2. TROCA-tangible reinforcement operant
conditioning audiometry
•TROCA is a highly structured testing
approach originally described for use with
difficult to test patients , such as those with
developmental disabilities.
•Difficult to test is a general term used to
mean those who cannot be readily assessed
with conventional behaviours tests.
3. So that special methods are needed,
-patients may be difficult to test due to physical ,
developmental, perceptual, cognitive, emotional, or
others problems ,or to any combination of these
factors.
-approaches like TROCA , which were developed
for the difficult to test ,are also effective with
normal , young children.
-upon hearing a tone(or other test signal),the child
is required to push a response button or to make
another simple but specific motor response within
his range of neuromotor capabilities.
4. -Correct responses are rewarded by tangible
reward , which might be corneal , candy,
tokens , and other small trinklets .
- False positive responses are discouraged
because they are followed by time out periods.
- the periods procedure is accomplished with
instrumentation programmed to present the
stimuli , monitor the responses , and deliver
the reinforcers according to a predefined
operant conditioning schedule.
5. -Conditioned play audiometry, or play audiometry,
involves training the child to listen for stimuli and
then make a specific motor response within the
framework of a game, usually in combination with
social reinforcement such as smiles, praise, etc.
-Conditioned Play Audiometry (CPA) is a hearing
test designed to access the hearing for very young
children between the ages of 2 and 5 years old.
6. Purpose
Assesses hearing ability using conditioned responses
to sound by engaging in play oriented activities.
Test room setting
-For many children testing is most easily
accomplished using two testers in a two-room test
setup.
-One audiologist will present test stimuli from the
control room and the audiology assistant will work
with the child in the test room. This two-room test
procedure is especially important for soundfield
testing.
7. -When earphone testing is being performed, it is
possible to have one tester sit next to the child in
the sound room and act as both tester and test
assistant.
-In a one-tester situation, it is difficult to test
hearing in the soundfield. If there is only one tester,
and if there is concern that the child will not accept
earphones immediately, it is possible to train the
child to perform the listen-and-drop task before the
earphones are placed on her head.
8. -Put the earphones on the test table near the
child and set the signal to a loud level that the
child can be expected to hear based on previous
observations.
-Then train the child to perform the play
audiometry task. Once the child is responding
reliably, place the earphones on her head and
proceed in the usual way.
9.
10. -Play audiometry employs two clinicians who
communicate by intercom and visually through the
window between the control and test rooms.
- One of them operates the audiometer and the
other stays with the child. The child is generally
seated at a small table, which is the play surface,
either next to or opposite one of the examiners. A
collection of games should be kept on hand so that
when the child gets bored with one activity you
can quickly and smoothly replace it with another.
11. -Keep the backup games out of sight so they do
not distract the child from the task at hand. If
accepted by the child, earphone testing may be
attempted at the start, or at least as soon as
possible.
-Some children accept earphones immediately. In
other cases, getting the child to accept earphones
is a challenge in which the audiologist's personal
"way with kids" comes to the fore.
12. -Earphone acceptance is sometimes facilitated if
the clinician first puts on her own headset
(which houses the intercom and permits her to
monitor the test signals).
-A reasonable amount of good-natured firmness
and confident tenacity often works, but keep in
mind that "winning" means getting the child to
cooperate sufficiently that valid and reliable
audiological information can be obtained,
13. -which will not happen if he is crying hysterically. If
earphones are simply out of the question, then in
the most matter-of-fact manner try the bone-
conduction vibrator or insert earphones.
-If all reasonable attempts fail, simply place the
headset on the table where the child can see it,
and start the test in the sound field.
14. Choosing the test stimulus
If a child responds to speech (e.g., if the child
answers when called), it may be best to begin with
a speech stimulus. The easiest speech utterance
may be the command "Put it in." The child will
understand the verbal command and learn the
task easily. Use of a speech stimulus will provide a
speech awareness threshold but will not give any
frequency-specific information.
15. -Once the child is conditioned to the listen-
and-drop task, change the stimulus to tones or
narrowband noise to obtain an audiogram.
-If the child displays some developmental
concerns, such as autism, PDD, or multisystem
developmental delay, the child may not
respond to speech stimuli. In that case, testing
should begin with tones, noise bands, or music.
16. Results
This test is usually performed under ear phones
to obtain ear- and frequency specific
information about hearing ability. Results will
assist to define the nature and degree of hearing
impairment.
Limitations
Results obtained may sometimes vary with the
child's developmental level.
