Aural Rehab SLP401
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| Early treatment | If amplification and EI are in place by 6 months of age, a child is much more likely to acquire age- level language and learning milestones (Downs & Yoshinaga-Itano, 1999)
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| CORE | Overall Participation, Education
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| CORE Assessment/CARE Management | (E) Environmental factors. Giving strategies to use in their environment.
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| Why AR in schools? | -Impact of HL on learning (15dB thresholds, instead of 20dB). -Tendency for low math and reading scores compared to typically hearing peers -General impact on language (less incidental learning) -Mandated services
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| Hearing Loss and Learning | The more severe the loss, the more difficult learning can be (McFadden & Pittman, 2008). -Even mild losses put children at risk. -Unilateral losses can also put children at risk
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| 18 months | -Normal Hearing (NH): Vocabulary of 25 words. -Profound HL: No words
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| 2-3 years | -NH: Understands directions, uses short sentences, asks questions. -PHL: Few words, yells and points to express desires
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| 3-4 years | -NH: Makes long sentences -PHL: Some single words
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| 17 years | -NH: >80,000 words. -PHL: Vocabulary less than a 3rd grader
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| PL 94- 142: Education of all Handicapped Children Act (1975) | -1st Mandate: FAPE -2nd Mandate: Each public agency must have a system in place in order to ensure that HAs/CIs/FM systems are functioning appropriately. -Opened the door for AR in school settings
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| PL 99-457: Education of Handicapped Act Amendments (1st Reauthorization, 1986) | Included birth to 5 population Formally brought AR into the area of EI services for infants/toddlers and their families.
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| PL 101-476 Individuals with Disabilities Education Act (IDEA) 1990 | New name - IDEA Removed "handicapped" from title. -Use of people-first language. -Children with hearing loss vs. hearing impaired. -Preferred to be looked at as an individual who happens to have a disability
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| Amendments to IDEA 1997 | -Functional educational goals related to performance and expectations. Progress reports at least as often as those without disabilities. -Integration of special ed. goals into general ed. -Curriculum through inclusion of the general education teacher.
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| Amendments to IDEA 2004 | Aligned law with the 2001 NCLB Act 16
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| IDEA Key Concepts | -FAPE -LRE -IEP
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| FAPE | -Free and Appropriate Education -Paid for by public funds -Appropriate left vaguely defined
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| LRE | -Least Restrictive Environment synonymous with mainstreaming -the most access to educational, social, and emotional support -IDEA left this open to interpretation depending on situation.
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| LRE continuum | -Full-time, regular education in home school district or neighborhood -Regular ed. with in-class support (SLPs or teacher of HI) -Regular ed. with pull-out into another classroom -Part-time regular ed / part-time special ed. (resource room).
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| LRE continuum (contd) | -Full-time special ed. in school district with small # of other children with HL/ neighborhood (Separate or Self-contained classroom) -Full-time special ed. / center-based / in or out of child’s neighborhood -Residential home (St Mary's)
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| Mild-moderately-severe HL | May succeed in a regular classroom if full support is provided to address variety of language and listening needs that can impede learning
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| LRE may be different for those who are deaf | Commission on Education of the Deaf (1988) – “placement of a deaf child in a regular classroom, even with an interpreter, may be more restrictive than placement in a fully signing environment with deaf peers”.
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| DOE - "Policy Guidance” | “ the communicative nature of the disability is inherently isolating” FAPE supersedes LRE (A=appropriate)
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| Choosing an Approach for School (Review) | 1.Oral - Aural 2.Sign Only 3.Combined Approach: TC 4.Cued Speech
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| Oral - Aural Method | -Oral (speech communication) -Aural (use of residual hearing) -Speech reading?Yes. Sign-language?No. -Later: Auditory - Verbal Method (discourages speech reading as well). -52% of those with Mod-Sev loss
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| Sign Only | ASL primary language. -11% of children. [1% are bi-bi signers (bi-lingual / bi-cultural)]. -Speech production and listening skills are not emphasized.
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| Total Communication (1960s) | Use of some form of sign (ASL, SEE – depicting an oral language with manual symbols) Spoken language. Residual hearing. Speech reading. Nonverbal communication – body language and facial expressions. 34% of those with HL.
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| Cued Speech Developed (1960s) | -Visual support system to facilitate speech reading. -1% of classroom instruction (Gallaudet)
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| What is AR in the School? (6) | 1.Screening and assessment 2.Management of amplification 3.Direct instruction and indirect consultation 4.Hearing conservation (teen music habits) 5.Evaluation and modification of classroom acoustics 6.Transition planning to postsecondary placements
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| Screening and Assessment (4) | 1.Early ID of HL (newborn screening) 2.K-12 screening (state mandates) 3.Assessment (rescreen after failed screening) 4.Assessment (yearly with known loss): conventional testing, speech recognition, speech reading, and performance with amplification.
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| Early Identification and Screening (NYS) | Within 6mos of admission and grades k, 1, 3, 5, 7 and 10 +. School nurse (training not addressed by law). Includes, but not be limited to, pure tone and threshold air conduction screening (also tymp, OAE). Equipment standards not addressed by law. P
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| Management of Amplification/Audition: Big 3 | Personal HAs. FM systems. CIs. (also sound fiels ample., asstv devices.)
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| Monitoring Programs | Daily visual inspection. Listening check. Semesterly electroacoustic analysis of HAs and FM systems (black box)
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| Direct Instruction (3) | Listening skills. Speech production. Use of language.
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| Indirect Consultation | Audiologist trains teacher to perform listening check; SLP provides information on how to develop language skills within the curriculum.
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| Hearing Conservation (Prevention & Monitoring) | Monitor fluctuating hearing levels of children who: Are taking ototoxic drugs and Experience chronic otitis media
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| Evaluation and Modification of Classroom Acoustics (3 components) | 1.Noise levels 2.Reverberation 3.Distance between teacher and student
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| Noise | Typically greater than teacher’s voice: Children working in groups. Feet on floors. HVAC, computers, more.
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| Reverberation | Linoleum/tile, Plaster/Brick Wall vs Carpet, Ceiling Acoustic Tile
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| Distance between student and teacher | Ideal: 60 dB SPL from 6 feet (best achieved through FM system).
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| FM System types (2) | Personal or Sound field (whole room, desktop, or loop).
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| FM System components (2) | 1.Transmitter Unit 2.Receiver Unit: receives, amplifies, and delivers signal to student’s ears. Attached or built in (can have FM only)
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| Classroom Acoustics | Fed. gov: Acoustics of a school should allow for full acoustic access to oral instruction.
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| Transition Planning to Postsecondary Placements | ITP, GAP
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| Individualized Transition Plan | Once students graduate, SE guidelines no longer in place. Must include a statement of responsibilities of each public agency/participating agency before the student leaves the school setting. 71% dropout rate vs. 47%.
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| Guide to Access Planning | Interactive curriculum to help teens and young adults develop personal responsibility and self advocacy skills.
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| AR Team | 30 – 40% of children with HL have additional disabilities: Teachers (reg., Deaf/HH, sp. ed.), educ. aud., SLP, nurse, psych, PE, mobility/orientaion specialists.
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