This document provides a case study treatment plan for a student named Allan who has a bilateral conductive hearing loss as well as impairments in language, articulation, and suspected vision problems. It includes background information, diagnoses, test results and descriptions, proposed audiological and speech-language treatments and interventions, considerations of how Allan's hearing loss impacts his communication and learning, and the role of the speech-language pathologist in working with a client who has hearing loss.
This document provides a case study treatment plan for a student named Allan who has a bilateral conductive hearing loss as well as impairments in language, articulation, and suspected vision problems. It includes background information, diagnoses, test results and descriptions, proposed audiological and speech-language treatments and interventions, considerations of how Allan's hearing loss impacts his communication and learning, and the role of the speech-language pathologist in working with a client who has hearing loss.
This document provides a case study treatment plan for a student named Allan who has a bilateral conductive hearing loss as well as impairments in language, articulation, and suspected vision problems. It includes background information, diagnoses, test results and descriptions, proposed audiological and speech-language treatments and interventions, considerations of how Allan's hearing loss impacts his communication and learning, and the role of the speech-language pathologist in working with a client who has hearing loss.
This document provides a case study treatment plan for a student named Allan who has a bilateral conductive hearing loss as well as impairments in language, articulation, and suspected vision problems. It includes background information, diagnoses, test results and descriptions, proposed audiological and speech-language treatments and interventions, considerations of how Allan's hearing loss impacts his communication and learning, and the role of the speech-language pathologist in working with a client who has hearing loss.
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Running Head: Case Study Treatment Plan Project 1
Case Study Treatment Plan Project
Erin Alexander, Marlee Cohen, Danielle Da Cunha, Christine Von Cappeln Dr. Welling Seton Hall University Fall 2016 CASE STUDY TREATMENT PLAN PROJECT 2
Case Study Treatment Plan Project
1. Background history information:
Please refer to attached case history document (1.1)
2. Diagnosis: Allan's primary condition is a bilateral chronic and fluctuating conductive hearing loss with secondary conditions including impaired expressive and receptive language, an articulation disorder, and suspected vision impairment. Due to frequent middle ear infections as a young child, Allan received PE tubes to relieve the pressure and fluid that had accumulated in his middle ears. The opening where the myringotomy tubes were placed never healed properly which led to perforations of his ear drums and resulted in a bilateral conductive hearing loss. The comorbid diagnoses to Allan's hearing loss are an expressive and receptive language disorder and articulation disorder. Allan's teacher has also expressed concerns regarding a vision impairment, all which have led to Allan's difficulties with academics and social interactions.
3. Description of diagnoses/disorders: Figure 3.1: Un-Aided Audiogram
Figure 3.2: Aided Audiogram
CASE STUDY TREATMENT PLAN PROJECT 3
Figure 3.3: Tympanogram
An OAE would not be an appropriate test to perform on Allan. See further detail below.
Unaided The audiogram shows a binaural moderate conductive hearing loss. Allan's speech detection threshold is 55dB, pure tone average is 48dB, speech reception threshold is 45dB, and his word detection threshold is 80dB. There is a moderate impairment in his air conduction while bone conduction is within normal limits resulting an air bone gap. The air bone gap distinguished the hearing loss as conductive.
Tympanogram Due to Allan having binaural perforated ear drums his tympanogram in both ears is Type B (flat). This is because the perforations do not allow any compliance or any pressure to take place; thus, the air goes straight through the canal to the middle ear with no resistance. OAE CASE STUDY TREATMENT PLAN PROJECT 4
The otoacoustics emission results do not show any response because the signal is unable to reach the hairs of the cochlea because of the conductive hearing loss. This is not to say that the inner ear is not functioning, but that this test would not be able to properly assess the inner ear because the path the signal needs to take is damaged. Do these findings corroborate the rest of the audiometric result? These findings do corroborate the findings within the audiograms. The audiogram shows that there is a conductive hearing loss and the results from the tympanogram confirm the malfunction of the ear drum being that it is type B. There would be no results from the OAE, not from a malfunction of the inner ear, but because the signal would not able to properly pass through and reach the inner ear. The un-aided audiograms bone conduction showed that the inner ear is properly functioning showing that it is in fact a conductive hearing loss. Aided An aided audiogram was used to show if there would be an improvement in Allan's audiological results with the trial use of the BAHA. Results from the audiogram proved that the BAHA was an effective intervention. Allan's speech detection threshold is 30dB, pure tone average is 23dB, speech reception threshold is 20dB, and his word detection threshold is 55dB. The use of the BAHA closed the air bone gap on the audiogram putting Allan's hearing in the normal to mild range. What is/are the medical diagnoses Allan's medical diagnosis is a fluctuating conductive hearing loss due to bilateral perforations of his ear drums from PE tubes that were surgically inserted to alleviate the effects of chronic otitis media. The area that the tubes were inserted never healed causing the chronic perforations. Characterize the speech-language impairment. Allan's speech-language impairments include impaired expressive and receptive language skills, problems with articulation, and he is experiencing academic difficulty.
4. What are the audiological treatments/remediation's/interventions?
Before audiological intervention takes place, a referral to an ENT would be necessary to ensure that routine checkups and medical management are occurring. Once intervention begins, an open line of communication with the ENT should be established. A trial period with a BAHA on a band would be implemented for six months while keeping consistent communication with Allan's audiologist. A classroom assessment would be performed and the proper FM system would need to be used in each class that he attends. If Allan has success with the use of a BAHA on a band, he may then be considered as a candidate for the surgery. As a follow-up plan, Allan's hearing will be re-checked biyearly by an audiologist. Allan will also visit an ENT quarterly to ensure no infection or other medical issues arise. The SLP will ensure that FM systems in Allan's classrooms are operating and his teachers are well trained on the function of these systems. The SLP will also notify all school employees of what a BAHA system is and what it looks like incase the device is misplaced. The use of a BAHA should increase Allan's hearing threshold from 50dB to 20-25dB. In addition, the FM system will help to further amplify the auditory information he is receiving in the classroom where distractions or disturbances may occur. The increase in Allan's hearing abilities should allow him to be more stimulable for speech therapy services relating to his articulation issue.
5. Impact of hearing loss on communication:
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Two additional scales that were considered in order to assess Allan's overall difficulties included a classroom checklist filled out by his teacher, and a vision history questionnaire, which was filled out by his parents. (Refer to attached forms; 5.1 and 5.2) His teacher emphasized a concern for his hearing and vision. It was stated that Alan consistently needs directions repeated and clarification during classroom activities. Per his case history form he also tends to repeat certain words and phrases excessively. A concern for his vision arose when his teacher noticed him rubbing his eyes often and squinting his eyes when trying to read what was on the board. A referral to an optometrist was made to ensure that he was not straining his eyes and effecting his vision. The classroom communication and learning checklist showed that Allan's hearing loss is effecting many elements in his educational environment. One in particular is social activities. This includes his timid demeanor when socializing with his peers. He has difficulty initiating play with others and typically avoids any social interactions. His academics are also affected because of his difficulties following directions and focusing on what is happening in class. The case history reiterated this by stating that Allan expresses frustration often due to his communication restrictions which also occur at home. He's lacking the appropriate comprehension skills, which overall effects his lexicon and writing efficiency. Allan's primary mode of communication is spoken. His hearing impairment has not affected his speech to the extent that sign language or any alternative forms of communication are necessary.
6. Additional Aspects to Considerations
Visual impairment concerns have been raised by Allan's teacher. A referral to an optometrist has been made and test results are pending. This will be done to ensure that his vision is not impacting his performance in school. Being that Allan's hearing loss is fluctuating, it is imperative to be continuously monitoring the status of Allan's ear. Consent from the ENT to allow open and continual communication on any information or medical status that would help in Allan's case.
7. How does the (entire) audiologic/auditory status impact your role as an SLP with this particular client? When assessing a client with hearing loss an SLP must collaborate with the audiologist to gain a complete understanding of how this affects his or her communication. In Allan's case, his hearing loss has contributed to difficulties in articulation and expressive and receptive language. To accommodate Allan's impairments, assessment in a sound treated environment would be necessary. Since Allan will have a BAHA, it is important that the SLP ensures the device is functioning properly each time that they meet. Keeping up with interprofessional communication, the SLP should contact the audiologist on the case if there are any problems with the device. To continuously provide an optimal environment the SLP should make certain that they are consistently speaking within the child's hearing range and at the same eye-level as the child. The modifications that are being implemented in the assessment environment should be carried over into the treatment setting. Intervention targets would focus on strengthening Allan's expressive and receptive language, overall enhancing his social skills. Activities that involve the sequencing and re-telling of a narrative could be a focus point. Simple conversational skills can be improved by beginning every session asking Allan how his day went. Because of noted CASE STUDY TREATMENT PLAN PROJECT 6
difficulties with vision, the SLP would have to ensure that all materials are within his visual field. If visual difficulties persist and begin to affect treatment progress, an optometrist should be contacted by the SLP to disregard any extraneous factors that could be affecting his speech and language abilities.
8. What additional resources will you provide to the client and/or family? 1. The Individuals with Disabilities Education Act (IDEA), Parental Rights in Special Education (PRISE), and American's with Disabilities Act (ADA) all apply to Allan and his family. IDEA ensures that Allan has access to the general education curriculum and any assistive technology he may require while being in the classroom (i.e. FM system). PRISE gives Allan's parents the right disagree with services or programs recommended by the school to ensure that they are in control and comfortable with the services Allan will receive. ADA protects Allan from being excluded from participating in federally funded program or activities. Additionally, information regarding the BAHA surgery after the 6-month trial period has been completed would be beneficial for the family to be able to review. If Allan shows improvement in the various areas that had previously shown concern, moving forward with the surgery could be extremely beneficial for him. Relevant literature and resources, like cochlear.com, would be an efficient way for the family to educate and familiarize themselves on the procedure.
2. After the initial use of a BAHA and speech therapy services, if social issues are still present, a referral to the school psychologist would be necessary. Counseling along with speech therapy would potentially help Allan with any social issues he continues to exhibit with his peers.
Final Note: If improvement after the 6-month trial period is substantial then a consultation with Allan's Teacher, ENT, Audiologist, SLP, and Parents to see if a more permanent BAHA through surgery would be beneficial.
Resources: Baha bone conduction implants. (n.d.). Retrieved November 30, 2016, from http://www.cochlear.com/wps/wcm/connect/intl/home/discover/baha-bone-conduction-implants CASE STUDY TREATMENT PLAN PROJECT 7
Child Vision History Questionnaire for Parent/Caregiver [PDF]. (2016, January). St. Paul: Minnesota Department of Health. Classroom communication and learning checklist [PDF]. (n.d.). Wiig & Secord. Speech-language Hearing Case History Form [PDF]. (2004). Greenville: Super Duper. Welling, D. R., & Ukstins, C. A. (2015). Fundamentals of Audiology for the speech-language pathologist. Burlington, VA: Jones & Bartlett Learning.
Appendix 1.1 Parent Questionnaire CASE STUDY TREATMENT PLAN PROJECT 8
