Hearing loss and Down syndrome

Hey guys,
     This semester I have been taking an aural rehabilitation class.  A part of this class is to do something interesting related to hearing or hearing loss.  I thought you guys would be interested in learning some interesting information regarding Down syndrome and hearing loss.  This information is intended for clinicians and students.  Attached is a worksheet for clients to work on during a hearing screening or evaluation. Hope you enjoy and learn something new!

What is the prevalence of people with Down syndrome having hearing loss? 
      People with Down syndrome tend to have more health problems than other people.  Specifically, there is a higher incidence of hearing problems in people with Down syndrome.  According to Down Syndrome Education Online, 80% of people with Down syndrome have hearing loss (2011).

How do people hear?
     The ear is divided into three parts leading to the brain. The ear is made up of the outer ear, the middle ear and the inner ear (ASHA, 2012).
     Sounds travel through the air in pressure waves.  As the sound hits the ear, it is transformed from acoustic energy to electrical energy.  It then travels to the ear drum and puts it in motion.  The eardrum then vibrates and then causes the bones of the ear or ossicles to move.  The movements of the ossicles allow for the vibrations to hit the oval window of the middle ear and inner ear.  Then the fluid in the middle ear goes into motion and the hair cells of the cochlea become stimulated.  Then the sound is transferred into nerve impulses and travels to the brain due to the auditory nerves functioning (Down Syndrome Education Online, 2011).

What is a hearing loss?
Three characteristics of hearing loss: type, degree, and configuration.

Type:
·         Conductive hearing loss- This type of hearing loss occurs in the outer ear and middle ear.  It can be treated with the help of a hearing aid.   
·         Sensory-neural hearing loss- This type of hearing loss occurs in the inner ear (cochlea).  It cannot be treated or corrected medically. This type of hearing loss is permanent.
·         Mixed hearing loss- This type of hearing loss occurs in the outer, middle, and inner ear. This hearing loss is a mixture of the previous two types of hearing loss. 

Degree of hearing loss refers to the severity of the hearing loss.

Degree of hearing loss	Hearing loss range (dB HL)
Normal	–10 to 15
Slight	16 to 25
Mild	26 to 40
Moderate	41 to 55
Moderately severe	56 to 70
Severe	71 to 90
Profound	91+

(ASHA, 2012)

Configuration
·         It is also known as the shape of the hearing loss.  It is the pattern of hearing loss across frequencies (ASHA, 2012).
*Note hearing loss is never measured in percent!

What is the most prevalent type of hearing loss in people with Down syndrome?
Conductive hearing loss is the most prevalent hearing loss among people with Down syndrome (Mazzoni, D.S., Ackley, R.S., & Nash, D.J., 1994).

What are some common hearing-related issues that people with Down syndrome experience?
     Abnormal ear formations are common in people with Down syndrome.  Most common, there is a congenital problem.  When the baby is developing there is a malformation of the middle ear ossicles (Mazzoni, D.S. et al, 1994).

      Wax can be a major problem if it interferes with hearing.  Ear wax can become hard and build up if it is not removed properly.  Wax accumulation is common in people with Down syndrome because of their ear canals are more narrow than others.
     Glue Ear is a common problem that can cause conductive hearing loss in people with Down syndrome.  It is a condition that the mucoid secretion builds up in the middle ear.  This build up affects hearing. It is a very sticky substance. 
     Middle ear infections are more common in people with Down syndrome due to glue ear and other factors.  In addition people with Down syndrome are more susceptible to infections (Down Syndrome Education Online, 2011).

     If hearing loss is not detected in people with Down syndrome, it can be very influential in their overall development.  Most importantly, hearing loss has a serious effect on people with Down syndrome’s cognitive abilities, language and auditory processing abilities, and overall IQ levels.  Many people with Down syndrome have hearing loss and it goes undetected. To prevent this from occurring a yearly hearing screening will eliminate this problem (Mazzoni, D.S. et al, 1994).
    
 If a person with Down syndrome experiences any of the previous information it is good to contact a local Audiologist for a screening.  Hearing screenings are quick and easy. All people need to receive a hearing screening if they have not had one recently.  If you live in Illinois, here is a list of certified Audiologists that work with clients with Down syndrome.

Resources

American Speech-Language-Hearing Association. (2012). Communication for a lifetime.

     Retrieved from http://www.asha.org/public/

Down Syndrome Education Online. (2011). An overview of the development of infants with
     Down syndrome (0-5 years). Down syndrome issues and information. Retrieved
     from http://www.down-syndrome.org/information/development/early/?page=6

Mazzoni, D.S., Ackley, R.S., & Nash, D.J. (1994). Abnormal pinna type and hearing
     loss correlations in Down's syndrome. Journal of Intellectual Disability Research. 38 (6),
     pp.549-60. Retrieved from http://ehis.ebscohost.com.proxy.lib.ilstu.edu/eds/
     detail?vid=7&hid=20&sid=79b69c8e-2987-4f76-88bc-d6a4c97fc8d1
     %40sessionmgr13&bdata=JnNp dGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3
     d%3d#db=cmedm&AN=7881226

Here is a worksheet to use with clients to learn about hearing. It is also a good tool to learn what they can and cannot hear in their environment.

Here are audiologists of Illinois who provide audiological services for people with Down syndrome.
Contact your local audiologist today and get a hearing screening.

A special thank you to Annie Farris for finding audiologists in Illinois!

Hope this was helpful!
xoxo,

SP Girl

An egg-cellent idea!

Hi,
Hope everyone had a wonderful Easter! Now that Easter is over the stores have all their Easter items on sale! Here is a good idea to use cheap artificial Easter eggs.

Materials you will need:
Artificial Easter eggs, permanent marker

Take an egg. Then using the marker write on both sides of the egg. You can write prefixes and suffices. This is also good to learn sounds. Any form of writing out words or sounds will make this activity fun and different for the client. You can separate the egg and have the client put the egg together to make words or have them already together and turn the egg for multiple sounds or words. Lastly, the client could also go on a hunt to look for the eggs throughout the room.

A special thanks to http://drjeanandfriends.blogspot.com/ for such a cute idea!
Hope you enjoy!

XOXO,
 SP Girl

Spring has Sprung!

      Happy Spring! Hope everyone is enjoying the nice weather! Here are some fun ideas that can be used inside or outside depending on the day you do your therapy. Since its been awhile since I've blogged I've decided to share three ideas I found on a Disney site called FamilyFun.go.com.

1.Adventure Waterscope

 Things you will need: can opener, coffee or large juice can, duct tape, plastic wrap, and a wide rubber band. (Possibly a bucket, water, and target words/objects)

    First use a can opener to cut both ends off the can. Cover the can's edges so they will not cut the client.  Next, stretch the plastic wrap over one end of the can.  Then secure it with the rubber band and duct tape. Dip the covered end into the water and peer inside. The waterscope can be used in the lake, pool, or bathtub.  If done in a clinic room fill a bucket with water. Place different plastic colorful objects in the bottom of the bucket. Have the client use the waterscope to look through the water to see the different objects. The main idea for this activity is to have the client say his or her target words. You could also laminate different words on paper if necessary.  Remember to have towels, because water can get messy sometimes.

http://familyfun.go.com/crafts/holiday-seasonal-crafts/spring-crafts-backyard-gardening/all-spring-crafts/magnifying-waterscope-848314/

2.Colorful nature hunt

Things you will need: Egg carton, paint, paint brush, water, paper towels, magnifying glass,

     Before therapy paint an egg carton with the colors of the small nature objects you have.  The main idea of this activity is to get the client to use the mangifying glass to look for different objects in the room or outside that match the color on the carton.  Encourage the client to look at the objects and discover new things. You want the client to be able to match the colors and say the objects found.

http://familyfun.go.com/crafts/holiday-seasonal-crafts/spring-crafts-backyard-gardening/all-spring-crafts/a-trail-tote-672562/

3. Flower Fairies

Things you will need: Colorful artificial flowers, scissors, red and pink markers, fine-tip black marker, drilled 16 mm round wooden bead, pipe cleaner for the body, wire cutters, yarn (about 4 feet), pipe cleaner for wings, and craft glue.

     First separate the flower and the stem from the artificial flowers.  Then using the marker, draw the face on the wooden bead (make sure the hole is on top of the bead).  Later bend the body pipe cleaner into thirds and use wire cutters to snip off a third.  Take the yarn and wrap it arround your hand to make a skein as such for the hair.

Then bend the longer piece of pipe cleaner in half and tuck the yarn in the fold. Thread both pipe cleaner ends through the bead head.

Later cut the two bends in the yarn to make the hair fall down on the bead.

Wrap the arms towards the middle of the body.

Then thread the legs through the flower petals and twist the legs so the petals are secured.

 

Place the wings on the back towards the middle of the body and twist them on in three parts.

This activity could be used as a reward in therapy as the client does a worksheet or structured actifity they get to complete the next part of the fairy.

http://familyfun.go.com/crafts/holiday-seasonal-crafts/spring-crafts-backyard-gardening/all-spring-crafts/flower-friends-667264/

I hope you enjoyed these cool Spring- filled activities. Have fun and enjoy!

xoxo,

SP Girl

Psychogenic what?

Hey guys,

So I have recently been taking a class in organic voice disorders. We have been going through many different issues concerning the voice. If some of you do not know my minor is psychology and we have been studying psychogenic or somatoform disorders. This relates to organics because there is a voice disorder called psychogenic aphonia. If anyone is interested in learning about this topic here is some interesting information!

(Juerg & Kollbrunner, 2010).

Psychogenic Aphonia

         Psychogenic aphonia or psychogenic conversion aphonia is a non-organic voice disorder. It is a psychological issue within the person that causes at first a minor dysphonia. This minor dysphonia causes partial loss of voice, and after time, if the voice disorder becomes extreme enough, they get aphonia or a complete loss of the voice. This aphonia could be sudden or it can progress over time. Chronic emotional stress is usually common in patients with this type of non-organic disorder. Psychological issues such as traumatic life changes, and extreme stress and tension are common causes of this disorder. Most patients are said to feel overburdened with their lives and become depressed and less open toward others (Juerg & Kollbrunner, 2010).

       The disorder’s main symptom is the loss of voice. Voice loss can occur gradually or suddenly. The symptoms for the disorder depend on the patient and the severity of the disorder. The most common form of psychogenic aphonia is complete voice loss. The structures are all intact and appear normal, but when it comes to phonating for speech there is no sound production. Some patients with psychogenic aphonia can produce a whisper. Even though there is no voice production, patients are able to make certain noises. For example, coughing, crying, and laughing (Kent, 2003). In other cases of psychogenic aphonia, hoarseness is present with the ability to whisper (Seifert & Kollbrunner, 2005).

       The appearance of the vocal folds depends on the severity of the patient. In most cases the patient’s vocal folds are bowed and fail to adduct to the midline during phonation. The vocal folds do meet in the midline when the patient is asked to cough. Physically, the vocal folds do not appear to be injured or damaged. The disorder is caused by a traumatic event, psychologically damaging event, or the voice is changed for a short amount of time (Deirdre, 2012). The vocal folds are restricted simply because the client cannot control his or her voice (Juerg & Kollbrunner, 2010).

       There are many characteristics of psychogenic aphonia, but one specific characteristic is the production of a resonant coughing. This distinguishes psychogenic aphonia from aphonia caused by disruption of nerves in the larynx. Psychogenic aphonia occurs in a healthy, functional larynx; for this reason, psychogenic aphonia is considered a non-organic voice disorder. Often, psychogenic aphonia occurs in clients with past psychological diagnoses (Kollbrunner, Menet, & Seifert, 2010).

       Psychogenic aphonia can be treated by two types of people: a speech-language pathologist or by a psychologist. If the patient does not know the cause of their psychogenic aphonia, a psychologist may be able to help. The psychologist can help the patient come to terms with the cause of their psychogenic aphonia and perhaps help them overcome it. A speech-language pathologist can help the patient relearn how to use their voice again. This can be achieved by using non-speech techniques at first then moving into phonation techniques (Voice of emotion: The speech-language pathologist’s role in managing stress related voice disorders, 2003).

       Psychogenic aphonia is a unique conversion disorder. Although it is a rare disorder, it is essential to understand how to approach and treat this disorder in a client, and to refer the client to a psychologist, when necessary.



                                                               Resources

Deirdre, M. (2012). Types of voice disorders. Retrieved from http://www.lionsvoiceclinic.umn.edu/page3b.htm

Kent, R.D. (2003). MIT Encyclopedia of communication disorders. Retrieved from http://site.ebrary.com.proxy.lib.ilstu.edu/lib/milner/docDetail.action?docID= 0225312

Kollbrunner, J., Menet, A., & Seifert, E. (2010). Psychogenic aphonia: No fixation even after a lengthy period of aphonia. Swiss Medical Weekly, 140 (1-2). Retrieved from http://www.smw.ch/docs/pdfcontent/smw-12776.pdf

Seifert, E. & Kollbrunner, J. (2005). Stress and distress in non-organic voice disorders. Swiss Medical Weekly Journal, 135. Retrieved from http://www.smw.ch/docs/pdf200x/2005/27/smw-10346.PDF

Voice of emotion: The speech-language pathologist’s role in managing stress related voice disorders (2003). Retrieved from http://www.londonspeech.com/article7.htm



Hope you enjoyed this! A special thanks to all the CSD girls that helped find this information!xoxo,

SP Girl

A fun way to sequence!

Hey guys! Happy Febuary!

Here is a fun work sheet to use when working on sequences with your student.
Thanks to firstgradesweetlife for the cool idea!
-SP Girl


Here is the link to the original copy to download!

Puffy Snowman

Hello,
This is a fun way to make a snowman.  The shaving cream and glue dries puffy. The client loved to make the snowman.

Materials:
Heavy card stock paper for the snowman
Shaving Cream
White Elmer's glue
Black and orange paper for the nose, eyes, hat, and pieces of coal
paper plate
plastic spoon
paint brush
sparkles

Directions:

First prepare for the therapy session by cutting out the shape of a snowman.  Then cut out a black hat and orange nose. A hole punch was used for the eyes and pieces of coal.  When with the client mix equal parts of the shaving cream and glue. Mix on a paper plate with a plastic spoon.  Later have the client use a paint brush to paint the white mixture on the paper snowman.  Add sparkles if wanted. After the mixture dries glue on the hat, eyes, pieces of coal and nose.
 
I saw this idea on www.homemakingfun.blogspot.com. Enjoy!

- SP Girl

Cup Rocket

Today's idea comes from Michigan, where I'm in a warm hoodie and drinking hot cocoa. A lot of ideas may be geared towards girls. Here is an idea for an active little boy that you may have trouble keeping focused in therapy.
Materials:
2 solo cups
A cut out rocket drawing
2 rubber bands
Tape

First either print out a rocket picture and have the client color it or have the client color a picture of a rocket his or her self. Then take the plastic cup make 4 evenly spaced, half-inch cuts in the rim of one cup. Then cut 2 rubber bands, knot them, and place them in the slits so that they are tight. Place the tape over the cuts on the inside of the cup so they are secure. Then put the rocket drawing on the side of the rubber band cup. To use, press the rubber band cup on top of the other cup and bounce it off. The client can use any words for this activity, specifically, up or high. A special thanks to Disney's Family Fun magazine for the fun activity! Hope you enjoy!

-SP Girl