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Children with Cochlear Implants in Mainstream Classrooms

Children with Cochlear Implants in Mainstream Classrooms. NOCCCI Akron, Ohio August 5, 2009. Mary E. Koch , MA Auditory Education Consultant Baltimore, MD maryekoch@gmail.com. Agenda. The impact of hearing loss Hearing loss and literacy What does it mean to “hear?”

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Children with Cochlear Implants in Mainstream Classrooms

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  1. Children with Cochlear Implants in Mainstream Classrooms NOCCCI Akron, Ohio August 5, 2009 Mary E. Koch, MA Auditory Education Consultant Baltimore, MD maryekoch@gmail.com

  2. Agenda • The impact of hearing loss • Hearing loss and literacy • What does it mean to “hear?” • Balancing auditory and visual information • Mainstream Dashboard • Tips for Teachers

  3. symbols ideas stories education poetry concepts thoughts internet humor books names LANGUAGE movies literature conversations words employment relationships history friends In a culture using spoken language

  4. Components of Literacy Fluency Ability to decode a text accurately and quickly. Writing Expression of language through written words. Phonological Awareness The awareness of, and ability to manipulate, the phonological segments in words at the phoneme, syllable, and rhyme level (Blachman, 1991; Treiman& Zukowski, 1991). Vocabulary Associating meaning with spoken, signed or written words. Phonics Relationship between written letters and spoken sounds.

  5. Comprehension The ability to understand or get meaning from text. It is the thinking done before, during, and after reading. (Fountas) It is the interaction between the text being read and the reader's existing prior knowledge. Expectations will generate meaning and comprehension. (Leu and Kinzer, 1995)

  6. If readers can “read” the words but do not understand what they are reading, they are not really reading.

  7. Communication Priority Pyramid

  8. Precision Modality Language Communication Cognition CONNECTION Fluency Phonological Awareness Phonics Writing Comprehension Vocabulary

  9. Sign language Spoken language ...languages with radically different sensory modalities such as speech and sign are processed at similar brain sites.” Petitto et al

  10. Communication Continuum Auditory-Verbal Auditory-Oral Cued Speech Simultaneous Communication ASL Language Communication Cognition AUDITORY VISUAL * [Adapted source: Robbins, 2000; AuSpLan (2003); Modified by M. Koch

  11. A Av AV VA V Communication Continuum Fully Auditory Communicator Mostly Auditory Communicator Mostly Visual Communicator Fully Visual Communicator * [Adapted source: Robbins 2000, AuSpLan (2003);

  12. Speech reading Pointing Sign Gesture Picture Object Written word Demonstration Visual Clarifiers

  13. Continuum in Context • New:Language and concepts being presented for the first or second time. • Review:language and concepts that have been presented repeatedly over a period of at least 2 weeks. • Routine:The language of the daily activities of the classroom: transition, snack, instructional routines, etc.

  14. Sensory Communication Profile

  15. Mainstream teachers… • Should have consistent access to support team members to address concerns in a timely manner. • Should be given time to meet with specialists (SLP, itinerant teacher of the deaf, educational audiologist) to discuss the progress, needs and concerns of the CI child.

  16. CI children in mainstream settings: • Should be encouraged to interact directly with peers.

  17. What does a mainstream teacher need to keep in mind? • Classroom noise levels • Function of equipment • Use of FM system • Familiarity of content • Visual vs. auditory • Academic vs. auditory challenge • Use of interpreter • Peer interaction

  18. ACCESS 3 Review HA 2 4 1 5 Routine EQUIPMENT CI New FM Academic/ Linguistic Level m Familiarity of Content 3 2 oo VA 4 IT Av TI VA 1 IT 5 ah I V T A Interpreter Teacher LING 6 SOUND TEST ee sh Auditory Skill Interpreter Use Visual vs. Auditory ss EXPECTATION INDICATORS FM USE SKILL LEVELS 2 2 3 3 1 1 visual quiet auditory loud 4 4 0 0 ON: Talking directly to student ON: Group instruction ON: “Specials” teachers Instructional Social OFF: Talking to other students Expectation Noise OFF: Talking to other adults ON: With distance and noise OFF: Talking to other adults OFF: Teacher leaving room PEER INTERACTION NOISE LEVEL & EXPECTATION MAINSTREAM DASHBOARD Boys Town National Research Hospital © 2009

  19. ACCESS 3 Review HA 2 4 1 5 Routine EQUIPMENT CI New • AUDITORY ACCESS CHECKLIST • Equipment Checks: • 1.Visually check the status of the following: • Settings (Volume, sensitivity, T-coil, etc.) • Battery (Use battery tester) • Microphone (Use CI microphone headphones) • Cords (Check for frays; wiggle cords while watching light blink on CI processor.) • Dials (Check setting, and for movement) • Earmolds (Check for wax, vapor, cracks) • Tubing (Check for flexibility, cracks, fit) • 2. Hearing Aid Listening Check: • Using stethoset, listen to each hearing aid and FM device while doing the following: • Repeating the Ling 6 Sound Test • Moving dials • Flexing cords FM Academic/ Linguistic Level m Familiarity of Content 3 2 oo VA 4 IT Av TI VA 1 IT 5 ah I V T A Interpreter Teacher LING 6 SOUND TEST ee sh Auditory Skill Interpreter Use Visual vs. Auditory ss EXPECTATION INDICATORS FM USE SKILL LEVELS 2 2 3 3 1 1 visual quiet auditory loud 4 4 0 0 ON: Talking directly to student ON: Group instruction ON: “Specials” teachers Instructional Social OFF: Talking to other students Expectation Noise OFF: Talking to other adults OFF: Teacher leaving room OFF: Talking to other adults ON: With distance and noise PEER INTERACTION NOISE LEVEL & EXPECTATION MAINSTREAM DASHBOARD Boys Town National Research Hospital © 2009

  20. ACCESS 3 Review HA 2 4 1 5 • AUDITORY ACCESS CHECKLIST • Ling 6 Sound Test • MM, AH, OO, EE, SH, SS • In quiet: • Present each sound at quietest level audible. • Ask student for conditioned response (raising hand, dropping ball etc.) • Record responses. • In noise: • Present sound at moderate to moderately loud volume. • Ask student to imitate sound. • Record responses. Routine EQUIPMENT CI New FM Academic/ Linguistic Level m Familiarity of Content 3 2 oo VA 4 IT Av TI VA 1 IT 5 ah I V T A Interpreter Teacher LING 6 SOUND TEST ee sh Auditory Skill Interpreter Use Visual vs. Auditory ss EXPECTATION INDICATORS FM USE SKILL LEVELS 2 2 3 3 1 1 visual quiet auditory loud 4 4 0 0 ON: Talking directly to student ON: Group instruction ON: “Specials” teachers Instructional Social OFF: Talking to other students Expectation Noise OFF: Talking to other adults OFF: Teacher leaving room OFF: Talking to other adults ON: With distance and noise PEER INTERACTION NOISE LEVEL & EXPECTATION MAINSTREAM DASHBOARD Boys Town National Research Hospital © 2009

  21. ACCESS 3 Review HA 2 4 1 5 Routine EQUIPMENT CI New FM Academic/ Linguistic Level m Familiarity of Content 3 2 oo VA 4 IT Av TI VA 1 IT 5 ah I V T A Interpreter Teacher LING 6 SOUND TEST ee sh Auditory Skill Interpreter Use Visual vs. Auditory ss EXPECTATION INDICATORS FM USE SKILL LEVELS 2 2 3 3 1 1 visual quiet auditory loud 4 4 0 0 ON: Talking directly to student ON: Group instruction ON: “Specials” teachers Instructional Social OFF: Talking to other students Expectation Noise OFF: Talking to other adults ON: With distance and noise OFF: Talking to other adults OFF: Teacher leaving room PEER INTERACTION NOISE LEVEL & EXPECTATION MAINSTREAM DASHBOARD Boys Town National Research Hospital © 2009 • FM To-Do List • Both soundfield and personal FM systems provide significant benefit to CI students in the mainstream. HOWEVER, the FM MUST be managed properly or it may provide irrelevant noise to the child. This takes a consistent effort on the part of the teacher, assistant, SLP etc. • FM must be checked daily. • Ling 6 Sound Test must be performed daily when FM is linked with CI and/or hearing aid. • FM must be synched for each room change. • Teacher’s microphone must be turned on/off appropriately. • Microphone should be passed between speakers. • FM battery must be charged nightly.

  22. ACCESS 3 Review HA 2 4 1 5 Routine EQUIPMENT CI New FM Academic/ Linguistic Level m Familiarity of Content 3 2 oo VA 4 IT Av TI VA 1 IT 5 Familiarity of Content As students with CIs learn to understand what they are hearing, they may be able to rely more on hearing and less on visual information. For NEW content, there will be more need of visual supports (sign, demonstration, pictures, pointing etc.). For ROUTINE information, a student may be able to understand through listening alone. For REVIEW information, the teacher must “fish” for the child’s optimal understanding level: Providing auditory information first, and then adding visual supports as needed. ah I V T A Interpreter Teacher LING 6 SOUND TEST ee sh Auditory Skill Interpreter Use Visual vs. Auditory ss EXPECTATION INDICATORS FM USE SKILL LEVELS 2 2 3 3 1 1 visual quiet auditory loud 4 4 0 0 ON: Talking directly to student ON: Group instruction ON: “Specials” teachers Instructional Social OFF: Talking to other students Expectation Noise OFF: Talking to other adults OFF: Teacher leaving room OFF: Talking to other adults ON: With distance and noise PEER INTERACTION NOISE LEVEL & EXPECTATION MAINSTREAM DASHBOARD Boys Town National Research Hospital © 2009

  23. ACCESS 3 Review HA 2 4 1 5 Routine EQUIPMENT CI New FM Academic/ Linguistic Level m Familiarity of Content 3 2 oo VA 4 IT Av TI VA 1 IT 5 ah I V T A Interpreter Teacher LING 6 SOUND TEST ee sh Auditory Skill Interpreter Use Visual vs. Auditory ss EXPECTATION INDICATORS FM USE SKILL LEVELS Auditory vs. Visual Expectations A child’s ability to understand spoken-only vs. visually-supported communication will vary based on instructional (new, review and routine) and social contexts. If a child is capable of understanding routines through listening alone, they should be expected to do so. 2 2 3 3 1 1 visual quiet auditory loud 4 4 0 0 ON: Talking directly to student ON: “Specials” teachers ON: Group instruction Instructional Social OFF: Talking to other students Expectation Noise OFF: Talking to other adults OFF: Talking to other adults ON: With distance and noise OFF: Teacher leaving room PEER INTERACTION NOISE LEVEL & EXPECTATION MAINSTREAM DASHBOARD Boys Town National Research Hospital © 2009

  24. ACCESS 3 Review HA 2 4 1 5 Routine EQUIPMENT CI New FM Academic/ Linguistic Level m Familiarity of Content 3 2 oo VA 4 IT Av TI VA 1 IT 5 ah I V T A Interpreter Teacher LING 6 SOUND TEST ee sh Auditory Skill Interpreter Use Visual vs. Auditory ss EXPECTATION INDICATORS FM USE SKILL LEVELS Use of Educational Interpreter The use of the interpreter can be a controversial topic. One way to incorporate a sign language interpreter is to examine familiarity of content, and use the interpreter for new and some review instruction, but to encourage the child to listen in routines. 2 2 3 3 1 1 visual quiet auditory loud 4 4 0 0 ON: Talking directly to student ON: Group instruction ON: “Specials” teachers Instructional Social OFF: Talking to other students Expectation Noise OFF: Talking to other adults OFF: Teacher leaving room OFF: Talking to other adults ON: With distance and noise PEER INTERACTION NOISE LEVEL & EXPECTATION MAINSTREAM DASHBOARD Boys Town National Research Hospital © 2009 Dependence on Interpreter (I) vs. Teacher (T). I = Interpreter only. IT = Primarily interpreter, looking at teacher in familiar contexts. IT = Equal dependence on interpreter and teacher. TI = Primarily attending to teacher, looking to interpreter for confirmation or clarification. T = Attending only to teacher.

  25. ACCESS 3 Review HA 2 4 1 5 • Balancing Challenge Levels: • Academic vs. Auditory • Academic/Linguistic Level: Should be appropriate to the skill level of the child and should not be tied to auditory skill level. Language of instruction needs to be fully accessible to child through appropriate supports and/or modifications. • Auditory Level: Child should not be expected to comprehend instruction that is presented through spoken language/listening alone—even though it is at an appropriate cognitive/linguistic level—but is above child’s ability to process auditorally. Routine EQUIPMENT CI New FM Academic/ Linguistic Level m Familiarity of Content 3 2 oo VA 4 IT Av TI VA 1 IT 5 ah I V T A Interpreter Teacher LING 6 SOUND TEST ee sh Auditory Skill Interpreter Use Visual vs. Auditory ss EXPECTATION INDICATORS FM USE SKILL LEVELS 2 2 3 3 1 1 visual quiet auditory loud 4 4 0 0 ON: Talking directly to student ON: Group instruction ON: “Specials” teachers Instructional Social OFF: Talking to other students Expectation Noise OFF: Talking to other adults OFF: Teacher leaving room OFF: Talking to other adults ON: With distance and noise PEER INTERACTION NOISE LEVEL & EXPECTATION MAINSTREAM DASHBOARD Boys Town National Research Hospital © 2009

  26. ACCESS 3 Review HA 2 4 • FM Use • Personal FM systems (that transmit directly to students CI and/or hearing aid) are difficult to monitor. Therefore, it is very easy to forget to manage the microphone appropriately. REMEMBER; If the microphone is ON, your voice is transmitting louder than any other sound, directly into the student’s ear. That’s great IF you are talking to the student—either individually or in a group. It is NOT great if you are talking to another teacher or student, walking in the hall, in the restroom or any other situation that does not involve the student! • PASS the MICROPHONE to whoever is speaking!!! 1 5 Routine EQUIPMENT CI New FM Academic/ Linguistic Level m Familiarity of Content 3 2 oo VA 4 IT Av TI VA 1 IT 5 ah I V T A Interpreter Teacher LING 6 SOUND TEST ee sh Auditory Skill Interpreter Use Visual vs. Auditory ss EXPECTATION INDICATORS FM USE SKILL LEVELS 2 2 3 3 1 1 visual quiet auditory loud 4 4 0 0 ON: Talking directly to student ON: Group instruction ON: “Specials” teachers Instructional Social OFF: Talking to other students Expectation Noise OFF: Talking to other adults OFF: Teacher leaving room OFF: Talking to other adults ON: With distance and noise PEER INTERACTION NOISE LEVEL & EXPECTATION MAINSTREAM DASHBOARD Boys Town National Research Hospital © 2009

  27. ACCESS 3 Review HA 2 4 1 5 Routine EQUIPMENT CI New FM Academic/ Linguistic Level m Familiarity of Content 3 2 oo VA 4 IT Av TI VA 1 IT 5 ah I V T A Interpreter Teacher LING 6 SOUND TEST ee sh Auditory Skill Interpreter Use Visual vs. Auditory ss *NOTE: Even in quiet environments listening is compromised due to distance from the speaker to the child, therefore it is important to consistently use FM system. EXPECTATION INDICATORS FM USE SKILL LEVELS 2 2 3 3 1 1 visual quiet auditory loud 4 4 0 0 ON: Talking directly to student ON: Group instruction ON: “Specials” teachers Instructional Social OFF: Talking to other students Expectation Noise ON: With distance and noise OFF: Talking to other adults OFF: Talking to other adults OFF: Teacher leaving room PEER INTERACTION NOISE LEVEL & EXPECTATION MAINSTREAM DASHBOARD Boys Town National Research Hospital © 2009 Noise Level Listening Modifications

  28. ACCESS 3 Review HA 2 4 1 5 • Peer Interaction • Strategies for communicating with a student with a CI can be modeled for classroom peers, i.e. getting student’s attention before starting to talk, speaking clearly, not covering mouth, using signs or other visual clarifiers as needed. • Academic:Peer interaction can be facilitated in instructional groupings. • Social: Student should be encouraged to communicate directly with peers during unstructured/play time. Providing models will help the process, but peers should not depend on constant teacher support. Routine EQUIPMENT CI New FM Academic/ Linguistic Level m Familiarity of Content 3 2 oo VA 4 IT Av TI VA 1 IT 5 ah I V T A Interpreter Teacher LING 6 SOUND TEST ee sh Auditory Skill Interpreter Use Visual vs. Auditory ss EXPECTATION INDICATORS FM USE SKILL LEVELS 2 2 3 3 1 1 visual quiet auditory loud 4 4 0 0 ON: Talking directly to student ON: Group instruction ON: “Specials” teachers Instructional Social OFF: Talking to other students Expectation Noise OFF: Talking to other adults OFF: Teacher leaving room OFF: Talking to other adults ON: With distance and noise PEER INTERACTION NOISE LEVEL & EXPECTATION MAINSTREAM DASHBOARD Boys Town National Research Hospital © 2009

  29. ACCESS 3 Review HA 2 4 1 5 Routine EQUIPMENT CI New FM Academic/ Linguistic Level m Familiarity of Content 3 2 oo VA 4 IT Av TI VA 1 IT 5 ah I V T A Interpreter Teacher LING 6 SOUND TEST ee sh Auditory Skill Interpreter Use Visual vs. Auditory ss EXPECTATION INDICATORS FM USE SKILL LEVELS 2 2 3 3 1 1 visual quiet auditory loud 4 4 0 0 ON: Talking directly to student ON: Group instruction ON: “Specials” teachers Instructional Social OFF: Talking to other students Expectation Noise OFF: Talking to other adults ON: With distance and noise OFF: Talking to other adults OFF: Teacher leaving room PEER INTERACTION NOISE LEVEL & EXPECTATION MAINSTREAM DASHBOARD Boys Town National Research Hospital © 2009

  30. Classroom Considerations GROUPING: Student with CI should be in a group appropriate to academic level. SCHEDULING: Ensuring that pull-out services do not detract from class. STAFFING: Having appropriate staff to assist in instruction. SPACE: If working in groups, there must be a quiet space for instruction.

  31. Reduce smooth flat surfaces (floors, walls, windows)—carpet, curtains, pictures, egg cartons, etc. • Close doors to reduce hallway noise. • Eliminate multi-speaker talk as much as possible. Encourage students to talk ONE AT A TIME. • If a noise occurs, such as an intercom announcement or a passing siren, stop talking until the noise stops. • Do not have simultaneous instruction by two or more adults in the same classroom space. 1 Classroom Noise

  32. Away from ambient noise sources (vents, AC, fish tanks, computers, hallways, etc.) • In front and to the side of the classroom to optimize access to teacher, classmates and blackboard. 2 Preferential Seating

  33. Microphone should be no more than about 4-6 inches from speaker’s mouth. • Microphone should be OFF unless speaking to student individual or in group. • Microphone should be passed when another student or teacher is speaking. 3 Manage FM microphone

  34. Avoid talking while writing on the blackboard, • Instead, use an overhead projector. This allows the child to have access to lipreading while you are writing and talking. • Make sure all TV/video presentations are captioned. (Or an assistant is available to help student follow content. 4 Visual access to instruction

  35. Assign one or two students in the class to be a “buddy.” This student can assist the student with a CI in following instructions (page number, following text, schedules etc.) • Buddy can assist in conversations with peers by filling in what student may have missed. 5 Classroom “Buddy”

  36. When reading aloud, assign a “buddy” to assist the child with the CI in following the text. • Pass the FM microphone to student/teacher who is reading. 6 Reading aloud

  37. Other students in the class should be selected as notetakers for the student with the hearing loss. • All of the notes should be copied and presented to the student at the end of each day. • Teachers should monitor the notes to ensure that they are accurate and complete. • Teachers should add additional information if necessary. 7 Notetaking

  38. A student with hearing loss cannot speechread and write at the same time. • Read the word slowly. • Repeat the word. • Give word in sentence to provide context. • Repeat the word. 8 Spelling Tests

  39. Extended time (up to double time) • Separate location • Special acoustics (quiet area) • Directions read or explained • Additional examples (for understanding language of questions) • Frequent breaks • Minimal distractions • Listening sections repeated or signed 9 Test Accommodations /www.hearingpocket.com/mainstreaming.shtml

  40. Have a notebook dedicated to communicating with the student’s family. Send home daily. Encourage parents to communicate regularly. • Provide a set of all textbooks and workbooks for use at home for preview and review of content. 10 Home Support

  41. Resources • DeConde-Johnson, C. (2006). Gearing Up My Classroom: Strategies to Support a Student with a Cochlear Implant. HOPE Online Library. Available at www.cochlear.com/HOPE. • The Mainstream Center at Clarke School for the Deaf: www.clarkeschool.org. • Mainstream Tip series: Tips for Kids and Tips for Friends Moog Center for Deaf Education. Email: publications@moogcenter.org. • Mangiardi, A. (1993). A Child with Hearing Impairment in Your Classroom? Don’t Panic! Washington DC: AG Bell Publications. • Nevins, M.E., & Garber, A.S. (2006). Issues in Mainstreaming. HOPE Online Library. Available at www.cochlear.com/HOPE. • Otto, D., & Kozak, V. (1998). Questions Teachers Ask: A Guide for the Mainstream Classroom Teacher with a Hearing-Impaired Student. Washington DC: AG Bell Publications. • Sorkin, D.S. (2005). Children and Cochlear Implants: What They Need at School. AG Bell Online Seminar. Available at ww.cochlear.com/HOPE. • Tools for Schools; Advanced Bionics; www.bionicear.com • http://www.cochlearcommunity.com/services/cc_pdf/HOPE_FUN664.pdf

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