Monday, July 18, 2016

Hearing Aids, Cochlear Implants, and Bahas, Oh My!

A few months ago I was a guest blogger for Hallie over at Speech Time Fun as part of her series on Tips & Tricks for SLPs.  I had so much fun, and realized that it would also be a great idea to share the post with my followers as well!  If you're anything like I am, you had one Aural Rehabilitation class in grad school and survived it by reassuring yourself that you would probably never work with this population once you were in the real world.  Most likely, that proved to be true for you.  I, however, ended up scoring a CFY at a school for the Deaf and have been there ever since. Initially I assumed that all of my kiddos would be using ASL.

WRONG!

So many students are now listening and spoken language users, rather than signers, or using both languages to communicate.  Auditory-verbal therapy has exploded on the scene ever since cochlear implants became popular, and now younger and younger children are receiving cochlear implant surgery.  To be successful at becoming a listening and spoken language user, these students need to have working equipment during all waking hours, which means speech perception checks are imperative.

Working with this population has made speech perception checks secondhand, but I was thinking about how difficult and unfamiliar this must be for the majority of SLPs who come across only one or two deaf/hard of hearing children throughout their entire careers.  It is also difficult for the children, who become used to professionals as well as students who are unfamiliar with hearing loss.  I've discussed this in detail in El Deafo.  

Here is the bare minimum of what you need to know and do if a child comes through your speech door with some kind of amplification equipment.

1. Don't panic!  Look at the equipment.  Is it a cochlear implant? Hearing aid? Baha?  Whatever it is, you are going to complete your listening check exactly the same way.  You do not need to run out and purchase a stethoset or a wand.  (Although if you want to, go for it!)

2. Take note if the child is aided/implanted bilaterally or on just one side.  Write this info down in case they come to you one day with a hearing aid missing.

3. Become familiar with, or make a cheat sheet on your wall of, the LING 6 sounds.  These sounds are:

/ɑ/   as in the word Hot
/i/    as in the word Bee
/u/   as in the word Food
/m/  as in the word Mom
/s/    as in the word Sue
/ʃ/    as in the word She

These 6 sounds are important because they cover all of the speech frequencies.  The LING 6 sound check is meant to be fast, easy and to not take more than a few minutes at the beginning of your speech session.  When I say the beginning, I truly mean the beginning.  For a child with any kind of amplification equipment, the LING 6 sound check should be the first thing you do with them as soon as they sit down in your room.  Starting a speech or language activity with a child who is either having malfunctioning equipment, or something else going on (an ear infection perhaps) preventing them from hearing and having full access to all speech frequencies is not beneficial.  Additionally, be sure to cover your mouth entirely when doing the LING 6 check.  You can use your hand, a piece of paper, or a cute animal picture for young kiddos.  You do not want the child to lip-read these 6 sounds.  It needs to be auditory only -- no visual cues!

4. For children who have cognitive impairments, or children who are very young, you are going to ask for the child to detect these 6 sounds on each side if they wear bilateral equipment.  You will take off the right side equipment first, complete the following task, then place the right side back on, remove left side equipment and repeat the LING 6 check.  This can be through raising their hand if they are cognitively able to comprehend that task, or it can be through play: e.g. stacking rings, dropping blocks in a bucket, or pegboard use.  Hand a child whatever you choose to use and have them place it by their ear. When you say the LING 6 sound, let them complete the task (put peg in board, drop block in bucket) or anything that can be fun.  I even made a crocodile for this, which the kids love "feeding"!  Repeat for all 6 sounds.  You may need to begin by using hand-over-hand until your student is able to complete the detection task independently.



5. For older children, you can have them identify (repeat) the sounds.  If they are able to repeat all 6 sounds, you know that they were able to accurately perceive them as well as produce them.  If they do not produce any sound, make a note of this because it may mean they were unable to perceive that LING 6 sound.  It may also mean that, motorically, they are unable to produce the sound that they heard.  You will need to know your student well to be able to determine if it is a perception or articulation problem.

6. Make a chart or download one off of the internet, where you can keep data on your student's ability to perceive these 6 sounds every day.  This will help you note if any changes occur.  If a student is typically able to perceive /s/ but then all of a sudden is not hearing it, this is good information to have.  A sudden loss in high frequency sounds could be due to an ear infection or there may be a problem with their amplification equipment.  This would be information you want to write down and send home to their parent, who can then share it with their private audiologist.

Note: Change up the order of LING 6 sounds that you present or your student may just memorize it, and your speech perception test will not be an accurate assessment of their speech perception!


My student is detecting/identifying none of the sounds, Lauren!
Okay -- this may mean that their equipment is dead.  Try changing the batteries and check again.  You should always asks the parents to leave you a pack of batteries just in case.  

I changed the batteries and they still aren't doing anything when I say the 6 sounds! 
This could mean that there is a different problem with their equipment.  Are their ear molds or tubes clogged with wax?  If so, this would prevent sound from entering your students' ear canals.  Are your students having behavioral challenges?  They may be purposefully remaining quiet.  There may also be a larger problem with the equipment that an audiologist will need to troubleshoot.  Be sure to let the parent know!

To summarize, when working with a child who is wearing amplification, the most essential rule to remember is to ensure that the equipment is functioning appropriately and granting them full access to the speech frequencies.  By utilizing the LING 6 speech perception sound check, you not only are verifying that this equipment is working correctly, but you are also confirming that your student is not suffering from any kind of underlying condition such as an ear infection.  Make sure to remember the importance of collaboration.  If you note any changes in the student's ability to detect or identify the LING 6 sounds, relay this information to the rest of his or her team members: e.g. parental unit, teacher, audiologist, teacher of the Deaf, or social worker. 

-Lauren



Lauren DiBiase, MA CCC-SLP is a Speech-Language Pathologist who has worked in a school for the Deaf for four years, in addition to providing home-care services for the past two years. She is PROMPT Certified and currently preparing to sit for her Auditory-Verbal Therapist Certification exam.  In her spare time she enjoys petting dogs, crocheting, and garage sale shopping. You can visit her BlogShop her store, or follow her on Instagram.

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