Book Review: Auditory-Verbal Therapy reviewed by Helen M. Morrison, Ph.D., CCC/A, LSLS Cert. AVT

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Auditory-Verbal Therapy: For Young Children with Hearing Loss and Their Families, and the Practitioners Who Guide Them, by Warren Estabrooks, Karen MacIver-Lux and Ellen A. Rhoades, Plural Publishing, 2016.

Reviewed by Helen M. Morrison, Ph.D., CCC/A, LSLS Cert. AVT

 

 

 

Auditory-Verbal Therapy provides a thorough, 21st century resource for professionals, families, and students. Each chapter is organized in a way that technical information is accompanied by suggestions for practical application, making it a likely “go-to” reference that will be consulted frequently.

The history of Auditory-Verbal therapy (AVT) described in the first chapter is comprehensive and much needed in order to ensure that the story of the approach is not lost to current and future generations of professionals and families. The book is clear about the principles of AVT, what it is and is not, all while demonstrating how AV therapy has evolved to apply evidence-based practices that meet the needs of today’s diverse families and children.

A highlight of the book is a systematic review of literature concerning AVT that utilizes the most current techniques and standards for scientific rigor to describe the state of evidence supporting the approach. The chapters that address audiological procedures and hearing technology are current and provide a basis for deeper reading of the topics discussed. The book addresses each of the knowledge domains that Auditory-Verbal therapists apply in practice, including comprehensive developmental milestones, emergent literacy, inclusion and specific strategies for parent coaching.

An important section of this book provides a rationale and framework for planning and implementing AVT sessions, followed by a series of case studies and lesson plans written by experienced AV therapists that apply this framework. The children and families in these case studies and lessons represent a range of ages, diagnoses, additional disabilities, and cultural/economic situations. The lesson plans at first glance may not seem like conventional lesson plans. They illustrate how important teaching within the conversational context is in AVT, beginning with initial greetings and entering the therapy room or home. Following the child’s lead and exploiting teachable moments are highlighted.

Finally, families from across the global community tell their own stories, demonstrating the universality of the approach. The families not only hail from many different countries, but they are each unique in their cultural and economic situations, types of hearing loss and the ages at which their children entered AVT. Many of the children in these families have challenges in addition to hearing loss.

This book is a must-have for anyone who works with children with hearing loss and their families. The information has value for professionals and families across the communication options that families might choose. This book is essential for professionals working to attain Listening and Spoken Language Specialist certification. It will guide their learning during their certification period and serve as a foundational source for examination preparation.

Brain-Based Listening and Spoken Language: The Focus of the Third Edition of Cole and Flexer (2016)

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By Elizabeth B. Cole and Carol Flexer, author of Children With Hearing Loss: Developing Listening and Talking, Birth to Six, Third Edition

Spoken language is acoustically based. When the expectation is that a child will learn spoken language, hearing loss presents a critical spoken language-information-accessing obstacle to the child’s brain. When, through the miracle of modern technology and expertise, the audiologist provides the child’s ears with appropriately selected and programmed hearing aids or cochlear implants, the child’s brain now has access to the acoustic information encoded in spoken language. Looking at it this way, for the child who is learning spoken language, untreated hearing loss presents not only an ear problem, but also a brain access problem. Luckily, given sufficient acoustic access to spoken language in meaningful, varied-but-repetitive contexts, the child’s brain learns to make sense of the auditory input and learns to understand and produce spoken language. That process can be described in just one sentence, but is far from simple. The process of helping a child with hearing loss learn to listen and talk fluently requires a great deal of time, commitment, and sustained effort from all those who care for the child.

In recent years, there has been a veritable explosion of information and technology about testing for and managing hearing loss in infants and children, thereby enhancing their opportunities for auditory brain access. The vanguard of this explosion has been newborn hearing screening. As a result, in this day and age, we are dealing with a vastly different population of children with hearing loss, a population that we’ve never had before in our history. With this new population whose hearing loss is identified at birth, we can facilitate access of enriched auditory/linguistic information to the baby’s brain. The miracle is that we can prevent the negative developmental and communicative effects of hearing loss (such as delayed speech, language, reading and social skills) that were so common just a few years ago. With these babies and young children, we can now work from a neurological, developmental, and preventative perspective rather than a remedial, corrective approach. As we implement brain-based science, the effects on the field of hearing loss are truly revolutionary.

The following are some suggestions for families and practitioners who want to grow the baby/child’s brain for listening and spoken language. Many of the suggestions describe things that any devoted parent would likely do with a child. Beyond the technology, what is different for the parent of a child with hearing loss is the requirement for constant vigilance for decreasing noise and distance, and the requirement for sustained effort at increasing appropriate and meaningful verbal interactions with the child. These are the so simple, yet so difficult, keys for successfully laying the spoken language foundation that the child needs for the rest of his or her life. The authors take their hats off to all of the thousands of parents who have internalized all of the strategies and accomplished just exactly that!

  1. Your child must wear his or her hearing aid or cochlear implant every waking moment and every day of the week—“eyes open, technology on” (even when bathing or swimming, use technology that is water resistant/proof). The brain needs constant, detailed auditory information in order to develop. The technology is your access to the brain and your child’s access to full knowledge of the world around him or her. If your child pulls off the devices, promptly, persistently, and calmly replace them.
  2. Check your child’s technology regularly. Equipment malfunctions often. Become proficient at troubleshooting.
  3. The quieter the room and the closer you are to your child, the better you will be heard. The child may have difficulty overhearing conversations and hearing you from a distance. You need to be close to your child when you speak, and noise in the environment (especially from nonstop TV or other electronics) needs to be greatly reduced or eliminated. Keep the TV, computer/tablet, and CD player off when not actively listening to them.
  4. Use an FM system at home to facilitate distance hearing and incidental learning. An FM system can also be used when the child is reading out loud to improve the signal-to-noise ratio and to facilitate the development of auditory self-monitoring. Place the FM microphone on the child so that he or she can clearly hear his or her own speech, thereby facilitating the development of the “auditory feedback loop.”
  5. Focus on listening, not just watching. Call attention to sounds and to conversations in the room. Point to your ear and smile, and talk about the sounds you just heard and what they mean. Use listening words such as “You heard that,” “You were listening,” and “I heard you.”
  6. Maintain a joint focus of attention when reading and when engaged in activities. That is, the child should be looking at the book or at the activity while listening to you so that he or she has a chance to gain confidence in his or her ability to listen and understand without watching.
  7. Speak in sentences and phrases, not single words, with clear speech and correct grammar using lots of melody. Speak a bit slower to allow the child time to process the words, but be careful not to exaggerate your mouth movements. Many adults speak faster than most children can listen.
  8. Read aloud to your child daily. Even infants can be read to, as can older children. Try to read at least ten books to your baby or child each day. You should be reading chapter books by preschool.
  9. Sing and read nursery rhymes to your baby or young child every day. Fill his or her days with all kinds of music and songs to promote interhemispheric transfer. Singing is a whole brain workout!
  10. Constantly be mindful of expanding your child’s vocabulary. Deliberately use new words (in appropriate phrases and sentences) with the child for objects, foods, activities, and people as you encounter them in the environment during daily routines.
  11. Talk about and describe how things sound, look, and feel.
  12. Talk about where objects are located. You will use many prepositions such as in, on, under, behind, beside, next to, and between. Prepositions are the bridge between concrete and abstract thinking.
  13. Compare how objects or actions are similar and different in size, shape, quantity, smell, color, and texture.
  14. Describe sequences. Talk about the steps involved in activities as you are doing the activity. Sequencing is necessary for organization and for the successful completion of any task.
  15. Tell familiar stories or stories about events from your day or from your past. Keep narratives simpler for younger children, and increase complexity as your child grows.

Above all, love, play, and have fun with your child!

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Please read Dr. Cole and Dr. Flexer’s Children With Hearing Loss: Developing Listening and Talking, Birth to Six, Third Edition for detailed information about audiology, technology, parent coaching, and listening and spoken language development.

Plural Author Blake Wilson Awarded Fritz J. and Dolores H. Russ Prize

Blake WilsonOn January 7, 2015 the National Academy of Engineering announced that the 2015 Fritz J. and Dolores H. Russ Prize would be awarded to Blake S. Wilson, Grame M. Clark, Erwin Hochmair, Ingebord J. Hochmair-Desoyer, and Michael M. Merzench “for engineering cochlear implants that enable the deaf to hear.” The $500,000 biennial award recognizes a bioengineering achievement that significantly improves the human condition.1

“This year’s Russ Prize recipients personify how engineering transforms the health and happiness of people across the globe,” said NAE President C.D. Mote Jr. “The creators of the cochlear implant have improved remarkably the lives of people everywhere who are hearing impaired.”1

Dr. Blake S. Wilson is the Co-Director (with Debara L. Tucci, MD) of the Duke Hearing Center and is an adjunct professor in each of two departments at Duke, Surgery and Electrical Engineering. He also is the chief strategy advisor for MED-EL Medical Electronics GmbH of Innsbruck, Austria, and a Senior Fellow Emeritus of the Research Triangle Institute (RTI) in the Research Triangle Park, NC, USA. He has been involved in the development of the cochlear implant (CI) for the past three decades, and is the inventor of many of the signal processing strategies used with the present-day devices.

Dr. Wilson and the teams he has directed have been recognized with a high number of awards and honors, most notably the 1996 Discover Award for Technological Innovation; the American Otological Society’s President’s Citation in 1997 for Major contributions to the restoration of hearing in profoundly deaf persons (to the RTI team); the 2007 Distinguished Alumnus Award from the Pratt School of Engineering at Duke; the Neel Distinguished Research Lectureship at the 2008 Annual Meeting of the American Academy of Otolaryngology, Head & Neck Surgery; and recently the Lasker-De-Bakey Clinical Medicine Research Award in 2013.

Better Hearing with Cochlear ImplantsDr. Wilson co-authored Plural Publishing book Better Hearing with Cochlear Implants which provides a comprehensive account of a decades-long research effort to improve cochlear implants (CIs). The research was conducted primarily at the Research Triangle Institute (RTI) in North Carolina, USA, and the results provided key pillars in the foundation for the present-day devices.

 

1. National Academy of Engineering. Inventors of Cochlear Implant Win 2015 Fritz J. and Dolores H. Russ Prize [Press Release]. Retrieved from http://www.nae.edu/Projects/MediaRoom/20095/107830/129146.aspx

Ten Advances in Cochlear Implant Technology and Services

By: Jace Wolfe, PhD

Over the past several years, there have been numerous advances in cochlear implant technology and services. As recent as a decade ago, there were little to no technological solutions available to assist a cochlear implant candidate/recipient, who presented with severe to profound hearing loss, with speech recognition in difficult listening situations—understanding speech in noisy and reverberant settings, over the telephone or television, and when spoken from a distance. Today, cochlear implant manufacturers offer a wide variety of solutions to meet the needs of patients with hearing aids or cochlear implant processors who struggle to communicate. This article identifies ten ways in which cochlear implant technology and services have evolved and improved in the past few years.

10. Automatic scene classification: Hearing aids have featured acoustic scene classifiers for almost a decade. Through these systems, hearing aids classify an environment as one that possesses background noise, speech in quiet or in noise, music, wind, and so forth. Once the listening situation is classified into one of these environments, the hearing aid selects the appropriate form of signal processing that will theoretically optimize performance in the given environment. This technology can be quite valuable as many users are unlikely to manually switch to programs designed for specific, challenging situations. Furthermore, this system will likely be well-received by cochlear implant users as it makes its way to implant sound processors.

9. The development of new speech recognition materials that provide a more realistic assessment of how hearing aid and implant users perform in real-life listening situations: Cochlear implant technology has improved so much that many users score near 100% correct on sentence recognition tests in a quiet environment with a single talker who is male and speaks at a slow to moderate rate. Additionally, many hearing aid users who struggle substantially in realistic situations also often score too well on these tests to meet the indications for cochlear implant candidacy. This fact makes it difficult to distinguish between excellent implant and hearing aid users and good users who may benefit from additional services.

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Looking Inside the Bionic Ear

shell2Dr. Graeme Clark explains of the bionic ear that the challenge was to put the wire around the inner ear which is only about 2-3 cm in diameter. Dr. Graeme got the idea to curl the wire from shells’ spirals and found that in this way a wire could go around the inner ear if it was bendable and flexible enough. This led them to designing the first prototype from the University of Melbourne; along with the electronics, which had to be reduced to match the size of the silicone tubes.

The bionic ear cochlear implant works by having an outside speech processor with a microphone and an imbedded receiver stimulator which stimulates the hearing. When one speaks the microphone picks up the sound waves, sends them through the speech processor which converts this into patterns of electrical signals which are then sent by radio waves through the skin to the implant. Then the implant stimulates the wires around the inner ear. This is the process by which a deaf person is able to hear. Listen to Dr. Graeme Clark explain this process.

Graeme Clark and Rod Saunders“There were many times during the early stages of my involvement with the bionic ear that I could have given up, but didn’t. In spite of problems, criticisms and difficulties I felt that I just had to go on to explore the possibilities to the very end. Someone had to do it, because it was the only chance that profoundly deaf people could have of being able to hear.” – Professor Graeme Clark AC (http://www.graemeclarkoration.org.au/about-graeme-clark.php)

 

The cochlear implant has evolved significantly due to the persistent innovative work and dedication from various teams and researchers. They have been successfully used since the 1980s.

Just last year, researches at the Tel Aviv University discovered that under certain conditions, bilateral cochlear implants (implants placed in both ears) have the ability to salvage binaural sound processing for the deaf. Learn more about Dr. Henkin’s work.

Plural Author in the News: Blake Wilson Awarded Lasker Prize

Authors_in_the_NewsOn September 9th of this year, Plural author Dr. Blake Wilson was awarded the Lasker-DeBakey Clinical Medicine Research Award for his pioneering efforts in cochlear implantation, along with Graeme Clark and Ingeborg Hochmair. Dr. Wilson was chosen to receive the award because he, “oversaw a giant leap forward in speech encoding for implants that ingeniously manipulated the timing and place of stimulation so as to minimize distortion and channel interaction.” 1

Blake WilsonHe is the Co-Director for the Duke Hearing Center and an adjunct professor for the university. He also is Chief Strategy Advisor for MED-EL Medical Electronics GmbH of Innsbruck, Austria and a Senior Fellow Emeritus of the Research Triangle Institute (RTI) in the Research Triangle Park, NC. He has been involved in the development of the cochlear implant (CI) for the past three decades and is the inventor of many of the signal processing strategies used with the present-day devices. His book Better Hearing with Cochlear Implants: Studies at Research Triangle Institute describes his and Dr. Michael Dorman’s research in more depth.

Current cochlear implants still have limitations in delivering speech signals but are able to distinguish speech in loud noise areas, as well as identify a speaker’s gender. Dr. Wilson and the other awardees contributions to the field have given 300,000 implant recipients the gift of hearing.

1. O’Donoghue, G. Cochlear Implants — Science, Serendipity, and Success. The New England Journal of Medicine, Sept. 9, 2013, doi: 10.1056/NEJMp1310111

 

Just Published!

This week two new books came into the warehouse! First we have Evidence-Based Practice in Audiology: Evaluating Interventions for Children and Adults with Hearing Impairment by Lena Wong, PhD, and Louise Hickson, PhD. Also released this week is Cochlear Implants and Other Implantable Hearing Devices by Michael J. Ruckenstein, MD.

  

Be sure to check them out and order your copies today!

Cochlear Implants

28 million Americans have a hearing impairment and 3 out of every 1,000 children born in the U.S. have some degree of hearing loss. To meet this need, Plural has established a collection of cochlear implant resources.

 

 

One of our great cochlear implant resources is Patricia Chute and Mary Ellen Nevins’ School Professionals Working with Children with Cochlear Implants. The authors detail the effects of more and younger children receiving cochlear implants entering into school systems and discuss the emerging and increased role of the speech pathologist. The book is the ideal guide and supplies the school professional with tools for providing the best possible direction and options for children with cochlear implants.

From texts, to clinical and educational resources, to resources for parents and caregivers, Plural has it all. For more information and to order your cochlear implant resources today, click here!


Cochlear Implants

Plural has a substantial amount of resources regarding cochlear implants. We have texts for parents, clinicians, cochlear implant users, and others! One such text is Laurie Eisenberg’s Clinical Management of Children with Cochlear Implants!

The book builds on nearly thirty years of collective experience in pediatric cochlear implantation and addresses the pertinent issues of today, including clinical assessment, case management, medical/surgical practices, mapping, habilitation, and educational guidelines. The authors, many of whom are master clinicians and leading researchers in the field, share their expertise in such disciplines as otolaryngology, audiology, speech-language, pathology, education, early intervention, speech perception, electrophysiology, and psychology.

Click here for some of our cochlear implant titles and to order today!

Are you a Parent?

If you are a parent with a child who has hearing problems or autism, then check out one of these three titles: Cochlear Implants: What Parents should know, Your Child’s Hearing Loss, and Parenting on the Autism Spectrum. Each of these titles offers easy-to-follow guidance and help for parents. They help parents be proactive with their children, giving them the necessary information and tools to come alongside their children through these difficult times. Plural is proud to supply the best and most useful resources for parents.