Deaf and hard-of-hearing (d/ hh ) students in the mainstream setting

1. Deaf and hard-of-hearing (d/hh) students in the mainstream setting By: Pam George

2. Questions you may ask yourself: • How will I communicate with this student? • Do I need to learn sign language? • Can he/she hear me when I am teaching a lesson? • Who is the hearing support teacher and what does that person do? • Who is the interpreter and what does that individual do? • What is this chart with X’s and O’s on it? • What does a hearing loss sound like?

3. Hearing support teacher’s role and responsibilities • Resource for information regarding hearing loss • In-service staff in school building about hearing loss • Ensuring student success rates in mainstream setting • Addressing any and all concerns classroom teacher may have • Troubleshooting equipment • “Hub” of IEP team • On-going communication between team members • Caseload manager • Familiarizing teachers with specially designed instruction and student needs • Modifications to tests, assignments, etc.

4. Anatomy of the ear

5. The outer ear • Outer Ear (Pinna) • The part of the ear you see every day. • Made of cartilage and skin. • Ear Canal (External Auditory Meatus) • You find ear wax in this part of the ear. • Purpose of the Outer Ear • Amplifies sound • Assists in localization of sound, especially elevation and front and back

6. The middle ear • Tympanic Membrane (Eardrum) • Thin layer of skin stretched tightly to allow vibration of sound • Ossicles • Malleus, Incus, Stapes- the smallest bones in the body! • Eustachian Tube • Runs from the middle ear to the back of the throat • Purpose of the Middle Ear • Serves as a bridge from the outer ear to the inner ear

7. The inner ear • Cochlea • The hearing portion of the ear filled with fluid • Shaped like a snail • Has tiny hairs that move to create impulses that are sent to the brain • Beyond the cochlea • The VIII Nerve • Carries impulses from cochlea to brainstem • The Brainstem • Serves as a relay station • The Brain • Receives signals from the brainstem and interprets the signals in terms of their sound content

8. Let’s see how sound travels!

9. Hearing loss- defined • Four types of hearing loss: • Conductive • Caused by injury, obstruction, or disease of the outer or middle ear that prevents the ear from conducting sound. • Fluid in the middle ear, wax build-up, absence or malformation of the outer ear, ear infections • The loss CAN be medically or surgically corrected • Sensorineural • Damage to the sensory hair cells of the inner ear or the auditory nerve that leads to the brain • Effects the way one hears clearly and how one understands speech correctly • The loss is permanent and CANNOT be corrected

10. Mixed • A combination of conductive and sensorineural losses • Part of the damage is in the outer ear or middle ear and the other part is in the inner ear. • Central • The outer, middle, and inner ear are intact. • The impairment is to the VIII nerve or brain.

11. Degree of hearing loss Decibel: the unit measurement of intensity, or loudness, of sound

12. Degrees of hearing loss • MILD (26 to 40 dB) • Difficulty understanding faint or distant speech • May need work to develop vocabulary • Favorable seating and lighting in classroom • MODERATE (41-55 dB) • Understands speaker face to face or a short distance • May miss as much as 50% of class discussion • May need vocabulary development, speech therapy, or special class placement in primary grades

13. MODERATELY SEVERE (56-70 dB) • Conversation must be loud to be heard • Will need a hearing aid and training with its use • Is likely to have problems pronouncing sounds, have language delays, and limited vocabulary • Will need extra help in Language Arts, speech therapy • SEVERE (71-90 dB) • May hear loud voices or sounds very close to ear • Speech and language development are delayed. • Will need extra help with language skills, concept development, speech, intensive communication building skills should be taught • May be a candidate for cochlear implant(s)

14. PROFOUND (91+ dB) • May be a candidate for cochlear implant(s) • Socializing with hearing peers may be difficult • May have language delays, very limited vocabulary, intensive speech therapy • Note-taking, captioning, and other visual enhancement strategies are necessary

15. Listening with a different set of ears… • http://www.audibel.com/understanding/simulator_flash.html

16. audiograms • Gives us volumes of information about what a student can and cannot hear. • It is conducted by an audiologist in a sound-proof booth • Child wears headphones and listens for tones, or beeps, and gives a conditioned response • Raising hand • Placing toys into bins

17. Let’s look at an Audiogram Low High Soft Red: Right Ear Blue: Left Ear Loud

18. Audiogram continued… • Does this student have a hearing loss? • Take a look at the DEGREE of hearing loss chart and compare…

19. Facts & statistics • Approximately 28 million Americans have a hearing impairment. • Hearing loss affects approximately 17 in 1,000 children under age 18. Incidence increases with age: Approximately 314 in 1,000 people over age 65 have hearing loss and 40 to 50 percent of people 75 and older have a hearing loss. • About 2 to 3 out of every 1,000 children in the United States are born deaf or hard-of-hearing. 9 out of every 10 children who are born deaf are born to parents who can hear. • Everyday in the United States, approximately 1 in 1,000 newborns (or 33 babies every day) is born profoundly deaf with another 2-3 out of 1,000 babies born with partial hearing loss, making hearing loss the number one birth defect in America • Only 1 out of 5 people who could benefit from a hearing aid actually wears one. • Three out of 4 children experience ear infection (otitis media) by the time they are 3 years old. • There are approximately 22 million hearing-impaired persons in the U.S. • Deaf people have safer driving records than hearing people nationally. • The huddle formation used by football teams originated at Gallaudet University, a liberal arts college for deaf people in Washington, DC, to prevent other schools from reading their sign language.

20. Common misconceptions • Misconceptions: • All students use residual hearing the same way. • Examples: • A student with a PROFOUND hearing loss may use speech only and is a good lip reader and another student with a PROFOUND loss may use sign language with no speech and does not lip read. • When I talk, the student looks like she’s heard me and understands what I’ve said. • If you hear a person speaking Japanese, you HEARD it, but did you UNDERSTAND it? • Hearing aids and cochlear implants cure hearing loss. • Yelling at a deaf person will help him/her understand you better. • All deaf and hard of hearing students use sign language. • Politically correct: Deaf and Hard of Hearing

21. listening devices and assistive technology • Amplification allows a better chance of understanding speech • Help a child access residual hearing and learn how to use this hearing in the most optimal way • Let’s take a look at different listening devices and assistive technology…

22. Hearing aids • How they work: • All have a… • Microphone: receives sound/signal • Amplifying circuit: shapes the sound to make it louder • Receiver: changes the signal back into sound that can be heard • Earmold: the colored ear piece in the ear canal • Are powered by batteries • Internal controls are set by an audiologist • External controls are set by the user (volume)

23. Behind-the-ear (bte) • Most common among children • Can attach to assistive listening devices (FM) • Microphone is on the back part behind the ear • May hear “squealing” from the aid • This is called FEEDBACK • Due to the closeness of the microphone to the receiver, there is “feedback” or squealing when the earmold is loose or too small

24. bte

25. Let’s check the hearing aids! • Each group has a hearing aid, stethoscope, battery tester, and a battery • 1st: Check the battery in the tester • 2nd: Put into the hearing aid • 3rd: Put canal part of earmold into the stethoscope hose • 4th: Turn on hearing aid • 5th: Ling Six Sound Test • Say: /ah/, /ee/, /oo/, /s/, /sh/, /m/ How did it sound?????

26. Other hearing aids • In the Ear (ITE) • In the Canal (ITC) • These types of hearing aids are rarely used with children.

27. Cochlear implants • Surgically implanted device • Offers severe-to-profoundly deaf children access to sound • Bypasses the damaged part of the inner ear, stimulates nerve, sends information directly to brain • Three parts: • Receiver- the part that is implanted • Transmitter- head piece (circular piece) • Speech Processor- worn on the body, shapes sound

29. But how does it work??! • Sound waves enter the microphone located in the headpiece • Sound is sent through the transmitter and along the wire to the speech processor • Speech processor changes the sound into a special signal that is sent to the implanted receiver • The receiver sends the signal to the brain where it is interpreted into sound • LET’S WATCH!!

30. Cochlear implants continued • How a cochlear implant works... Cochlear Implant Simulations

31. Fm systems • What is an FM? • Frequency-Modulated system that allows a D/HH student hear over a distance and sends the speaker’s voice directly to the hearing aid or cochlear implant *Without an FM, the speaker’s voice can be difficult to understand when paired with everyday background noise (heaters, buzzing lights, pencil sharpeners, etc.)

32. Personal fm system • An assistive listening device that’s microphone is worn 6 inches from the mouth • Improves the sound-to-noise ratio by reducing distance of sound source • Each personal FM system can be very different depending on the hearing aid type and its unique features Campus S Easylink

33. Sound field systems • Accessibility of the teacher’s voice to all students in the classroom • A microphone is worn around the neck • Sound is sent from the microphone to amplifier that is connected to loudspeakers • Carpeted box in all of the classrooms • Has several benefits to both D/HH students AND hearing students

34. Benefits of sound fields • Many children benefit from sound field systems: • Children with hearing loss • Children with central auditory processing disorder • Students with ADD and ADHD • Students with developmental delays • Preschoolers, kindergarteners, and first graders who are in crucial learning stages of language development • ESL students • Students with dyslexia

35. Communication modes • Several Different Modes: • Auditory/Oral • Auditory-Verbal • American Sign Language (ASL) • Cued Speech • Signed English or (SEE) • Total Communication • Rochester Method • Contact Signing • Manually Coded English (MCE) • There is no ONE PERFECT mode for every child. • Each child’s hearing loss is unique and his/her communication mode should match that loss.

36. Sign language interpreter’s role Responsibilities: • Facilitate communication • Sign everything that is voiced • Will stand/sit close to teacher Not responsible: • Classroom management • Tasks such as teaching, grading papers, making copies • Disciplining students (deaf and hearing)

37. One major “do” and “don’t” of using an interpreter

38. Hearing loss: Impact on student learning • Language delayed • Spoken language • Not uncommon for students to speak with nasal or atonal quality • Academic performance • Vocabulary development delays • Reading and writing difficulty • Difficulty in comprehension across academic subjects • Idioms and familiar English phrases interpreted literally • Written and oral language will reflect the way he/she hears -Word endings –s,-ed, -ing • Depends on age child was diagnosed with a hearing loss. • Many deaf children are not “vanilla deaf” • Limited phonemic awareness • What does the student hear during everyday conversation? Look at the Speech Banana. • Example: The fox saw two hens. Even with a mild loss, the student misses most of those sounds. /e ok aw oo en/ • Imagine reading and pronouncing these sounds that D/HH students so rarely hear.

39. Examples: Message: Ann needed new shoes. Question: “Who needed new shoes?” Student’s response: “Ann nanna” DID vs. DIG *A student who uses sign and speech to communicate reads a passage two times. The first time is with speech ONLY. He reads, “The boy walked to school. He did this everyday”. Then, when asked to SIGN the sentences, he signs The-boy-walk-to-school. He DIG this everyday. Did he get it right? Is the message still the same? No way!

40. Instructional strategies to use in your classroom

41. Classroom structure • What can be done to setup the deaf student for success? • SEATING • “U” shaped desk arrangement • Close to where teacher will be doing most of lecturing • Facing away from the windows • Students with cochlear implants should sit with C.I. side closest to speaker. • At ear level to the sound field, if used, approximately 3-6 feet away • Avoid seating the student next to noisy heaters and fans, buzzing lights, computers/printers, projectors, pencil sharpeners, or classroom sink • ACOUSTICS • Cover hard, smooth surfaces with sound-absorbing materials like carpeting, felt, table cloths. • When noise is present, the student will have difficulty understanding or attending to discussion. • Inappropriate acoustics can compromise understanding speech, behavior, language experiences, concentration and academic achievement.

42. Specially designed instruction • Modified curriculum • Accessibility to communication via an educational interpreter • Clear desk prior to new assignment • Establish eye contact prior to giving directions • Management of noise level in classroom • Increased wait time to allow for language processing • Use of appropriate amplification (hearing aids, C.I.’s, etc.) • Modify assignments to meet language needs • Preferential seating • Frequent review of skills and concepts

43. Hearing loss prevention • Exposure to loud noises over an extended period of time damages the hair cells in the ear. • These hair cells cannot grow back causing noise-induced hearing loss. • Examples of harmful loud noises: • Motorcycles • Firecrackers • Explosions • Concerts • MP3 players at loud volume • Chainsaws • Jet Engines • The length of time exposed to these noises will determine whether a person will acquire noise-induced hearing loss. • What can be done to prevent it? • Limit exposure and time of exposure to loud harmful sounds • Wear protective hearing devices or earplugs

44. References: American Speech-Language-Hearing Association. (2005). Acoustics in Educational Settings: Position Statement [Position Statement]. Available from www.asha.org/policy Bess F. The minimally hearing-impaired child. Ear and Hearing, 1985; 6:43-47 Centers for Disease Control and Prevention. National Center for Birth Defects and Developmental Disabilities, Early Hearing Detection and Intervention Program. http://www.cdc.gov/ncbddd/ehdi/default.htm. "Interesting Facts about the Deaf." DeafNet. 19 July 2008 <www.deaf.net>. http://kidshealth.org/parent/general/eyes/cochlear.html website Laughton, Joan. "Educating Children Who are Deaf or Hard of Hearing: Cochlear Implants." ERIC Clearinghouse on Disabilities and Gifted Education Reston, VA. 15 Sep. 2008 <www.ericdigests.org/1998-2/implants.htm>. “Mainstreaming the Student Who is Deaf or Hard-of-Hearing.” Guidebook. Melanie Doyle, M.Ed., Linda Dye, M.A., CCC-A Director of CCHAT Center, SanDiego. January 2002.

45. National Association of the Deaf website. Community & Culture. <www.nad.org> "Noise-Induced Hearing Loss." www.nidcd.nih.gov. 1 May 2007 <nidcd.nih.gov/health/hearing/noise.asp>. http://www.nidcd.nih.gov/health/hearing/coch.asp website Images: http://www.bcchildrens.ca/NR/rdonlyres/1E47B20B-D686-44BF-A811-B4AE48E4DCB7/16095/BTE.jpg http://www.theitinerantconnection.com/images/hearing%20aid%20in%20ear.jpg http://mortonplant.com/images/In%20canal.jpg http://www.youtube.com/watch?v=SmNpP2fr57A http://www.phonak.com/de/professional/productsp/instrumentsp/digitalp/products_instruments_digital_micropower.htm?activetab=31736 http://www.netac.rit.edu/gphx/tipsheets/cued.gif