2016-10-19_Hearing.Issues-Auditory.Training This video is posted online with the following chapter markers: Chapter 1. Continuum of Auditory Skills Development Chapter 2. Tips for Effective Auditory Training Chapter 3. Review Video Examples Description of graphical content is included between Description Start and Description End. Transcript Start [Music] Fade up from black. Animation: Text for TSBVI transform into braille cells for TSBVI. [Music face out] Fade to black. Chapter 1. Continuum of Auditory Skills Development [ Slide start: ] Description Start: Title: Texas School for the Blind & Visually Impaired Outreach Programs Content: Hearing Issues for Students with Deafblindness: Auditory Training October 19, 2016 Facilitated by Adam Graves, Education Consultant, gravesa@tsbvi.edu Robbie Blaha, Education Consultant, blahar@tsbvi.edu Description End: Adam Graves: Welcome to hearing issues for students with deafblindness. Today we're going to be discussing auditory training. This is a follow‑up to one of the webinars that we did‑‑ actually, it was two years ago that we did this first webinar. Robbie Blaha: Was that with Susie Tiggs? Adam: With Susie Tiggs, yes, and Kate Hurst. I am Adam Graves and‑‑ Robbie: I'm Robbie Blaha. Adam: Thank you. And if you all need to reference the initial webinar on auditory training, the website is up there for you. [ Slide start: ] Description Start: Title: Auditory Training 101 Content: The introductory webinar on auditory training for students with deafblindness can be found at the web address below... http://www.tsbvi.edu/selected-topics/deafblindness#w Description End: It's www.TSBVI.edu/selected‑topics/deafblindness#w. So you can go back and look at that and watch these together and it might help give you a little bit more background if maybe you've forgotten some of the stuff that we talked about last time. [ Slide end: ] So today what we want to do is we want to just briefly go over some of the things that we talked about in that initial webinar, and... then give you some examples of some of the techniques that we were describing in that webinar. And we're going to start out by talking about the Continuum of Auditory Skills Development. [ Slide start: ] Description Start: Title: Continuum of Auditory Skills Development Content: Figure 1: Graphic depicting a line with arrowheads on each end. Between the arrowheads are five points along the auditory skills continuum. From left to right the dots are labeled Awareness, Recognition,Locating, Discrimination, and Comprehension. Description End: This was a topic that was raised in that initial webinar, and we talked about, you know, the beginning level of building auditory skills and moving on through that to the level of comprehension. And we started the awareness level, and... the continuum... begins with just being aware of sounds‑‑ starting at the very basic level of knowing that there is a sound, or reacting to the presence or absence of a sound. And that is the awareness level. [ Slide end: ] And as we work through that continuum, we go through recognizing sounds, that is, knowing the difference between familiar sounds, such as recognizing the difference between the mother's voice and the father's voice. That is sort of the recognition. And then locating sound... is the... ability to turn towards a sound, and make movement in the direction that a sound is coming from. And then we move into discrimination and comprehension. And there are many different terms that people use to describe this continuum. Some people refer to it as gross and fine discrimination, but basically... what they all are describing is this- this continuum of first being aware of a sound, and then being able to... to respond appropriately to that sound, and understanding the meaning of multiple sounds in an array. So... just to give you some examples of... the difference between awareness and comprehension, we have two videos. The first one is going to be... a video of a student who is... demonstrating an awareness level of sound comprehension. So let's take a look at that. [ Video start: ] [grinding noises] Adam: There we go. [loudly] There we go! [ Video end: ] So if you'll... notice, the student in that video, basically his reaction was to the sound of the blender. He didn't... really‑‑ he didn't respond to... the teacher's out burst of saying "For crying out loud". His basic level of understanding of sound was that there was the presence of a sound that wasn't there before. And... in this case it was the blender. So that is a very good example of... awareness. So let's look now at... comprehension. Here's a video of a young man who... is listening for sounds in his environment, and being asked to identify them, and where they're coming from. So let's take a look. [ Video start: ] O&M instructor: The traffic behind you, do you hear the traffic? Now listen carefully. Ah‑ha, yes, you hear the bird! Do you hear the bird? Where? Where? Quiet. A little bit bird-- a little bird, the music. Oh, yeah! That's good, happy. Where is the bird? Over there? Here's the bird, and the tree, and the pu-pu-pu. [ Video end: ] Adam: So that's a good example of sound comprehension. He- that student has some-- he has a concept of what birds are... so he-- and he knows what kind of a sound the bird is making or that birds make, so when she asks him what he hears, he's able to identify that sound as being a bird. And, in addition to that, he also with the background knowledge that he has of birds, he knows that birds could be up in the tree, or they could be on the ground, so he's looking around for the source of that sound, based on his knowledge of where birds might exist. So that is the difference between awareness and comprehension. The first student didn't... really even know where the sound was coming from, and the second student knew, not only that there could be multiple places that the sound was coming from, but that it was... coming from a very specific source that he could name. Chapter 2. Tips for Effective Auditory Training So I want to go ahead and bring Robbie into the discussion a little bit, and talk about some of the things that we discussed in that introductory webinar. And the first one is... 'Be Effective.' [ Slide start: ] Description Start: Title: Be Effective Content: • Avoid auditory and visual clutter • Allow time for processing • Try to use a consistent pitch, rhythm, vocabulary, and physical gestures when describing or drawing attention to a sound. Description End: That was one of the tips that we gave. And... some of the ways that we discussed that you could be more effective, would be to avoid auditory and visual clutter, allow time for processing, and try to use a consistent pitch, rhythm, vocabulary and physical gestures when describing or drawing attention to a sound. [ Slide end: ] Robbie, I wanted to ask you about this particular tip, because... I know you've had experience in designing instruction that incorporates these things, and so I hope-- I was hoping that you might be able to give us some examples. Robbie: Well, actually, I wanted to kind of speak to the first one about... controlling auditory and visual clutter. I think that it's much easier, in my experience, to manage the visual clutter. To move things out of the way. To put contrasting materials, so that the object you're talking about is clearly visual. And... you know, a lot of the kids use their hands as their eyes, or to supplement their vision, and so that the object that you pick is something that they would find acceptable tactilely. Because, there are different kinds of blenders. Some seem very, very big to a very, very small child, but finding things that would kind of fit that kid, if you're going to get a blender, and what would be the best one for that child. Some kids like stuff a little heavier, some like a little more vibration, but... so selecting the object, presenting it in a way that it's attractive and not cluttered. It's easier visually. What I have a hard time with, is the auditory clutter that can be going on in classrooms. That's a very difficult thing to manage, sometimes with announcements-- Adam: Yeah. Robbie: So one of the things that-- Adam: And just the- just the general din of the classrooms, with kids-- multiple kids having discussions, you know, at the same time-- yeah, that can be very difficult to control. Robbie: One thing I've found is to get the adults on your side, and let them know... that during a period of time if they could avoid talking. You know, avoid comments or just... logging on to a computer, and you hear the Mac start up, as they check their email in the background. Just working as a team to kind of limit the auditory sound, as best as you can. You may have to actually pick another area to work sometimes. Adam: Well, and that's- that's what I was going to say is, that sometimes it's so impossible to be able to have enough control over that auditory environment, that sometimes you have to create another environment in order to focus on... using the auditory skills that the child already has. So, yeah, I'm glad you mentioned that. Takes a little extra effort, doesn't it. Adam: Yeah, it does. Yeah. But it's worth it in the end, because if-- without it, the child-- especially a child who is just on an awareness level, is going to be-- it's going to be really difficult for them to be able to focus in on one-- on the one sound that you want them to be isolating, including speech. So, you know, that's a very important thing to keep in mind. So the next topic was making it motivating. And this is a huge part of everything that we do in deafblindness, is making it motivating, but this is especially true I think for sounds, because sounds-- it's so easy, I think, for-- well, let me just put it this way; our brains are wired to block out sounds that aren't motivating to us. So if there's not a reason for us to listen to a sound, we're just... bound to... not pay attention, eventually. And so if there are sounds that you definitely want to make sure that the child is listening for, adding that motivation for them to listen is incredibly important. Robbie: I think that I probably got ahead of myself talking about the blender, because some items are more motivating. You want that item to be selected. Also, their favorite activity, what does it sound like? What are the sounds in it. Yeah, I think the motivation is a huge piece, because otherwise they-- you do habituate the sounds like clock ticking, and the air conditioner coming on, and we don't want them to habituate to important environmental sounds. Adam: Right, right. And also, I mean, getting back to that habituation, a lot of sounds sound very similar to each other, like an air conditioner, so it might be okay for them to block out an air conditioner, but it also might sound very much like a water fountain, or a vending machine that you want them to cue into when they're traveling, so that they can anticipate a turn or squaring off, or something like that. So, you know, that's a really important thing to- to keep in mind when you're introducing sounds. Robbie: And it may be one of the most important. Adam: Yeah. Robbie: Because they're going to learn what they love, and what it sounds like. [ Slide start: ] Description Start: Title: Make it Motivating Content: • Use sounds in the child’s hearing range • Be clear and consistent on which sounds you want the child to attend to and how you would like them to respond to those sounds. Description End: Adam: Yeah, it's true. So just‑‑ other ideas on how to make it motivating, make sure that the sounds are in the child's hearing range. I mean, that seems like it's pretty obvious, but, I mean, I know that I have very often, you know, tried to get students to respond to sounds that aren't in their hearing range, you know, and it's easy for us to do because the human voice, you know, is-- has a pretty wide range of frequencies. [ Slide end: ] And... so, you know, like my voice is very different from, you know, your voice or, you know, someone else's voice who has a much higher voice than either of us. Robbie: And sweeter. Adam: And sweeter, and maybe more sing‑songy. And that's another thing too, pitch is a huge, huge part of that. So that's something to definitely keep in mind. Make sure you check that audiogram to see where that child's primary hearing range is, so that you can make sure that when you're delivering, especially speech to them, that it is in that frequency range that is best for them. [ Slide start: ] Repeat previous slide And then also consistency. We always are talking about being consistent in the delivery. Robbie: And one thing, if you're not sure about the sounds, what's in the child's hearing range, it's worth a discussion with an audiologist. [ Slide end: ] Adam: Absolutely. Robbie: Don't assume that-- don't assume anything. It's worth having that relationship and talking to the audiologist about items that might be in their range. Adam: Yes. Or the Teacher of the Deaf and Hard-of-Hearing. Robbie: Yes, yes. Adam: That's a great point. [ Slide start: ] Description Start: Title: Make it Motivating Content: • Use objects or experiences to which the student has an emotional connection • Take time to build trust so that the student is open to engaging in new or unfamiliar activities. Description End: And then objects or experience to which the student has an emotional connection, that's another aspect of deafblindness that we talk about a lot, that isn't just related to hearing, but emotion, connecting objects or... discussion points to an emotional experience is... so important, because a lot of what our students... understand is on a basic emotional level. And... so if you can make a connection between this object, and the sound that it makes, and the feeling that they have towards that object... they'll pick it up a lot quicker, and they'll respond a lot more positively to that. [ Slide end: ] Going along with that, sort of along those same lines, is it's really important that you build trust with the child, because... that level of trust, that feeling of safety that a child is going to have with you, is going to... make them feel a lot more comfortable going outside of... the immediate area where they feel the most... self‑assured, because they know they can come back to you, and you'll be able to provide them with some reassurance that the things that they are used to, and are most comfortable with, will still be there. So- so that's a really important aspect, too. Robbie: I really am glad you emphasized that, because I do think... it's very-- I think especially with sound. Sound, when it's unfamiliar, is an easy thing to shut down to and withdraw from. And you do see kids covering up their ears... a lot. And I think feeling safe makes you... feel less a need to defend yourself. And I'm glad you put that in. Adam: Yeah. Well, and that's a good point, because you see kids shutting down like that and closing off their ears, but if you have a good relationship with the child, just sitting next to them... you'll find that eventually they'll start to... remove their hands from their ears, just so that they can hear your voice. Robbie: Yes. Adam: Because it's reassuring to them. And once they hear your voice that provides them with... some amount of self‑soothing, that they can then like maybe move on and start to-- you can start to introduce those sounds that they're so afraid of to them, so that they're... they're more familiar with them the next time that that sound comes into their environment. Robbie: Yes, I think that's true. [ Slide start: ] Description Start: Title: Seize the Opportunity Content: • Environmental sounds – when do they start or stop-does the student react? • Responding to and making note of the difference between sounds that people make intentionally and sounds made involuntarily Description End: Adam: Yeah, that's a really good point. Finally, seize the opportunity. We talk about that. And basically, what we're talking about there, is... when there are... sounds in the environment that we don't often think about. You know, we were talking about the sounds of... you know, appliances, like the vending machine. Robbie: Right. Adam: If you hear it go on-- if you're going-- [ Slide end: ] I think this is a good example, is if you're out traveling with a student, and you walk past the vending machine-- or a water fountain is probably more likely, then the water fountain suddenly turns on, you want to make sure that the child is aware of that, and you get-- the two of you explore that water fountain together and really, like, get up next to it so that you're listening for it, together, and take advantage of those opportunities when they arise, because that's something that you want the child to cue into if it's a- if it's a landmark, especially. But even just sounds in the classroom, you know. Robbie: You know, and one thing I- I just tending to go more toward vision. I don't know why. Eyes are bossy, I guess, so when I go on a walk, I'm more likely to point out something visual to a child, Adam: Oh, yeah, absolutely. Robbie: And I really need to remind myself that sometimes, maybe, we're on a listening walk; almost have to tell myself we're listening on this walk, because otherwise I wind up just throwing the sounds in as an afterthought. Do you know what I mean? Adam: Yeah, I do. I do that all the time too. Well, because, we are so used to, like, looking for visual landmarks. We're not used to listening for them. But echos, you know, are a huge part of... orientation and mobility, listening for those sound shadows and those echos. And I know I've worked with several students that will stop at a long- at a hallway, you know, that's a long cross hallway, and... and just listen, because they hear the echo coming down from either side of the hall, and it's confusing to them, because they're not sure, like, where the sound is coming from and whether it's coming from behind them, or to the sides or in front. And if it's coming from in front, is it something that I need to, like, avoid? You know, so those are things that we don't even think about. Robbie: And if I can just put one more thing in there. And I don't know who told me this, but it really stuck with me, is that for children with vision loss, hearing is their distance sense. Adam: Right, yeah, absolutely. Robbie: And, you know, so it kind of makes you bump it up a little bit. Adam: Yeah, yeah, that's true. [ Slide start: ] Repeat previous slide And then finally, responding to and making note of the difference that-- between sounds that people make intentionally, and sounds that are made involuntarily. And an example of this that I... like to use is, there's a big difference between a child banging a pot on a table, and dropping a pot on the floor, as they're walking to the dishwasher or- or the microwave. [ Slide end: ] And making them aware of the-- that the pot makes the same sound, whether you're banging on it, or dropping it on the floor, but when you drop it on the floor, there's an added element to it where you have to go and look for it. So, those are things that, again, we don't often think about drawing attention to, but it's important to do. Robbie: And... what about vocalizations that children make unintentionally. Adam: Well, yeah, and vocalizations-- or like, you know, sneezes are a good example. Robbie: Yeah, they are. Adam: When a child sneezes, and repeating that sneeze back to them Robbie: Uh-huh. Adam: And mimicking it back to let them know, 'Oh, you made a sneeze,' and that's different than when you on purpose, you know, make a ba‑ba‑ba sound. Robbie: Right. Adam: You know. It's important to- to repeat. We talk a lot about... mimicking the child's sounds, but it's important to do that with the sounds that they make a purpose, in addition to the sounds that they make... without, you know, doing it on purpose. Robbie: Right. Adam: Thanks. I'm glad you brought that up. Chapter 3. Review Video Examples So our next section is talking a little bit more about what this looks like. And... actually Robbie and I were... in here a little bit earlier, and going over some of these videos, and we had the opportunity to chat about what was-- what we saw on the videos. And we actually recorded that conversation. So we're just going to show the conversation-- we'll show the videos that we... had prepared and then the conversation that Robbie and I had. [ Video start: ] [ Slide start: ] Description Start: Title: What Does this Look Like? Description End: Yeah. Adam: Hurt. Hurt. Yeah. [Silence ] You have a hurt on your mouth. Hurt. Hurt. Your mouth. You have a hurt. You have a hurt on your eye, hurt in your mouth. Hurt in your eye and hurt in your mouth. Yeah. [grinding teeth] Uh‑huh. Eye. Hurt. Hurt. Hurt. Mouth. Hurt. Hurt. Hurt. Hurt. [Loudly] Head. Head. Mouth. Mouth. Mouth. [ Laughter ] Head, head, head, head. Chin. Chin. Chin, chin. Eye. Eye. Hurt, hurt. Eye. Hurt eye. Hurt mouth. Hurt mouth. Hurt mouth. Hurt eye. Eye. Hurt eye. Hurt eye. Hurt eye. Hurt eye. Eye. Hurt eye. [ Video end: ] Adam: So, one of the things I really like about that video is the fact that-- I don't know if you were able to notice that initially she wasn't even wearing her CI. We just started with the tactile. And that was-- that was the mode of communication that she was most comfortable with. And... that was... a good way for... me to be able to develop a little bit of trust with her, because she's the type of student who is kind of reluctant to put on her CI, at first, because she's-- there were a lot of sounds that bothered her. So, when we were comfortable that the auditory clutter had been reduced sufficiently that she could focus on the sound of our voice, and that she felt comfortable with me being in such close proximity to her, then we added the cochlear implant, later. And so, I think that that's a-- I really like using that as an example of-- that auditory training doesn't necessarily‑‑ it's part of a holistic approach. Robbie: Well, there were a lot of things I liked about that. Adam: Yeah. Robbie: About that clip. You know, the-‑ it's interesting because when a child is hurt you think, well, maybe this wouldn't be a good time to work, but she really wanted to talk about it. Adam: Yeah, she did. Robbie: She wanted it to be acknowledged. So, it was a topic that was important to her. Adam: Right. Robbie: And your pacing was so nice, because she was hurt. And the clutter-- you kept the language to two words. And... I just-- I think the kindness and everything, it was a very comforting package for her. And it's interesting that the way you're always thinking about how to overlay the auditory... on a situation. It's not about, okay, auditory training, we're here, let's do it, let's focus on auditory. You put that layer on in a way that it meant something. Adam: Yes. Yes. And I think that's really, kind of-- what makes, for me, this clip a very good example of all of the points that we were stressing earlier, is the fact that it is sort of part of that layer of trust, and of processing, and all of those things that we're talking about. They all go together. And the auditory is just a piece of that. Robbie: But that's where it gets the meaning. Adam: Yes, yeah, exactly. [ Slide start: ] Description Start: Title: Tips for Making Auditory Training Effective and Motivating Description End: [ Slide end: ] [ Slide start: ] Description Start: Title: Start close to the body and work your way out Content: • This provides physical and emotional stability • Attach other sensory elements (sounds) to the experience after you have established a strong and meaningful physical base Description End: So one of the things we saw in the video with Zoe, was the fact that the physical interaction was the basis from which the language was placed on top. That's kind of going back to one of the tenets that we had talked about in our previous auditory training session, which is, start close to the body and work your way out. And the reasons for this are the fact that it provides a physical and emotional stability for the students. We know that it's so important that tactile interaction with the students is really kind of the base from which they are able to gain so much sensory information. So that's where we're going to start. And then, we attach the other sensory elements, in this case sounds, on top of that. Let's take a look at a couple of videos that illustrate that. [ Slide end: ] [ Video start: ] [Singing] Beep! Boo! Beep! Boo! Beep! Boo! Beep! Boo! Beep! Boo! Beep! Boo! Beep! Boo! Beep! Boo! Adam: I-- that video-- I watched that video a lot in preparing for this... webinar, and we showed that in the previous auditory training webinar. And every time I see it, that song just gets stuck in my head. [ Laughter ] Robbie: I know. Adam: And not only that, but every time I hear her do the 'beep!,' I just want to like-- I want to raise my hand, you know, because it's so visceral. But I love that video because, you know, it's just a wonderful illustration of- of incorporating all of those physical elements first, and then adding the sounds on top of it, and then making it motivating. That's obviously a really fun activity for both of them. Robbie: And it has such a clear juncture point when that motivating-- I can't do the sound the way you do it. Beep! Boo! Robbie: You're just kind of waiting for it, you know. And something about the intonation and rhythm carry you along and keep you engaged and keep it light and stuff. It's very simple, but that really features the auditory. Adam: Oh, yeah. Yeah, absolutely. So, that's- that's a perfect example of a way to start out with a really simple exercise... in introducing auditory cues to a student... in an activity in which you're... in close proximity to them, and starting at the body... and... at-- you know, giving them meaningful sounds to respond to. I think that- that's a great example of how to do that. Robbie: And talk about-- it just... shows how much fun it can be. Adam: Oh, yeah. Robbie: Simple and fun. Adam: Yeah, yeah, absolutely. So, let's take a look at this video of Trey and... this is-- there's a little bit more going on here, so let's watch this and then talk about it. [ Video start: ] Staff: The little ball. One, two, three, four, five, six, seven, eight, nine, 10. Nice job. Are you going to throw that ball. One, two, three-- you know how to shotput, Trey. Good job. One, two, three... throw the ball! Good job. Here's another one. That's a big one. One, two, three, throw the ball! Good. Last ball. One, two, three! Throw the ball! Nice job. High five. Let me try again. There. Ready? One, two, three, throw the ball! Good one, Trey. All right, high five. What do you think? Do you want more balls? All right. Are you ready? One two three, throw the ball! Nice! Wooo! Good job. What do you want? You want more balls? Okay, this will be your last time, okay? We're going to do three more balls, and then we're going to walk back to the classroom. Okay? One two three, throw the ball! Woo! Good job, Trey! Good job. Okay. Ball exercise is finished. We're going to talk back to the classroom. I'm going to get those balls, let's put them in the cart. Okay. This one. All right. Let's go back and mark the calendar, ball exercise. [ Video end: ] Adam: So that video I think is-- it's-- I think that that really is a good illustration of... kind of expanding on what we saw in the video with Ray. It's a video obviously, you know, they're not in quite as close proximity to each other... but she still is maintaining physical-- a physical connection with him at the beginning of the activity, so that he knows that... he can-- that his communicative attempts are going to be responded to, in a way that is meaningful to him. Robbie: And the connection, maintaining that connection is really important with him, because, as I recall, he did not have vision. Adam: Right. Robbie: And so maintaining a connection with someone who can't see you. Adam: Um, hmm. Robbie: She did a great job of that, using the auditory. Adam: Yeah, she did. Robbie: To keep that connection going. And... I think another thing that was really cool about that, is when she was celebrating with the auditory. Yaaaay! Adam: Yeah. Robbie: That he-- it-- he showed comprehension, because he went-- Adam: Yes. Yes. Yeah, and that's a good way for her to check to make sure that he... is-- that his auditory processing skills are- are being developed, and that he's using those skills; for her to be able to go through that routine, and when she gets to the celebratory part, you know, the yay and the clapping. You know, this is obviously something that they've practiced, that... they clap and there's a certain sound that goes along with that, and then there's... a high five. So, you know, he's responding to- to that... auditory input that she's giving him by making those celebratory sounds. So that's a good comprehension check that she just did, you know. I mean, it's a natural thing to do, but- but you know, if you sit down and actually analyze it, you can see, "Oh, yeah, I can really check to make sure that he can hear what I'm saying, because he knows to do this." Robbie: You know, another thing about it... that I thought was kind of interesting, originally you had said, you know, watch out for clutter. Keep it clean. Adam: Yes. Robbie: So with Zoe, Hurt. Eye. Very clean. Then it got a little more complex, but still clean, with Julie, by that repet- repetitive song, but there was more to it. They had to- you know, attend longer, Adam: Yes. Robbie: But it was still... clean, in that there was no clutter, or chatting or anything. Then, in this one, it got a little more natural. Adam: Uh,hmm. Robbie: But Kim still did not throw in comments. Adam: Right. Robbie: A lot, you know, she might- she made a couple, like the shotput, kind of acknowledging him. So, you could see that she trusted... his ability to stay attending, with a little bit of more natural banter coming in, but primarily it was clean. Adam: Uh,hmm. Robbie: You know, the way she spoke to him. Adam: Yeah. Yeah, and along with that, when she did need to add more information, such as letting him know that they were going to throw three more balls, and then walk back to the classroom; she supported that with tactile sign, so that it wasn't-- she wasn't asking him to rely solely on his hearing. She gave him the sign language to go along with it, and she reduced that-- she increased the proximity to him... so that he could, you know, get that information in a clear form that he understood, you know, in combination with the auditory information that she was providing with him. Robbie: So, it sounds like you're saying she trusted him to get the fun and the banter without tactile support, but once it came into speech and language, she tied the tactile speech and language to ensure that the speech was understood, because that's more complex. Adam: It is. Robbie: So it's really neat that she knew-- that she made that shift. That's why she is who she is, but it's neat that-- that's a neat example, of knowing when to come in precisely and support that understanding of speech. Adam: Oh, yeah, absolutely. And it's a great-- yeah, like you said, I really like the way that it- it demonstrates the fact that, you know, as you said, as you increase the distance, the simplicity in the auditory information also increases, but as you decrease the distance, you can add a little bit more complexity to the-- to the... language that you're providing to the student. Robbie: But you know that one thing, the further out you go and the simpler you get, the more motivating and sparkling you need to be, in terms of auditory, because it's so easy to disconnect when you can't see. Adam: That's true. Robbie: And your hearing is a little faulty. Adam: Well, and that's why she added the- the clap when she- when she moved further away. Robbie: She really ramped up the personality to keep that- that auditory motivating, so he would stay connected to her even when he couldn't touch her. Adam: Exactly. Yeah. All right. That was great. I like that video a lot. Robbie: I do, too. [ Slide start: ] Description Start: Title: Establish Joint T actile Attention Content: Joint attention between communication partners is a critical component of concept and language development. For most students with deafblindness, joint attention is best developed through touch. Description End: So let's talk a little bit about joint tactile attention. That's-- we saw a little bit of that in-- well, we saw quite a bit of it actually in the video with Julie and Ray. And then we saw a little bit of it with Kim and Trey, as well. But that-- it's really important-- joint tactile attention is really important, especially if you are thinking of auditory training in terms of language, and being able to listen for language, because without joint tactile attention, the ability for the students to be able to conceptualize what it is that you are referring to, is impossible. If they don't know what it is that you're talking about. [ Slide end: ] Robbie: It could be anything you're talking about. Adam: Right. Robbie: And so, to ensure that you all are on the same page, that tactile is critical. Adam: Right. And we talk about this a lot... but, you know, it really is just like the- the basic building block of language-- is to be able to maintain joint attention. And for a student like the kids that we work with who are deafblind, that joint attention primarily is going to come from... tactile, which means that you both need to be attending to that object tactilely. So, let's take a look at a... video that illustrates this point, I think really well. [ Video start: ] Ball. Ball. Yes. We brought you a ball. [music & vibration] I'm right here. Ball. [ Video end: ] Adam: So, that's just a very... simple example, but I think it's a really strong one, because you can see that the teacher's hands are available to the student... during that entire interaction, and... by doing that she's not necessarily guiding the interaction, she's allowing the student to guide the interaction, but she also is able to comment, you know, and sign the word "ball," so she's able to-- there's... there's an exchange of turns there, between the two of them, where the student asks her to both attend to the object that she's interested in, and then the teacher is able to then take that attention, and add a little bit more information to it. And... that's-- to me that's a perfect example of step one in joint tactile attention, and... using tactile sign language as well as pairing it with auditory information. [ Slide start: ] Description Start: Title: Move Beyond Cause and Effect Activities Content: Cause and effect activities are great for teaching children that certain sounds are associated with certain object that they are capable of controlling. But don’t stop there... Each new sound needs to be taken through the continiuum. Description End: So let's talk about cause and effect activities. A lot of the things that we do with the students when we're... trying to introduce auditory information, or... some sort of auditory element into their... routines [ Slide end: ] is that we'll use cause and effect activities, or cause and effect... technology like, you know, the buttons that you push that have a voice output. Robbie: Right. Adam: And those are-- they are effective in- in teaching the kids that they might be associated with a certain object. We saw that with Abbey and ball. The... ball had a certain noise-- she could tell. She was able to learn that when she shook the ball it made a certain sound. And it can also teach them that they can control sounds, by either pushing this thing, or shaking this object, or not. Robbie: Right. Adam: But... that's just... the very basic level. That doesn't help them-- that doesn't really go that extra step that we want to be able to... make sure that they're getting all of the sensory information that they need about that object. [ Slide start: ] repeat previous slide So... it's a really important thing to remember that each new sound that you introduce needs to be taken through that auditory continuum. As it gets more complex-- Robbie: All the way to comprehension. Adam: Yes. Robbie: If you introduce a new sound, take it back through there is what you're saying? Adam: Yes. So that-- yes. Make-- well-- and, you know... do those comprehension checks for awareness, and for discrimination, and all the way up through comprehension. Robbie: You know, that's a good reminder, because sometimes when I see a kid comprehending, comprehending, comprehending; I forget that all these sounds and words that they comprehend are based-- are solid, because they went through that continuum. And I can't assume that on a new sound, or a new word, they're going to leap to comprehension automatically. Adam: Right. Robbie: There's no rule that says well, they've got 15, now, the 16th one, just pop it in there. It doesn't need roots, or supports, but that's not true, based on what you're saying. Adam: Right. And I think that that's something that - that we're really trying to... emphasize, is the fact that every time that a new sound... comes in to the student's understanding, or awareness, they need to still have that- that solid tactile reinforcement, in order for them to really reach that comprehension stage. They really need to understand that object fully and what it means, what it represents, where it's coming from, the localization, all of that-- all of those elements need to be incorporated for each new sound. And it'll-- for students who are able to go through that continuum quicker, they'll- they'll go through it faster. You know, for example, the student that we used earlier... who was listening for the sounds of the birds, you know, that is a good example of a student who- who probably moves through the continuum really quickly, but that doesn't mean that when a new sound comes in, he still doesn't have to figure out what's the source of that sound? You know, where is that sound coming from? What is the-- what is the purpose of that sound? What do I do when I hear this sound? What should my reaction be? So, it doesn't change just because he can-- he has the language to be able to talk through that quick- more quickly. Robbie: Right. And... I- I like your emphasis on that, because you're not underestimating the student, or shortchanging him on his ability, when you go back. Adam: Right. Robbie: You are honoring the deafblind learning style, because they're so at risk, permanently at risk, for incidental learning, or inability to gather information simply, and synthesize it the way typical learners do. Adam: Yeah. Robbie: So, the fact that they need this process, is not an indication that they're very slow learners or anything like that. That's just getting the information in on their radar, in a way they got it. Adam: Right. Robbie: And can move ahead with it. That's the deafblind learning style. And you're going to see that with... students with formal language, with emerging language, and, you know, that's just a very good rule to carry around in your head. You've always got to do with the work with every new sound and every new word. You've got to do the work. Adam: Yeah. Yeah, I think that's important to remember. Well, let's take a look at a video of a cause and effect... activity. [ Video start: ] [loud air blower] [blower off] It's quiet. It's quiet. I don't hear anything. [blower on] Machine. I hear it. [blower off] I hear nothing. Nothing. [blower on] With the machine on, I hear it. [blower off] [ Video end: ] Adam: So that's-- you know, I- I think there's- there's... some elements in there that are... a little bit... beyond the-- strictly the awareness level... but really that activity in itself is-- it's basically just a... "I can do this, and then this happens." And-- which is important. That's- that's a very important first step, but if that were all that the routine were about, and that were the-- that was the only auditory information that he got from that routine, then... it would be difficult for him to then build on those skills to be able to, like, move on through that continuum. So I think that that's a-- it's a good-- Robbie: It's essential. Adam: Yeah, it's a good place to start. Robbie: But you're not done, is what you're saying. You've got more to do. He knew that they thought sound was important, too. Adam: Yeah. That's actually a really good point, because their reactions indicated to him that that was something worth listening for, and that's another thing to keep in mind when you're working with kids who are, you know, being-- who are working on trying to listen for specific sounds, or you're trying to help the students listen for specific sounds. It's really important to make sure to reinforce that with the kids. So we have just a few more minutes left, and... we have one more video that we really want to take a look at. And this is on playing imitation and turn taking games. [ Slide start: ] Description Start: Title: Play Imitation/Turn-Taking Games Content: Auditory turn taking games are a great way for students and instructors to practice providing and listening for auditory and/or verbal cues with each other. Description End: And the reason we've included this one is because imitation games are a great way to practice listening for verbal or other auditory cues. And... so we have an example of that with Emma, so we're going to show you that video right now. [ Video start: ] Adam: Your turn. Oh, my turn. My turn. Clap, clap, clap, clap, clap. [ Laughter ] Clap. [Emma vocalizing] It's your-- Clap. Your turn. Your turn. Here. There. Clap, clap, clap, clap, clap. Clap, clap, clap, clap, clap. Clap, clap, clap, clap, clap. My-- Is it my turn? My turn. My turn. Clap, clap, clap, clap, clap. [Emma vocalizing] Excited. My turn. Oh. Tap your knee. Knee, knee, knee, knee, knee. Knee, knee, knee, knee, knee. [ Laughter ] Oh, it's your turn. Knee, knee, knee, knee, knee. [ Laughter ] My turn. Knee, knee, knee, knee, knee. Emma: Yah! Knee. Adam: Knee. My turn. Knee, knee, knee, knee, knee. [ Video end: ] Adam: So I don't know if you noticed in that... video that she was repeating the word clap and knee... when it was... my turn. And... so-- and that- that's just a... a good example there of incorporating, you know, those- those-- all those elements that we talked about before, but the physical, as well as the auditory, in order to reinforce the language that you want to-- them to be able to incorporate. [ Slide start: ] Description Start: Title: References Content: Susie Tiggs’s Live Binder Expanded Core Curriculum for Students who are Deaf or Hard of Hearing Description End: Some references that you might use... when you're planning auditory training activities, are the LiveBinder that Susie Tiggs has created. That's a very good reference. The website is listed there, below. Also, there's the Expanded Core Curriculum for Students who are Deaf or Hard of Hearing. There's a website for that, as well. And that's another good resource for you to look at when you're thinking about... the auditory needs of students who... are deaf or hard of hearing. And, also, there's some good information in there for students who are deafblind, as well. [ Slide start: ] Description Start: Title: References Content: Barclay, Lizbeth A. Learning to Listen Listening to Learn, AFB Press. 2012 Description End: Also, the book, Learning to Listen, Listening to Learn by Elizabeth Barclay is an excellent book, which I highly recommend. And that's available through AFB Press. And I would-- if you have a chance to... purchase that book, I would recommend that, it's got some wonderful information in there. [ Slide start: ] Description Start: Title: References Content: Jim Durkel & Kate Moss. The Importance of Auditory Training for Children Who Are Deafblind Huebner, Kathleen M., Prickett, Jeanne, G., Welch, Therese, R., and Joffee, Elga, editors. Hand in Hand, Early Intervention for Infants with Deafblindness. New York. AFB Press. 1995 Description End: And, of course, we have the articles by Jim Durkel and Kate Moss. That's another excellent reference; The Auditory Training for Children who are Deafblind. That's one we use quite a bit, here at the school, and... one that is an excellent reference for you. And, finally, we have Kathleen... Huebner's Hand in Hand, Early Intervention for Infants with Deafblindness. That's another great reference book that, if you don't already have it, I recommend you get. [ Slide start: ] Description Start: Title: Additional Videos & Discussion Description End: What we really want to emphasis is that all of these... things take a lot of practice. [ Slide start: ] Description Start: Title: Practice Practice Practice Content: Let's revisit a couple of our students to see how auditory training can be practiced in the classroom and the community. Description End: All of these auditory skills need to be practiced over and over and over, in many different situations, and with many different individuals, service providers, teachers, and so on. [ Slide end: ] And we're going to start with a young man who has low vision, and a cochlear implant, and... as you're watching the video I want... you to take a close look and keep an eye how the teacher's react to the student, and also... how the- they draw attention to certain sounds in the environment, so that he is made aware of them. [ Video start: ] [loud air blower] [blower off] It's quiet. It's quiet. I don't hear anything. [blower on] Machine. I hear it. [blower off] I hear nothing. Nothing. [blower on] With the machine on, I hear it. [blower off] Female teacher: Make it loud. Make it loud, Jenny. Student: [shouts] Huh! Female teacher: When he's not looking. Can you do it when he's not looking? Male teacher: Are you going to drop it? Jenny: Yeah. Male teacher: Oh, good. [loud bang] Student: [shouts] Huh! [ Laughter ] Female teacher: Did you hear that? It was the ice. Psss! [ Laughter ] It was loud. Male teacher: Thank you, Jenny. Female teacher: it was loud. Later Jenny. Male teacher: I heard the ice, fell in the sink. Student: [vocalizes] Male teacher: Yeah. Female teacher: We need some salt. Where's the salt? Student: [stomps foot loudly] Huh! Male teacher: Right there. Female teacher: Right there!? Student: Huh! Male teacher: Did you [Indiscernible] Ice. Student: Ah! Ahhh! Male teacher: It's was loud. The ice... [slaps hand] in the sink. Student: [stomps foot] Male teacher: She poured it in. I can hear it. Student: Ahhh! [ Laughter ] Male teacher: Yes, she poured it in and it was loud. Female teacher: Use your voice Stephanie. Stephanie: [loudly] Bluuuue! Female teacher: I heard that. [ Laughter ] Do it again. Stephanie: Just making sure you-- Bluuue! Student: [laughing] Ahh! Female teacher: Stephanie. Male teacher: Stephanie's voice. Student: Haaa? Female teacher: Yes, you heard Stephanie's voice. Do it again. Stephanie: [loudly] Bluuuue! Student: [laughing] Ahh! Teachers: [singing] Stir, stir, stir, stir, stir, stir, stir, stir, stir, stir, stir, stir-- do, do, do, do, do-do! Yayyyy! [ Laughter ] Female teacher: Thank you. Student: Ohhh! Oh, oh, oh. Oh, oh! Female teacher: I hear you. [school bell ringing] Ohh! What's that. Student: [claps hands] Female teacher: I heard it. The school bell. [ Video end: ] Adam: So, if you noticed in that video, hopefully, you noticed. There were... a number of different situations that occurred, in which there was auditory information that was... presented to the student. And... some of it was presented on purpose, for example when the teachers were making use of their voice... and encouraging the student to use his voice, as well. That turn taking and mimicking game... that we had talked about earlier is... part of that... that's an illustration of that particular... strategy. There was also the... introduction of noises... that were made involuntarily; the teacher dumping ice into the sink, is the one that comes to mind in that one. It was a natural sound... but the student couldn't see the ice going into the sink, and he had to react to the sound of it. And... it wasn't that the teacher intentionally made it... loud-- well she did, of course, because... she was asked to-- but that is a sound that... could unintentionally be a loud sound, and that might draw one's attention. And... as a result you saw the instructors, that were in that video, reacting to... the student's reaction of hearing the sound of the ice hitting the... the sink. And then, also, again, like the- the-- modulating the vocalizations and going through that range of... of hearing... the range of auditory development, and... that- that was illustrated, fairly well, by the woman who came in and used a different vocaliztion, a funny vocaliztion, to say the student's name. And-- so you can see, there's a whole... pattern of- of activities, and-- different listening for different types of sounds-- listening for familiar sounds... in a familiar environment. Also listening for unfamiliar sounds in a familiar environment. And then, all the way down to the cause and effect of turning the popcorn popper on and off, as we talked about before. All of those things are incorporated into this one activity. And then, you also may have noticed that there wasn't a whole lot of auditory clutter in that... activity. Which is another thing that we had talked about, and how important it was, and it made it that much easier for the student to listen for those sounds, and to be able to... pick out those individual sounds as they occurred, rather than having to listen for them in a spectrum of sounds and background noise that was occurring. So, that... was a good illustration of a way to set up a routine in an environment in which there wasn't a lot of auditory clutter, and which the student could listen for a variety of different sounds, and a variety of different types of sounds. So, now let's look at another illustration of... how to do some auditory training with a student. This student... is the... the student that we saw earlier, who was listening for the birds. And we're going to go ahead and watch the entirety of that experience. And this is a good one of-- to use for O&M instructors; is to kinda go on a listening walk, or listening adventure, where the student goes out and begins-- you have certain sounds that you want the student to listen for. And also be able to identify where those sounds are coming from, in order for them to be able to... help with their orientation and mobility skills. So, let's take a look at that video. [ Video start: ] O&M instructor: Tell me when you hear it, okay? You hear it? Where? Point. Student: [verbalizing] O&M instructor: That? Yes? To the left. You hear it? Student: I hear. O&M instructor: Now, tell me when it goes behind you. Tell me when it goes behind you. Student: [Indiscernible] O&M instructor: Okay. Where is it now? Now? Where? Now, where is it? Student: I hear. O&M instructor: Over here? [car motor starting] O&M instructor: It went around you, in the back, right? Student: I hear. O&M instructor: You hear it. [grating sound] O&M instructor: Where? Point. Student: [Indiscernible] O&M instrutor: On the left? You hear a car. Okay. Now. Now. You hear it. Oh, it's going that way? Student: [Indiscernible] O&M instructor: On the right? Yes? Student: [Indiscernible] O&M instructor: Okay, now, nothing else. [ Video end: ] Adam: So, that student had an FM system. And the O&M instructor was able to provide him with auditory instructions, using the microphone from the FM, and... in addition, he had on... a... an environmental setting on the hearing aids that he was using, so that he could listen... for the cars, as they go past. And that... particular video is a good illustration of ways that you can... work with a student to go and listen for particular sound cues in multiple environments. So, if you were doing an O&M lesson, say, or even just walking in the hall. Certain sounds that are predicable in... in environments that the student spends a lot of time in, might be a good activity... even if you're not an O&M instructor, to occasionally just go on a little walk and listen for those... cues that happen in the student's natural environment. And you can help them... be aware of all the sounds by drawing their attention to it, by noticing it yourself; even for a student who it isn't, maybe, quite as-- has a high-level of language as the one in the video that we just saw. You can still... help draw a student's attention to sounds in their environment... by, you now, exploring with them tactilely, or you know, putting your ear up toward a sound that you particularly want them to hear. So, that they can get a little bit closer to it, and know exactly what that sound is and where it's coming from. So, those are few ideas for you to use when you're in your practice. Those are, hopefully, going to help you, when you start to thinking about auditory training; how you can incorporate it into... multiple activities, and hopefully, in every activity that you design with your student. Because, as Susie Tiggs reminded us in our previous webinar. [ Slide start: ] Description Start: Title: Remember.... Content: "Auditory training is something that happens all day, every day, not just Tuesday at 4:30." - Susie Tiggs Description End: It is not something that happens only once a day, it happens all the time. I hope that you all... were able to get quite a bit out of this, and that you were able to find some- some ideas for activities that you can do with your students that will help you build in auditory training into your routines. And Robbie, do you have anything to add? Robbie: I think you've said it all, Adam, I really do. Adam: All right. Well, thank you so much for joining us and we'll see you next time. [Silence] [ Slide start: ] Description Start: Title: Texas School for the Blind & Visually Impaired Outreach Programs Content: Hearing Issues for Students with Deafblindness: Auditory Training October 19, 2016 Facilitated by Adam Graves, Education Consultant, gravesa@tsbvi.edu Robbie Blaha, Education Consultant, blahar@tsbvi.edu Description End: Fade up from black. Animation: Text for TSBVI transform into braille cells for TSBVI. Fade to black.