Chapter 6 Sensory Impairments: Hearing and Vision

1. Chapter 6Sensory Impairments: Hearing and Vision

2. Hearing Impairment • The Individuals with Disabilities Education Act (IDEA), formerly the Education of the Handicapped Act (P.L. 94-142), includes "hearing impairment" and "deafness" as two of the categories under which children with disabilities may be eligible for special education and related services programming. • While the term "hearing impairment" is often used generically to describe a wide range of hearing losses, including deafness, the regulations for IDEA define hearing loss and deafness separately.

3. Hearing Impairment • Hearing impairment is defined by IDEA as "an impairment in hearing, whether permanent or fluctuating, that adversely affects a child's educational performance." • Deafness is defined as "a hearing impairment that is so severe that the child is impaired in processing linguistic information through hearing, with or without amplification."

4. Deafness and Hearing Loss • Hard of hearing refers to a lesser loss, but one that nevertheless has a definite effect on social, cognitive, and language development.

5. Deafness and Hearing Loss (continued) • Types of hearing loss • Conductive hearing loss • A loss in the outer or middle ear • Sensorineural hearing loss • A loss in the inner ear (cochlea) • Central deafness • A loss in the higher auditory cortex • Combined loss • A loss in two or more of the above

6. Deafness and Hearing Loss (continued) • Causes and prevention • Conductive hearing loss can occur from frequent ear infections. • It can usually be aided by amplification systems. • Sensorineural hearing loss and central deafness are caused by malformation of the ear or severe infections. • A cochlear implant may be needed.

7. Cochlear Implant • Cochlear implants are devices that take the place of damaged inner ear structures that cause profound hearing loss. • In the past, profound hearing loss was commonly referred to as nerve deafness. • This was incorrect because the problem was often not with the hearing nerves, but with the hair cells that line the cochlea. • The cochlea is the spiral part of the inner ear containing nerve endings that carry information about sound to the brain.

8. Cochlear Implant • A cochlear implant (bionic ear) is a surgically implanted device for the hearing-impaired. It is the first medical technology able to functionally restore a human sense - hearing. • Unlike a hearing aid that amplifies sound to make it loud enough for an impaired ear, a cochlear implant bypasses the damaged area and sends sound signals directly to the auditory nerve. A cochlear implant consists of an internal and an external component.

9. Cochlear Implant • The Internal Component has two main parts (neither are visible from the outside): • A receiver-stimulator [3] placed under the skin behind the ear • An electrode array [4] sitting within the inner ear • The External Component has two main parts: • A speech processor [1] which may be worn behind the ear or on the body • A transmitter coil [2]

10. Deafness and Hearing Loss (continued) • Warning signs • Tugs on ears • Used to talk and respond and now does not • Drops initial consonants • Seems inattentive • Looks confused when given directions • Turns head to one side to hear better

11. Deafness and Hearing Loss (continued) • The impact of hearing loss on development • Effect on language development • A child who cannot hear sounds during the critical period may never master those sounds. • Language delays are probable. • Parents and caregivers may stop speaking to the child, because he or she cannot hear them.

12. Deafness and Hearing Loss (continued) • Effect on cognitive development • Language and cognitive skills go hand in hand. • If children are behind in language skills, they are more than likely going to be delayed cognitively as well. • Children with little or no hearing tend to be years behind their normally developing peers.

13. Deafness and Hearing Loss (continued) • Effect on social development • Shy and withdrawn categorize this child. • These children tend to be socially immature. • They also tend to be impulsive and hyperactive. • Unintentionally, they are often left out, because hearing is so much a part of our world.

14. Deafness and Hearing Loss (continued) • Effects on family life • Frustration • Lack of time to learn new methods • Need for behavior management • Family therapy and counseling

15. Deafness and Hearing Loss (continued) • Methods of communication • Speech reading—child learns to read your lips while you talk • Cued speech—a system of hand shapes and mouth movements in which the child learns the combinations to understand the spoken word

16. Deafness and Hearing Loss (continued) • American Sign Language—a language that consists of hand movements with or without speaking • Signed English • Finger spelling • Total communication—combines speech and hand motions

17. Deafness and Hearing Loss (continued) • Which method? • It is family preference. • No one method has been proven to be the best. • Total communication leads to more communication with the outside world.

18. Deafness and Hearing Loss (continued) • Early intervention • As with all disabilities: The earlier intervention is begun, the better. • Children need to learn to use what residual hearing they have. • They need to exercise their vocal chords for speech.

19. Deafness and Hearing Loss (continued) • Guidelines for teachers • Get down on the child’s level. • Sit close to the child when talking. • Make eye contact. • Use short, simple sentences. • Use concrete examples.

20. Amplification devices Hearing aids—an amplification device is molded to fit the child’s ear. • Problems: bad fit, dead batteries, feedback, on and off switch, sore ears

21. Amplification devices FM system—child wears a receiver and the teacher wears the microphone. • Problems: dead batteries, on and off switch

22. Blindness and Vision Impairments • Blind—visual loss is severe enough that it is not possible to read print. • Low vision—residual vision is sufficient to allow a child to read large print or possibly regular print under special conditions and to use other visual materials for educational purposes.

23. Blindness and Vision Impairments (continued) • Total blindness is the inability to distinguish between light and dark. • Most children can see some light and shadows.

24. Visual Impairment • "Partially sighted" indicates some type of visual problem has resulted in a need for special education; • "Low vision" generally refers to a severe visual impairment, not necessarily limited to distance vision. Low vision applies to all individuals with sight who are unable to read the newspaper at a normal viewing distance, even with the aid of eyeglasses or contact lenses. They use a combination of vision and other senses to learn, although they may require adaptations in lighting or the size of print, and, sometimes, braille; • "Legally blind" indicates that a person has less than 20/200 vision in the better eye or a very limited field of vision (20 degrees at its widest point); and • Totally blind students learn via braille or other non-visual media.

25. Blindness and Vision Impairments (continued) • Types of vision problems • Physical abnormalities • Cataracts • Glaucoma

26. Blindness and Vision Impairments (continued) Physical abnormalities • Retinopathy of prematurity • Cortical blindness (Neurological Visual Impairment or Cortical Visual Impairment)

27. Blindness and Vision Impairments (continued) • Visual acuity problems • Refractive errors Astigmatism: uneven refraction Myopia: nearsightedness Hyperopia: farsightedness

28. Blindness and Vision Impairments (continued) • Identifying vision problems • This is rather difficult until a child is in school. • A few tests are available for the younger child • Snellen Illiterate E • Teller Acuity Cards • Photo Screening • Children often do not know they have a problem, because they do not know what they are looking at.

29. Blindness and Vision Impairments (continued) • Muscular abnormalities • Strabismus: eyes are not aligned (crossed eyes) • Amblyopia (lazy eye): • Nystygmus

30. Blindness and Vision Impairments (continued) • Identifying vision problems • This is rather difficult until a child is in school. • A few tests are available for the younger child • Snellen Illiterate E • Teller Acuity Cards • Photo Screening • Children often do not know they have a problem, because they do not know what they are looking at.

31. Blindness and Vision Impairments (continued) • Warning signs • Rubbing eyes • Closes one eye • Watery or itchy eyes, not allergy related • Inability to see, squinting • Blurred vision

32. Signs of Vision Problems • Holding a book very close (only 7 or 8 inches away). • Child holds head at an extreme angle to the book when reading. • Child shuts or covers one eye; tilts head, thrusts it forward. • Child squints, squeezes eyelids together, frowns. • Child blinks excessively or becomes irritable when doing close work. • Child is unable to see distant things clearly. • Child has crossed eyes or eyes that each turn outward. • Child has red-rimmed, encrusted or swollen eyelids • Child has recurring sties • Child has itchy, burning, or scratchy feeling eyes.

33. Blindness and Vision Impairments (continued) • The impact of vision problems on development • Effects on language development • Child cannot see objects, so they have trouble learning the meaning of the spoken word. • Children must be given time to explore concrete objects to learn meaning. • Teacher must develop the use of descriptors.

34. Blindness and Vision Impairments (continued) • Effect on cognitive development • Delays due to language development problems • Usually catch up by six years of age • Effect on motor development • Children will be delayed because they cannot see objects to reach for them. • Children are also afraid to move because they cannot see what is in front of them.

35. Blindness and Vision Impairments (continued) • Effect on social development • The children tend to be quiet and passive. • They do not make facial expressions when people talk to them. • Often they do not even turn toward the sound.

36. Blindness and Vision Impairments (continued) • Early intervention programs • Orientation and mobility training • This is a must. • It exposes the children to their environment. • If things are not moved often, the children can learn independence at play and cleanup.

37. Blindness and Vision Impairments (continued) • Teaching children with vision loss • Take advantage of their other senses • Concrete objects • Descriptions of objects • Rich vocabulary

38. Blindness and Vision Impairments (continued) • Guidelines for teachers • Use words for everything. • Be specific. • Let the children discover through touch. • Put different textured fabric at each center, identifying the boundaries. • Make use of their residual vision: • Write words extra large and in bold colors.