Auditory Therapy: The Missing Ingredient


By Dan Schwartz and Anne S, with an extensive comment by Jane R Madell, PhD

February 24, 2012 Update: Added free pediatric resources from John Tracy Clinic, with corrected links~

Often, the missing ingredient for many hearing impaired people is auditory therapy, or (re)habilitation (AR), especially for those who are sold hearing aids for mild to moderately severe hearing loss. AR is typically given along with speech therapy for hearing impaired children, and is especially important in the first three years as the regions of the brain that process auditory and visual information overlap: With a hearing impaired child, the natural tendency is for them to use the “easier” means of visual and manual communication — sign language — which will “crowd out” auditory development.

For teens & adults, AR is also sometimes included at some of the 250 CI centers in the US (you pay your dues and you take your chances); and at all 21 CI centres in the UK.

The John Tracy Clinic, one of the finest pediatric audiology centers in the world, now has three free Distance Learning for Parents Courses, which can be taken  mail or now turbocharged by the Internet, online anywhere in the world.

  • Mini Course: Designed for use by families in the first few years after identification of their child’s hearing loss, this course summarizes initial information, provides considerations for decision making and gives suggestions on support. It has separate sections about hearing loss, communication and parent roles. Extended learning ideas help parents recognize what they know, consider how they feel and identify steps they wish to take.
  • Baby Course: Geared toward infants and toddlers (i.e., birth to two), this course discusses early hearing loss, infant-toddler development, parent-child communication and learning through play. Suggestions are given for emphasizing communication through natural routines. Parents can choose specific ideas to encourage beginning language and auditory learning.
  • Preschool Course: Developed with preschoolers in mind (i.e., ages two to five), this course provides parents with tools to foster language growth and facilitate family interactions. Modules discuss communication, thinking and social development. Suggestions are given for activities to encourage language, listening and speech. Parents choose ideas that fit their child’s developmental level and their family’s current concerns.

These self-paced lessons are available at no cost to parents; and are available online or through the mail. Parents receive family friendly information with fun activities; and then submit report forms with their comments. Also, individualized encouragement and personalized correspondence from experienced parent educators is sent by the Clinic via web or mail. We at The Hearing Blog  recommend these courses for grandparents & caregivers; and strongly recommend them for both parents of hearing impaired infants and children: Click this link right now to register. Now, not tomorrow or later today: It’s that important.

 Well-respected University of California-San Francisco (UCSF) audiology professor Robert Sweetow has the very good Neurotone LACE Listening Program AR (auditory therapy) DVD and Web based program with many dozens of exercises. I have received good reports on LACE from audiologists, including one who dispenses hearing aids and includes it in her package. There are samples of each of the exercises you can download on the Neurotone website;

 There are additional resources from the cochlear implant (CI) community available for auditory therapy available for free from Advanced Bionics and for a fee from Cochlear

  • Advanced Bionics has The Listening Room as part of their “Hearing Journey” website, with a number of environmental sound, speech, and music exercises. Although they may seem simple for people with mild to moderately severe hearing loss, they still nonetheless can be quite helpful as a “reality check;”
  • MedEl has a number of AR packages available for both purchase, and also complimentary web-based and downloadable SoundScape exercises. Download the Bridge PDF catalog for an entire listing of their AR pacages & materials for all ages;
  • Cochlear Americas has their extensive HOPE program which consists of their Sound and WAY Beyond and HOPE Notes software. To see how HOPE Notes was created by Providence RI musician Richard Reed, click here to read an interview of him by AudiologyOnline Editor Carolyn Smaka. If you are .NOT. in the Americas, i.e. in the EuroZone, Australia, or elsewhere, please click here and select your region and country from the map. Also, your CI centre may supply you the Sound and WAY Beyond &∓/or HOPE Notes software to supplement your auditory (re)habilitation program, as this will vary by country — Some — Like UK — provide much better post-implant rehab services than we receive here in America.

If you don’t believe me that it can really suck here in the US, see the next item…

 Underscoring the importance of what happens when AR is not done, one need only watch the superb and touching HBO documentary Hear and Now, as filmmaker Irene Taylor Brodsky accidentally documents what happened when her parents did .NOT. get the AR they needed. From my detailed Movie Review on the Amazon.com Hear and Now page:

I strongly recommend this movie for anyone who already has a cochlear implants, prospective CI candidates or parents of kids with CI’s; and also all Audiologists, whether practicing or are studying to become one, as filmmaker Irene Taylor Brodsky accidentally documented two avoidable CI failures, with Sally’s worse than Paul’s.

Watch the movie twice: The first time, just sit back and enjoy the story with your entire family, as any member of the viewing public would do so, as that alone rates a good Four Stars. But then, watch the second half again, from the implant surgery forward through 1st stim and subsequent MAP’s to the end.

Notice something missing?! HINT: Sally Taylor has personally told me this is the most common question asked at film screenings.

—> WHERE IS THE FOLLOWUP AUDITORY THERAPY? <—

That’s right, Paul and (especially) Sally were victimized by their CI center, with poor quality 1st stim, followup MAPs, and the total *lack* of auditory (re)habilitation. This is a superb documentary of an absolute, miserable #FAIL by the Audiology profession, *especially* in Rochester, NY, which has 90,000 deaf residents — The highest concentration in the world. In fact, both Sally and Paul are retirees from NTID (National Technical Institute for the Deaf; one of eight Colleges at RIT), so it’s not like deafness is an unknown quantity among the healthcare profession in the area.

If you already watched the edited version on HBO, buy the DVD anyway as it has an additional 20 minutes that didn’t make the cut, mostly of booth testing… But it’s worth it to those to both groups — Hearing healthcare professionals and hearing impaired patients & their families.

I very strongly recommend this film for any and all in the hearing healthcare industry, as it clearly demonstrates how auditory rehab is critical to patient success; and what happens when professionals #FAIL to provide adequate followup care.

I also strongly recommend this film to any and all members of the hearing impaired (hard-of-hearing, deaf and Deaf) community, as well as to their families.

Please see my detailed review on the Amazon.com Hear and Now page for a more extensive discussion of the importance of Auditory Therapy

•  The John Tracy Clinic also offers intensive three-week On Site Family Summer Sessions for children with hearing loss 2 through 5 years old and their families worldwide are offered at the John Tracy Clinic (JTC) campus in Los Angeles. Children attend a spoken language preschool designed to identify their strengths and needs. Parents participate in an education program to learn about hearing loss, auditory-verbal techniques, emotional support for families and educational services for their children.Specialists provide audiology, counseling and consultation services to children and families. Summer sessions include a(n):

  • Auditory-oral preschool program
  • Comprehensive audiological services
  • Daily intensive parent education classes
  • In-depth speech-language assessments
  • Parent support groups led by trained counselors
  • Recreation programs for brothers and sisters, grades 1st through 6th

Summer services are offered free of charge as are all other family services at John Tracy Clinic. To learn more, read the Overview page, read a first-hand account written by a parent, or download a one-page informational PDF. Enrollment applications and answers to general inquiries can be obtained by calling 1-800-522-4582 or emailing pals@jtc.org. ~Dan Schwartz, Editor


Some of the listening practice stuff that I do… I have worked 1-on-1 with the CI program audiologist for an hour every week for most of the past 3 years; but many of what I’ve done are exercises you can do on websites like some of the ones that I have listed below, and some things with a friend or family member… And you don’t need a special sound-proof booth to do these. People often ask how I have improved so much with my level of comprehension of speech with my ABI, and I usually say that I’ve practiced a lot; but people say, “what do you mean by that?” How do you practice listening?” With the ABI [Ed.: Auditory Brainstem Implant], it’s kind of like you have to learn how to hear again, because as a baby you learned how to hear naturally, but now I needed to learn those sounds are not the same as they were before, and fit things together like its a big puzzle. I don’t understand everything with the ABI, but I do understand a lot. [The other day, I talked to my mom on my cell phone for 15 minutes and understood mostly everything she said!]

Here are some of the things I use for listening practice, for my fellow ABI user friends…. (I tried to only tag people who’ve gotten ABI or CI in the past few years, or might be getting one soon… And people who just think that robot ears are awesome!)

SUGGESTION: Keep a record of scores on the online listening quizzes and games, then do the same one in a few months or next week and see if you can improve your scores;

LISTENING STORY/CONVERSATION ACTIVITY: Get a family or friend to try to talk with you while holding a piece of paper (or thin fabric, which works better) in front of their face. It can be challenging but when I started doing that, it was just sounds really. I’ve progressed to being able to have pretty clear conversation, or repeat back person reading a story — Read a sentence, pause, listener repeats… etc.)

PHONE ACTIVITY WITH SOMEONE: Practice talking on the phone by calling a friend or family member (whom you know the voice of well) while they are in another room of the same house/apt/building. Try planning the call by making a list of what you will talk about. Example: You ask them a question about what they did this weekend, and they answer, then you confirm if that was what they said. Strategies include: Ask for spelling of words that you get stuck on (and I found it helpful to sometimes try using the military code alphabet letter list which you can switch some around on or make your own but you need 2 copies of same thing. A = Alpha, B = Bravo, C = Charlie… so if the word you didn’t understand was, for example dog, they can say “D – Delta, O- oscar, G-golf”), ask for something that is unclear to be rephrased, or repeated (but if 3 repeats don’t work, try spelling or rephrasing).

PHONE ACTIVITY ALONE: And try listening to the words and stories on here: 1-800-458-4999 – Cochlear Practice telephone recordings, which can be viewed here. There are new recordings every day. If you get bored of the fairy-tales, there is some pretty interesting different ones, usually on the weekends, like such as the time line of Abe Lincoln, Dr Martin Luther King Jr’s “I have a dream” speech, Robert Frost poems, Cochlear Implantee success stories, and more.)

OTHER ACTIVITIES: Lots of great stuff from the home page of the ManyThings.org links here and here. Play around and find what you like. The “minimal pairs” sound comparisons are great; or go to the home page of this site and try the “easy activities/games for beginners.”

  • www.elllo.org has a lot of listening activities at various levels here, here, here, and here. Most of them are geared at foreign students learning English, but its a great site.
  • There are also a large number of listening practice selections available through the TalkEnglish.com website
  • Free music online at www.GrooveShark.com , LOL. [Editor's note: This website uses the very latest browser plug-ins, which can at times cause computer lockups and crashes.]
  • The Grammar Girl: Listen, and you can read it too, but this one is really boring, I thought. My audiologist said she thinks this changes each week, but this particular link is new to me, so I’m not sure yet.

~Anne S., Auditory Brainstem Implant user

 

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About the author

Dan Schwartz

Electrical Engineer, via Georgia Tech

20 Comments

  1. Sue
    January 27, 2011 at 8:41 pm

    I was totally turned off by your first paragraph. Not just because you use the term “hearing impaired” over and over which is offensive and demeaning, but because you try to devalue the use of sign language by stating that it “crowds out” auditory development. This statement is NOT research based nor is there any scientific proof that this occurs. It’s ironic you acknowledge that sign language is the natural tendency for deaf and hard of hearing and it is an “easier means of visual and manual communication” and yet you put oralism above manualism. Even worse is that you are not valuing both…sign language and English (spoken and written). This is the problem….a one way approach meaning speaking and listening ONLY without sign language. No wonder so many deaf and hard of hearing children are language delayed. My opinion is that AV alone “crowds out” language development.


  2. Charles Wildbank
    January 30, 2011 at 10:41 am

    @Dan…. great resourceful page! Thanks so much for this. I agree on the auditory followup. I’ve been profoundly deaf since birth and got much auditory support during my developmental years and still continue to improvise my own auditory training. You just got to WANT to. However, since my CI implantation 2 years ago, I had comfort issues on threshold levels so was not able to wear the CI all of the time. My ear would tell me time out, time to remove the CI as fatigue set in often. I am happy to say that this year, my CI ear has opened up and ALLOWED sounds in more. I listened to many of my iPhone apps via headphones on T-Coil like YouTube, Quick Record, iPad and all the other wonderful auditory opportunities that go with the iPhone.

    About the HOPE cd, I was not too pleased with the skimpy lessons. It belongs in an audiologist library and in no way can work unaided by a professional and without a more detailed, step by step. The Hope offered no hope, sorry to say that. It needs work. A good idea though, but lacking in many stages for win-win study.

    @Sue… mind you, Dan is also deaf. He has nothing against sign language. He seems he struck a nerve, but yes, you can do BOTH ASL and auditory development, out of your CHOICE. There is nothing wrong with the integrity of what Dan is offering here. He is offering RESOURCES, for your picking or not, but not to pick on. I do both oralism and total communication as I please. It depends on the person. If you are protecting a culture or the feelings of the deaf individual, what we can do is EMPHASIZE allowing diversity with respect and yet encouragement on the choices the individual does make. I like to feel supportive of everyone over their choices by allowing and making it okay to make the choice that is best suited for trial or adoption. We all learn and we are for the better in this type of climate of allowing. Dan to me is of the allowing kind. He will grant anyone who comes to him what they need and if he detects that something should be mentioned, he will enlighten one with observational facts that may help the person end up with an even better and educated choice. I wind up knowing a lot more than I did after I close a conversation with Dan. He is really there to help and he would not put you down if you disagree on anything.

    I agree with you Sue, that ASL is great for everyone and because of its multisensory properties, it boosts one’s intelligence at such a young age. So, let’s continue to encourage sign language for all, even animals. Animals astonish me too! We are just not offering the beneficial opportunity of sign language in all the classrooms of society. I am behind you on this. I am sure Dan is too. He also knows that auditory training DOES enhance your quality of life, and again it should never replace sign language training at young age. It’s about fostering super-intelligence through multi-linguism. As for “crowd out” auditory development, it is an unfortunate choice of words in a short blog. That is what can happen, when auditory development is not in your educational program. ASL and auditory can be two different programs, yes, and ultimately, listening can catch up while the visual skyrockets. Not everyone is doing this. Just know it CAN BE DONE. I am doing both myself. When one reaches a certain maturity, one approaches mastery. So go ahead, encourage everyone to be the best they can be, without pressure. If the European and Asian kids can speak several languages so can we on this side of the world.

    Big thumbs up for both Sue and Dan.


  3. Jane Madell
    January 30, 2011 at 1:05 pm

    There is a lot of evidence that indicates that there is a window of opportunity to learn to use hearing. The research of Shama and Dorman shows that auditory brain development is accomplished before age 7 or is difficult to accomplish. The extensive Moog and Geers study also shows that children who learn to use hearing early have significantly better skills, including reading, than children who do not learn to use hearing. One reason for this may be that English and ASL have different grammars so if a child is using ASL as their basic language they are communicating in a different language than the one used for reading. The words may be similar but the word order is not. It would be difficult to speak English at home and try to learn to read Italian. They are different languages. Same with spoken English and ASL. This is not to say that ASL is a bad thing but it is important to understand the effect of using ASL on academic skills. The research on brain plasticity is extensive. It is accomplished best in the first few years of life. My experience as a pediatric audiologist for more than 40 years has convinced me that if we do not fit appropriate technology and provide appropriate therapy to kids in the early years, giving them auditory information later in life, even in teen years, is not successful. I have seen too many disappointed families when kids who had not been taught to use hearing got CI’s [cochlear implants Ed.] as teens and could not use them. On the other hand, kids who had hearing aids and auditory therapy, even if they were struggling, do learn to use CI’s when they get them later. On the other hand, after developing auditory skills, kids can learn to sign and then have use of both systems. Unfortunately, it does not work the other way around. if it did, things would be easier. But it does not work.


  4. Leah Demeter
    January 30, 2011 at 8:25 pm

    It’s unfortunate that people are so stuck on labels– deaf, Deaf, hoh, hearing impaired. Why the word “hearing impaired” is seen as offensive and demeaning is beyond me. In my view, someone is hearing impaired when aided with hearing aids or a cochlear implant, but does not have perfect hearing. I call myself hearing impaired and prefer that people don’t call me deaf. But I do not want to dwell on silly labels in this post.

    Sue, I don’t know where you get your evidence, but there is plenty of positive evidence of people who are thriving in the mainstream by taking the auditory approach like myself. And plenty of other people that I’d be glad to introduce you to. Some of them were born profoundly deaf, were fitted with hearing aids and cochlear implants, had intensive auditory-verbal therapy, were raised in the mainstream, went on to Ivy League schools, and are very successful in their careers. AVT opens a world of opportunity and allows them to lead independent lives. There is scientific research also. In fact, a study was just published in Fall of 2010 in The Volta Review that proves auditory-verbal therapy provides positive speech and language outcomes. So no, AV alone DOES NOT “crowd out” language development.

    About this particular study conducted by Donan, Hickson et al, a group of children in an AVT program was compared to a group of children with typical hearing (ages 2 to 6 years at start). The study ran assessments over the course of 50 months for speech, language, reading, mathematics, and self esteem. It reported no significant differences between the groups for speech, language and self-esteem. It concluded that auditory-verbal therapy is effective for children with hearing losses.

    Auditory rehabilitation is the most important component for patients to learn the new sounds and to realize the full benefits of their implant device. I don’t know if sign language is the “easy way out.” but it certainly limits communication with the larger world. And as Charles points out, the grammar between ASL and English is different, and my experience in meeting people who communicate only in ASL have broken English writing skills.

    There is another study that I read that shows that an infant brain begins responding to new pitch percepts by 4 months, so yes, the earlier the intervention process, the much better the child will be off in acquiring speech and language.


  5. auds and ends
    February 5, 2011 at 12:08 am

    This is an interesting change from your self-aggrandizing investigation and self-declared expose of the nefarious activity at Advanced Bionics, but I can’t stop being curious about why you were too cowardly to publish my previous comment regarding what I learned regarding your judgmental, negative comments about Deaf culture? What happened to your supposed belief in truth and transparency? Hypocrisy, I guess.


    • Supervisor
      February 12, 2011 at 9:09 pm

      @Auds and Ends: Truthfully, I may have missed your comment, as I get about 20-30 spam comments per day; and about 2-3 legit comments per week. Which article did you comment on?

      If you want to make sure it gets published, please email it to me at Dan@###, as I post all non-spam comments. (Email address mailed to you).

      ~Dan Schwartz, Editor


  6. Gigi Schleusner
    February 12, 2011 at 8:07 pm

    Nice post. I was checking this blog and I’m impressed! Extremely useful information particularly the last part :) I care for such information a lot. I was looking for this particular information for a very long time. Thank you and best of luck.


  7. Liz
    February 16, 2011 at 7:37 am

    This is good piece of information. With your permission, could I copy this post for Notts Hearing Loss forum, adding your link at the beginning of it, so that the forum users know its come from here, and they can then come here to read more. :)


  8. Mary D
    March 20, 2011 at 10:20 pm

    Nice work, guys!

    I am late deafened, but I consider myself hearing impaired because I could once hear, and currently hear with an auditory brain stem implant. I’m a little confused as to why that would be offensive, and feel that it is in no way degrading to me.

    Dan, you are a great source of information to all of us in the HOH/deaf community, and I appreciate your willingness to put yourself out there and collect valuable information for all of us that chose to utilize it. Way to go!


    • Supervisor
      March 21, 2011 at 2:43 am

      Mary, you’re making me blush!

      Thank you very much for the compliment: It’s kind words like yours that keep me going; but more importantly, it’s success stories like yours with your ABI that make it all worthwhile!

      People like you who are in the top percentile for understanding speech so well and so rapidly give hope to many others which have conditions beyond what cochlear implants (CI’s) can help — And not just NF2’ers, but other conditions like severely malformed, missing, ossified, or common cavity cochleas.

      The most important thing you can now do is to shout from the mountaintop (perhaps Clingman’s Dome?) that Yes, ABI’s work, and can work well: You give both sufferers of deafness and also parents of small deaf children true hope that they can hear… and understand.

      By the way, if you’re not a Member of the Cochlear Community, you should join; and if possible become an ABI evangelist, where you would travel to conventions and meetings to talk about your experience: You’d be great at that!

      ~Dan


  9. Supervisor
    March 21, 2011 at 2:15 am

    Liz, I’m not sure if I gave you permission before via Facebook; but yes, please do use this for the Notts Hearing Loss Forum!

    Is the Ear Foundation a member of your Forum, too? They do a whole lot of good work!


  10. Mann Laketa
    April 29, 2011 at 4:54 pm

    Mind you: This is just my initial opinion (haven’t read any comments)

    Interesting… not everyone would agree with some of its content, but it is understood and the points are valid. However, ASL can be beneficial in many ways. I don’t think it “crowds out” auditory development. I think there is a need for …BOTH auditory therapy and ASL in language development for the deaf and hard of hearing. I have no CI or ABI, I’ve worn hearing aids on and off throughout my entire life, and wouldn’t hear you talking unless I’m reading your lips. Adding to all of that, I speak well (not perfectly) for someone who’s profoundly deaf. I’ve gone mainstream with hearing children and turned out just fine, but there are still some missing links when a ton of deaf people don’t consider you as “one of them” because you know proper English or communicate differently. I am FOR DEAF schools because mainstream is HARDER – I will admit that, but my Englsih is intact. I want the DEAF SCHOOL to teach proper ENGLISH because it’s not fair to them, and that can’t be done without Auditory/Speech Therapy. Also, I’m currently learning ASL because I believe it will ADD to my abilities. What about those who don’t have ABI, CI, or hearing aids… auditory therapy may not work for them — but learning ASL could. Nice article btw. (Had to repost on my FB as well, because there are alot of closed minded people out there who don’t understand that the MORE YOU KNOW the easier it is…. and for the deaf – KNOWING how to speak your language is a BONUS)


  11. Laurel
    May 3, 2011 at 8:22 pm

    Great article. The very reason I kept my son away from sign language in his early years while learning to speak. And now that he is on target with speech we are ready to learn sign language.


  12. Anthea Sapon
    July 2, 2011 at 12:11 am

    Hi there,

    I hope that I’m not the cheeky ONE now :)

    I came across http://thehearingblog.com and wondered whether you might be interested in mentioning my blog dedicated to “English Speaking” up there?

    It is located here –> http://www.englishspeaking.org

    Thanks for looking into it!

    Sincerely,
    Anthea Sapon


    • Dan Schwartz
      July 2, 2011 at 2:18 am

      Good morning Anthea! I just looked at your blog, and indeed it is quite interesting: In fact, I just gave it a shout-out on my Facebook page :-)

      As for mentioning it, let me chew on this overnight: I try to keep The Hearing Blog content tightly focused.


  13. Sharla Enlow
    July 29, 2011 at 12:26 pm

    As a newly activated Envoy Esteem Implantee, the exercises listed here will really help me with SR. Thanks Dan for sending me the link to this article you co-wrote.

    [Editors' note: The Envoy Esteem is a fully implanted hearing aid; and will be the subject for an upcoming Hearing Blog article. DLS]


  14. Sarah
    March 26, 2012 at 6:10 pm

    This is a great post! Loved the video. I’ve been doing a lot of research the past week on hearing loss and the best two resources I’ve found is this post and the info on this hearing site.


    • Dan Schwartz
      March 26, 2012 at 6:42 pm

      Thank you Sarah for the kind words. Is it you who has a hearing loss, or a loved one?

      Dan Schwartz,
      Editor, The Hearing Blog
      Follow The Hearing Blog on Facebook

      Send me a Friend request on Facebook for my presence for Hearing & Deafness discussions


  15. Dan
    October 28, 2012 at 2:33 pm

    Also, please see The Expanding World of Sigrid Cerf
    Cochlear Implant Pioneer Advocates for Adult Aural Rehabilitation


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