hearing disorders · hearing disorders dr. ashok kumar sinha director ali yavar jung national...
TRANSCRIPT
HEARING DISORDERS
DR. ASHOK KUMAR SINHA
DIRECTOR
ALI YAVAR JUNG NATIONAL INSTITUTE OF SPEECH AND
HEARING DISABILITIES MUMBAI
THE RIGHTS OF PERSONS WITH DISABILITIES ACT, 2016
• 2016: WINTER SESSION
• MSJE: 19.4.17
• RULES : 15.6.17
• GUIDELINES: 05.1. 18
• 21 CATEGORIES
A : LOCOMOTOR DISABILITY
• LEPROSY CURED/ CEREBRAL PALSY
• DWARFISM/ MUSCULAR DYSTROPHY
• ACID ATTACK VICTIM
B: VISUAL IMPAIRMENT
• BLINDNESS/ LOW VISION
1. PHYSICAL DISABILITY
C. HEARING IMPAIRMENT
• DEAF/ HOH
D: SPEECH AND LANGUAGE DISABILITY • LARYNGECTOMY / APHASIA
RPWD ACT, 2016
2. INTELLECTUAL DISABILITY
• SPECIFIC LEARNING DISABILITY,
• AUTISM SPECTRUM DISORDERS
3. MENTAL BEHAVIOUR: MENTAL ILLNESS
RPWD ACT, 2016
4. CHRONIC NEUROLOGICAL CONDITIONS
• MULTIPLE SCLEROSIS • PARKINSON'S DISEASE
BLOOD DISORDERS • HAEMOPHILIA/ THALASSEMIA • SICKLE DISEASE
5. MULTIPLE DISABILITIES : DB
6. ANY OTHER
RPWD ACT, 2016
LEARNING TO SPEAK
n DYNAMIC PROCESS
n PREREQUISITE: WITHIN CHILD
n ENVIRONMENTAL FACTOR
n VOCAL PLAY/ FIRST WORD
n ADULT-LIKE SPEECH: 5 YEARS
EAR
COCHLEA
AUDITORY NERVE
AUDIOLOGY
n CONDUCTIVE/ SENSORINEURAL
n MIXED/ RETROCHLEAR PATHOLOGIES: CAPD/ AN
n MALINGERING
n BALANCE DISORDERS/ TINNITUS
DIAGNOSIS
n SUBJECTIVE:
n TUNING FORK/ DISTANCE
n PURETONE/ NOSIE/ SPEECH
n OBJECTIVE:
n IMMETANCE/ ABR/ ASSR/ OAE
GOLDEN TEST
AUDIOMETER
IMMITTANCE AUDIOMETERS
INSTRUMENTATION
NORMAL TYMPANOGRAM
ABR/ ASSR
OAE
IMPACT
o LANGUAGE AND SPEECH DEVELOPMENT
o EDUCATION/SOCIAL AND EMOTIONAL
o VOCATIONAL
o FUNCTION BELOW POTENTIALS
ELIMINATION OF COMMUNICATION BARRIER
n RULE 1 - 3 - 6
n AUTOMATED
n UHSP
n INTERVENTION
n SUCCESS
MANAGEMENT
n PERSONAL HEARING AIDS
n COCHLEAR IMPLANTS
n ASSITIVE LISTENING DEVICES
n CLASSROOM DEVICES
n SIGN LANGUAGE
PHA
n BODY WORN HEARING AIDS/ MOULDS
n BTE/ ITC/ CIC/ RIC
n CROS
n DIGITAL
n PROGRAMMABLE/ TRIMMER
ADIP n BWHA
n BTE
n < 15000/ PER MONTH
n DISABILITY CERTIFICATE
n 125000 PER ANNUM
GWR
COCHLEAR IMPLANTS
n 1980: SURGICAL PROCEDURE
n SINGLE ELECTRODE
n FOR ADULTS ONLY
n CHILDREN BELOW ONE YEAR
n ONLY FOUR MANUFACTURES
INTERNAL DEVICE
n Casing of the receiver: titanium/ceramic
n Length and structure of electrode array/ current flow: 25mm/Bipolar
n Channels: 12-22
n Dimensions :30mm
n Weight:10g/ Frequency band:63
n Speed of stimulation: 24000 pps
EXTERNAL COMPONENT
• MICROPHONE
• SPEECH PROCESSOR: Sp. Coding
Strategies(formants/compressed
analog/neural firing
• CONNECTING CABLES
• TRANSMITTER COIL
COST
n PRE OPERATIVE: ASSESSMENT
n COCHLEAR IMPLANT
n MEDICAL AND SURGICAL
n POST OPERATIVE REHABILITATION
n MAINTENANCE
PRESENT STATUS
• PRIVATE
• SPONSORED
• STATE GOVERNMENT
• DEFENCE
• MSJE-DEPwD- ADIP
ADIP
n NODAL AGENCY
n TARGET: 500/ 1000
n ASSISTANCE: 6.00 LAKHS/ CHILD
n PRE AND POST INTERVENTION
n CI PROCUREMENT: ALIMCO
CANDIDACY
n BILATERAL SEVERE TO PROFOUND
n UPTO 5 YEARS
n NO ASSOCIATED DEVELOPMENTAL DELAYS
n NO MENTAL RETARDATION/ UNILATERAL IMPLANTATION
LAUNCH
n 3RD DECEMBER 2014
n ASHOK D RANSHUR : 2.1 Yrs / Male
n BYL NAIR HOSPITAL, MUMBAI
HospitalsEmpanelledforCochlearImplantSurgery
Telangana
ADIP CI
n 172 HOSPITALS
n FIVE ZONES/ 1050 CI SURGERY
n POST OPERATIVE REHABILITATION
n AICs / ZCs
n www.adipcochlearimplant.in
CSR
• PFCL
• AAI
• SBI
• MDSL
• OTHERS
POR
n AIC (POR) / ZCS
n SWITCH ON/ MAPPING/ THERAPY
n TELEPHONIC/ E MAIL/ POST
n PROGRESS FORMAT/ FEEDBACK
n TRAINING OF PARENTS
OUTCOMES
n AUDITORY AWARENESS/ PERCEPTION OF SOUND
n COMPREHENSION OD SIMPLE COMMANDS
n EXPRESSION: 1/2 WORDS SENTENCES
n PARENTS SATISFACTION
OUTCOMES n NEW SET UPS/ SURGEONS
n REHAB PROFESSIONALS
n LOWERING OF COST
n STATE PARTICIPATION
n NATIONAL STRATEGY
CHALLENGES • DISTRICT
• HOME BASED THERAPY
• ACCESSORIES/ UPGRADATION
• BATTERY/ LOST PROCESSOR
• ICT/ TELE- REHAB/ MAPPING
BACKGROUND ROOM NOISE
n AUDITORY DISTURBANCES
n SNR
n +15dB SNRs OR GREATER n < 35 dB A n NO STANDARDS
REVERBERATION
o PROLONGATION OF SOUND
o DEGRADES SPEECH PERCEPTION
o RT > 1.0 SECOND
o SNHL < 0.4 TO 0.5 SECOND
o NOISE AND REVERBERATION
DISTANCE
n DECREASE IN SOUND
n INVERSE SQUARE LAW: 6 dB SPL
n EARLY SOUND REFLECTION: 50msec
n CRITICAL DISTANCE: 6- 12 FEET
ACOUSTIC MODIFICATION
n SNR >15 dB, AMBIENT NOISE < 35dBA
n ACOUSTIC TILES/CARPETING THE FLOORS/
n ACOUSTIC FURNITURE TREATMENT
n COST/ STANDARD/LEGISLATION
SNR-ENHANCING TECH.
o D-MICROPHONE/ BEAMFORMERS
o ASP TECHNOLOGY
o BILL/TILL/NR/ CROS
o CLASSROOM AMPLIFICATION DEVICES
SOUND–FIELD FM AMPLIFICATION
n 8- 10 dB UNIFORM AMPLIFICATION n BENEFIT ALL CHILDREN
n COST EFFECTIVE
n LESSEN BURDEN ON RESOURCE ROOM
n LESS VOCAL STRESS AND STRAIN
HARDWIRED SYSTEM
n NOT SPECIFIED AS MEDICAL DEVICE-FDA
n NO SPECIFICATION
n EAC AND REAL EAR
n RESTRICTED MOBILITY
ELIS
n 1938
n 1999: 3 D LOOP SYSTEM n EMBEDDED IN MAT
n 30 dB REDUCTION
n US ACCESS BOARD
ALDs
• VOICE AMPLIFIERS
• TELEPHONE HEADPHONES
• TELEPHONE/ TELEVISION ADAPTERS
HAT
FLASHING / VIBRATING
HAT
o LIGHT FLASHERS
o DOORBELLS
o SMOKE /FIRE ALARMS
o TTY/ TELECOMMUNICATION DEVICE FOR THE DEAF (TTD)
o SMS
TV VIEWING
n CAPTIONED MEDIA
n CLOSED, REAL, AND OPEN
n (TELEPHONE DECODER CIRCUITRY ACT, 1990)
COMMUNICATION STRATEGIES
n CLEAR PRONUNCIATION
n SLIGHT LOWER RATE OF SPEECH
n HIGHER INTENSITY
n FACE-TO-FACE COMMUNICATION
n LACE
SIGN LANGUAGE RECOGNITION AND TRANSLATION
n TEXT TO SPEECH
n SPEECH TO TEXT
n SIGN TO SPEAK- SIGN
AIC
n 24.9.15
n BUILT IN INFRASTRUCTURE
n TRANSPORTATION
n ICT
n NATIONAL PROGRAM
LOOKING FORWARD
n BIS SPECIFICATIONS
n UNDER ADIP SCHEME
n INDIGENOUS DESIGN AND DEVELOPMENT
n ASSESSMENT AND TRIAL/ PRESCRIBTION
NEW INITIATIVES n RPWD ACT 2016
n EARLY IDENTIFICATION
n STATE PARTICIPATION
n NATIONAL/ STATE FUNDS
n SPEECH AND LANGUAGE DISABILITY
SPEECH
LARYNGECTOMY/
GLOSSECTOMY
BILATERAL VOCAL CORD PARALYSIS
MAXILLOFACIAL ANOMALIES
DYSARTHRIA/ APRAXIA OF SPEECH
% OF SPEECH DISABILITY = 2 X UR OF SIA + UR OF OVCA 3 • BENCHMARK SPEECH DISABILITY: 40%
• SLP AND ENT SPECIALIST
• SPEECH SAMPLE • DIGITAL PLATFORM
LANGUAGE DISABILITY: APHASIA
n WESTERN APHASIA BATTERY (WAB)
n INDIAN LANGUAGES/ SPONTANEOUS SPEECH/ NAMING
COMPREHENSION/ REPETITIONS/
n SLP AND ENT/ NEUROLOGIST
n APHASIA QUOTIENT (AQ)
AQ
n MAXIMUM AQ: 99
n AQ OF 94 ONWARDS : 0% LANGUAGE DISABILITY
n AQ OF 0: 100% LANGUAGE DISABILITY
n AQ OF 56: 40% ( 1% INCREASE)
n READY RECKONER : AQ
TENS
PLACE IN AQ
UNIT PLACE IN AQ
0 1 2 3 4 5 6 7 8 9
0 100 98.9 97.8 96.8 95.7 94.6 93.6 92.5 91.4 90.4
1 89.3 88.2 87.2 86.1 85.0 84.0 82.9 81.8 80.8 79.7
2 78.6 77.6 76.5 75.4 74.4 73.3 72.2 71.2 70.1 69.0
3 68.0 66.9 65.8 64.8 63.7 62.6 61.6 60.5 59.4 58.4
4 57.3 56.2 55.2 54.1 53.0 52.0 50.9 49.8 48.8 47.7
5 46.6 45.6 44.5 43.4 42.4 41.3 40.0 39.2 38.1 37.1
6 36.0 34.9 33.9 32.8 31.7 30.7 29.6 28.5 27.5 26.4
7 25.3 24.3 23.2 22.1 21.1 20 18.9 17.9 16.8 15.7
8 14.7 13.6 12.5 11.5 10.4 09.3 8.3 07.2 06.1 05.1
9 4.0 2.9 1.9 0.8 00.0 00.0 00.0 00.0 00.0 00.0
ADIP SCHEME
n BTE/ CI/ ALDS/ I PAD/ ELECTRO LARYNX
n UHSP: OAE/ABR
n RESEARCH: SPEECH PROCESSORS
n MANUFACTURING
THANKS
n HAPPY NEW YEAR 2018 n HAPPY SARASVATI PUJA n HAPPY REPUBLIC DAY
n HAPPY REPUBLIC DAY