technology audiologic rehabilitation for children & educational audiology spa 6581 – spring...
TRANSCRIPT
Technology
Rationale for personal hearing instruments and hearing assistive technology
Recent trends and regulatory considerations
Assessment of the personal hearing instrument and hearing assistance technology needs of children and youth
Personal hearing instruments and hearing assistance technology options
Implementation and Management of hearing technology
Other Assistive Technologies
Technology: Rationale
Well researcher and documented: Negative effects of noise, distance, and
reverberation
The above can impact any child, but are particularly deleterious to children with deficiencies in: Hearing
Auditory processing
Language
Attention
Learning
Non-native English speakers
Recent trends and regulatory considerations
Regulations IDEA
No Child Left Behind Act of 2001
Section 504 of the Rehabilitation Ac of 1973
The Americans with Disabilities Act of 1990
HAT is not classified as durable medical equipment Little regulation of performance with regards to the companies
Widespread commercial availability! May mean that audiologists are not involved in their selection, purchase,
and fitting Need to be well versed in Professional Practice Standards and Scope of
Practice
HAT fitting issues should ALWAYS be addressed as part of the IFSP or IEP so that all members of the planning team understand and are informed of the necessity for a qualified person to perform this service.
REVIEW The AAA Clinical Practice Guidelines for HAT
Technology: Assessment of HAT
needs Candidacy and Candidacy Considerations
Every child and youth with HL should be considered a candidate for personal hearing instruments*
Personal choice
Regardless of the decision to fit personal hearing instruments, the next consideration is for HAT. Should be considered for the following populations (AAA, 2008): Hearing loss
Auditory processing deficits
Auditory neuropathy spectrum disorder
Learning disabilities
Language deficits
Attention deficits
English language learners
The decision to proceed with HAT should be based on evidence that links the deficit to hearing, listening or learning problems whether in or out of school.
Technology: Assessment of HAT
needs Candidacy and Candidacy Considerations
The decision to proceed with HAT should be based on evidence that links the deficit to hearing, listening or learning problems whether in or out of school.
Technology: Assessment of HAT
needs Next step is to consider the
social emotional, functional, and support implications for use of HAT
Social-emotional
Motivation (student, teachers, child and family members)
Attention and fatigue (listening and looking)
Self-image
Self-advocacy
Social acceptance
Classroom culture
Family support
Functional
Age
Chronological and developmental
Academic
Communication skills
Home communication environment
Support
Awareness
External acceptance
Ability to use and manage technology
Financial resources
ADA obligations
Technology: Assessment of HAT
needs Device Selection Considerations for HAT
Developmental considerations Age, academic performance, and additional learning problems
The listening Environment Extends beyond school to the home and community activities
and is one of the most critical areas affecting communication access
Technology See next slide
Funding Although it should not dictate the recommendation for HAT or
the type of HAT selected, it can be a deterrent
Device Determination The decision is made after all of these considerations have
been discussed
Technology: Assessment of HAT
needs Device Selection Considerations for HAT
Technology Considerations Convenience
Wearability
Reliability
Maintenance
Ease of monitoring
Manufacturer or dealer support
Compatibility with existing amplification
Compatibility with computers, phones, and other devices
Signal interference
Multiple FM frequencies
Bluetooth capability
Electromagnetic capability
Technology: HAT technology options
Type: Air conduction, Bone conduction, Cochlear implant, Implantable bone conduction device (FDA approved for children 5 years and older)
Style: BTE, BTE open fit, BTE RITE, All in the ear
Receiver type options: ear level personal FM system, induction, targeted area audio distribution system (ADS), classroom audio distribution system (ADS)
Wireless transmitters: Location: lapel mic connected to body-worn transmitter, head or cheek boom
mic connected to body-worn transmitter, lavalier – mic and transmitter in one unit, conference – mic and transmitter in one unit that sits on a table top
Type: omni-directional, directional
Other Features: Adaptive FM
Single-fixed FM channel
Multichannel selectable
Accessories Audio input jack
Bluetooth
Technology: HAT technology options
Goals: Speech recognition that is commensurate with performance
in ideal listening conditions
Full audibility of self and others Consistent signal from the talker regardless of head
movement
Technology that will be worn consistently by the individual, parent, or teacher
Technology that will provide full audibility according to the listening group Group 1 = children and youth with hearing loss who are actual
or potential hearing aid uses. (default recommended arrangement: bilateral ear-level wireless technology and fewest equipment adjustments)
Group 2 = children and youth with cochlear implants (default recommended arrangement: bilateral wireless technology)
Group 3 = children and youth with normal hearing sensitivity who have special listening requirements (no default arrangement)
Reduced effects of distance, noise, and reverberation
Technology: Implementation and
Management Fitting and Verification
Orientation and Training
The Usage Plan
Validation
Monitoring and Equipment Management
Fitting and Verification
AAA Pediatric Amplification Guidelines (2004) Addresses fitting and verification for
hearing aids
AAA HAT Guidelines, Supplement A (2008) Addresses fitting and verification for ear-
level FM
Fitting and Verification
Basic premise for HAT? All verification measures of the relationship between the FM and the
HA microphones are based on the assumption that the hearing aid portion of the system has been adjusted to provide appropriate audibility and output for the individual child!
Personal FM system should increase the level of the perceived speech in the listener’s ear by at least 10 dB relative to reception by hearing aid only.
If simultaneous use of the personal FM and hearing aid is normal for the child, the assessment of the FM And hearing aid should be performed in that condition
Assess performance electroacoustically with a speech-weighted input
True estimates of the maximum output of the system are obtained from the HA microphone, not the personal FM system microphone, because of the presence of input automatic gain control in the FM system
Fitting and Verification
Electroacoustic verification and Real-ear measurements Necessary to verify that the instrument is functioning
according to the manufacturer’s specifications
Crucial to check before fitting
Determine that there is “transparency” between devices When the same input is given to the hearing aid microphone
and to the personal FM system transmitter, the hearing aid with the FM receiver attached should perform in an identical manner
Difference? Adjustments before continuing with the verification process
Real Ear measures verify optimal audibility and maximum output for the individual user and are routinely performed
Measurements for FM verification rely mostly on the 2cc coupler
Fitting and Verification
Behavioral verification Purpose is to determine that what has been
selected and fitted functions as expected for the child or youth
Performance with the FM in an ideal listening condition should be as good as the hearing aid alone in that same condition
Testing in noise to compare the performance with a hearing aid alone to performance with the FM microphone engaged is also necessary to determine the benefit provided by the FM
Orientation and Training
As a service required under IDEA (2004), orientation and training activities for assistive devices should be included in the IEP for each child and should be provided as part of the audiologist’s consultation time Including caregivers if devices are used at
home
Should be face-to-face in addition to written information
Orientation and TrainingTopics for
children and youth
Implications of hearing loss
Basic function of device(s)
Appropriate use of device and features
Expectations: benefits and limitations, when to use and when not to use
Care and maintenance
Basic troubleshooting
Self-monitoring of function
Self-advocacy
Topics for teachers,
parents, and others
Basic implications of hearing loss
Basic function of the device
Appropriate use of device and features
Expectations
Listening check and basic troubleshooting
The Usage Plan
With leadership from the audiologist and input from the student (when age appropriate), the IFSP or IEP team needs to determine a usage plan that identifies when the HAT will be used.
Out of school events such as: therapy, education classes, organized activities should also be considered School-owned HAT would only be used if the
IEP team determined it was necessary for FAPE
Validation
Purpose? To determine that the hearing instruments audiologists
have fit, prepared children or youth to use, and trained the teachers and staff to support actually result in the intended outcomes in classrooms, homes, and other settings
Should identify strengths and limitations of HAT, and be ongoing in its evaluation LIFE
ELF
CHILD
SIFTER
IT-MAIS
etc
Monitoring and Equipment
Management Monitoring – not an option
IDEA 34CFR300.113 specifies that monitoring must occur, it does not state the frequency or procedure with which the monitoring should occur
Daily checks
Monitoring plan
Need battery testing, listening stethoscope, extra batteries, cleaning brush, wax loop, earmold puffer, diagram of hearing aids with parts labeled, directions for physical and listening checks, who to call when a problem is identified
Classroom Acoustics
Audiologic Rehabilitation for Children
&
Educational Audiology
SPA 6581 Spring 2015
Acoustical Parameters in
Classrooms They change as a function of:
Time
Specific learning activity
Other factors
Measuring Classroom Acoustics
Classroom Observation
Instrumentation and Software Programs
Classroom Noise Measurements
Classroom Reverberation Measurements
Estimating Critical Distance
ANSI/ASA Standard (2010) and ASHA Guidelines for Addressing
Acoustics in Educational Settings (2005)
Specific procedures should be used: 1) Measure background noise levels in dBA
2) Measure or estimate reverberation time
3) Measure or estimate SNR
Also – estimation of critical distance should be included as part of the classroom survey and acoustical measurements
Classroom Observation
Before measuring classroom acoustics, the educational audiologist should conduct an observation of the specific learning space(s).
Subjective appraisal of noise and reverberation characteristics and information about teaching style and physical room characteristics
Observe both OCCUPIED AND UNOCCUPIED space before measuring noise and reverberation
Classroom Observation:
Referrals 1) General concern about noise and
reverberation levels
2) Student-specific concern related to hearing loss, auditory processing, or the effects of noise and reverberation on academic achievement
3) concern expressed by a teacher experiencing excessive vocal stress or fatigue
Classroom Observation: Data
Useful in making follow-up recommendations for acoustical modifications in the teaching and learning enviroment
Instrumentation and Software Programs
Sound Level Meters Type 1: integrating-averaging type capable of measuring
time-average sound levels
Type 2: conventional sound level meter capable of measuring slow time-weighted sound levels
Most educational audiology facilities supported by local education agencies? Type 2
Capable of measuring both A and C weighted filter networks is adequate for conducting classroom noise measurements
Some Sound Level Meter manufacturers offer software that allows for transfer of data for analysis. Calculation of reverberation time, etc.
Classroom Reverberation Measurements
The average Reverberation Time of a classroom is calculated by averaging the RTs at 500, 1000, and 2000 Hz.
All classrooms with the same RT are not the same acoustically. May differ with respect to the predominant type of
reverberation or the frequency characteristics of the reverberation
What is the equipment is not available to the educational audiologist? The use of estimating software or manual calculation is a
good alternative
Applications are available on smart phones, etc.
Classroom Acoustical Screening Survey Worksheet – see pdf
Estimating Critical Distance
It is important to know what the critical distance is for a given classroom and for different learning activities.
Learners who are seated beyond the critical distance in the learning environment may experience difficulty comprehending instruction, and as a result, learning opportunities may be missed.
Critical Distance is dependent upon… The dimensions of the learning space and the Reverberation Time
(RT), and the directionality of the auditory signal.
Including critical distance information in the classroom acoustic measurements may provide convincing support when recommending: acoustical modifications
room arrangement
seating options
other strategies to enhance the listening and learning environment for students AND teachers.