hello readers... am back after a long hiatus. Back to discuss yet another important topic plaguing not just adults but a large number of school children too.
Unilateral hearing loss:
this means that hearing loss effects only one ear. Usually results from trauma to the ear and /or infections. Do remember unless Normal life is effected, usually hearing aids are not prescribed. If they are (as in case of assymetrical hearing loss) then the better ear is fitted with the hearing aid. It is very important to note that the naturally better ear will always respond first, irrespective of hearing aids!
Partial deafness:
Many a times it is seen that a child doesnt do well academically and needs instructions to be repeated many a times. besides suspecting learning disability (LD), currently made famous by Aamir Khan's "TZP", hearing also should be assessed. This especially if the speech is unclear. Hearing Aid fitting followed by spech-language therapy will help the child.
in case of adults, the symptoms typically include, "can hear sounds but cant make out....." Raising volumes too doesnt help much. Usually observed in case of high frequency hearing loss. Hearing aids in these cases have to be fitted with extreme precision.
So the next time we come across a child who otherwise seems normal but has unclear speech and poor in academics........ we know what has to be done!
i look forward for your opinions and comments.
P
Saturday, February 9, 2008
Wednesday, December 12, 2007
what is speech therapy?
Speech-Language Therapy
The purpose of speech-language therapy is to enhance intentional communication via expression of ideas, obtaining desires, sharing information and interpersonal interaction.
Language is the means by which communication is achieved.Components of language include but are not limited to
The purpose of speech-language therapy is to enhance intentional communication via expression of ideas, obtaining desires, sharing information and interpersonal interaction.
Language is the means by which communication is achieved.Components of language include but are not limited to
- suntax...... sentence construction also called grammar (content)
- semantics...... i.e. meaning includes proverbs, humour etc.
- pragmatics i.e. use of language in social contexts alos enhanced by body orientation, facial expressions and gestures.
Therefore, speech therapy focuses around teaching the child what he or she
needs and also making use of language for communication.For the child who is not currently using words, language is still possible through other means. A child may be taught to use various ways of utilizing their language skills to convey meaning. These may consist of gestures, eye contact, facial expression, vocalizations or manual tools such as communication pictures/boards/books. These however are subject to discreetion of the therapist.
Oral-motor deficits are also addressed in speech-language tharapy. Since proper structure and function of the oral areas is necessary for speech and sound production, intervention to improve coordination, strength, movement of the lips, tongue, jaw and cheeks (both internally and externally) is required.
What causes speech and language problems?
Speech and language disorder is a common reason for speech/language problems in kids. This involves the following areas:
• Spoken language—delays and disorders in listening and speaking
• Written language—problems with reading, writing and spelling
• Arithmetic—trouble doing arithmetic or understanding basic concepts
• Reasoning—problems organizing and putting together thoughts
• Memory—problems remembering facts and instructions.
These kids may have trouble producing speech sounds, using spoken language to communicate, or understanding what other people say. Speech and language problems are often the earliest sign of other disorders.
• Hearing loss is often overlooked, and easily identified. If your child is speech/language delayed, their hearing should be tested.
• Mental retardation is described as below-average general intellectual function with associated deficits in adaptive behavior that can be seen in early years, common cause of speech and language delay.
• Autism, : diagnostic category of pervasive developmental disorders (PDD) refers to a group of disorders characterized by delays in the development of socialization and communication skills. Parents may note symptoms as early as infancy, although the typical age of onset is before 3 years of age. Symptoms may include problems with using and understanding language; difficulty relating to people, objects, and events; unusual play with toys and other objects; difficulty with changes in routine or familiar surroundings, and repetitive body movements or behavior patterns. Children with PDD vary widely in abilities, intelligence, and behaviors. Some children do not speak at all, others speak in limited phrases or conversations, and some have relatively normal language development. Repetitive play skills and limited social skills are generally evident. Unusual responses to sensory information, such as loud noises and lights, are also common.
• Extreme environmental deprivation can cause speech delay. this also includes Children out of intercaste marriages under pressure to pick up both the langauges simultaneously!
• Premature births can lead to developmental delays, including speech/language problems.
• Neurological problems like cerebral palsy, muscular dystrophy, and traumatic brain injury can affect the muscles needed for speaking.
• Structural problems like cleft lip or cleft palate can also interfere with normal speech
.• Apraxia of speech is a specific speech disorder in which the child has difficulty in sequencing and executing speech movements.
• Selective mutism is also called funtional disorder at times when a child does not talk at all in certain situations.
If your child does not follow regular speech/language development milestones, you should talk to your pediatrician. or rehabilitation professional
Monday, December 10, 2007
"NOISE"........... beware!
TOO LOUD????Our ears evolved over the millennia in the backdrop ofsilence. In ancient times, our life was marked by thesound of wind, of water, temple bells, of the cries ofwild animals and, most importantly, laughter.Come 20th Century, all this changed. Industry,automobiles, aircraft, jackhammers arrived. Also,engineering equipment began tearing up the ground tobuild tall buildings and skyscrapers — there was bignoise all around.Today, we are marooned with a medley of noise that ourears were never designed for.Honking, music systems, personal stereos, and iPods…the list is endless. They have only added to blazingcacophony.Too much noise is damaging to us. The irony is — wedon't notice until it's too late to do anything aboutit.
ORIGIN OF SOUND AS LANGAUGE OS SPEECH: the infant hears his first sounds outside the womb, the moment it is born. A normal hearing infant is exposed to all kinds of sounds, i.e. Speech-language of his environment, sounds of toys, birds chirping…. The list is endless. This according to the Chomskian theory of Language development helps him to develop adequate speech and Language skills.
Following are the typical milestones regarding the child’s’ speech and hearing development:
Birth – 2 months → startling response to loud sounds
2months – 6months → eye movements to sounds
6months – 12 months → head turning response to sounds, human voice
> 12 months → child babbles mama…baba… etc.
1½ years → single meaningful words
2½ years → 2- word phrases (“mama give”; “give ball”)
3 years and above → meaningful simple sentences (“mama give ball”)
It is known and seen that any disruption in the sensory status of the Ear (any degree or type of deafness) causes marked speech-language delay.
POWER VIS-A-VIS SOUND:
Sound may be described in terms of physical as well as psychological phenomena. I.e. a series of disturbances of molecules within an elastic medium and an auditory experience- hearing something, respectively.
Sound is generated by vibration and is carried through the air around us in form of pressure waves. Only when these waves strike the ear that hearing takes place.
Human reactions to sound are psychological and reflect such subjective experiences as pitch, loudness, sound quality and ability to tell the direction of the sound source. The range of human ear is very great and so the unit called “ decibel (dB)” is used for intensity.
Airborne sounds are measured by devices called Sound Level Meters as concern over noise pollution grows SLMs are useful in the study of acoustics in industry and environment.
All sounds that normal hearing persons may hear without discomfort can be found in the range form: threshold of audibility to threshold of discomfort.
The approximations can be determined with the help of the following table
0dB: just audible sound
10dB: soft rustle of leaves
20dB: whisper at 4ft
30dB: gurgling of a stream
40dB: night noises in the city (threshold or outskirts of city)
50dB: quiet automobile 10ft away
60-70dB: normal conversation at 3ft
80dB: heavy traffic/ loud telephone rings
90dB: pneumatic drill 10ft away
100-110dB: oil tanker explosion few ft away
120dB: A blaring stereo close by (1ft)./ aeroplane flying (near airports)
Noise Induced hearing loss (NIHL)
The industrial Revolution’s introduction of high noise levels brought a greater threat to the human auditory system than evolution had prepared for. In some cases hearing losses may result from brief exposure to high-level sounds, with subsequent partial or complete recovery (temporary hearing threshold shift). In other cases repeated exposure to high-level sounds result in permanent hearing impairment (permanent hearing threshold shift). According to studies hearing loss may be due to biological changes in the sensory cells (of the inner ear), physical dislodging of hair cells during hyper acoustic stimulation, changes in the cochlear blood supply, loss of outer hair cells, rupture of Reissner’s membrane, or detachment of the organ of corti from the basilar membrane.
Acoustic trauma indicates NIHL from impulsive sounds such as explosions.
Exposure to jet engines, drop forges, pneumatic hammers, subways, rock music, and even computers has been documented to be causing hearing loss.
Hearing conservation program (HCP):
1 identifies people who are at risk for NIHL
2 abates dangerous noise levels as economically as possible
3 protects employees who are at-risk for NIHL. (use of protective hearing devices such as ear muffs or ear plugs)
4 periodic hearing examinations a must.
5 setting regulations for the society (deadlines for loudspeakers)
importance of the awareness: many persons effected usally are unaware of the hearing losses caused due to noise exposure. By the time they do, severe communicative difficulties also set in, thus effecting the person overall.
Bottom line: Take care of your ears before it is too late. Hearing aids of even the best technological advantage cannot replicate the human ear.
PREVENTION IS ALWAYS BETTER THAN CURE.
ORIGIN OF SOUND AS LANGAUGE OS SPEECH: the infant hears his first sounds outside the womb, the moment it is born. A normal hearing infant is exposed to all kinds of sounds, i.e. Speech-language of his environment, sounds of toys, birds chirping…. The list is endless. This according to the Chomskian theory of Language development helps him to develop adequate speech and Language skills.
Following are the typical milestones regarding the child’s’ speech and hearing development:
Birth – 2 months → startling response to loud sounds
2months – 6months → eye movements to sounds
6months – 12 months → head turning response to sounds, human voice
> 12 months → child babbles mama…baba… etc.
1½ years → single meaningful words
2½ years → 2- word phrases (“mama give”; “give ball”)
3 years and above → meaningful simple sentences (“mama give ball”)
It is known and seen that any disruption in the sensory status of the Ear (any degree or type of deafness) causes marked speech-language delay.
POWER VIS-A-VIS SOUND:
Sound may be described in terms of physical as well as psychological phenomena. I.e. a series of disturbances of molecules within an elastic medium and an auditory experience- hearing something, respectively.
Sound is generated by vibration and is carried through the air around us in form of pressure waves. Only when these waves strike the ear that hearing takes place.
Human reactions to sound are psychological and reflect such subjective experiences as pitch, loudness, sound quality and ability to tell the direction of the sound source. The range of human ear is very great and so the unit called “ decibel (dB)” is used for intensity.
Airborne sounds are measured by devices called Sound Level Meters as concern over noise pollution grows SLMs are useful in the study of acoustics in industry and environment.
All sounds that normal hearing persons may hear without discomfort can be found in the range form: threshold of audibility to threshold of discomfort.
The approximations can be determined with the help of the following table
0dB: just audible sound
10dB: soft rustle of leaves
20dB: whisper at 4ft
30dB: gurgling of a stream
40dB: night noises in the city (threshold or outskirts of city)
50dB: quiet automobile 10ft away
60-70dB: normal conversation at 3ft
80dB: heavy traffic/ loud telephone rings
90dB: pneumatic drill 10ft away
100-110dB: oil tanker explosion few ft away
120dB: A blaring stereo close by (1ft)./ aeroplane flying (near airports)
Noise Induced hearing loss (NIHL)
The industrial Revolution’s introduction of high noise levels brought a greater threat to the human auditory system than evolution had prepared for. In some cases hearing losses may result from brief exposure to high-level sounds, with subsequent partial or complete recovery (temporary hearing threshold shift). In other cases repeated exposure to high-level sounds result in permanent hearing impairment (permanent hearing threshold shift). According to studies hearing loss may be due to biological changes in the sensory cells (of the inner ear), physical dislodging of hair cells during hyper acoustic stimulation, changes in the cochlear blood supply, loss of outer hair cells, rupture of Reissner’s membrane, or detachment of the organ of corti from the basilar membrane.
Acoustic trauma indicates NIHL from impulsive sounds such as explosions.
Exposure to jet engines, drop forges, pneumatic hammers, subways, rock music, and even computers has been documented to be causing hearing loss.
Hearing conservation program (HCP):
1 identifies people who are at risk for NIHL
2 abates dangerous noise levels as economically as possible
3 protects employees who are at-risk for NIHL. (use of protective hearing devices such as ear muffs or ear plugs)
4 periodic hearing examinations a must.
5 setting regulations for the society (deadlines for loudspeakers)
importance of the awareness: many persons effected usally are unaware of the hearing losses caused due to noise exposure. By the time they do, severe communicative difficulties also set in, thus effecting the person overall.
Bottom line: Take care of your ears before it is too late. Hearing aids of even the best technological advantage cannot replicate the human ear.
PREVENTION IS ALWAYS BETTER THAN CURE.
 |
| hearing conservation program |
Thursday, December 6, 2007
what should you do?
many a times i hear from my clients who tell me "had we known earlier we could have done better for our child...". Unfortunately by the time ppl realise their child has a problem (in this topic- HEARING IMPAIRMENT {HI}) its usually too late. This is because, every child has a 'critical period' for speech-language development. In a gist following are the typical milestones:
(for parents and child health practitioners.)
Early response to be looked for:
Birth – 2 months → startling response to loud sounds
2months – 6months → eye movements to sounds
6months – 12 months → head turning response to sounds, human voice
> 12 months → child babbles mama…baba… etc.
1½ years → single meaningful words
2½ years → 2- word phrases (“mama give”; “give ball”)
3 years and above → meaningful simple sentences (“mama give ball”)
Very often in todays times it is seen that both parents pursue careers and at such times the child is left in the care of day care centres (usually household ones). By the time the mother returns she gets busy with the housework and this routine continues. Ther child may occasionally respond to lod door banging or high volumes, loud name call or rock music. In such cases the parents may not suspect anything amiss in the child. Its usually when the child is about 3 yrs old and admitted to a school that teachers usually point out the facts to parents.
Then follows a series of doctor shopping and different reactions from parents... Denial, Anger, guilt etc. By the time parents accept the fact that their child is hearing impaired and needs to wear a hearing -Aid throughout his life its almost another yr which passes along.
The main goal of writing this article is to make the parents aware as to what they can do once hearing loss is suspected.
(for parents and child health practitioners.)
Early response to be looked for:
Birth – 2 months → startling response to loud sounds
2months – 6months → eye movements to sounds
6months – 12 months → head turning response to sounds, human voice
> 12 months → child babbles mama…baba… etc.
1½ years → single meaningful words
2½ years → 2- word phrases (“mama give”; “give ball”)
3 years and above → meaningful simple sentences (“mama give ball”)
Very often in todays times it is seen that both parents pursue careers and at such times the child is left in the care of day care centres (usually household ones). By the time the mother returns she gets busy with the housework and this routine continues. Ther child may occasionally respond to lod door banging or high volumes, loud name call or rock music. In such cases the parents may not suspect anything amiss in the child. Its usually when the child is about 3 yrs old and admitted to a school that teachers usually point out the facts to parents.
Then follows a series of doctor shopping and different reactions from parents... Denial, Anger, guilt etc. By the time parents accept the fact that their child is hearing impaired and needs to wear a hearing -Aid throughout his life its almost another yr which passes along.
The main goal of writing this article is to make the parents aware as to what they can do once hearing loss is suspected.
- Visit the nearest ENT &/ Audiologist. The tests usually performed are : Pure Tone Audiometry (for children above 3yrs), Behavioral Observation Audiometry (BOA), VIsual response Audiometry(VRA). If these tests cant get to a conclusion then a BERA is recommended to arrive at a final conclusion.
- Based on the type and severity of the hearing loss
(pls ask the audiologist to give u the details of the problem), different options are recommended to the parents. - the options include, fitting of hearing aid/s, or the recent Cochlear Implantation. The latter is very expensive and one needs to consult the concerned profesional regarding the details (Hinduja Hospital in Mumbai).
- if Hearing Aid/s need to be fitted then the moulds have to be made first. These are very important for adequate benefits of the aid and to prevent the loss of amplified sounds.
- this should be followed by trials of different aids (based on power and company). Avoid buying aids without a trial.
- once the fitting is done auditory training begins along with speech-language therapy. As far as possible visit a qualified speech therapist near ur area. Their information is usually available with the ENT or local hospitals.
- Schooling type (regular or special school) depends on a lot of factors and should be decided along with the speech therapist and the Special Educator for the Hearing Impaired.
A very Important point here is to remember: In rehabilitation the child rides a bicycle. The front wheel is the rehab team member and the back wheel with a hub is the parent. Unless the back wheel moves the front will not move!
i await readers comments and suggestions.
{look ahead for further information and links on hearing aids}
reply to comments
i'll definitely answer ur concerns in the privious post. As for adopting a child u need to contact the Registered agencies. THey have different criteria and norms which u ve to fullfill irrespective of whom u want to adopt. As for using the word "special" , it stands for "the specially abled" U seem to have suffered too so u must understand the term better.U are correct about the society. It doesnt accept the specially abled infact creates trouble for them...... be it at pre-school, school or vocational level. Once in my clinic i had organised a grooup schedule for a homogenous group of my clentele. U'll be surprised to know that parents who had another "normal" child refused to get them to participate with the selected group. Charity begins at home isnt it? Such changes which we expect from the society ahoud begin in the homes of the effected individuals.
Tuesday, November 20, 2007
please be alert
Hello readers,
I had a call yesterday from a friend of an acquaintance who wanted to discuss her son's problem. He has severe to profound hearing loss in both ears and very inadequate speech-language skills as expected of a normal 13 yr old. Now, this child was fitted with a 'programmable hearing aid' worth Rs.65ooo. When i asked the mother as to why was a programmable aid given to a child who was finding it difficult to discriminate even gross sounds in the environment (programmable hearing aids follow the audiogram contour and help in enhancing the hearing by reducing interference. For this however one needs to know what it is to hear "well". Preferrably someone who has known what 'normal' hearing is.), the mother replied, "what could i do? I did what the audiologist asked me to." She was also over charged and did not know that hearing-aids too have MRPs which further can be bargained upon.
Be alert!
Mail me ur comments or queries in this regard.
I had a call yesterday from a friend of an acquaintance who wanted to discuss her son's problem. He has severe to profound hearing loss in both ears and very inadequate speech-language skills as expected of a normal 13 yr old. Now, this child was fitted with a 'programmable hearing aid' worth Rs.65ooo. When i asked the mother as to why was a programmable aid given to a child who was finding it difficult to discriminate even gross sounds in the environment (programmable hearing aids follow the audiogram contour and help in enhancing the hearing by reducing interference. For this however one needs to know what it is to hear "well". Preferrably someone who has known what 'normal' hearing is.), the mother replied, "what could i do? I did what the audiologist asked me to." She was also over charged and did not know that hearing-aids too have MRPs which further can be bargained upon.
- The biggest menance we professionals face is ENTs prescribing and dispencing hearing-aids. What people do not know is that they are not qualified enough to do so and muslt consult an audiologist for the process.
- Secondly, not everyone with hearing loss needs hearing aids. The audiologist in tandem with the client determines it. There are a large variety to choose from.
- A very important aspect is the pricing. The MRP includes commisions to the professionals dispencing the hearing aids. Just like other electronic items, please insist on being shown the MRP chart. take second opinions if needed. Information on prices can be obtained from the internet.
Be alert!
Mail me ur comments or queries in this regard.
Wednesday, November 14, 2007
My experience.......... a touching one
This is something i'll never forget......... I was a student in second yr of graduation. We were posted in a department which was used to test the little children (below3 yrs) for hearing loss. One day a man in his 40s visited with a small kid not more than 2yrs old. He had to wait with us students as there was another kid in the test room. But in these 15min the kiddo won over ur hearts. Then they were taken in for the test. During the process his file revealed that this child was from an orphanage and was considered for adoption by the gentleman. With our hearts thudding we observed the process of testing. The child was diagnosed with severe to profound hearing loss in both ears. finally during the "parent" counselling our worst fears came true. The man declared that he wouldnt be "taking" the child...... who by now was clinging to him and he tried pushing him off as if the child had just contracted a communicable disease. No reasoning by our psychologist could change his mind and the social worker took the child back to the orphanage. It left us wondering about the psychological impact this incident must have had on the child.
This further implies the need for hearing screening in young children to be made compulsory especially if they fall in the high risk category.
I look forward for discussions and queries if any regarding this true incident.
This further implies the need for hearing screening in young children to be made compulsory especially if they fall in the high risk category.
I look forward for discussions and queries if any regarding this true incident.
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