AuditoryVerbal Therapy Shelley Chesney M S CCCSLP LSLS
Auditory-Verbal Therapy Shelley Chesney, M. S. , CCC-SLP LSLS Cert AVT
The Craziest Language We’ll begin with a box and the plural is boxes; But the plural of ox should be oxen not oxes. Then one fowl is a goose, but two are called geese. Yet the plural of moose should never be meese. You may find a lone mouse or a nest full of mice; Yet the plural of house is houses, not hice. If the plural of man is always called men; Why shouldn’t the plural of pan be called pen? If I spoke of my foot and then show you my feet, And I give you a boot, would a pair be called beet? If one is a tooth and the whole set are teeth; Why shouldn’t the plural of booth be called beeth?
Then one may be that, and three would be those, Yet hat in the plural would never be hose, And the plural of cat is cats, not cose. We speak of a brother and also of brethren, But though we say mother, we never say methren. Then the masculine pronouns are he, his and him, But imagine the feminine, shis and shim. So English I fancy you will agree, Is the craziest language you ever did see. Author Unknown
The Communication Mode Continuum �No access to sound Full access across all frequencies within the normal range and �No verbal speech Complete verbal communication
The Communication Mode Continuum No Hearing SEE/ASL Hearing WNL TC No Verbal Communication Cued Speech AO AV Verbal Speech
The Communication Mode Continuum SIGN LANGUAGE: ASL Signed English SEE
The Communication Mode Continuum TOTAL COMMUNICATION – Signs Speech Written
The Communication Mode Continuum CUED SPEECH 8 hand shapes 4 locations around the face Words are cued in syllables Cued Speech is for children who are in an oral environment since one must speak and cue at the same time for the cues to be meaningful.
The Communication Mode Continuum AUDITORY ORAL Required amplification via hearing aids, CIs, FM systems, etc. . Strong emphasis on lip reading Natural gestures allowed Strong focus on auditory training Allows a lot of visual support
The Communication Mode Continuum AUDITORY-VERBAL Requires use of amplification during all waking hours No manual communication* Discourages visual cues and support* Strong parental participation in every therapy session Mainstreamed from the beginning or as soon as possible Therapy focuses on natural developmental patterns for listening, speech & language *unless embedded within a sandwich!
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Guiding Principles of Auditory-Verbal Therapy 1. Promote early diagnosis of hearing loss in newborns, infants, toddlers, and young children, followed by immediate audiologic management and Auditory. Verbal therapy. 2. Recommend immediate assessment and use of appropriate, state-of-the-art hearing technology to obtain maximum benefits of auditory stimulation. 3. Guide and coach parents to help their child use hearing as the primary sensory modality in developing listening and spoken language.
Guiding Principles of Auditory-Verbal Therapy 4. Guide and coach parents¹ to become the primary facilitators of their child's listening and spoken language development through active consistent participation in individualized Auditory-Verbal therapy. 5. Guide and coach parents¹ to create environments that support listening for the acquisition of spoken language throughout the child's daily activities. 6. Guide and coach parents¹ to help their child integrate listening and spoken language into all aspects of the child's life.
Guiding Principles of Auditory-Verbal Therapy 7. Guide and coach parents¹ to use natural developmental patterns of audition, speech, language, cognition, and communication. 8. Guide and coach parents¹ to help their child self-monitor spoken language through listening. 9. Administer ongoing formal and informal diagnostic assessments to develop individualized Auditory-Verbal treatment plans, to monitor progress and to evaluate the effectiveness of the plans for the child and family.
Guiding Principles of Auditory-Verbal Therapy 10. Promote education in regular schools with peers who have typical hearing and with appropriate services from early childhood onwards. *An Auditory-Verbal Practice requires all 10 principles. ¹The term "parents" also includes grandparents, relatives, guardians, and any caregivers who interact with the child. (Adapted from the Principles originally developed by Doreen Pollack, 1970) Adopted by the AG Bell Academy for Listening and Spoken Language®, July 26, 2007.
Evaluation �Why? What’s the point? �What to evaluate?
Evaluation: Speech, Language & Aural Rehabilitation �Language: �CELF �PLS �Vocabulary: (PPVT/EVT; ROWVT/EOWVT) �Speech Sound Production �GFTA �CAAP �PAIS �Auditory �ESP �LING 6 �CLIX – AB Clix on i. Pad
Evaluation: Audiogram �Unaided? Aided? �Pieces & Parts. �Application
Evaluation: Done. Now what? �Standard Scores & Age Equivalencies �Writing Goals
Anatomy of an AVT Session �Every AVT session should include goals and objectives in the following areas: Audition Speech Language: Receptive & Expressive Communication Cognition Parent Counseling/Coaching
Writing Goals: Audition �Where do you start? At the beginning �Why? Children are considered a “newborn” the day they get access to sound. �What are your resources? Auditory Learning Guide Auditory-Verbal Practice, Warren Estabrooks
Writing Goals: Speech �Where do you start? Where they are PERFORMING! �Why? �What are your resources? Sanders, 1972 Templin, 1957
Writing Goals: Language �Where do you start? Start where they are PERFORMING! �Why? �What are your resources? Speech & Language Developmental Milestones chart by Pro. Ed Cottage Acquisition Scales for Listening, Language and Speech – CASLLS Bloom & Lahey Others?
Writing Goals: Communication �Where do you start? �Why? �What are your resources? Asking questions Exclamations Figurative Language Turn Taking/Pauses
Writing Goals: Cognition �Where do you start? �Why? �What are your resources? CASLLS
Writing Goals: Parent Counseling/Coaching �Where do you start? �Why? �What are your resources? �Guiding Principles of AVT �Biological process of hearing �Type, Degree & Configuration of Hearing Loss �Pieces & Parts of an audiogram �Cochlear Implants vs Hearing Aids �Modes of Communication �AUDITORY LEARNING GUIDE �Developmental Milestones
Auditory-Verbal Modules �Hearing & Hearing Technology �Auditory Functioning �Spoken Language Communication �Child Development �Parent Guidance, Education & Support �History, Philosophy & Professional Issues �Education �Emergent Literacy �Last, but not least…. .
Auditory-Verbal Techniques & Strategies �The following techniques & strategies will help you direct your student to utilize LISTENING through their cochlear implant to develop their speech and language skills with efficiency! �NOTE: There is a required minimum of 40 Hours of instruction by a LSLS Cert AVT in AV Techniques & Procedures for those seeking certification. This is what moves the needle forward to listening and spoken language for our children with cochlear implants! �The following mnemonics were cleverly crafted by Kathryn Wilson, M. A. , CCC-SLP, LSLS Cert. AVT
Auditory-Verbal Techniques & Strategies �The most misunderstood of all AV techniques and strategies is……. THE HANDCUE � Signals the child to listen � Used to encourage imitation � Can also use toys, pictures or objects � Used to prevent lip reading � DO NOT USE if the child is not looking at you! � Ensure that you are not distorting your voice, but just occluding the visual of your mouth. In other words, don’t put your hand over your mouth so that you distort the sound of your voice. Hold your hand out and away from your mouth so that your voice has room to travel around your hand.
Where do I sit? ? �Behind the child? �In front of the child? �Beside the child? �On top of the child? (Only if they are misbehaving!!) �Best position is slightly behind and to the side, in good range of the device microphone, while the child is looking at the materials you are discussing and not your face.
Wait. �You must give the child plenty of time to process what he is hearing and then respond, so waiting in silence provides him time to do this. �With very young children you can wait as much as 45 seconds! Try it now. This will seem like an eternity but to the new listener it is a great gift! �Pay attention to their behavioral cues to know when to move on. You will be able to tell if they are “thinking” or checked out!
Tell & Show, not Show & Tell �Any time you are presenting new information or information you want the student to listen to and respond, always talk about the item BEFORE you show him the item. �EX: If you are working on Learning to Listen sounds, hide the toy in a container that the child cannot see into, like a coffee can. Barely open the lid so that only you can see what is inside and say, “Oh I see a cow! The cow says mooooo. ” Use the can as your “handcue” to block your mouth so that the child is not reading your lips. Hold the can toward the child and see if he will say “mooooooo” as well. Eventually open the can and let him play with the cow only AFTER you have said “moooooo” a couple of times.
Tell & Show, not Show & Tell, continued �Ex: If you are reading a picture book, read the page BEFORE you turn it around and show the picture to your student. �Tell & THEN show. �Think about the math flash cards concept. A flash card will only say 3 X 5. Not 3 X 5 = 15. If the answer is always there, then it will take longer and it will be harder for them to memorize their math facts. Forcing the student to think about and mentally visualize what he hears will enhance their auditory memory.
The Expectant Look. �Lean forward, eyebrows up, looking straight at the child. Look a the student with this expectant look to cue him to respond. �Ex: Say, “Jack and Jill went up the (insert expectant look here)? ” This cues the student that they are supposed to finish your sentence.
Give the child a CHOICE �Ex: You have 4 Learning to Listen toys on the table. “Which one says moooooo? ” If the student does not respond, you can ask “Is it the cow or the duck? ” instead of just giving him the answer.
Auditory-Visual-Auditory Sandwich �Sometimes the student NEEDS visual support via lip reading or even signs. If this is the case, sandwich that visual cue between two auditory presentations. �If you need to provide a visual cues, ALWAYS follow it with “Ok, now listen to that word again. I said (insert handcue to cover your mouth) mama’s shoes. ” �If you want the student to respond to what he hears, then the last presentation has to be auditory only.
“What did you hear? ” �When as child says “huh? ” or “what? ” do not automatically repeat yourself. Instead, ask “What did you hear me say? ” That way you can find out what part of the message he missed and repair just that part. �It also forces him to think about what he heard and process as much of it as possible in order to repeat it back to you. �It gives the child practice at asking for clarification.
POINT to your ear �When you hear something �When you want them to listen. �For our new listeners, they have likely never had any experience with sound, so all they have to related to this new auditory signal are their other 4 senses. They can’t be sure if they felt something, or saw something, but when you point to your ear and say “I heard that!” you are teaching and directing them that this new device is providing them with sound.
Be an ENVIRONMENTalist �This is where you want to take inventory and manipulate your classroom so that you are providing the best acoustical environment for your students with cochlear implants. �Take a listening walk around your classroom. Stand or sit in various places that your students sit, close your eyes and just listen. What kind of background noises do you hear that you can eliminate? � The air conditioner? Can you turn it off during lecture/teaching and back on during independent work? If not, be sure to seat your student with a CI as far away from it as possible. � The overhead projector fan? Again, move your student away from the white noise of the fan. Be sure to turn it off when not in use. � Background music? Not during teaching time! �Is your room echo-y? Can you add some textiles, like an area rug, curtains, canvas posters on the walls around your room to absorb the sound waves?
We are all MODELS!! �If you want your student to speak with clarity and good grammar, you must provide a perfect model for him to imitate.
TEACH, don’t test �Any time a student misses something, stop right then and teach the concept again. �Don’t just mark it on your tally sheet as “–” and go on. Stop and Teach!
PRE-TEACHing is NOT cheating!! � There are 2 people involved in pre-teaching: the teacher & the parent. � The teacher’s responsibilities: � Provide the parent with a text book to keep at home. � Provide the parent with the next chapter that will be taught in class approximately 1 -2 days prior. � The parent’s responsibilities: � Review the chapter with the child a day or two before they start. � Read the chapter title & subheadings. � Read the captions below the pictures &/or graphics � Read the bold vocabulary words. Can read the definitions too if you want. � Read the questions at the end of the chapter. � That is all. They do NOT spend time reading the whole chapter. This is about exposing them to new vocabulary so that the student has enough of an idea about what the teacher will be talking about so that he can participate in the discussion more effectively.
Acoustic Highlighting �Verbally stress different parts of a message with your voice by saying it a little louder, or drawing it out a little longer, or changing your pitch just a little. �You can stress a phoneme, syllable, word, or entire phrase �Whisper. Say the words “cat” and “cap”. Now say them again, but whisper them. What happens to the ending sounds /t/ and /p/ when you whisper them vs when you say them out loud? They’re more pronounced, aren’t they? That’s because when you whisper, you remove the energy of the vowel, which in turn, increases the energy of the other sounds in the word, thus highlighting those ending sounds that your student is having a hard time with! �SING what you say
Role Reversal. �Let the child be the teacher for a little bit and ask you questions or provide you with things to listen to.
Slooooooowwwww Down. �Give the student time to process what you are saying by slowing down your own rate just a little. �Keep your words connected. Don’t slow down so much that you start to sound like a robot.
Delayed Imitation �Let’s say you are trying to teach your student to appropriately answer questions. You ask, “What color is this apple? ” He responds with “Apple!” Instead of correcting him and giving him the answer, turn to his neighbor and ask “What color is this apple? ” and he says “red!” You, “That’s right!” Then turn back to your student with a CI and ask again “What color is this apple? ” He will (hopefully) then respond with “Red!” SUCCESS!
Get a little CLOSER �You can increase the loudness of your voice, not by speaking louder, but by getting closer to your student. This maintains proper prosody, as the louder you get, the more distorted your prosody becomes.
A Final Note about Certification �Master’s Degree in Audiology, SLP or Deaf Ed �Valid License to practice Audiology, SLP or Deaf Ed �At least 80 hours in post-graduate study in Strategies for Listening & Spoken Language Development within the past 3 years � 40 hours minimum in AV Techniques & Procedures � 10 hours minimumof structured observations of at least 2 different LSLS Cert AVTs � 30 hours maximum in Related Areas (Listed on AV Modules Slide)
� 900 Clock Hours providing AV Therapy within the past 3 years � 750 in Direct Therapy � 150 hours maximum in Related Activities (Assessments, Parent Conferences, School In-Services, etc. ) �Self Written Description of your Professional Experience in AV Practice within the past 3 years �Signed Commitment to the “Principles of AV Therapy” � 18 Hours of Supervised Direct Therapy by a LSLS Cert AVT over a 3 year period � 3 Parent Letters of Recommendation �PASS THE TEST!
Contact Information Shelley Chesney, M. S. , CCC-SLP LSLS Cert AVT Chesney Center Therapies, LLC 5422 Superior Dr. , Ste B Baton Rouge, LA 70816 (225) 302 -5030 Fax (225) 372 -2604 shelley. chesney@chesneycentertherapies. com
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