5/06/2014

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
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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)
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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.
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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
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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
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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
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THANK YOU
www.avuk.org / @auditoryverbal / rosie@avuk.org
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 .
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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
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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
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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
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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)
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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.
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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
marietta.paterson@usm.edu
christina.perigoe@usm.edu
• 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
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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”.
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