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

CART

• Computer Aided Realtime Translation
• Instant translation of spoken word to English text
• in classroom or done remotely
• uses stenotype machine, laptop and special software

C-Print and Typewell

• content based transcriptions
• requires a laptop with special software
• trascriber trained but not as much as CART
• C-Print has new graphic program

Captions

• most things can be captions
• harder online
• scripts available if not captioned (but not as useful)
• if you can't give visual access, don't use it
  

Extracurricular Activities

• accommodations and modifications also apply to school activities sponsored after school

ESY

• extended school year also needs to be using these things

Key Take Home Points

• reduce background noise
• minimize reverb
• quieter classrooms
• lunch buddy (don't eat in cafe)
• allow normal conversation in library
• be creative with classroom tech

Why do these things?

• to allow full access
• it is the law