Audiology is the science of measuring and managing hearing loss. In order to manage hearing loss, it must first be quantified or measured. This is critical information on the basis of which the course of each child’s management is charted. Therefore, the more precise the measurement, the more accurate is the fitting of the hearing devices (hearing aids or cochlear implants) that the child needs to access Conversation. This provides reliable information with which the child’s auditory skills are monitored.
Children with hearing loss need for their brains to have sufficient auditory access to be able to understand spoken language, not merely detect it. In order to do this, they need to have their hearing loss aggressively managed so as to enable them to understand the world of spoken language.
Audiologists are professionals qualified to test and monitor hearing loss. Paediatric audiologists are experienced in working with and testing hearing loss in infants, babies and young children, fitting early and appropriate hearing devices (hearing aids or cochlear implants) and guiding families about hearing devices, their care and maintenance, usage and trouble shooting. Paediatric audiologists are experienced in monitoring hearing status in infants, babies and young children.
Audiologists begin by taking a detailed birth history of the infant and a detailed history of the mother’s health and medical records during her pregnancy leading up to the birth. This is valuable information in tracing the cause of hearing loss and in gaining insight on how stable the hearing loss is likely to be. It is important to understand that it is not always possible to ascertain the cause of hearing loss: in fifty percent of children with hearing loss, there is no known cause. Given birth history, the audiologist guides families to understand whether or not their baby’s hearing loss is likely to change or fluctuate and whether their baby is likely to have additional difficulties.
Audiologists use a battery of tests to test hearing in infants, babies and young children. This test battery comprises of both electrophysiological tests and behavioural tests of hearing. Electrophysiological tests such as the Diagnostic Auditory Brainstem Response (ABR), Evoked Otoacoustic Emissions (EOAEs) , Auditory Steady State Response/Steady State Evoked Potential (ASSR/SSEP)and Immittance Audiometry give information about whether or not the auditory pathway is working. They require the baby to be asleep and are completed in a single session. Audiologists further use behavioural tests of hearing using ear inserts or headphones in order to obtain ear specific and frequency specific information about the baby’s hearing. In order to do so, audiologists need to test the infant in a specially sound treated two-room audiology booth using modern equipment, over multiple sessions, closely observing the infant’s responses to the sounds presented. The type of behavioural test chosen (Visual Reinforcement Audiometry (VRA) or Conditioned Play Audiometry (CPA)will depend on the developmental stage of the child. Audiologists use the information obtained from behavioural testing to plot an audiogram or a graph that visually represents the baby’s hearing. Results from the electrophysiological and behavioural testing provide audiologists with the baseline information they need about the baby’s hearing to recommend and fit appropriate hearing aids.
Once the baby is appropriately fitted with hearing aids, audiologists collaborate closely with families to monitor their baby’s auditory development. Throughout this process, audiologists collaborate closely with the therapist or LSLS professional and guide families to observe their baby’s detection and understanding of spoken language.
Accurate management of hearing loss in babies paves the way to providing their brains with the auditory access they need to understand spoken language and to talk.
Your baby will wear hearing aids and/or cochlear implants, once you look upon the hearing device (hearing aids or cochlear implants) as a part of your baby’s body. Keeping hearing devices on those tiny ears takes persistence and patience!
As your growing baby becomes increasingly more mobile and dexterous, teasing off the hearing devices every time you turn away, may become a game. Stay calm, as you patiently and reassuringly put them back on. Consider using ‘Huggies’ with a string and a kinder clip which will prevent your baby’s hearing devices from falling off and getting lost or damaged.
Cochlear’s recently launched KANSO wireless processor, with it’s excellent retention, makes it very difficult for babies and young children to yank their hearing devices off!
Your baby needs to wear hearing devices through all waking hours.
Your baby will become habituated to wearing his or her hearing devices through all waking hours. Once your baby understands that the hearing devices keeps him or her connected to sound, s/he will not want to take them off. That happens early…but we need to persist in those early days.
As listening becomes a part of your baby’s everyday experience, s/he will want to remain connected to sound until s/he falls asleep and as soon as s/he wakes up. Gently ease your baby’s hearing devices off the ears, once baby is asleep;insert them as s/he begins to stir.
Allow your baby the joy of being connected to Sound through all his or her waking hours.
It is not possible to offer any guaranty regarding outcomes for your baby. However, research strongly demonstrates that the earlier babies receive early and effective intervention, the sooner they will listen, learn and talk.
At Sound Steps, babies who begin receiving services before eighteen months of age, in the absence of additional difficulties and whose families follow up appropriately, tend to develop age appropriate learning and levels of functioning, within three to four years of receiving services.
Babies born with hearing loss are more similar to other babies their age than they are different.
Families choose Auditory-Verbal Therapy to raise their baby to listen, learn and talk. In choosing to stimulate their baby’s hearing from infancy, they opt for Early Intervention. This early and enriched stimulation is crucial in helping the baby’s brain grow, in the same manner as that of other babies the same age. The decision to intervene early and effectively enables the auditory pathways to the baby’s brain to be appropriately stimulated so that they remain open and the baby continues to learn by listening alone.
“Auditory-Verbal Therapy is an early intervention approach for children with hearing loss and their families. Auditory-Verbal Therapy focuses on education, guidance, advocacy, family support and the rigorous application of techniques, strategies, conditions and procedures that promote optimal acquisition of spoken language through listening.”(Ref: Estabrooks, W,.(2006) ‘Auditory-Verbal Therapy and Practice’, A G Bell Association for the Deaf and Hard of Hearing)The reader is also referred to Principles of Auditory-Verbal Therapy.
Auditory-Verbal Therapy recognises that the family is central to the nurture of the child. The LSLS professional and family work together, to track the progress of the child and to plan, implement and review the developmental path of their child using the “Auditory-Verbal Treatment Plan”.
Auditory-Verbal Therapy focusses on achieving age-appropriate levels of functioning for the young child with hearing loss. Once age appropriateness is achieved and the family is stable and confident, they continue to chart their child’s future, on their own, in keeping with the philosophy of early intervention.
90% of what children with typical hearing learn is acquired through over-hearing conversation. (Beck D.L, Flexer C. Listening is where hearing meets brain…in children and adults. Hearing Review. 2011; 18(2):30-35) Listening therefore is inextricably linked to the development of spoken language in children, world-wide. Typical hearing children absorb the spoken language of their environment through passive listening that is not specifically taught to them. The presence of hearing loss does not facilitate the spontaneous development of skills such as listening, whispering and over-hearing, as in typical hearing children. Babies need to be taught to listen and then to use that listening to understand spoken language. Once they become confident listeners, they will use their listening to acquire skills, vocabulary and concepts even though they have not been specifically taught to them. They will keep track of sudden changes in conversation. They will use their listening to remain connected to the world of sound and to the even more exciting world of Conversation!
Auditory-Verbal children learn to understand spoken language via listening alone. As they grow up with listening, they learn to self-monitor and modulate their speech, to fine-tune it to match the accent of their environment, making themselves independent in the communities of their choice. Listening connects them to their social environment, making them members of the “cool” club of trendy teenage talk and keeping them abreast of current jokes. All of this assumes that the environment is one that supports listening. Listening in noisy environments will continue to be tiring and challenging; far more so than it is for those of us with typical hearing.
Auditory-Verbal Therapy nurtures the synchronous development of children in the many areas that comprise their personality: audition, language, cognition, speech and communication. Finally, Auditory-Verbal Therapy guides families to nurture their child’s potential so that they understand how best to achieve it.
A Listening and Spoken Language Specialist (LSLS) is a professional who has committed herself to the development of age appropriate spoken language in babies and young children with hearing loss based on the use of their audition alone without relying on either lip-reading and/or sign language, in accordance with international standards as set by the A G Bell Academy for Listening and Spoken Language (USA).
The LSLS professional must meet high level academic and clinical requirements and must undergo rigorous study of Auditory-Verbal Therapy with a mentor accredited to the AG Bell Academy for a period of three to five years and must also sit a written examination.
The LSLS professional is committed to guiding and coaching parents to develop age appropriate listening, learning and speech skills in their babies, infants, toddlers and young children with hearing loss based on audition alone as also the development of parent advocacy and education.
Fitting appropriate hearing aids on babies and young children or activating their cochlear implants provides them with tools they need to access the world of sound. The hearing device (hearing aid or cochlear implant) does not make the hearing loss go away.
Auditory-Verbal therapy teaches babies to listen and to use that listening ability to develop spoken language. Auditory-Verbal Therapy allows babies to learn at their pace so that they make more than twelve months progress in twelve months time and eventually learn alongside typical hearing children their age. Effective Auditory-Verbal Therapy sessions guide and support families and allow young children to learn the skills they need to understand spoken language and talk, in a timely manner, so that they can participate in the communities of their choice.
Research suggests that all babies enjoy being sung to especially by the adult who cares for them. Singing helps the auditory systems of babies grow and mature and it stimulates them to pay attention early in infancy. Singing creates a bond between baby and caregiver that lays the foundations of trust, security and confidence.
The melody and rhythm of songs represent supra-segmental information that babies can detect, including those with a profound hearing loss. Supra-segmental information refers to information about loudness, duration, melody and pitch. Hold your baby close and sing; your baby hears the love in your voice.
All children learn through play. Your Auditory-Verbal therapist will guide you on how to weave your targets for the week into your play and household activities so that your child receives the enriched language input he or she needs to listen, learn and talk.
Research suggests that babies are ready to be read to as soon as they can sit up supporting themselves. Typically, babies achieve this developmental milestone by the age of six months.
Your paediatrician will guide you on how to prop your baby up so that he or she is best positioned to be able to see the pictures in the books you read from. Choose large picture books with large colourful pictures preferably one to a page or even one large picture to a double page. Position yourself so that you are at baby’s ear level: keep baby in your lap or propped up against a big pillow or in a high chair. Talk about the picture before you show it to your baby so that you have alerted him or her to listen, with your voice. As with singing, you will hold baby’s attention with your voice. Reading old favourites again and again helps embed both spoken language and sequence in baby’s brain and in time your baby may even predict the next picture.
Auditory-Verbal Therapy benefits children with unilateral loss because it guides families to provide the enriched language input their child needs to develop early listening skills. These skills lay the foundation in developing age-appropriate spoken language skills in young children with unilateral loss. Auditory-Verbal Therapy will help monitor the child’s unilateral hearing loss so that an appropriate decision may be taken on whether or not s/he should be fitted with a hearing device.
Children with a unilateral hearing loss do have hearing difficulty. Auditory-Verbal Therapy will track their development, closing any lag and allow children with a unilateral hearing loss to learn alongside typical children their age.
Given that your child has a hearing loss, the language she hears for as many of her waking hours as possible, will become her first language. Your child will be most fluent in that language. It is recommended that the language she is most fluent in also be the language in which she is educated, so that she can learn at her pace and achieve her highest potential.
As she becomes a confident listener, she may demonstrate that she also understands your mother tongue or the language that is spoken at home. Allow her to learn this as a second language, spoken by family members other than her parents. This will allow her to continue to listen to an enriched language pattern in the language in which she is being educated and to consolidate on her fluency in that language.
Auditory-Verbal Therapy as the name suggests, uses audition exclusively to teach babies with hearing loss to listen, learn and talk. Auditory-Verbal Therapy becomes a way of life for the families that adopt it, developing spoken language in the baby via listening alone, all day, every day, throughout the baby’s waking hours.
Auditory Training accompanies lip reading in developing spoken language in children with hearing loss. It focusses on listening work done for a finite period of time, the rest of the day being spent on developing spoken language via lip reading.Auditory Training aims at developing listening skills in children but not exclusively and allows the child to rely on lip reading.
At Sound Steps, parents make informed decisions. Parents who feel the need for support beyond that received in therapy ask how they can best receive it. The LSLS professional may recommend it to certain others. Discussion on these and related issues allow parents to make the decision of whether or not they need to attend counselling.
All human beings learn a lot from the information they receive from their 5 senses and their sense of movement (or the Vestibular system) and the positional sense (or the sense of Proprioception). Babies too learn a lot from these senses. The brain learns to integrate the information conveyed by all these senses into a meaningful unit or pattern and to store it for easy retrieval as needed.
In some babies, the brain perceives and integrates this sensory information differently. Babies or children or adults who have sensory difficulty are either under stimulated or overwhelmed by the sensory information they receive. Therefore their brains process this information differently. This causes them to react differently than other babies or children would to the same stimulus. E.g. If your baby is touch sensitive, the simple act of being hugged by you may be perceived by him or her as being overwhelming and so your baby may push away and hit out, leaving you feeling rejected.
Occupational Therapy guides you and your family to understand how your baby or child is perceiving all the sensory information he or she receives so that then you can help your baby perceive this information in much the same way as other babies of the same age. As with most things related to babies, the earlier sensory difficulties are identified and services begun, the faster your baby will develop like other babies of the same age.
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