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Get on the Brain Train

January 5th, 2014 by | Tags: , , , , , , | 16 Comments »

mri-head-scan-370098-mWhenever people ask me what I do, I tell them that I help families of children with hearing loss teach their children to listen and speak without the use of sign language.  Inevitably, the next question I hear is, “HOW?!?”  Those poor people.  Little do they know that they’ve opened up the door for me to talk them to death about my one of my favorite subjects: The Auditory Brain.  Most people think that hearing loss is an ear problem.  Makes sense, right?  But that answer fails to look into the complicated, incredible processes that help us communicate.  It’s important for the general public to understand, but it’s even more important for the families of children with hearing loss and those who work with them.

Ears are incredible.  Even those weird-looking folds on the outside of your ear (the pinna) are specially formed to capture sound and send it down your ear canal.  The bones in your middle ear — the tiniest bones in your body — work together to send the sound through the system.  The snail-shaped cochlea is filled with many, many tiny hair cells that move when sound waves pass through the fluid that surrounds them, stimulating the auditory nerve and sending impulses to the brain.  All of those steps are important, but here’s the thing: if we could get those electrical impulses to the brain without needing any of those intermediary structures, a person could still experience sound.  That’s what happens with the electrical signals of a cochlear implant (or an auditory brain stem implant).  Those electrical signals travel up the auditory nerve to the auditory centers of the brain.

That’s when the real magic starts to happen.  You see, no matter how good your hearing aids or how well programmed your cochlear implants, those sound waves or electrical impulses are meaningless until they are processed by the auditory cortex in the brain and become linked to sounds, words, or music.  The brain has fantastic capacity to grow and change, and it is one of the crucial components to success with a cochlear implant.  The brain has what we call experience dependent plasticity — a fancy way of saying “what happens to you shapes your brain.”  For a child whose parents have chosen a listening and spoken language outcome, the more words that go in, the more listening experiences that child has, the more that center of their brain will grow.  Conversely, if a person has gone through a long period of auditory deprivation (relying primarily on visual communication and/or not using hearing technology), that part of the brain gets pirated away to be used for different purposes (use it or lose it).

The brain is also all about connection.  All of the cells in your brain (called neurons) connect to one another to form complex webs.  These connections are called synapses.  When a child hears the sound of a word and then puts it together with its meaning, a synapse is formed.  Over time, those connections build stronger and stronger webs that enable us, for example, to hear the word “dog” and know not only what that means but also to connect it to a web of other information we know and have experienced (names of our family pets, different types of dogs, the sound a dog makes, stories we’ve read about dogs, etc.).  If a child’s access to input is limited, either because they are not in a listening, talking environment, do not have appropriate hearing technology, or are not wearing their technology all waking hours, these synapses can be weaker, disorganized or even disconnected.  The richer, fuller input a child receives going IN, the better speech, language, comprehension, and cognition they are going to have coming OUT.  Remember: the quality of the INPUT determines the quality of the OUTPUT.  

The importance of the brain is why many leaders in the field have called hearing loss a “neurodevelopmental emergency.”  If children with hearing loss do not receive access to sound and appropriate intervention as soon as possible, the auditory centers of their brain may never regain the infinite potential they have at birth to become fully functioning members of a world full of speech and sound.  It is also one reason why we see varied results among cochlear implant users.  If we — people with hearing loss, parents, professionals, and the public at large — could stop thinking “ears” when we think about hearing loss and start thinking BRAIN, we would be one step closer to achieving optimal outcomes!

For more information on this topic, I recommend anything written by Dr. Carol Flexer, the queen of the auditory brain!  You can visit her website or listen to this wonderful free recorded webinar.

Written by

Elizabeth Rosenzweig MS CCC-SLP LSLS Cert. AVT is a Listening and Spoken Language Specialist Certified Auditory Verbal Therapist. She provides auditory verbal therapy, aural rehabilitation, IEP advocacy, consultation, and LSLS mentoring for clients around the world via teletherapy. You can learn more about Elizabeth's services on her Website or Facebook.


January 5, 2014 at 8:21 pm

Loved this small snippet and as a father of a bilateral implantee would love to learn more about what I can do to help my beautiful daughter access more brain stimulus and if what we are doing is enough.

January 5, 2014 at 9:12 pm

Thank you for your kind words, Mark! One of the most important things you can do for your daughter and your whole family is to get involved in a therapy program with a Listening and Spoken Language Specialist near you. If you haven’t already found a professional, please let me know and I’d be happy to connect you with someone in your area. Other than that, it’s important to talk, read, and sing to you daughter as much as possible to make sure she gets optimal auditory input. Best wishes as you begin your hearing journey!

Donald Liveley

January 6, 2014 at 12:42 am

For all the parents out there who wonder what could happen – I am 62 years old and can testify with nearly 59 years of experiences that this articles is absolutely correct and spot on. I would add to Dr. Flexer’s comments that immerse them in a heavily intellectual and literary environment. Emphasize qualitative and quantitative interactions! Work on their motivation and work ethics. Hey, my vocabulary – top 5%. My mild deafened accent – became a little stronger as my hearing wore down, but one CI has made a difference and #2 is slated for 3 weeks from now. Before my CI’s my db threshold was 100-105.


January 8, 2014 at 10:50 am

Fabulous article. Well written and very ‘parent-friendly’.
Thank you!


January 19, 2014 at 6:09 pm

This article explains very well, what I try to make people understand, when they ask me about my son’s CI. Over the years I have met many implantees. 2 of them received the same services as my son, got their CIs at about the age of 4 after using hearing aids. Both children were not able to learn to listen and speak after after 2 years. (They continued with ASL and soon will graduate from Highschool.) I am wondering where the connection to the auditory brain fails for these individuals? It seems like a door is locked or not even there to access that part of the brain?

Don Liveley

January 19, 2014 at 6:19 pm

Meggi, as the article suggested the brain is amazingly intricate – and it works. And when it does not work out as hopped, the answers then are often as intricate and difficult to ascertain. The possibilities are very large numbers and presently the capabilities to pinpoint is still at best limited. For me, the achievements were significant. My prior post explains my inferences of those achievements. The terminology that I would suggest is self -efficacy. That is two conjoined concepts – self esteem and competency. Build those and it will generally go well. I have seen statistics that say 40% of child born deaf have secondary disabling conditions. that alters the equation significantly.


January 20, 2014 at 1:22 am

Don, I agree, that self-efficacy would describe the way to and the achievements themselves very well. My son absorbed countless books and reports over the years. His vocabulary is extraordinary and he loves the exchange with other interested people. However, his hearing is almost completely gone now and after one of his ears finally deafened, he got CI #1, which catapulted him into social life after a couple of months hard work to train his brain. It was funny how clicks and beeps turned slowly into voices and environmental sounds. It does not happen all by itself and It surely did not happen over night, but it did happen with determination! He will get #2 in 5 weeks. I am generally very interested in the future research as we will learn more about all the highways, backroads and possible detours in our brains.

Don Liveley

January 20, 2014 at 2:24 am

Meggi, Basically your son upbringing is a clone of mine. My parents turned me loose in the library and the rest is history. Except mine started on my fourth birthday in 1955. 59 years on the 7th of next month. His vocabulary is similar to mine (always top 510 and now higher and he is very inclusive verbally like me. He will likely do very well. But, one warning, adulthood is more tenuous and difficult than child hood where you have a deeper and wider support system to affirm your efforts. I am going to go further and ask this – are you familiar with the concept of correlation beyond the simple methodological aspects of statistics? I believe that the really sharp (educated) and confident deaf folks have extra ordinary correlation skills which translates to greater spatial intelligence. That is the THE summary intelligence capability. So analytical disciplines are great to pursue and where he can excel. If I get approval by the insurance folks tomorrow my 2nd CI will be one week from tomorrow at the University of Utah. Good luck with yours!


January 21, 2014 at 5:21 pm

Don, I crossed my fingers for your approval – did you get it?
As for correlations: for our son, yes, we had to fight for certain support and got it, but made it very clear to him that life is not all fuzzy and warm. Remaining in a comfort zone might be nice sometimes, but if one does not challenge himself he will have serious problems later in life (that’s not only true for HOH, but for any youth). He never complained about his hearing situation and being a very curious person he follows his interests and opportunities. He is able to translate concepts into real life and sees clearly where possibilities could take him – that skill is a significant factor in the intelligence capability equation. He will be off to college this fall and I’m sure he will not have any problems to stay afloat :) As for me: the statistics came later – the field work was first, making sure my son got the access to his school curriculum and grew up as ordinary as our other children. English is my second language, so it took some time anyway before I possibly could have made any sense of pure English data and scholarly articles. But I always was very interested in medicine per se – long before I had a family. The statistics only are interesting when one can make the connection to the real thing: the source of the data aka the humans behind the data ;)
Good luck with #2!

Don Liveley

January 21, 2014 at 6:07 pm

Will find out in the few hours for sure on the approval.


January 29, 2014 at 11:09 am

Dear Elizabeth!

Thank you so much for your article! Dr. Flexer shared it with me a few weeks ago, just before her visit to Israel where she presented on this topic in front of professionals and families of children with hearing impairment. I would like to post a link to your article on our organization’s website (AV Israel), and translate it to Hebrew to serve our Hebrew speaking families. Could you kindly grant me you permission to do so and share your full name and title for an accurate citation? Thank you!

January 30, 2014 at 12:51 am

Thank you, Eila! I am flattered. I will be in touch via email.


February 10, 2014 at 5:43 pm

This is a wonderful article that makes something so complex very simple to understand! You don’t possibly have it translated in Spanish, do you?

Pam B.

February 14, 2014 at 4:25 pm

This is a great article! Thanks for sharing. I am always looking for information like this to better educate myself (parent of a 5yr old bilateral cochlear implant user). Very easy read for the average person to understand. Thanks again!

February 16, 2014 at 9:50 pm

Thank you for the kind words, Pam! Best wishes to you and your son!

February 16, 2014 at 9:50 pm

Thank you, Landon! Unfortunately, I do not currently have it translated in Spanish. That would be a great project for the future, though. Thank you for suggesting it! I will get to work trying to make that happen.