Katie Duncan, Au.D . & Angie Bruno, M.S.Ed .

1. Just Stop, Look, And Listen: Supporting Access for Students Who Are Deaf and Hard of Hearing Through Daily Listening Checks Katie Duncan, Au.D. & Angie Bruno, M.S.Ed. Maine Educational Center for the Deaf and Hard of Hearing September 9, 2014

2. What does HAT (Hearing Assistive Technology) Do for the Student ? • Hearing aids, Cochlear Implants and BAHAs • Well-fit technology provides some level of aided benefit, resulting in reduced listening fatigue, better speech understanding/more environmental sound awareness. • FM systems • FM systems provides access to the teacher’s/speakers voice across a variety of situations and reduces the negative impact of noise and distance on the listener. • FM systems offer options which accommodate difficult listening situations. (Pass microphones and patch cords allow quality access in a variety of learning environments)

3. Why is it important to check my student’s technology? • Children expected to use audition as their primary system to receive communication must have consistent access to auditory information in order to be successful in school….. • Inconsistent/intermittent use of HAT results in restricted access to education • Inconsistent/intermittent use of HAT create student outcomes that do not reflect the student’s potential to learn

4. Students may not have the skills or confidence to be able to notify you if their equipment is not working. • Taking the time to check equipment tells the student you recognize it is an important part of their education Learning depends on ACCESS!

5. Ensuring Access in all situations • One teacher • Team teaching • Small group settings • Large group settings (assemblies, etc.) • One-on-one therapy (speech/language, OT, PT) • Gym • Field Trips • Smart Boards/media/films

6. Oh yeah, and it’s the Law! • IDEA states “Each public agency must ensure that hearing aids worn in school by children with hearing impairments, including deafness, are functioning properly.” Part B, 300.113 • Cochlear implants: while schools are not responsible for Mapping, maintenance, and replacement of CI processor, the law states that these exceptions do not limit “the right of a child with a surgically implanted device (e.g., cochlear implant) to receive related services…determined by the IEP team to be necessary for the child to receive FAPE” such as “routine checking of the external component.” Part A 300.34

7. Oh yeah, and it’s the law! • “To allow a child to sit in a classroom when the child’s hearing aid or cochlear implant is not functioning is to effectively exclude the child from receiving an appropriate education.” Department of Education • The IDEA statute 20 U.S.C. 1400(c)(5)(H) specifies that schools must: "support the use of assistive technology devices and assistive technology services to maximize accessibility for children with disabilities."

8. Where to begin? • Some basic materials are needed prior to beginning a basic listening check

9. Terminology is important! • In each of the following sections, the correct terminology will be used for the various parts of each type of technology • Using the correct names for each part helps to minimize misunderstandings, and instead may result in more efficient problem-solving (example: “audio shoe and receiver” instead of “FM boot”) • Knowing the names helps you to explain any problems to your audiologist/TOD via email or over the phone – again, issues are resolved more quickly

10. Terminology: Hearing Aid Earhook Tubing Earmold Battery Door

11. Technology check: Hearing Aid • Inspection: make sure all parts are present, put together properly • Tears in earmold/tubing? • Wax in earmold? • Listen for distortion, weak signal, static • Ling Sounds: aa, oo, ee, s, sh, mm • Checks audibility across speech frequency range

12. Listening Check: Hearing aid

13. Terminology: FM system Audio shoe Receiver Transmitter

14. Technology check: Hearing aid + FM • Inspection: make sure all parts are present, and connected in the appropriate manner • FM receiver  audio shoe  hearing aid • Is the FM receiver synced to the appropriate channel? • Listening check: is the signal received by the FM receiver? • If so, is it clear of distortion, static? • FM transmitter – mute vs. turning off • Mute is easier, more appropriate for any time where the teacher briefly speaks with a student other than the student using the FM system – individual work, etc. • Must remember that you are speaking to the student as if you are 4 inches from their ear – they cannot ignore you!

16. Listening Check: Hearing Aid + FM

17. Other types of FM receivers Dedicated receivers (vs. Universal previously shown) Listening to FM signal via neckloop

18. Terminology: Cochlear Implant processor cable coil earhook battery

19. Technology check: Cochlear Implant • Is the CI properly assembled, with all pieces present? • Listening check via monitor headphones: Please note, each CI manufacturer uses different monitor headphones! • Important to remember that listening check of cochlear implant only provides information on the status of the processor microphones. It does not tell you how the student is hearing through their internal device • Important to take note of student’s feedback, particularly if the processor sounds fine but the student is complaining

20. Listening Check: Cochlear Implant

21. Terminology: Cochlear Implant + FM Euroadapter Receiver

22. Technology Check: Cochlear Implant + FM • Inspection: make sure all parts are present, and connected in the appropriate manner • FM receiver  Euroadapter Cochlear Implant • Listening check: is the signal received by the FM receiver? • If so, is it clear of distortion, static?

23. Listening CHECK: CochleAR Implant + FM

24. Terminology: BAHA Abutment Snap

25. Technology Check: BAHA • Is it turned on? • Listening check via special accessory – allows you to hear signal through bone conduction! • Note: listening through bone conduction may sound strange to you! • Must plug one or both ears for maximum effect • Is signal clear, free of distortion and static?

26. Listening Check: BAHA

27. Technology Check: BAHA + FM • Are all pieces present? • Typically, just need universal BAHA receiver that plugs into accessory port • Listening for FM signal: is it being transmitted? If so, is it clear, undistorted, free of static?

28. Listening CHECK: BAHA + FM

29. Note on Personal FM receivers • Some students with unilateral hearing loss or auditory attention issues (APD, ADD, etc.) may be fit with a personal FM receiver • A listening check will be performed in much the same way – use stethoset to listen to receiver to ensure a clear signal is being sent

30. Important note • It is important to maintain contact with your student’s family or primary care audiologist to determine if their hearing technology needs to be put into “FM mode” for the FM to work • Technology should either be sent to the student’s audiologist or the FM manufacturer for summer service to ensure that it is functioning properly prior to the beginning of the following school year • Technology is always changing, so this resource only gives a general overview – every company does things a little differently!

31. Basic TroubleshootingHearing aids • Weak signal? • Check for dead battery – change battery • Moisture in tubing – use tube blower • Wax in earmold – use wax pick • Feedback? • Loose fitting earmold – needs to see audiologist to order new mold • Crack in tubing – must be repaired by audiologist • Wax or middle ear fluid – must be seen by pediatrician or audiologist

32. Basic TroubleshootingCochlear Implants • No sound? • Dead battery – change battery • Read processor lights to check for errors • Processors are usually programmed to have indicator lights – have a copy of the description of these indicator lights handy so you can quickly identify any issues • The best way to monitor the function of the cochlear implant is to document any changes in listening behavior, and communicate with the mapping audiologist so that they can make any necessary changes to the CI programming

33. Basic troubleshootingBAHA • No sound? • Dead battery – change battery • Feedback? • Remove hat • Again, the BAHA indicator lights can give you information about its function

34. BASIC TROUBLESHOOTINGFM Systems • No signal? • Is everything connected properly? (audio shoe, receiver, etc.) • Is the device in FM Mode? (if necessary) • Are you on the correct channel? Sync with transmitter • Is the sound quality poor? • Check microphone placement • Look for an upcoming webinar with more information on proper FM system usage! • A word of caution: the FM microphone cord often houses the antenna – proper care is important to avoid damage that can affect the quality of the signal!

35. Important note Regarding different types of technology • You may see many different types of technology in your school, including many different FM receivers, hearing aids, cochlear implant processors • This webinar only covers more common types of equipment – please contact your PSO consultant if you do not see your equipment here – we can still help you!

36. Questions??

37. Acknowledgements and Resources Thank you to Cochlear, Phonak, and Oticon for loaning demo equipment • www.successforkidswithhearingloss.com/inservicing-the-classroom-teacher • PPT: What you need to know about student’s hearing technology for classroom listening • “We Need to Hear it All: Please Patch Us In!” webinar http://www.mecdhh.org/news/39/91/Webinar-We-Need-To-Hear-It-All-Please-Patch-Us-In/