TROCA.pptx

Troca

1. Topic-TROCA and Play audiometry

2. TROCA- tangible reinforcement operant conditioning audiometry TROCA is a highly structured testing approach originally described for use with difficult to test patients , such as those with developmental disabilities. Difficult to test is a general term used to mean those who cannot be readily assessed with conventional behaviours tests.

3. So that special methods are needed, -patients may be difficult to test due to physical , developmental, perceptual, cognitive, emotional, or others problems ,or to any combination of these factors. -approaches like TROCA , which were developed for the difficult to test ,are also effective with normal , young children. -upon hearing a tone(or other test signal),the child is required to push a response button or to make another simple but specific motor response within his range of neuromotor capabilities.

4. -Correct responses are rewarded by tangible reward , which might be corneal , candy, tokens , and other small trinklets . - False positive responses are discouraged because they are followed by time out periods. - the periods procedure is accomplished with instrumentation programmed to present the stimuli , monitor the responses , and deliver the reinforcers according to a predefined operant conditioning schedule.

5. -Conditioned play audiometry, or play audiometry, involves training the child to listen for stimuli and then make a specific motor response within the framework of a game, usually in combination with social reinforcement such as smiles, praise, etc. -Conditioned Play Audiometry (CPA) is a hearing test designed to access the hearing for very young children between the ages of 2 and 5 years old.

6. Purpose Assesses hearing ability using conditioned responses to sound by engaging in play oriented activities. Test room setting - For many children testing is most easily accomplished using two testers in a two-room test setup . - One audiologist will present test stimuli from the control room and the audiology assistant will work with the child in the test room. This two-room test procedure is especially important for soundfield testing.

7. -When earphone testing is being performed, it is possible to have one tester sit next to the child in the sound room and act as both tester and test assistant. - In a one-tester situation, it is difficult to test hearing in the soundfield . If there is only one tester, and if there is concern that the child will not accept earphones immediately, it is possible to train the child to perform the listen-and-drop task before the earphones are placed on her head.

8. -Put the earphones on the test table near the child and set the signal to a loud level that the child can be expected to hear based on previous observations. -Then train the child to perform the play audiometry task. Once the child is responding reliably, place the earphones on her head and proceed in the usual way.

9. -Play audiometry employs two clinicians who communicate by intercom and visually through the window between the control and test rooms. - One of them operates the audiometer and the other stays with the child. The child is generally seated at a small table, which is the play surface, either next to or opposite one of the examiners. A collection of games should be kept on hand so that when the child gets bored with one activity you can quickly and smoothly replace it with another.

10. -Keep the backup games out of sight so they do not distract the child from the task at hand. If accepted by the child, earphone testing may be attempted at the start, or at least as soon as possible. -Some children accept earphones immediately. In other cases, getting the child to accept earphones is a challenge in which the audiologist's personal "way with kids" comes to the fore.

11. -Earphone acceptance is sometimes facilitated if the clinician first puts on her own headset (which houses the intercom and permits her to monitor the test signals). -A reasonable amount of good-natured firmness and confident tenacity often works, but keep in mind that "winning" means getting the child to cooperate sufficiently that valid and reliable audiological information can be obtained,

12. -which will not happen if he is crying hysterically. If earphones are simply out of the question, then in the most matter-of-fact manner try the bone-conduction vibrator or insert earphones. -If all reasonable attempts fail, simply place the headset on the table where the child can see it, and start the test in the sound field.

13. Choosing the test stimulus If a child responds to speech (e.g., if the child answers when called), it may be best to begin with a speech stimulus. The easiest speech utterance may be the command "Put it in." The child will understand the verbal command and learn the task easily. Use of a speech stimulus will provide a speech awareness threshold but will not give any frequency-specific information .

14. -Once the child is conditioned to the listen-and-drop task, change the stimulus to tones or narrowband noise to obtain an audiogram. -If the child displays some developmental concerns, such as autism, PDD, or multisystem developmental delay, the child may not respond to speech stimuli. In that case, testing should begin with tones, noise bands, or music.

15. Results This test is usually performed under ear phones to obtain ear- and frequency specific information about hearing ability. Results will assist to define the nature and degree of hearing impairment. Limitations Results obtained may sometimes vary with the child's developmental level .