurements may provide convincing support when recommending: acoustical modifications

room arrangement

seating options

other strategies to enhance the listening and learning environment for students AND teachers.