Hearing Impairment

Hearing Impairment

Hearing Impairment affects nearly 50 million people in the United States alone. Hearing Impairment affects not only conversation, but enjoyment of music, tv, and other entertainment options. Grandparents can no longer hear their children laugh, husbands have difficulty talking to their wives on the telephone, children cannot hear their teacher, and music is harder to enjoy.

There isn't anything a therapist or medical professional can do to cure hearing impairment, however there are many things conversation partners and therapists can do to help those with hearing problems listen, understand, and better comprehend what is going on around them. An audiologist will be able to additionally assist a person suffering from hearing impairment with hearing aids, cochlear implants, and other hearing related medical advice.

Types of Hearing Loss

• Conductive- this type of hearing loss is caused by a problem with the ear's ability to conduct sound.  Causes of conductive hearing loss may be an ear infection in which middle ear fluid presses against the ear drum (typmanic membrane) and does not allow it to move, causing a loss of hearing. Similar problems could be caused by impacted ear wax, allergies, poor eustacian tube function, swimmer's ear, malformations, and multiple other causes. Oftentimes, but not always, conductive hearing loss can be fixed with tubes, removal of wax, antibiotics which stop an infection, and other medical management.
• Sensorineural- this type of hearing loss is caused by a problem with the ear nerves or with the nerves that transmit sound information to the brain. Possible causes include loud noise exposure (so turn down your TV!), illnesses, aging, trauma, and ototoxic drugs. 
• Mixed- this is a mixture of both conductive and sensorineural hearing loss.  So, for example, if your Grandfather who has lost some hearing due to aging and working on a tractor also has a lot of ear wax, he may have both types of hearing loss or "mixed" hearing loss.

Degree of Hearing Loss

 

Hearing is measured in decibels, abbreviated to dB.  You want to be able to hear all frequencies (low and high sounds) at 0 decibels for a perfectly normal hearing test.   As that decibel number rises there are different degrees of hearing loss. 

• Normal:-10-15dB
• Slight Hearing Loss: 15-25
• Mild Hearing Loss: 26-40
• Moderate Hearing Loss: 41-55
• Moderately Severe Hearing Loss: 56-70
• Severe Hearing Loss: 71-90
• Profound Hearing Loss: 91+

Configuration of Hearing Loss

 

The configuration of hearing loss is the shape of the hearing loss.  This would mostly consist of a description about what the hearing loss looks like.  There are 4 configurations:

• Bilateral vs Unilateral: Bilateral hearing loss is a loss in both ears.  Unilateral hearing loss is a loss in a single ear.
• Symmetrical vs Asymmetrical: Symmetrical hearing loss would be the same severity of loss in both ears. Asymmetrical would be a different severity in each ear.
• Progressive vs Sudden: Progressive hearing loss occurs over a period of time (like a loss due to aging). Sudden hearing loss occurs very quickly (like a loss due to a severe illness or a very loud noise).
• Fluctuating vs Stable: A fluctuating loss changes over time, sometimes better and sometimes worse (for example, a conductive loss due to ear infections will be worse during an infection and better after the infection is gone). Stable hearing loss would remain the same over time.

Development and Hearing Loss

Hearing is an essential part of developing typical speech, language, and communication skills. If you cannot hear a word, it will be extremely difficult to learn that word. As such, the earlier a hearing impairment occurs in a child the more significantly their development will be impacted by that loss.  Early intervention is crucial for children who may have a hearing loss to ensure that they are given all the help they need to develop speech and language milestones. According to the American Speech Language Hearing Association, hearing loss affects children in four major ways:

1. "It causes delay in the development of receptive and expressive communication skills (speech and language).
2. The language deficit causes learning problems that result in reduced academic achievement.
3. Communication difficulties often lead to social isolation and poor self-concept.
4. It may have an impact on vocational choices."

If you think your child may be experiencing a hearing loss, please take your child to a trusted pediatrician or audiologist to have their hearing tested so that should intervention be required, it can be started as early as possible. "Recent research indicates that children identified with a hearing loss who begin services early may be able to develop language (spoken and/or signed) on a par with their hearing peers. If a hearing loss is detected in your child, early family-centered intervention is recommended to promote language (speech and/or signed depending on family choices) and cognitive development."

What can I do to help someone with a Hearing Impairment?

• Reduce auditory distractions- when at a restaurant, you can ask that the music be turned down, at home or in the car, turn off the tv or radio while talking
• Turn up the lights- turn lights and lamps on so the person has the ability to see your face and put together context clues from facial expressions
• Frequently check for understanding- make sure they are listening and understanding by asking questions and listening for more than just, "mmhmm"
• Repeat or rephrase information as needed
• Enhance speech reading conditions- don't chew gum, put your hands or objects over your mouth and face, make sure to face the person head on when talking
• Obtain the person's full attention prior to speaking
• Clearly enunciate speech- Don't talk with your mouth full!
• Turn closed captioning on the television

References

• http://www.starkey.com/hearing-loss-simulator This tool simulates hearing loss at 3 different levels in several settings so you can see how different voices and environments are affected.
• American Speech Language Hearing Association on Hearing Loss http://www.asha.org/public/hearing/Hearing-Loss/ 
• Success for Kids with Hearing Loss- Accommodations for Students With Hearing Loss http://successforkidswithhearingloss.com/relationship-hl-listen-learn/accommodations

Guest post! Food Chaining: A technique to help your picky eater

Food Chaining:

A technique to help your picky eater

By: Brittany Warby

 We all know a child or two who is what we call “extremely picky.” They won’t eat anything red, crunchy, cold, hot, sweet, hard, soft, etc. They seem to eat the same limited foods everyday and no matter what they seem to refuse anything else. They may push the food away, spit it out, or gag whenever a less desired food is presented.

It is easy to place blame in a situation like this. I often hear “If the parents would just force the child to eat it…” or “Sometimes you just need to lay down the law and not give in.” Unfortunately it is not always that easy. The child who ate a variety of textures, colors, and types of food yesterday may turn into a picky eater tomorrow. 

According to an article, “Feeding Disorders in Infants and Children”, published in the scientific journal Pediatric Clinics of North America, between 25 to 35 percent of children in the United States have feeding disorders, and up to 40 to 70 percent of children with chronic medical problems have problems related to feeding and nutrition.

Causes of Picky eating:

Picky eating habits can be caused by a variety of things such as vitamin or mineral deficiencies, malnutrition, oral aversion, congestion, erratic sleep patterns, or a variety of frequent or chronic illnesses.  Other children will simply refuse a food due to its smell, taste, or texture. In other cases the refusal of food could be physiological struggle with the process of chewing and swallowing.

In order to determine what the main issue is, it is best to seek help from a feeding specialist who can assess the situation and can help pinpoint a cause. For many of these children a technique known as food chaining can be helpful in assisting the child. Food chaining can help the child cope with an aversion and gradually increase the types of food the child is comfortable eating.

What is food chaining?

Food chaining is a child-friendly feeding technique. It is designed to build the child’s successful eating experiences by studying the types of food the child will easily accept and choosing similar food to gradually build the child’s menu. New foods with similar texture, taste, and/or temperature are presented to the child. These new foods create a food chain or link between what the child will easily accept and the targeted food we would like for him/her to eat.

Food chaining can use a variety of methods to make the food presented more desirable. Flavors can be added that will make the child more likely to accept the new food. Examples of this would be adding ketchup or ranch dipping sauce. This masks the flavor of the new food and can offer a means to coax the child to gradually accept the new food.

Another successful method is by using transitional foods. This is done by giving the child a bite or two of a familiar and accepted food followed by a bite of the new food, followed by another bite of the familiar food. Transitional foods can help to reduce aftertaste and help to cleanse a child’s palate when introducing a new food.

When doing food chaining it is important that the feeding specialist rate the child’s reactions to new foods and continually monitor the changes in preferences over time. It is also important NOT TO FORCE foods. Food chaining allows a child to be desensitized to taste and textures enough to allow them to try food in a variety of different food groups and can help in improving nutrition.

Examples of a food chain:

Example 1:

Child’s current accepted food choice: McDonalds Chicken Nuggets

Target food: Baked chicken breast made by mom

Chain:  McDonalds Chicken Nuggets > other brands of chicken nuggets > homemade chicken nuggets > non-breaded/skinless chicken nuggets > small chicken breast

Example 2:

Child’s current accepted food choice: Goldfish

Target food: Mac and Cheese

Chain: Goldfish > other flavors/sizes of goldfish > other brands of cheese flavored crackers > Soft crackers > Shredded cheese > Cheese with pasta > Mac and Cheese

It is important to remember that no single chain will work for all children and that each child may require more or less steps before reaching the target food.  Although there is no one fix all for a picky eater, food chaining is a technique that has proven to help children build variety and types of foods they will accept.

Resources:

http://www.abilitypath.org/health-daily-care/health/growth-and-nutrition/articles/obesity/pdfs/parent_toolkit-_food_chaining.pdf

http://cheriandlaura.blogspot.com

Fraker, Cheri. Food Chaining: The Proven 6-step Plan to Stop Picky Eating, Solve Feeding Problems, and Expand Your Child's Diet. New York: Marlowe, 2007.

http://mealtimehostage.com/tag/food-chaining/

Speech Tips for Parents

Speech Tips for Parents

After working in the field of speech language pathology for a couple of years at this point, I have started creating a list of things I wish parents knew, things I wish parents did, and things I wish more people knew about speech. While I addressed these lists to parents in particular, you can replace parent with older sibling, aunt, uncle, grandparent, godparent, friend of the family, etc. I know very few people who have absolutely nothing to do with a child, almost everyone I know has siblings, nieces and nephews, friends who have kids, etc. so I think these lists are pretty applicable to everyone.

 

Here they are, in no particular order of importance:

What I Wish People Knew About Speech

·         Speech Language Pathologists (SLPs) are professionals who go through a total of 7 years of higher education and training including a national exam before they are allowed to become licensed. While you may know every grammar structure in the literate world and every developmental milestone, a speech therapist is able to use those developmental milestones and grammatical structures inside of research and experience-guided therapy in order to increase your child’s speech and language skills at the greatest possible rate. 

·         Speech therapy does not only include children saying their R’s. Speech therapy can include:

o   Articulation- saying speech sounds correctly

o   Fluency- stuttering

o   Swallowing- that’s right—if you have trouble swallowing, we’re who diagnoses you

o   Language- focusing on your internal grammar abilities. Language can be both expressive (what you say) and receptive (what you hear)

o   Cognition- we work with executive function issues, memory, etc.

o   Pragmatics- this is also known as social language- its everything you say with your body language and tone of voice

o   Voice- this includes vocal nodules, vocal paralysis, etc.

o   Aural Rehabilitation- this works with children and adults who are learning to use the hearing they have or hearing devices to hear and respond to the world around them to the best of their ability.

o   AAC- Augmentative and Alternative Communication- we use everything from a single button to a complex eye-gaze system to help people get a message across to their communication partners

·         Speech therapy is best when started EARLY!!! If your child is 3, they’ve already missed prime therapy time. By 10, there’s only so much we can really do. For adults, speech therapy after a stroke or other neurologic event is best in the first year, after that, there’s only so much we can do. When you break a bone, you don’t wait around for several years saying, “Well, it’s going to heal just fine on its own, so why bother to get a cast?”

·         Speech and Language skills affect everything that we do. Have you ever gone to the grocery store when no one spoke to you? Ever gone on a date? Ever made it through the school day with no one speaking? Ever had to communicate that you were hungry or tired? Ever tried to make it through school without reading or writing?

What I Wish Parents Knew

• Where to look up speech development guides. Most parents don’t really need to know that k, g, t, d, p, b, m, n, ng, and the vowels should be developed by three, s by four, r by 7, etc. But, I have so many parents that ask me if they’re child is ok that I wish more parents had access to the information in the first place.  An excellent resource is www.handyhandouts.com. My favorite hand out for this topic is “When Should I Worry if My Child is Behind?” (available here)
•  Your children model your behavior. Monkey see, monkey do. The more educated you are (about everything), the better model your children have.
• There is nothing better you can do for your child than talk to them and read to them.
• Talking to your child does not mean, “No, stop, don’t.” Talking to them includes talking about your world (“Man, the trees look so nice in the fall, don’t they?”), talking to them about what you’re doing (“Here we go, driving to school!”), talking to them about what they are doing (“I see you throwing that big, red ball”), and talking about how to do things (“First we put the groceries on the belt, then we need to pay”). Guess who teaches your child everything about the world for the first few years? You do!
• I wish you knew WHY your child is being recommended or is getting speech therapy. That includes knowing what goals they’re working on. In one of my most memorable meetings at school, I had a parent who’s child had been receiving speech therapy for at least 4 years who said, “I don’t know why Sue* is getting speech. She talks all the time.” Sue was one of my most severe students for language, but she was pretty talkative. The problem was she talked about nothing to do with anything we were doing and couldn’t answer simple questions accurately. Despite being given evaluations and going to 4 years of meetings, this poor parent didn’t have a clue. I encountered many more like her and I wish parents really strove to understand what speech was doing for their child. (That being said, many parents do make that step). (*Name has been changed)
• Language and learning disorders run in families, if you or your siblings (or in-laws) have one, your kids have a higher chance of getting them. You can ask for screenings from the school therapists or go to a private clinic for a screening to make sure you can get to therapy as soon as possible.
• School therapists are very restricted in what they can and cannot treat. For example, I had very strict guidelines of scores my school would allow me to treat, if a child didn’t score low enough on an assessment, or was performing at grade level in class, or their impairment didn’t have a clearly identifiable educational impact (they could be understood with their bad R for example), I was not allowed to treat them, despite them needing therapy in my professional opinion. I did my best to refer them out to private therapists (I always provided at least 3 options one of which was free) so that they could get the therapy they needed. If you think your child needs therapy, private therapy may be your only option. Speech grad schools also have clinics which may be able to provide therapy at reduced prices. Insurance may help cover some of the cost as well.
• Sometimes therapy everyday all day will not be able to “fix” the problem. Sometimes even the maximum therapy schools or hospitals can’t “fix” the issue. Sometimes kids will not be able to recover to normal. That being said, therapists from speech, occupational therapy, physical therapy, social work, etc. are able to do amazing things to help your child cope with the world with the skills they have. We can help identify strengths and help your kiddo use those strengths to overcome or minimize their weaknesses.
• Googling speech disorders to diagnose your child or tell us what to do is kind of like using WebMD to diagnose the flu and telling the doctor to give you chemotherapy. Remember, SLPs studied for 7 years in order to diagnose speech and language disorders, google will not tell you all you need to know, how to treat the disorder, or the prognosis. SLPs are going to be able to do all of that and provide individualized treatment for your child. That being said, don’t be afraid to approach with ideas you’ve looked up and discuss why you like them with your therapist.
• We are NOT PLAYING. Yes, to the untrained eye, it make look like we are just carving a pumpkin, however we are actually working on following directions, dealing with sensory issues, using focused stimulation to elicit language from your child, using music and finger play to work on imitation, working on social skills, working on joint and sustained attention, helping the OT with her pencil grip goals, and simultaneously trying not to make sure no knife accidents occur.

Things I Wish Parents Did

• Read. Read. Read. Read. Read. Read. Read EVERYTHING: cereal boxes, instruction manuals, picture books, chapter books, shampoo bottles, street signs, movie titles, recipes, pamphlets, text messages, newspapers, magazines, scriptures, coupons, grocery aisle signs, maps, etc. You and your children grow up in a world full of words. The more you read, the more your child realizes that words have meaning. The more words have meaning, the more they understand. Kids learn rules, social structure, vocabulary, etc. from books.
• Fun fact: the only research based method to learn new vocabulary is by reading.
• Fun fact: The difference between children of parents with high income and children of parents with low income is about 30 million words over 4 years. Reading can help bridge this vocabulary gap. (Hart, B. & Risley, T.R. “The Early Catastrophe” (2004) Education Review, 77(1), 100-118
• Did I mention reading? When reading to your child, ask questions, talk about the pictures, talk about the characters motivations and interests, talk about the character’s feelings, talk about your feelings, talk about likes and dislikes, talk about character’s choices… In short, talk about anything and everything in the book. You don’t have to do that every single time, sometimes you can just read the book—other times, make your kid work for the book. 
• Talk to your child. You'll be amazed at what they understand. Don't talk at your child, talk with them. Ask them about their day, what their favorite subject is, what they think about the book you read, what their favorite color is, why do butterflies have wings, etc. I particularly enjoy asking younger children (around 4) deeper questions (why is the sky blue? Did dinosaurs have restaurants?) to watch them really think about things. 
• If you're concerned about a kiddo, I wish more than anything that you would ask questions. Go get an assessment, talk to a speech therapist, talk to your pediatrician, talk to your school. Ask someone you trust and if you can't find answers keep asking.  Kids can't advocate for themselves, they need a loving parent to help them.

Resources for Parents and Caregivers

For a more complete list see the "My Favorite Resources" page on this blog.

• Handy Handouts- wonderful handouts put out by SuperDuper Inc. which explain speech and language issues and concepts in parent friendly language. They also provide lots of additional resources and tools parents can use at home. www.handyhandouts.com
• American Speech Language Hearing Association- this is the national association for Speech Therapists. There are wonderful resources for both parents and therapists as well as a search to find a therapist if you need an assessment or a new therapist should you move. 

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Picture Sources 

1. http://amorganslp.blogspot.com/2009/05/things-to-know-about-speech-therapy.html 
2. http://www.hasdpa.net/Domain/86
3. http://www.zazzle.com/speech+therapy+posters 
4.  https://carmenwiki.osu.edu/display/hdfs361sp20119489/Children+Speech+Therapy+By+Brooke+Laird