A WHY? - showmemsha.org · –Acoustic reflexes ... Interpreting CAP test results. 3/22/2018 9...

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A rose by any other name… Assessing and treating auditory‐language

processing deficits

Jeanane M Ferre, PhDAudiologist, CCC-A

[email protected]

WHY?• Deficits in our ability to process what we hear can adversely affect academics, communication, and psychosocial wellness

• The practical importance of making a correct diagnosis is that children having different types of problems vary significantly in their needs and unless a differential diagnosis is made, their potentialities are lost.

‐H. Myklebust, 1954

DISCRIMINATION

OUTPUTSYNTHESIS Continuum of Processing

• Detect, analyze, & synthesize

Acoustic processing

• Attach meaning & integrate with other information

Phonologic/linguistic processing • Organize,

execute a response, maintain focus

Linguistic /cognitive processing

• In general, these auditory processes are defined by the “geography” of the system

– where within system does action take

place

– how does mechanism work

Peripheral Auditory system

Outer ear

Middle earInner ear

8th nerve

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• Hearing sensitivity and reflex action

– Signal collection – outer ear

– Signal transmission – middle ear

– Signal detection – inner ear

– Signal transformation – 8th nerve

Ascending CANS: brainstem

Brainstem level Central Auditory Functions

• Binaural interaction – how the two EARS work together

– “additive” functions – provide a more robust signal for higher centers

– “difference” functions – help with localization and hearing in noise

• Acoustic feature extraction: timing and frequency cues

– Assists in signal perception

– Different cells respond differently

Cortical system

Frontal lobe

Temporal lobe

Parietal lobe

Occipital lobe

Right hemisphere

Left hemisphere

SECOND FUNCTIONAL UNIT = PARIETAL,

OCCIPITAL, TEMPORAL LOBES

• Posterior two‐thirds of cortex

• Isolate neural impulses into discrete areas for analysis, storage, coding, organization

–Visual stimuli = Occipital

– Tactile stimuli = Parietal

– Auditory stimuli = Temporal

• Each cortical section further delineated into three zones

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PRIMARY ZONE

• Reception of incoming neural impulses

– Visual stimuli = Occipital

– Tactile stimuli = Parietal

– Auditory stimuli = Temporal

• NOT involved in interpretation of meaningfulness of stimuli; only sensory analysis/sensation

• Impairment = sensory/perceptual impairment; not a deficit in higher order processing, but may contribute to deficit in higher order processing

Subcortical/cortical central auditory functions

• Auditory discrimination – ability to analyze fine acoustic differences in signal spectra (frequency, intensity, time)

• Occurs at thalamic level AND primary auditory cortex (Heschl’s gyrus)

• Perception of ACOUSTIC signal

• Temporal processing – ability to use timing aspects of signal

– Temporal resolution‐ a left hemisphere skill involving ability to perceive “1” versus “2” targets

– Temporal patterning – a right hemisphere skill involving ability to perceive order/sequence

• BOTH skills important for perception of running speech

• Dichotic listening – interaction between the two HEMISPHERES

• Reflects integrity of the left hemisphere, right hemisphere, and corpus callosum

–Binaural integration: process all information presented to the two ears

–Binaural separation: “hear” what’s in both ears BUT ignore one target or the other

AUDITORY SYSTEM DOMINANCE

Heschl’sGyrus

CORPUS CALLOSUM

ipsilateral ipsilateral

contralateral

Left Cochlea Right Cochlea

pathway pathway

pathways

Heschl’sGyrus

LeftHemi

RightHemi

SECONDARY ZONE

• Organize incoming information according to rules of language ‐ attach meaning to input

–Visual meaning = Occipital

– Tactile meaning = Parietal

–Auditory meaning = Temporal

• Interpretation through coding, organizing, associating, storing

• Integrate into meaningful experiences

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TERTIARY ZONE• Multisensory neural integration among sensory secondary zones

– integrate newly organized stimuli with stored information

– integrate discrete neural impulses between modality areas

• Coordinate higher level processing

– integrate information from all cortices

– transfer passive receptive input into active expressive output

Phonetic /Phonemic Processing

• Preliteracy foundation

– Sound‐symbol correspondence

– Spelling

–Reading

–Written Language

• Weak area for this generation

–Visual learners

– “Text speak”

Linguistic Processing

• Language Foundation for metalinguistic skills

• Ability to comprehend and express ideas through auditory to verbal modality

• Conceptual basis for higher level, more complex language

THIRD FUNCTIONAL UNIT = FRONTAL LOBES

• Anterior one‐third of cortex, including frontal lobes, motor/pre‐motor cortex

• Active response through motoric expression to stimuli processed in second functional unit

• Planning and execution, managing of person’s behavior in relation to perceptions and knowledge ‐ through motor response

Executive Functions

• Ability to plan, organize, manage, execute response

• Coordinate and integrate the foundation skills from the temporal lobe

• Under frontal lobe, pre‐motor, motor cortex control

• Computer isn’t spooling to the printer

So, when it comes to processing…It takes a village

• Intact peripheral auditory system – perceive and receive acoustic stimulus

• Intact CANS – transmit through brainstem to upper cortex

• Phonemic knowledge to recognize “sounds”

• Linguistic knowledge to decode message

• Executive function skills to attend, organize, execute behavioral response

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Executive functions

Language & learning

Sensory processing

Another way to “look” at process Shared symptomatology across processing disorders

Learning Disabilities

Attention Deficit

Disorder

Speech-Language & Language Processing

Disorder

Central auditory

processing disorders

• Attention Deficit Disorder– distractible, inattentive, disorganization

• Executive Function Difficulties– poor working memory, strategy development

• Behavior Disorders– opposition, perseveration, noncompliance

• Asperger’s Syndrome– poor social language, impaired affect

• Nonverbal Learning Disability– impaired prosody, use of nonverbal cues

• Speech‐Language Impairment– poor phonological awareness, pragmatic language

• Differentiates among disorders having similar symptoms/manifestations

• Psychologists, neuropsychologists & others provide insights re: listener’s auditory performance in various contexts

• Audiologists use norm‐referenced tests that minimize influence of language, cognition & other sensory skills & maximize auditory system function

• SLPs use tests designed to assess phonetic‐phonemic, linguistic, memory, and related skills

• Patterns across tests allow diagnosis of DEFICIT‐specific processing disorders

• Results lead to DEFICIT‐specific differential intervention

Differential diagnosis

Differential Intervention ◦ Balance of deficit‐specific treatment and management based upon neuroscientific principles and derived from assessment results

◦ Customizes treatment and management plans to treat impaired skills & to minimize impact on listener’s life

Neuroscience foundations

managementtreatment

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Central Auditory Processing Language Processing

Transition AreaPhonemic Processing

audiologist speech-language pathologist

audiologist and speech-language pathologist

Acoustic Linguistic

Assessment

• Screening determines those listeners at‐riskfor a disorder

• Screening by test, checklist, record review, informal

tasks

• NO standard screening protocol for CAPDs

• Diagnostic testing determines presence/absence of a disorder AND specifies the nature

• It “takes a village”

• Test battery recommended

Diagnostic CAPD Testing Battery

• What?–Battery of tests to determine how efficiently CANS operates

• How? –Overloading or overworking it

• Who?–Children as young as 6 years–Results compared to age‐matched peersPerformance profiles yield insights into nature of CAPD

The diagnostic CAP test battery

• Minimize influence of language, cognition & other sensory skills on performance

• Maximize function of CANS

• Results examined re:

– central auditory processes being taxed

– anatomical sites subserving those skills

CAPD Test Battery

• Standard audiometrics

–Puretone air/bone

– Speech thresholds

–Word recognition

• Standard immittance tests

– Tympanogram

–Acoustic reflexes

CAP Test Battery‐ taxing binaural processing

• Binaural interaction tasks

– Tap brainstem level interaction between ears

• Acoustic reflexes

• Binaural fusion

• Masking level difference

• LISN

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CAPD Test Battery‐

cortical level binaural processing

• Binaural Separation

– Tap cortical level separation skills

– Provide information re neuromaturation

• Competing sentence tests

• Binaural Integration

– Tap cortical level integration skills

• Dichotic digits

• Dichotic rhyme

• Staggered spondaic words

• Dichotic CVs

• Competing words

CAPD Test Battery‐taxing auditory discrimination

• Monaural low redundancy tasks

– Tap cortical auditory closure/discrimination

• Low‐pass filtered speech

• Time‐compressed speech

• Speech in noise: SPIN, SCAN, and SSI‐ICM

CAPD Test Battery‐taxing temporal processing

• Temporal processing tasks

– Tap LH, RH, interhemispheric function

– Temporal resolution tasks

• Random Gap Detection Test

• Gaps in noise Test– Temporal patterning tasks

• Pitch patterns sequence test• Duration patterns sequence test

CAPD testing considerations

• Hearing sensitivity

• Sufficient expressive speech skills

• Sufficient receptive language skills

• Intelligence

brainsteminteraction between ears;discrimination

binaural fusion, MLD RASPLISN

primary auditory cortex

auditory closure;auditory discrimination

filtered speechtime-compressed speech

peripheral/centralsignal transmissiontympanogramacoustic reflexes

peripheral mechanism

hearing sensitivity/acuity

puretone air/bonespeech thresholdsword recognitionOAEs

Underlying siteProcess assessedTest Type

RH, LH, CCtemporal patterning

Temporal resolution/discrimination

pitch patterns test duration patterns testrandom gap detectiongaps in noise

speech-in-noise tests variedvaried

Underlying SiteProcesses AssessedTest Type

LH, RH, CCneuromaturationseparation

competing sentences

LH, RH, CCclosure integrationordering

dichotic digits, dichotic rhyme, dichotic CVs, staggered spondaic words (SSW),competing words

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Assessing phonological processing

• Phonological awareness test (PAT)

• Comprehensive Test of Phonological Processing (CTOPP)

• Sound blending and auditory closure tests

• Check spelling skills

Assessing language processing and related skills

• Check receptive vocabulary (e.g., PPVT)

• Assess hierarchy of language processing skills

– e.g., LPT, CASL, WORD Test

• Assess multisensory and related memory

– Test of Problem Solving, CELF, Listening Test, Detroit

– Word retrieval – Test of word finding

– Memory for unrelated/related information – digit span, sentence memory tasks

Assessing executive skills

• NEPSY – attention, planning, flexibility, impulsivity, self‐monitoring, problem‐solving

• Wisconsin Card Sorting test – processing speed/ accuracy and “learning to learn”

• Conners’ Continuous Performance Test – attention

• Ruff Figural Fluency Test – ages 16‐70, fluid thinking and divergent reasoning

• Test of Problem‐Solving (TOPS‐3) – information extrapolation

• BRIEF – rating scale for executive functioning

• BADS‐C – behavioral assessment of dysexecutive syndrome

Processing Level Anatomiclocation

Processing skills Assessment examples

Acoustic Outer, middle, inner ear; 8th nerve;brainstem, Heschl’s gyrus, RH, CC

Auditory Acuity;Neurologic transfer; Discrim/Integration of acoustic cues

Pure tone hearing, word recognition, patterning, binaural recognition,degraded speech

Phonologic Heschl’s gyrus, temporal lobe

Discrim/recognition of phonemic aspects of signal

Word segmentationRhymingPhoneme blendingAuditory closure

Linguistic Temporal Lobe –Wernicke’s area and angular gyrus

Discrim/recognition of linguistic aspects of signal; attach meaning using code

Identifying objectsIdentifying conceptsSemantics (synonym, antonym, homonym)

Executivefunctions

Prefrontal/Frontal lobes; Motor Strip

Planning and executing response

Pragmatic languageProblem solving/ reasoningProsodic Interpretation

• Absolute analysis

– Norm‐referenced

– Compare to age‐matched peers

– Per test pass‐fail criterion: >2SDs below mean for age

– CAP test scores can be normal or abnormal (NOT average, below average or above average)

Interpreting CAP test results

• Relative analysis

– Examination of patterns across tests

– Ear differences across tests

– Contradictory findings

– “Ties that bind” – Follow the clues

– What are the tests measuring?

– Behavioral Observations

– Using “typing” models (e.g., Buffalo, Bellis‐Ferre)

• Look for deficit‐specificity

Interpreting CAP test results

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Auditory discrimination deficits

• Poor scores on tests of degraded speech

– frequency‐filtered speech, time‐altered speech, listening in noise

• MAY show poor scores on “language‐loaded” binaural tasks

• Bellis‐Ferre decoding deficit

Auditory discrimination inefficient analysis of acoustic cues

• Impacts

– Phonological awareness

– Spelling

– Listening stamina

– Direction following

– Comprehension

– Language skills

– Foreign language acquisition

• Treatment needs

– Sound discrimination

– Auditory closure

– Phonemic awareness

– Recognition in noise

– Use of visual cues

– Listening comprehension

Binaural processing deficits• Inter‐hemispheric based deficit

– Left ear suppression on dichotic listening tests

– Difficulty labelling tonal patterns

– Due to corpus callosum inefficiency

– Bellis‐Ferre Integration Deficit

• Intra‐hemispheric based deficit

– Left ear or bilateral suppression on dichotic tests

– Usually can imitate and label patterns

– Likely due to inefficient communication between Heschl’s gyrus and Wernicke’s area

– Bellis‐Ferre 2ndary Associative profile (Language)

Binaural processing

• Impacts

– Comprehension‐reading

– Spelling/listening

– Processing speed


– Task completion

– Note‐taking

– Working memory

• Treatment needs

– Dichotic listening

– Interhemispheric communication

– Synthesis of multiple auditory targets

– Manipulation of auditory & non‐auditory signals

Temporal processing deficits

• Brainstem based deficit

– May show globally depressed scores

– May reflect an auditory neuropathy

• Right hemisphere‐based deficit

– Inability to label OR imitate tonal patterns

– Exhibits left ear suppression on dichotic tests

– Bellis‐Ferre Prosodic Deficit

Temporal processing deficits

• Left hemisphere‐based deficit

– Impaired temporal discrimination and resolution

– May have 2ndary difficulty with pattern recognition

– Looks “global” but is not

• Frontal/motor cortex based

– Sequencing and omission errors, greater difficulty with multiple targets

– Issues in noise

– Bellis‐Ferre 2ndary Output‐Organization profile

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Temporal processing

• Impacts

– Comprehension –reading/listening

– Memory, incl. working

– Processing speed

– Social/pragmatic language

– Direction‐following

– Reading fluency

• Treatment needs

– Pattern recognition

– Use of prosody



– Working memory

– Sequencing

Test results help professionals develop deficit‐specific intervention strategies

Effective intervention includes

managementremediation

Neuroscientific principles & test results

Management

Modification of the communicative environment

Use of compensatory strategies

Minimizes adverse effect of disorder of client’s life

Remediation

Formal and informal therapy to develop deficient skills AND

Teach compensatory strategies

Designed to reduce or resolve deficit

message

mediumme

Communication

Intervention Tripod

Direct Remediation-focus on listener

Compensatory Strategies –focus on message

Environmental Modifications –focus on environment

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• Why remediate for specific CAPDs?

• CAP skills represent foundational skills ‐ contribute to success in and interact with other skills

• CAPDs can affect academics, communication, and psychosocial wellness

• Educationally relevant to ALL Common Core standards, including those for Speaking and Listening

• Deficits in foundational skills reduce system efficiency, requiring over‐use of higher order central resources

• CCSS.ELA‐literacy.CCRA.SL.1

– Prepare for and participate effectively in a range of conversations and collaborations with diverse partners, building on others’ ideas and expressing their own clearly and persuasively


– Integrate and evaluate information presented in diverse media and formats, including visually, quantitatively, and orally.


– Evaluate a speaker’s point of view, reasoning, and use of evidence and rhetoric

• Why remediate for specific CAPDs? • The CNS is plastic – it can change/adapt in response to internal or external stimulus

• A skill that can be tested can be trained

• If deficits in foundational skills are reduced or resolved, “gaps” in higher‐level skills are more likely to resolve/reduce

• Goal of treatment to improve foundational CAP skills in order to improve function of client in real‐life situations

Direct Remediation for PDs

• Remediation based on research in neural plasticity.

– Plasticity is brain’s ability to organize/reorganize in response to internal/external changes.

• When choosing treatment program, consider

– Reported efficacy of program for specific populations – Does it work?

– Program’s neuroscientific foundations – Should it work?

– Appropriateness for type of deficit identified – Does it fit?

Remediation for PDs

• Auditory ‐phonologic training – bottom‐up therapy, plasticity‐based

– auditory, although not exclusively, stimuli

– stimuli are repetitive

– max number of responses elicited

– feedback on accuracy provide

– activities adaptive, systematic, and varied

– nearly any CAP/phonologic skill can be trained

Remediation for PDs

• Linguistic‐Cognitive therapy

– top‐down therapy

–based on neurocognitive theory

– concept‐driven

• Strategy‐based

– teaches compensatory strategies

• central resources training

• use of visual cues

• counseling

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CAP processes

• Auditory discrimination ‐ ability to analyze fine differences in acoustic spectra

• Binaural processing ‐ ability to recognize and manipulate multiple acoustic targets

• Temporal processing ‐ ability to use timing aspects of auditory signals

Auditory discrimination inefficient analysis of acoustic cues

• Impacts

– Phonological awareness

– Spelling

– Listening stamina


– Comprehension

– Language skills

– Foreign language acquisition

• Treatment needs

– Sound discrimination

– Auditory closure

– Phonemic awareness

– Recognition in noise



Improving auditory discrimination • Designed to improve auditory system’s ability to extract acoustic

cues from within speech spectrum

• Targets include CVs/VCs, words, spondees/trochees, multisyllabic words, words in sentences, nonsense and real sentences, connected discourse, nonspeech targets

• Uses adaptive minimal pairs discrimination, identification and recognition training with targets altered to “tax” system

– Temporal and/or frequency discrimination, recognition in noise

• Computer‐assisted programs

– Fast ForWord

– HearBuilder

– Customized Learning: Exercises for Aural Rehabilitation (clEAR)

– Listening and Communication Enhancement (LACE)

Computer‐assisted training

• HearBuilder (www.hearbuilder.com)

• clEAR‐ Customized Learning: Exercises for Aural Rehabilitation (www.clearworks4ears.com)

• LACE‐ Listening and Communication Enhancement (www.neurotone.com)

• Fast ForWord (www.scilearn.com)

• www.lipreading.org

Improving binaural processing

• Brainstem level binaural interaction training – Localization training/training temporal‐spatial skills

• Computer‐assisted LISN and Learn auditory training program (www.capd.nal.gov.au/lisn‐learn)

– Training with competing signals, e.g., speech‐in‐noise

• Cortical level dichotic listening training – Dichotic Interaural Intensity Difference (DIID)– Zoo Caper SkyScraper– CAPDOTS

Dichotic listening (DL) training• Addresses dichotic listening deficits due to impaired/

inefficient communication between right ‐left hemispheres

– Researchers theorize maturational delay in myelin development of the corpus callosum in learning disabled

• Impaired dichotic listening characterized by excessive left ear suppression on dichotic listening tasks

• Goal: improve interhemispheric communication by increasing score of “poorer” ear to normal‐near normal level and to level similar to that of stronger (usually right) ear

• Programs use words, numbers, animal sounds, sentences presented simultaneously, one or more to each ear

• Client responds to all targets – binaural integration OR to only one ear’s targets – binaural separation

• DIID, Zoo Caper, CAPDOTS

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Computer‐assisted training

• Zoo Caper Skyscraper dichotic listening program (www.acousticpioneer.com)

• CAPDOTS dichotic listening training (www.capdots.com)

• www.clearworks4ears.com

• www.brainhq.com

• www.lipreading.org

Improving temporal processing

• Insane Earplane

– Targets lateralization and temporal pattern recognition

• clEAR

– Targets temporal resolution

• Fast ForWord

– Uses temporally altered speech

• LACE

– Increases rate of speech adaptively

• Lipreading/speechreading

• Auditory closure (fill‐in‐the‐blank)

• Language processing treatment activities

• Teaching Meta‐memory strategies

– Reflexive strategies : verbal rehearsal, rote memory

– Explicit Declarative Strategies: visual imagery, chunking, mnemonics, rhymes

– Episodic Strategies: “mark” learning with places, circumstances, field trips

– Procedural Strategies: teach with movement, working models, songs

Using visual cues‐ lipreading/speechreading

• Discriminate same‐different for visual‐only target with 90% accuracy

• Identify viseme group for target “sound” in initial/final position of word with 90% accuracy

• Identify target compound word visually only from closed set of (up to) 30 choices 90% accuracy

• Identify sentences/phrases from closed set of up to 10 choices with 90% accuracy

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• Auditory vigilance training

• Interhemispheric transfer training

• Noise tolerance training

• Prosody training

• Active listening Strategies– Self‐monitoring

– Assertiveness training and self‐advocacy

For all students

• Student will demonstrate ability to use active listening strategies

– Active listening ‐ taking responsibility for one’s listening success or failure by understanding impact of auditory impairment in one’s life, recognizing aspects of communication under listener’s control, displaying effortful listening behaviors, taking overt steps to avoid or correct potential communication mishaps.

• Student will maintain auditory vigilance for “X” amount of time

Active listening• Student will state two difficult listening situations that he/she has encountered

• For a self‐reported difficult listening situation, student will state (and practice) one strategy to minimize the listening difficulty

• Student will follow conditional directions, requesting clarification as needed

Auditory vigilance

• Given a string of random words (or phonemes), student will indicate through hand signal each occurrence of pre‐determined “target” word

• Student will indicate through hand signal “rare” or different target from within a string of common targets (e.g., buh‐buh‐dee‐buh‐buh‐buh‐buh‐dee)

Computer programs: listening and related skills

• www.brainhq.com• www.interactivemetronome.com

• Apps from • www.superduperinc.com• www.smartyearsapps.com• www.virtualspeech.com• www.hamiguchiapps.com

Intervention Tripod

Direct Remediation-focus on listener

Compensatory Strategies –focus on message

Environmental Modifications –focus on environment

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Focus on the environment

• Noise & reverberation (echo)

– Listener’s ability to function in background noise depends upon

• Type of noise

• Loudness of noise relative to background

• Location of noise relative to target

• Task demands

• Distance, lighting, distractions

• Direct signal enhancement via assistive listening technology (ALDs)

Noise/reverberation

• Recommended classroom SNR should exceed +15dB with RT of <0.4 seconds

• Noise abatement

– Increase absorptive material

– Use baffles, damp reflective surfaces

– Eliminate open classrooms

– Alter lighting

– Infrastructure changes

– Earplug/earphone use

– Noise abatement using “masking”

Distance, Lighting, distractions

• Optimal speaker‐listener distance = 3‐6 feet

–Preferential seating

–Change in location for tests, studying, etc.

–Use of study/work carrels

–Changes in seating ergonomics to minimize physical distractions

Direct signal enhancement via ALDs• Improves SNR reaching listener’s ear

– Personal wearable – FM, digital, PSAPs– Soundfield systems– Personal soundfield systems

• Can improve attention to, discrimination of, and memory for signals

• NOT an option for all students

Focus on the message

• Clear speech

• Visual cues

• Clear Language

• Educational accommodations

Message: Clear Speech

• Clear Speech improves perception and recognition

• Training to speak at slightly slower rate, including strategic use of pausing and slightly increased loudness

• Simple repetition with Clear Speech ensures perception for most listeners

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Message: visual cues

• Couple clear speech with AV presentation

– Model look and listen

• Not all listeners can look and listen

– Use look or listen

• Add complementary visual cues

– Show me

• For teachers and parents

– Look then listen

Message: Clear Language• Improves comprehension• Say what you mean and mean what you say• Rephrase • Minimize generic and ambiguous language• Add “tag” words• Consider overall amount of information• Break instructions down• Allow “waiting” and “thinking” time• Verbal cueing• Preteaching

** Key Point: More complex/novel the information to be presented, greater the need for Clear Language

Educational accommodations

• Extended time/Untimed tests • Separate location for testing• Adjusting amount of information• Adjusting homework loads• Using technology‐ “smart pens”, notetaking apps

• Changes in curriculum

Level System Task Assessment Intervention examples

Acoustic(AUD)

Receiving the signal/intact transmission –I “hear it”

Peripheral & central auditory tests

FM System (for some)Preferential SeatingLipreadingAssistive technologyFigure-Ground

Phonologic(AUD & SLP)

Analyzing signal – discrimination & recognition –I “know” it

Phonetic and phonemic tasks

Sound BlendingAnalysis-synthesisClosureSound-symbol association

Linguistic(SLP)

Attaching meaning - I “get” it

Language, language processing, memory tests

Concept DevelopmentWord/Object AssociationAnswering wh questionsCompare/Contrast Tasks

Executive Functions

Managing and organizing a response –I can “use” it

Pragmatics, Problem solving ReasoningOrganization

Role-play pragmatics Work on impulse controlJudgment and interpretationActive listening

Resources for therapy• www.proedinc.com ‐ Differential Processing Training Program – auditory, phonologic and linguistic goals

• www.acousticpioneer.com – dichotic listening and temporal patterning training

• www.neurotone.com – LACE: Listening & Communication enhancement – for adults

• www.clearworks4ears.com – activities that enhance an array of auditory & related skills

• www.brainHQ.com‐ activities to enhance auditory, visual and thinking/reasoning skills

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Resources for therapy

• www.scilearn.com – Fast ForWord program discrimination, temporal/phonologic processing

• www.capdots.com – dichotic listening program

• www.superduperinc.com – HearBuilder ‐phonologic awareness, discrimination, memory for auditory info, usage

• www.lipreading.org – using visual cues

• www.interactivemetronome.com – multisensory training, enhances sequencing, speed, attention

• www.capd.nal.gov.au/lisn‐learn ‐ enhances spatial listening and auditory vigilance

Resources for therapy

• Apps from

• www.superduperinc.com

• www.smartyears.com

• www.virtualspeech.com

• www.hamaguchiapps.com

Thirty great games/books to enhance auditory processing and related skills

Game Processing skill taxed

• A Rhyme in Time sound discrimination, auditory closure• Battleship listening, visual patterning, integration • Blind Man’s Bluff localization, binaural interaction• Boggle pattern recognition, integration• Bopit, integration, vigilance• Brain Warp vigilance, integration, problem‐solving• Card games pattern recognition, sequencing• Catch Phrase integration, vocabulary, output • Clever Endeavour metalinguistic strategies, critical listening• Feely Bag interhemispheric communication

Game processing skills taxed

• Ending sound game auditory discrimination

• Mad Gab temporal patterning, language

• Marco Polo localization, binaural interaction

• Musical Chairs vigilance

• Name that tune interhemispheric integration

• Password vocabulary, linguistic skills

• Plexers metalinguistic strategies

• Rags to Riches metalinguistic skills (idioms)

• Read My Lips lipreading/speechreading

• Red Light‐Green light vigilance, active listening

Game Processing skills taxed

• Rummikub patterning, problem solving, integration• Scattergories vocabulary building, linguistic strategies• Scrabble integration, language, visual patterning• Simon auditory‐visual patterning• Simon Says vigilance, active listening• Taboo vocabulary, metalinguistic strategies• Telephone game attention, active listening, discrimination• Twister integration, critical listening• UpWords integration, visual patterning• Wheel of Fortune auditory closure

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