Life is Bliss - Lily's Cochlear Implant Journey

Hearing First - Impressive new LSL resource

Hearing First is an impressive new resource that presents the various aspects of a Listening and Spoken Language (LSL) approach.  

http://www.hearingfirst.org

Through a variety of informational resources, families and professionals can use this site to learn about strategies used to improve outcomes when teaching children with hearing loss to talk and listen.  

Second Grade

Second grade seems to be going well.   We had a "pre-meeting" the day before school started with all the second grade teachers and new staff at the school. This was in addition to the regular IEP team transition meeting which also had new faces like a new SLP and Assistant Principal.  It reminded me of the critical need of training and re-training teachers to maximize the educational experience for our kids.   

The new SLP, who was just out of graduate school, told me that she's already met Lily.   Then she adds that as a student she attended our local parent group meeting Amplify, where we have SLP students "babysit" and she was able to meet kids with CIs.   Feels like a small success that this may have been her exposure to kids with CIs.  

Video - School Poetry performance

Lily reads her poem about bubbles during a first-grade poetry celebration.  

 

Hearing Our Way Magazine

Interesting new magazine called Hearing Our Way for children and teens with hearing loss.  Subscribe on the website to get a free subscription mailed to you today.  

Hearing Our Way is an educational magazine for children and teens with hearing loss designed with language, listening, self-advocacy, and cognitive skills in mind. Independent readers will enjoy the magazine on their own, though students of all ages and reading levels can benefit from using the magazine as a classroom reader guided by a teacher or parent. Articles and features are great discussion starters, and content can be easily implemented into current curriculum, IEP goals, and Common Core standards. 

 

 

 

Family uses media effectively to gain cochlear implant coverage

Great story of a family overcoming an insurance denial by Conventry for Cochlear Implant coverage.  He even received Advanced Bionics.  

 

Therapy via IPads for children with cochlear implants

Great story on using IPads for teletherapy in a program called BabyTalk.  For newly implanted children under three, this program helps babies in Northern California learn how to listen and speak.  It's a partnership between Stanford School of Medicine and Jean Weingarten Peninsula Oral School.  

Lucile is one of about 17 other hearing-impaired toddlers from across Northern California — from Salinas to the Oregon border — to participate in a new "teletherapy" program called BabyTalk, a collaboration between the Stanford School of Medicine's Department of Otolaryngology and the Jean Weingarten Peninsula Oral School for the Deaf in Redwood City. - See more at: http://med.stanford.edu/ism/2013/december/babytalk-1209.html#sthash.OYDThTLM.dpuf

Lucile is one of about 17 other hearing-impaired toddlers from across Northern California — from Salinas to the Oregon border — to participate in a new "teletherapy" program called BabyTalk, a collaboration between the Stanford School of Medicine's Department of Otolaryngology and the Jean Weingarten Peninsula Oral School for the Deaf in Redwood City. - See more at: http://med.stanford.edu/ism/2013/december/babytalk-1209.html#sthash.OYDThTLM.dpuf

Lucile is one of about 17 other hearing-impaired toddlers from across Northern California — from Salinas to the Oregon border — to participate in a new "teletherapy" program called BabyTalk, a collaboration between the Stanford School of Medicine's Department of Otolaryngology and the Jean Weingarten Peninsula Oral School for the Deaf in Redwood City. - See more at: http://med.stanford.edu/ism/2013/december/babytalk-1209.html#sthash.OYDThTLM.dpuf

Lucile is one of about 17 other hearing-impaired toddlers from across Northern California — from Salinas to the Oregon border — to participate in a new "teletherapy" program called BabyTalk, a collaboration between the Stanford School of Medicine's Department of Otolaryngology and the Jean Weingarten Peninsula Oral School for the Deaf in Redwood City. - See more at: http://med.stanford.edu/ism/2013/december/babytalk-1209.html#sthash.OYDThTLM.dpuf

Supporting Success for Children with Hearing Loss

Supporting Success for Children with Hearing Loss is a great new resource filled with information about the learning and social issues of children with hearing loss and what you can do to better support the future success of these children. Resources are at no cost, designed to be easy to understand quickly, and practical to use.

Oberkotter Foundation establishes new national center for professional learning in LSL

Oberkotter Foundation plans to establish a new national center for professional learning in listening and spoken language. It will be launched in spring of 2015. 

This is such a needed resource to support professionals teaching children with hearing loss.  It can't come soon enough. 

Dana Suskind, CI Surgeon and language advocate

Loving this recent article in the Chicago Tribune about Dana Suskind, a Chicago area CI Surgeon and language advocate.  Her research program, outlined below, particularly resonated with me.  

Teaching parents about the importance of language is a key component that must drive early intervention engagement.  Tools like LENA help bring awareness to how much and how you are talking and it gives parents a 30,000 word benchmark for real direction.  And this could be applied to any family, not only to those with a child with hearing loss.  

Suskind worked with her University of Chicago colleagues to launch 30 Million Words, a program that sends research assistants to the homes of at-risk children for 13 weeks and educates their parents about the importance of engaging their children in an ongoing dialogue — and, equally important, offers them the tools to do so.

Researchers work with the parents to develop weekly word goals, with an ongoing emphasis on "the three Ts: Tune in, talk more, take turns," Suskind says.

"Babies aren't born smart," she says. "They're made smart. And how are they made smart? Your words."

"All parents should be allowed to know the power they have. If we can change how parents view their language and the power they have to impact their kids' trajectories, it will be amazing."

 

Music perception - What can Lily hear?

I had a wonderful discussion with one of our blog readers about how Lily might hear the different notes on the piano.  I'm appreciative of her expert explanation and feedback.  
 
Lily, depending on where you play the notes on the keyboard, may be able to tell the difference of 1-4 semitones. In some areas, she’ll be able to tell you that C-C# sound different (when not looking) but may not always be able to tell you which direction they are going. In other areas of the keyboard, she may have to have C-E or larger to tell a difference. In addition, most implants are programmed for speech at around 250Hz, which is the F# below middle C. This usually knocks out the rest of the notes below there, but not always. Her larger challenge would be telling major from minor chords (and honestly, as a trained musician, it can be challenging).
 
Regarding music you have ‘The Good, The Bad and the Ugly.’  The good is rhythm, the bad is timbre and the ugly is pitch. Mainly that is  because rhythm is a significant part of speech and helps us so it’s conveyed very well. Timbre, the ability to detect different tone qualities is harder, but can be learned.   It is hard because of its complex spectral quality. Think about how similar a clarinet and saxophone sound, for instance, now add in the complexity of a cochlear implant’s processing strategy.  Finally,pitch is the hardest, simply because you and I have 30,000 hair cells (each of which responds to one frequency) and Lily now has 18 electrodes to represent those same 30,000 hairs cells. That’s not to say she won’t be amazing (she clearly already is), but that she may have a “sweet spot” for certain types of music perception and production (ie., singing on key in a specific range).

Then Lily's fabulous music teacher, who shows so much interest in this topic (thank you), told us the following:

Semitone is another word for a half step, which would be the difference between one note next to another one on the piano, like B-C, E-F, or B flat-B. Lily was able to sing descending Major triads starting on Eb (E flat) and ending on G below middle C (which is pretty low for a kindergartner) So she sang descending triads in the Major keys of Eb, D, Db, C, B, Bb, A, Ab, and G. I'm convinced she can hear the difference between 1 semitone.

Amazing!

Good Speech Apps for IPhone/IPad

Here are a few useful speech apps for IPhone/IPad that you can experiment with for developing expressive and receptive language in toddlers.  These tools can help learn skills like imitating sentences and answering questions with a picture context, as well as following directions embedded in a sentence. 

• My PlayHome - Following directions - Lite version is free. 
• My Scene - Age 2+ Story Creation - Free
• Outdoor Fun - $2.99
• Toddler Seek and Find - Lots of versions - Good reviews - Free to $2.99
• Fun with Directions - Following Directions - $.99
• What's in the bag - (literally) Guessing - Can be used with all ages** - $.99

 

 

Improving literacy for children with cochlear implants

Two new studies have been referenced by the Hearing Review concerning children and Cochlear Implants.  This is particularly interesting for Lily who is entering Kindergarten this fall with minimal services. This research recommends that we remain vigilant with intensive language supports, at least through the early elementary years.  

Both papers are based on a decade-long study that has followed over 100 children with hearing loss and normal hearing, some from birth, with a goal of establishing predictors of future language abilities and the long-term extent of support needed for their success. The studies offer a look at what measures are the most accurate predictors, and the types of interventions that may improve literacy.

In "Measuring what matters: Effectively predicting language and literacy in children with cochlear implants," published in International Journal of Pediatric Otorhinolaryngology, her goal was to evaluate how well various language measures typically used with very young children after they receive cochlear implants predict language and literacy skills as they enter school. The study included 50 children, some with normal hearing and some with cochlear implants. She concluded that before 24 months of age, the best predictor of later language success is language comprehension. In general, measures that index a child's cognitive processing of language are the most sensitive predictors of school-age language abilities.

The second article published in Ear and Hearing, "Emergent Literacy in Kindergartners with Cochlear Implants," examined the early or emergent literacy of young cochlear implant recipients. The study looked at 27 deaf children with CIs, who had just completed kindergarten and had been tested on emergent literacy, and on cognitive and linguistic skills that support emergent literacy.

They found that intensive language support needs to continue through at least the early elementary grades for these patients. Also, a period of bimodal stimulation during the preschool years can help boost emergent literacy skills to some extent.

 

AgBell Conference 2012 - Auditory Skill Development: Basics and Beyond

Auditory Skill Development
Betsy Moog Brooks, M.S., CED, LSLS Cert AVEd, Amy Birath, Au.D., CCC-SPL, FAAA, LSLS Cert. AVEd, The Moog Center for Deaf Education, St. Louis , MO

Increased performance expectation because of early hearing aid fitting (They are getting calls from the hospital)

Speech perception test
- early speech perception test
- 18 months should have 25 words, 1 year post implant should have 100, age 3 - using utterances of 3 and 4 words

*****Auditory memory - ability to repeat back items after presentation - attending, listening, processing, storing and recalling.  May produce benefits for kids with Cis

*****Auditory skill development - clef and wisc tests

Activities - 
- digit span - make one presentation, recall numbers in a row
- word span for unrelated items
- words with different number of syllables

Listening in  Noise - value in practicing.  Auditory training in noise improved performance with CIs.   (Og 2011)
- first in quiet
- multi talker babble
     Auditec.com
      Babel babble (app)
- introduce noise at +10 SNR 
- noise should come from behind the child
- studio 6 audio tool - sound level meters 

Activities
- imitating sentences with a picture context
- following directions imbedded in a sentence 1-4 critical elements
- sentences without context 6-8 word sentence in noise
- riddles in sentences in 3-5 words and each riddle has 3-5 sentences 

I have wings
I cannot fly
I can swim

I am at school
I open and close
People read me

Riddles with 6 or more words

I am made of wood but I might be different colors
I have four legs and sometimes I have two arms
People like to sit on me

Stories with illustrations

AgBell Conference 2012 - What does acoustic accessibility look like?

What does acoustic accessibility look like?

Carol Flexer, PH.D., LSLS Cert AVT, The University of Akron, Kent, Ohio and Jane Madell, PH.D., LSLS Cert. AVT, Private Practice, New York, N.Y.

- Audiologist has the critical role because of brain access
- Everyone in a child's life needs to be involved in communication
- Hearing is access to auditory brain
- Sound must be clear
- Kids need more brain development with more repetition 
- SNR is critical - FM is key
- Repetition in classrooms of what other kids say by teacher
- Any unoccupied class should be no more than 35dbs
- Need single events in classrooms for kids to hear
- What is the important sound going on in the classroom.  Don't have two groups at the same time.
- Dominant tissue in brain is auditory designated tissue.  Must be stimulated
- Earlier is better = brain had plasticity
- Earlier= more practice
- Brain is a probability organizer
- Typical babies are born with 20 weeks auditory development
- 20,000 hours of listening as a basis of reading
- Children with hearing loss need three times the exposure to learn new words and exposure
- Eyes open, technology on
- A child with four hours of aids will need six years to equal one year of an ordinary hearing
- Must have all three -Perfect technology, good program, and parents
- The real ear is the brain
- Must use a pediatric audiologists - All audiologists are not the same
- Children with profound loss at age 5 - 44% are progressive
- 40% of hearing aids were under fit (mp)
- Plan for a progressive loss
- Use FM at home
- Auditory access is not just at home
- Always suspect technology first if something is wrong
- Use Ling6 and 44 phonemes ****** (We heard test with phonemes multiple times)
- Noise noise noise - infants should have FMs
- Turn the music off unless it's adult directed
- Always walk out with a copy of the audiology report
- Behavior tests are more important than objective testing
- Do speech perception testing after mapping
- How does kid hear at 50db, 35db and noise at 5db - thresholds and discrimination each ear and binaural
- If you are not sure if your child is hearing they are not
- CIs should be mapped between 15 to 20 db
- Record specific phoneme errors
- Distance hearing
- Voice quality is an indicator
- Do lings naturally 
- Speech perception qualifiers 
   Excellent 90-100
   Good 80-89
   Fair 70-79
   Poor <70%
- Mild hearing loss places child at 10 times risk

iHear - Online Therapy in Nebraska

iHear, an on-line therapy program for children with hearing loss, is ready to assist families in Nebraska who have children with a hearing loss.

Thanks to the Omaha Hearing School Foundation, St. Joseph Institute for the Deaf has received a grant to provide speech and language therapy services via the Internet to children in Nebraska and western Iowa.  

This is an incredible opportunity for families to receive high quality therapy from SLPs or Hearing Resource teachers that are certified AVTs or AVEds and also LSLS certified who work with kids with hearing loss everyday.  

On-line therapy is a great addition or supplement to a child's current therapy or as an alternative for families who cannot access highly-trained therapists in their area.  

For more information, see http://ihearlearning.org/

Lily and her SLP Carole

Carole has been Lily's speech teacher since she was 10 month old.  That means we've seen her approximately every week for four years.  Now that Lily is almost five, she will move on to very limited speech services in her elementary school this fall.  

We are truly saddened to have to say goodbye to a wonderful resource and friend.  Carole's been positive, supportive, creative, resourceful, engaging and connective.  She taught us so much about speech, ourselves and about life.  I hope we were able to teach her a few things too.  

Carole is definitely a big factor in Lily's success and we thank her from the bottom of our hearts.  

Nebraska Online Speech Therapy for kids with hearing loss

UPDATE for online speech therapy opportunity for Nebraska kids with hearing loss

If you are interested in high quality listening and spoken language online speech therapy, go to www.ihearlearning.org....or call direct to Cheryl Broekelmann at ihear 636.532.2672.  

The cost per session is $35/half hour for families.  There is some money for scholarships and St. Joseph staff are currently working to see if insurance plans will cover the cost.

Internet Therapy Offered to Nebraska Children with Hearing Loss

Just when things are wonderful in the Cochlear Implant world, they get even better for kids in Nebraska.

We received a note today letting us know about new Internet Therapy for Nebraska families who have children with hearing loss from the St. Joseph Institute for the Deaf.   (see our iHear Nov 2011 blog post)

Our beloved Omaha Hearing School, although now formally closed, has reformed as a foundation and has funded this opportunity to provide speech and language therapy services over the internet to children in Nebraska and Western Iowa.   Services will be provided though St. Joeseph's innovative and groundbreaking internet therapy program called iHear.  

“By 
working 
with 
St 
Joseph
 Institute 
for 
the 
Deaf, 
the 
mission 
of 
the 
Omaha 
Hearing 
School
 Foundation 
to
teach
 young 
children 
with 
hearing 
loss 
how 
to 
listen 
and 
speak 
remains 
vibrant,” 
says
 Britt 
Thedinger,
 MD,
 an
 otologist 
and
neurotologist 
and 
a 
board
 member 
of 
the 
Omaha
 Hearing
 School 
Foundation.
 

SJI’s 
ihear 
program
 enables 
children 
with 
a 
range 
of 
hearing 
impairments
—
from
 cochlear 
implant
 recipients
to 
those 
who 
use 
hearing
 aids
—
to 
work 
with
 skilled 
listening 
and 
spoken
 language
 specialists 
via 
the 
secure
internet 
link.
  

Essential 
to 
the 
program’s
 success 
is 
its 
collaborative
 coaching 
model,
 in 
which 
the 
ihear 
staff
 coach
 a
 parent 
or 
educator 
present 
with 
the 
child
 in 
each
 ihear
 session.  
The 
coaches 
are 
then 
able 
to 
reinforce
 the 
exercises 
and 
lessons 
learned 
in 
between
 the 
therapy 
sessions.  
Children
 enrolled
 in
 the 
program
 typically 
are 
scheduled
 for 
two, 
half‐hour
 therapy
 sessions 
per 
week.

Thanks Dr. Britt 
Thedinger for your commitment to Nebraska's kids.  We'll provide more details on this program as we receive them.  

For
 more 
information
 about ihear,
 visit www.ihearlearning.org

 

 

The Auditory Brain - Carol Flexer - Speech transcript - So Good!

We are huge fans of Carol Flexer an Audiologist, professor, book author and presenter on The Auditory Brain: Conversations for Pediatric Audiologists.  This link is to a transcript of a presentation and Q&A Dr Flexer made on AudiologyOnline last spring.  So, so, so good!  Mandatory reading.  

CI Video Story: Implanted at 20 months and now a teen

A beautiful documentary on the life of Skye Carter.  She was first implanted as a child (20 months) and now is in her teen years. 

Apps - An Emerging Tool for SLPs

Excellent article on Useful Apps for SLPs and parents.  Now Lily will want her own IPad or IPhone.  

Preschool Update

Lily is now in her second year of mainstream preschool.  She attends two different preschools and is loving it.  She has grown from a more reserved three year old, to a eager four year old answering and asking endless questions.  

For Lily's new preschool this year, we (my public school SLP, TOD and I) met with the teachers before class started and discussed good teaching strategies for kids with hearing loss, as well as "how tos" with her CIs and FMs. It's the "how tos" and the "this could happen but probably won't" that scares the teachers the most.  We also asked the preschool to use static spray on the plastic slides and plastic play structure.

They took it all in, asked great questions and have placed static spray around the building :).  We've had no problems with the CIs or FMs at preschool.  In fact one of her teachers said she loved the FM.  Great to hear.   I love the FM too.  Such a great tool, especially in noise.  

Already during the second week of preschool, Lily was eager to serve as a host for a new student, showing her the ropes. Lily's made lots of new friends and is off to a great start. 

We continue to work with our public school SLP three times a month, through home-based services and have a TOD visit once a month, typically to Lily's preschools or on-call for technology issues.   This has been a perfect fit of services for our family and has helped Lily to thrive.   

$1 in EI Services = $2 of Benefit

Social and economic benefits of early intervention for deaf children far outweigh investment cost says new report.

"Every dollar invested in early intervention services for deaf children produces almost two dollars worth of social, educational, vocational and economic benefit"

Parents Magazine Covers Cochlear Implants

Great article in the most recent Parents magazine discussing kids and cochlear implants.  

The author, Debbie Waldman, did a great job capturing a positive story about the very engaged Bennett family and their 4-year old daughter.  

It is a real story about a little girl who receives Cochlear Implants and now talks like a champ in a mainstream environment.  This story is sure to educate all families about hearing loss and give those families hope who find themselves on a hearing loss journey.  

It also avoids the old tired story that is often covered in the media which says deaf people hate cochlear implants.  While there certainly are haters, this attitude is rapidly changing.  

Ironically, Lily was going to be the featured kid in this article.  

We spoke with the author at length, multiple times, over two years ago.  It seemed that because Lily was implanted at 10 months (before the 1 year FDA guideline), Parents Magazine editors were worried about running her story.  

Alas...Cochlear Implant implantation before one year is fairly standard and the research continues to show that earlier is better.   While we're disappointed Lily's story wasn't told, we are thrilled that this article ran.  It's a story that should be told every year!!   

Thanks Parents magazine for covering an important issue that impacts thousands of families everyday.  

 

 

Early Intervention - Benefits of being proactive

Parents: Don't Hope Your Child Will Just Outgrow An Early Language Problem - Good article by ASHA suppporting early intervention and not taking a wait and see attitude.  Early diagnosis of hearing loss makes all the difference.

IEP - 4 years old

At 4 years old, the following are Lily's IEP goals for the next year.

- Given visual/verbal cues, Lily will improve her speech production of /l/, /l/ blends and initial and final /th/ from the baseline of 10% accuracy in imitation of single words to 80% accuracy in sentences and structured speech as measured by the LPS SLP Articulation Data Collection Chart.

- Given a structured activity, Lily will produce phrases/sentences with correct use of comparatives and superlatives, words denoting time, nouns with two descriptive adjectives, and a variety of prepositional phrases (at least 12 each) improving from a baseline of 25% to 80% as measured by the LPS ECSE Grammar Rubric.

- Given an interaction with a teacher or a peer, Lily will improve her social communication skills (maintain/stay on topic of conversation for 3-4 turns, advocate for herself when she doesn't hear or understand a peer's comments or questions), improving from a baseline of 2 points to 4 points,as measured by the LPS SLP Social Skills Rubric.

 

Omaha Hearing School....How do I love thee?

This weekend we attended a fabulous fundraiser for the Omaha Hearing School.  It was at the top of the Midtown Crossing Condos overlooking the city.  A perfect space, with fabulous food from local restaurants, a giant deck with temperatures like bath water and a packed room of supporters.  

At the end of the evening, the Director asked if we would address the crowd and tell Lily's story.  

Talking about Lily comes easy, as did my gratitude and thanks for all the support we've received.  Since Lily was two months old, we've worked weekly with the Omaha Hearing School.  They've shaped the way we teach Lily to talk and listen, with remarkable results.  They've provided unending support for our family.  They've set our goals higher than we ever thought possible.  

After Lily turned three, driving to Omaha for the mainstream preschool twice a week has been a major commitment. However, we sleep well knowing Lily is in an incredibly language-rich environment with great acoustics, and teachers who are highly skilled and committed to maximizing the technology.   The Omaha Hearing School staff is extremely flexible to Lily's needs and they take parent input seriously and act upon it. Dreamy, I know!

After we spoke at the event, a Omaha Hearing School graduate spoke, who is now age 26.  She is a gorgeous young woman who graduated from college at the top of her class and is a successful CPA.  Her family still generously supports the school and feels they can never "Repay" the school for how they have helped their daughter. Her Dad gave us a squeeze and through a few tears said he agreed with everything we said.   Pretty special.  

To any of our readers who want to invest in a organization that changes lives, here's your chance.  The Omaha Hearing School is an incredible 501(c)3 which is making a major difference in the lives of kids who have hearing loss in Nebraska and the surrounding area.  We hope you will consider a contribution.   

Pediatric Audiology Free Online Conference - March 14-18

AudiologyOnline Virtual Conference starting tomorrow - Pediatric Audiology-Raising the Bar - Tremendous!!!   Worth signing up if you only listen to Carol Flexer.  A lot of other top notch pros as well.  

Auditory Verbal/Auditory Oral - Why being language focused is critical

This is an excellent blog, written by two Moms of kids with Cochlear Implants.   They advocate for Auditory Verbal Therapy (AVT) and early implantation of Cochlear Implants.   Two things I believe in strongly. 

The blog references interesting articles on How Babies Process Langague and Baby Talk which reinforce the importance of early langague input. 

Another recent early langague article with a twist is called Why Rich Parents Don't Matter.  It speculates that:

When it came to the mental ability of 10-month-olds, the home environment was the key variable, across every socioeconomic class. But results for the 2-year-olds were dramatically different. In children from poorer households, the choices of parents still mattered. In fact, the researchers estimated that the home environment accounted for approximately 80% of the individual variance in mental ability among poor 2-year-olds. The effect of genetics was negligible.

The opposite pattern appeared in 2-year-olds from wealthy households. For these kids, genetics primarily determined performance, accounting for nearly 50% of all variation in mental ability. (The scientists made this conclusion based on the fact that identical twins performed much more similarly than fraternal twins.) The home environment was a distant second. For parents, the correlation appears to be clear: As wealth increases, the choices of adults play a much smaller role in determining the mental ability of their children.

In Nebraska, it is critical that we increase the number of certified AVT and AVEd (Auditory Oral) teachers, especially working in early intervention (birth to five).  This should be a top policy priority.  With advancements in technology, it is vitally important that we continue to develop these skilled AVT/AVED teachers and reinforce auditory communication teaching strategies at every level. 

The Ls have come

Lily is starting to get the /L/ sound.  While this is a much later developmental sound, she has been making good attempts at the sound consistently for the past week.  You can see her stop to think about getting her tongue to the top of the mouth before saying light, lollipop or leg.  With a name like Lily Bliss, that L sound is so important.  Thanks to her great SLPs and lots of attention to L words.

Lena System Results - 34,627 words

Researchers Hart and Risley, conducted nearly 10 years of research to learn why some children perform better than others in school. 

They concluded the quantity of talk and interactions that parents had with their child predicted a child’s IQ and vocabulary size more so than any other variable, including parents’ education or socioeconomic status.  They also indicated that to ensure your baby’s optimal growth, your baby needs to hear 30 million words in the first four years of life.

We have been using the Lena System (a little digital voice recorder) once a month as part of a study with the Omaha Hearing School and I always find the results fascinating and eye-opening.  The study is trying to gauge whether knowing you and your child's language results from the Lena system, impacts your ability to increase conversations with your child. 

This month we used the Lena on a day Lily attended preschool. 

As we saw last month, conversational turns decline during the preschool period, as do child vocalizations.  However, Lily was the "line leader" during this recording so it seemed she had more opportunity to talk. We also see a lot more Distant Speech during the preschool period, instead of Meaningful Speech.  The Distant Speech is either that of other children or is hopefully being addressed through the use of an FM system. 

Adult words for this day were at 34,627. That is well above our daily goal of 30,000. Total conversational turns were at 1,660 and Child Vocalizations were at 5,129.

At 30,000 words a day (and this is up at the 99th percentile and takes lot of very intentional talking), Lily would hear 42 million words over four years.  However, since she didn't hear for for the first 10+ months, we have to subtract 9 million+ words.  That means were back to around 33 million words, which is above the 30 million, but not by much.    

For me, this certainly strenghtens the arugement for earier implantation and front loading services.  Parents don't have enough time to fill these language databases up, before the windows start closing.

Baby Signing - Is it beneficial?

Very interesting literature review of the pros and cons of Baby Signing

Chickens, Cakes and Cold - K and G Sounds

LIly has been working hard in speech therapy.  Here is a note we received last week from her SLP at OHS.

Just wanted to let you know how great LiIy is coming along with her "g" and "k" productions especially at the beginning of words.  She sometimes needs a reminder to put her tongue back but when she is focused on that sound she does real well.  In spontaneous production she still needs quite a few reminders, but can correct her production when I repeat her mispronunciation.  These sounds at the end or middle of words is still harder, which is expected.  She is still working hard to produce the "l".  She has been comparing this sound to the "n" sound which is placed in the same spot but with a little length difference. She can make the "n" sound several times before attempting the "l" to help her place the "l" tongue tip in the correct spot instead of flicking it...So she would say "n", "n", "n" (quietly) "lion."  Hopefully this will encourage her tongue to not flick so much. 

Hearing Loss in Children - Great Resource by the CDC

The U.S. Center for Disease Control recently launched a very thorough page on Hearing Loss in Children.  Worth some time reviewing, especially those newer to the hearing journey.

Carving Pumpkins = Talking Lily VIDEO

Carving a pumpkin seemed like a perfect time to play around with the video camera.  Our thought was to ask a range of questions to highlight the depth and clarity of Lily's language.   The pumpkin didn't turn out to be too scary, but it did get bilateral BWP Cochlear Implants.   

 

Omaha Hearing School - Two-Way Mirrors

One of the things I love about the physical structure of the Omaha Hearing School besides the unbelievable acoustics are the little observation rooms attached to every classroom.  What an incredible way to promote parent interaction without disturbing the class and teacher.

Does your kid act the same when you are not around?  Now you can find out.

Here is a picture of Lily working with her new SLP Lisa.  It was taken through a two-way mirror.  When I showed it to Lily, she said "How did you get this picture.  You weren't there."  Oooops.

Babylab - 36-38 months

Diagnostic Impressions

Lily produced 200 complete and intelligible utterances in this sample, and her mean length of utterance was 4.63 morphemes. Lily's sample was compared to a data base of 30 children with normal hearing (age range 2.8 to 3.5) who were matched on a number of utterances in the sample.  When matched on this dimension, Lily's scores were one standard deviation above the mean on utterance length and complexity and number of different words used. This is an encouraging finding, supporting the impression that Lily is using complex utterances that include varied vocabulary terms.  She was comparable to the normative sample on intelligibility of spontaneous utterances; 97% were fully intelligible to the transcriber.

The table below lists the types of bound morphemes that were used spontaneously by Lily, along with error rates.  Lily is using a variety of word endings, including some that are particularly complex for her age (e.g. friendly, passer, Mister Beary).  A total of 10 morpheme omissions were observed in the sample, and the most common omission involved the contracted copula or auxiliary (she/'s  not feeling well; I think that one/'s too big).  Lily asked a variety of questions, that involved use of auxiliary/modal verb forms (e.g. Can we take off her diaper? Should we put on the clothes in here? Do you want some more dessert?  Won't we go with Mister Beary?).   Later in the session, Lily asked a "Why" question, and demonstrated that auxiliary inversion in complex questions is still emerging (e.g. Why it has claws?).  She appropriately answers Why questions starting with "because" and providing reasons.  Occasionally, she showed word order differences when using particles (e.g. She turned off it).  In general, Lily demonstrates strong grammatical development for a child of her age.  An example of one of the most complex utterances produced was:  Maybe we can go to Omaha after we go to the doctor/z with you.  This sentence was produced during a pretend sequence, and included a temporal conjunction.

Number Occ.  - Number Omit - % of Oblig. Content

• /'D - 1 - 0 - 100
• /'LL - 2 -0  - 100
• /'M - 11 - 1 - 91
• /'NT - 1 - 0 - 100
• /'S - 15 - 6 - 71
• /3S - 7 -1 - 87
• /ED - 0 - 1 - 0
• /ER - 1 - 0 - 100
• /EZ - 1 - 0 - 100
• /ING - 15 - 0 - 100
• /LY - 1 - 0 - 100
• /S - 16 - 2 - 88
• /Y - 1 - 0 - 100
• /Z - 3 - 0 - 100

Lily also demonstrated advanced development on the PLS-4.  This measure was administered across two sessions.  Lily scored well above average for her age on both subtests.  Standard scores were 138 for auditory comprehension and 142 for expressive communication (average = 100 with a standard deviation of 15).   On the receptive scale, she demonstrated emerging understanding of the concept of rhyming, and clear ability to identify words that share initial sounds.  It was encouraging to see her practice (/s/ - /s/...sun!).  She also demonstrated recognition of agrammatical sentences and an ability to modify them.  A particularly impressive aspect of her performance on the expressive scale was her responses to story retell opportunities.  For example, after listening to the Buddy Story, she started her retell with, "Once upon a time, there was a puppy named Buddy and one night..."  She appears to be developing well in terms of narrative skills.

As noted earlier, Lily has progressed well in speech production, resulting in spontaneous utterances that are easily understood most of the time.  She often fronts the back sounds [k/g], producing them as [t/d].  This phonological process is often observed in children of this age. Sometimes when Lily is formulating multi-word sentences, she produces each word with similar timing, resulting in a staccato rhythm.  Her mother reported that this is observed only occasionally at home, and appears to be when she is really thinking about what she is trying to say.

Lily's mother provides rich input to her daughter throughout their interactions.  Complex pretend episodes with sequences and role assignments are observed when they play. Use of mental state terms (e.g. pretend, think, know, remember) was seen often in both mother and child talk.  In summary, Lily is making excellent progress in all aspects of spoken language development. She scored above age expectations of the majority of measures gathered in these sessions.  It is encouraging to see the impressive changes in Lily's understanding and use of spoken language.

IEP - 3 Years Old - Goals and Objectives

Lily's first IEP, at three years old, includes the following goals and objectives.

Goal 1

When asked a question or given verbal directions, Lily will demonstrate an increase in her auditory and receptive language skills by mastering the following benchmarks, improving from a baseline of 25% to 80%, measured by observation, data collection and language sampling collected quarterly.

Objectives

1. Perform 3-4 step directions correctly that demonstrate understanding of at least 5 phrases each, probing for:  Order or sequence, Words of description, Comparatives and superlatives, Adverbs of time, Regular and irregular past tense verbs, Prepositions showing place, and Conjunctions
2. Perform a requested action by correctly identifying the one word, phrase, sentence, song/fingerplay which matches the requested 4-8 word stimulus item in 10 opportunities
3. Provide an appropriate verbal response to 10 each of "Wh" questions (who, what if, where, why, when, how) when asked a question about a story, recent or past experience or about adult instructions.

Goal 2

Given a verbal model, Lily will imitate and produce phrases and sentences using correct syntax and grammatical structures, listed in the benchmarks that follow. Progress on these benchmarks will be measured in four quarterly language samplings, showing improvement from a baseline of 25% to 100%

Objectives

Correct use of 8 auxiliaries and/or copulas, 8 words showing negation, 8 irregular past tense verbs, 5 conjunctions, 8 prepositional phrases, 5 indefinite pronouns, 5 adverbs of time, 5 comparatives or superlatives, 8 descriptive adjectives with appropriate nouns, and 5 nouns accompanied by 2 descriptive adjectives.  

Goal 3

Given visual/verbal cues, Lily will improve her speech production of targeted sounds /v/, /k/, /g/, initial /l/, /l/ blends from a baseline of 0% accuracy in any context to 60% accuracy in imitation/consonant-vowel combinations/vowel/consonant combinations and single worlds as measured by the SLP Articulation Data Collection Chart.  

Objectives

1. Use of listening activities to achieve correct production of targeted speech sounds
2. Auditory discrimination of paired words contrasting error vs correct sound productions
3. Auditory discrimination of correct/incorrect targeted sound productions in verbal models
4. Auditory discrimination of correct/incorrect targeted sound productions in her own speech

First Day of School

This week Lily was off to the Omaha Hearing School.  She is the only kid with a hearing loss in their Neighborhood Preschool.   It's mainstream preschool, but with hearing support backups if needed. We are also doing some SLP sessions and time with a hearing resource teacher after preschool to make sure she stays on the right course.   We really love the Omaha Hearing School.  They have supported us since Lily was a baby. 

Lily came home with rave review from her teachers, something like acting like a three year old, but talking like a 30 year old.  As she left the building she said, "That was fun."   I'm so glad.  Only a few tears from me upon leaving her at preschool. She is certainly growing up. 

SLP Quarterly Summary

Our fabulous private SLP provides us with quarterly speech reports.  Here's an excerpt:

Current Goals

• Increased discrimination of words through listening alone that differ in only one feature of the initial or final consonant
• Three part auditory memory tasks
• Use of age-appropriate grammatical markers
• Monitor distance listening abilities

Progress

Lily continues to make nice gains. We've worked this quarter on Lily's ability to listen and understand recorded messages.  This is a listening challenge that Lily has enjoyed as it's involved listening and following directions to different songs and recorded stimuli. 

In addition we've worked on Lily ability to discriminate words that differ in only one feature in larger set sizes. At last date collection, Lily was able to discriminate between words differing in only one feature of the initial or final consonant in sets of 4 with 80% accuracy.

We also assessed her distance listening.  Lily was making some auditory confusion between /m/ and "oo" at distances between 3 and 15 feet, as well as a no response to /s/ at 30 feet.  Ideally she would be able to identify all Ling sounds at a distance of 45 feet.  Due in part to testing, Lily's parents took her to have her map adjusted.  At the next testing, she was consistent on all Ling sounds between 0 and 35 ft.  

Lily's expressive language continues to develop nicely. She is using her contactable "to be" verbs, past tense and irregular past tense with greater frequency and with a high level of accuracy.   We will continue this quarter focusing on her expressive/receptive language, auditory comprehension and will add a peripheral focus on her speech articulation. 

Lily is approximately 90% intelligible to a familiar listener but does demonstrate some sound substitutions that are developmentally appropriate for her age including /t/ for /k/ and /d/ for /g/.  We'll begin putting an emphasis on these sounds to give her greater exposure to hearing them as well as opportunities to practice them.

IEPs and a LIttle Reflection

We are knee deep in IEP (Individualized Education Plan)  planning, our first one since Lily turned three.  An IEP lays out what Lily's goals and objectives will be for the next year and the services that will be provided to meet those goals.  It also describes any technology the school will provide to help her meet those goals. 

Last week we received all of Lily's test scores from our public school.  To say she did super fabulous, would about capture the results. 

Are there areas that still could use our focus?  Sure.  Has she built a foundation on which to grow and thrive for the future. Yes!  Do I wish I could have seen this day when I spent months crying about Lily's future.  Yes.  Did I realize this moment would come when she was three?  No. 

Do I remember vividly our "CI expectation counseling appointment" when they asked us our goals for Lily and we said mainstreamed by kindergarten, secretly hoping that it would be much earlier. 

Then the counselor said "Well...that is the Gold Standard" and implied that it was not very likely.  Then she showed us a scale that had "All Signing" on one side and "All Auditory Learner" on the other, and implied that the chance for us to have an all auditory learner was slim.  

So to her I say meet Lily, an all Auditory Learner who is busting nearly every talking and listening curve.  As Carol Flexer says, "It's all about the brain."  Give these kids good access to sound and they should thrive.  

Don't tell parents to set your expectations low.  Did I say that loud enough.  Don't tell parents to set your expectations low.   Tell them to set their expectations high.  It's better to shoot for the moon and miss, than to shoot for the lamppost and hit it.  However,  we also need to tell parents 'this is what it is going to take (eg 30,000 words a day)" and "here are all the tools to help your kid achieve the unachievable."  

Rosie's Ranch: Ride - Listen - Speak

While at AgBell, we found this interesting ranch in Colorado called Rosie's Ranch that identifies itself as a therapeutic riding center for listening and spoken language development. 

Their vision says "At Rosie's Ranch, we dream of providing a therapeutic, family-centered, authentic western atmosphere where, by engaging with horses, children with deafness or other oral language hurdles will expand verbal, listening and reading skills."   How Cool!!! 

Carol Flexer - It's All About the Brain (Part 2)

Here's part two of my mini-notes.

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• Sound field device is a strong teaching tool.
• FMs need to be programmed to the individual child by the audiologist with sound room testing and listening in the classroom. All that is at stake is their brain.
• +6dB is what adults require to hear in noise. Twice as loud as background sounds. 
• 10 times louder is required by all children +15-20dB
• Most classrooms have inconsistent SNR. Proximity to speaker does not work alone.
• Six year olds can't navigate like a 50 year old.

Carol Flexer - It's All About the Brain (Part 1)

Had the opportunity this weekend to spend some time with Carol Flexer at the Aurora Leadership Center where she came to speak to parents and professionals about hearing loss. We've promoted her book Children With Hearing Loss: Developing Listening and Talking Birth to Six in our Amazon list since we started this blog and it was nice to finally meet her and get some first hand teachings and insights. 

 

She spent two days presenting on a variety of topics - all relevant, engaging, and spot on to our hearing journey and others. Can't recommend enough to see her speak if you get the chance (She'll be speaking the AG Bell Conference we mentioned last post). 

Anyway, here's a series of mini notes I took during the sessions.

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Speech Sounds We're Working On

Lily's speech is very clear.  To a familiar listener, there is not much you can't understand.  However, there are a couple of speech sounds that are not quite there yet.  While they seem to all be developmental, there's no harm in starting to work on them now as Lily approaches her third birthday.

Phoneme and Age of Acquisition for Females

/k/ - (kite) - Age 3.6

/g/ - (girl) - Age 3.6

th (voiced) - (the) - Age 4.6

/l-/ - (Lily) - Age 5

/-l/ - (shall) - Age 6

th (voiceless) - (breathe) - Age 6

Speech Summary Report

Wanted to post part of our private speech therapy report from March 30.   Although this report is only six weeks old, Lily's speech continues to change rapidly. 

Lily has improved her ability to follow two part directions and auditory memory tasks though listening alone.  We will be expanding this goal to include three part auditory memory tasks and two step directions with early concept words and prepositions.  During times of breakdown through listening alone, Lily typically needs only repetition with visual cues to follow through appropriately.  She responds well to clues that help lead her to the correct answer. 

Her expressive language continues to develop nicely.  She participated in formal assessment this quarter using the Cottage Acquisition Scales to look at her syntactical development.  Lily demonstrated 80% correct use or better of the following grammatical markers: present progressive -ing, plural-s, possessive-s, use of subject and personal pronouns (I, you, me,he, etc), possessive pronouns, negative forms (no, not, don't can't), variety of wh- questions, and beginning spatial concepts (in, on).  She also showed the following forms that appeared to be emerging at this time: use on uncontractable "to be" verbs (is, are), contracted is/are, past tense-ed, use of can and do in question form, irregular past tense, and spatial prepositions (under, above, behind).

In addition to working on her expressive and receptive language, we've also targeted her auditory skill development this quarter.  Lily has improved in her ability to discriminate words though listening alone that differ in only one feature.  We've focused on words that have sounds that differ only in their place of articulation (pat vs cat).  At last data collection, she was able to discriminate these types of words with 100% accuracy, a huge improvement from last quarter in a closed set of two. We will continue to work on this level of discrimination in larger sized sets. 

Ling 6 Test - Iphone/Ipod App

Here's a new Iphone/Ipad application to test the Ling 6 Sounds

This app creates a quick, easy and fun way to check and see that a child detects those sounds that lie within the speech spectrum of hearing and can be used daily to insure that cochlear implants are functioning properly.  In the "old days" we used a big bag of toys. 

Great Idea!!!

IEP Goal Bank

Here's an IEP Bank full of ideas on writing language and listening goals for kids.  As Lily approaches three this summer, we are starting to think about this transition. 

Princess Time at the SLP

Last summer, we switched SLPs to work with Beth.  It was a hard decision, but one that turned out to be terrific.  Beth is very organized, strategic, creative and engaging.  She can always keep Lily's attention and comes up with so many wonderful activities.  Beth is continually looking for speech, language or listening gaps to focus on in fun ways. 

Last week, Lily got to pick a costume, before they read their book.  Of course it was a princess.   A crown always makes reading easier. 

IFSP Goals - 2.6 years old

Here are Lily's latest IFSP goals at 2.6 years old.  

Lily will demonstrate increased listening/auditory skills by:

1) Showing recognition of a song, nursery rhyme or finger play being sung or stated by pointing to the correct picture or object (given a set of 6-10 pictures or objects) with different voices presented taped or live.

2)  Showing understanding of verbal messages presented at greater distances (6 feet, 9 feet, other rooms)

3)  Identifying a word/phrase or sentence stated by her teacher or parent (given a set of 4-8 pictures or objects)

4)  Self-advocating when her CI is not functioning or she does not understand a verbal message.

5)  Identifying an object from several related descriptors in open-set tasks. 

Lily will demonstrate increased understanding of language by:

1)  Following 10 directions containing 3-5 critical elements.

2)  Showing understanding of "First, next, last" when given directions/requests.

3)  Answering basic /wh/ questions about short stories that have been read to her.

4)  Showing understanding of negation (not, didn't, don't) and preposition (around, beside, over, etc.) in directions given to her.

Lily will demonstrate increased expressive language by:

1)  Increasing the mean length of her utterance and the complexity of her language in two spontaneous language samples collected over the next six months.  

2)  Using the following syntactic elements in two spontaneous speech samples:  adjective + adjective + noun is verb+ing, simple and past tense -ed verbs, five irregular past tense verbs, articles, conjunctions, negatives, words marking time and quantity, use of "who" and "why" question forms, answering "where questions using prepositions (e.g. in, on under, over, around, behind.)