Teaching Learners with Multiple Special Needs: Improving Auditory Access to the Curriculum through Technology

Tuesday, August 11, 2009

Improving Auditory Access to the Curriculum through Technology

notes on a presentation by Charlotte Mullen MA-CCC-A Audiologist Children's Hospital - Waltham

Mass ESE Deaf/HOH Seminar August 11, 2009 Holy Cross College

This discussion is about students who are Deaf/HOH and use audition to learn in the classroom - other modalities may be used but this is about kids who use audition - amplification or implants.

Why are their more Deaf/HOH kids in the mainstream?

newborn hearing screening

41 states, PR, DC mandate - MA included -- homebirths can be an issue, accidental homebirths usually tested planned home births usually not
age of ID down from 2.5 to infancy
mild ID also now ID at infancy down from kindergarten (age 5)
screen by 1 month, diagnosed by 3 months, amplification and treatment by 6 months will stay on normal developmental course
thus incidence of hearing loss is the same but placement in public schools is up and placement in private schools is down

cochlear implants happening as early as 12 months, thus students ready for mainstream education in pre-school or kindergarten

Goal of amplification and implants is to allow students to use audition for instruction because 60%+ of learning in schools is auditory.
Consideration must be made for socialization as well as academics.

Factors that affect a child's auditory performance:

degree of hearing loss
type of hearing loss (where in the ear the loss is coming from)
age of diagnosis was made and intervention began
stability of hearing loss (static, progressive, fluctuating)

Note: Good speech does not mean good hearing!

Question re: aided audiogram

no longer done because of new digital hearing aide technology, the aided audiogram only tells you what the hearing aide is doing for soft sounds which is really how well the hearing aide is working, not the ability to hear

What to take from the Audiological Evaluation

An overall description of the child's degree of hearing impairment
Unaided word recognition scores
A description of what the child is able to hear with their amplification device (hearing aids, cochlear implant(s), combo)
how do they do on the single word level, in sentences, in conversations, how do they do in quiet, how do they do in noisy places, how do they do with visual cues
if the audiological report does not include a description of the child's ability to hear and understand speech under different conditions a new referral may need to be made

Simulation of Spelling Test with Hearing Loss
List One My Guesses at the Words severe loss with aides
(note: the blank ones I could not hear at all)
1.
2.
3.
4. move
5.
6. loud
7. twist
8. say
9. bite
10. beet

List two (same list) moderate loss with aides
1. pill
2. pap
3. pump
4. move
5. wise
6. back
7. sit
8. froze
9. purse
10. juice

List three (same list) normal hearing

1. fill
2. catch
3. thumb
4. knee
5. wise
6. bath
7. fish
8. shows
9. bed
10. juice

(My comments --- wow! The only word I got all three times was move! That's 10 percent! The first list - which I could not understand really at all was like a kid with severe hearing loss WITH hearing aides! The second list was moderate loss WITH hearing aides! This makes me feel terrible for all my moderate HOH kids with aides AND other disabilities trying to function in my room. I need to do so much more for these students!!! Teachers of the Deaf are so so so important! they need to be on the teams for these kids, actively involved and there to point out what we speducators need to be doing!)

IDEA says every school/LEA is required to ensure that hearing aids worn in school by children with hearing impairments and Deafness are functioning properly (Section 300.113 (a) and (b))

someone must be appointed to check the equipment and make sure it is working (CHECK ADAPTED LEARNING I HAVE POSTED A HEARING AID CHECK LIST)
there MUST be a back up person to check
there MUST be a back up plan if it does not work

Classroom Considerations

distance between speaker and listener

average conversational speech is 3-4 feet
every doubling of distance speech is decreased by 6 decibels

background noise

classrooms are noisy places
heaters, air conditioners, lights, etc - old buildings can be very noisy
kids making noise (kid with ADD and nylon wind pants, all the kids turning to page 93 and the teacher keeps talking)
noise from outside the classroom - street, playground, hallway, cafeteria, gym, low flying planes, sirens, car alarms, lockers, printers, projectors etc
noise type makes it easier or harder to ignore but noise is noise, noise may exceed the loudness of teachers voice effecting ability to be hear (and leading to teacher vocal strain, increasing teacher sick time)
speech to noise ratio ASHA and acoustical society of America recommend speech be 15 dB higher than background words... but it needs to be higher
open classrooms/open schools are a real problem
as are modified large spaces (redone/sub divided gyms or auditoriums)
modular classrooms are noisy with HVAC on top and thin walls

acoustics and reverberation

you want some, but not too much reverberation
surfaces near teacher should be hard
soft, absorbant surfaces should be else where
acoustical tiles (reduces reflection of noise does not reduce noise through ceiling)
quietclassrooms.org is a good place for more info

preferential seating

in front of wear the teacher gives the majority of instruction - where the teacher actually is, not his or her desk
away from obvious noise
away from not obvious noise (fish tank, hampster cage, kids who are involuntarily noisy, etc)

consider professional help

an acoustical engineer can be higher to measure ambient background noise and reverberation (about $2,000-3,000 - but you will save that in ligation)
put the wrong things in place you can make it worse
they can locate noise sources and give suggestions

tips

get an area rug, it can follow a kid through the years (send out to be cleaned every year)
chair socks (standard tennis balls have latex and you might lose a finger cutting them)
Quiet Feet felt pads go on chair legs
plastic chair glides that are felt on the bottom
reduce reflective surfaces, curtains, quilts, carpets, blankets, flags, blankets

Paying for Modifications

sped funds
building funds
21st century green high performing schools facility act HR3221 goes before senate in fall
stimulus money

Who should address classroom modifications?
Chapter 433 of the Acts of 2004 (Mass Law) Assistive Technology (not Deaf/HOH - all)

What was being used then (2004) (number of educators using):

comm boards (79)
FM systems (75)
PECS (73)
Alphasmart (64)
Voice Output Device (49)
TTS readers (18)
Other (31)

Who does the training on Classroom Mod and Amplification Systems in Schools (in descending order)

SLP
Don't Know
Other
Clinical Audiologist
Some IEP Member
Teacher

Is the person doing the training comfortable?
about 50/50 yes/no!!!!!

In other states, an Educational Audiologist is a standard member of the TEAM for a student who is Deaf/HOH.

Make recommendations
Manages equipment/tech
Not consistent mechanism in MA
Only 2 or 3 in public school systems in MA (OMG!!!!)
(Side Note CB, teacher of the Deaf/HOH I worked with at Old Job, I appreciate you more than ever!!!)
Scope of Practice - Based on professional scopes of practice ion audiology (AAA, 2004,; ASHA 2004), the audiologist is the ONLY ONE qualified to deal with the technology for learners who are Deaf/HOH
Under IDEA Educational Audiology, teacher of the deaf and speech-language pathologists are sperate roles/scopes of practice (as are severe sped teachers for that matter)
Educational Audiologists are members of the IEP team (or legally should be!)

Amplification Options for the Classroom

just hearing aides
just cochlear implants
ALD (assistive listening devices)

individual FM systems

designed to overcome effects of distance, noise and room acoustics
teacher wears microphone and FM transmitter
child wears attachment on hearing aide or implant
FM signal goes directly into hearing aide/implant
no matter where teacher moves her voice can be heard
teacher voice always louder than background noise
two manufacturers - Otocon (used to be Phonic Ear) and Phonac
two kinds of hearing aide/implant receivers - clip on (called "shoe" or "boot") and all-in-one -- schools like the shoes
to find out what you need talk to audiologist
do I have to buy something new? maybe not. what do you have? discuss with audiologist
FM systems usually last 5-6 years (even if you are careful they get dropped, wear and tear etc)
companies offer services contract that allow you to send systems back in the summer for cleaning and upgrade and will replace a boot or shoe one time in the life time of a device for a boot or shoe replacement for $100 instead of $800
rechargeable batteries (in transmitter) are only good for 12-18 months
before the student uses a system it MUST be evaluated by an audiologist - purchase the system from a local dispensing audiologist (who will charge more, but will do the evaluation part too and will fix any problems and will trouble shoot any issues)
adult with normal hearing must monitor the system daily (aides/implant and FM) ask different questions daily
FM does not preclude the need for other services
older kids may not want to wear or carry

Soundfield FM

amplifies whole room
if the room has poor acoustics this will make it worse
can be added to personal FM

Teaching Tips

secret signal to redirect attention
rephrase when kids ask questions, comment, give answers
use visuals
give handouts, outlines
use powerpoint and SMART Boards, etc
in Foreign Lang remember listening labs and websites do not have any visual cues
many Deaf/HOH require a foreign lang exemption
some schools allow ASL as alternative to foreign lang
may require a note taker
think about social impliications of handing off a personal FM every period to teachers
if you are taking notes you can't be looking for facial cues/lip reading
if you don't have a note taker at least compare notes
use carbonless notebook paper
use notesharing websites
if the child can type allow use of laptop or alphasmart
be creatice with technolgy - give kids powerpoints, share SMART notes, use web 2.0