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Management of Auditory Processing Disorders

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  • Has difficulties both at home and in school.
  • CHAPS is a survey performed by the Teacher/Educator. Goes from +1 (less difficulty) to -5 (cannot function at all) He was borderline at “Ideal” (quiet room, no distractions, eye contact) = Normal Worse at MEM – Auditory Memory Sequencing (recalling spoken info.) Teacher reported he did poorly in verbally based subjects and didn’t seem to understand auditory information.
  • Assess ability to integrate or separate out different auditory stimuli presented simultaneously to both ears. Provide information regarding neuromaturity of CANS.
  • Patients with lesions to aud reception centers on right or left side exhibit scores in mod. range in ear contra to damaged hemisphere. Ear Effect: Right Ear = 6; Left Ear = 21. Significant. No Sig. Order Effect
  • Frequency Pattern Test is valuable for detecting central auditory processing deficits in children with learning disabilities (Musiek, 1994). Tests of auditory pattern recognition provide info about the perception of suprasegmental cues in speech.
  • WRS by px w/ temporal lobe lesions are poorer in the ear contralateral to the lesion. Monaural low redundancy speech tests assess ability to understand degraded speech (speech in noise). Inconsistent with Findings!!
  • Tests selective attention (correct responses to stimuli) and sustained attention (maintain throughout testing).
  • ABR – Assess auditory pathways and brainstem functions. Should have been done first!! RGDT – Temporal deficits documented by poor performance on FPT, DPT, and RGDT Since he’s poor in the FPT, and normal in DPT – it would be helpful to include a 3 rd test (RGDT)
  • Right Temporal Lobe: Primary Auditory Cortex (Brodmann areas 41 and 42) Semantics in Speech & Vision Long-Term Memory (Hippocampus) Comprehension & Naming Right Parietal Lobe: Integrating Sensory Info. From different parts of body Multisensory Left Side Neglect
  • Chermak (2002) – Many behaviors of ADHD and CAPD overlap. Created a Chart for Behavioral Observations of ADHD vs. CAPD. Rate of Information Processing, Poor Memory, & Difficulty Discriminating Speech = Unique to APD.
  • Preferential Seating: 24% decrease in children’s WRS as speaker-listener distance doubles from 6-12 feet (Crandell, 1993).
  • APD Presentation

    1. 1. Central Auditory Management Project Holly Dircks & Tiffany Colon Auditory Diagnostics II
    2. 2. Case History <ul><li>9 Year Old Male </li></ul><ul><li>Report from Mom: </li></ul><ul><ul><li>Possibility of a TBI from a Young Age </li></ul></ul><ul><ul><li>Developmental Milestones Borderline or Delayed </li></ul></ul><ul><ul><li>Initially Reported No Positive History of CANS Involvement </li></ul></ul><ul><li>Report from Teachers: </li></ul><ul><ul><li>Poor School Performance in Verbally Based Subjects </li></ul></ul><ul><ul><li>Not Understanding Auditory Information </li></ul></ul>
    3. 3. Audiogram Results
    4. 4. Results Continued… <ul><li>Transient Evoked OAEs: WNL for All Frequencies Bilaterally </li></ul>
    5. 5. CAPD Test Battery
    6. 6. Children’s Auditory Performance Scale C.H.A.P.S.
    7. 7. Dichotic Digits Test <ul><li>*Bellis, 2003 (pg. 243) </li></ul><ul><li>Right Ear is Within Normal Limits. </li></ul><ul><li>Left Ear is Below Normal Limits for this Specific Test. </li></ul>
    8. 8. Staggered Spondaic Words <ul><li>*Katz, 1977 (pg. 12) </li></ul><ul><li>C-SSW </li></ul><ul><ul><li>Total & Ear Scores = Mild </li></ul></ul><ul><ul><li>Condition Score = Moderate </li></ul></ul><ul><li>A-SSW </li></ul><ul><ul><li>Total & Ear Scores = Normal </li></ul></ul><ul><ul><li>Condition Score = Mild </li></ul></ul>
    9. 9. Frequency & Duration Pattern Tests <ul><li>*Bellis, 2003 (pg. 252) for age 9;0 to 9;11 </li></ul>*Bellis, 2003 (pg. 253) for age 9;0 to 9;11
    10. 10. Low-Pass Filtered Speech *Bornstein et al. 1994 (pg. 263) <ul><li>Right & Left Ears are Within Normal Limits. </li></ul><ul><li>Inconsistent with What is Expected. </li></ul>
    11. 11. Auditory Continuous Performance Test *Keith, 1994 (pg. 30) <ul><li>The “Total Error Score-Fail” Criterion is 19 or More Errors for a 9 Year Old. </li></ul>
    12. 12. Summary of the Results
    13. 13. Strengths & Weaknesses <ul><li>DDT Right Ear </li></ul><ul><li>Duration Pattern Test </li></ul><ul><li>Low-Pass Filtered Speech </li></ul><ul><li>DDT Left Ear </li></ul><ul><li>SSW (Especially LEF) </li></ul><ul><li>Frequency Pattern Test </li></ul><ul><li>ACPT </li></ul>Within Normal Below Normal
    14. 14. Additional Testing <ul><li>Auditory Brainstem Response </li></ul><ul><ul><li>Assess Auditory Pathways & Brainstem Functions </li></ul></ul><ul><li>Random Gap Detection Test </li></ul><ul><ul><li>Performed Poorly in FPT; Normal in DPT </li></ul></ul><ul><li>Behavioral Observations on the ACPT </li></ul><ul><ul><li>Was the child fidgeting? </li></ul></ul><ul><ul><li>Moving around in chair? </li></ul></ul><ul><ul><li>Looking around, or distracted? </li></ul></ul>
    15. 15. Role of Professionals in a Multidisciplinary Approach
    16. 16. Role of the Audiologist <ul><li>Diagnosis of Central Auditory Processing Disorders </li></ul><ul><li>Provide an FM System on Trial Basis </li></ul><ul><ul><li>Decrease Signal-to-Noise Ratio </li></ul></ul><ul><ul><li>Enhance Speech Signal by 15-20 dB ! </li></ul></ul><ul><ul><li>Performed Best on “Ideal Condition” on C.H.A.P.S. </li></ul></ul><ul><li>Educate the Teacher on Classroom Modifications & Strategies </li></ul><ul><li>Within the Audiologists Scope of Practice to Conduct Auditory Training </li></ul><ul><li>Facilitate Referrals to Other Professionals </li></ul><ul><ul><li>Multidisciplinary Approach </li></ul></ul>
    17. 17. Role of the Neurologist <ul><li>Following the CAPD evaluation, the child was referred to a neurologist for an MRI to rule out a lesion in the CANS. </li></ul><ul><li>Results Revealed: </li></ul><ul><ul><li>Atrophy of Right Hemisphere </li></ul></ul><ul><ul><ul><li>Right Parietal Lobe </li></ul></ul></ul><ul><ul><ul><li>Right Temporal Lobe </li></ul></ul></ul>
    18. 18. Role of the Developmental Pediatrician <ul><li>A Developmental Pediatrician can make a formal diagnosis to rule out an Attention Deficit Hyperactive Disorder (ADHD). </li></ul>Chermak (2002)
    19. 19. Role of the SLP/Au.D. <ul><li>Role of SLP is to “Provide Differential Diagnosis of Language Processing Disorders from APD” (DeBonis & Moncrieff, 2008) </li></ul><ul><li>Refer to a Speech-Language Pathologist with Auditory Training Experience. </li></ul><ul><li>Super Duper Inc. </li></ul><ul><li>Can Work on Auditory Memory </li></ul><ul><ul><li>“ Go to the end of the hall </li></ul></ul><ul><ul><li>and pick up the red book.” </li></ul></ul><ul><ul><li>“ Go to the end of the hall </li></ul></ul><ul><ul><li>and pick up the red book & green hat.” </li></ul></ul>
    20. 20. Role of the SLP/Au.D. <ul><li>Poor Performance on the FPT Warrants Prosody Training </li></ul><ul><ul><li>Benefits of Music for Prosody Training </li></ul></ul><ul><ul><ul><li>Activates Many Regions of the Brain (Including Temporal & Frontal Lobes) </li></ul></ul></ul><ul><ul><ul><li>Enhance Attention, Learning, Communication, & Memory </li></ul></ul></ul><ul><ul><ul><li>Stresses Client’s Timing Skills & Temporal Patterning </li></ul></ul></ul><ul><ul><ul><li>Combination of Bottom-Up and Top-Down Processing </li></ul></ul></ul><ul><ul><ul><li>Very Engaging For Children </li></ul></ul></ul><ul><li>Auditory & Visual Attention (Poor Performance on ACPT) </li></ul><ul><ul><li>BrainTrain </li></ul></ul>Chermak (2010)
    21. 21. Role of the SLP/Au.D. <ul><li>Dichotic Digits Test (DDT) – Poor Performance in Left Ear </li></ul><ul><ul><li>DDT is Subject to Left-Ear Deficits </li></ul></ul><ul><ul><li>Child is Presented with a Story on Tape </li></ul></ul><ul><ul><li>Under Headphones (Presented to Left Ear Only) </li></ul></ul><ul><ul><li>SLP/Au.D. Monitors Story Under Their Own Headphones </li></ul></ul><ul><ul><ul><li>After 2 Minutes, Child is Asked Basic Questions about Story </li></ul></ul></ul><ul><ul><ul><li>Ex: “What color was his shirt?” or “Who was Arthur painting with?” </li></ul></ul></ul><ul><ul><li>Can Re-Administer the DDT Periodically to Assess Improvement </li></ul></ul>English et al. (2003)
    22. 22. Role of the Teacher <ul><li>Provide Preferential Seating </li></ul><ul><ul><li>Reduces effect of SNR, Distortion of Signal, & Reverberation </li></ul></ul><ul><li>Minimize Reverberation with Acoustic Materials </li></ul><ul><li>Minimize Visual Distractions </li></ul><ul><ul><li>Talking with hands & Very colorful decorations around the room </li></ul></ul><ul><li>Don’t Talk with Back to Child </li></ul><ul><ul><li>Maximize Visual Cues </li></ul></ul><ul><li>In-Service Training </li></ul><ul><li>Positive Reinforcement </li></ul><ul><ul><li>Encourage & Promote effort in listening tasks </li></ul></ul><ul><ul><li>Ask if they need repetitions, or have understood directions. </li></ul></ul>
    23. 23. References <ul><li>Bellis, T. J. (2003). Assessment and management of central auditory processing disorders in the educational setting from science to practice, (2 nd ed.). Thompson Delmar Learning, Canada. </li></ul><ul><li>Bornstein, S., Wilson, H., & Cambron, N. (1994). Low and high pass filtered Northwestern University auditory test No. 6 for monaural and binaural evaluation. Journal of the American Academy of Audiology , 5 , 259-264. </li></ul><ul><li>Chermak, G. (2010). Music and auditory training. The Hearing Journal, 63( 4), 58. </li></ul><ul><li>Chermak, G., Tucker, E., & Seikel, J. A. (2002). Behavioral characteristics of auditory processing disorder and attention-deficit hyperactivity disorder: Predominantly inattentive type. Journal of the American Academy of Audiology, 13, 332-338. </li></ul><ul><li>DeBonis, D., & Moncrieff, D. (2008). Auditory processing disorders: An update for speech-language pathologists. American Journal of Speech-Language Pathology, 17 (1), 4-18. </li></ul><ul><li>English, K., Martonik, J., & Moire, L. (2003). An auditory training technique to improve dichotic listening. The Hearing Journal, 56 (1), 34-38. </li></ul><ul><li>Gelfand, S. A., Schwander, T., & Silman, S. (1990). Acoustic reflex thresholds in normal and cochlear-impaired ears: Effects of no-response rates on 90 th percentiles in a large sample. The Journal of Speech & Hearing Disorders, 55 (2), 198-205. </li></ul>
    24. 24. References (Cont’d) <ul><li>Katz, J. (1977). The SSW test manual (2 nd ed.). St. Louis, Missouri: AudiTec. </li></ul><ul><li>Keith, R. W. (1994). ACPT: Auditory continuous performance test. San Antonio: The Psychology Corporation. </li></ul><ul><li>Musiek, F. E. (1983). Assessment of central auditory dysfunction: The Dichotic Digit Test revisited. Ear & Hearing, 4 (2), 79-83. </li></ul><ul><li>Musiek, F. (1994). Frequency (pitch) and duration pattern tests. Journal of the American Academy of Audiology , 5 , 265-268. </li></ul><ul><li>Wilson, R. H., Preece, J. P., Salamon, D. L., Sperry, J. L., & Bornstein, S. P. (1994). Effects of time compression and time compression plus reverberation on the intelligibility of Northwestern University Auditory Test No. 6. Journal of the American Academy of Audiology, 5, 269-277. </li></ul>