Introduction to Aural Rehabilitation Lisa Bowers, Ph.D. CCC-SLP

Review Dr. Donna Smiley – EARS Nathalie Davis – MEDEL Dr. Gilbertson – Hearing aids Vicki Rokeby – bilateral CI user Hear and Now

Language of the Deaf and Hard of Hearing Chapter Six (pages 211-229)

Koch, 2002

Communication Modalities Sign Languages Sim – Com Signed Exact English Cued Speech Auditory-Oral Auditory Verbal These are all forms of manually coded communication. Auditory only Visual/ Auditory Manual/Visual/Auditory Manual

American Sign Language (ASL) ASL is a full and complete language, using visual-spatial information to communicate thoughts and ideas. ASL is not a manual form of spoken English, it has an entirely different grammar and syntax from English. ASL has it’s own unique linguistic properties; however, there is no official written form of ASL. ASL use is not associated with a specific geographic location or region.

Differences in Languages ASL Gloss English Translation DOG BROWN I HAVE. TWO CATS I HAVE. NAME BILLY. BOB. WOW. YOUR BIKE RED ME LIKE. STORE I GO. TENNIS I LIKE PLAY WHY? FUN I have a brown dog. I have two cats and they are named Billy and Bob. I really like your red bike! I go to the store. I like to play tennis, because it is fun.

ASL as a language Cued Speech Signed Exact English ASL Sim-Com Pidgin Signed English Match English exactly Not “true” language ASL makes use of spatial relationships, facial expression, and body positioning. The other forms of manual communication are linear and use the vocabulary, syntax and pragmatics of English, and are generally thought to support the reception of speech. These are all forms of manually coded communication.

Bilingual / Bicultural Approach Children learn 2 languages  ASL and English ASL is typically considered the “first” or “primary” language Bi-Bi differs between families Some use no spoken language, ASL to communicate, English for reading/writing Some use ASL and spoken English to communication as well as English for literacy Bi-Bi doesn’t look the same between all families

Manual / Visual Systems that support English Sim - Com Pidgin Signed English Signed Exact English Cued Speech

Manually Coded English forms Simultaneous Communication (Sim-Com) Manually coded signs and spoken English at the same time Typically uses ASL signs only Does not use the signs for the verb “to be” or morphological endings (e.g., “ed”) that are part of SEE Used often in school environments Idea is to “support” spoken English with signs while speaking Unfortunately, the reality is children do not get a full representation of either language (ASL or English)

Manually Coded English forms Pidgin Signed English (PSE) (contact sign) – Combination of ASL signs with English syntax What you often see non native ASL signers use Deaf individuals are very adept at using PSE with hearing individuals

Manually Coded English forms Signed Exact English – Is the direct translation of English using signs Is not another language, but a way to represent English visually includes things like pronouns, plurals, possession, and the verb "to be” often used in school environments

Manually Coded English forms Cued Speech Uses mouth and handshapes to visually differentiate phonemes of a spoken language cues represent the phonemes of English language “Full visual access to spoken language” Can learn in a 2 day workshop (12 -15 hours estimate) cued speech (see handouts in Additional & supplemental readings)

Total Communication (TC) A communication philosophy that incorporates all means of communication formal signs natural gestures fingerspelling body language listening lipreading speech  Sim-Com is a methodology that is often confused with TC (see handout in additional readings)

Sign Language as a Bridge to Spoken Language Type of TC (see handout in additional materials) use basic sign vocabulary to learn language visually as child associates sound with meaning, signs “bridge the gap” transfer knowledge learned visually to acoustic information

Listening and Spoken Language 1995 – 40% of families chose a spoken language option 2005 – 85% of families chose a spoken language option Probably higher now 10 years later

Listening and Spoken Language(LSL) Auditory Oral Auditory Verbal

Listening and Spoken Language Auditory-Oral approach Uses residual hearing and consistent aided hearing (hearing aid, cochlear implant) Goal is to develop spoken language Speech reading cues are used Visual cues are used Gestures are OK, ASL not usually encouraged Clark School Moog Center - St. Louis

Listening and Spoken Language Auditory – Verbal Therapy Advocates amplification and CI use Auditory skills are emphasized Visual cues are limited / not focused on Teaches parents techniques to integrate listening and spoken language in home activities Listening and Spoken Language Specialist (LSLS) AVT vs. “auditory-based intervention”

Foundations of language for d/hh infants and children

Hearing as the Foundation for Speech and Language Hearing = speech perception  language 1 – 3 – 6 1 identified – 3 aided – 6 intervention Yoshinaga-Itano, Sedey, Coulter, & Mehl (1998) (Efficacy of intervention handout in additional readings) Research shows kids identified by 6 months have significantly better language than those identified later

Technology Full time aided use is the goal Easier said than done! DLC – daily listening check (Ling sounds) Downs Approach

Factors affecting speech and language acquisition Age of identification Language in the home English (83%) Spanish (22%) ASL (4%) Cultural influences

Other factors 40% of children with hearing loss have another disability 10% - learning disability 9% - lower IQ 7% - Attention deficit 5% - visual impairment 3% - cerebral palsy 2% emotional disturbance 13% - other This is deaf and hard of hearing clumped together

Language Characteristics Table 6.1 in text

Language Assessment Formal language measures Communication checklists / criterion-referenced assessments Language sample and narrative analysis Table 6.2