Hearing Issues for Students with Deafblindness #5 This video is posted online with the following chapter markers: Chapter 1. Auditory Issues for Deafblindness - Chapter 2. Working on Auditory Skills - Chapter 3. Tactile Input in Auditory Training - Chapter 4. Student Response Awareness - Hearing Issues for Students with Deafblindness #5 Transcript [Silence] Chapter 1. Auditory Issues for Deafblindness [ Start slide: ] Adam: Alright. Chris: Hi, everybody. Adam: Hello, Susie and Chris. Thank you for being here. Chris: Adam. Kate: Thank you. Chris: Kate. Adam: And Kate, yes. Thank you all for joining us. We're going to go ahead and get started. And we're just going to jump right in and sort of -- we want to tie into some of the things that we've been talking about in our previous sessions as to how vision effects hearing and -- and the ability to listen. So we're just going to start out by outlining some auditory issues for students who are deafblind. And the first one is that the lack of sufficient vision makes it difficult for them to associate sounds with their sources and this is often something that we'll see teachers of the deaf and hard of hearing having trouble with because a lot of the techniques that are used to help typically deaf kids understand connections between sounds, rely on the -- being able to watch the child shift their gaze on to the sound source and you -- that's not as reliable with a kid who's deafblind. [ End slide: ] [ Start slide: ] The next issue is that a student who is deafblind may not recognize that sound has any meaning. You know, if it's not -- if the sound isn't of interest to them, then there's no reason for -- and there's no reason for them to -- to have to focus on it, then they may not -- it maybe diff -- more difficult for them to pay attention to sounds in general because, you know, just like any skill, the ability to listen requires the ability to generalize that skill from, you know, from the specific to the broader array of sounds. [ End slide: ] [ Start slide: ] The third issue that we could move on into, Chris. Chris: So a lot of what Adam is talking about with all of this is kind of that idea of joint attention. And I think a lot of times when we think of joint attention, it's both of us are going to look at this and when we say look we think visually. But with a student who doesn't have vision or maybe has limited vision, they're going to have to do that tactually. So if there's a sound source, you might need to go to the sound source so that you can explore it tactually. Maybe you'll have a sound source that's close to your body, we'll talk about that later and then kind of expand out from there. Speaking of joint attention, you know, that's one of the major tenets of conversation is being able to have that interaction around the subject matter and so it -- it also makes it very hard for a student or a person with limited vision or no vision on top of that auditory problem to kind of get the mechanics of how a conversation goes. My turn, your turn, kind of thing. [ End slide: ] [ Start slide: ] Without the ability to learn visually, there's -- there's the mechanics of speech. Again, it goes into the idea of conversation. What does it -- you know, I can't really see how your mouth is moving. That when you do this with your mouth like maybe something's coming out, that idea is lost. So there are some things that you can try to do. I don't know if you guys listening in have heard of Tadoma, that's a formal method of tactually using your mouth to realize that there's speech, there's something coming out of the person's face. But you can do that less formally too, just tactually, you know, letting -- letting the student's hand rest on your throat or by your mouth. I always try the do things and this is usually with the younger littler kid of body resonance. So that if I position them so that maybe their back is against my chest and they can feel my body resonate and get that idea that when I am doing this, there is like resonance. You know, there's sound coming out. There's also some things you can do. Again I don't do -- you know, it's got to be age appropriate. You don't want to go up to a teenager or something and do this, but you know, with the idea of -- of having your head against the other person, and you get that resonance from your skull, that cranial resonance and that can be pretty powerful too. So just some ideas for you there. One other thing, real quick. I -- and making a sandwich between you and the sound source. So if you've got a little kid, again, it really only works with little kids. Placing them so their back is on your chest and then a lot of times I used to do it with a guitar. I'd put the guitar then in front of the kiddo so we kind of made a sandwich. But you could do that with a speaker or -- or a musical -- other musical instrument too. [ End slide: ] [ Start slide: ] This whole idea that other people are wearing hearing aids or using assistive listening devices, same deal. You can't see a person talking, you might have a lot of trouble understanding that anybody else in the room might need to wear some sort of a hearing aid or assistive listening device. Again it's something that you're going to have to tactually let this -- let this student of yours explore. I'm working with a teacher who is hard of hearing and he wears hearing aids. His students has a cochlear implant. And he's let the little guy feel that, "hey, you know, let's compare. Look at my hearing aids. Oh you have a cochlear implant." and kind of -- and it's made this little guy -- everytime he meets somebody now he has to reach up to see if, you know, "What's going on? This person has, you know, have one of these things?" So just kind of clueing people in tactually, that's the thing here. You've got to -- you've got to let them feel it. Kate: And Chris, this is Kate. I'm going to just throw this in too as an idea, especially for those younger kids that you're trying to get that hearing aid on and who doesn't want to keep it on, who'd much rather see it go down the toilet, or, you know, pitch it somewhere. If you can, and you can get a used behind the ear aid or something, an old one, or make some kind of dummy shape that's like it and can attach it to something that you can put in your ear, even just letting them have the experience of seeing that you're putting something in your ear... Chris: Yeah. Kate: may motivate them to let you do that with them and to hang in there and you both can -- you can model taking it out when the activity is finished, you know, whether -- and putting it in a box rather than pitching it across the room, or whatever. Chris: Absolutely, this teacher's got a leg up, because he actually wears one. But for those of you who don't. Kate: Yeah. Chris: It's a great idea. [ End slide: ] [ Start slide: ] Susie: Okay. So when we're working with our students with deafblindness, we have many different people who are providing services and the teacher of the deaf or hard of hearing or the speech therapist or both can do a lot by supporting that team in -- the many ways, really making sure that there's good collaboration going on. If there's not good collaboration, then there's going to be all sorts of holes. And students have audiograms and while those of us who were raised in that deaf ed. field, there's a lot of people who can't just look at an audiogram and understand what that means. And not just recognizing where the sounds are but what are the implications for instruction, what does that mean for communication, if a student can't hear specific sounds. We also need to make sure that we do a thorough listening evaluation. We've got an audiogram that, you know, shows us on a chart but what does that mean during music class? What does that mean out on the playground? What does that mean if we don't have our hearing aids on or we do have our hearing aid but not our F-M system. Things like. And then we also need to be teaching those people who are working with the students every day how to take care and how to use the hearing aid and the F-M system, how to check to make sure that the devices are working correctly. Many of the itinerant services are not provided on a daily basis but that equipment needs to be checked daily. [ End slide: ] [ Start slide: ] Kate: Amen to that, Susie. Everyone: Amen! [ Laughter ] Susie: Several times daily for some of our kids. Adam: Yeah. Susie: And we also as the teacher of the deaf or as the S-L-P need to be working together with the classroom staff and the T-V-I to provide some information on audio -- auditory training and activities that can be incorporated within the regular schedule and not that "Okay it's Tuesday at 4:30 so I'm going to work on auditory training" but it's something that happens all day every day. That -- again, that collaboration piece is important as we look at working together with the people who understand the vision part of it. We've got our teachers of the deaf who know the deafness portion really well but don't necessarily know the V-I so let's work together with our teachers of the visually impaired and kind of talk about how best to modify some of these activities so that we can make them accessible for our students. The Expanded Core Curriculum for the deaf and hard of hearing has several different sections that address auditory skill development, amplification management, things like that. So let's look at how we can implement that into the I-E-P as well. Kate: And Susie, I just have to say that I wasn't really aware that there was an E-C-C for deaf or hard of hearing until you pointed it out to us and showed it to us in the live binder and that is in our resources, and if folks, especially T-V-Is who may not be aware that there is an E-C-C for deaf and hard of hearing, though there's not the same laws that is now governing you to make sure that you're doing assessment and instruction and it -- it does serve as a great guide and I think it might help you understand more how to work with your teachers of the deaf and hard of hearing when you look at the things that they're focused in on as part of their E-C-C commitment. Chris: Well and to be aware for that kid With deafblindness, too. Kate: Yeah, absolutely. Susie: Definitely, and I'd have to say that a lot of the teachers of the deaf don't understand that there's an E-C-C yet, and but that's one of the things that we're really working hard is making sure that people know it's out there. Adam: They will soon! [ Laughter ] Susie: As much as I would love have to in it law, I've been told that I probably personally can't get that done today, but you know, I'm -- maybe at some point. Kate: Well, we'll work towards that. [ End slide: ] [ Start slide: ] Susie: These are the eight areas, well not -- these are -- there are several -- there are eight areas of the Expanded Core Curriculum for deaf and hard of hearing and one of the areas is communication and that deals with auditory skill development, sign language, speech, all sorts of different areas. But here we've pulled out the specific skills that are in the auditory skill development area. Those would be things like awareness, recognizing that there isn't even -- that there is even a sound, turning towards it. Recognizing what that sound is. Locating it. Being able to hear at different distances or levels. Discriminating between sounds. Comprehension of sounds. As well as listening skills. [ End slide: ] [ Start slide: ] These are just some examples, goals and objectives that you might see that go along with your E-C-C. When we do our assessment, we determine what are some of the areas that are needed, what do we want the student to be able to do? What can the student do now and then how will we know if the student's mastered it? As well as identifying who's going to be responsible for teaching it assessing it. So these are just some examples. [ End slide: ] [ Start slide: ] Chris: Well, Susie mentioned that word collaboration a second ago so we're going to, like, collaborate, collaborate, collaborate [ Laughter ] during the whole thing. But it -- it's really important because you guys are all bringing -- we're all bringing different things we're good at and we've all got holes and deafblind kids are so complex most of the time that it does take a whole team to kind of look at this. I might know a lot about vision but I need my person with a deaf ed. background to help me on that side of the coin and then that's not to say that there's that other piece that's deafblindness that's still going to be different. And that's why it takes that whole team and the O&M person. I wanted to specifically point at number two on here and I think that it's really important that this goes both ways, that there's hearing information presented on the functional vision learning media assessment, especially the learning media assessment part. What implications does this hearing impairment cause? But then Susie was talking about the comm... Susie: The communication evaluation. Chris: Yes. Yeah. Susie: And when I see communication evaluations for students who are deaf and see learning media assessments for kids who are visually impaired, usually the L-M-A is done by the teacher of the visually impaired, the communication evaluation by the teacher of deaf, but there's not collaboration with each other. And we're addressing the whole visual component with auditory component in both so they really need to be teaming and collaborating on those assessments. Chris: Sort of like, I see that person at the ARD and then, you know. Susie: You do your -- you're Tuesdays I'm Thursdays, you know, [ Laughter ] that's all there is to it. Chris: Yep. Kate: And these two senses are so interwoven, that if you're not doing it -- you meet no one, until you're really thinking about it, can understand it, and I have to say for teachers of the visually impaired, you know, in their E-C-C they are looking at sensory efficiency, and compensatory skills, and so they're held responsible as well for stuff, serious working at how a person is using their listen skills and so, you know, it really behooves both of these professionals to work together on this because I don't think either one of them on their own can really do a sufficient job of assessment. Chris: And I think one of things that we're going to look at soon, hopefully, is -- is start to develop the idea of an E-C-C for deafblind and you would think that the con -- concept -- concept development, you know, it's big for everybody but it's like this giant elephant in the room, you know, for a deafblind kid. [ End slide: ] [ Start slide: ] Adam: Collaboration is the key. Chris: Everybody. Adam: Yeah. it's a -- I don't think that we can stress it enough, you know. It's like Susie and Chris and -- and Kate were saying, you know, when -- when you're able to sit down in a room together, just for a few minutes and talk through, you know -- you know the T-V-I be able to talk with the teacher of the deaf and hard of hearing and saying all these are the things we need to work on with this student based on his visual efficiency and when you sit down and start to describe those things with the teacher of the deaf and hard of hearing, that you be -- you might be surprised at how often you'll find them say, well, that -- he's probably not going to be able to hear you when you -- when you do that. So, you know, is there another way that we could -- we could approach this, and a lot of times that's going to be going through the tactile channel. And those are things that you both will need to list on your reports, in your communication report if you're the teacher of the deaf of the hard and hearing or the F-V-L-M-A if you're a -- the teacher of visual impairments. And the list there of some of the things that you'll need to talk about is the appropriateness of certain technologies like voice output, you know. If a student has a listening or a hearing impairment that makes speech, kind of, inaudible then a voice output device is just going to be in a bunch of gobbledegook, and it's going to be frustrating. And -- And then also aligning listening device with technology so that they're compatible. That's something that we as T-V-Is, I don't, you know I didn't really -- even working here, working with kids who are deafblind, you know, that was something that I -- I mean that's a constant learning process, because technology is always changing. And teachers of deaf and hard of hearing, I don't -- I mean I feel like the -- that -- that area of -- of the -- the I-E-P team, like, is a little bit more up‑to‑date on some of the changing technologies as far as listening devices are concerned and hearing aids and stuff so. And then also working together to develop auditory training goals and objectives in the I-E-P. You know, it shouldn't just come from one source. It really does need to be a collaboration between the hearing and the vision teams. Chris: Well and you might want your A-T person to come in and consult. Adam: Yeah. Yeah. Susan: Exactly. Adam: Good Point. Kate: Intercoms, you know. They've got to be there too. Everyone: Yeah. [ End slide: ] [ Start slide: ] Chapter 2. Working on Auditory Skills Adam: So to -- to start with, you're going to need to collect information and that includes some of the things that we've talked about in some of the other sessions, such as the audiogram. Any sort of hearing information like an O-A-E, the Tempanagram,things like that, a listening assessment, or a functional hearing assessment, which we talked about last time, is a great way to gather information in a way that is kind of written in layman's terms so that anybody on the team can understand, you know, what the child might be able to hear and it might be more accessible than -- than an audiogram for someone who doesn't know how to read that. And then moving on, you're -- you'll need do daily checks of the devices that the child is going to be using to help them listen and we'll get into the -- the Ling 6 sound test a little bit more -- a little bit further on. And then you'll also want to check -- and part of this device checks and -- and also your just daily assessment will be duplication of responses from the kids. You'll be checking for that. You're -- You're just going to be needing to do daily assessments on the students and, you know, checking to make sure that they are responding to the sounds that -- that you are providing them in their environment. And that they are, you know, responding in -- in a genuine kind of way that you can document. [ End slide: ] [ Start slide: ] And basically for a student who's learning how to hear, there -- there's kind of a continuum of -- of sound discrimination and being able to listen for sounds and it starts with gross discrimination which is basically referring to the ability to identify the presence or absence of sounds. And that -- that's the very basic level. And then fine discrimination is the ability to understand the meaning of those sounds. Chris: So both ends of the spectrum. Adam: Right. And -- and the -- and fine discrimination and we've talked about this a lot, too, is that -- I th -- and -- just for myself, you know, I usually think of fine discrimination in terms of speech and speech being the highest level of that spectrum, you know, the ability to understand individual sounds and how the combination of those sounds makes a word which has meaning beyond that -- those individual sounds, you know. And, but it's not just speech. It actually refers to the ability to pick out, you know, like very specific sounds such as an alarm clock, you know. And being able to recognize the alarm clock as opposed to the timer in the kitchen. And being able to recognize that the alarm clock is in the bedroom and the timer is in the kitchen. And that's -- Chris: Unless they live with you and god only knows where the timer's going to be. [ Laughter ] Adam: And, well the kitchen and the bedroom are the same room in my house. [ Laughter ] [ End slide: ] [ Start slide: ] Susie: We call this a speech banana. This is a familiar sounds audiogram. And it shows with different pictures what -- where those are on a regular audiogram. The yellow part is the speech banana and that's where all of your speech sounds fall. When we do a daily listening check, we look at the ones that are circled in red, which would include an I, an M, an A, a U, an S-H and an S. We call those the Ling 6 sounds and those, as you can see, start all the way with your lowest pitch and go all the way to the high pitch. And incorporate -- if your students can hear those six sounds or you feel good that their device is picking them up correctly, then they are going to able to hear most of the rest of the speech sounds. So those are the six that are picked out and that's why. Kate: And Susie, I just have to throw in here, one of the things I would share with especially gen. ed. teachers, who are the ones daily getting those hearing aids and doing things, that it's a really good idea to get your teacher of deaf and hard of hearing to give -- to get hearing aid stethoscope... Susie: Yes. Kate:...that you can attach to the child's ear mold and you can run through the sounds yourself before you put the hearing aid on the child because that's another way to detect the -- not only is it turned on and the battery is okay, but that there is not something wrong with the aid itself. If you're getting good quality sound on those Ling 6 sounds then the aid is probably working pretty well. Susie: Right. If the child's not responding to those six sounds and they usually do, it could either be the device or it could be that they have an ear infection and there's fluid in the ears. So if you've actually gone through the device first and cleared that and then the student is not responding to sounds that they usually respond to, then you may need to check with the school nurse or send the child onto a doctor. Kate: Or check if they turned it off. Because I know when I taught younger kids, what we would do throughout the day and they just knew to be ready for it is I would come up to them and get their attention and then I'd cover my mouth and I'd do the six sounds. And sometimes I would and sometimes I wouldn't and if they couldn't tell me where they heard or not, you know, then they knew it was -- the aid was going to get checked. So it was a game and the actually... Chris: Such a sneaky teacher. Kate:Oh, I was a sneaky teacher. I was. Susie: Well, and I learned very early on that as a teach, I need to do that daily. [ End slide: ] [ Start slide: ] I taught in Lubbock, where we had Texas Tech had a deaf ed program and we'd have students come observe us and I went to show them how to check a hearing aid on one of my students and the student says "Well why do you need the hearing aid?" I Said "Well, We're going to check it." "Okay well, it's fine, but there's no batteries in there." [ Laughter ] It didn't occur to me that my kids would be wearing hearing aids without batteries, so. Kate: It happens way too often. Susie: It does. We had taught him well. He had to have the hearing aids on. Chris: Then there's the old beat lima bean in the ear trick too. [ Laughter ] Susie: Yeah, we're just not even go there, so. With doing the Ling 6 sound test you want to do it where the student can't see your face. Which, if you have a student who is totally blind, or even just has some low vision, it's going to be a little harder to begin with. You can either cover your mouth or you can turn your head, they make little pretty screens you can put on so that you want to make sure that the student is actually hearing it and that they're not responding to any visual cues that they are seeing on their face. But the test has got to be done daily. Just checking the hearing aids, checking the hearing has got to be done on a daily basis. That can be done by the nurse, by a paraprofessional, by someone in the classroom. So the teacher of deaf needs the work with the classroom staff who's there on campus and determine who's going to test that daily. There is the stethoscope that you can put on your hearing aid if you have a student who actually has a cochlear implant, there is different equipment that you can use but that's available for testing as well. Kate: And I just have to say the other thing about doing this each day with your student and -- and as you go along encouraging the student to try to do it themselves with their own hearing aid is teaching them some ability to be a good self-advocate. If they check their hearing aid and it's not working then they can tell someone that it needs -- that they need to wait or they need to get a new battery, or they need to do this. And this is a very important skill for students to have as they move along in school. Especially when they get out in the outside world. If they can't stop someone and say " I can't -- my hearing aid is not working. I can't hear you. Then we've kind of missed the boat on stuff, so. Adam: And actually like -- I've actually written that as an I-E-P goal before. Kate: Mmhmm, absolutely. Adam: It's really important. Chris: That's a good thought. [ End slide: ] [ Start slide: ] Susie: And the student may not have enough speech to do ah, ee, oo, suh, shu, buh buh buh bum. Kate: Yeah! But even if they go ah. Yeah, yeah. Susie: Yeah, something to do that. Chris: We've pretty much covered all this so I'll be very brief here. But we're saying assistive listening devices and we just want to make sure that you guys know that this is hearing aids, cochlear implants, F-M systems, loops, making sure all that stuff is working and -- and like Susie just said, there are different procedures for checking all those things. Again, if you can model it, wearing those things, that's a great thing to do. One little caveat I think that we should mention is that if your student rejects it, don't force it. You know? Allow that to happen and try to -- you can work towards building in specific times of day on the calendar where an inactivity, you know, hopefully we're going to try your hearing aids here and try to expand that time that they'll wear it. But never force a hearing aid or a cochlear implant or anything. [ End slide: ] [ Start slide: ] Susie: And you can ask the audiologist if maybe that they can turn the sound down so it's not so loud to start off with and work up to sound as well. Chris: Here's a little overview of some of the stuff that we're going to cover as we go along. Making sounds interesting and motivating. This is kind of like, okay, we've talked about all this stuff now here's how you do it. Right? But make your -- make it motivating. Duh. Use sounds that are within the child's range of hearing. So, if they have a high frequency loss, you don't want to train to dog whistle sounds. Be aware of auditory clutter and and I would also be very aware of visual clutter, too, if the student has some vision. Call attention to specific sounds within activities. What sounds are you trying to teach to? Right? And make sure you're being specific about those. Being consistent with your words and vocalizations. So you don't want to have an activity where one person's using these words or sounds or gestures or signs and somebody else is doing different stuff. [ End slide: ] [ Start slide: ] Adam: All right. I'm going to ask Kate to bring up a video here. This is a student, an activity with a student where we are just working on vocalizations and -- and localization, and... Ahhhhhh [ Laughter ] Adam: So as you are watching this video, I just would like for you to -- all to be thinking about the ways in which the student and myself who happens to be the instructor in this video, are maintaining joint tactile, visual and auditory attention. And then also using aspects of speech, the super segmental aspects of speech, such as rhythm, tempo, pitch, intensity, novelty, things like that to introduce the sound into this activity. And to create a pattern that the student can then learn to replicate. And then also, if -- be thinking about ways that -- that this activity might be expanded to build an opportunity for imitation and turn taking. So here we go. [ Start video: ] Ahhhhhhh. Ahhhh. Ahhhhhhh. A Ah, ah. Ahhhhhh. Ahhhhhhhhhhhhhh. Ahhhhhhhhhhhh. Ahhhhhhhhhh. Ahhhhhhhhhhhhhhhhhhhhhh. [ End video: ] Adam: Okay. Chris: Is Karaoke the next activity? [ Laughter ] Adam: Yes. Yeah. So that's -- you can see that it goes from the student there went from just being using his -- his -- the back of his neck to listen to my -- the voice coming out of, you know, my mouth and the chin and feeling all of those resonators on my body and then we went to using his hand to feel the sounds that are -- that were coming out of the resonators from the speaker and then he went from that to actually sitting on the speaker and being able to feel the vibration and the resonance of the speaker throughout his entire body. Chris: I thought it was nice Adam and really qui -- really quick clip so I don't know that people saw this very clearly but it looked like you were really pausing and giving some wait time in between and almost waiting for him to request, you know, do this again. Adam: Yeah. Yeah, and that's -- that's -- that is one of those areas I think where, you know, in that particular -- those area for -- where there were pauses, you know, that's an opportunity for him to kind of think about what, you know, whether to register -- allow that sound to, like, register for him and then also to give him the opportunity respond if he wants, or to ask for repetition of the sound. Chris: Or tell you to stop. Adam: Or tell -- or ask for to it stop, yeah. Kate: And I just want to mention here, you know, one of things that I love is that you had that wonderful big old speaker that you could set him on and I know in the early days of deafblind education we all had those speakers and we had especially designed rooms where the floors vibrate and so we could work on that. And I just want to say that now we don't have so many big speakers anymore, one tip I will pass to you, is to use the resonance board and use your smaller device sitting on the resonance board to help get that -- make that connection to sound. You can use just a very small speaker and attach a mic to it and -- and if it's standing on the resonance board, you can get the same outcome as far as the child having that tactile input to go along with the sound. Chris: And if you don't have a resonance board, put your iPhone, go down to the music room and borrow a drum. Kate: Yeah. Chris: Stick your iPhone on top of the drum. Kate: Or a balloon. Yeah. [ End slide: ] [ Start slide: ] Adam: Go ahead, Susie. Susie: I was just going to say here that there's lots of sounds that are going on around us and some of them are sounds that we are going to intentionally make and then there are sounds that are just happening in the environment. [ End slide: ] [ Start video: ] We need to be thinking about all of those sounds really paying attention to the sounds that are going on and think about how we could just really be including those in our instruction. [ End slide: ] [ Start slide: ] Our kids don't learn incidentally, they are not picking up those sounds and saying, wait, I heard something, what is that? We have to be more intentional in how we do that. Add your piece to that? Adam: That is good. Chris: Yeah, I think that... [ Laughter ] Kate: Said it all. [ Laughter ] Adam: Short and sweet. Susie: It's all about intentionality. [ End slide: ] [ Start slide: ] Adam: Do you mind talking a little bit about the listening cue. Susie: As these sounds are coming on and as you are, you know, pointing them out to your student, pair it with pointing to your ear, touching the hearing aid, helping the student to know that, okay "I heard this sound, it's coming through my ear, it's going to take awhile for some of our students to make that connection. Our goal eventually would be for them to sit in a sound booth having an audiogram and they hear a sound and they raise their hand. So as we start making that connection to there is a sound, it's coming from my ear, I can do something with it. It just starts teaching that. And can start talking about it. I heard something. What did you hear? And having a whole conversation about it. Kate: Yeah, and I think that is so important to use that for deafblind students, especially to use that tactile cue of just touching their ear, to point that, you know, to begin to alert them that, oh, I should be listening. I mean that becomes really a piece of communication which says to the child, listen, you know, be aware. Adam: Well and also, you know, we have that little bullet point there about, you know, also using the assistive listening device or the hearing aid because sometimes, you know, for a student who -- who rejects their hearing aids in certain situations, if there are sounds that they do like to hear, you know, to be able to show them, well you'll be able to hear it better if you put this on, you know, that might be a more concrete way of telling them, you know, to listen then pointing to your ear. They may not understand that it actually comes from the ear, you know. But... Kate: That aid is god, yeah. Susie: Put it together. [ End slide: ] [ Start video: ] Adam: And again, as we saw in the video, adding wait time and pauses are really important when you're teaching listening skills because, you know, for students who are deafblind, the -- the sensory -- the multi-sensory issues that they typically have mean that they are going to require a little more time for processing. And so, you know, it might take their brain a little longer to actually hear the sound that has been produced. And so if you move on too fast, it might become too confusing for them and it will be unclear what it is that you want them to listen to. And so building in pauses and wait time are very, very important. Chris: And I think too, I'm not sure if I'll be able to explain this very well but I'm going to try. It's almost the succession of noise sometimes or succession of sound is not only for wait time but just as important as the sound. It's like when that air‑conditioner is droning in the background and it turns off "Oh I hear -- what was that?" Susie: Yeah. Adam: And that is part of building -- that is the beginning point of building sound discrimination is being able to recognize when a sound is occurring and when it is not, you know? Kate: Very first step. Adam: The building block, so, you know. Kate: Well, and this also, I have to mention once again, this is also why it is so important when you are really trying to work on auditory training to keep the auditory clutter to a minimum... Adam: Yes. Kate: So that you can take advantage of those -- of where the sound stops. If there is always sounds going it is really hard to know that it might be something interesting to pay attention to. [ End slide: ] [ Start slide: ] Chris: I hope I am not jumping ahead or something but I think we could have also missed it. We talked earlier when we were preparing about how a hearing aid can amplify all background noise. And we may not realize, for instance, that that air‑conditioner is really loud through these hearing aids. So try to be more aware or if there is a way you can duplicate the hearing aids, what the hearing aid is hearing so that you can experience it to know what your student is hearing, if there is a background hearing aid or you mentioned a ceiling fan. I am jumping ahead, but sorry. Susie: Even just doing something like a sound level meter or your phone, they are free apps, just to sit in a quiet classroom and see how quiet it really isn't. And it's not unusual to be in a classroom there is no kids there is no teaching going on but there is 45 D-B of noise just from the fan and from the kids outside or the... Chris: Computers maybe Susie: people in the hall, or you know, all sorts of things, so. Kate: And this is another area where your teachers of deaf and hard of hearing can really be a great asset to the team is to come into that environment and make some suggestions about how you can damp down some of that noise, you know, things like putting the old tennis balls on the bottom of the chairs and getting some wall hangings that will absorb some of the echo, things like that and they can be a great resource for that. Adam: So, just remember that when you're initiating auditory training, that is so important to include parent or caregiver and describe for them, you know, the issues that you are working on with the kid and some of the things that we are talking about here today about auditory clutter and -- and how to use the hearing aids so that you can get the most out of them. And then to employ techniques within the environment that are natural and meaningful for the child, you know so many times it's, you know just to take -- have kids listen to things that they don't like or don't really mean anything to them, it is going to make it that much more difficult for them to learn how to -- how to listen for things. And then make them age appropriate. And to remember that vision impacts hearing. [ End slide: ] [ Start slide: ] That is the most important thing. And hearing impacts vision as well. [ End slide: ] [ Start slide: ] Chapter 3. Tactile Input in Auditory Training Chris: We talked a little bit about this. But it is really important to include that tactile and bodily input. Have emotion. Emotion is memorable and emotion can be fun. Hopefully it is good emotion, not bad emotion. But big gestures, you don't have to really -- it doesn't have to be precise A-S-L. That can be -- have a whole lot less meaning than a big gesture or a movement. If you are gong to be on a swing and you're doing this, that can be very meaningful to a student. This idea of moving from the unnoticed into the meaningful, into the significant. So it's -- what Adam was talking about, first, you have to be aware of the sound. But for the sound to have meaning, that is good. We want to know that the refrigerator is over there making that vibration sound or that hum or whatever. But what does it mean for that to be significant? That means that you are attaching emotion to it. It's something, if I am driving to work everyday, that drive-in is always the same and suddenly I almost get in a wreck on the way to work, that was a significant drive in to work today. I am remembering what happened. So I am not saying have a car wreck when you are teaching. That wold be bad, or a train wreck. But, you know, how do you attach emotion to some of this stuff and how do you make it significant? [ End slide: ] [ Start slide: ] This whole idea of I hear you, acknowledging that conversation or that initiative from the student. If the student does a - you know I have had students when you put their hearing aids on immediately they would start to "whooooo," you know, kind of vocalize. Vocalize back. Make the sound, same sound back. It saying that I hear you and yes I am here I am with you in this. Adam alluded to this a second ago, too, but the super segment -- super segmentals, using pitch and rhythm. You know, how do you make this interesting and significant? Do you need to be close to your students so that they can hear you. Probably. It's probably going to work better. What kind of tactile feedback can you pair with it. Are they a kid who likes it rough and tumble, are they a kiddo who may not like that kind of strong feedback and you have to be aware of those things. Again, that conversational approach. If you are making a noise, try to get them to give you a signal back, whether it is a vocalization or not. But like you saw with Cameron and Adam with the -- with the microphone, you know Cameron was giving some really clear signals like "Adam, make that sound again." And Adam was waiting for that. So they had a really nice conversation going there. The sound of -- idea of sound location, you are going to have to get up and look for it. It's -- it is almost always going to have to be a tactual bodily experience with a kid who is deafblind. I would say start close to the body when you are trying to teach sounds -- sound localization. What sounds do my body make, you know? My mouth makes this. I might even use a balloon and rub it, you know, and it makes that squeaky sounds on your shirt or something. Things like that. And then start to explore and move further and further away. Kate: And Chris let me just spell out. Another neat thing to use, you know, A-P-H has a lot of balls and things like that, beep balls that can be turned on and that is a nice little activity to do with kids of a lot of different ages, is to start out with them just exploring that ball and getting that the ball is making the sound turning it off and on and then getting in where you are touching foot to foot and rolling the ball back and forth and listening for that and then hiding the ball around the room. You can do a lot of fun things with looking for the ball. So, you know, working on localization is -- is a real important skill and it is also a great skill for them to begin to -- to use related to orientation and mobility too. You know, that notice of there is a sound it's coming from some sound source but it is coming from some location, and that is a little bit harder to teach, so. Chris: Well, speaking of orientation and mobility, Kate, would you cue our next video. [ End slide: ] [ Start slide: ] Kate: I would be happy to do that. [ Laughter ] You introduce it while I am getting this up. Chris: This is me the teacher, Chris and the little guy Ray. And Ray is just learning to use a cane and we are going to walk down the hall. You will notice things that I am doing. I am making a really specific sound and it is in Ray's range, but I am also pairing that with a tactile cue. I'm doing -- I don't know if you will be able to see this real clearly but I am kind of rubbing him on his arm as I make that sound doing the turn, turn or go, go, go. Those are kind of the two sounds I am really trying to focus on here. You will notice him start the repeat that back and we have a conversation. But the turn is sort of a directional. When I say this on this side you go left, right, et cetera and the go, go, go is forward. Kate: Here we go, go, go. Chris: Go. Go. Go. [ Start video: ] Go. Go. Go. Go. Go. Go. Go. Go. Go. Go. Go. Go. Go. Go. Go. Go. Go. Go. [ End video: ] Kate: Oops. I think that's it. Chris: And there were some other things I was doing in there too that I don't know if you would pick up on was, you know, he's not really learned to shoreline with his cane yet so I was letting him bounce off me a little bit, but there is that and it is also letting him know that I am still close by so he has got that tactile proximity or the bodily proximity but then he has also got the proximity of my voice. Any questions about that? [ End slide: ] [ Start slide: ] [ Laughter ] It is a two way street people. Come on now, ask some questions. Okay. We talked about all of this auditory, and visual clutter. So we won't hit on that again, too much. But my gosh, we have to be very aware of that. Be concise with your language. Don't over-talk. So have a good idea before you go into that routine of here is my specific vocalizations. Here is what I am going to say. And say that. And everybody who does that routine say the same thing. And here is a little video. Let's... [ End slide: ] [ Start slide: ] Kate: I think we skipped it. Chris: We'll skip that one. Adam: Yeah. We can skip that video. [ End slide: ] [ Start slide: ] Chris: This is a little tool that is in your handouts that might be nice for you. You will see on it our screen but you also have it in actual size in your handouts. This is just a way that you can see this says Natasha's calendar symbols. So for each object she has in her calendar she has the meaning, she has the sign or gestures. The spoon means go to the cafeteria, the sign or gesture would be eat and everybody who uses that symbol with her needs to say, eat, eat, eat. All of us -- all of the staff do it the same way. And so be consistent. Susie: Consistent is good. Chris: Consistency is good. Adam: Indeed. Chris: Now do we have another video here, Kate? Kate: We do. The drum store. [ End slide: ] [ Start slide: ] Chris: Okay. So, I will set it up real quick. This is Jarvis going to the drum store. Its a famous video so some of you may have seen this already. But some of the things we really want to point out, we talk about that consistency and you will see these consistent body movements and you will see these consistency in vocalizations so that Jarvis starts to attach meaning to not only the experience of going to the drum store. You can see the significance. There is definite emotion attached in this stuff. But then the staff are saying and doing these things the same across the board. Kate: And it is brought back in not only in the experience of day and in the book that he builds but it is something that he can say and interact with another person with again... Chris: Yes. Kate: ...so he is getting many opportunities through out the day, throughout the week to revisit this sound and the memories of these things. Chris: For brevity I will say one more thing here that is not in this video, but after the experience, Matt, his teacher, goes back with him and practices these movements and vocalizations. A couple of days later you will see Tish do the same thing, his speech pathologist. Kate: Oh and also how it is paired with tactile symbols. Each sound is paired with a tactile symbol. [ Start video: ] [Sound from xylophone] [Drum beating] Back hands. Bumbabumbum. (Repeating) [ End video: ] Chris: That always makes everybody smile when they watch that video. It is so good. But you see Jarvis then take the initiative and start to make some of those sounds and gestures, which is very cool. Just what you want to happen. Kate: And it is not a formal pull out auditory training activity. But for a lot of our deafblind kids, this is way more meaningful than a formal pull out auditory training activity. Chris: It is like Susie was saying, it is infused all day long, it is part of the world. Susie:It's got to be. [ End slide: ] Chapter 5. Student Response Awareness [ Start slide: ] Chris: Okay, we are going to go real quick here. Watch your -- watch your student, you know, is there a behavior that we are seeing, it could be you see Jarvis cracking up in that video, are they tense, are they crying, startling, all these kinds of things to let the person know if there is a behavior that they are hearing something and this is information...(There is music on the line)...that you can give to an audiologist if you don't have that kiddo that can raise their hand that I heard that. Star what is it six to mute your phone? Kate: If you guys could do star 6. We are hearing some music in the background. (It sounds like music that is put on hold) Kate: Okay, I am going to mute everybody's mic for you. (On hold music playing) Chris: It's lovely music. (Beep) (music continues) [beep] [beep beep] Chris: This will be the meditative part of our show today. Kate: It's not working. Chris: We will keep rolling here. So our next slide is talking about using structure and being consistent. And we have talked a whole lot about that but you really want, to I think it is good if you can infuse this within the day but also have some structure again what words, gestures, vocalizations, are everybody using consistently in this activity. Should we skip this video, Kate? (On hold music playing) [ End slide: ] [ Start slide: ] Kate: It's the green activity. Chris: The Ray. Kate: We still have singing and playing the guitar but those were the last two, I believe, that we have. I'll leave it up to you guys. Chris: Well, do you want to move along, Adam? [ End slide: ] [ Start slide: ] Adam: Yeah. Let's keep moving. Olivia: I have a question. Kate: Okay, Olivia. Go. [ End slide: ] [ Start slide: ] Olivia: My question is related to orientation and mobility and I know that some things I have observed about myself, whenever I have like a cold and my ears clog up and I am walking, my balance isn't as good -- well it's not my balance, it's my sound localization. And I tend to veer, more of a left side veer than a right side veer. So I am wondering if you're -- when you are working with someone who is deafblind and especially if they are totally blind, sometimes I am sure that they are traveling within a route, you know a route, that is maybe from the classroom to the cafeteria or the classroom to the bus stop, and so on and so forth. So if they are walking independently and all of a sudden, you know, they -- they bump into the wall or whatever, they have gotten off track, you know, if -- if that is kind of shown to them like, oh, well, you have gone a little bit too much to the left, you know, somehow it reorients them that you have the tendency to go left so now you need to go more right so that you know that you are not lost. Because, you know, I have had instances where I have my ears clogged up and I come to a place and I go, what is this? And -- and so then of course, you know, I listen to sound and then I go, oh, my gosh, I went over too much to the right. [ End slide: ] [ Start slide: ] You know, this pillar -- I didn't even realize this pillar was here before. Adam: Yeah. Olivia: Any way. That is just my -- what I have observed about myself and I am thinking, gosh, if you are always, you know, with loss of hearing and vision, those are things to think about. Chris: Susie do you want to comment on that? Susie: Yeah. Olivia this is Susie and I was going say that it is not unusual if your ears are stopped up to actually have some vestibular problems. So you know, it could definitely be a combination of that balance being off because of the ears being stopped up as well as not hearing quite so well so not localizing, so both of those are things that need to be watched for. Adam: I was going to say, I think that question about orientation and mobility and being able to like figure out where you are and losing your balance and not being -- and having your spatial awareness be compromised when you are -- ears are stopped up like that's a that might be an indication to you that the student is having some inner ear infections or -- you now for a student who is non verbal and can't tell you that you know that might be one way for you to be able to really tell is if they usually turn, you know, at a cert -- like at the water fountain because they hear the water fountain and then all of the sudden they are like walking past it, you know, that might be an indication that either they have an ear infection or maybe their hearing is starting to deteriorate, so those are good cues. Susie: Good point. Olivia: Again this is Olivia and I'm glad you said that because I probably am mistaken then that having a hearing problem is not like necessarily having your ear stopped up, you're just -- your -- right? I mean this is -- this is probably -- everybody else might know this but that was an awareness to me. Susie: A lot of people who are deaf do not have vestibular problems, but everybody at some point does have their nose stopped up or their ears stopped up, and so that will... Olivia: Oh, yeah. Susie: ...happen but some hearing loss depending on the etiology comes along with vestibular difficulties as well so it's really important that you know your student really well and if what we are seeing are behaviors that are not typical of your student that's when you really have to worry about it. If know that he normally wonders and kind of stumbles along and he continues to stumble along that's not going to be helpful but if he normally stays really on a straight line and all of the sudden starts weaving then you have to watch for that. Kate: And Olivia not only do you need to watch for it about O&M because, you know, a child could have a sensory neural hearing loss and then wake up one day with a nose full of mucus and ears full of mucus and all of the sudden they have got a mixed hearing loss, and so that means that -- that their hearing that was already bad has gotten even worse and it can effect their balance just like it does you in some -- to some extent but it also is a red flag for "Oh, that child may be hearing even less well today than they heard in the past and so when you're getting little signs like that, those little red flags, it's really good if you've got a school nurse that's got an otoscope that can go take a look at those ears and see how things are looking there or -- or at least mention it to the parents so they can kind of be checking for, you know, middle ear infections and things like that that might need a doctor's follow up . Susie: Yes. Olivia: Thank you. Adam: You're welcome. Okay. So that -- moving into structured free time and how auditory training can be embedded into activities where you might not even be involved, you know, if you offer them a choice of headphones, never put headphones over hearing aids. But you might offer them a choice between headphones and speakers, maybe they want to keep their hearing aids on and listen to music through the speaker so they can hear, you know, what else is going on in the classroom at the same time that they're listening to the -- to the music. You know, that's one way to -- to ride auditory training and you can, you know, have -- you can set it up so that they need to in order to get it to a volume that they can hear it or that they like it they have to hit a switch in order to increase the volume or decrease the volume. And then also give them different genres of music to choose from, you can set up, you know, a switch system where one has one type of music that they don't really care for, and another one has one that they do like, and that's one way to test for, you know, their auditory discrimination, and -- and same thing with instruments, you know, they might prefer more percussive instruments to more melodic instruments, and a listening walk is another thing that you can do where you just go along and walk through the hallway or just even in the classroom and listen for like the gurgling of the fish tank and be able to identify the motor for the aerator in the fish tank. [ End slide: ] [ Start slide: ] And -- So, we're going to watch this video of this young man. This is Aaron and we're playing the guitar, and I just want you too, kind of, as you're watching this, be looking for the -- all of the different ways that he is using his hearing, actually and not just his hearing, using all of his senses to be able to participate in the activity and also to experience the activity in a full and comprehensive way. [ Start video: ] [guitar playing to tune of This Land is Your Land] Today was Friday we had a [indiscernible] we ate at Sonic and we had a [indiscernible] and now we are going to ride the bus home this land was made for you and me [ End video: ] Adam: So, hopefully you were able to see in that video that he was -- he was using -- he turned his head so that his ear was in a position to be able to hear my voice and -- and he was using his good ear to listen, that -- that's his better ear, his left ear. And then he knew that the guitar was there. He could hear the guitar, but he did -- wasn't exactly sure where it was so he put his hands down on the guitar to -- to feel, you know, the exact location of it. And -- and then he also, you know, there was a little bit of turn taking there, you know, he -- he was singing along a little bit. Chris: He was definitely dancing. Susie: He was. Adam: And he was dancing. Yeah. So it was -- and, you know, so there was a -- he moved himself closer to me when he needed to -- to hear better and -- and to be able to locate the guitar and -- and then he moved away when he was wanting to vocalize himself. So... [ End slide: ] [ Start slide: ] Susie: And auditory training is not something that only happens for a couple of years and then stops. Anytime our kids are learning new concepts, there's new there's new sounds that come along with it. And as technology changes sounds that the students used to not be able to hear may now be put into their range. My husband has a severe to profound hearing loss and he had gotten some new hearing aids and we were sitting in the living room talking and he kept saying "what is that sound? What is that sound?" and my daughter and I couldn't figure out what he was talking about and finally realized it was the ceiling fan he had never ever heard tat before but the new hearing aids were just improved in such a way that they were able to take those high frequency sounds and move them so where we could hear it. And we find after he gets a new hearing aids we have to do a little bit of auditory training [ Laughter ] for sounds that he'd never heard before. Never occurred to me I would be doing that, but, you know, it's something that we need to be doing. Chris: It's almost like this background music we have today isn't it? [ Laughter ] Susie: Exactly. Exactly, it is. [ End slide: ] [ Start slide: ] We want to make sure that we're paying attention to the sounds that we normally tune out and pointing those out to the student, but we also want to make sure that they are not interfering with what the student needs to be listening to. If we are doing a lesson and we want them to be paying attention to what we're doing and the air conditioner is so loud and the kids out in the hall are so loud that they can't pay attention then that is causing a problem as well. We want to make sure that we give the kids the vocabulary and the language to go along with the sounds so it's not just a sound it has a word it has a purpose it has a meaning it may not be meaningful to me but if I don't get to experience that concept I'm not going to know. So we have to give those students all that as well with it. And auditory skills happen all day long and so we need to make sure that we are intentionally including those in what we're doing at home as well as at school. [ End slide: ] [ Start slide: ] Chris: And wouldn't you say it's kind of like vision, it's like you don't shut your vision off. Your -- same with your hearing. Susie: Yes. The same with your hearing. You don't turn it off. There's lots of sounds that happen during your lessons that you may not even think about. Think about making oatmeal. you've got the sound of the package being opened, the water that's running, the microwave, the bell when the microwave is finished, the spoon in the bowl. Those are all sounds that we just don't even think about, but those are sounds that we could be pointing out to the student because that water running happens in several different locations, and so then we start getting some of that generalization. Get those conversations going, add the language, and the experiences. [ End slide: ] [ Start slide: ] These are some formal curricula that you can purchase to use with your student, but they really are meant for students who are working on speech discrimination. So if your student with deafblindness has already gotten to the point where they can identify sounds and they're working on being able to tell the difference between different speech sounds, these are some that you can purchase. Most regional day school programs for the deaf already have castles at the very least. The Listening, Learn, Talk and Sound Foundation's is free on the cochlear dot com website, but check with your teacher of the deaf to se if these are available if you've got a student who is working on those speech discrimination skills. Chris: Susie, would these -- would these assessments be something that you would use -- you would really ask the teacher of the deaf and hard of hearing, your speech language pathologist to... Susie: Yes. Chris: to do? Susie: There is going to be some activities within them that your classroom teacher could do but it definitely needs to be appearing between your teacher of the deaf in training on how to use these and chances are your teacher of the deaf may not know how to use these right off hand, because these are not something that we just automatically are taught, but they can look through it, see how it would be applicable to the student work together with the rest of the educational team to talk about how to implement it. Kate: And also I might mention that most of the service centers and most of your teachers of the deaf have access to the inside curriculum and there's some really good auditory activities in there to get you started with some of your students they might need to be adapted if the student is older, but it could give you a place to start and they do take into consideration the child's vision loss. That's another thing to kind of be aware of as a resource. [ End slide: ] [ Start slide: ] Plus we have some other resources to share with you as well those are if your hand out, but the one I really want you to mention, especially for our T-V-Is that may not be aware of it, is the live binder. Susie: We've pulled together a live binder for this workshop and it was on that -- on the very first one. Adam: Yeah. Susie: We've pulled together a lot of different articles, web sites, resources, things that would be really helpful for you. Some that are kind of geared towards teacher of the visually impaired, some teacher of the deaf, all sorts of different activities. And we'll continue to add to that so check that out. Adam: It's really good. I've used it... Chris: Yes. Adam: multiple times so I highly recommend it. Chris: Susie sent it -- sent it to us a while back and we were like "Oh, this is where this has been." [ Laughter ] Kate: And for you T-V-Is, if you have not already gotten from A-F-B press the Learning to Listening -- Listen, Listening to Learn, that is such a wonderful book. Adam: Yeah. Kate: It's worth checking out. It really is. Adam: Yeah it is. Kate: Okay, well I think we really have to go now. [ Laughter ] Susie: Okay. Kate: Thanks so much for those of you that hung in and for all -- to the bitter end, and we will maybe see a few of you at the S-L-K study group. I think that's our last one coming up, and then we'll be back next year with more hearing issues webinars I think. Susie: Okay, great. Adam: Excellent. Chris: Bye everybody. Everyone: Bye. Chris: Happy summer [ End slide: ] [Silence]