Introduction to Aural Rehabilitation

Lisa Bowers, Ph.D. CCC-SLP

NIDCD

Statistics reported as of December 2012

324,200 registered devices have been implanted

worldwide
In the United States - 58,000 adults & 38,000
children

Language of the Deaf and

Hard of Hearing
Chapter Six (pages 211-229)

Major decision parents will have make

www.ncbegin.org

Communication options

Video

The Great Divide

The Great Divide is not the divide it once

used to be
BUT

It is very important to understand all of the

options and terminology as a professional

Koch, 2002

Communication Modalities

Sign
Langua
ges

Manual

Sim
Com

Signed
Exact
English

Cued
Speech

Manual/Visual/Auditory

Auditor
y-Oral

Visual/
Auditory

Auditor
y Verbal

Auditory only

American Sign Language (ASL)

ASL is a full and complete language, using

visual-spatial information to communicate
thoughts and ideas.
ASL is not a manual form of spoken English, it
has an entirely different grammar and syntax
from English.
ASL has its own unique linguistic properties;
however, there is no official written form of
ASL.
ASL use is not associated with a specific
geographic location or region.

Differences in Languages
ASL Gloss

DOG BROWN I HAVE.

TWO CATS I HAVE.
NAME BILLY. BOB.
WOW. YOUR BIKE
RED ME LIKE.
STORE I GO.
TENNIS I LIKE PLAY
WHY? FUN

English Translation

I have a brown dog.

I have two cats and
they are named Billy
and Bob.
I really like your red
bike!
I go to the store.
I like to play tennis,
because it is fun.

ASL as a language
Cued
Spee
ch

Signe
d
Exact
Engli
sh

ASL

SimCom

Pidgi
n
Signe
d
Engli
sh

The other forms of manual communication are

linear and use the vocabulary, syntax and
pragmatics of English, and are generally
thought to support the reception of speech.
ASL makes use of spatial relationships, facial
expression, and body positioning.

Bilingual / Bicultural Approach

Children learn 2 languages ASL and English

ASL is typically considered the first or
primary language
Bi-Bi differs between families

Some use no spoken language, ASL to

communicate, English for reading/writing
Some use ASL and spoken English to
communication as well as English for literacy

Manual / Visual Systems that support

English

Sim Com

Pidgi
n
Signe
d
Engli
sh

Signe
d
Exact
Engli
sh

Cued
Spee
ch

Manually Coded English forms

Signed Exact English

Is the direct translation of English using signs

Is not another language, but a way to represent English
visually
includes things like pronouns, plurals, possession, and
the verb "to be
often used in school environments

Manually Coded English forms

Pidgin Signed English (PSE) (contact sign)

Combination of ASL signs with English syntax

What you often see non native ASL signers use
Deaf individuals are very adept at using PSE with
hearing individuals

Manually Coded English forms

Simultaneous Communication (Sim-Com)

Manually coded English and spoken English at the

same time

Typically uses ASL signs only

Does not use the signs for the verb to be or
morphological endings (e.g., ed) that are part of SEE

Used often in school environments

Idea is to support spoken English with signs
while speaking
Unfortunately, the reality is children do not get a
full representation of either language (ASL or
English)

Manually Coded English forms

Cued Speech

Uses mouth and handshapes to visually

differentiate phonemes of a spoken language
cues represent the phonemes of English language
Full visual access to spoken language
Can learn in a 2 day workshop (12 -15 hours
estimate)
cued speech
(see handouts in Additional & supplemental
readings)

Total Communication (TC)

A communication philosophy that incorporates

all means of communication

formal signs
natural gestures
fingerspelling
body language
listening,
lipreading
speech

Sim-Com is a methodology that is often confused

with TC
(see handout in additional readings)

Sign Language as a Bridge to Spoken Language

Type of TC (see handout in additional

materials)
use basic sign vocabulary to learn language
visually
as child associates sound with meaning, signs
bridge the gap
transfer knowledge learned visually to
acoustic information

Listening and Spoken Language

1995 40% of families chose a spoken

language option
2005 85% of families chose a spoken
language option

Probably higher now 10 years later

Listening and Spoken Language(LSL)

Auditor
y Oral

Auditor
y
Verbal

Listening and Spoken Language

Auditory-Oral approach

Uses residual hearing and consistent aided

hearing (hearing aid, cochlear implant)
Goal is to develop spoken language
Speech reading cues are used
Visual cues are used
Gestures are OK, ASL not usually encouraged
Clark School
Moog Center - St. Louis

Listening and Spoken Language

Auditory Verbal Therapy

Advocates amplification and CI use

Auditory skills are emphasized
Visual cues are limited / not focused on
Teaches parents techniques to integrate listening
and spoken language in home activities

Listening and Spoken Language Specialist (LSLS)

AVT vs. auditory-based intervention

Foundations of language for d/hh

infants and children

Hearing as the Foundation for Speech and Language

Hearing = speech perception language

136
identified aided intervention
Yoshinaga-Itano, Sedey, Coulter, & Mehl
(1998)

(Efficacy of intervention handout in additional

readings)

Technology

Full time aided use is the goal

Easier said than done!
DLC daily listening check (Ling sounds)
Downs Approach

Factors affecting speech and language

acquisition

Age of identification
Language in the home

English (83%)
Spanish (22%)
ASL (4%)

Cultural influences

Other factors

40% of children with hearing loss have

another disability

10% - learning disability

9% - lower IQ
7% - Attention deficit
5% - visual impairment
3% - cerebral palsy
2% emotional disturbance
13% - other

Language Characteristics

Table 6.1 in text

Language Assessment

Formal language measures

Communication checklists / criterionreferenced assessments
Language sample and narrative analysis

Table 6.2

Speech Development in Children

with Hearing Loss
Chapter Six (pages 230-236)

Speech development and Hearing Loss

infants with HL will produce typical

vocalizations

These include:

Differences (if HL is undetected):

fewer consonant-like sounds (6-10 months)

delay in reduplicated babbling

Areas of deficit

resonance
suprasegmental features

intensity, fundamental frequency and duration

reduced speaking rate

Assessment

typically includes traditional articulation and

phonology tests

e.g.,

Overall speech intelligibility

speech understood by the listener

Intervention A Family Centered

Approach

The Importance of Family Involvement

Most successful

High levels of
family involvement

Enrolled early in
intervention

Source: Moeller MP. Early intervention and language development in children who
are deaf and hard of hearing.
Pediatrics. 200;106:E43.

Missed Developmental Milestones

Newborn: Cries,
startles to loud sound

2-3 months:
Differentiates cries,
forms sounds in back
of mouth (goo)

4-6 months: Turns

head toward sound,
makes nonspeech
sounds (raspberries),
squeals and babbles
in melody of native
language

Missed Developmental Milestones

6-12 months:
Babbles, gestures to
communicate, knows
his or her name

12-18 months: Strings

sounds together, says
first words

18-36 months: Says

short sentences, sings
songs

The Team Approach

Family-Centered Approach

Yields the best options

integrates listening and talking in daily life

Goals for Infants and Toddlers

Develop auditory and language skills

teach infants to identify sound and attach
meaning
teach parents wats to incorporate lessons
into daily activities
monitor hearing aid performance

Early Hearing Detection and

Intervention

Early Hearing Detection and Intervention Programs

Birth admission screen

Follow-up evaluation
Audiologic referral
Intervention