CSD 5400REHABILITATION

PROCEDURES FOR THE HARD OF HEARING

Course OverviewDefinitions, Prevalence, Myths,

and Other Concerns

Course Purpose

During the semester, we will be exploring six fundamental areas related to aural (re)habilitation:Auditory perception of speech and the effects of HL on

speech understandingVisual stimuli in communication including speechreading and

manual communicationAmplification including “hearing aids” and cochlear implantsLanguage and speech characteristics of deaf and hard of

hearing childrenHearing loss and identity including psychosocial issuesEducational management of hard of hearing and deaf

children

Course Requirements

Exams (30%)Two exams total

1 in-class1 take-homeFinal exam is NOT comprehensive

Reflection papers (30%)3 required Related to feature films viewed in class

Oral and written clinical problems (40%)

Definitions of DeafnessWebster’s dictionary defines deaf as totally or

partially unable to hear

Professionals in the field of hearing; audiologists, ear, nose, and throat physicians, or hearing aid dispensers, normally address the term deaf or deafness to mean someone who is not able to hear and understand speech no matter how loud it is

Definitions of Deafness

The Individuals with Disabilities Education Act (IDEA) defines deafness as "a hearing impairment that is so severe that the child is impaired in processing linguistic information through hearing, with or without amplification."

Definitions of Deafness

From Office of Special Education:

“Deafness is a hearing impairment which is so severe that the child's hearing, with amplified sound, is nonfunctional for the purposes of educational performance”

Definitions of Deafness

This is a disability that is multi-dimensional

Depending on the author of the definition and their perspective (educational, medical, audiological, etc), the definition will differ.

Prevalence

National Center for Health Statistics in 1999 reported about 22 million people in the United States have some degree of hearing loss

Prevalence Rate By Age

PrevalenceFrom the 1999 National

Center for Health Statistics:

Severe to profound deafness affects about 0.5% of the general U.S. population

0.1% of these are kids

PrevalenceIn the 1996-1997 school

year:

1.3% of kids who received special ed services were hearing impaired

25% of kids who are deaf have another disability

Myths and Misconceptions of the Deaf

1. Deaf People Can’t Hear Anything

The degree of hearing loss is a continuum

Deafness has a cultural perspective

2. Most Deafness is Caused by a Fever or Sickness

Most causes of deafness are due to genetic factors

Nonsyndromal recessive genetic inheritance

3. All Deaf Children Have Deaf Parents

Deaf children having two deaf parents comprise about 3-4% of the deaf population

Over 80% of children born to deaf parents have normal hearing

4. All Deaf People Can Read Lips

Drawbacks to lipreading:

1. Only 50% of English speech sounds are visible

2. A lot of speech sounds look alike on the lips

3. In order to benefit from speechreading, you need to have a good command of the language

4. Speechreading is really tiring

5. All Deaf People Know Sign Language

Many deaf people are oral only

There are a number of (different) forms of manual communication

6. All Deaf People Are Mute

The speech production ability is really varied

7. Deaf People Can’t Read

Reading is a language-based skill

Most deaf adults achieve an average reading ability comparable to a 4th grade level

8. Deaf Children Don’t Attend School

Before the 1970s, at least half of all deaf children attended state residential schools for the deaf

By 1984, 74% of all school-aged deaf children attended day classes while living at home and 15% of deaf students attended regular classes with normal hearing kids on a full time basis

Today 30% of deaf school-age kids attend special schools

9. Deaf People Aren’t Intelligent

Intelligence and language level are closely connected

“Deaf and dumb”

10. Deaf People Have More Mental Health Problems

Cultural differences

11. Hearing Aids Allow the Deaf to Hear Speech Normally

What do hearing aids do?

Cochlear implants

12. All Deaf People Wish They Could hear Normally

Is deafness really a “disability”?

Deaf--with a capital “D”

13. Deaf People Can’t or Shouldn’t Drive

President’s Advisory Committee on Traffic Safety in 1968 found that deaf listeners were involved in 1/4 as many traffic accidents as hearing people

97% of warning signals are visual

14. Deaf People Can’t Work

American With Disabilities Act of 1990

15. Deaf People are Quiet and Antisocial

Please!!

Rehabilitative Audiology

Now that we’ve reviewed some characteristics related to hearing loss and deafness, let’s turn our attention to the purpose of this course; namely, aural rehabilitation

Definition of Audiologic Rehabilitation

The professional efforts designed to help a person with a hearing loss. These include services and procedures for lessening or compensating for a hearing loss and specifically involve facilitating adequate receptive and expressive communication

WHO Classification System

A Current Model of AR

CORE Portion (Assessment)

CARE Portion (Management)

An Important Question…

In what ways and to what degree does hearing loss or deafness affect an individual?

Variables That Affect Activity Participation

Degree of impairmentWhat amount of

auditory cues is available?

How are the temporal relations of speech preserved?

How well can the listener integrate partial information from a variety of sources?

Variables That Affect Activity Participation

Age of onsetPrelingual (birth)Postlingual (after age

5 or so)Deafened

(adulthood)

Variables That Affect Activity Participation

Site of lesionConductive, sensorineural, central

Family supportOther factors

Presence of other disabilitiesAvailability of special services

How Well Is Hearing Impairment Served?

Both children and adult hard of hearing listeners are underserved

ChildrenIssues related to identificationProvision of appropriate amplification and

educational services

AdultsMost don’t seek services related to amplification

or ways to improve effective communication

Why??

StigmaCostConfusing service delivery systemLow interest/motivationWhat can we do to promote these

services??

Americans WithDisabilities Act

Federal law passed in 1990 that guarantees equal opportunity for individuals with hearing loss in employment, public accomodations, transportation, state and local government services, and telecommunications

“Here’s to the ADA” video