1. Training Communication Partners of Adult CI Users Norman P
Training Communication Partners of Adult CI Users Norman P. Erber, PhD Graduate School of Education March 2014

2. What is communication? Send messages
Communication means sending messages and their meaning from one person to another. A response or feedback is not necessary: e.g., lecture, televsion.
Send messages
Statements, questions, requests, demands
Speech, facial expression, gesture, posture
(Response/feedback)

3. What is conversation? Situation Topic
Take turns (2-way <= => communication)
Exchange information, thoughts, & feelings
Cooperate (informative, brief, true, relevant)
Conversation is an extended exchange of messages about a topic. It involves 2-way communication, cooperation, and turn-taking.

4. For good conversation…
Adult CI users need:
Audible (and visible) cues
Good environment
Meaningful context
Clear speech and language
Good conversation partner
CI users need many things for good conversation. One of these things is a good conversation partner.

5. Many conversation partners
Stranger
Shop owner
Neighbour
Doctor
Friend
Family member
Therapist
Conversation partners range from strangers to good friends and family.

6. Stranger, unfamiliar person
Taxi driver, shop owner,
paramedic, sales person,
waitress, ticket seller, etc.
Meet/talk one time only
Know little about hearing loss / cochlear implants
Short conversation?
Single topic? (give/get information, buy something)
Interaction with a stranger may last a very short time and relate to a single topic. The stranger may know nothing about hearing loss or cochlear implants. The CI user may never see the stranger again.

7. Strangers = poor conversation partners?
Little empathy
Unclear speech, complex language
May not know how to clarify
Forget how to help…..need prompts
Some strangers are poor conversation partners for CI users. Are all strangers poor conversation partners? Don’t know…..

8. Conversation with strangers
Hard to train strangers to be good conversation partners.
Self-help strategies
Identify hearing loss / CI
Describe best conditions for communication
Manage distance & environment
Request face visibility
Request specific clarification
Prompt when necessary
It is probably hard to train strangers to be good conversation partners. That’s why someone invented self-help strategies.

9. When conversation breaks down…..
Recognize that a problem exists
Identify the problem
Apply a strategy
…..
Successful?
Etc……
Conversation with a stranger may be difficult. If so, problem-solving strategies can help.

10. Specific requests for clarification
Speech too soft > “Please speak a little louder.” Speech too fast > “Please speak a little slower.” Speech not clear > “Please say that more clearly.” Sentence too long > “Please say a shorter sentence.” Language too complex > “Please say that in a simpler way.” Identified part > Repeat part (“She went …where?”) Cannot identify problem > “Please say that again.”
Here are some ways the CI user can ask for help.

11. Other strategies Ask for a visible cue (e.g., gesture)
Ask for more information
Ask for written message
Find somebody to help
Find a different partner (waiter, shop assistant)
There are many other self-help strategies.

12. What is conversational fluency?
proportion of time conversation flows smoothly without…..
confusion (silence)
misunderstanding
clarification
verification (“Did you say…?”)
meta-communication (discussion of difficulty)
Rating scale: Low High
Conversational fluency is the proportion of time that conversation flows smoothly without misunderstanding or confusion. There is a 4-point rating scale.

13. How to get high conversational fluency:
the CI uses self-help strategies and asks for clarification
both the CI and the partner AVOID conversation breakdown
For high conversational fluency, it is better to avoid difficulty than to apply self-help strategies (self-help strategies take time away from good conversation).

14. Conversation with friends/family
A long-term, caring relationship
Good conversation partners…..
Learn how to AVOID problems
Friends and family members care about the CI user. They want to avoid problems and have good conversations.

15. Training methods Information + Demonstration + Discussion =>
There are many ways that friends and family can learn about good conversation.
Information + Demonstration + Discussion =>
KNOWLEDGE

16. Conversation partners can learn about
Sound / speech / hearing
Listening systems (HA, CI, FM)
Language / communication
Conversation process
Effects of noise & echo
They can learn about sound, CIs, communication, and conversation.

17. Watch video demonstrations
Observe how a good conversation partner…..
Controls the environment
Provides meaningful context
Encourages listening
Speaks clearly
Uses appropriate language
Clarifies when necessary
They can watch and listen to recorded demonstrations.

18. Share strategies with other partners
Hear Peers Community (Med-El)
EURO-CIU (European Association of Cochlear Implant Users
Ear Foundation (sound advice)
They can learn from each other.

19. But…..
It is hard to think about information and rules during a real conversation
What a person knows about good conversation may not be related to what the person does while conversing
The “know-do gap”…..
Knowledge about good conversation may not be related to conversational behaviour.

20. Other training methods (to avoid difficulty in conversation)
All rely on experience, guidance, and practice
There are other training methods that provide communication experience and practice.

21. Auditory simulation (observe)
Make audio recording of a person talking
Listen through a CI simulation system
Discuss the experience
Listen to what a CI user hears.

22. Auditory-visual simulation (observe)
Make video recording of a person talking
Watch & listen through a CI simulation system
Discuss the experience
Lipread while you listen to what a CI user hears.

23.
This is a webpage with some recorded demonstrations.

24. Auditory-visual simulation (interact)
Converse with another
person through a CI
simulation system
Apply clarification
strategies
Receive feedback
Learn clear speech/
language skills
Avoid difficulty (Erber, 2008)
Converse with another person who listens through a CI simulator.

25. “Situ-Action” Recognize poor situations / avoid difficulty
Seven important factors:
CI user’s hearing
CI user’s listening device(s)
CI user’s vision
Environment
Distance
Partner clarity & cooperation
Conversational complexity
This activity helps family and friends recognize poor situations and avoid them.

26. Situ-Action example Garden club meeting (see photo >)
Conversation distance = 1.5 m
Conversation with a friend
Social content
Estimate conversational fluency (poor good); why?
Action:
Instant therapy (What should the friend do now?)
Future needs (What should the friend do in the future?)
Here is an example. Rate conversational fluency. What should the friend do now? What should the friend do in the future?

27. Practice parts of conversation: Word-X
Friends/family can learn to speak difficult words in meaningful contexts (semantic strategies):
Related word
Sentence
Short story
Friends and family can learn to speak difficult words in meaningful contexts.

28. Related word (What is word X ?)
tail > X?
fur > X?
cat > X?
greyhound > X?
For example, the partner may say a related word.

29. Sentence (What is word X?)
I have a X.
My X has brown eyes.
A basenji is a X.
A poodle is a X.
The partner may put the word in a sentence.

30. Short story (What is word X?)
Rosie is small and black.
Rosie sleeps on the floor by our bed.
She barks when a stranger comes to the door.
Rosie is a X.
The partner may tell a short story about the word.

31. Rosamund (Rosie)
iPad
Rosie (4 months old).

32. Many other activities for conversation practice:
ASQue > (conversation starters)
QUEST?AR (half-scripted conversation)
Topicon (one-topic conversation)
Real conversation
There are many other activities for conversation practice (not enough time).

33. Self-assessment for partner (and CI user)
Knowledge
(what do I know now…
that I didn’t know before?)
Behaviour
(what can I do now…
that I couldn’t do before?)
Self-assessment has two parts: knowledge and behaviour.

34. Outcomes of training (to avoid difficulty in conversation)
Confidence when entering a conversation
Greater conversational fluency
Less stress for CI user and partner
Satisfaction when leaving a conversation
What are some of the benefits of conversation training?

35. What can I read?
Erber, N.P. & Lamb, N. (1995). Situ-Action: Teaching students to identify client needs with synthesized conversational scenarios. Journal of the Academy of Rehabilitative Audiology, 28,
Erber, N.P. (1996). Communication Therapy for Adults with Sensory Loss (2nd ed.). Melbourne: Clavis Publishing.
Erber, N.P. (2002). Hearing, Vision, Communication, and Older People. Melbourne: Clavis Publishing.
Erber, N.P. (2008). Hearing-Loss Simulation: Education, Training, Research. Melbourne: Helosonics.
Erber, N.P. (2011). Auditory Communication for Deaf Children. Melbourne: ACER Press.
Here are some books to read.

36. Available from Eurospan (UK) Special price for Med-El conference.
This is one of the books.
Available from Eurospan (UK)
Special price for Med-El conference

37. Thank you.