Download DHB Paed Audiology Inservice 2013

Paediatric Audiology In-service.
DHB AUDIOLOGY SERVICES
2013
P PERYMAN AUDIOLOGIST, VADEC
Workshop Content
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Helping parents understand about their child's
hearing following diagnosis.
Helping children themselves understand about
their own hearing.
Functional hearing assessment - beyond
electroacoustic calibration.
Audiological information needed by AODCs,
parents and teachers of the deaf.
Preparing hearing impaired students for transition
to adult services.
ANZCED PPT
1. Helping parents understand about their child's
hearing following diagnosis
 History and enquiry – the manner in which this is
done and engagement of parents/families. Parents
become aware that they have been observing their child’s
hearing and listening behavior and are reinforced for
doing so. They are advised that they are part of the
hearing assessment process. Their observations are
valued by the audiologist.
 Parents observe the hearing testing – invitation to
comment on the effects of seeing their child responding
to sound. Clinician commenting that the child can hear,
making a positive statement.
Helping parents understand about their child's
hearing following diagnosis
 Demonstration - Clinician indicates and demonstrates
what parents and others need to do in order for the child
to be able to hear consistently. Introduction of the notion
of communication behavior change to meet the hearing
needs of the child – the greater the hearing loss, the more
dramatic the change.
 Expectations and options - Clinician discusses
options to help the child’s hearing and communication,
and begins process of managing expectations and
understanding about benefits and limitations of
management options, including amplification.
Managing Conversations with Parents
 Let the parents set the pace for the consulation.
 We might ask or say,
 “Tell me more about the hearing behaviour you
have observed.”
 “What concerns you most about your child’s
hearing?”
 “You are the person who knows most about your
child’s hearing.”
 Name any likely emotions the person might be
expressing. eg, “You seem very worried...”
Managing Conversations with Parents - 2
 What works well now for the parents? “Can you tell
me what you do in order to help your child hear
better and communicate with them.”
 Clarify and summarise client’s comments. “You have
talked a lot about A and B. Let’s make sure we talk
more about A and B again later.”
 Clarify expectations. “What would you like me to
do?”
 Clarify motivation. “How important is it for you to
try to improve your child’s ability to hear and
communicate?”
Giving The Diagnosis - Technique
 Use Lay terminology.
 Avoid giving doubt, but say if unsure.
 Ensure info given is tailored to client’s concerns
expressed during interview.
 Keep statements concise.
 An audiogram is not enough - Explain how loss of
sensitivity, frequency selectivity and temporal
integration affect hearing, and how this in turn
affects communication.
Giving The Diagnosis – Technique 2
 Present simulations of the loss. EG:
http://www.betterhearing.org/hearing_loss/hearing_loss
_simulator/index.cfm
Oticon gateway
 Elicit concerns.
 Answer questions.
 Ask if client would like more detail.
 Repeat explanations in summary and check
understanding.
 Discuss home observation – eg, ELF, Karen Anderson.
 http://www.oticon.com/~asset/cache.ashx?id=10834&ty
pe=14&format=web
What Purposes Might This Initial Conversation
Style Serve?
 Audiologist finds out how the family copes and the
strategies that are in use.
 Family/parents feel the audiologist is taking a
personal interest – respect and empathy.
 Adds depth and builds trust.
 Family begins to explore their daily communication
activities in a way they may not have thought about
them before – self-efficacy (our belief in our ability
to succeed in certain situations) is advanced.
Further Reading
IAPO declaration on patient-centred health care:
www.patientsorganizations.org/pchreview
•
• http://www.health.org.uk/public/cms/75/76/313/3448/Help
ingPeopleShareDecisionMaking.pdf?realName=V9gR9i.pdf
• Four Habits Model:
http://kpnet.kp.org/cpc/
Karen Anderson, Counselling parents of children with hearing
loss - Gateway:
http://www.oticon.com/~asset/cache.ashx?id=10830&type=14
&format=web
2. Helping children understand their own
hearing.
 Anatomy and Causes of Hearing Loss
 Hearing Measurement – explanations
 Hearing Aids, Cochlear Implants, Assistive Listening
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Devices – function, care, maintenance
Coping with a Hearing Loss
Communication Strategies
Solution-Focused Conversation & Rational Emotive
Education
Stories of children
Resources, Bibliography
Who and when?
 Curriculum designed for primary school children.
 Age when child able to learn new independence skills
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and absorb new info.
Primary school child’s thought may still be concrete
(Piaget’s stage of concrete operations 7-12 years),
but...
There is an increased ability to maintain attention.
Increased ability to store and recall information.
Able to use of mental imagery to represent events,
etc.
Coping with a hearing loss – “My World”
 The My World tool can help facilitate an
understanding of hearing loss from the child's point
of view.
 The tool consists of three different environments: a
classroom, a home, and an outdoors area. The child
can place movable figures and everyday objects in
the various environments to describe
communication successes and challenges in everyday
life.
 There is also a photo album with pictures showing
scenes which present a challenge for the child.
Coping with a hearing loss – “My World” 2
 By playing with the tool components, the child can
externalize their hearing concerns and discuss how
they communicate with others in a concrete, nonthreatening way.
 The tool can help professional (and families) uncover
information about the child's communication
patterns, reinforce positive patterns, and formulate a
strategy for coping with everyday challenges.
 http://idainstitute.com/tool_room/my_world/
Coping with a Hearing Loss – Interactive
Situations
 Use of pictures of interactive situations to elicit
individual or group discussion by HI’d children.
eg, - Teacher does not face child when talking.
- Talking to other children at lunch or in the
playground – peer relationships.
- On the sports field.
- Classroom routines and teacher routines.
• Explore ways that child has managed or can try to
manage the situations.
• Role play adaptive strategies.
Communication Strategies
 What is the child presently using?
 Erber methods
 Adaptive speech perception – what does another
person need to do in order for a child to receive and
understand a spoken message?
 Conversation training.
 Telephone training.
Stories of Children
 These can be videos or printed stories produced by
the child themselves.
 Models of stories are available from sources such as
the “Family Book” , or Aust. Hrg’s “Choices” –
(Jack’s Story, p57).
Solution-Focused Conversation & Rational
Emotive Education
 Social skill dev’t; eg, approp. touching to get attention,
seeking repetition, learning when to talk in class.
 Building self-esteem.
 Self-efficacy – child may feel that it is too hard to make
changes or learn communication skills. Encourage child
to perform desired behaviour then draw their attention
to that performance – by shaping or slow
approximations.
 Teach child how to dispute irrational beliefs and replace
them with rational beliefs. Eg, child is not a bad person if
they don’t meet their goals; Playing a game for fun does
not mean it has to be won; Significant achievements are
not easy so hard work is needed.
Resources and Bibliography
 Knowledge is Power Curriculum
http://www.edaud.org/storelistitem.cfm?itemnumber
=18
• Barbara Taylor “Living with Deafness” London,
Franklin Watts – Aladdin Books, 1989.
 Erber NP, “Auditory Communication for Deaf
Children .” Victoria, Aust, ACER Press, 2011.
 “The Family Book.”
3. Assessments of Functional Listening
 Many speech perception tests yield a score which
may not be able to be easily interpreted in relation to
everyday functional communication.
 These tests also describe performance in a static
situation or test condition, such as using audition
alone, or listening in quiet and noise.
 Everyday functional communication can be assessed
using procedures with greater predictive value.
Adaptive hearing assessment
 This approach has a long tradition in what was called
auditory training – eg, Geoff Plant in Australia
(Plant, 1982).
 The basic tenet is one of varying systematically
(adaptively) the cues given to a child in order to
discover which combination of cues the child
requires in order to perceive speech or communicate
most fluently.
The Erber approach
 Describes the adaptive evaluation of functional
hearing ability in school-aged children.
 It is based on the reality of conversations between
the hearing impaired child and others, and the cues
children rely on to maintain some conversational
fluency (Erber, 2011).
 It is a form of diagnostic teaching in which
instruction is integrated with assessment, and almost
any speech perception test can be used in this way.
The Erber approach - method
 Select a list of words (eg, WIPI Test).
 Speak the test word using audition alone.
 If the child identifies the word correctly, proceed to the
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next stimulus.
If the child responds incorrectly, repeat the stimulus
word using audition alone.
If still incorrect, introduce the word into a sentence.
If still incorrect, repeat sentence with audition plus visual
cues.
When the child responds correctly, note the stimulus
condition in which the correct response occurred.
Results are plotted on a graph.
The Erber approach – result plot 1
The Erber approach – result plot 2
The Erber approach – result plot 3
Interpreting Adaptive Hearing Ass’t results
 The results specify the conditions under which the
child succeeds.
 Parents and other professionals can learn which
adaptive communication strategies are most effective
for the child.
 They can also adapt their own communication to suit
the child.
 A speech perception test score may underestimate a
child’s abilities, especially if the adaptive methods
show better ability.
Functional Listening Evaluation - FLE
(Johnson & VonAlmen, 1993, revised 2010)
 Required by IDEA (The Individuals with Disabilities
Education Act (IDEA) is a law ensuring services to
children with disabilities throughout the nation. IDEA
governs how states and public agencies provide early
intervention, special education and related services.)
to conduct a functional evaluation of the child in the
child’s customary environment.
 Compares student’s listening ability in a variety of
situations to identify effects of noise, distance and
visual cues.
Functional Listening Evaluation - FLE (Johnson &
VonAlmen, 1993, revised 2010) 2
 Provides authentic sample of student’s abilities for
teachers, parents, and others.
 Provides evidence for hearing assistance technology.
 May support choice of most appropriate hearing
assistance technology.
 Validates benefit of hearing assistance technology, eg
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Does it meet amplification goals for student?
Combined with classroom physical characs, and C/T – child
characs (“Classroom-at-a-glance” survey).
Functional Listening Evaluation (Johnson
& VonAlmen, 1993; Johnson, 2004, 2010)
FLE Test Set-up
student
3 ft
Noise
tape
examiner
student
3 ft
Noise
tape
12-15 ft
examiner
FM
 Fitting FM and remote microphone systems for
individual preferred listening levels - beyond
electroacoustic gain calibration.
 Clinical activity – speech in noise Cheryl DeConde
Johnson methods.
 Feedback and adjustment during trials – Listening
checks, classroom tests, child report, C/T report.
 Adjustment during use, post-issue – C/T voice
level/quality change.
Interpretation Matrix:
Effects of Noise with FM
Quiet
Noise
FM/Noise
Close-auditory
84
72
84
Close-auditory/visual
92
80
92
Distant-auditory
72
36
88
Distantauditory/visual
76
56
92
81%
61%
89%
Ave. of above scores:
4. Audiological Information Needed by AODCs,
Parents and Teachers of the Deaf.
 Important comments made by the child and
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parents/caregivers.
Audiogram with key to symbols.
Audiometry response reliability.
Description of degree of hearing loss.
Status of ear health and impact of middle ear
conditions if any.
Audiological Information Needed by AODCs,
Parents and Teachers of the Deaf. 2
 Is one ear hearing better than the other, and
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if so, should others sit on this side if working
1-1, etc?
Mention of any changes in hearing
sensitivity.
Aided audiometry including speech
perception and conditions in which tested.
Child’s estimated or measured best aided
listening range for speech in quiet.
Summary of functional hearing skills.
Audiological Information Needed by AODCs,
Parents and Teachers of the Deaf -3
 Hearing aid make, model, serial number, battery
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type, whether controls are active or automatic,
how aid will perform technically in noise and in
quiet (especially if in directional mic mode),
activation of frequency lowering, etc.
Were HAs adjusted, and how, plus for what
reason.
Assistive device (eg, FM system) , model, serial
number, battery type, whether controls are
active or automatic.
Follow-up recommendations.
When the child will be seen in the future.
5. Preparing Hearing Impaired Students for
Transition to Adult Services.
 Support for youth
 Transition support requirements
Support for Youth
 Karen Anderson, “Special Considerations for Parents
Raising a Teenager with a Hearing Loss.” Oticon
Paediatrics.
http://www.oticon.com/~asset/cache.ashx?id=10838
&type=14&format=web
 Cheryl DeConde Johnson, “Keeping Molehills from
Becoming Mountains.” Oticon Paediatrics.
http://www.oticon.com/~asset/cache.ashx?id=10839
&type=14&format=web
Support for Youth - 2
 SAC-A . Judy Elkayam andKris English, “Counselling
Adolescents with Hearing Loss with the use of a SelfAssessment Questionnaire.” JAAA, 14 (9), 485-499,
2003.
 Cochlear implant wearers:
http://www.hearforyou.com.au/new_zealand_mentor
s_at_hear_for_you.html
Transition Support Requirements
 Schroeder et al, 2010 – “My Patient is Taller Than
Me! Now What? Developing a Plan for Teenagers to
Transition to Adult Audiology Services”. Poster at
Sound Foundation Through early Amplification
Conference 2010.
 NDCS Quality Standards for Transition from
Paediatric to Adult Audiology Services. 2005.
Schroeder et al, 2010
 Ensure teen knows about their hearing and how it
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has an impact on their communication.
Taking ownership of hearing health care.
Development of transitioning plan.
Plan driven by teen and family needs.
Fine tune self-advocacy and assertiveness skills for
effective listening/communication. Who has a role in
this?
NDCS Quality Standards for Transition
 Services must have an agreed written protocol.
 Information pack.
 Arrange an app’t within adult service context.
 Person designated to provide support for person in
transition.
 Support, services and info tailored to indiv’s and
family’s needs.
Transition Resources
 MoE - Preparing to leave school:
http://www.minedu.govt.nz/Parents/AllAges/ParentI
nformationKit/BookletsforParents.aspx