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  1. Auditory Aerobics:® *Synaptic Modification of Auditory Processing American Speech-Language-Hearing Association 2008 Convention Saturday, November 22, 2008 John Isenhath, PhDAdvanced Hearing Care, Inc. Staunton, VA *(formerly Wordplay) ( NO Relation to Auditory Integration Training)

  2. The #1 problem • FACT: The # 1 problem associated with hearing loss is a progressive inability to understand words. • FACT: The # I complaint of hearing-impaired adults is, “I hear but I cannot understand words.” • Difficulty understanding does not always occur at the ear. • Just as food enters the mouth and is processed throughout the digestive system to provide nourishment, so speech sound enters the ear and then goes through a processing system to provide understanding.

  3. How we really understand speech Understanding actually depends on the vitality of the brain’s network of interconnecting neurons (brain cells), and especially on junctions between the neurons called synapses. It is at this site that all speech understanding and comprehension, emerges.

  4. It’sNOT about hearing sound by Permission

  5. It’s not about listening by Permission

  6. It’s about understanding what we hear

  7. Our ears hear sound, not words • A word is a mental construct. • The brain constructs a word by connecting sequences of physical energy (sound) with meanings stored in memory (words). Sound is a cue that triggers memory.

  8. The hearing system works like switchboard • A set of sounds enters the processing system, the sound triggers a connection with long-term memory. • This connection brings a memory to mind. • The memory contains the meaning we most often associate with that set of sounds.

  9. Hearing system’s #1 jobis to translate sound and give it meaning. The hearing system performs 3 critical functions. 1. It searches for sound patterns 2. It connects sound patterns with memory. 3. It constructs words by attaching meaning to sound and bringing it to mind.

  10. The synapse • The synapse is the gap between neurons that allows nerve cells to talk with one another. • When activated, each neuron sends an electrical charge through its ‘sending’ branch (axon) to the ‘message-receiving’ branch (dendrites) of its neighbor. • It is in the synaptic space that language, thought process, comprehension, etc. emerges.

  11. The Synaptic Connection The neuron’s interconnections are like the strands of a web. Every connection is interrelated to all the others. Each connection communicates with the others in much the same way that each filament of a web functions with respect to the others. This means that triggering one neuron can set off a chain reaction that brings up the memory.

  12. Synaptic Plasticity At any age, the brain remains plastic and changeable. It has the ability to revise its synaptic connections - for better or for worse - in response to stimuli and learning. Connections are made and unmade, forming vast, ever changing neural networks. Each connection can vary in intensity from very weak to very strong.

  13. Hebbian learning “Cells that fire together, wire together” – forming neural circuits. It is a type of associative learning (i.e., classical conditioning). It involves an automatic response to a certain stimulus that is acquired and reinforced through association.

  14. An example of Hebbian learning • Imagine a billboard that shows a beautiful woman alongside an automobile. • Two sets of brain cells fire at the same time: those that control sex appeal and those that recognize the car. • After repeatedly viewing the billboard, these two sets of brain cells become physically wired together simply because they have fired together again and again. • Eventually, seeing the car by itself will cause the man to be “turned on by the car.” That’s Hebbian learning.

  15. A type of associative learning • Any two units that are repeatedly active at the same time create a connection, so that activity in one unit facilitates activity in the other (the Organization of Behavior 1949, p70.). • If one neuron becomes active, the other one will also become active. Hebbian learning: • Synapses that fire together become stronger every time they occur (repetition). • Synapses fall apart when not activated (disuse).

  16. Some you use, Some you lose. • According to Hebbian learning, if a person builds new associations, and does this repeatedly, the useful connections become stronger. • Over time the connections created (by association) are strengthened and survive to become part of the neural network of the brain. • Synapses not reused, atrophy and fade away.

  17. For Better or for Worse At any age, the brain has the ability to revise its processing machinery, in response to stimulation and experience. Just as the brain can become stronger with activity, it can also grow weaker with inactivity. Two key factors (1) synapse deficiency and (2) lack of stimulation can impair our ability to understand speech.

  18. Synapse Deficiency Synaptic pruning is like pruning plants in a crowded garden: the ones that remain can grow larger and stronger. Eliminating seldom-used connections, makes room for more efficient neural networks. The result is brains circuits that are better organized and better suited for learning.

  19. Transience Forgetting is a normal part of aging. Transience refers to the gradual loss of memory over time. The density of synapses recedes through age-related pruning. This "normal" cognitive decline begins in middle age. “Use it or lose it.”

  20. Loss of Stimulation Hearing loss reduces synapses two basic ways: attenuation and distortion. Attenuation (the loss of sensitivity) reduces input, so that less neurons fire. Synapses not used, atrophy and fade away.

  21. Distortion As the inner ear deteriorates, the brain receives increasingly unclear signals to interpret. The effect is like water damage ruining a letter. Distorted sound becomes unreadable and does not cause neurons to fire.

  22. Like an old scanner It’s like a worn out scanner used at the post office. If the scanner can’t read the address --- The mail can’t be delivered. If it’s read wrong – It’s delivered to the wrong address.

  23. In Hearing . . . • When there’s NO CONNECTION: • you miss what’s said. • When it’s a WRONG CONNECTION: • you hear something different from what was said. • Untreated, the result is a progressive loss of the ability to understand speech.

  24. Keeping Synapses Healthy The good news is that nurturing and stimulating the neural connections, can improve the ability to understand speech and preserve it as hearing declines with age. Neurons that fire together, wire together!

  25. Auditory Aerobics® Auditory Aerobics® is a mental stimulation technique designed to facilitate neural plasticity, which can increase synaptic connections and result in maintained or improved speech understanding in hearing-impaired adults.

  26. Auditory Aerobics® The mental stimulation used in Auditory Aerobics® can deliver calculated sequences of input, and specific repetitive patterns of stimulation, to cause desirable and specific changes in the neural connections of the brain, specifically within the auditory processing system. Such stimulation is able to force the brain to create new neural pathways and increasingly complex connections!

  27. The process is a cycle GATHERING (information) CREATING ACTING (new meaning) (upon newly created ideas)

  28. Key elements of Auditory Aerobics® • (1) New, novel input » • (2) Stimulation of creative thinking » • (3) Produces many new ideas » • (4) Builds new associations » • (5) Repeats and reinforces until Hebbian learning develops through experience

  29. Strengthening Synapses Auditory Aerobics® is an idea-generating technique, designed to generate as many ideas as possible, with little concern for quality, just quantity.

  30. Random Connection Strategy This random connection strategy encourages the brain to make as many random associations as possible. Initially, the aim is to accumulate large numbers of random connections.

  31. (RCS) ”Connecting the dots” As the brain sifts through the large volume of displaced pieces of information and organizes and re-organizes it in many different combinations to see what connects with what. As it goes through this trial and error process, the brain makes many new connections When repeated useful connections become strengthened,

  32. Sensitization Sensitization is a process of becoming highly aware of something. Buy a new car and see how many of your model and color are suddenly around – you become sensitive to your focus. The purpose is to spark creative thinking.

  33. How it works • Imagine overhearing an interesting conversation you have only a vague idea what the topic might be. Just for the heck of it, you mull it over in your mind. Soon, random ideas start to form. At that moment • The brain plays with the words and with shades of meaning • Trying out different ideas • Trying out different scenarios • Different combinations of ideas to see what fits together. • Now imagine that on a large scale

  34. The way this works • You infer meaning when you eavesdrop. • You make educated guesses from scattered, incomplete bits of information. • You infer meaning by connecting seemingly unrelated pieces of information together to construct your own version through reasoning and trial and error. • You design your own scenario from what is being presented as you go along.

  35. Auditory Aerobics® requires active processing. The hearing system has to kick into high gear to do something it rarely does search for meaning of bits of information mixed up like pieces of a giant jigsaw puzzle. And the search for meaning is not about perfect-fit puzzle pieces. It’s about stumbling across seemingly unrelated ideas that sometimes turn out to be strangely related.

  36. If you can hear, You can improve how clearly you hear. • To date, 95% of over 250 participants have demonstrated significant improvement in their ability to understand speech. • Hearing loss ranges from mild to moderately severe. • Results are based on changes in the Speech-in-Noise Sentence (SIN) Test taken before and after the program.

  37. While results vary, consider this • Persons, with near normal hearing or mild hearing loss, have improved their ability to understand speech, an average of 69%. • As a result, they don’t need amplification at this time. • First-time hearing aid wearers improved an average of nearly 100%. • Many of them have doubled their ability to understand words.

  38. Experienced hearing aid wearers improved their scores an average 144%. • Some of them have tripled their ability to understand speech.

  39. An alternative to hearing aids • A new option for patients who are not candidates for hearing aids. This includes persons with mild hearing loss, limited high frequency hearing loss, etc. • Provides an option hearing aid candidates can try first, when they resist trying hearing aids.

  40. A complement to hearing aids • Provides a supplement for hearing aid wearers who hear but cannot understand words. • Offers a way for synaptic plasticity to improve the ability to understand amplified sound.

  41. Use it or lose it • Mental stimulation is the key to keeping the auditory system healthy and sharp as we age. • According to Robert Kotulak (Inside the Brain: Revolutionary Discoveries of How the Mind Works), because of brain plasticity, mental stimulation may be more essential to the adult brain than food. • It produces more neural connections, which provides a buffer against the decline in cognitive function.

  42. Hearing system is not static. It’s dynamic. • Research suggests that mental stimulation initiated at any age can significantly improve memory (and auditory) function. • When initiated in middle age – when many people start to notice subtle hearing and memory changes – may offer the strongest, most widespread benefits for memory (and auditory) function.

  43. The earlier, the better • Auditory Aerobics® ideally, should be initiated early in the aging process to enhance hearing performance before significant synaptic loss develops. • It should be initiated before fitting hearing aids to prepare the auditory system to handle the increased demands amplification will impose on the processing system. • It has been highly successful with many hearing aids wearers, although success varies widely with this group. • It is important to realize that time is a critical factor. • Synaptic atrophy over time becomes prohibitive. • It simply becomes too late to help.

  44. John Isenhath, PHDAdvanced Hearing Care, Inc. Phone: (540) 885-7044 Email: or