Deaf and Hard-of-Hearing Therapy Notes

Introduction

• The Speechie Show focuses on providing tricks and tools to make the job of speech-language pathologists easier.

• Today's topic: Where to start in therapy with deaf or hard-of-hearing students.

Guest Introduction: Erin from Your Speech Path LLC

• Passion for working with deaf and hard-of-hearing children.

• Background:

  • Bachelor's in Deaf Study.

  • Learned American Sign Language (ASL) in college.

  • Master's in Speech-Language Pathology from Gallaudet University.

• Experience: Early intervention, preschools, outpatient rehab, private practice, and own private practice.

Encouragement for Audience Participation

• Viewers are encouraged to type in questions about the deaf or hard-of-hearing community.

• Viewers are asked to share the age groups they work with.

Five Tips for Treating Deaf or Hard-of-Hearing Students

1. Background Information

• Importance of research before starting therapy.

• Key information to gather:

  • Child's age.

  • Age of onset of hearing loss (early vs. late diagnosis).

  • Degree of hearing loss (mild, moderate, severe, profound).

    • Severe to profound hearing loss often indicates the use of cochlear implants.

    • Mild to moderate hearing loss often indicates the use of hearing aids.

  • Type of hearing loss:

    • Conductive Hearing Loss: Sound waves have difficulty passing through the outer or middle ear.

      • Causes: Outer ear infections (otitis externa), middle ear infections (otitis media), hole in the eardrum (tympanic membrane), trauma, ear surgery.

    • Sensorineural Hearing Loss: Damage to the inner ear or cochlea, affecting nerve paths to the brain.

      • Damage to hair cells in the cochlea or a missing auditory nerve.

    • Mixed Hearing Loss: Combination of conductive and sensorineural hearing loss.

  • Age when hearing aids, cochlear implants, or Bone Anchored Hearing Aids (BAHA) were first used.

    • Early intervention is crucial for language acquisition.

2. Communication Methods

• Essential to discuss communication options with families.

• 95% of children with hearing loss are born to hearing parents who may need education on communication options.

• Communication methods to consider:

  • Auditory Verbal: Focus on listening and spoken speech without visual cues.

  • American Sign Language (ASL): A distinct language with its own syntax.

    • Differentiated from signing exact English.

  • Cued Speech: A phonemic-based visual system using handshapes (cues) to represent consonant-vowels.

    • Cues placed near the mouth indicate vowels, while cues farther from the face represent consonants.

  • Total Communication: Combines auditory-verbal/oral approaches with sign language.

• Sign language can be beneficial even for children with typical hearing.

• The importance of family involvement in chosen communication methods.

3. Device Management

• SLPs should be aware of the types of amplification devices a child uses:

  • Hearing aids (unilateral or bilateral).

  • Cochlear implants (unilateral or bilateral).

  • Bone Anchored Hearing Aid (BAHA).

• SLPs need to know how to:

  • Check the batteries.

  • Interpret device lights (varies by device).

  • Look for debris and earwax in the tubing.

  • Identify missing pieces.

• Recommend familiarizing yourself with troubleshooting tools.

• If amplification isn't working, therapy will not be productive.

• Frequency of Device Checks

  • Check the device every time you see the child.

  • Train teachers to do equipment checks.

4. Training in Listening

• Do not assume hearing happens automatically or that you don't have to address it.

• Listening is hard work, especially for children who haven't been hearing since birth or amplified since birth.

• Listening Hierarchy:

  • Detection: Responding to sound (e.g., turning head, moving eyes).

  • Discrimination: Differentiating between sounds (same vs. different).

  • Identification: Identifying what a sound is (e.g., fire truck vs. airplane).

  • Comprehension: Understanding the meaning of sounds (directions, vocabulary, reading).

• Listening Check: Use the Ling 6 sounds to determine a child’s auditory access to speech sounds.

  • Ling 6 sounds: /u/, /ɑ/, /i/, /ʃ/, /s/, /m/.

  • These sounds cover approximately 250 Hz to 4000 Hz on an audiogram, representing low, mid, and high frequencies.

  • Websites like cochlear.com and AdvancedBionics.com have resources for the Ling sounds.

• Implement Auditory hoop:

  • For younger kids, have them raise a hand when they detect the sound.

  • For older kids, do the exercise by repeating back the sound that I said.

5. Therapy Strategies

• Recommended strategies to incorporate in every therapy session:

  • Reduce the distance between the child and SLP. Have the child sit close to the best ear for unilateral loss.

  • Ensure appropriate seating in group settings.

  • Use short phrases, especially for comprehension issues.

  • Repeat yourself when giving directions.

  • Ask the child to repeat directions to ensure active listening.

  • Auditory highlighting / Acoustic highlighting: Emphasize specific phonemes or vocabulary.

  • Use a closed set instead of an open set.

  • Use auditory sandwiching with visual cues, auditory-visual-auditory:

    • A visual paired with language.

    • Give a generous pause between the auditory, visual, and the auditory to help processing.

Resources

• Speech banana laminated.

  • It gives common sounds and where they fall on an audiogram.

• Updated audiogram.

  • So that I can see what they are hearing aided and unaided.

Giveaways

• Sounds at Home bingo game from Amazon.

• Two free months in the Speech Therapy Solution membership.