Binaural Integration Dichotic Offset Training

Published Date: 02 Nov 2017

Submitted To: Prof.P.Manjula

Submitted By: Abhishek K. Sehta

All India Institute of Speech & Hearing

Introduction

Binaural integration is the ability of a listener to process information presented to both ears at the same time. This process also involves working memory and divided attention. An individual with deficit in binaural integration will not be able to integrate or process information from more than one source at a time.

Binaural separation is the ability of a listener to process an auditory message coming into one ear while ignoring a disparate message presented to the other ear at the same time. It is critical in everyday listening, particularly in a school environment.

Binaural processing training includes activities to increase binaural integration and separation skills. To improve binaural integration and separation, dichotic listening training is used in which the listener hears two (or more) different targets presented simultaneously, one or more to each ear, and is asked to attend to one (separation) or both (integration) signals. Along with this localization training is also given to improve both the processes.

Auditory closure is the ability to process a message after knowing that part of the message is missing or not get perceived. It’s like making a incomplete message as complete. Subject achieves this process by filling incomplete acoustical signal through a way in which they use their knowledge of world and context. They basically use their intrinsic redundancy to achieve this.

Auditory closure activities are designed to improve the ability to predict a missing target word or sound based upon context. In this the listener learns to listen to the whole message rather than trying to decode each word. Auditory closure activities require no special equipment or training and can be played anywhere.

Binaural Integration

Dichotic Offset Training (DOT)

The main objective of DOT is to differentially integrate the two different stimuli which are separately given to both ears.

Katz, Chertoff & Sawush (1984) studied DOT in 10 children aged between 7-10 years who demonstrated difficulty on a dichotic SSW test. They were given DOT for 15 one-hour sessions, twice a week.

Therapy: Staggered Dichotic Digit test (SDD) was used for training. The training was given using different offset conditions (500, 400, 300, 200, 100 & 0ms). The first training session starts with exposure to easiest condition – 500ms offset. Experimental group were re-evaluated after 15 sessions.

Results:

Performance on the DOT material was first compared between pre-therapy & post-therapy

For all conditions including 500ms & 0ms condition, there was substantial differences between the therapy performance & the baseline.

There is an increase in error with decreasing offset from 500-0ms.

Significant improvement was noted for the experimental group from the 5th session through the 15th session.

Performance on the DOT material was then compared between the control & experimental group

The experimental group improved significantly over the control group on the SDD.

Also improvements were seen on the SSW & SPIN test, which are however not statistically significant.

Priya,G & Yathiraj (2007) studied the efficacy of DOT in children with an APD who had failed the Screening Checklist for Auditory Processing (SCAP) developed by Yathiraj & Mascarennas (2002) & also had low scores on dichotic tests (DCV & DDT).

Subjects: 2 groups (experimental & control) in the age range of 7 – 12 years

Methods: Training was given under headphones for 10-15 sessions, based on the ability of the child. The training material developed by Yathiraj (2006) consisted of monosyllabic words with & without blends with different offset lags. Initially the children were trained with the easiest lag time (500ms) & gradually the lag times were reduced to increase the difficulty level.

Results: A statistically significant improvement following DOT based on post therapy scores of dichotic tests was obtained. The overall scores post therapy was better for DCV test as compared to DDT.

Auditory Training Technique

Table 1: Selected Formal and Informal Auditory Training Techniques Targeting Specific Auditory Processes Process Assessment Test/Procedure (Re)Habilitation

Process

Assessment Test/Procedure

(Re)Habilitation

Auditory closure

Distorted speech recognition (e.g. filtered speech)

acoustically degraded words in sentence context

Binaural separation

Directed dichotic speech recognition;

Diotic Intensity altered dichotic listening

Intensity altered dichotic listening;

speech recognition in competition;

listen to intensity imbalanced stereo music

Binaural integration

Non directed dichotic speech recognition

Same as BS.

English, Martonik & Moir (2003) described another treatment for children with deficit in dichotic learning skill.

Subjects: 10 children in the age range of 5.10 years to 10.9 years

Task: required listeners to attend to listen to the story delivered to the left ear alone for 2mins & were asked questions relating to the story. [DDT was re-administered at the mid-point of training. If scores were within normal limits they discontinued left ear stimulation & if scores were not normal, they continued left ear stimulation]

Results: DDT – double pairs were administered after treatment & again 4-6 weeks later.

It was found that for most subjects, providing auditory stimulation to the left ear only improved left ear dichotic performance as measured by DDT (pre-therapy: 32%, post-therapy: 95%).

9 subjects showed age appropriate DD scores after receiving left ear only auditory training. All 9 subjects who had achieved normal scores were found to maintain them.

Dichotic Interaural Intensity Difference (DIID):

Musiek (2003) recommended using dichotic stimuli where a more intense signal is delivered to the deficit ear while the better ear receives a weaker signal to improve binaural listening.

DIID training initially lowers strong ear intensity levels until weak ear performance increases to a satisfactory level. Then the intensity level to the strong ear is gradually increased so that high performance is maintained in the weak ear.

With training, the intensity to the strong ear is increased to match weak ear levels. Stimuli are varied & include sounds, words, phrases & sentences. Training session may take place in a sound field or with ear phones. The task can also be modified to strengthen binaural separation skills (attend to one ear only) or binaural integration skills (attend to both ears).

Exercise for binaural integration training (Bellis, 1996):

Materials: 2 record players/ 2 radios kept on either side of the child

Step 1 - both ears: familiar words

Step 2 – both ears: familiar sentences

Step 3 – one ear: familiar word & other ear: unfamiliar word

Step 4 - one ear: familiar sentence & other ear: unfamiliar sentence

Step 5 – both ears: unfamiliar words

Step 6 - both ears: unfamiliar sentences

Binaural Separation

Figure-ground or competing sound stimuli often represent serious learning blocks to the auditorially disabled individual. The listener’s attention is easily distracted from the signal in the presence of extraneous, irrelevant sounds. According to Heasley (1980) the development of auditory attention and attention span will help the listener to attend to desired message while ignoring other sounds. Initially the child was asked to listen and repeat two ore three words in the presence of soft background noise heard from a record player. Then the task was made difficult by asking them to repeat short sentences and asking questions in the presence of gradually louder extraneous sound. The next step was to tell a story against background sound that could be controlled for loudness or softness and asking questions related to the story. A system of timed reinforcements was used.

Training in top down compensatory skills that aid in context-derived prediction of missing elements will help compensate for the inevitable misunderstandings that can ensue from decreases in intrinsic signal redundancy.

NOISE DESENSITIZATION THERAPY

i) NOISE DESENSITIZATION TRAINING

Purpose

Improvement of understanding of Speech in Noise.

Increase in the ability of the patient to tolerate noise.

Principle

It involves increasing the levels of competing noise with a constant level of speech (Katz and Burge, 1971).

Age Group

It can be used for all age groups.

Ferre (1998) proposed the Noise Tolerance and Auditory Training Paradigm. This involves the manipulation of 4 parameters, one at a time over a preset range from high-low redundancy.

Type of signal: Eg: From Sentences to Nonsense Words or CV syllables

Type of background noise: Eg: From Narrow Band Noise to Speech Babble

Signal-noise ratio: Eg: From positive SNR to Negative SNR

Type of available visual cue: Eg: Visual Cues are initially present and are later absent.

Maters (1998) gave the following guidelines for noise desensitization therapy.

Introduce noise at a low volume, selected by the child.

The heirarchy should begin with white noise and ends with the noise that is the most problematic for the individual.

The type of noise present in the individual’s environment should be included.

Initially, the material used should be at a level at which the child demonstrates 100% success in quiet.

Newer vocabulary and recently established therapy goals should be reserved for sessions at the end of the noise therapy heirarchy.

For young children, the noise therapy should be conducted in the initial or middle portion of the session.

Check for physical symptoms induced by noise.

Supporting Studies

Katz and Burge (1971)

Subjects: Children with LD in the age range of 5-14 years.

Task: Picture pointing in response to monosyllabic words in presence of noise (monaural and stereo presentation)

Results: Improvement by 2 ½- 3 items were seen in both conditions. The greatest improvement was seen in children in the age range of 5-7 years.

Conculsions : Children exposed to this type of training were able to develop a greater tolerance to background noise and show a greater ability to respond correctly to speech under noise conditions.

Maggu and Yathiraj (2008)

Aim: To verify the efficacy of Speech-in-noise-desensitization training program in children with poor SPIN scores.

Participants: 5+5 children (8-11 years old) who failed in SCAP and SPIN at 0 dB SNR.

Method: The experimental group was given 15-20 sessions each within a period of 20 days. The control group was not provided any training. The type of competing noise was varied from environmental noise to speech noise to speech babble. The SNRs were varied from +10-0 dB.

Results: The scores of experimental and control group was significantly different post-training Pre-training and post-training scores of experimental group varied significantly.

Conclusion: There was a significant improvement in the speech perception abilities of the children with CAPD in the presence of noise following the training.

Katz et al. (2002)

Aim: To investigate the treatment efficacy of a structured intervention program for APD aimed at improving overall Auditory Processing abilities especially in a noisy environment via environmental modifications, remediation techniques and compensatory strategies.

Subjects: They consisted of 20 children; ages ranged from 7 years 11 months to 14 years 4 months. The children were divided into 2 groups. Group 1 consisted of 11 subjects who had reduced performance on SPIN and normal performance on dichotic tasks. Group 2 consisted of 9 subjects who showed reduced performance on both tasks

Tasks: The subjects were made to carry out listening and comprehension activities in the presence of noise and competing verbal stimuli. Selective (repeat stimuli given to only one ear) and divided attention (repeat stimuli given to both ears separately) tasks were also carried out.

Results: Group 1 showed significant improvement for right ear SPIN scores following treatment while group 2 showed significant improvement following intervention except on short CST for right ear.

ii) EXERCISES FOR BINAURAL SEPARATION TRAINING (Bellis, 2002)

Task: Among this set of exercises, the name repetition in noise task involves the therapist presenting 2-3 words while a soft background sound is heard from record player or radio. The task is gradually increased in complexity from repetition of words, then sentences and finally to listening to a story and answering questions based on the same.

Instructions: The child has to repeat the words in the presence of the background sound which is gradually increased.

iii) AUDITORY SEPARATION AND LOW REDUNDANCY (Yathiraj and Mascarenhas, 2003)

Aim: To train the child to listen to the relevant sound (speech) and to ignore the unwanted noise

Stimuli :Questions, short stories, short paragraphs, phrases and words delivered in the presence of recorded noise (traffic noise, speech babble, household noises or other competing signals)

Response Mode: For Stories and Paragraphs, Questions would have to be answered. Phrases and words would have to be repeated.

Procedure: It consists of the following steps.

Step 1: Start with an easier task such as reading material with redundant cues such as short paragraphs or stories. Present competing stimulus at a lower level i.e. approximately at +20 dB.

Step 2: When the passage/story is complete, stop the noise. Ask the child to answer questions based on it. When the child attains a score of 80%, move to the next step.

Step 3: Repeat step 1 with a different story. During step 2, do not switch off the noise when asking questions

Step 4: Repeat previous steps until the client is able to perform the task at 0 dB SNR.

Step 5: Noise is higher than the signal (approx. -10 dB SNR) Repeat the same steps as before.

Step 6: Stimuli used are unfamiliar stories, phrases and isolated unrelated words. Repeat same steps as 1-4. Do not interrupt the noise during the repetition task. No contextual cues should be given when the stimuli are presented.

SPEECH RECOGNITION TRAINING (Chermak and Musiek, 2002)

Aim: It can be used to train for both binaural separation and integration.

Stimuli: Stimuli such as words, sentences and CVC syllables are presented through 2 speakers, one of which delivers the stimuli at a lower intensity level.

Response: The subject has to repeat the stimuli from the target loudspeaker while ignoring the stimuli from the other loudspeaker.

BINAURAL SEPARATION DICHOTIC TRAINING PARADIGM (Bellis, 2003)

Task: It involves presentation of a target message to the weaker ear and a competing message to the stronger ear. The client will be instructed to listen to the story presented to the weaker ear and summarize it.

Procedure: The process involves the following steps.

Determine beginning target-competition ratio: Should be chosen so as to allow children to hear the target messages clearly while being aware of the competing message to the opposite ear.

Manipulation of target-competition ratio: Intensity of the competing signal is increased gradually over many sessions to make the task more challenging, while at the same time maintaining the interest, motivation and success of the listeners.

Re-adjustment of target-competition ratio: If the client begins to exhibit significant frustration with the task or are unable to summarize at the end, the level of competing signal will have to be reduced. Simpler material may also be substituted.

Auditory Closure

Auditory Closure Activities

The purpose of auditory closure activities is to assist children in learning to fill in the missing parts in order to perceive a meaningful whole. As such, context plays an important role in auditory closure, because prediction of the complete word or message often depends on the surrounding context. The activities described here are in a sequential manner, from least to most difficult. Children should demonstrate mastery of one level before moving on to the next.

Missing word exercises:

These exercises are designed to teach children to use context to fill in the missing word in a message. It is best to begin with familiar subject matter and then move to new information. For example, when working with very young children, it is ideal to begin with familiar songs and nursery rhymes to familiarize them with the task of listening to the whole in order to predict the missing part.

Twinkle, twinkle, little _______

Child is expected to complete the rhyme by saying star.

Some children would find it very difficult to even do a task which is very familiar and with great amount of external redundancy. In such cases, children should be prompted with questions such as "what word comes next when you sing the song".

A slightly higher level activity might be prediction of rhyming words. For example; child may be asked a question such as animal that rhymes with house. The expected answer is mouse. If the child is unable to perform the task, prompts should be given that guide them in solving the puzzle. For example, they can be instructed to begin at the beginning of the alphabet and substitute the initial consonant of the word with different letters until the correct consonant is reached.

Once these levels are mastered, activities should include unfamiliar messages in which children must utilize the context of the phrases, sentence or paragraph in order to predict the missing component. When using this approach, clinicians should begin with simple sentences (eg., when I’m hungry, I ____ ), then move to more complex materials, such as paragraphs in textbooks or popular novels. In addition, clinicians should move from omitting the subject or object of the sentence or phrase, to the omission of verbs, adjectives and other portions of the message. Children should be prompted continually to use the context in order to predict the missing components, as well as to derive meaning from the whole message. In addition, materials appropriate for this exercise can be taken from classes in which children are demonstrating difficulty, in order to assist them in further understanding of the class material.

Missing syllable exercises:

Once children master activities of predicting missing words based on context, the next level should move to omission of syllables. Missing syllable exercises should be presented in a progression from least to most difficult. Achieving closure for words in which the initial syllable is omitted is a more difficult task than for words in which the final syllable is omitted. Therefore training should begin by omitting the final syllable of the word, and once mastery is achieved, move to omission of medial and initial syllables.

Clinicians may begin with sentences in which the target word is embedded (eg., there are 26 letters in the alpha___ ) and then gradually move to single words in which the only contextual cue may be a category designation (eg., sports: base___, soc___, ten___ ). Through repeated drills such as these, children learn to become less dependent on hearing and decoding every component of the target word and more aware of the need for contextual derivation when the complete acoustic signal is inaccessible.

Missing phoneme exercises:

It is similar to missing syllable exercises, except that phonemes are omitted in this. A progression method should be used, from least to most difficult, moving to next stage only if children achieve mastery of previous stage.

Initially, stimulus should be provided along with context, then move to isolated words along. (eg., I like to (w)atch (t)elevision). A tape recorded stimulus is preferred. With specialized equipment, phonemes can be electronically edited from isolated words or running speech, thus preserving the co articulation characteristics of surrounding phonemes. Some of the computer assisted auditory skills training programs currently available commercially already include such phoneme deletion auditory closure activities. Mastery over final phonemes is necessary to move to medial and initial phonemes.

Speech in Noise Training:

Virtually any method whereby the extrinsic redundancy of the acoustic signal is reduced may be utilized to train auditory closure skills. Therefore, auditory closure activities such as those discussed earlier maybe undertaken in distracting or noisy situations to increase the difficulty of the task further. In addition, variation of speakers, such as the introduction of regional dialects, misarticulations, and other speaker-related characteristics may be utilized to help train children to use context to achieve auditory closure.

It is best however, to progress to this step only after children are successful at the same activity in quiet listening environments to avoid frustration and facilitate generalization of auditory closure strategies to classroom and other listening environments.

Katz & Burge (1971) reported that children who were exposed to speech under controlled noise conditions were able to develop a greater tolerance for background noise and showed a greater ability to respond correctly to speech under noisy conditions.

Vocabulary Building

Children with CAPD exhibit poor auditory closure skills due to missing syllable or phoneme requiring the listener to use context to predict the word. But, what if the word is not familiar to the listener? The condition that is poor vocabulary also would lead to poor auditory closure. Chermak & Musiek (1997) and Musiek (1999) have found that vocabulary building is useful for children with auditory closure deficits.

Just as a jigsaw puzzle is much easier to complete when we have a picture of what the final assembly should represent, putting together disjointed elements of a message is easier when we know the topic and vocabulary. However, many children with CAPD also exhibit poor vocabularies, a difficulty that exacerbates their auditory closure deficits and renders them more disabling in listening and learning situations. The use of context derived vocabulary building, as discussed in this section, serves both to aid children in determining the meaning of unfamiliar or missed elements of a message and to build better vocabulary skills.

Miller & Gildea (1987) pointed out several points in describing how children learn new vocabulary:

First, children should be able to associate sound of the word with its meaning. Later, many new words are encountered and learned through reading. Most important, children must be exposed to the new word in different contexts in order to internalize the meaning of the word fully. Musiek (1999) emphasized that most effective way for learning the meaning of new vocabulary is through contextual derivation, or utilizing the surrounding context to predict the meaning of the unfamiliar word.

First children should learn to say the word loud a few times, a technique known as reauditorization, so that the sight and sound of the word becomes familiar. Then they should be encouraged to attempt a definition of the new word based on the context in which it appears. Next, the actual definition of the word should be provided. It should be noted that, although dictionary skills are encouraged in academic pursuits, the goal of vocabulary building is to help children achieve closure.

Finally, children should be encouraged to define a new word in their own way, thus assuming comprehension of the provided definition has been achieved. By following this process, children learn to recognize the new word auditorily and visually, utilize contextual cues to achieve closure, and also add a new word to their internal vocabulary stores.

Materials for vocabulary building should be interesting and encourage maintenance of a high level of motivation. Therefore, popular novels and stories are often good choices for this activity. In addition, because vocabulary is frequently a weak area for children with CAPD, it may be useful to utilize new vocabulary from student specific academic classes so that they are able to become familiar with the new terminology prior to its introduction in the classroom setting.

Finally, although vocabulary building is a beneficial activity in and of itself, it serves as a vehicle for emphasizing the skills learned all auditory closure activities – namely, the use of context to predict missing or unfamiliar components of the whole. Therefore the use of contextual cues to deduce a word’s meaning is an appropriate addition to a comprehensive CAPD management plan (Chermak & Musiek, 1992) particularly when children exhibit a deficit in the area of auditory closure.

Bellis & Anzalone (2008) reported a case study of an 8 year old child with deficits in auditory closure along with other deficits. Activities to facilitate contextual derivation skills included auditory closure activities, using stimuli in which words, syllables, or phonemes were excised, along with context-based vocabulary building, which focuses on using surrounding context to derive the meaning of unfamiliar words that are encountered during reading. Specific auditory training activities focused on speech-sound discrimination using consonant-vowel syllables and words with minimal pair contrasts (e.g., ten/pen), especially those involving stop consonants in initial, medial, and final positions of words. This training was combined with basic phonological awareness training and, ultimately, speech-to-print skills training for transfer of trained contrasts and application to orthographic symbols. To facilitate this process, a computer-based auditory training program, Earobics was employed 30 min per day, 5 days a week, for 6 weeks. Because of scheduling constraints in the child’s school setting, this therapy was conducted in the audiology clinic using a computer and a quiet therapy room. Once fundamental discrimination of problematic phonemes in various word positions was mastered, training of the same skills in various backgrounds of noise was undertaken. The speech in noise training, along with additional discrimination and phonological awareness activities, was integrated into the speech and language services that were already being provided to the child to address his reading and spelling difficulties.

A central auditory re-evaluation was conducted 3 months (12 weeks) after the initial test date. Post-training results indicated an improvement in auditory closure abilities as measured by LPFS, with performance in the normal range for age for the left ear and in the borderline normal range for the right ear.

Mascarenhas & Yathiraj (2003) conducted a study on 2 groups (experimental and control) of 5 children each who failed on the SCAP. These children showed deficits in dichotic CV, speech in noise, duration pattern test and auditory sequence test. Therapy consisted of 5 stages – training of sounds of English alphabet, integration (included closure in this section), memory, noise desensitization & temporal sequencing. Closure activities included missing word – phoneme exercises (rhyming words taught before this using nursery rhymes & multiple choice activities). Following training, there was significant difference in the scores of all the tests in the experimental group.

Training and activities for auditory closure

Prosody Training: is the top-down extension of temporal pattern training. The listeners learn to attach the meaning from the prosodic or suprasegmetal aspects. In prosody training the focus is on the intent of the message rather than the words i.e the way you said something. A common area for practice includes recognizing sarcasm. Eg: Object VS. OBJECT.

RHYMING WORDS: Supplying appropriate words that rhyme with context cue words.

Instruction: you are going to read some phrases that end with a word that can be rhymed. Ask the children to respond with the correct word that rhymes with the last word of each phrase.

Eg: vehicle that rhyme with star (car). A drink that rhymes with joke (coke). A number that rhymes with door (four). A number that rhymes with fix (six).

2) Supplying words with the same final sounds as the stimulus word.

Instruction: you are going to say some words that can be rhymed. The students have to form as many words as possible that rhyme with the listed word.

Eg: air---- chair,stair,hair,

Add---- sad, glad,

Ball--- tall, call, wall

Eat--- meat, sweet,seat

Sentence completion:

You read some sentence ask them to complete the question. The clue words may be in the sentence. I am happy. Are you......? David had a cat and dog. Do u have a ........??

2) Supplying omitted nouns:

We see with our.....( eyes), we write with a......(pen), we hear with our .......( ear)

Phrase completion:

Supplying appropriate familiar words in context.

Instruction: you are going to read some incomplete phrases. U will say the beginning sound of the missing word and the child has to complete the phrases.

Read and wr......, bat and b......, table and ch....., right and wr......., boys and g.......,

Phrase completion:

Supplying omitted nouns and verbs. Instruction: you are going to read some incomplete phrases. Verb or noun will be omitted from each phrase and the child has to complete the phrases with correct noun or verb.

Eg: a glass of ........( water, milk). A cup of .....( tea, coffee)

........ a song.( sing). ...... a bike( ride)

Word completion:

Supplying sounds omitted from the familiar words in context.

Instruction: you are going to read a list of sentences in which some of words will have omitted sounds, and ask the child to identify and say those words correctly.

Eg: Baljeet likes to drive b----, the zebra has black and white str...., Nandan had a birthday c......

Word completion:

Supplying sounds omitted from familiar words in idioms.

Instruction: you are going to read some sentences and the part of it will be omitted. Next the child has to complete the sentences.

You blow my..... ind (mind). He has a .... art of gold( heart). Egg and gobi Manchuria turns Jon’s stom....( stomach).

Word completion:

Supplying sounds omitted from familiar words in context.

Instruction: you are going to read a list of clues. At the end of each clue you will give the answer in which you have omitted one or more sounds. Ask the student to identify and say the answer correctly.

I am something that ticks. ......ock.(clock).I am a flower. Ro...(Rose), I am a fruit app...( apple), I am something that is very hot. ....ire.(fire).

SOME ACTIVITIES FOR AUDITORY CLOSURE:

Auditory closure is defined as the ability to utilize extrinsic and intrinsic redundancy to fill the missing portions of auditory signals to recognize a whole massage.

Exercise 1:

Name: find the missing word

Materials: list of words (individual activity)

Procedure: The therapist will be reading a loud a sequence of sounds or words. Then the sequence of words will be repeated again but one word will be omitted. The task is to identify the omitted sounds. As the skills gained the no of omitted words should be increased. If child does above task, sentences can be used. Therapist reads a sentence and then repeats once again omitting any one word, the child has to identify omitted word. Next the sentence length and number of omitted words should be increased.

1.1

Name: associated words

Materials: none

Procedure: therapist will say a sentence and the child has to provide as many appropriate words as possible. Scores are given for correct words.

Eg: stimulus sentence: Don’t touch it, it will hurt.

Possible words: fire, hot, razer,blade, knife, thorn,pins iron.

1.2

Name: who am I

Materials: picture cards

Procedure: the therapist will read the description about of an object or an item, the child has to guess wat that item is? Choice of 3-4 pictures as a cues. Eg: I am a vegetable, i grow on a tree. I am a long and green part of my name is that of a musical instrument. Who am i?

Response: guess in a complete sentence. "are you a drumstick"?

1.3

Name: What goes together?

Procedure: interesting activity for children, the therapist will say word and the child has to say what goes together with it. Eg: bread and ....... Pen and .....

1.4

Part of what.??

Material : picture card : therapist will say word and child has to say as to what it is part of.

eg: pages... notebook , wheel.... car/ bus

1.5

Name: Sentence completion

Material: none

Procedure: this game involves the therapist reading sentences that are constructed around various situations. The child task is to complete the given sentence.

Eg: The meal after breakfast is called......

When the circle will get dark, it turns on the ...

1.6

Name: rhyme time

Material:none

Procedure: this game the therapist will reads a sentence and the child has to finish the sentence with rhyming words. Sentences will be decided on the age of the child.

Eg: George and paul , Chased the ball.

The old gray cat chased the rat.

1.7

Name: guess me

Material:none

Procedure: the therapist says a list of words which are related to a vocation or activity, and the child task to identify, what vocation these words are indicating.

Eg: thread, scissors, pin, needle, ans: sewing.

1.9

Name: opposite

Material: picture cards

Procedure: the therapist says a word. The child should listen carefully and select the picture of opposite word or give its name verbally or write the opposite word.

EG: Out* in , up* down

1.10

Name: Fill in the blanks material: none

Procedure: this exercise involves making syntactical closure. The clinician reads a sentence with a blank in between, and the child has fill in the blank with syntactically appropriate words.

EG: Dad saw a tiger. I saw two tigers.

1.11

Name: unscramble:

Material: none

Procedure: the clinician reads a sentence and the listener has to unscramble on or more words to make a meaningful sentence.

Eg: She left her boothtrush on the sink. Toothbrush

1.12

Name: correct the incorrect

Material: none

Procedure: this activity involves grammatical in closure. The clinician reads aloud the incorrect sentence and the child has to correct it.

Eg: Mother said I done a good job. I have done a good job.

1.13

Name: select a card

Material: word card

Procedure: A lists of cards are given and child is told that short story will be read by him in which word is omitted. Then the clinician will read and asks the listener pausing, were the omission occurs.

1.14

Guess the missing word: this activity work on auditory closure activities which help the children quickly to learn structural cues and semantic context.

Autumn arrived and the ...... began.

1.15 Rebus

Material: picture card and object

Procedure: Rebus is a representation of word or phrase through symbols or pictures. The rebus can be used to work on the auditory closure ability. The clinician says a sentence and will show symbols or pictures for a syllable, word or phrase and the children have to identify what the sentence is.

Eg: If the sentence is pencil.

The clinician says this is a then shows a pen and says cil. The child should identify it as pencil.