Transcript Sensorineural Loss

Deaf and Hard-of-Hearing
Conditions
Chapter 26
Introduction
• Gallaudet University - 1864
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Liberal arts college for Deaf persons
Leader in sports, education, and sign language
Invented football huddle
Student revolt of 1988 - student walk-out until
a Deaf president was appointed
Introduction
• Deaf athletes in mainstream sport
– Kenny Walker - Denver Broncos
– William “Dummy” Hoy
• Baseball player
• Institution of umpire hand signals
• Participate in general physical education
• Deaf Sport
Deaf Sport and Deaf Community
• Deaf Sport - all sport opportunities provided
by the Deaf community
• Deaf Community - describes the cultural
and linguistic separateness from the
hearing, speaking world
– Do not advocate person-first terminology
– Do not consider themselves disabled
Deaf Sport
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Rules, strategies, and skills are not adapted
Change only in communication modes
CISS - international organization
USADSF - U.S. organization
Not affiliated with Paralympics
Deaflympics held every two years
Eligibility - 55 dB or greater hearing loss
Deaf Community
• Various sporting opportunities available and
valued at all levels
– Intercollegiate
– Interscholastic
– Family-oriented recreational opportunities
• Athletes may compete in both hearing and
deaf sport - Jamel Bradley
Definitions and Concepts
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Deaf - Deaf community/IDEA
Hard of hearing - Deaf community
Deafness - IDEA
Hearing impaired - IDEA
Deaf-blindness - IDEA
Definitions
• Deaf Community
– Deaf - unable to hear with ears with or
without amplification
– Hard of hearing - ability to hear with ears
with or without amplification even though
hearing is hard
Definitions
• IDEA
– Deafness - severe HI that impairs processing
linguistic information through hearing with or
without amplification and adversely effects
education
– Hearing impaired - impairment in hearing,
whether permanent or fluctuating, that adversely
effects education but that is not included in
IDEA’s definition of deafness
Concepts
• Deafness closely associated with speech
impairment and specific learning disability
• About 6-8% of Deaf and HH children also
have learning disabilities
• Deaf persons generally match intelligence
and thinking skills with hearing peers
• Many have problems with reading and
writing beyond the 5th grade level
Language and Communication
• Language - inner, receptive, or expressive
• Communication - verbal or nonverbal
– Verbal - oral, written, sign
– Nonverbal - facial expressions, postures, body
language, or gestures
• Not interchangeable terms
Language and Communication
• Modes of communication vary
– Reading lips or speechreading
– Sign language
– Fingerspelling
• Selected mode depends on:
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Age when loss sustained
Training
Ability
Cultural affiliation
Teaching Communication
• Manual - signing and fingerspellling
– Signing - ASL is recognized language of Deaf
– Fingerspelling - specific hand position used for
each letter of the alphabet
• Oral or speech only
• Total communication - combines both
manual and oral methods
• Controversy over better method
Speechreading (lipreading)
• Difficult because many sounds look
identical
• Much of speechreading is guesswork
• About 30-40% is understanding
• 60-70% is context guessing to fill in
gaps
Cued Speech
• Spoken words supplemented with hand
signs near the face for words that look
alike
• Eight hand shapes presented in four
positions near the face
• Created by Cornett
Difficulties with Speechreading
• New people harder to comprehend
• Some people are impossible to
speechread - speak fast, don’t move
lips much, chew gum, have a mustache
• More difficult in group conversations
• High concentration needed
• Lighting conditions can hinder ability
American Sign Language
• Language with its own grammar and syntax
• High level of skill requires practice
• Expresses both abstract and concrete
thoughts
• Dominant language of the Deaf community
in U.S. and Canada with regional variations
and dialects
• Sentence structure does not match English
Other Forms of Sign
• Signed English - links signs in same order
as spoken English
• Most often used with total communication
to enhance reading and writing skills
• Pidgin sign - mixture of English and ASL
• Many Deaf persons use both ASL and
signed English
Learning Some Signs
• Sign is a viable instructional supplement
• Can be worked into various games
• Most beginners start with fingerspelling and
signed English
• Interpreters translate spoken English to ASL
and vice versa
• Both speaker and interpreter need to be in
same visual field for the student
Sound and Vibration
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Sounds waves are really vibration
Most people both hear and feel vibrations
Deafness limits the hearing
Three attributes of sound
– Intensity
– Frequency
– Timbre or tone
Attributes of Sound
• Intensity
– Perception of loudness and softness
– Measured in decibels (dB)
• Frequency
– Perception of high and low pitch
– Measured in hertz (Hz)
• Timbre or tone
– Qualities besides intensity and frequency that enable us
to distinguish between sounds, voices, and musical
instruments (resonance quality)
Testing and Classifying Hearing Loss
• Audiometer is used to test hearing
• Wide range of classifications
– Slight, mild, and moderate - HH
– Severe and profound - Deaf
• Classifications offer generalized hearing
and speaking limitations
Classifications and Considerations
for Teaching
Degree of
Loss
Difficulty With:
Slight
Whispered speech
Mild
Normal speech at distance greater than 3 to 5 ft.
Marked or
Moderate
Understanding loud or shouted speech at close
range; group discussions
Severe
Understanding speech at close range, even when
amplified
Profound
Hearing most sounds, including telephone rings
and musical instruments
Congenital and Acquired Conditions
• Acquired or adventitiously deaf
– Prelingual/postlingual - before or after
development of language
– Vary in severity - depends on degree of loss and
age of onset
• Congenital
– Parents hearing or Deaf
– Language spoken in home - spoken English,
sign or both
Types and Causes of Hearing Loss
• Conductive Loss - diminished sound which
results in HH condition, not deafness
• Sensorineural Loss - reduces sound and
causes distortions in residual hearing
• Mixed Loss - combination of conductive
and sensorineural loss
• Tinnitus - sound sensation in one or both
ears
Conductive Loss
• Disorders of the external ear
– Artresia - born without an ear canal
– Obstruction - impacted earwax
– Injury
– Infection - external otitis
Conductive Loss
• Disorders of the middle ear
– Otitis media - inflammation of the middle
ear
– Clogged Eustachian tubes
• Insert ventilation tubes
• Swimming is contraindicated
Sensorineural Loss
• Occurs in the inner ear or between cochlea and
brainstem
• May impact vestibular apparatus
• Delays development of language concepts
• Causes
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Congenital
Infections and diseases
Noise
Deterioration with age
Causes of Sensorineural Loss
• Congenital
– Over 60 types of hereditary hearing loss
– 50% have idiopathic etiology
• Infections and diseases
– Meningitis and viral infections
– Maternal illnesses during pregnancy
Causes of Sensorineural Loss
• Noise - most common cause for adolescents
and adults
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Occupations with hazardous noise levels
Living in a large city
Sports with high noise levels
Loud music at concerts or using personal
earphones
• Deterioration with age - noise a major factor
Mixed Loss and Tinnitus
• Senior citizens often have combination of
conductive and sensorineural losses
• Tinnitus - associated with both conductive
and sensorineural losses
– Sporadic or continuous sound in one or both
ears such as whistling, hissing, buzzing
– Medical management or people learn to block it
out
Prevalence and Incidence
• 17 million American have hearing losses
– 2 million of these are profoundly Deaf
– More prevalent in males
• Highest prevalence in senior citizens
• Higher risk for those with Down syndrome,
cleft palate, and face/head malformations
• Presbycusis - degeneration with age ~ 50%
of those age 75 have significant loss
Assistive Listening Devices and
Systems
• All electronic and electromechanical
devices except personal hearing aids
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Amplify sounds
Convert sounds to light
Convert sounds to vibration
Decode sounds to typed words (closedcaptioning)
Personal Hearing Aids
• Basic criterion is 25- to 40-dB loss
• Amplify sound - some can tune out ambient noise
• Work best in quiet, structured environments when
the speaker is close or wears a special device to
transmit sound waves
• Various types
• Performance not 100%
• Moisture can create problems
• Personal preference to use when physically active
Cochlear Implants
• Cochlear implants - converts sounds to
electrical signals which are transmitted to
the auditory nerve
– Remove when engaged in contact sports,
swimming, or balloon activities (generate
static)
– Controversial within Deaf community
Telecommunication Device for the Deaf
• Telecommunication device for the deaf permits telephone communication by Deaf
• Three parts
– Portable typewriter
– Screen
– Rubber cups for the handset
• Should be available in government, public, and
private offices
Educational Placement
• First residential schools in U.S. were for
Deaf students (1817)
– Strong physical education and sports programs
• Trend toward general education placement
– Most attend general physical education
– Some need adapted physical education
• Impaired vestibular system may impact balance
• May have nondisability related motor problems
Assessment of Performance
• Completed in native language - ASL
• Optimal lighting and a speaker they can
understand if speechreading
• Interpreter may be necessary
• Demonstrate delays related to
understanding the instructions as opposed to
inability to demonstrate the skill
Physical Education Instruction
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Self-concept
Social competence
Fun/tension release
Motor skills and patterns
Leisure-time skills
Physical fitness
Play and game behaviors
Perceptual-motor function and sensory integration
Creative expression
Self-Concept
• Study reasons for low self-concept
• Insure that students hear, speechread, or see
praise and encouragement
• Examine the value placed on physical
abilities by parents and others
• Language, speech, and hearing training may
take priority over physical activity
• Children may be overprotected
Social Competence
• Plan interventions appropriately
• Learn at least basic sign
• Examine class size and curriculum toward
developing social competence skills
• Deaf student often has to be better at the
skill than his/her partner to earn respect
• Team sport settings can be beneficial
• Deaf student may be shy and lack initiative
Fun/Tension Release
• Concentration for communication requires a
time for fun/tension release
• Appropriate goals
– Relax and have fun - cooperative activities
– Release frustrations and tension in a healthy
way - competitive sports
Motor Skills and Patterns
• Performance same as for hearing peers
unless there are inner ear problems that
impact balance
• Contradictory findings in research
– Etiology not considered
– Communication of instructions not optimal
– Learning opportunities not examined
Leisure-Time Skills
• Deaf persons tend to participate more in
Deaf sport than integrated sports
– Related to ease of communication; and
– Social acceptance
• Watch a lot of television
• Receive little encouragement to be active
– Need knowledge of opportunities; and
– Assistance creating support systems
Physical Fitness
• Comprehensive study shows similarities in
all fitness tests except abdominal strength
where hearing students are superior
• Other studies contradict - same weaknesses
as motor performance studies
• Attention to etiology and balance function
needed
Play and Game Behaviors
• Important in development of language
concepts
• Limited opportunities in play so need
instruction
– Communication and social acceptance lacking
– Time spent in speech, hearing, and language
training that other children spend in play
Perceptual-Motor Function and
Sensory Integration
• Balance is most important component
• Compensatory measures can be learned
• Body image training
– Learn body parts, sounds, rhythmic patterns
• Use to teach language and academics
– Prepositions
– Animal movements
Creative Expression
• Utilize movement exploration and dance in
physical education
• Weave creativity, movement skill, and
language together to improve total
communication
Balance Problems Related to
Infection or Injury
• Damage to vestibular apparatus
• Identify type of balance problems and
movements that interfere with ADL and PE
• Address specific problems to compensate
for balance deficits
• Utilize vision, kinesthesis, and body
awareness activities
• Provide instruction in equilibrium principles
General Guidelines for Deaf and
Hard-of-Hearing Conditions
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Placement of student
Learn and teach basic signs
Assign a peer buddy
Ascertain ability to understand speech
Utilize shorter sentences
Speak normally and utilize nonverbal
communication
General Guidelines for Deaf and
Hard-of-Hearing Conditions
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Repeat sentences when needed
Ask for repetitions if you do not understand
Empty your mouth before speaking
Keep your lips fully visible
Keep lighting conditions optimal
Position yourself to face light glares or the
sun
General Guidelines for Deaf and
Hard-of-Hearing Conditions
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Minimize background noise and distractions
Do not raise your voice
Use lots of visual aids and demonstrations
Consider whether behavior problems are
associated with not seeing or hearing
instructions
• Encourage student to place themselves
optimally to see and hear
General Guidelines for Deaf and
Hard-of-Hearing Conditions
• Learn basic signs and utilize them as part of
instruction
• Consider that ability to see starting and
stopping signals may adversely affect
performance
• Communication may impact swimming (not
wanting to swim with face in the water)
“The world has watched the Deaf
community come of age. We will no longer
accept limits on what we can achieve…. We
know that Deaf people can do anything
hearing people can do except hear.”
I. King Jordan, Deaf President of Gallaudet University