(HBOT 130) - Listening Therapy Ended

It has been 10 days since I last blogged. A few things have happened. I will try to segregate them as best as I can.


The Listenting Program therapy (new version of Tomatis)
Jonathan completed 10 days of an intense TLP therapy. Because he had gone through 7 loops of Tomatis before, the therapist believed that a 10-day refresher focusing on his weak areas would be best.

He did quite well, but I don't really see much of a change in him. However, I know that he usually reacts 4 to 6 weeks after therapy is complete. So I should see (hopefully) some nice gains in a few weeks. I have a follow up meeting on Sept. 16 to talk about what they observed and how he reacted to the therapy. I will also take an opportunity to talk about their report.

Someone asked a question in my previous blog about being able to use headphones after this therapy. This therapy is pretty save and does not disrupt the ear as Berard's therapy does. Therefore, yes you can use headphones safely after the therapy is done. People that decide to use Berard's therapy, cannot use headphones after completing the therapy. Depending on the problem that is being targetted, Berard's therapy might be better. Just research and ask lots of questions before picking one versus the other. Here is what I found on their website: "It is strongly suggested that an individual who completes the Berard AIT program not wear headphones to listen to music. It is permissible to use headphones for listening to books on tape, for example, or to do spelling drills. Dr. Berard found that listening to music on headphones minimized the efficacy of the training."

Behavioral changes and other observations
Jonathan has been a bit less focused the past week and has terrible diarrhea. I got the CDSA kit and I am going to collect his stools this weekend to figure out what is going on. I suspect yeast overgrowth. But it is so bad, that not even he can control it. and I am concerned about first grade. He has accidents every day and he is very concerned when he dirties his underware. I need to fix that problem asap.

Also, last night (08/29/08), he had a very high fever of 103.8. After a couple of hours, it came down to 101.2. After another 2 hours, it came down totally. I gave him motrin and 3 hours later tylenol. This morning, he had a fever of 101.8. I gave him some motrin and sent him to HBOT (I checked first to make sure it was okay). He doesn't have any upper respiratory problems, no ear infections, no pain in his body whatsoever. Very strange. We went to a friend's house, and this afternoon he didn't have any fever at all. Very odd.

He has also been acting very silly. The auditory processing therapist noticed it 2 days before he finished. It could be a combination of gut issues, HBOT and auditory therapy regression. His regression however seems so minor compared to what regressions used to look like 1 or 2 years ago. So I don't mind them too much.

The Listening Program evaluation summary
I received the report of the assessment that was conductec on July 24, 2008. I was both pleased and worried about the results. I liked that it gives me more information that I can use to continue this road to recovery. Because the more concrete the information you have, the better your possibility of finding alternative approaches to solving the issues.

Here are the areas that he was tested on and the results:

• FAIR: The SCAN Test of Auditory Processing Disorders: This test consists of one syllable words that are filtered to pass through information of frequencies of 1000 Hz and below. These words are presented to one ear at a time under headphones. This task requires the listener to use "auditory closure" skills in order to complete a word. Poor functioning of this skill could result, for example, in difficulty understanding a teacher who is speaking with histher back to the class when writing on the chalkboard (especially when the child is seated toward the back of the room), or difficulty understanding someone who has an accent or speaks too rapidly. Jonathan's performance on this test revealed a raw score of 29, placing him in the 371h percentile, which is essentially within normal limits for auditory closure skills.
  
• POOR: Auditory Figure Ground test: consists of one syllable words presented to one ear with a competing background of people talking.Jonathan's raw score was 22, which places him in the 5" percentile, which is below normal limits for single syllable words. These Results indicate that Jonathan has great difficulty filtering out unnecessary information and focusing on the primary message when background noise is present.
• POOR: Competing Words test: It consists of one syllable words presented to each ear dichotically. This task required Jonathan to repeat different words that are said simultaneously to each ear, meaning one word is presented to the right ear and a second word is presented to the left ear at the same time. Jonathan's raw score on this was 21, placing him in the 91h percentile, which is below normal limits. This skill should be monitored closely as it emerges at around 5-6 years of age . These test results indicate weaknesses in interhemisoheric communication between ears. If the hemispheres are unable to share linguistic/auditory information in an efficient and symmetrical manner, then hig-h er order skills such as attention, focus and working memory may be compromised. THIS IS ONE OF MY BIGGEST WORRIES. This explains a great deal about why Jonathan doesn't understand certain things.
• POOR: Staggered Spondaic Word test (SSW): This test is composed of two spondaic words (two syllable words with equal stress to both syllables, i.e. playground, ice cream) presented in a "staggered" manner for each ear. The SSW is a dichotic listening test. An example of the presentation method is:
  
  ----------1st time frame----2nd time frame----- 3rd time frame
  right ear -----------play-----------ground
  left ear---------------------------------ice--------------cream
  
  A score can be obtained for each ear in a competing and non-competing listening situation. Jonathan scored below normal limits on this task. For a child his age he should have a maximum of 38 errors and he had 50 errors. He had difficulty on this test because there is more information to process and verbally recall in competing environments. Test results indicate a breakdown interhemispheric communication between ears.
• GOOD: The Test of Auditory Analysis Skills test: It was administered to test Jonathan's auditory perceptual skills and to identify goals for teaching these skills. This test involves sorting out the individual sounds within a spoken work. For example: Say, "cowboy". "Now say it again and don't say boy". Jonathan scored at the second grade level for this test indicating some excellent higher level decoding skills.
• GOOD: The Beny Test of Visual Motor Integration (VMI), Visual Perceptual, and Motor Coordination test: The Vh4I requires the child to copy a developmental sequence of geometric forms with a pencil. This test is designed to assess the extent to which the child can integrate their visual and motor abilities. Jonathan had a raw score of 15 points, which gives him an age equivalent of 6 years, 6 months old.
  
• GOOD: Two supplemental standardized tests -(1) Visual Perception and Motor Coordimation are administered to compare Jonathan's individual VMI results with pure visual and motor performances. On the Visual Perceptual Test Jonathan had a raw score of 21 points, which gives him an age equivalent of 9 years, 8 months old. (2) The Motor Coordination Test requires an individual to connect the dots, while staying within the boundaries of the shape. Jonathan had a raw score of 21 points, which gives him an age equivalent of 9 years, 2 month old. These tests findings indicate above average visual motor skills and above average visual perceptual and motor coordination skills. However, it should also be reported that when visual eye tracking was assessed Jonathan had difficulty dissociating eye movement from whole head movement. Additionally, he had difficulty with eye convergence at near point.
• POOR: Vestibular processing. The vestibular system detects motion and gravity and is an individual's main balance organ. The vestibular sense also helps maintain muscle tone, the coordination of the two sides of the body, arousal level, and holds the head up against gravity. It automatically coordinates the movements of one's eyes, head, and body. The proprioceptive system gives an individual feedback as to where your muscles and joints are in space (spatial awareness). During the assessment Jonathan was unable to assume and maintain a prone extension posture. This indicates low muscle tone in his extensor muscles. However, he was able to assume and maintain a supine flexion posture for the full 20 seconds; indicating adequate tone in his flexor muscles. Jonathan demonstrated difficulty with static standing balance both with his eyes open and closed. With his eyes open he was only able to balance on his left foot for 6 seconds and his right foot for 5 seconds. With his eyes closed he was unable to balance on either foot for more then 3 seconds. Overall, Jonathan appears to present with depressed processing within his vestibular/proprioceptive system.
• FAIR to POOR: Motor planning or praxis is the ability to spontaneously sequence and organize movements in a coordinated manner. Imitating postures is a measure of motor planning abilities. Jonathan was accurately able to imitate simple gross motor postures, but was slow in his execution. It should be noted that he appeared to be cog~tivelyth inking through each movement prior to executing the posture. He clearly had a more challenging time organizing his body to imitate fine motor postures. Jonathan had easier time sequencing the movements of his thumb to opposing fingers. He was able to complete this task with one and two hands, both with his eyes open and closed. Motor planning difficulties may be contributing to the speed at which he is able to complete new or unfamiliar activities.

Their recommendations were:

1. Jonathan should receive preferential seating in all academic settings to facilitate attention and obtain the best auditory and visual advantage.
2. Competing auditory information should be minimized whenever possible. Frequent checks should be made to assure what is heard. Auditory information shoild be rephrased rather than just repeated when communicati& breaks down. Multiple step instructions should also be broken down into parts and repeated when necessary.
3. Given Jonathan's weaknesses in auditory processing, it is highly recommended that there is simultaneous visual cue in a learning environment to supplement the auditory message as much as possible.
4. A multi-sensory approach should be utilized when teaching Jonathan new information.
5. It is imperative that Jonathan has an appropriate sensory diet throughout his school day. The more sensor-y in-p ut Jonathan receives during- his day the more regulated he will feel; and consequently present with better attention.
   
6. Jonathan should continue to receive occupational and speech therapy.

It was great to have this evaluation and recommendations done. The afternoon I read this report, I also met with the Children's Hospital doctor that saw him on 08/04/08. She, in her own words, gave me the same comments and recommendations that the auditory processing therapist gave me and added "looking into medicine" for minor attention problems. BTW, my meeting with the Children's Hospital Dr. went well because it was very focused. She did tell me that she could drop the diagnosis today but she wasn't going to because of his language deficiencies. If she did, we would not get the support we need to address his receptive and expressive language problems. So, after an hour meeting, I left feeling greatful for continuing to have the diagnosis knowing that it is only a language issue at this point. He does have "social cognition" areas that need to be addressed, but she believes it is also due to his language deficiencies. She told me to work on the problem areas and come back in a couple of years. She highly recommended that I look into RDI and gave me the name of a therapist that will hopefully be covered by insurance, also told me to have 2 hours of one-on-one speech therapy and 1 hour of group therapy a week and added looking into medicine.

However, these recommendations are not going to "recover" him. Just help some. So besides these recommendations (which I clearly stated to the 1st grade teacher and special ed last Thursday), I need to explore other avenues. I am still researching. But I am greatful for this indepth evaluation because between this, the neurofeedback EEG and the Children's Hospitals observations, I again have a goal. I will email Yasko for her feedback.