Chapter 5 Auditory Only Training Perry C. Hanavan, Au.D.

??????? “You have to hear what you don’t hear to know what you don’t want to hear.”

Factoid 40% of 170 pediatric SNHL in study had structural peripheral auditory abnormalities diagnosed with MRI May not have complete audibility even with best hearing aids 50% had mal-functioning issues with hearing aids Battery Earmold FM connection

Auditory Training Utilize residual hearing Emphasizing that the primary therapeutic goal is training the mind to be aware of, attend to, and use sound. Speech and language activities are founded in this mental training. To help integrate listening into one’s development of communication and social skills To help monitor one’s own voices and the voices of others in order to enhance the intelligibility of spoken language Utilize residual hearing with amplification and/or cochlear implant, and hearing assistance technologies

The Early Auditory Experience Hart and Risley, 1995 Welfare Working Class Professional Words heard per hour 616 1,251 2,153 Words heard per week 62,000 125,000 215,000 Words heard per year 3.2 million 6.5 million 11.2 million Words heard by age 4 45 million

Words Understood Age No. of Words 2 years 300 2.5 years 500 3 years 900 4 years 1,500 to 2,000 5 years 2,500 to 2,800 6 years 13,000 7 years 20,000 to 26,000 Note: Between ages 5 and 6, children are learning about 28 words a day

Hart & Risely Study (1995)

The More Parents Talk to Child

Average IQ & Levels of Talk

30 Million Word Gap Initiative

LENA

LENA: Average Words Per Hour

LENA: Word & Turn Taking

LENA: TV Time & Media

Hearing Loss Impact on Phonological Processes Vowel substitutions Deletion of unstressed syllable – “di(na)sour” Deletion of initial syllable of word – (e)lephant Vowel insertion - “cuppa” for “cup” Cluster reduction – “fower” for “flower” Final consonant sound deletion – “cu” for “cup”

At-Risk Language Components in Children with Hearing Loss Plurals Sounds like “s” (cats) Sounds like “z” (dogs) Sounds like “es” (horses) Suffixes and Prefixes Friendly, happiness Widest, toxic Disable, misbehave

At-risk Language Components, Cont. Past tense Sounds like “t” (walked) Sounds like “d” (bobbed) Sounds like “ed” (beaded) Possessives The cat’s mitten The truck’s wheel

At-risk Language Components, Cont. Copulas/Connecting words Is Of Have If Present progressive Going Swimming Pronouns and 3rd person He, his She, her It Vocabulary!

Question Which of the following is NOT an auditory skill level? Detection Discrimination Recognition Comprehension Transformation

Four Design Principles Auditory Skill Awareness, detection Discrimination Identification Comprehension Stimuli Phonetic level Sentence level Activity Type Formal Informal Difficulty Level Response type Closed, limited, open Stimulus unit Words, phrases, sentences Stimulus similarity Contextual support Task structure Highly structured, spontaneous Listening conditions

detection discrimination identification comprehension 1. Auditory Skill Level Awareness/Detection Presence/absence of sound Discrimination Same/different Identification Recognition/labeling Comprehension Understanding/meaning detection discrimination identification comprehension

Question Analytic works on the— Phoneme level Sentence level Paragraph level None of the above

2. Stimulus Units Analytic Synthetic Phoneme, syllable, word Individual auditory cues Synthetic Sentence, communication discourse Meaning of utterance analytic synthetic

Question The analytic approach typically begins with: Consonants Vowels Diphthongs Syllables Words

Analytic Auditory Approach Two primary objectives often targeted in analytic approach Vowels More intensity in lower frequencies, thus more audible to most Vowel formants: back, front, central, high, mid, low Consonants Focus on place, manner and voicing characteristics

Vowel Formants

Question The first 2 formants are all below: 1000 Hz 2000 Hz 3000 Hz

Analytic Auditory Assessment Non-speech Phoneme Syllable Word Supra-segmental Detection Discrimination Identification Comprehension

Audibility Assessment UWO Plurals Test Phonak Logatom Test Mr. Potato Head Test PBK BKB-SIN Cincinnati Auditory Test CHAPS SIFTER FLE LENA CAEP

Auditory Assessment Examples Segmental-word: Early Speech Perception Segmental-vowel: Early Speech Perception, Ling Segmental-consonant: Minimal Pairs Test, Ling Connected Speech – Mr. Potato Head Test, Common Phrase Tests (synthetic)

3. Activity Kind Informal Training Formal Occurs as part of the daily routine Often incorporated into other activities Formal Highly structured Usually one-on-one training formal informal

4. Difficulty Level Stimulus set Stimulus unit Stimulus similarity easy hard Stimulus set Stimulus unit Stimulus similarity Context Task SNR closed limited open phoneme syllable word sentence dissimilar similar high low structured spontaneous good poor

Nancy Tye-Murray: Auditory Training

LACE Auditory Training LACE Auditory Training: a key to hearing better in noise

Keira's therapy part 1

Auditory Oral School of NY

Brain Plasticity Ability of brain to change Learning possible

Plasticity Physiological changes in the CNS (and PNS – auditory nerve) that occurs from sensory experiences Brain’s ability to reorganize space Benefit from HA, CI, HATs may need to be measured at later date Brain may continue to acclimate for several years following HA, CI, HAT, therapy

Auditory Reorganization/Plasticity Cochlear dead regions Brain reorganization will occur with damage to regions of the cochlea

Dr. Nina Kraus

Dr. Patricia Kuhl

Top Down Bottom Up

Hierarchy of Listening Tasks Familiar expressions/common phrases Single directions/two directions Classroom instructions Sequencing three directions Multielement directions Sequencing three events in a story Answering questions about a story Comprehension activities/exercises in noisy environs Onomatopoeic words (Estabrooks, 1994)

Friday Morning Appointment The audiologist has just completed an audiologic evaluation and referred them for AR or you are an educator of the deaf or speech language pathologist? What audiologic tests measure detection? What audiologic tests measure identification?

Auditory Training Apps AB CLIX free (iOS) AB Listening Adventures $1.99 (iOS) Auditory Verbal $3.99 (iOS) VocAB Scenes $1.99 (iOS) Hear Coach (Starkey) free (iOS, Android) Hope Words LITE (Cochlear Ltd) free (iOS) Hope Words (Cochlear Ltd) $2.99 (iOS) Hope Words HD (Cochlear Ltd) $2.99 (iOS) i-Angel Sound free (iOS) iHear That free (iOS) (Ling 6 Sound Game) Oceans & Continents (MED-EL) free (iOS, Android) Rehabilitation Game (Oticon) free (iOS) Siemens Hearing Test free (iOS) Sound Match free (iOS)

Analytic Auditory Training (bottom-up) Non-speech Phoneme Syllable Word Supra-segmental Detection Discrimination Identification Comprehension

Analytic: Vowel I e i a o u tu/ti/ta tube e vs. o tu vs. ta Non-speech Phoneme Syllable Word Detection I e i a o u tu/ti/ta tube Discrimination e vs. o tu vs. ta tub vs. tube Identification i, u o, a ti tu to Tom Tim Tam Comprehension Explain or show understanding

More Analytic Strategies quiet vs. noise noise vs. quiet various types of noise near vs. far...various distances

More Analytic Strategies Ling 6 sounds CAT words PBK word lists UWO Plurals Test Phonak Phoneme Test WIPI lists

Analytic Strategy

Analytic Strategy

Auditory Training: Analytic Phonemes – common consonant confusions

Analytic Will discriminate vowels that differ in first formant information Will discriminate vowels that differ in second formant information (e.g. beet, bit; boot, but) Will discriminate words that have vowels with similar first and second formant information (e.g., “meet, mat”; boot, bought) Will identify words with different vowels, using a four-item response set (e.g., beet from beet, boot, bat, and bet) Will identify words with different vowels, from an open set of vocabulary

Auditory Training Apps HOPE Words iBaldi ListenListen Melody Match Siemens Hearing Test Word Magic Starkey Hear Coach Auditory Verbal Sound Match Mr. Potato Head Oticon Medical-Neurelec Rehabilitation Game Minimal Pairs

CI Resources Cochlear Americas Advanced Bionics Med-el HOPE School Age Advanced Bionics School Tools Listening Room Med-el Bridge to Better Communication Oticon Medical - Neurelec Rehabilitation

Question Which is not synthetic? Sentences Discourse Phonemes Paragraphs

Synthetic (top-down) Will discriminate between a declarative and interrogative sentence (How are you? ;You are fine) Will carry on a conversation Can follow the instructions of simple commands (Go to the chalkboard; write your name on the board; jump three times, etc.

Auditory Training: Synthetic Topic of Conversation Sentence Matrix Continents Listening Tasks

Analytic to Synthetic Analytic Synthetic Non-speech Phoneme Syllable Word Sentence Discourse Detection Discrimination Identification Comprehension Analytic Synthetic

Context Low High Non-speech Phoneme Syllable Word Sentence Discourse Detection Discrimination Identification Comprehension Low High

Stimulus Unit Non-speech Discourse Non-speech Phoneme Syllable Word Sentence Discourse Detection Discrimination Identification Comprehension Non-speech Discourse

Audiologic Evaluation Non-speech Phoneme Syllable Word Sentence Discourse Detection Pure tone Ling 6 SAT Discrimination Larson UWO Plurals Identification Phonak Logatome Iowa Vowel Iowa Consonant WIPI NU-6 W-22 CAT SRT Isophonemic DSI HINT QuickSIN BKB-SIN Comprehension TOPICON

AR Evaluation (Auditory) Non-speech Phoneme Syllable Word Sentence Discourse Detection Ling 6 Discrimination Larson Identification SPAC NU-CHIPS WIPI CAT BKB CUNY Quick-SIN BKB-SIN Comprehension TOPICON

AR Training(Auditory) Non-speech Phoneme Syllable Word Sentence Discourse Detection Ling Vowel Consonant Syllable forms monosyllabic NU-6 Monosyllabic trochees Spondees multisyllabic Discrimination Pitch Loudness Duration Rate Identification noise makers everyday noises BKB CID Tracking Comprehension Discussion TOPICON

10 am Appointment Early childhood program has identified a 3 year old child with profound loss which was recently fitted. Child has accepted the hearing aids and is responding to sound. Develop 6 analytic auditory objectives from the paradigm that will encourage continued growth in exploring sound

Tongue Position for Vowels

Question What is cycling? Washing clothes in wash machine Separating trash into separate bins Repeating Reviewing a task already accomplished Riding a bicycle

Cycling Reviewing or practicing tasks already accomplished or demonstrated e.g., student is struggling with identification of words—you review or practice at a simpler level of discrimination by comparing two words e.g., student is struggling with hearing comprehending sentences—you practice at a word level before returning to work with sentences

11 am Appointment The student now 8 years of age has worn a cochlear implant since 2 and has been successfully integrated for the past three years in a regular classroom Develop 6 synthetic objectives from the paradigm that will help the child succeed

KidTrax

KidTrax

KidTrax and TesTrax

Loudness Scales

Computer Programs

LACE Listening Demo Click on the LACE Listening Demo http://lacelistening.com/demo

SPATS http://comdistec.com

CAST Free from Angel Sound http://angelsound.emilyfufoundation.org/angelsound_download.html

Mobile Apps App OS Child/Adult Comments AB Listening Adventures iOS C For HA or CI users, listening for word differences in both quiet & noise AB MAIS Assess young child’s response to sound with hearing technology Oticon Medical Neurelec Rehabilitation Game A/C Practice listening to environmental sounds, detecting sounds and listening for different between speech sounds (like ba pa) Starkey Hear Coach iOS/A A Interactive listening games designed to challenge cognitive and auditory skills, helping improve ability to listen in noise Cochlear HOPE Words Created to expose children to speech sounds in the English language Auditory Verbal  Ling 6 sound discrimination

Music Training with HA & CI Rhythm Pitch Melody Timbre Instrument identification Name that tune