The service descriptions provided on this and the other service description pages are intended to give a general overview of the service. They cannot go into every detail of each of the services.
Audiological (Hearing) Evaluation
A comprehensive audiological evaluation includes several tests of the auditory system. A measure of hearing sensitivity is conducted in a sound calibrated room, through earphones. An individual will be given pure tone stimuli that assess hearing sensitivity at various frequencies. The softest intensity that the person responds to (threshold) will be plotted on a frequency-loudness graph called an audiogram. The hearing test also include measures of word recognition (speech discrimination) ability. Other tests assess movement of the tympanic membrane (tympanometry), middle ear muscle tests, and otoacoustic emissions, the latter comprising the minimal test battery. An audiological evaluation provides information as to whether an individual has normal hearing sensitivity or if there is a hearing deficit. Results of the hearing test can provide information about whether the loss is due to mechanical involvement of the middle ear structures (conductive hearing loss), of it it involves the cochlea, auditory nerve (sensorineural hearing loss), or whether there is the possibility of auditory processing disorder (APD).
Individuals with hearing loss have communication difficulties. Aural rehabilitation involves working with the hearing impaired individual and their families to provide an understanding of: a) how one’s hearing loss impacts communication, b) how the hearing loss affects interaction with family, friends and colleagues, and in different settings, c) how family and friends can more effectively communicate with individuals who are hearing impaired, d) strategies and communicative approaches that are most beneficial for improving communication, e) suggestions for the use and care of hearing aids, and such. In some cases, the use of assistive listening devices will be considered to enhance communication. Aural rehabilitation often involves significant others and may require their participation. In the case of hearing impaired children, this may involve developing strategies for family, educators and other professionals who interact with the child.
Auditory Processing Disorder (APD) Testing / Central Auditory Processing Testing
An auditory processing disorder (APD) is a condition in which an individual has normal hearing sensitivity but has difficulty comprehending or understanding spoken language under unfavorable listening conditions. In some cases, those with hearing loss may also have APD. Following are some of the more common symptoms associated with APD:
- exceptional difficulty hearing or discriminating speech in noise,
- easily distracted by noise,
- trouble following oral language conversations,
- problems understanding the speech of individuals who speak indistinctly or who have accented voices,
- difficulty staying focused while someone is speaking,
- is identified as “not listening” or of being a “selective listener” (also called husbanditis ;-),
- has difficulty learning phonics, learning to read, or with reading comprehension,
- speaks with a loud voice,
- has difficulty understanding telephone conversations,
- is identified as being a “poor auditory learner”,
- has a history of repeated otitis media (middle ear disease such as infection or fluid)
APD tests can be administered to children and adults who exhibit these symptoms. Some tests are appropriate for young children but if formal APD tests are not appropriate due to immaturity, informal auditory tests and auditory-language tests may help to identify the possible presence of APD. In the latter case, testing may be recommended when the child is able to do the tasks. Other children may be referred for special electrophysiological tests. For more information go to Maxine’s CAPD White Paper (Recognizing and Treating Children with Central Auditory Processing Disorders). To determine if there is APD, a battery of tests is administered that includes auditory-specific tests that use tonal stimuli, as well as behavioral, auditory language tests. All referrals for APD testing will include a Comprehensive Audiological Evaluation. Checklists that can be completed by parents, teachers and therapists are available. These may be used to help screen prior to doing APD testing. These may be used as screening instruments prior to doing APD testing.
Fast ForWord Training
Children, adolescents and adults who have problems with auditory processing, language processing and/or reading problems may be candidates for Fast ForWord training. These are CD-ROM, auditory-language training programs that were developed based on the research of four of the nation’s leading neuroscientists. Clinical field trials were done on 500 children from across the nation with results that were even better than the results reported from the research laboratory prototype of Fast ForWord. These intense programs can be done in the child’s home, using PC or Mac computers, and have the ability to improve auditory processing, language processing, and APD-related reading skills by 1½ to 2 standard deviations, following the 4 to 8 week training.
- Fast ForWord Language and Fast ForWord Middle School/Adult, are the training programs that utilize algorithmically processed speech signals available to synchronize neurons in the auditory cortex that are responsible for the following: a) processing rapid spoken language, b) processing speech in noise, c) discriminating subtle acoustic differences in sound such as /p/ and /t/ or /b/ and /d/, that contribute to both processing spoken language and learning to read. Fast ForWord Language uses enticing graphics and less complex language stimuli that are appropriate for children with mild to severe auditory and language processing disorder. Fast ForWord Middle School/Adult uses the same algorithmically treated stimuli but has graphics that may be more appealing to adolescents and adults. Fast ForWord may be appropriate for certain left hemisphere neurologically impaired individuals such as those who have had strokes, head trauma, or CNS pathology. It has also been used to help children who have cochlear implants. Very young children who have auditory language difficulties may require the use of Fast ForWord Basics to prepare them for Fast ForWord trainings.
- Fast ForWord Language to Reading is an advanced auditory training program that not only has the potential to improve APD, but includes the use of short vowel CVC (consonant-vowel-consonant) stimuli that was developed to improve word reading fluency, word reading automaticity, short vowel discrimination, processing speech in noise, listening and language comprehension, verbal working memory, and auditory attention.
- Fast ForWord Basics is a preschool software program that can be used to improve a young child’s pre-reading, listening, and computer skills. Exercises help the child learn basic colors, shapes, following simple to more complex directions, auditory vigilance, auditory attention, alphabet naming, lower and upper case identification, and click and drag skills. This software not only provides essential pre-school skills but can be used to prepare a child to do the Fast ForWord Language training program. Fast ForWord Bookshelf is a series of beautifully illustrated and delightfully written children’s books on CD that use algorithmically treated speech, which in combination with Fast ForWord Basics can help improve speech-to-print awareness as well as listening comprehension, appreciation of rhyme, and story retelling. These two software programs can be individualized for your child depending on his/her needs and abilities. They can be done at home on a PC or Mac computer and may be done as a supplemental program to language therapy.
Fast ForWord Candidacy Evaluation
Processing test battery, conducted in a sound proof room under headphones, are used to determine if an individual is a candidate for Fast ForWord auditory-language trainings. In addition to determining if APD is present, selected tests of language processing, working memory, and/or reading assessments may also be included. These test results, in addition to information about the child’s academic performance, listening profiles, and APD screening checklists will be used to determine if Fast ForWord training is indicated, which Fast ForWord training is most appropriate, or if both trainings should be considered. Fast ForWord Reading is a supplemental reading software program for elementary aged children who are reading at least on the 3rd grade level. This software reading program may be appropriate for some children who do Fast ForWord, depending on the child’s academic profile and reading ability
Otoacoustic Emissions Testing
Advancements in auditory assessment have produced a test that assesses the outer hair cell function of the cochlea (the end organ of hearing). An Otoacoustic emissions (OAE) test is an electrophysiological test whereby the stimuli are generated by and the responses obtained automatically by audiological test equipment bypassing the need for voluntary patient response. It is a routine test procedure and part of the minimal test battery for all hearing tests for children and adults. Results can be obtained whether a child is awake or asleep as long as they are in a quiet state. Used in conjunction with other electrophysiological tests, OAE measurements can assist in determining the functional status of the auditory system. While it is not a test of hearing sensitivity, OAE tests are helpful in determining the integrity of the auditory system in babies and children or anyone who is unable to participate in behavioral audiological evaluations.
Results may be used to rule out disorders such as auditory neuropathy (AN). The latter is a rare condition in which the cochlea has normal function but transmission of the auditory stimuli is significantly disordered as they travel into the auditory brainstem affecting language comprehension and listening ability. Individuals with an usually act as if they are deaf, and have severe communication deficits and language delays, even though they have normal hearing sensitivity. In rare cases, the condition may be unilateral affecting only one ear, or be less severe, and have a lesser degree of communicative impairment. Less severe AN may contribute to symptoms of auditory processing disorder, even though the two disorders are in fact different. Any child with a significant delay in speech and language development not only needs to have their hearing tested, but needs OAE testing as well.
Tympanometry is an electrophysiological test that is used to determine if there is abnormality in the middle ear system. This system includes the ear drum (tympanic membrane), the ossicles or three tiny middle ear bones, and their mechanical ability to conduct sound into the cochlea (end organ of hearing). A probe, placed at the entrance to the outer ear canal, generates tonal stimuli and varying degrees of air pressure that automatically registers middle ear mobility and function on audiometric equipment. This is one of the three minimal procedures used in assessment of all who require hearing testing and can be used in conjunction with OAEs to help rule out auditory neuropathy. Since middle ear disorders (fluid behind the ear drum, middle ear infection, movement of the ossicles, etc.) are more common in babies and children, the electrophysiological test is useful and does not require the child (or adult) to volunteer a response.