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CD444- Notes 6

by: Leah Larabee

CD444- Notes 6 CD 444

Leah Larabee
GPA 3.7
Aural Rehabilitation
Dr. Brooks

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Aural Rehabilitation
Dr. Brooks
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This 58 page Bundle was uploaded by Leah Larabee on Wednesday March 11, 2015. The Bundle belongs to CD 444 at University of Alabama - Tuscaloosa taught by Dr. Brooks in Spring2015. Since its upload, it has received 127 views. For similar materials see Aural Rehabilitation in Language at University of Alabama - Tuscaloosa.


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Date Created: 03/11/15
Implications of Hearing Loss in Children Everyone Wants to Belong We want to be successful among our peers Arthur Boothroyd Coined the term developmental asynchrony delay in one area of development causes delay in other areas of development Children develop in several areas simultaneously Without early identification and intervention hearing loss can adversely affect development in multiple areas When the right things don t happen at an early age Child s development is compromised Speech Language Cognition Social and emotional development Educational progress Employment and independent living skills Hearing loss can interfere with limit family and social opportunity to learn relationships inCidentally OFfFOm limit school success seeial experiences lead to falselower FGSU in delays in expectations from aCClUiSitiOH 0f authority figures and important developmental skills Communication Cognition Parenting Parenting child with HL can be difficult Become overly protective Lower expectations Do not know how to establish and achieve goals with regard to managing HL and behavior Might overcompensate Might not challenge child lf parent does not feel good about child he will not feel good about himself Codependent relationship is not uncommon Child under achieves parent enables Parents do not hold the child accountable for inappropriate behavior Make excuses for child Psychosocial development and hearing loss Establishing independent behavior Difficult if linguistic and social competencies necessary to control environment are lacking Difficult if others have low expectations or underestimate abilities Caregivers parents foster dependency Independent learning is harder Communication barrier interferes with the ability to Learn from environment Interact with othersestablish peer relationships Be successful at school and in other activities Affect others have power Integrate into the family The child can be left feeling powerless Self esteem suffers Motivation is diminished Child is likely to withdraw or develop undesirable behavior Social and Emotional Development HI kids have same emotional and social needs as other children Socially appropriate behavior results from a healthy selfimage and successful experiences and interactions with others Child has to be able to communicate to meet social needs and experience success Adequate language and cognitive skills are necessary to learn social rules Our skills do not exist in bubble cognition PsychoSOCIa literacy THE MOST SERIOUS IMPLICATION OF HEARING LOSS IS ITS IMPACT ON LANGUAGE Language language language is always the most important goal Language is the basis of communication and learning Language basis for communication and learning Typical Language Characteristics of Kids with SNHL Form Shorter sentences MLU Simple sentences and phrases with limited use of compound and complex sentences Reduced use of grammatical morphemes plurals possessive markers prefixes and suffixes verb tense Incorrect word order Incorrect use of irregular verb tense Typical Language Characteristics of Kids with SNHL Content Reduced expressive and Difficulty with idioms receptive vocabulary piece of cake hit the More nouns and verbs bOOkS costs an arm and fewer abstract concepts 3 eg 39 Reduced ability t0 Difficulty with metaphors PrOdUCG GateQOFY labels snow was like a white Reduced understanding blanket 01 objectfunction Difficulty with technical Difficulty with multiple and new vocabulary meanings pitcher trip bark Homonyms are good examples How much can a bare bear bear The pitcher spilled the pitcher Can you pass the can of milk Mary s mother is merry that she will marry Note we typically learn these differences incidentally by being exposed to language models in our normal environment Typical Language Characteristics of Kids with SNHL Use Restricted range of Limited knowledge and communication intent use of repair strategies reluctant to ask question what to do when or initiate communication communication breaks Lack of knowledge dOW regarding conventions turn taking changing topics social cues Language has strong connection to literacy Kids who are read to Have better language skills Are better readers Develop a broader cognitive base Kids who have good language skills are better readers So Reading and written language are built upon a foundation of spoken language Phonology is a vital aspect of spoken language and is difficult for children with SNHL Listening and talking are sensory partners of reading and writing Receptive language subsets Reading Listening Expressive language subsets Writing Talking Reading level cannot exceed language level 3rd grader with 5 year language level will not read at 3rd grade level Phonology Articulation Production of speech sounds or sound combinations Phonology rules that govern speech sounds Segmentals phonemes Suprasegmentals prosodic elements of speech intonation rhythm stress pause Child needs to be able to blend and segment phonemes to begin reading process requires control of suprasegmentals Suprasegmentals develop before segmentals Phonological Processes Ways young children simplify adult speech At a young age phonological processes are developmentally appropriate By age 3 kids are outgrowing these errors But they must know rules Examples of phonological errors Duplication of an element Bobo for bottle Wawa for water Substituting sounds example all back sounds g ork ford ort Deletion of all final consonants Pi for pig cu for cup Failure to use initial blends Kool for school or boke for broke Simplification of words Nana for banana Not the same as an articulation error HI kids may not develop good phonological skills because they do not hear the difference or learn rules through everyday listening Must be able to match phonological production to visual correlate when learning to read Literacy and Hearing Loss Historically deaf adults read at 4th grade level after graduation from high school Knowledge of spoken language is directly linked to literacy When learning to read kids learn to decode visually what they already learned auditorily Elm l l sill f R r N lnl How to change 4th grade statistic Early identification Good language skills EHDI Dependent on EHDI Early identification Provide underpinning for Early amplification literacy Eany intervention Involves family support as well as educational suppon Cochlear ImplantsHearing Aids Kids implanted or aided early reach language milestones closer to age of typical peers Have better chance of falling within normal range for literacy skills Often read within 1 SD of hearing peers Have good phonological foundation Fewer language gaps better overall language Success is tied to Age ofidentification Intervention Literacy Signing and Cued Speech Cued Speech Sign Language Not sign for all words Not phonologically based Not based on English syntax Sign system Not phonologically based Based on English syntax Visual correlate of spoken EngHsh Based on phonetics Any word can be cued Does not offer good representation of suprasegmentals Cognition is the process of knowing the world we live in our perception of reality Cognition and language are interdependent Adequate cognitive development is a prerequisite for language development Objectpermanence Meansend relationships Causality Imitation Joint attention Once developed language becomes a powerful tool for further cognitive development Without language cognition remains at concrete level Language is necessary to abstract and imply subtlety Language is best predictor of future cognition Communication intent awareness of environment and desire to engage with others are prerequisites to communication Cognitive awareness and a developmentally appropriate knowledge base are necessary Speech Development and Hearing Loss Deaf kids and hard of hearing kids have dramatically different levels of speech intelligibility Audiogram is a gross indicator of prognosis but other factors have strong in uence Age of onset identification Use of amplification Family support and intervention Speech Speech is an auditorymotor event Babies hear the speech of others and learn to match their own vocalizations to those models When access to speech models is limited due to hearing loss speech problems occur HI individuals often have speech problems involving articulation voice prosody phonology and automaticity It is more difficult to establish normal speech when hearing loss is prelingual than to maintain normal speech when hearing loss is postlingual Basis for speech development begins in infancy Suprasegmentals develop early FeedbackFeedfonNard Loop has been described by Daniel Ling Feedback and monitoring When babies vocalize they receive feedback Hear themselves Feel themselves Receive social feedback from others When others especially caregivers vocalize The baby hears and often sees the vocalization The baby tries to match his vocalization to the model which is feedforward The baby receives feedback social and verbal from other speakers regarding his efforts Babies practices these skills during vocal play Eventually speech emerges 1 9 Characteristics of Deaf Speech Difficulty with nonsegmental characteristics of speech Vowel errors Consonant errors Difficulty with coarticulation 1 NonSegmental Features of Speech Prosody and Voice Normal breath control provides basis for flow of speech Prosody can be analyzed according to features Pitch too high Loudness uncontrolled Pause wrong place Duration too long Tension too much Intonation flat Clinical significance of nonsegmental features of speech Contribute to intelligibility of speech and carry meaning Studies have shown that poor prosody contributes as much or more to low intelligibility of deaf speech as consonant errors As with breath control prosody is established early in the developmental process Prosody errors are often unaddressed in therapy with HI kids Don t forget Speech is learned through hearing but control is maintained through internal sensory feedback Lack of appropriate feedback during early development interferes with normal speech development or feedforvvard Lack of appropriate feedback after speech is acquired interferes with maintenance of normal speech Rhythm of speech Contributes to intelligibility Carries meaning ls combination of pause duration intonation Should be addressed as part of comprehensive therapy program Vowel errors Failure to contrast vowels neutralized and sound similar Nasalization of vowels due to oul de sac resonance Substitution Omission of one component of diphthong bo for boy Consonant errors Nonfunctional production moving lips but no sound production seen mostly with very deaf people Omission especially voiceless and high frequency Substitution Confusion of voiced and voiceless Substitution of back consonants gaggy for daddy Coarticulation production of one sound influences production of adjacent sounds HI speakers have difficulty transitioning from one sound to another and from one word to another Developing auditorymotor associations is difficult in presence of hearing loss and was often not learned during babbling Speech skills have often been taught inappropriately contributing to coartic problems Note Drilling speech sound production in isolation often leads to Increase in tension resulting in appropriate stress Difficulty With coarticulation sanow cabadriver Working at the repetitive and varied syllable level is recommended by Daniel Ling to avoid these errors Babababababa not ba ba ba Babobabobabo Matimatimati Working to the level of automaticity is also recommended by Ling Ability to produce compleX speech patterns Without conscious effort Having client complete a task While rapidly repeating target is a way to check for automaticity This not new Aural Rehabilitation Daniel and Agnes Ling 1978 Family Considerations Prior to newborn hearing screening Children with permanent hearing loss were identified at 212 to 3 years of age Parent initiated evaluation due to their concerns or suspicion of pediatrician etc Since newborn hearing screening Identification is initiated by hospitalhealth care providers Takes parents by surprise Grief process When baby is diagnosed with HL parents go through grief process Denialshock Anxiety Anger Acceptance Image of normal perfect baby dies Both parents are affected Parents do not grieve in same way or at the same rate Often feel isolated from one another Not all parents can handle it Divorce rate among parents of special needs kids is significantly greater than among parents of typically developing kids Heavy load for single parents DenialShock Parents are often shocked when the diagnosis is confirmed They report they felt numb and confused The unknown ahead of them is ovenNhelming Denial can delay diagnosis and intervention Provide factual information using terms easy to understand Don t be judgmental Anxiety Unmanaged confusion Feelings of powerlessness Lot of information comes at them quickly Many decisions need to be made Stress over finances jobs child care marriage other children Unsure of themselves as parents OvenNhelmed Anger Directed at If one parent is angry Child risk of abuse and the other guilty increases for Special relationship is fragile needs kids Spouse abuse divorce rate increases God crisis of faith Professionals Themselves Other children in family Acceptance Parents work through these stages and are able to accept diagnosis and its implications Incorporate this unexpected change into their lives and are OK with it Ideally parents will achieve acceptance quickly It is unhealthy to get stuck in denial anxiety or anger Some families will benefit from counseling How to promote acceptance NEVER say I know how you feel Avoid platitudes lt s ck don t worry he ll be fine Be a good listener Answer questions honestly and clearly Be a resource for information Develop a plan that works and parents can live with it has to be doable Be supportive and empathetic without overinvesting yourself personally professional boundaries Never be judgmental Help parents focus on a goal or a step at time without obsessing over future Help parents understand that hearing loss is a communioationeduoational problem not a medical problem Reality vs Problem Reality cannot be fixed Problems can be solved Help parents differentiate reality from problem REALITY SNHL is permanent cannot be fixed ovenNhelming PROBLEMS result from hearing loss need help with solutions You have a problem you need a plan What is the plan Problem 1 hearing loss causes limited access to spoken language Problem 2 child pulls hearing aids off Problem 3 mother is embarrassed when people in public comment on hearing aids Problem 4 mother looses pay when she misses work for appointments When problem cannot be solved you have to deal with it as a reality


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