10 Tips for successful AVT Therapy at home

Below are 10 Tips from Mrs Gowry - the distinguished wife of Singapore Ambassador for Indonesia on how to do a successful home therapy for your hearing impaired child.

1. Teach Reading Early
Even when your child is very young, there is nothing wrong with 'labelling' your furnitures e.g bed, refrigerator, etc. Try to use single words and not phrases under all pictures for younger age children. Read to your child every day.....

2. Teach, don't test
Talk the whole phrases, not only single words. Try create a 'play' with the animal toys (in the barn, in the forest, etc) with different sounds. In your therapy time, speak 1 minute about anything that your child would like to hear.... to exercise his/her listening skill. Children would now if they are being tested so the minute you sense your child lost his cooperation it may be time to switch the approach - play time... without testing... learn new vocab..play drama... without testing.

3. Make it fun
Be creative, make therapy a fun session with new things, use water, food colourings, matches (only when you are around) and candles, play doh, cards. Do things that new to your child to attract his attention. If possible involve siblings to put their ideas for a fun therapy session !

4. Music is essentials
Teach nursery rhymes - use/make cards for each phrases of the song - to put meaning to the sounds, then ask your child to take each related cards after you finish singing that paragraph. Introduce music instruments e.g piano after your child can understand simple instruction e.g around 6-7 years.

5. Set Goals
Set yearly, monthly, weekly and daily goals. Set a higher goal for hearing impaired child than for normal child. Plan ahead daily what specific objective you want to achieve and how would you do it (what's the game, the tools, etc).

6. Wait...wait...wait
Give 3 times to the hearing impaired child before you help him/her. Let him ask for someone to repeat his sentence until 3 times before you help him. Give him 3 chances to speak before you jump in and speak for him.

7. Make Live Hard
Put your child out of their comfort zone e.g change their routine such that they try to fix it up by producing the words e.g asking for the right utensils to eat (spoons), asking for the right pair of socks, etc.

8. Give Confidence
Your child would be different from normal child, but you have to try to minimize him feeling different so that he can be confidence of himself e.g tuck in his implant processor under his shirts, choose the correct colour for the coil to match his hair colour, etc. It is also important to share your view different people needs different things, some needs eyeglasses, some needs braces, and some needs cochlea implant/hearing aids. Let your child order Mc Donalds by themselves...

9. Put aside extra time to communicate
Sometimes with busy schedule either it's work, minding house chores, taking the other siblings to school, etc. you take communication for granted. You talk while you walk, you mumble a lot, that's not enough for your hearing impaired child, especially for the young ones. It is advisable that you set aside an extra time to communicate one on one with him/her. You can talk about your day at work, or ask about his day at nursery/school/home. Also you can talk to prepare him for somethings that new to him, e.g going to supermarket or going down to a friends house. Talk to him about what to expect and what people usually do in that kind of new situations. This way your hearing impaired child does not feel awkward with the new situation.

10. Support from the whole family
If you come from big family - as you would if you origins from Indonesia - spend some time with your big family of how they can support the hearing impaired child. Support can mean sticking to one language at home (to avoid confusion and quicker language imersion for the hearing impaired child), or actively play a role to support AVT therapy principles at home. If you are the only one that practising AVT at home while the other family member (grandpa/grandma, nanny, sibblings) do not even know what AVT is then it is something that you have to work on.

Making Meaningful Progress - 9 December 06

Today is a very special day for me and Fakhri. He has been working hard this past weeks learning to differentiate his early listening sounds. I am confident that he has understand a good deal of early listening sounds, but he has to prove it yet to his therapist !

I have proposed to his therapist San-San that I bring Fakhri toys from home for this session. I noticed that Fakhri is a bit reserved boy, he is holding himself to new people, new surrounding, and new toys ! I hope by using his toys in the therapy session he can gets comfortable and willing to open up himself just like at home with me.

San-san was very supportive and in fact she asked me to lead the session. So I starts by drawing Fakhri's attention to a box in my hand that contains 3 items - all animals. I make a sound... "Mooo", offer him the box and ask Fakhri to pick up the cow. Fakhri opens up the box and take out the cow! We tried several time again, each round with 3 animals, and then up to 4 animals, and Fakhri picked up the correct animals! We then moved to transportation toys such as airplane, train, bus, etc... and Fakhri do good as well. Following is 6 ling sounds - there was time where Fakhri has eyed the correct toys e.g Monkey for the "i...i..." sound I produce, but then his attention is drawn to a new toy in the box that he then choose that new toy... :)

After that, San San introduced her toys and match it up with Fakhri's toy. We hope next time Fakhri will like to play with this toys without hesitant.

We also sing "Topi saya bundar" and introduce "Wee..." by playing sliding toy with him. He looks very interested and at the end of the session he lean to San San ask her to hold him. Myself and San San put a mark on Fakhri receptive & expressive sounds. There are 19 receptive sounds (transportation, ling sounds, and transportation toy sounds) that Fakhri has understood including some of them are cat, cow, fish, horese, lam, monkey, pig, puppy, tiger, airplane, bus, car, train, cock, duck). Receptive sounds are still limited at this point he can produces "Aaaa" for airplane, "Brmmm" for car, "Mmmm" for foods.

It is 2 months post-implant, and Fakhri has seems to understand his name. He turn his head whenever he hears his name is called - and this is not coincidence, as he does not turn his head if we call him by another name. I thank God Allah SWT for all of this and pray that Fakhri will gets better and better in absorbing new lessons......

10 November 06 - The Second Mapping

Fakhri in airplane back to Jkt

we activated the red indicator on the 2nd mapping

This is our 2nd trip to Singapore for Fakhri's mapping. We stayed at the same serviced apartment - which is only 5 minute walk from Orchard Road.

We now know what to expect - more or less. And Fakhri did a good job again. He did not complain, or gets jumpy, etc. Instead he sat for about 1 hour during the mapping process. This time - Deepak explained - he is putting 4 programs, instead of 3. The current P1 (Program 1) is louder than the last time P3. The loudest program is still P3 now, while P4 is in fact the P3 from previous mapping.

During soft sound mapping, Fakhri looked comfortable, but he suddenly cried and shake his head when Deepak put the P3 (the loudest program). This time Deepak asked us to really take our time before moving to the next program. It usually takes couple of day for Fakhri to get used to P1 then we can move to P2 and so on until he is comfortable to wear P3. We mentioned how Fakhri seems dizzy in the morning everytime we put his implant on. He usually likes to be hold for 5 seconds to adjust to the surrounding sounds that get into his brain. Deepak suggest to lower the volume before we put the device on and later increase the volume when Fakhri looks comfortable.

We spent the weekend on apartment. We have another appointment with Stephanie - the AV Therapist - on Monday. There was a very surprising moment on Saturday. Fakhri was with me in the living room, while his father was in the bathroom (connecting to the bedroom). The bedroom door was open, and when his father bang the bathroom door unpurposedly .... Fakhri looks surprised, turn his head, and cried!! Oh my god.... this is a very rewarding moment.....

We talked about this during the AV session on Monday with Stephanie. She is very glad to see Fakhri's progress. She said Fakhri seems adapting quickly with his implant. He is a good listener, as he always stop 'talking' whenever Stephanie is talking. He pays a lot attention when Steph is talking and pulling out the toys from the box. We even demonstrated that he can look at the door when Steph is knocking from outside. This is all a good progress - says Steph, and we should expect more in a month to come. For the next month target, Steph would like to see if Fakhri can identify several animal & transportation toys from the sounds e.g Train (Chooo...0...00), Car (Brmm...mm....mm), and understand simple verbs e.g roll...roll the toys, push... push the car... etc.

We are working on this and will involve San San ... our therapist in Jakarta to include this item in the therapy session.

10 October 06 - Activation Day!

Finally.... activation day! We are very excited today that Fakhri's Nucleus Implant gonna be activated. That means he will hear his first sounds! We have hear lots of stories about babies on their activation day. Lots of them are jumpy and crying when the device is switched on, and some of them even try to pull out the coil from their head.

We have 10.am appointment with Deepak - the audiologist at SGH. Deepak seems quite nervous - later we found out it because the AV Therapist is not available to help him in the activation process. The process was started with Fakhri seated on high chair. There was a girl to help Deepak distract Fakhri's attention with toys. Fakhri is now wearing his coil on his head, but still using the programmable BTE from Deepak.

The mapping/programming process for each 24 channel went smoothly. Total it took about 1.5 hours. Fakhri seemed enjoying his session with so many new interesting toys, he did not realize that he has been sitting for 1 hour ! The process involve programming each channel with specific frequency and ask Fakhri to turn his head to the sounds when he hears them.

And then the swich on time! Deepak gave the cue that he is gonna switch on the device from his computer. 1....2....3..... he push the button and suddenly Fakhri turn his head on to the left (where the computer is). He was a brave boy! He did not cry at all!

We were very proud of him. Later after that session we went to hospital cafetaria to have some lunch. Unfortunately we forget to lower the volume (it was set to maximum), and Fakhri got uncomfortable and crying in the loud cafetaria (you can imagine how busy it is during lunch time). Then we go back to apartment and let Fakhri sleeps. It was a tiring day for him......