5/06/2014 ALEXANDER GRAHAM BELL CONVENTION “MAGIC MADE REAL: CELEBRATING OUR HERITAGE, TRANSFORMING OUR FUTURE” A LING CONSORTIUM DISCOVERY SESSION FUNCTIONAL AND PRACTICAL APPLICATION OF LING’S STRATEGIES: A GLOBAL PERSPECTIVE A LING CONSORTIUM DISCOVERY SESSION Introduction Dimity Dornan, A.O., Ph.D., LSLS Cert AVT Hear and Say, University of Queensland, Australia and Griffith University, Australia Ling Consortium _______________________________ Ling Consortium _____________________________ • International consortium of professionals • Developing and delivering globally recognized university-based courses on teaching listening and spoken language • Focused on bringing speech and hearing to children with hearing loss • Enabling a life of abundance • Named in honor of the foundational work and extraordinary contributions of the late Dr. Daniel Ling, O.C., a pioneer of Auditory-Verbal practice for children with hearing loss. Global Vision: Children and adults with hearing loss will reach their full potential through listening and speaking. Global Mission: The Ling Consortium is helping more children to speak and hear thanks to a coordinated worldwide effort. Who was Dr. Daniel Ling and why are his theories and practices still relevant today? ____________________________________ • One of the pioneers of listening and spoken language for children with hearing loss – Auditory-Verbal practice. • Audiologist and internationally recognized authority on teaching speech to children who are deaf/hard of hearing. Objectives: Participants will… • examine how Daniel Ling’s legacy has transformed the field of listening and spoken language for children and adults with hearing loss • appraise how his legacy exists in harmony with knowledge from neuroscience and 21st century hearing technology • analyze current research in the field of speech development 1 5/06/2014 Objectives: Participants will… • appraise how Daniel Ling’s legacy has influenced practitioners from around the world • Discuss future influences of Daniel Ling’s legacy FUNCTIONAL AND PRACTICAL APPLICATION OF LING’S STRATEGIES: A GLOBAL PERSPECTIVE A LING CONSORTIUM DISCOVERY SESSION Summary of Current Research on Speech Development Elizabeth Fitzpatrick University of Ottawa Children’s Hospital of Eastern Ontario Research Institute The way we were…. Speech production Speech intelligibility • Speech development in children with hearing loss is highly susceptible to delays and disorders. • Severity of hearing loss affected the extent of speech disorders (Boothroyd, 1969; Levitt, 1987). • Infants produced less and later canonical babbling and more limited range of consonants (e.g., Oller & • For children with severe to profound loss, about 20% of words were intelligible to unfamiliar listeners (Markides, 1979; Smith, 1975, Eilers, 1988, Lynch et al., 1989; Stoel-Gammon, 1988; YoshinagaItano, 2000). • Phonetic repertoires of infants with severeprofound loss were very restricted; e.g., fewer multisyllabic utterances (e.g., Kent et al., 1987; Lach, Ling, et al., Osberger, 1992). • Little improvement after ~age 8 yrs (Smith, 1975; McGarr, 1987). 1970; Stoel-Gammon & Otomo 1986) Early speech development: Cochlear implants The way we are… • Access to speech spectrum results in many more children with intelligible speech – ‘Typical’ children with any degree of hearing loss are expected to develop highly intelligible speech. • Predictors of speech development: – Cognitive abilities (Geers et al., 2002; Tobey et al., 2003) – Auditory experience (e.g., Geers, 2004) – Integrity of the oromotor system – Other language disorders or additional disabilities • Children with CI achieved majority of speech-like utterances after 12 m of auditory experience compared to 18 m experience for peers with normal hearing. (Ertmer, 2013). • Consonant production accuracy was delayed in children with CI with 24 m experience (Ertmer et al., 2012; Leigh et al., 2013). • Children with CI showed consonant acquisition patterns similar to peers with normal hearing when CI age was similar to chronological age of peers (Spencer & Guo, 2012). • The phonetic complexity of early babbling is related to later speech and language skills (Walker et Bass-Ringdahl, 2008) 2 5/06/2014 Early speech development Children with hearing loss Speech sound accuracy: Children with cochlear implants • At 12 m, children with HL (>50 dB) showed fewer consonant multisyllabic utterances , fewer fricatives/stops and more restricted vowel tongue positions (McGowan et al., 2008). • At 10-24 m, children with HL showed delays in consistent canonical babble and in consonant development (Moeller et al., 2007). • At age 24 m, children with mild to severe HL had vowel production similar to peers with normal hearing but weaker consonant production (Ambrose et al 2014). • At age 3-4 y, consonant clusters were within the expected range for children with normal hearing (Fulcher et al., 2014). FIGURE 4. Mean percent-accurate scores for final consonants produced by the CI and TD groups for each developmental sound class. Source: Ertmer et al. Consonant production accuracy in young cochlear implant recipients: Developmental sound classes and word position effects. Am J Speech-Lang Pathol, 21; 342-353, 2012 Speech sound accuracy : Children with cochlear implants Speech production At 3 yrs, speech production on GFTA-2 = mean standard score of 74 (late) to 101 (early) (standard score) and from 86 to 106 by age 5 yrs (Fulcher et al., 2013). At 3 yrs, speech production on DEAP = median standard score of ~80 (consonants) to ~85(vowels) (Ching et al., 2013). FIGURE 6. Phoneme accuracy for consonants in the final position in words as produced by children in the TD and CI groups. Number of productions per target appears in parenthesis. Source: Ertmer et al. Consonant production accuracy in young cochlear implant recipients: Developmental sound classes and word position effects. Am J Speech-Lang Pathol, 21; 342-353, 2012 At 4-5 yrs, speech production on GFTA-2 = mean standard score of 93 for children with HA and 80 for children with CI, and 107 for peers with normal hearing. (Fitzpatrick et al., 2011). Speech production scores Speech intelligibility • Over 90% of children with profound loss develop intelligible speech (Yoshinaga-Itano, 2008). • At age 5.5 yrs, children with CI implanted before 2 yrs had intelligibility scores of > 80% (Habib et al., 2013) • For adolescents with CI, speech intelligibility scores (McGarr sentences) ranged from 81 to 88% (Tobey et al., 2010). Fig. 4. Distribution of Goldman Fristoe Test of Articulation-2 scores for 49 children according to three categories of hearing loss. Fitzpatrick et al. A descriptive analysis of language and speech skills in 4- 5-year old children with hearing loss. Ear Hear,32, 605-16, 2011. 3 5/06/2014 Conclusions • Children with hearing loss still have reduced access, later access, and reduced auditory experience compared to peers = – they are still at risk for speech difficulties • “Improved hearing sensitivity does not, by itself, guarantee the ability to discriminate between sounds or to interpret speech for oral communication purposes.” FUNCTIONAL AND PRACTICAL APPLICATION OF LING’S STRATEGIES: A GLOBAL PERSPECTIVE A LING CONSORTIUM DISCOVERY SESSION THE CANADIAN LANDSCAPE Anita Bernstein, M.Sc., LSLS Cert AVT VOICE for Hearing Impaired Children (http://www.asha.org/aud/Facts-about-Pediatric-Hearing-Loss/) The Ling Thing 38 years of Ling • Addressed the link between Speech Perception and Speech Production • Children SPEAK the way they HEAR • Evaluate both what they can HEAR and what they can SAY The Ling Speech Model • • • • • Theoretical framework Order for assessment and teaching Specific speech teaching strategies Strategies related to speech acoustics Emphasis on listening as the primary modality for learning spoken language GOAL: Oral Communication The Ling Speech Model • Remedial hierarchy of learning speech for older children • Can be adapted for developmental approach The Incubator The McGill University program Auditory-Oral (Re)habilitation & Education of Hearing Impaired Children (AORE) • Began in 1977 • Approximately 50 AORE graduates • Additional 12 research Masters and PhD graduates 4 5/06/2014 Current Canadian Landscape 2 university programs • Training professionals to support Deaf and Hard of Hearing • Course content focused on the Ling speech system including an applied component Current Landscape Current Landscape Survey of 3 training programs for Speech Language Pathologists Exposure to development of speech utilizing an auditory approach, the Ling remedial system and Ling 6 sound test Informal Survey 2 programs developed to enhance the skills of practitioners with a focus on developing listening and spoken language • VOICE Mentorship program • Certificate in Auditory Verbal Development Intensive theory and practice component on the Ling Speech Model Informal Survey Rate on a scale 1-5 1. introductory 2. more in depth discussion of the Ling model ; acoustics of speech and 6 sound test 3. knowledge and some practical experience 4. able to apply the Ling approach with students with hearing loss 5. confident in the application of the Ling speech model Moving Forward Interest and need by professionals in developing knowledge and skill in the Ling Speech Model Introductory More in depth knowledge Knowledge & practice Able to apply model Confident in application of Ling model THANK YOU 5 5/06/2014 FUNCTIONAL AND PRACTICAL APPLICATION OF LING’S STRATEGIES: A GLOBAL PERSPECTIVE Auditory verbal UK Rosie Richardson, LSLS Cert AVT, Clinical Lead A LING CONSORTIUM DISCOVERY SESSION Auditory verbal UK Rosie Richardson, LSLS Cert AVT, Clinical Lead The VALUE To AVUK of Ling’s principles Infants Expectations & techniques Parents Structure & Clarity Professionals Language At AVUK London •50% of our families have E2L •16 different first languages, many more different countries Stages of the parental Journey (Stokes, 2013) What is it you want for your child? What are your hopes for him/her? What is it going to take? Goal setting It works! Using Ling principles with OUR RANGE OF languages Accent The challenge of using Ling’s principles across cultures What innovative practices are you using with special populations? • English is non-rhotic • Scottish & Irish are rhotic ANSD functional discrimination • Using the parent’s knowledge • Knowing home language development pattern Special populations Ling • Ling teaching strategies work once the speech target is identified. Championing early intervention PROMPT 6 5/06/2014 THANK YOU www.avuk.org / @auditoryverbal / [email protected] FUNCTIONAL AND PRACTICAL APPLICATION OF LING’S STRATEGIES: A GLOBAL PERSPECTIVE A LING CONSORTIUM DISCOVERY SESSION The Aziza Grid Aziza Tyabji Hydari India AURED Mumbai: Established in 1986 First AVT Centre in India. Started by 2 professionals with 16 and 17 years experience in teaching deaf children. Enrolled today- 700 of which 550 are CI recipients, from 90 cities in India and 16 neighbouring countries 80% receive free therapy and mapping 40% with additional challenges 95% integrated Age group - 4 months onwards Established a Satellite centre in Hyderabad. Affiliate centres in Delhi and Kenya. Introduction of Daniel Ling and AVT 1981 & 1991 – Ling Workshops + 6 hours of mentoring by Ling in individual therapy sessions. 1986 – 1991, mentored in AVT by Alan Kelly, AVT Cert., Australia, who studied under Ling for his MSc An in-depth study of Ling’s Foundation of Spoken Language & Speech & the Hearing Impaired Child – applied in Language, Speech and Auditory development of children at AURED. 17 therapists and 4 audiologists Total Staff-22 Introduction of Daniel Ling and AVT Speech Evaluation chart has been adapted and modified for additional consonants unavailable in the English Language. Special emphasis on Ling’s Speech Acoustics AURED partners a University course in AVT for graduates in Sp. Education. The Aziza Grid Dearth of tools to explain complex terms of mapping parameters. The Aziza Grid was developed primarily to give a visual picture of the map and to enhance communication amongst audiologist/therapist/teacher and parent. Correlation between frequencies represented in each electrode and Ling’s Acoustic phonetic and phonologic levels. 1996 - Cochlear Implants . 7 5/06/2014 Purposes of The Aziza Grid Serves several purposes: A tool for Auditory Habilitation a) Tracking children’s speech perception progress post switch-on/activation b) Guidelines in setting appropriate auditory goals c) Trouble-shooting Purposes of The Aziza Grid Maps may vary due to the category the candidate falls into : Adults, pre-lingual. post-lingual, older children, infants, anatomical deformities, medical side effects After each Map, a child’s T and C levels should be transferred to the Grid Auditory goals should be targeted with a diagnostic approach 1st 5 maps – post switch-on Nupur’s maps • 1st Map • 4th Map • 2nd Map • 5th Map • 3rd Map • Overview THANK YOU Thank you! AURED-Aural Education for Hearing Impaired Children, Affiliated with AG Bell www.aured.org …continued This tool is for the development of listening skills. Follow Ling’s Hierarchy of listening. Listening cannot be separated from the general process of communication through speech and language. When setting goals, therapist must correlate auditory development with the candidate’s ability to process language. Progress will depend on the category the CI recipient falls into. The question now is – What’s next? FUNCTIONAL AND PRACTICAL APPLICATION OF LING’S STRATEGIES: A GLOBAL PERSPECTIVE A LING CONSORTIUM DISCOVERY SESSION An Australian Perspective Roxanne Innes Hear and Say, Australia 8 5/06/2014 An Australian Perspective Hear and Say Children and Families Auditory-Verbal Therapy Audiology Social Skills Education Support Hear and Say Research and Innovation Evidenced-based Clinical Practice Hear and Say WorldWide Professional Training and Education Parent Education The Ling Six Sound Test mmm ooo eee shh sss ahh Ling’s Principles In Action Ling’s Work is Relevant Today … and will be Tomorrow Professional Education Opportunities Amplification For Special Children 9 5/06/2014 Thoughts For The Future Access to listening and spoken language must be the first option for all children with hearing loss FUNCTIONAL AND PRACTICAL APPLICATION OF LING’S STRATEGIES: A GLOBAL PERSPECTIVE A LING CONSORTIUM DISCOVERY SESSION Auditory-Verbal Practice in Korea son-A Chang Korea Background Information Korea had not had a long history of special education or therapeutic services for the deaf and hard-of-hearing. Korea in the World AV T The first cochlear implantation was done at 1989 and the surgery cases increased quickly by late 1990s and early 2000s. AVT was introduced along CI AV T It has been introduced by well-known AVTs like Warren Estabrooks, Dimity Dornan, Judy Simser, Ann Fultcher, etc. They offered lectures and supervision mainly for the speech AV T therapists. Special schools and centers which deal with mainly hearing aids resisted to the concept and techniques of AVT at the beginning. Ling’s 7 Stage Model: Phonetic and Phonological Levels (English) Ling’s 7 Stage Model: Phonetic and Phonological Levels (Korean) All speech intelligible and voice patterns natural Some sentences said clearly w. good voice patterns Phonologic Level Some phrases said clearly w/ good voice patterns Some words said clearly w/ good voice patterns Uses different vowels to approximate words Uses different voice patterns meaningfully Uses vocalization as means of communication 1 2 3 4 Vocalizes Freely & On Demand Initial & Final Blends 5 Consonants by voicing w/ all vowels Consonants by place w/ all vowels Consonants by Manner w/ all vowels All Vowels & Diphth w/ voice control Bases of Suprasegmental patterns 6 자연스러운 목소리 패턴을 사용하여 모든 구어를 명료하게 사용 7 Phonetic Level 좋은 목소리 패턴으로 몇 개의 문장을 분명하게 말함 좋은 목소리 패턴으로 몇 개의 구절을 분명하게 말함 좋은 목소리 패턴으로 몇 개의 단어를 분명하게 말함 단어와 비슷하게 들리는 다양한 모음을 사용 다양한 음성 패턴을 의미있게 사용함 의사소통의 수단으로 발성을 사용 초성과 종성자 음사용 모든 모음과 유무성 자음을 사용조음 모든 모음과 위치에 따른 모든 자음조음 사용 모든 모음과 방법에 따른 모든 사용 모든 모음과 목소리를자음 통제하며 이중모음을 사용함 초분절적 패턴의 기초를 가짐 스스로 발성을 하고 요구되었을 때 발성을 함 10 5/06/2014 Ling’s Principles Korean has less phonemes in high frequency region Ling 6 Test is still useful Different symbols for /a/, /i/, /u/ Professional Education Courses The first Korean Auditory Verbal Therapist was certified in 2004. Before and after the first Korean received certification, many lectures and seminars were held in Korea. Several universities adopted the concepts and practices of Ling’s methods. Yet, official education programs of Ling’s practices or AVT was not opened in Korea. Currently, Ling’s concepts are being taught to emerging clinicians at several universities and graduate schools. Professional and Extended Education Program is Coming Without official and fundamental education programs teaching Ling’s practices and AVT, therapy for the deaf and hard-of-hearing has been altered in some ways in Korea. THANK YOU Nowadays, the practitioners are moving to form the committee of AVT and open an official program teaching AVT based on Ling’s work. We are expecting to gather and share as well as learn and practice AVT, so that many innovative idea and practices can be facilitated in Korea. FUNCTIONAL AND PRACTICAL APPLICATION OF LING’S STRATEGIES: A GLOBAL PERSPECTIVE A LING CONSORTIUM DISCOVERY SESSION The Ling Speech Model for Children with Hearing Loss and Multiple Challenges Marietta Paterson, Ed.D. Christina Perigoe, Ph.D., LSLS Cert AVT The University of Southern Mississippi 40% with Other Special Needs: All have a range of severity. • • • • • • Sensory (e.g., hearing, vision) Motor/Physical (e.g., Cerebral Palsy, Oral-Motor) Cognitive (e.g., Down Syndrome) Learning Disability/disorder (verbal, non-verbal) Behavioral & Emotional (e.g., ADHD/ODD) Communication (e.g., Autism Spectrum DisorderASD, PDD) 11 5/06/2014 40% with Other Special Needs: • Neurological (e.g., TBI, seizures) • Medically Fragile / Chronic Illness (e.g., Cystic Fibrosis) • Multicultural / Multilingual • Socioeconomic • Gifted • Multiple Special Needs (esp. syndromes) • Specific to Speech (cleft palate, dyspraxia, dysarthria, dysfluency, phonological disorder) • Consider also “Late Starters” (late to listening) Ling System - Assessment and Development of Speech Sounds (Remedial) Consonants Step 1 Step 2 Step 3 Step 4 b/p d/t g/k voicing stop b/p stop d/t stop k/g b-p w (wh) /j/ (y) d-t h l r g-k f/v s/z ch/dg f - v, th - th th/th sh/zh s - z, sh - zh m n ng ch - dg Initial Consonant Blends > developed concurrently Final Consonant Blends Children with Hearing Loss with optimal auditory access (otherwise typically developing) Expect Developmental acquisition of: Suprasegmentals Vowels and Consonants and Consonant blends Children with Hearing Loss with optimal auditory access PLUS Additional Challenges • Suprasegmental issues • Consonants issues – Monotone Tongue movement (tip) – prosody Nasalization • Vowel issues • Consonant blend issues – Neutralization Cluster reduction – Diphthongs>monothong Can’t co-formulate s REMEDIAL . Ling System - Assessment and Development of Speech Sounds (Remedial) Vocalization: spontaneous / on demand Suprasegmental Patterns: Duration, Intensity, Pitch Vowels and Diphthongs Step 1 /a/ hot /i/ bee /u/ two /au/ cow /ai/ pie Step 2 “aw” saw “oi” boy /E/ bed /U/ book /I/ pig Step 3 /ae/ hat “uh” cup /o/ boat /a/ dog /ei/ cake Step 4 r-colored vowels Setting Speech Goals: Speech Target Summary Phonetic Level Syllables Phonologic Level Words Phrases Sentences Suprasegmentals Vowels & Diphthongs Step 1 Consonants Step 2 Consonants Step 3 Consonants Step 4 Consonants Initial Blends Final Blends Paterson, M. & Perigoe, C. (in press). Speech production assessment. Hearing Loss + PLUS: May have Characteristics of “Deaf Speech” • Remedial Assessment and Teaching Model • Criterion referenced testing – flexible (compared to self rather than norms) • Importance of establishing prerequisite skills • Strategies are appropriate based on the sense modality best for the child • Remedial model and strategies are needed • May require additional practice Perigoe, C. (2013). Developing speech skills: Part of the Ling legacy. Volta Voices, Nov-Dec. 2013. 12 5/06/2014 Adapting Assessments & Teaching • • • • • VIDEO Adapt to child’s hearing age Adapt to child’s language level Adapt to child’s cognitive level Involve parents/caregivers Include real-life observations and play assessments and teaching Do not underestimate the value of teacher-made tests.. DIAGNOSTIC TEACHING GOAL: Speech needs to be linked to FUNCTIONAL LANGUAGE and CONVERSATION. Your turn! • Please note any use of Ling’s principals that have not already been mentioned. THANK YOU [email protected] [email protected] • Please note any education courses that are available in your location. • Please note any innovative practices you are using that have not yet been mentioned. • What do you want from the LING consortium? (Resources, continuing education courses, webcasts, symposium…) ROUNDTABLE DISCUSSIONS FUNCTIONAL AND PRACTICAL APPLICATION OF LING’S STRATEGIES: A GLOBAL PERSPECTIVE A LING CONSORTIUM DISCOVERY SESSION SUMMARY: Future Steps Trudy Smith, Manager Continuing Education Royal Institute for Deaf and Blind Children (RIDBC), North Rocks, NSW, Australia Final Thoughts Dimity Dornan, A.O., Ph.D., LSLS Cert AVT Hear and Say, University of Queensland, Australia and Griffith University, Australia 13 5/06/2014 Who was Dr. Daniel Ling and why are his theories and practices still relevant? • Trained with the Ewings in England and emigrated to Canada. (Montreal Oral School for the Deaf. McGill University.) • Speech and the Hearing-Impaired Child: Theory and Practice (1976, 2002). • Foundations of Spoken Language (1989). • Aural Habilitation (with A. Phillips Ling 1978) • Ling Speech Cards (now available through John Tracy Clinic) • Numerous articles and book chapters. Ling & Current Best Practices Foundation: Hearing and Audiology Maximize Audition Emphasis on auditory strategies - visual and tactile used later if needed - then put back into hearing Ling used knowledge of speech acoustics & perception (what the child hears) to drive his model for teaching speech production (what the child says). Ling & Current Best Practices The Ling Thing Early Identification and Intervention 38 years of Ling • Addressed the link between Speech Perception and Speech Production • Children SPEAK the way they HEAR • Evaluate both what they can HEAR and what they can SAY - child must be well aided as early as possible from the first few weeks/ months of life ~ Developmental Approach ~ Parent Guidance (Ling Model: Remedial hierarchy of learning speech for older children. Can be adapted for developmental approach.) Major Contributions Ling Six Sound Test: m, oo, ah, ee, sh, s, Determine access to sounds across the speech spectrum (Speech Banana) Phonetic Level Evaluation Phonologic Level Evaluation Speech Teaching System based on speech acoustics, prerequisite speech skills, practice and carryover into spoken language Ling’s Legacy “A life of abundance” for children with hearing loss everywhere, will continue to be transformational well into the future - truly “Magic Made Real”. 14
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