CASE ONE:

Ally is currently 5 years old and has been wearing bilateral cochlear implants for 3 years. She

was born with normal hearing, however developed bacterial meningitis at 18 months, which

resulted in severe to profound sensorineural hearing loss bilaterally. She has made great strides in

her overall speech and language development regarding articulation. Despite consistent use of

her cochlear implants, she continues to struggle with expressing her needs and within social

interactions with friends at school. Her parents are hoping to increase her conversational, or

pragmatic, abilities so she can make friends within the neighborhood and at school with ease

and confidence.

The first strategy I would want to utilize with Ally is the repair strategy. Since it seems

Ally has a difficult time communicating her needs, especially in a social context, educating her

on strategies that will aid in repair of a conversation, should there be a breakdown, will ensure

that she has successful social interactions where she is able to express herself, as well as receive

messages from her communication partners adequately. I would also want to use auditory

training, as Ally is a good candidate for it, given the fact that she has cochlear implants and

needs to work on taking her strong listening skills and applying them to the communication

opportunities she will have at school so that she can improve upon her pragmatic skills. I

specifically would like to utilize the pragmatic method, as it will help Ally gain control over her

communicative encounters with peers and ensure that she is correctly listening to her

communication partner, because if she struggles on the receptive end, then she will struggle on

the expressive end when it come to sharing her thoughts and needs. Lastly, I would want to use

the Erber approach, as it goes through a hierarchy of conversational approaches while focusing

on auditory training. Working on different conversational contexts- from natural, to specific, will
hopefully allow for Ally to gain a better understanding of different conversations so that she can

respond and contribute more frequently, especially in a way that is pragmatically appropriate.

One activity I feel Ally would benefit significantly from is sabotage activities. These activities

are designed to specifically improve upon a child’s use of their language. If I were to purposely

shift something in Ally’s routine, it would force her to speak up and utilize her communication

skills to rectify the problem, resulting in her appropriately utilizing pragmatic skills to express a

need of hers. I would also like to administer an assessment, so that I can gather baseline

information pertaining to Ally’s skills, as well as use it throughout treatment to measure her

progress with the given strategies and activity. I would like to administer the Cottage Acquisition

Scales for Listening, Language, and Speech (CASLLS). This is a criterion referenced

assessment, therefore it will allow for me to initially see Ally’s initial communication skills, as

well as allow me to observe the growth of her language skills as aural rehabilitation progressed.

This assessment covers several components, including cognition, semantics, syntax, morphology,

phonology, and pragmatics (Michigan Department of Education, 2025). Given the extensiveness

of topics covered, this assessment will give me a comprehensive look at Ally’s communication

skills, including the main area of concern, pragmatics.

CASE TWO:

Carter is a 6 year old boy born with moderate to severe sensorineural hearing loss and currently

wears hearing aids bilaterally. His hearing loss was identified at birth and his parents were

proactive in treatment (i.e., identification and obtaining the proper hearing aids). When he first

started wearing hearing aids he was not very receptive and would often try to pull his hearing

aids out. This resulted in less than ideal stimulation. His parents worked endlessly with the early

intervention staff (including his SLP) and his pediatric audiologist to work on overcoming
barriers for consistent use of his devices. His speech and language development has made great

progressions, however it is noted his vocabulary, or content in conversation, does not match his

peers. His parents are hoping to increase his vocabulary and proper use of vocabulary as he

begins a new school year in the Fall.

​ One approach I would recommend for Carter is the Carhart Approach for Prelingually

Deafened Children. The main reason as to why I would want to utilize this approach is because

Carter was born deaf, therefore he is a good candidate for this approach- as it was designed for

prelingually deafened children. Given the fact that Carter did not enjoy wearing his hearing aids

initially, he did not receive the best stimulation and input during a critical time for language

development. This approach will help build his awareness of sounds, as well as help make

discriminations between speech sounds as well. I would also want to utilize incidental learning,

as well as pre and post teaching. Both of these approaches are based on improving one’s content,

or in other words, the meaning behind language. Given Carter’s decreased vocabulary, or content

within language, these approaches will hopefully help him expand upon this skill. Incidental

learning can help Carter learn new vocabulary in a more indirect manner, such as hearing a

clinician read something, potentially going through steps, a routine, or even reading a story he

enjoys. This approach can easily be carried over at home with his parents as well. Pre and post

teaching will allow Carter to initially be introduced to new vocabulary, either through reading, or

even through play, and then have it reiterated to him after the session or class is over so that it is

ensured he understands the word and its usage or meaning. For assessments, I would want to

administer Additionally, I would want to obtain a language sample, as this informal assessment

measure would give me a more naturalistic understanding of Carter’s language abilities,

including his vocabulary usage, and diversity of words. ****citation****

Carter is a 35 year old male who was born with a mild to moderate hearing sensorineural loss.

When he was younger, hearing aids were suitable for his speech and language development. He

developed his speech and language skills not too far behind his peers and was mainstreamed in

his classes, no longer needing speech therapy, by age 7. Recently, he has noticed a rapid decline

in his hearing and his most recent audiogram revealed a moderate to severe hearing loss in his

right ear and a profound hearing loss in his left ear. His audiology and medical team

recommended he seek out a bimodal approach to amplification. Andrew was confident in

undergoing the procedure for a cochlear implant on his left ear. After several visits with his

audiologist, Andrew found himself misunderstanding certain consonants and often substituting

high frequency consonants with the incorrect sounds. He hopes with your help, he can better

adapt to this new way of hearing and have less consonant errors in conversation. \

I would first recommend the Carhart approach for adults, as the goal is to help individuals

with hearing loss be able to identify distinct differences in sounds, which is something Carter

currently has trouble with. I would also want to incorporate some form of auditory training,

specifically the analytic approach, as auditory training as a whole is good for individuals who

were recently fit with hearing aids or cochlear implants and have poor speech recognition, both

of which apply to Carter. The analytic approach is especially a good fit for Carter because it has

a focus on perceiving the differences between vowels or consonants down to the syllable or word

level. This will be a good place for him to start in his aural rehabilitation since he has issues

deciphering certain high frequency consonants in conversation. Lastly, I would like to use

consonant recognition training with Carter. This approach incorporates the analytic approach, so
the two will mesh nicely together for his rehabilitation. It focuses on similar targets, including

determining similarities or differences between syllable pairs, as well as picking out nonsense

syllables. For assessments, I would want to administer the California Consonant Test because

Carter has issues with perceiving consonants correctly, so I would want to see where his issues

lie to help better guide his aural rehabilitation ****citation****. Additionally, Central Institute

for the Dead (CID) Everyday Speech Sentences would be another assessment that could learn

more about Carter’s skills in a functional matter, as the assessment will apply his consonant

discrimination skills to varying phrases and sentences. ****citation****

Case 4:

Amy is a 65 year old woman who just received her first pair of hearing aids after being

diagnosed with a mild to moderately - severe sensorineural hearing loss. Her family has reported

her hearing loss to be noticed for over 10 years and she has finally decided to seek amplification.

Her communication process with hearing loss has not been easy on her. She began as a passive

listener which quickly escalated to an aggressive listener when her family and friends began to

point out her hearing loss. Over time and acceptance of her hearing loss she has become more

assertive in her communication skills but still struggles while adapting to her hearing aids. She

finds she struggles with clarity of conversation and often misinterprets certain high frequency

sounds. She also hopes to learn ways to strategize to have her communication

environment/situation be optimized so she can get the most out of conversations/events.

For Amy, I would like to educate her on anticipatory strategies so that she can continue to

be an assertive communicator and tell her communication partners when she needs
environmental modifications (e.g. get closer to the speaker, minimize background noise) in order

to be successful in expressing, as well as understanding. Similarly, repair strategies will aid Amy

in taking control of the conversation when needed. These strategies will teach her to request her

communication partner for clarification whenever she experiences a breakdown in

communication (i.e. she does not understand them). This may include asking the speaker to

repeat themself, or simplify what they had said. The last strategy I would utilize is Listening and

Communication Enhancement (LACE), as it will help Amy improve her communication

strategies, and if she were to ever find herself in the situation, be able to listen in louder settings

with increased ease. As for assessments, I would first want to administer the Speech Perception

in Noise (SPIN), as it will help me see her baseline ability to understand presented stimuli when

there is background noise. ****citation**** Similarly, I would also administer the Hearing in

Noise Test (HINT) to again assess her ability to listen correctly even when she is not in an ideal

listening environment. ****citation****

Michigan Department of Education. (2025). Cottage Acquisition Scales for Listening Language

& Speech (CASLLS). Mdelio.org.

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