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

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

3. Language of the Deaf and Hard of Hearing
Chapter Six (pages )

4. Koch, 2002

5. 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

6. 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.

7. 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.

8. 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.

9. 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

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

11. 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)

12. 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

13. 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

14. 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 ( hours estimate)
cued speech
(see handouts in Additional & supplemental readings)

15. 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)

16. 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

17. 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

18. Listening and Spoken Language(LSL)
Auditory Oral
Auditory Verbal

19. 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

20. 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”

21. Foundations of language for d/hh infants and children

22. 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

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

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

25. 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

26. Language Characteristics
Table 6.1 in text

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