Hearing Issues for Students with Deafblindness - LMA This video is posted online with the following chapter markers: Chapter 1. What Do I Need for an LMA? Chapter 2. Determining Sensory Channels Chapter 3. TVI & TDHH Collaboration Chapter 4. Assessment Tools Description of graphical content is included between Description Start and Description End. Transcript Start Chapter 1. What Do I Need for an LMA? Fade up from black. Animation: Text for TSBVI transforms into braille cells for TSBVI. Fade to black. Fade up from black. Adam Graves: Why don't we go ahead and get started. This is a presentation that was... prepared by myself, as well as Robbie Blaha and Susie Tiggs from Region 11, who is the Deaf and Hard of Hearing Specialist at Region 11. [ Slide start: ] Description Start: Title: What Do I Need to Know About Hearing for the LMA? Content: Before you begin writing the Learning Media Assessment you should be able to explain and describe the impact of the student’s hearing (aided) in the classroom or other instructional settings. Description End: I had the pleasure of doing an interview with Susie, back in October, where we were able to discuss a lot of the issues concerning the Learning Media Assessment and documentation of hearing issues on the Learning Media Assessment; [ Slide end: ] and we're going to be watching clips of that interview throughout this presentation. So, I'm going to go ahead and get started with our first slide, which is a question, and that question is: What do I need to know about hearing for the LMA? [ Slide start: ] Repeat previous slide And this is a question -- if you're a Teacher of the Visually Impaired, this is a question that you're going to have to ask yourself as you're filling out the Learning Media Assessment, and if you're a Teacher of the Deaf and Hard of Hearing, you might be asking, "What is an LMA?" The Learning Media Assessment describes the type of learning media that the student will be using in the classroom in order to access instruction. And it's a part of  -- it's a form that is completed by the Teacher of the Visually Impaired to help... develop that, the media for the classroom teacher, and anyone who's going to be working with that student. So before you begin writing the Learning Media Assessment, you should be able to explain and describe the impact of the student's hearing, the student's aided hearing in the classroom or other instructional settings. [ Slide end: ] That's basically where you're going to need to start out. We talked in our previous webinars about assistive listening devices, and so... you're going to draw on some of that knowledge about the different types of assistive listening devices, the different types of hearing loss, and how the differently listening devices help the student hear. And... so then, you're going to ask yourself, how do I do that? [ Slide start: ] Description Start: Title: How do I do that? Content: Begin with a review of the audiological information. This should enable you to describe how the child’s etiology and the nature of their hearing loss impact their ability to detect and interpret environmental sounds and understand speech within a variety of classroom settings. Description End: Well, you're going to have to start out by reviewing the audiological information. We talked in our previous webinars, also, about some of the information that you might encounter as you go through the audiological information; such as, the audiogram and things of that nature, also the communication report. These things should enable you to describe how the child's etiology and the nature of their hearing loss impact their ability to detect and interpret environmental sounds, and understand speech within a variety of classroom settings. [ Slide end: ] And you'll probably find that this is going to be different, depending on what your role is. A lot of times you'll see that the Teacher of the Deaf and Hard of Hearing and the Audiologist are going to be very focused on speech, and the impact that hearing loss has on the child's ability to understand speech. The VI and the O&M teachers might be more focused on the environmental sounds, because they're going to be thinking about the sounds the child needs to be able to hear in order to orient themselves in the classroom. So, it's going to be important that both of those needs are met, and addressed when you're completing the Learning Media Assessment. And we'll talk about some of the ways to do that, as we move forward. [ Slide start: ] Description Start: Title: How do I do that? Content: Review the appropriate use of assistive listening devices with the audiologist and the Teacher of the Deaf and Hard of Hearing. • This will provide information to the team on how and when to synch assistive listening devices to technology in order to provide the student with optimal access to speech and/or instructional technology within various settings. Description End: So, the next thing you want to do is review the appropriate use of assissting -- assistive listening devices with the audiologist and the Teacher of the Deaf and Hard of Hearing. That, again, is referring to the -- how... how the child's devices have been programmed, what the settings are on their devices. You may need to go back and ask the audiologist, or the Teacher of the Deaf and Hard of Hearing, if there is a setting for environmental sounds; and if not, maybe discuss the option of having a program for that. [ Slide end: ] And... so with that in mind, let's go ahead and watch the first clip from our interview with Susie Tiggs. [ Video start: ] Adam: What is it that you need to know about the impact of vision loss in order to make an objective decision about how the child is able to use their hearing in an efficient way? Susie: Most of us don't use just one sensory channel, primarily. We use other information around us to help clarify that information. So, I might hear what you said, but maybe I didn't understand it, until I realized that you're pointing at a book, or recognize the facial expression that you're making that helps me to understand that maybe that was a question, versus a comment. Susie: And so, vision provides us additional information about what might have been said, or what might have been heard. Adam: Okay. So, can you go into that a little bit more? Susie: Uh‑huh. Adam: Because I think that that's something that -- especially when you're talking about facial recognition -- I think that that's something that a lot of us kind of take for granted. You know, that -- or something that we all do on a subconscious level is, we gain understanding about what is said and how something is said, based on a person's body language and their facial expressions. And that's something that is, for most kids who are deafblind, even if they have some vision, they aren't able to read those cues, those facial cues. And -- so, could you maybe go into that a little bit more, and the importance of being able to add those subtle little cues like that, in order to gain some context. Susie: A huge part of language and of listening and communication isn't just what was actually said, but how it was said. The intonation of the voice or the inflection of the voice, but then also the facial expression that goes with it. I might ask you, "Please sit down," our I might say, "Sit down!" That voice makes a difference. Well, the same with the eyebrows, or the same with facial expression. Am I asking you nicely or am I getting very angry? And so that might make a difference on how you would respond, "Oh, yes," or doing it real quickly. For our students in a classroom, you know -- is this something that the teacher is just asking in general? Is this something that's more specific? How angry is the teacher getting? [laughing] Adam: Right. Susie: And what kind of trouble is our student going to get in, because they're not picking up those cues. Or a lot of our students might laugh at an inappropriate time, because they don't realize what somebody has said is more serious, they might think it's a joke. Or vice versa, they might not laugh, because a lot of that is actually on the face. It's a non‑verbal cue, and something that really is dependent on vision. Adam: Well, and I think, too, you know, for a student who has low vision... sometimes, you know, we'll have an interpreter in the classroom with them in order to help provide the... the information about the subject matter, but then when it comes to all those other areas, that you're talking about, in terms, of like, the... the information about what's happening in the classroom, you know, what the other students are saying, what they're -- the way that their intonation is -- and their facial expressions are... are providing that additional information. You know, that's something that a student who has normal vision would be able to pick up on from the interpreter, but a student who has low vision, or who isn't able to see the whole picture, might not be able to... get, you know, from just watching the interpreter -- because they might just be watching their hands, you know, and not be able to see all of the facial expressions that they're providing, as well. Susie: Exactly. And most people who are working with a student with deafblindness may forget that those are important pieces, and so, they may not remember to actually describe what's happening, or bring in those extra cues, or emphasize something that they're just assuming that others are picking up; whether it be the interpreter or the teacher or classmate. Adam: Yeah. [ Video end: ] [ Slide start: ] Description Start: Title: How do I do that? Content: Review the list of accommodations that the Teacher of the Deaf and Hard of Hearing has completed for the classroom setting. • Recommendations provided by the TDHH, such as how to reduce auditory clutter or use vocalizations or environmental sounds to gain the child’s attention before providing instruction, will help you describe how to enable the child make the best use of their auditory channel. Description End: Adam: And the next thing that you want to -- you're going to want to do after you review the use of assistive listening devices, is review the list of accommodations that the Teacher of the Deaf and Hard of Hearing has completed, for the classroom settings. That -- the Teacher of the Deaf and Hard of Hearing should have taken into account, you know, that hierarchy of hearing when they were filling out the communication report, and so that should give you an idea of some of the things that-that you might need to document in the LMA as needing to be addressed, as part of the student's sensory needs, when you're writing that report. And how to enable them to make the best use of their auditory channel. [ Slide end: ] [ Slide start: ] Description Start: Title: Examples of recommendations for a student with a hearing impairment: Content: Keep the classroom door closed to minimize noise in the hallway from interfering with learning. Teacher avoids standing in front of a window so that his/her face can be seen without glare from the sun or outside distractions. Description End: So let's look at some of the recommendations that you might see on a communication report. Some of them are going to be probably pretty good, and you won't need to change them at all. For example, keeping the classroom door closed to minimize noise in the hallway. That would be a good recommendation for a student who also has a visual impairment, because it also reduces -- reduces -- excuse me -- visual clutter... and distractions. Teacher avoids standing in front of a window so that his or her face can be seen without glare from the sun or outside distractions. [ Slide end: ] Again, that's just a good idea regardless. If you have a student who has a visual impairment, you know, if they're photophobic, having the teacher stand in front of a bright light or in front of a window is going to be extremely distracting for them. And then there are some recommendations that, you know, you might need to tweak a little bit. [ Slide start: ] Description Start: Title: Examples of recommendations for a student with a hearing impairment: Content: All new directions, concepts and information should be presented from the front of the room, not when the teacher is moving between desks or during noisy classroom transition times. Adhere to a classroom routine; if a student misses something they will be better able to predict what they should be doing or what will happen next. Description End: For example, if we go to the next slide, we have, "All new directions, concepts, and information should be presented from the front of the room, not when the teacher is moving between desks or during noisy classroom transition times." This seems like it's a pretty good idea... and, you know, parts of it are. You know, you certainly don't want to be providing information during a noisy transition time. However, the teacher standing in front of the room might not be the best placement for a student with a visual impairment to be able to access the information that the teacher is providing, from that-that vantage point. So it might be better for the teacher to actually be somewhere in between the desks, for the student who has a... sensory impairment. Or you might need to have someone else who is providing that information in a -- the student's field of vision, an intervenor or a... or an interpreter. [ Slide end: ] So those are things to keep in mind. I'm not going to go through all of these, because there are quite a few, and they're all listed in your handout. So you can go through and look at them and kind of figure out for yourselves which ones are... going to be... the ones -- things that you can just apply directly to the LMA, and which ones you might need to sit down and discuss with the Teacher of the Deaf and Hard of Hearing, to make them applicable to a student who is deafblind. [ Slide start: ] Description Start: Title: Communication Report Content: left-side text: The communication report will provide you with information on the child’s acquisition of language as well as their skills in speech and literacy. This information can be very helpful when developing recommendations on how to implement learning media. right-side photo: Figure 1: A young boy places his head near a video screen on which captioned video is being presented. Description End: So, let's talk a little bit more about the communication report. The communication report should provide you with information on the child's acquisition of language, as well as their skills in speech and literacy. And... that's going to be extremely useful when you're thinking about learning media for the child. And Teachers of the Deaf and Hard of Hearing know that a child with a hearing loss will typically experience a delay in language and speech acquisition, due to their inability to hear articles and consonants. [ Slide end: ] You know, a student with a... with a hearing impairment has a very difficult time distinguishing between consonants like 'Sss' and 'Taa'. They're very different syllables. The language acquisition... the delay in language acquisition is compounded for students with deafblindness, because they don't have the ability to understand the words that describe the visual properties of an object, or an item in their environment. Or to recognize the different hand gestures in a manual language system. So those are things that you're really going to have to be watching out for when you are thinking about learning media, and also... what -- how you're going to implement language for that student. Chapter 2. Determining Sensory Channels So let's go on to the next section of the presentation, which is about determining sensory channels. [ Slide start: ] Description Start: Title: Determining Sensory Channels Content: left-side text: When attempting to determine the student’s primary and secondary sensory channels think about the recommendations for instructional delivery that you would include in an LMA for a visually impaired student without a hearing loss. right-side photo: Figure 2: An audiologist uses an otoscope to examine the ear of a boy seated in an exam room. Description End: And depending on what form -- what your LMA form looks like, and sometimes it will ask you to list a primary and a secondary sensory channel; and sometimes it'll just ask you to describe the student's sensory channels. And it's really important, when you're thinking about sensory channels, that you think about the recommendations you would make for instructional delivery... for a student who didn't have a hearing impairment. You know, if you have a student with low vision, what are some of the recommendations that you would make for that student, or if you had a student who had no vision, or light perception? You know, what are the recommendations that you would make? And, you know, just kind of -- I think we all have kind of a grab bag of recommendations that we tend to go into. So, you know, you might want to just write some of those down. [ Slide end: ] [ Slide start: ] Description Start: Title: Determining Sensory Channels Content: left-side text: Now ask yourself how much those recommendations are dependent upon a student being able to clearly and accurately detect, hear and understand speech. What are the implications for learning if the student only understands a small range of vocal sounds? How might this change your recommendations for instructional delivery? right-side photo: Figure 3: A woman wearing a microphone holds open an experience book containing a combination of tactile symbols and braille. A young boy wearing an FM system is seated on her right. He is using his right hand to explore one of the tactile symbols contained in the book. Description End: And then, go back and look at those recommendations and think about the complications of those recommendations for a student who can't hear, and who can't clearly understand and accurately detect speech. What are the implications for learning? What are the implications for them being able to understand language? And how do you need to change your recommendations then based on those -- that information? And I want to add a little note in here about students who are at a sensory-motor level of development. [ Slide end: ] If you have... an LMA form that asks you to list the primary and secondary sensory channels, Millie Smith says, and I think that this is very wise, that a student who is on a sensory-motor level of development should never have auditory listed as their primary sensory channel. Because in that hierarchy of hearing, they're very much at an awareness level. They are just being -- they're just becoming aware of sounds. They're not making any meaning from the sounds that they are receiving. So, it's really important, if you think that that student is going to be -- if you would list them as an auditory student, maybe start thinking about saying -- moving more toward tactile as being their primary sensory channel. Bcause the auditory information is going to be inconsistent for them. And any auditory information that you provide them is going to need to be provided in a very concise, very clear, very simple way, and be directly related to whatever the objects are that they're interacting with. So keep that in mind when you're -- when you're thinking about sensory channels. So, let's go on to the next clip and... hear what Susie has to say about the implications for learning for a visually impaired student with a hearing loss, and... how to make recommendations. [ Video start: ] Adam: One of the pieces of information that are needed by TVIs -- I'm going to ask you to put on your TVI hat now. [laughing] Susie: Okay. Adam: In order to make recommendations about the preferred sensory channel and the learning media, that are typically missing for a student who has hearing loss. You know, I think, like as TVIs, we're pretty good about, like... being able to recognize preferred sensory channels, you know, for students who have normal hearing. But when there's a hearing loss involved, you know, as we were just talking about, there's a lot more -- it gets a lot more complicated. So -- Susie: Uh‑huh. I think it's important that they really understand how that student does use their hearing functionally, how much of their hearing is just location, or just discrimination, versus true comprehension. And if the Teacher of the Visually Impaired doesn't understand how that student truly, functionally is using their hearing, then they're going to make assumptions that maybe the auditory channel may be the appropriate channel for the child, because they do turn their head when somebody calls their name, without recognizing there is not true comprehension going on. So it's important that the TVI understand how that student really is functionally using their hearing for communication, for social, as well as for academic. Adam: I think this happens with vision, too, you know, as a vision teacher, I've... I've seen people discuss the fact that, "Oh, well, he can see," you know, "He can read this particular sign," or, you know, whatever it is. But really, it's -- the comprehension of what's really happening around is... is... it's very limited. And so, it sounds like, when you have -- what you're saying is that being able to understand the -- how the child's hearing is affecting their ability to use their vision is... is important to document. Susie: Exactly. Adam: Okay. Susie: And recognizing how much of it is the vision and how much of it is the hearing. A lot of our students who have typical vision depend a lot on lip‑reading. And so it might seem like they're using their hearing really well, but they're really depending more on lip‑reading or facial expression. So, when you add that vision loss in there, you have to make sure that... if the student is not picking up on those, how much of it is auditory that they're using, how much is vision and, you know, if it's dark, or if the light is too bright, or things like that, where the student in ideal situations may be able to use their vision; maybe they can't so well in the different situation. Adam: Not enough contrast, something like that? Susie: Uh‑huh. [ Video end: ] Adam: All right. So let's -- with that in mind, let's go and look at the next slide, and I've compiled some typical examples of recommendations for students with visual impairments. [ Slide start: ] Description Start: Title: Examples of recommendations for student with a visual impairment Content: Supplemental aids and adaptive equipment include: monocular, magnifier, adapted CD player, books on CD, audio recorder, talking calculator, talking watch, raised marks on appliances, and cane. Audio recordings of materials should be provided when visual latency becomes prolonged due to fatigue Description End: These... a lot of these are going to ask the student to rely on their auditory sensory channel, in order to obtain the necessary information about their environment and instruction. And, so we can -- I'm not going to read all of them, but we'll just scroll through some of them and  -- so that you can take a look at them. They are also in your handouts. So, you can go back and take a look and... and kind of, you know, review and think about some of the recommendations that you might rely on for some of your students, and... and whether or not they're effective for all of your students, and particularly if they're effective for your students who are deafblind. [ Slide end: ] The most important part that you really have to take into account is that the LMA should... list the impact that vision has on the student's ability to comprehend auditory information. And... I think that that's something that we don't really often think about when we're doing an LMA. You know, we're so focused on vision, and... and the LMA is a very vision‑centric doc-document, but for a student with multi-sensory impairments, it's going to be really important that you consider all of the aspects of that student's sensory needs, and especially their hearing. So let's take a look at another clip from have Susie where she discusses that -- the difference between an LMA for a typically blind student and a student who is deafblind. [ Video start: ] Adam: ...an LMA for a for a kid who is... who does have... who has deafblindness is going to look very different in terms of -- you know, it's going to be a lot more individualized, like you said, you know, in terms of their needs, you know. It's not going to be like a generic checklist of, "Here are the things that we use." Susie: No. I think you really have to look at what are the implications of the hearing loss on the vision. What are the implications of the vision on the hearing loss, and constantly keeping that in mind. Adam: Yeah. And I think that that's important to remember, too, because it's easy to just kind of look at the LMA and say, "Oh, well, these are the things that work," you know, and then -- and just go with those, and then not -- and just forget to, like, add, as you come up with new ideas, to add those into the document. Susie: Right. Adam: And which is -- it's an easy process, you know. You can just do it every time they have an IEP meeting, you can just add a one -- that extra... that extra accommodation or learning media. Can you provide some examples of methods and materials that are unique to deafblindness, and that you find students often need in order to access information? Susie: I think a lot of what would be unique for our students is truly best practices for all students, of making sure that the students have the concepts to begin with. A lot of our students are missing those underlying concepts, so they're not understanding some of the more concept -- the more difficult concepts as they get into school. So, it's really important that the staff, that's working with the students, make sure that the student has the basic concept that they need to understand the more difficult concept that we're addressing. They need to make sure that the materials are being presented in... in a format that the student is understanding, and that they're watching carefully to make sure that the student is truly getting it. Adam: Uh‑huh. Susie: We... we have what we call the "deaf nod," the [nodding head] "I‑understand‑you," Really, I have no clue what you're saying, but I'm going to smile and nod. And we have to watch and make sure our students aren't doing that, "Oh, yeah, I get it, I get it," but not really understanding. Making sure that the visual accommodations are working, that the auditory accommodations are working, and that the student really is grasping the concept. Making sure that it's presented in a variety of ways, but not in such a way that it's overwhelming; for our students who have cortical visual impairments, for our students with auditory neuropathy, When you start getting some of those multi-channels, "Here, see it, and hear it, and touch it, and experience it!" It's too much information. So knowing the student really well, and knowing what... where their thresholds are, of what can I present, or how do I present it, in such a way that it's not bombarding them, but still providing them enough information. A lot of things like that. And really, that is just good teaching for all students, whether they have a disability or not. But truly with our kids with deafblindness, we have to watch for those. Adam: I'm glad you brought up that aspect of the multi-sensory... presentation of materials, because we talk about that a lot, and -- but it can be overwhelming for a lot of kids, especially the kids with CVI. And so we have to be really aware of that. I think that's really important. And it's important to have that, you know, documented somewhere in the IEP, and, you know, that, yes, wheat they need is a variety -- they need materials presented in a variety of ways, but it needs to be systematic and you need to address, you know, their hearing needs and their visual needs, but not necessarily at the same time. Susie: Right. Adam: And I think it's important to make that distinction. [ Video end: ] Adam: I hope that what you're getting out of what we've talk about so far, is that in order to complete an LMA on a student who is deafblind, you're going to -- there's going to be a variety of assessments that you're going to need to perform. And there's a lot of assessment documents that you're going to have to look at, and a lot of sensory needs that you're going to have to take into consideration. I think that we probably already know that, for the most part, but it's nice to have a little reminder, from time to time. And it's different for students who are deafblind, because their needs are so unique, and they are so intense. Chapter 3. TVI & TDHH Collaboration [ Slide start: ] Description Start: Title: Determining Sensory Channels Content: left-side text: Once you have collected assessment data it is a good idea for the TDHH and the TVI to analyze it and determine TOGETHER the primary and secondary sensory channels for providing access to instruction. Remember to take into account the impact of vision loss on the student’s ability to effectively use his or her hearing. right-side photo: Figure 4: A young girl holding a cup with a straw in her right hand simultaneously grasps the straw with her left hand while resting hand with the straw on the hand of her intervener. The intervener is leaning in close to the girl's left ear to talk to her. Description End: So let's move on to the next slide, and talk about what you do once you've collected all that assessment data. You're going to need to get together with the Teacher of the Deaf and Hard of Hearing... and analyze that data together. It's really important to work together to talk about the primary and secondary sensory channels or -- or just talk about how the student is using their sensory channels, whether it's tactile, visual, or auditory. And to remember to take into account the impact of vision loss on the student's ability to hear, and the impact of hearing loss on the student's ability to understand what they're seeing. So those are things that are going to be -- you're going to be able to, I think, assess a lot better when you have the opportunity to talk with your colleague, on the hearing side, or the vision side, in order to make those determinations. [ Slide end: ] So let's -- we have another clip where we're... going to hear about how the student -- a child uses his or her hearing and vision to access information in their environment, and... how the TVI and the Teacher of Deaf and Hard of Hearing can have those discussions. [ Video start: ] Adam: My next question for you is, "How do you determine the types of general media that will be used in the classroom for a student who has a combined vision and hearing loss?" Susie: First, you want to see what the teacher is going to be using as part of their... general curriculum, are they using textbooks, are they using movies, are they using any specific type of lab equipment or special -- and then you look at what accommodations might be necessary for our student with deafblindness. If they don't have the vision to be able to see a lot of the equipment, are there additional equipment that we could access to help accommodate for that? If the movie is captioned, does the student have enough vision to be able to read the captioning, and if not, what do we need to do for that? So it's going to be very individualized, depending on the specific needs of the deafblind student, but you always want to start with the general... items that the teacher is going to be using in the classroom. Sometimes there's not going to need to be accommodations for accessing it, but then based on the student's individual vision and hearing, then you make some adaptations as it goes. Adam: Okay. And how do you make that determination, then, like when you do wind up... making the accommodations, how do you come to that determination? Is it something, you know -- is it -- I mean, I know it's a collaborative process, but like how do you kind of -- what does that collaboration look like, I guess, is what I'm asking. Susie: As a Teacher of the Visually Impaired, what I always did is, I sat down with the gen-ed teacher to begin with, with the APH catalog, the American Printing House for the Blind, to look at some of the different pieces of equipment, or the different possibilities that were available, and we kind of walked through some of the curriculum. You're going to be doing this lesson, you're going to be doing this activity. What do you have available? If it's not meeting the needs of the student, here are some of the different pieces that are available. And then constantly keeping in mind, as well, and having to remind the gen-ed teacher, often, that, you know, okay, this is what he can see, this is what he can hear, these are some of the different limitations that we have, and keeping that in mind. A lot of brainstorming. A lot of trial by fire, sometimes. Oh, this is exactly what we need. Okay, wait, that didn't work quite so well. Adam: Yeah. Susie: And... Adam: So it sounds like, you know, you just have -- each member of the team, you know, kind of contributes ideas and -- and you kind of see, based on what you know about the student's... sensory needs, you know, you kind of make a determination together as to whether or not, yeah, that is good idea, we should -- let's implement it and see what happens, and if it doesn't work, then you go back to the drawing board. Susie: I think so. And if you've got a student who is maybe a little bit older and a little bit more confident in what their accommodation needs are, I would definitely include them; what they're willing to use, what they're comfortable using, what they've used in the past that's been successful. For younger students ,or students with cognitive disabilities, that may not work quite so well. Adam: So it sounds kind of like you may have to -- that when you're documenting learning media on the LMA... and accommodations, that is going to have to be kind of... a work in progress as -- you know, from year to year. Susie: Uh‑huh. Adam: Which I don't think -- you know, I think that's kind of a new concept of, like, you know, updating accommodations every year, as opposed to like, every three years, when the reports come due. Susie: Right. We can make some generalizations knowing that a student with myopia normally needs... general type of accommodations, but a student who is taking a career and technology class like floral designing, as opposed to one in chemistry, you know, really, it's going to be dependent on the child's schedule, the teacher's teaching style, the student's particular vision and hearing. It has to be a lot of thinking outside the box, and being willing to experiment. [ Video end: ] Adam: You heard Susie there talking about how it's not an exact science, you know, it takes a lot of trial and error, and sometimes what works one year might not work the next year. And luckily, the LMA is a living document. You can go back and change some of the accommodations and recommendations that you may have documented the year before, as the student's needs change, and as their ability to acquire language, or acquire new skills changes, as well. And as you get new assessment data, you might want to go back and change some of your recommendations in the LMA. Chapter 4. Assessment Tools [ Slide start: ] Description Start: Title: Assessment Tools Content: left-side text: Assessment tools used to determine the child’s primary and secondary sensory channels should help you describe how the child: • Alerts to sounds • Explores new/unfamiliar objects/environments • Entertains themselves or others • Expresses emotion • Seeks out a communication partner right-side photo: Figure 5: A young boy sits on a mat on the floor with his teacher. The teacher is holding one end of an orange pool noodle up to her mouth and speaking into it. The boy is holding the other end of the noodle up to his ear. Description End: So let's go and talk about some of those assessment tools that you're going to want to use. So the tools that you want to look at, when you're doing an assessment for a student who's deafblind, you want to be able to describe how the student alerts to sounds, explores new and unfamiliar objects or environments; and by that, we mean, you know, do they explore -- tend to explore more tactilely, do they tend to do more auditory exploration. Same thing with entertaining themselves. Do they gravitate more toward toys that make noise, or have more visual stimulating things going on. And then, when -- you're going to want to document how they express emotion. Do they -- do they verbalize and wait for an auditory or a tactile cue from an... an adult when they're upset, or do they scan the room for someone? These are the things that the assessment tools you're going to want to use should help you describe. [ Slide end: ] So let's go on to the next slide where there's a list of some of the tools that you might want to look at. [ Slide start: ] Description Start: Title: Assessment Tools Content: left-side text: Some assessment tools that may help you to determine primary and secondary sensory channels and corresponding learning media: • Use of Sensory Channels: Observation Form (Koenig-Foundations) • General Learning Media Checklist (Koenig-Foundations) • Communication Matrix (Rowland) • Functional Listening Evaluation (ELF, FAPI, IFHE) • Basic/Infused Skills Assessments (TSBVI) • ADAMLS- describes impact of vision loss on acquisition of manual language systems right-side photo: Figure 6: Two deafblind girls sit in front of a computer. The girl on the left is wearing headphones and reading a refreshable braille display, which rests in her lap with her right hand. The girl on the right uses her right hand and reaches under the left arm of the girl wearing the headphones to simultaneously read the braille display with her friend. Description End: The Foundations in Visual Impairment book, the Alan Koenig book -- the big purple book that we all have -- has the the observation -- the Use of Sensory Channels: Observation Form and the General Learning Media Checklist. That can be very helpful. There's also the wonderful communication matrix from Charity Rowland. There's the Functional Listening Evaluation. The ELF is for -- can be used for students who... have emerging language or haven't developed formal language, yet. FAPI can also be used for those students -- that's the F‑A‑P‑I, and it's... but it's a little -- it can be used also for students who have a more formal language development. And then the IFHE, which is currently being developed here at TSBVI and through NCDB, and should be available, in about a year or so, which we talked about last year. And then, of course, there's the basic infused skills assessment. That will provide you a lot of information on how a student uses their sensory channels as well. And then finally, the ADAMLS describes the impact of vision loss on the acquisition of manual language systems, that is sign language, cued speech, things like that. [ Slide end: ] And we'll talk a little bit more about the ADAMLS after this clip. But I want to make sure that we get a chance to show this clip where Susie discusses -- or Susie and I, actually -- I'm in there, too -- we discuss how students acquire language, and how to implement language for a student -- formal language -- for a student who has deafblindness. And whether or not the student should even be using a manual language system, how to determine that. [ Video start: ] Adam: When you're talking about... presenting things in a variety of ways, and making sure that the students understand the concept, could you just go into that a little bit more about ways to do that? Because in my mind, like I'm thinking, you know, that it needs to be more experiential for a student who has deafblindness. It can't just be, you know, abstract letters, or paragraphs on a page, you know, that there's more hands‑on learning. Susie: Research has shown that experiential learning, the hands‑on, the firsthand experiences are so much more meaningful to our students. And then those concepts build on each other. So, if you don't get to experience something from firsthand, and then you're trying to learn some of the higher concepts without having the base, it... it's a trickling effect, that it gets more and more and more complicated, and our students have a further gap of understanding what it is. So having that base of getting to touch that piece of fruit, and actually get it from the store, and cut it with a knife, and peel it before eating it, as opposed to it just magically appearing, helps the student truly understand the concept of apple, so much better. We tend to fall into the fairy godmother syndrome. Our students sit very nicely at a desk and things magically appear in front of them, but they don't have good concepts of where it originated from. And at some point things stop magically appearing, and if our students don't understand how to advocate for themselves, and how to actually go get things, and make them appear, then they're going to be missing out on some of the finer points in life. Adam: Yeah. Susie: As teachers, we have to make those experiences happen. The majority of learning for our students who have typical vision and typical hearing is incidental. They're overhearing things, they're seeing things happen. With our kids with deafblindness, they're missing out on that, and so those incidental experiences have to be presented. They actually have to be very methodically taught for our kids. Adam: Yeah. Susie: And the teachers working with our students need to recognize that, and not make assumptions that the student already knows that, or that they are familiar with it. Adam: Yeah. Or that they-they -- yeah. They've seen it before, or, you know, they've heard about it from somebody. Yeah. Susie: Yeah. Adam: Yeah. I think that's a really good point. Susie: Awesome. And missing out on a lot. Adam: Yeah. Well, that kind of leads into the next question, which is, the fact that we know that speech and literacy are based on language, and the acquisition of language, which happens at a very early age for typically developing children. And we also know, that there are delays in language acquisition for students who are -- particularly for students who are deaf. And so could you just describe the impact of hearing loss on the literacy rate and application of language for a student who is deafblind, because I think those language delays don't necessarily -- you know, for a student who is blind, they might not have a significant delay in-in the acquisition of language, and so their literacy might be close to grade level. But that wouldn't be true for a student who is deaf, and it -- and when you have the combination of both of those, you know, it would -- it seems like it would delay -- it would increase the amount of delays in, both the acquisition and use of language, and their ability to read, whether it's Braille or print or whatever. Susie: Right. Typically developing children are picking up language at a very high rate, in their -- infants, toddlers, and preschoolers, are picking up two and three new words a day, picking up an immense amount of language. By the time they start school, they have anywhere from five to ten thousand words that they're just picking up, because they've overheard it. But studies show that we can really only teach eight to ten words a week. In such a way that the students are learning it. But by the time our kids graduate from high school, typically developing kids have a vocabulary of about 25,000 words, which does not correspond with being able to teach eight to ten words a week. Adam: Right. Susie: And so the kids are picking it up incidentally. They're hearing it, they're hearing their parents use words, and so then they're trying to use it. They're experiencing and experimenting with that language. You know, mom said this. What happens if I use this. Oh, that got a great response. And so kids are learning that way. Well, kids who are deaf and hard of hearing aren't overhearing all those words. And if they are in a family who is not intentionally working on that vocabulary with them, be it with sign, be it listening in spoken language, if the family is depending on the spoken word for vocabulary development, it's not going to happen. And it's not unusual for our kids to start school with a vocabulary of maybe two or three hundred words, as opposed to the five to ten thousand words that their typically developing peers are coming with. As our students are learning more and more and more, our typically developing kids are just shooting through the roof in their language development, our kids are developing it much more slowly. Adam: Yeah. And falling further and further behind. Susie: They really are. They really are. And then that ends up corresponding with their literacy as well. They don't have the language. They don't have the experiences. They don't have the vocabulary. And so when it comes to reading decoding, or when it comes to the learning that really is dependent on language, if they don't have the language skills, it's harder for them to be able to really learn at the rate that they are peers are doing. And so we see that in literacy rates. It is not unusual for our kids who are deaf or hard of hearing who have typical vision, generally, to graduate from high school with a grade level of reading that is way below their peers. When you add in the complication of division as well, then they're missing even so much more. And so it's really important that our kids have a good early base in language. Doesn't matter whether it's sign or oral and spoken language so much, as long as it is very consistently taught, very consistently used. It's important that our students have amplification and that they have consistent access to language, from very early on. Adam: Well, and I would add to that, also, going back to the last question, or, you know, some of the other things that we've talked about is that they have access -- that the language is -- is... is functional and is practical for them, you know. It's experiential, you know, because as we were saying before, you know, that it's going to be -- they're going to learn concepts a lot more -- with a lot more frequency, and they're going to be able to maintain those concepts, and build on those concepts a lot better if they have, you know, more practical hands‑on kind of experience. And so when you include language as part of that, it helps you to be able to build the... the -- not just the concept, but the language that goes along with the building of the concept. Susie: Exactly. Teachers at school and families at home need to be creating an environment that is very rich in language. And knowing that the incidental learning isn't going to be occurring, they need to build those into, and taking advantage of any opportunity. You know, if we go for a walk and we see a worm, are we stopping to talk about the worm, and why the worm is inside the apple, and, you know, what happens if I bite into the apple, and where's the worm going, and what is he doing? Or are we just saying, "Oh, look, there's an apple on the ground and there's a worm," and then going on. We need to really be taking advantage of a lot of the incidental activities that are going around it, and building it into our learning in our lessons. Adam: Yeah. And I think that that's important to -- that's another thing I think that you can -- when we're talking about the LMA, and making sure that we... we document that as well, you know, that -- when we're talking about the modifications and the recommendations that we're going to put on the LMA, that language acquisition in a practical, real world, experiential kind of environment is part of that. Susie: Right. [ Video end: ] Adam: I really like that discussion, because I think it really hits on a lot of the things that we try to... preach here from our ivory tower in Austin. That those practical experiences, those hands‑on opportunities for the students are very important to their ability to learn. And it's important that the teacher of the deafblind and the teacher of ‑‑ I'm sorry, the Teacher of the Visually Impaired and the Teacher of Deaf and Hard of hearing, you know, get together and talk about those things, and how they can provide those experiences, and how you can both document those in the respective reports for the Teacher of the Deaf and Hard of Hearing, in the Communication Report, and in the Learning Media Assessment, in particular, for the Teacher of the Visually Impaired. And I'm just going to -- having said that, I'm going to put in a little plug here for Teachers of the Deafblind. This is one area where having a teacher who has experience with deafblindness, who has training in deafblindness, who has had coursework in deafblindness, can really be a huge asset. If you -- if you know someone that has some experience in that, you know, they can provide you with a lot of resources for assessments, and how to use assessments in your documentation, how to determine whether or not the student needs an intervenor in order to access their instruction. That's a skill set that is very unique, and it's one of the things that a teacher of the deafblind can provide. And so, I just want to make sure that I mention that, and any other encourage those of you who are interested in the subject, to continue to look at the OHOA modules, the Open Hand Open Access modules through the National Center for Deafblindness, where you can get a little more information about that. And come to our website, as well. So, shameless plug. Finally, I want to close by, first looking at some recommendations, some LMA recommendations for a student with deafblindness. [ Slide start: ] Description Start: Title: Examples of LMA recommendations for a student with deafblindness Content: • Student requires total communication. This means staff should use speech, tactile sign language, and real objects and materials when communicating with the student. • Student requires an intervener or staff who can provide tactile sign language. Description End: Things like: Student requires total communication and real objects, an intervenor or staff who can provide tactile sign language. That might be a recommendation that you would document in the LMA. [ Slide end: ] [ Slide start: ] Description Start: Title: Examples of LMA recommendations for a student with deafblindness Content: • Staff should greet student by saying their name before touching him/her. • Before using tactile sign language with student, staff should gently touch the student’s shoulder or the back of his hand to initiate communication. • Staff should use hand-under-hand technique when exploring materials co-actively. Description End: The greeting is so important. There's so many times students who are deafblind have people just flying out of nowhere, saying hi to them, and they have no idea that they're there. So providing an auditory cue before the tactile cue for a student who has some functional hearing is so important to give them a heads‑up that you're there. And hand-under-hand, of course, is very important. Moving on to some more recommendations. [ Slide end: ] [ Slide start: ] Description Start: Title: Examples of LMA recommendations for a student with deafblindness Content: • Information/sounds should be presented centrally or on the side of the preferred ear. • Allow student to turn his or her head when listening in order to scan the auditory environment and to use his or her preferred ear to listen for information. • Staff should use clear/simple speech within familiar routines to help student anticipate and process linguistic information. Description End: Making sure that sounds -- when you're presenting sounds, that you know which ear is the preferred ear. That should be in the...in the LMA. You need to know how the student is going to access auditory information, if you're recommending that the instructional staff provide them information auditorily. And in order to do that, you have to know which ear they prefer. [ Slide end: ] [ Slide start: ] Description Start: Title: Examples of LMA recommendations for a student with deafblindness Content: • Provide additional wait time in order to allow student to detect, discriminate and respond to auditory information. • Allow and encourage student to move closer to sound sources or place them near his or her preferred ear. Description End: And then moving on, providing simple speech, as we talked about before, concise speech, additional wait time for processing. Even for students who are high functioning and who are -- have a high level of language, processing time is going to be very important for them. [ Slide end: ] So, before we end, I just want to say a word about sign language. If you're going to be using a manual language system, such as sign language, with your students, it's really important that you do an assessment on them. And...I recommend the ADAMLS. It's available, again, on the NCDB website. [ Slide start: ] Description Start: Title: A word about sign language Content: If you are going to be using sign language with a student who is deafblind, it is important for the communication report to list adaptations that the student will need to be visually or tactually access signs. This includes, but is not limited to, the consideration of: • Distance • Placement • Rate • Frequency • Lighting Reference: (ADAMLS; Blaha, Carlson) Description End: And...the reason that you want to do that is, because you have to take into account the...the adaptations that the students are going to need in order to access manual language, which includes distance, placement, rate, frequency, and lighting. And...those have to be -- you really need to know how that student's going to be learning language or taking in language. If you're using sign language with them, you want to make sure they're getting all the language that you are presenting. [ Slide end: ] So we're just about out of time. I'm going to go ahead and skip the next slide, because we already talked about it, and just finish up by asking that question again, "What do I need to know about hearing for the LMA?" [ Slide start: ] Description Start: Title: What Do I Need to Know About Hearing for the LMA? Content: Before you begin writing the Learning Media Assessment you should be able to explain and describe the impact of the student’s hearing (aided) in the classroom or other instructional settings. Description End: And you need to assess, document, and collaborate. Those are the three keys. Make sure you have all the audiological and communication reports. Make sure you have the questions that you're going to ask, and talk to each other about how you're going to implement them. [ Slide end: ] Thank you very much for joining us, and I look forward to seeing you in February. [ Slide start: ] Description Start: Title: Thanks for joining us! Content: Documenting Hearing Issues on the Learning Media Assessment; December 3, 2015 right-side graphic: TSBVI logo Description End: [Silence] Fade up from black. Animation: Text for TSBVI transforms into braille cells for TSBVI. Fade to black.