The purpose of this research synthesis is to review and summarize research findings and descriptive articles pertaining to media, materials and technology (MMT) which provide access to education of deaf and hard-of-hearing children from early childhood through eighth grade. The goal of the research synthesis is to use research findings and expert opinion to present guidelines and criteria for what constitutes optimal tools for this purpose.
The research synthesis deals with the following areas:
The research synthesis does not include media, materials and technology pertaining to parent education, use of interpreters, and curricular areas such as math, reading, social studies, science, music, art, health education, drug and sex education. Media, materials and technology for deaf adult learners, postsecondary instruction, vocational education, transitional programs, and adolescent substance abuse programs are not included. Materials to develop manually coded English and Cued Speech are also not included.
The target population includes all deaf and hard-of-hearing children from preschool through grade 8 with prelingual and later onset of hearing loss ranging from mild to profound. The document is relevant to manual, oral, English and ASL communicators and applicable to oral, total communication, bilingual/bicultural (ASL), Cued Speech, self contained and mainstreamed programs.
The research syntheses were based on computer searches of data bases covering the period from January, l981 to June, 1993, including CATS, ERIC, Dissertation Abstracts, Washington Research Library Consortium, Periodical Indexes, and Newspaper Abstracts. Computer and manual searches of the following periodicals were conducted: Volta Review, American Annals of the Deaf, Journal of the Academy of Rehabilitative Audiology, Gallaudet Deafness Collection, Perspectives in Education and Deafness, Educational Technology, Educational Technology Research and Development, Computer and Education Journal, The Computer Resource Quarterly for People with Disabilities, and other selected curricula and books. In addition to these sources, the syntheses draw from the research and clinical experience of the authors as well as contact with selected individuals, currently working with deaf children.
ASSISTIVE TECHNOLOGY FOR EDUCATION
The following general considerations for development of quality visual or auditory MMT for deaf and hard-of-hearing children appeared in the few documents that were found:
Apple microcomputers and associated software are used in the vast majority of programs for deaf and hard-of-hearing children. Very few software programs, however, are designed specifically for deaf or hard-of-hearing children and those that are, are not necessarily more effective that adapted programs. Continued development of educational software programs for deaf and hard-of-hearing children is needed, with more use of IBM computers. Captioning systems need to be more user-friendly, with more open-caption software programs designed for use by students. Teachers report that successful software is characterized by the following features:
Increased use of interactive video is desirable. Additional captioned educational videodisc programs should be developed using multimedia environments. Digital equipment needs to be made available at affordable prices, including tools for creating multimedia captions.
Auditory Technology
Induction loop systems are being used in educational settings, but are limited by spillover problems. Oval Window Audio has developed the 3-D Induction loop system to minimize this problem. Development of such innovative products should continue. Standards for induction loop systems and hearing aid telecoils are needed.
FM systems are the most widely used auditory technology used in education. They should contain the following features:
RECEPTIVE SKILL DEVELOPMENT
This synthesis deals with deaf and hard-of-hearing children. Not included are children with central auditory processing disorders, auditory learning disabilities, deaf-blindness or other disabilities in addition to deafness.
Although review of the literature revealed essentially no research data on guidelines and criteria for MMT, there was a considerable amount of discussion based on expert opinion. The following discussion and recommendations are based largely on this expert opinion.
Auditory Skills
Auditory training programs should include activities to develop skills in the following areas: detection, localization, selective attention, memory/sequencing, discrimination of suprasegmental and segmental speech features, closed-set and open-set identification of speech and environmental sounds, comprehension, figure-ground skills, voice monitoring, and use of suprasegmental information.
Both analytic and synthetic activities should be included, but the focus should be on language based activities using real life situations. Auditory training activities should be integrated with language training, speech production and speechreading. Some activities may be unimodal but audiovisual integration should be a priority. Discrimination training, especially activities using non-linguistic materials, should be minimized.
All activities should be interactive, meaningful, intrinsically rewarding, provide for individual adaptation, and allow for expansion and remediation strategies, as needed. Curricula and programs should include assessment procedures and provide individual programming.
All auditory training activities are predicated on the proper use of hearing aids. Therefore, all auditory skills curricula should include hearing aid orientation activities which teach parents and children realistic expectations of their hearing aids, how the hearing aid functions, proper use and care, ability to perform daily visual and listening hearing aid checks, and ability to troubleshoot malfunctions.
Similarly, curricula need to include orientation to assistive listening systems, particularly FM. There is a need to incorporate objectives and activities into school curricula and a need for studies evaluating the benefits of such training.
Although most schools for deaf and hard-of-hearing children have developed auditory skills curricula, several of which have been disseminated, for the most part these curricula use an analytic, bottom-up approach. There is a need for synthetic, language and situation based programs suitable for natural conversational or language experience approaches in the classroom, using materials that are suitable for the language competence and interests of a wide range of children. Simulated or actual real life situations need to be utilized to a much greater extent than currently exists.
Although most auditory skills curricula contain hearing aid orientation objectives and activities, there is a notable absence of orientation and training materials for assistive devices and cochlear implants. Only one comprehensive cochlear implant curriculum for adults (Cochlear Corporation) was found and this is not readily available to schools. Aural rehabilitation is essential to the successful use of the increasing numbers of cochlear implants being fitted to deaf children. Comprehensive training programs incorporating orientation activities, top-down and bottom-up auditory and audiovisual training integrated with speech production activities are needed. Of particular importance are materials to help families and children develop realistic expectations of the benefits of cochlear implants.
Voice telephone and TTY training involve auditory skills, speech production, language skills, communication strategies, use of assistive devices, and informational counseling. Although several curricula have been developed for adults, only one program for elementary school children has been identified. This program does not contain speech production activities nor instruction in use of third party relay systems. Telephone training curricula, in print and interactive video form, are needed for children.
Speechreading and Communication Strategies
Speechreading programs for children should also be primarily language based, using meaningful real life experiences. Speechreading should be integrated with auditory, receptive and expressive communication strategies training. Programs should include training in assertive behavior and conversational strategies. Although several top-down curricula have been developed and disseminated by the Pre-college programs at Gallaudet University, there is need for additional curricula incorporating a synthetic, interactive, integrative focus.
Connective discourse tracking is an excellent activitity for developing speechreading, audiovisual, and communication strategies skills. It can also be used to improve speech intelligibility. There is need for development of age and language appropriate tracking materials for children.
Interactive videodisc technology can be used for auditory skills, speechreading, and communication strategies training. It is interactive, highly motivating, can provide immediate feedback, and can individualize instruction by tailoring stimulus presentation to the child's responses. Tye-Murray and colleagues have developed several videodisc programs for children which contain both analytic (bottom-up) and synthetic (top-down) programs. There is need for additional programs which focus on real life situations. Much of the printed curricular materials, including tracking activities, can be adapted to video technology.
ENGLISH LANGUAGE DEVELOPMENT AND REFINEMENT
In order to effectively use the linguistic code of English, the language learner must have knowledge and expertise in the areas of:
Children learn the various aspects of language through interaction with a primary caretaker through natural play and daily routines. Lack of auditory input provides incomplete access to the form of language and may effect the ease with which pragmatic aspects of English are learned. Children with hearing loss need to be given continuous opportunities to participate and use language through communicative interaction with others in their environment. At the same time, they may need structured assistance in refining specific areas of language.
Materials are reviewed in the synthesis which are representative of the available programs currently used with deaf and hard-of-hearing children. Reading curricula, language materials used for teaching content information, and MMT used for training memory, problem-solving, inferencing, etc. are not included.
The most commonly used materials for parent-infant work are the SKI-HI materials developed at the University of Utah. The program includes screening, referral, diagnosis, psychosocial support for parents, and parental language facilitation skill development in the home. Although longitudinal research in the efficacy of this program is in process, no published research is available. The results of needed programmatic research in the field of language development of deaf children should play an active role in the development of new materials.
Programs for school-age deaf and hard-of-hearing children tend to focus on a structural approach to written English in contrast to the focus on natural verbal language at the preschool level. Teacher emphasize specific skill areas, particularly syntax and grammar, at the school level. The Apple Tree program is reported to be widely used as an instructional language guide. Few programs in the areas of vocabulary and figurative language have been designed for children with hearing loss.
Programs to teach semantics are needed which are flexible in terms of complexity, cultural differences, interest level, and current experience. Children should not be expected to master many different figurative expressions in a short period of time.
Computer assisted instruction (CAI) is being used for drill, practice and tutorials. In addition, it can be used for simulation of real life situations, problem solving activities, exploration and discovery activities, and instructional games which sharpen note-taking abilities, ability to follow directions, hypothesis testing, and cause-effect relationships. Videodisc technology and hypermedia learning which uses materials that access multiple senses, facilitate language programming. Several interactive computerized programs for children loss are reviewed:
Following are recommendations for future development of MMT for English language development of children with hearing loss:
This section reviews existing media, materials and technology related to the teaching of ASL to children with hearing loss. MMT related to English signing systems, Cued Speech, and the use of sign language interpreters in education are not included.
There are materials that teach ASL to non-native users as a second language and other materials that teach English as a second language to students already proficient in ASL. However, there is a dearth of curricula, media, materials and technology for developing ASL as a first language. The document "Unlocking the Curriculum: Principles for Achieving Access in Deaf Education" proposes a model for teaching ASL as a first language during early childhood and later teaching English as a second language in written form. Early communication occurs exclusively through sign language, with literacy in English occurring during later childhood. Students learn to speak and speechread at the time they develop English literacy. MMT that are recommended as part of this model include:
The most promising materials to date are those using interactive video learning and videotape series that attempt to develop all aspects of ASL, not merely lists of vocabulary. The most effective materials are those that encourage interaction with users of ASL, either between adult language users and deaf children or between deaf children themselves.
Materials and technology that encourage family members to interact with adult language models are needed. Videotapes and interactive computer programs for home use should focus on whole language learning rather than only vocabulary, and should provide information to hearing family members about how to get a deaf child's attention, how to interact visually, and how to recognize stages of ASL acquisition in their children. The use of interactive video-conferencing technologies may make it possible for deaf children to acquire ASL from native signers more effectively.
SPEECH PRODUCTION TEACHING
Sensory information plays a key role in speech acquisition by permitting development of models and providing feedback to mediate speech change. For many deaf children, audition is too limited to be adequate as the primary source of feedback; they require alternate sensory information. Although studies examining the overall efficacy of existing computer-based speech teaching systems suggest their use contributes to speech improvement, more studies are needed to compare their use to more traditional approaches (eg. Ling).
A promising aspect of computer-based systems is their potential for independent drill and practice. This is important for many school programs because of reduced class time for speech development activities. While home use is an important application of these systems, safeguards must be taken to limit development of inappropriate speech behaviors resulting from drill and practice of incorrect patterns.
Tactile devices have been found useful for teaching prosodic production features such as intonation. Additional wearable devices need to be developed and evaluated as aids to speech monitoring.
Existing curricular texts, media, and supportive materials based on the Ling model need revision to incorporate our current understanding of speech learning by deaf children. Alternative or modified approaches to speech teaching with curricula, particularly those based on more top-down, synthetic, language-based teaching strategies, need to be described and developed.
Current technologies focus primarily on suprasegmentals and vowel production or on elicitation, automation, and some degree of generalization of targets. Speech teaching devices are needed that focus on consonant production and facilitation of linguistic use. Current systems are limited in the availability of cues used for development of carryover of skills taught; greater flexibility in presentation of cues is needed.
Results of needed basic research on the value of different forms of feedback need to be incorporated in speech training devices. Although provision of feedback is the primary feature of many devices, in most cases they lack flexibility in controlling feedback parameters. Basic evaluation of tactile and visual feedback devices is needed to determine for which speech skill areas each type of system is most useful.
More clinical efficacy studies on commonly-used commercially available systems are needed, including efficacy of programs using combinations of existing technologies. Such studies should be child-centered rather than device-centered, since speech production training needs vary with individual children.
National Center to Improve the Quality of Technology,
Media and Materials: Research Synthesis
Design of effective media, materials and technology for
deaf and hard-of-hearing students
Introduction
Hearing loss of any degree can impact oral and written language skills, with consequent social, emotional, and academic difficulties. Most deaf and hard of hearing children have intact nervous systems and cognitive abilities. It is possible to lessen the effects of hearing loss with early and appropriate intervention in the following areas: language development (English and/or American Sign Language); hearing aids and assistive technology with proper orientation to their use; speech development; auditory skill development; speechreading; and use of communication strategies. Communication strategies are behaviors that people can use to prevent anticipated communication difficulties or resolve communication breakdown when it occurs. Although development of normal English language skills and subsequent academic success are difficult tasks for most deaf and hard of hearing children, these goals can be facilitated if early appropriatate intervention occurs (Lenneberg and Lenneberg, 1975; Ling and Ling, l978) The Education of All Handicapped Children Act (P.L. 94-142) and the amendments of l986 (P.L. 99-457) mandate basic levels of educational and management services for all children with special needs from birth through age 21.
Purpose and Goal of Research Synthesis
The purpose of this research synthesis is to review and summarize research findings and descriptive articles pertaining to media, materials and technology (MMT) which provide access to education of deaf and hard of hearing children starting in early childhood. The synthesis has been commissioned by staff of the National Center to Improve the Tools of Educators (NCITE).
The goal of the research synthesis is to use research findings and expert opinion to present guidelines and criteria for what constitutes optimal tools to provide access to education for deaf and hard of hearing children. Hopefully this information will provide the basis for development and/or improvement of such tools so that academic and social education becomes more accessible for children with hearing loss.
In addition to guidelines and criteria, the synthesis discusses how well existing MMT meet guidelines, how they might be modified, limitations of the state of the art, and areas in which new development is needed.
The research synthesis deals with the following areas as they pertain to deaf and hard of hearing children:
For each area, criteria and guidelines for optimal tools, critique of existing materials, and developmental needs are discussed. In addition, each section includes discussion of limitations and restrictions of the research and citation of databases accessed in the literature search.
The research synthesis does not include media, materials, and technology pertaining to parent education, use of interpreters, and curricular areas such as math, reading, social studies, science, music, art, health education, drug and sex education. The ages of the deaf and hard of hearing children addressed in the document range from preschool to grade 8. Therefore, media, materials and technology for deaf adult learners, postsecondary instruction, vocational education, transitional programs, and adolescent substance abuse are not included. Although materials to develop American Sign Language are included, manually coded English and Cued Speech are not. Perhaps future synthesis can deal with these content areas.
Incidence
According to Flexer (l991), deaf and hard-of-hearing children, including all degrees of hearing loss from mild to profound, constitute one of the largest populations requiring special services within the schools. She reports 66,000 educationally handicapped children in the United States with moderate, severe, and profound bilateral losses. The numbers increase significantly when children with mild bilateral hearing loss are included. Various prevalence rates of deaf and hard of hearing children have been cited in the literature. Freeman et. al. (l981) and Rodda & Grove (l987) report rates of chronic childhood hearing loss from .1 to .2% of the general population. Hallahan, Keller, and Ball (l986) report prevalence rates for states from .09 to .35% of all students, with a mean of .19%. Demographic data indicate that the incidence of profound congenital deafness has been estimated at approximately .1% of all births, and the number of school-age hard of hearing children has been estimated at 1.6% of the school population (Ross, et al. l991). Ross, et. al. believe that prevalence rates are higher because these figures do not include those children with very mild or unilateral hearing losses. The variability of reported prevalence and incidence rates probably reflects differences in the definitions of "deaf", "hard of hearing", and what constitutes hearing loss. In addition, many of the prevalence figures do not include multiply disabled children for whom hearing loss is a secondary disability.
Characteristics of deaf and hard of hearing children
Definitions
Although complete agreement as to definitions of the terms "deaf" and "hard of hearing" does not exist, the definitions discussed in the following paragraphs have been accepted by the majority of the deaf community. These definitions are used in this research synthesis.
The terms are used differently in a cultural sense compared to medical or audiological use. Culturally Deaf people consider themselves to be members of a Deaf community which may also include hearing people who support the goals of the community. All culturally Deaf people have some degree of hearing loss, but the loss may be profound, mild to moderate, or even unilateral. Culturally Deaf individuals communicate visually through the use of sign language and share a variety of interests, experiences and backgrounds. The majority of these individuals were born with hearing loss or acquired it early in life (Schein, l989; Baker and Cokely, l980).
A deaf individual in the medical or audiological sense is one who experiences significant difficulty understanding speech through audition alone, with or without amplification. The deaf child's primary mode of communication is visual involving speechreading, sign language or both. Audition functions as a support sense (Amon, l981; Schein, l989; Ross, et al., 1991). The labels "deaf" and "hard of hearing" should not be applied based solely on the audiogram. A child with a profound hearing loss may function either as a deaf or hard of hearing person.
A hard of hearing individual is someone who has developed basic communication skills primarily through the auditory channel; audition serves as the primary communication mode, with vision used as a support sense. Most hard of hearing children have more residual hearing than deaf children and can benefit to a greater degree from amplification in the understanding of speech. The vast majority of hard of hearing children, however, can benefit from training in speechreading, communication strategies, auditory skills, speech and/or language in addition to amplification to communicate effectively through a spoken language.
There are some children who cannot be neatly categorized as deaf or hard of hearing. They may function primarily through audition in some situations (eg. discussion of a known or restricted topic), but depend primarily on vision for other communication situations. Although educational needs tend to differ depending on whether a child functions as deaf or hard-of- hearing, all children need to be evaluated as individuals in the development of educational plans.
The term "hearing impaired" is used by some people to mean hard of hearing. Others use the term in a generic sense to include all degrees of hearing loss. Because of the lack of agreement about the meaning of this term and because the deaf and hard of hearing communities considers it objectionable, the term "hearing impaired" will not be used in this research synthesis.
Prelingually deaf or hard of hearing children are those who have acquired hearing loss before attaining fluency in the spoken language of the home, between two and three years of age (Schein, l989). The hearing loss may be present at birth (congenital) or acquired sometime after birth. Those children who acquire their hearing losses after attaining basic fluency in spoken language are considered postlingually deaf or hard of hearing. Prelingually and postlingually deaf children may have identical audiograms, but often have distinctly different needs and function very differently. According to a national survey published by the American Annals of the Deaf (Schildroth & Hotto, l993) 94% of 32,000 children in the United States with hearing loss acquired their losses before age three.
Degree of Hearing Loss
There has been some attempt to evaluate the effect of degree of hearing loss on communication and academic achievement. Karchmer, Milone, & Wolk (l979) reported that degree of hearing loss strongly influences type of educational placement, speech intelligibility, use of amplification, and the particular communication method the student is likely to use. They found that 86% of a group of children with hearing losses of 70 dB or less were judged to have intelligible speech as compared to 55% of another group of children with losses between 71 and 90 dB and 23% of a third group with losses above 90 dB. Jensema and Trybus (1978) conducted a survey of deaf and hard of hearing children and reported that as degree of hearing loss increases, use of sign language increases, speech intelligibility decreases, use of amplification increases except for those with the most severe losses, and residential educational placements become more common. Expressive language in most cases took the form of speech up to a 70 dB loss; above 70 dB expressive communication was primarily through speech and sign language or sign language alone.
Several studies have reported decrease in academic achievement with increase in degree of hearing loss (Davis, Shepard, Stelmachowicz, & Gorga, l981; Quigley & Thomure, l968). In a later study, however, Davis, Elfenbein, Schum & Bentler (1986) correlated degree of hearing loss and educational performance for children with various degrees of hearing loss and concluded that degree of hearing loss alone cannot be used as sole predictor for academic performance. Musselman, Lindsay & Wilson (l988) examined the effects of hearing loss, age, intelligence, type of educational program, and type of communication in the home on language and academic achievement. In contrast to the findings of Davis et al (l986), they found degree of hearing loss to have the most signifcant correlation with language and educational achievement.
The literature suggests that although a clear relationship between degree of hearing loss, communication skills, and academic achievement exists, other factors seem to influence these relationships.
Age of Onset
Most children with congenital and acquired prelingual hearing losses of 70 dB or greater experience delays in acquiring receptive and expressive English language skills. Speech and English language skills of children with less severe losses depend on the degree of hearing loss and the age at which use of amplification and language training began. Speech and English language development of children with postlingual onset of hearing loss depends on degree and configuration of hearing loss, how soon after onset of loss intervention began, developmental level at time of hearing loss, and type of intervention. English language skills of children who had acquired fluency in spoken language before acquiring hearing loss generally do not deteriorate, but speech frequently becomes less intelligible because of inadequate auditory feedback (Johnson & Evans, 1991).
Deaf children of deaf parents who use American Sign Language (ASL) as their normal mode of communication tend to progress through stages of acquisition of ASL in the same manner that hearing children progress through stages of spoken language acquisition. Such children may show delays and difficulties with the development of English, but it is incorrect to assume that general language problems exist. These children frequently come to school with a well formed ASL language base which may be used to help develop English skills.
Few studies have specifically examined the effects of onset of hearing loss on educational performance. Allen and Osborn (l984) compared reading comprehension scores of students who had incurred hearing loss before age three with others who had lost hearing after age three. Separate comparisons were made for deaf children who were mainstreamed and for deaf children in self-contained programs. Scores of the postlingually deafened children were higher than those of the prelingually deafened children within the mainstream educational settings. However, the prelingually deaf children scored higher than their postlingually deafened counterparts in the self-contained classes. Apparently, age of onset as a predictive variable was confounded by type of educational program. Further research is needed to isolate age of onset as a predictive variable .
Language of the Home
The majority of deaf children are born to hearing parents who, in the United States, use English as their native language. Even when hearing parents use sign language in the home, most signs are in English form. There are, however, a small group of deaf children who are born to deaf parents, most of whom use American Sign Language in the home.
Much of the research since the 1960's documents that deaf children of deaf parents perform better than deaf children of hearing parents in academic achievement and emotional adjustment (Moores, l987; Quigley & Kretschmer, l982; Schlesinger, l986; Weisel, l988). It is not clear, however, whether this difference is attributable to mode of communication, hearing status of the parents, degree of hearing loss, age of onset, or age at intervention.
Vernon and Koh (l971) compared the written language skills and overall academic achievement of three groups of deaf children: deaf children of deaf parents with no preschool training, deaf children of hearing parents with no preschool training, deaf children of hearing parents with preschool training. They found that the children of deaf parents scored higher than the two groups of children with hearing parents. Vernon and Koh concluded that the children's early exposure to American Sign Language resulted in high academic achievement.
Contradictory results were found by Brasil and Quigley (l977). They compared academic performance and English linguistic skills of two groups of deaf adolescents from total communication programs. The group whose parents used manually coded English (signs in English format) in the home scored higher than the group whose parents used American Sign Language. There was no discussion in the study of whether both sets of parents were equally competent as signing models.
Corson (1973) compared the reading and writing skills of four groups of deaf children: Group one had deaf parents and used sign language at home; Group two had hearing parents and used sign language at home; Group three had deaf parents and used oral communication at home; Group four had hearing parents and used oral communication at home. The first two groups attended total communication programs; groups three and four attended oral programs. Results indicated that the children of deaf parents outperformed the children of hearing parents regardless of the mode of communication in the home or the type of educational program. Apparently the use of sign language in the home is not sufficient to explain the academic superiority of deaf children of deaf parents.
Apparently, the specific language of the home and the specific educational methodology are not the sole factors responsible for differences in educational performance of deaf children. Weisel (l988) found that deaf children with two deaf parents "showed higher levels of reading comprehension, were better emotionally adjusted, had better self images and were more motivated to communicate with both hearing and hearing-impaired people" as compared with deaf children having two hearing parents. He suggested that the educational superiority of the first group of deaf children may be attributable to the early and continuous exposure to sign language and a difference in "family climate" present in the homes with deaf parents.
Research data suggests that adjustment and attitudes of the family to the hearing loss and the quality of communication in the home are the primary factors responsible for superior educational achievement of deaf children. Easy comfortably communication with a deaf child facilitates development of a rich knowledge/experience base which is a significant factor in reading readiness. A delayed, impoverished experience base is a major problem for many prelingually, severely or profoundly deaf children from hearing families. Therefore, intervention programs are needed to help parents accept and adjust to hearing loss and maximize communication with their deaf children.
Sign Skills of Teachers
One major confounding factor in studies which evaluate linguistic and academic achievement of children in educational programs using sign language is that many teachers of the deaf do not recognize the visual needs of their students. They are not fluent signers and therefore cannot serve as communication models for their children. They often have difficulty understanding children who are fluent signers in their own classrooms (Marmor & Pettito, 1979; Kluwin, 1981; Woodward & Allen, 1988).
Reading
Although the intelligence and general ability of deaf students are not different from the rest of the population, reading achievement has been much lower for deaf children. Based on surveys carried out since l969 by the Center for Assessment and Demographic Studies at Gallaudet University, Quigley and Paul (1986) noted that upon completion of secondary school the average deaf student performed at the level of an average 9 or 10 year old hearing student (fourth or fifth grade reading level). They pointed out, however, that there are deaf students who have achieved reading levels comparable to their hearing peers (Quigley and Paul, l989).
An adequate internalized English language system is necessary to understand written English. Although deaf children have the same learning potential as their hearing counterparts, the considerable delay in development of English language vocabulary and syntax interferes with learning to read (Quigley and Paul, l989; Johnson & Evans, 1991).
Types of Educational Programs
Communication Methodologies
Oralism
Oral education, also called aural-oral, does not use sign language. Instead it relies on developing good use of residual hearing, speechreading, and speech skills through which students learn and communicate. Some programs rely more heavily on auditory skills, while others give equal weight to speechreading. Oral education works best when children have usable residual hearing and when there is an existing English language base as with postlingual deafness. The goal of oral education is complete integration into hearing society. Disadvantages of this approach are that many children are unable to learn a first language from the limited auditory cues available and that it discourages participation in the deaf community. Since English language acquisition is delayed and sign language is withheld, academic achievement is often seriously affected. When oral education works well, it maximizes the ability of the deaf individual to communicate with hearing people.
Total Communication
Most of the deaf education programs today subscribe to the philosophy of Total Communication. Total Communication requires the use of appropriate aural, manual, and oral modes of communication to maximize communication in all situations with both hearing and deaf people. Although it does not require simultaneous speech and signing in all or most situations, speech and some form of sign language is usually used simultaneously. Total communication practitioners generally use some form of signed English in which American Sign Language (ASL) vocabulary is presented in English grammatical format. "Signing in English" may be done in a number of ways. Although ASL vocabulary is usually presented according to the grammatical structure of English, some educational programs require that every English word be signed, while others omit function words such as "a", and "the". It is not clear how different modes of "signing English" affect educational outcomes.
Proponents of Total Communication believe that if children consistently see English represented on the hands as well as seen on the lips and heard thorough amplified residual hearing, learning of English language will be facilitated. English presented by the hands can reinforce English presented orally.
Opponents argue that English is not consistently represented on the hands; it is often absent or misrepresented, providing confusing and conflicting signals to deaf children. Additionally, conversational pacing and phrasing of English is distorted. Use of selected grammatical features of ASL can enhance English signing but many hearing users do not have this knowledge and cannot adequately use the ASL systems. Advocates of ASL alone argue that signed English systems mix features of two languages, effectively representing neither.
Total Communication provides flexibility, permitting the instructor to vary the type of language input from situation to situation. The system works best when Total Communication is used consistently in the home as well as in the classroom.
Bilingual/bicultural (ASL) programs
This educational approach is based on the premise that American Sign Language with its unique grammatical structure is the naturally acquired language of deaf people. Therefore, deaf children can best learn English as a second language in written form using ASL as the language base and as a teaching vehicle. This type of program is being implemented in a number of residential schools (eg. Indiana School for the Deaf). It requires the sole use of ASL in all classes until children demonstrate ASL fluency; at that time English is taught in written form. Fingerspelling may be used from the beginning and printed materials may be used as appropriate, although it is unclear how printed materials are used with young children who do not know English. Hearing parents are encouraged to use ASL in the home to supplement classroom communication. Since most deaf children are not exposed to ASL in the home, it often requires a number of years to achieve ASL fluency. Although bilingual/ bicultural programs advocate amplification, auditory training, and speech training, it is unclear how listening and speech skills are to be developed in children who are not continually exposed to spoken language.
Cued Speech
Cued Speech is designed to visually represent the sounds of English (or any other spoken language) rather than words or concepts. It consists of eight finger configurations denoting consonants and four hand positions around the face denoting vowels. In running speech the hand cues are coarticualated with spoken syllables. The hand cues are designed to allow the speechreader to perceive differences between homophenous sounds that would otherwise look identical on the lips. Therefore, the hand cues in conjunction with the information on the lips allow a child to clearly see every sound of spoken English. Children are expected to match the visual cue with the visible mouth movement and then be able to acquire the structure of spoken English through natural acquisition processes.
In contrast to sign language, Cued Speech is not a language, but a system to facilitate reception of the spoken word. It can be learned very quickly and used to facilitate English language development in the home and school. It does not confuse the two languages, English and ASL, in any way. Cued Speech is being used in selected mainstream programs around the country (eg. Montgomery County, Maryland public schools, Fairfax County, Virginia public schools), but has received little attention from researchers and has not received the support of most deaf people and educators. There is a need for research on the effectiveness of this system as a way of developing reception of spoken English.
Educational Placement Alternatives
Self-contained classes
Self-contained classes for deaf students, either in day or residential schools, represent traditional educational settings.
Some of these programs are oral while others use some form of English signing or ASL. They offer highly structured programs. Students attending self-contained classes tend to have more severe losses than those attending integrated classes (Karchmer and Trybus, l977). The children in programs using sign language tend to come from deaf or hearing families that stress deaf culture. Residential and self-contained day schools tend to have a greater availability and variety of audiologic and other support services (Kretschmer and Quigley, l982). They also provide a larger core group of deaf peers for interaction and will sometimes have deaf teachers as well. Deaf teachers tend to sign more fluently than hearing teachers, thereby serving as good communication models.
Partial Mainstreaming
Partial mainstreaming occurs when a deaf child attends some classes with hearing students and others in a self-contained environment, usually a resource room or one-to-one instruction. In some public school environments, self-contained classes for deaf students are used instead of the resource room. This placement is appropriate for those deaf children who cannot handle all of the academic material in regular education classes, but function on grade level for some subjects.
Social Mainstreaming
All academic subjects are taken in a resource room or classroom for deaf children. The deaf children, however, are placed in regular-education classes for such activities as music, art and physical education; they are also given the opportunity to interact with hearing children during lunch and recess.
Full Mainstreaming
When the deaf child is fully mainstreamed, he or she attends a local public school in which all subjects are taken in regular education classes with regular education teachers. Typically the child uses an FM classroom amplification system instead of the personal hearing aid and receives educationally related language management. Some children who rely on sign language may be mainstreamed with the help of a full-time interpreter.
Deaf children in any educational setting rely on vision to access educational material to a far greater degree than hearing children. Mainstream classrooms may not be designed to provide total visual access and teachers may not be trained to structure their teaching styles to provide sufficient visual input. Sign language interpreting, if not used judiciously, may compete with visual stimuli in the classroom. These factors should be considered when mainstreaming is contemplated.
Regardless of the type of mainstream program in which a child is placed, support services are needed. Services include classroom amplification, speech, language, and auditory training, academic tutoring, amplification monitoring, and interpreting.
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Acknowledgements
We would like to acknowledgment the following people, whose assistance made this research synthesis possible: Fred Brandt, Senior Clinical and Research Engineer, Department of Audiology and Speech Language Pathology; Monica Payne, Administrative Secretary, Department of Audiology and Speech Language Pathology; Barbara Virven, Technology Assessment Program; Kenneth Kurlychek, Model Secondary School for the Deaf; Tracy FitzPatrick, Interpreter Sign Language Associates; Jaleh Sue Garman, Audiologist Townson State University; Melony Stanton, graduate student Department of Audiology and Speech Language Pathology.
ASSISTIVE TECHNOLOGY FOR EDUCATION
A. Literature Search
This research synthesis contains references found from the CATS and ERIC databases. CATS lists resources owned by members of the Washington Research Library Consortium (WRLC). ERIC is the on-line version of the databases produced by the Educational Resources Information Center. ERIC includes two subfiles: Resources in Education (ED), from 1966 to the present; and the Current Index to Journals in Education (EJ), from 1969 to the present. Only articles and books published since 1980 are included in this research synthesis. The literature review for what makes quality media, materials, and technology (MMT) for deaf and hard of hearing children yielded meager results. Although many educators of deaf students are using MMT, little of their work has been documented.
B. Visual Technology
Deninger (1985) reports that 96% of state schools for deaf children use computers as part of their instructional programs. Seventy six percent of all deaf education programs (including mainstreamed settings and special classrooms) report some instructional use of computers. Use of computers in school programs has likely increased since the time of Deninger's study.
Much of the literature focuses on computer-assisted instruction (CAI) in the classroom. In fact, Braden and Shaw (1987) identify 162 references that focus primarily on the application of computers for educational purposes. They report that slightly more than 9% of those references evaluate CAI efficacy, with the majority of the research descriptive in nature. Braden and Shaw question whether CAI has a true positive impact on educational achievement in deaf children compared to alternative forms of instruction. What they term "poisonous" side effects - decreased interaction among children or between children and teachers - has not been addressed in the literature.
Despite Braden and Shaw's report, computers are here to stay. Even without hard documentation, the computer appears to be a perfect tool to use in deaf education, largely because it is a visual medium. Even if computers and other instructional materials are equal in effectiveness, there is merit in having students learn to use computers as preparation for entering the work world.
Apple computers are most prevalent in educational settings, with use of IBM and compatible computers increasing (Kurlychek, personal communication). Consequently, most educational software is written for Apple computers, although software for the IBM is also available.
The ability to hear plays a small part in being able to use a computer effectively. The audible beep that signals a user to an error is an example of an instance in which audition might be required. A software program that visually displays the audible beep is available. It is called SeeBEEP. This program allows the user to run standard text or graphics applications and not miss any error messages. Each time the computer sounds an audible beep, the user can choose to have a visual, on-line screen message appear at the cursor location, or flash the entire screen. Additionally, the flashing beep can be as short as .2 seconds or as long as two seconds. This program works with most IBM or compatible computers and requires DOS 3.0 or higher. It is available from Microsystems Software, Inc. of Framingham, Massachusetts.
Apple computers address this situation in a different way. In the newer computers, (Macintosh and Apple II GS), the system software is designed to provide a visual cue when the volume control is set to zero. With the older Apple IIs, a visual indication could only be obtained if it were written into the computer software program being used. Another possible way of being alerted to a computer beeping sound with Apple II computers is to couple the sound system of the computer to a flashing light set-up (Moulton, 1993).
The criteria that make educational software effective for a deaf or hard of hearing child are the same as those for a successful program for a hearing child. Very few software programs are designed specifically for deaf and hard of hearing children; those that are, are not necessarily better or more effective.
Ken Kurlychek, materials evaluator at the Model Secondary School for the Deaf (MSSD), developed and maintains the Software Evaluation Clearinghouse for Educators of the Hearing Impaired (SECEHI). The clearinghouse is an educational software lending- library with a collection of more than 600 commercially available software programs for Apple and IBM computers. The collection is listed in a catalog titled, Software to Go. Schools interested in borrowing software pay a nominal annual membership fee. There are currently 110 member schools with 45 schools actively borrowing. Schools may borrow the software for up to four weeks. Teachers are asked to complete a review form and return it with the software (Abrams and Kurlychek, 1989). From those evaluation forms, Kurlychek has compiled a list of features that make a software program successful (Kurlychek, personal communication).
The most frequent response from teachers was that a particular program was enjoyable to students. These programs tended to use a game-like format with high-resolution graphic displays. Programs designed in this fashion motivated the students to use the software and thereby learn the material. Reinforcement for correct answers was provided by a graphic rather than a word. For example, a clown jumping and clapping indicates a correct response as opposed to merely displaying the word "correct" or "good." Similarly, positive feedback should be used to correct mistakes. Large displays of the word "wrong" should be avoided; some kind of icon encouraging the student to "try again" is preferable.
Text should be kept to a minimum, especially for younger children. The challenge is to make the instructions readable without being overly simple. Any auditory components of the program must be modified to include a visual component be it a graphic or sign language display.
Teachers preferred programs that displayed instructions on the screen and lessened the need for the manual. These programs require minimal adult involvement and allow students to work more independently. Menu-driven programs are one such example.
Teachers and students preferred programs that use visual cues to provide information as to what the computer is doing when screens change. Depending on the computer's speed, a student may not know that the computer is loading a program, processing a response, or displaying a new screen. It is important to inform the student of this. Effective programs will display a message such as "loading", or "please wait a minute." These prompts also help prevent the student from indiscriminately pressing keys to get a response. In addition, a successful program will have foolproof keying, i.e., hitting the wrong keys will not cause the program to re-boot or exit the student's document.
Teachers also liked programs that were flexible. This means the program could be used in a variety of subject areas with a variety of students. Teachers liked the ability to adjust the level of difficulty to match their students' abilities. They also reported wanting the ability to modify the program by adding specific vocabulary words.
Captioning is the process by which the audio track on television shows and videotapes is transformed into text form. Captioning can be closed or open. With closed-captioning, the text is encoded onto Line 21 of the vertical blanking interval. All captioned television shows and videotape movies are closed-captioned. A decoder is needed to retrieve the captions and make them visible on the television screen. Until recently, the decoder was a separate piece of equipment that connected to a television. Today, all televisions at least 13 inches in size that are manufactured for use in the United States contain a decoder chip, making the decoder box unnecessary.
Captioning can be a very expensive process, costing from $500 to $1,000 per program hour. This is well beyond the budget of most schools interested in having their educational and training films captioned. Open-captioning is an option for these schools. A decoder is not necessary to view open-captioned videotapes. The videotape can be played in any videocassette recorder (VCR). This also allows the original videotape to be captioned in various ways. Open captioned educational and entertainment films and videotapes are available on a free loan basis to school personal. The U.S. Department of Education funds this program. Currently the captioned films and videos are distributed by Modern Talking Picture Service of St. Petersburg, Florida.
Any pre-recorded videotape can be captioned. The equipment needed to produce open-captions is a computer system and captioning software, two VCRs (one to play the original videotape and the other to record the open-captioned tape), a television monitor, and a decoder.
There are many benefits of in-house captioning. It permits greater latitude in choosing videotapes and adapting them for educational use. Teachers can create captions appropriate to their students' language levels and reading speed. Schools can assemble libraries of captioned videotapes for everyone to share (Singer, 1991).
Currently there are four companies that produce open-caption software for both IBM computers (or compatibles) and Apple computers. The companies that produce IBM compatible software are Image Logic (AutoCap), The Caption Center (CC Writer) and Computer Prompting and Captioning Company (CPC-700). Silent Software produces FastCap software for the Apple. These software programs are menu-driven and easy to use, even for a novice computer user. The Caption Center has also produced open-caption software designed specifically for children. The software is called CC Schools. Research is being conducted to evaluate its effectiveness. Teachers at the Marie Katzenbach School for the Deaf in Trenton, New Jersey, were shown a demonstration copy of the software and commented on how easy it was to learn and use. Harkins, 1993)
Computer-assisted notetaking (CAN) is a technique that uses computer products to enhance communication access for hard of hearing people. This technique uses a computer and display to provide live notes of a meeting, lecture, or group discussion. The notes can be displayed on a computer screen, a television monitor, or projection screen. A transmissive overhead projector and projection pad are needed to display the notes on a screen to a group of people. The notetaker types a summary of what is being said. CAN should not be confused with real-time captioning, as it is not intended to provide a verbatim transcript, but rather summary notes. Of course, depending on the skill of the notetaker, and the speed at which a speaker is talking, near verbatim notes are possible (Virvan, 1991).
A computer equipped with a word processing program or text editor is needed to provide CAN. One advantage of this technique is that it can be made portable by using a laptop computer. It is helpful if the word processing program can support an expansion software program in the background, such as Productivity Plus (PRD+). An expansion software program is a time-saving device that allows the notetaker to use abbreviations (i.e. "hoh" for hard of hearing). When the abbreviation is followed by pressing the 'Enter' key, the full word appears on the screen. People's names and other frequently used vocabulary can be pre-programmed into the computer. So that projected notes can be read easily by a large group, the brightest transmissive overhead should be used. While the projection pad can be monochrome, it should be bright, have high resolution, and even contrast.
CAN has become very popular among hard of hearing groups. Of 103 people surveyed by the Technology Assessment Program at Gallaudet University, more than 80% reported watching the notes. Everyone who watched the notes said the notes were "very helpful" or "somewhat helpful." Only 20 people reported not watching the notes at all because they could either not see the screen from their seats, could hear the speaker well enough, or found the notes distracting when trying to speechread the speaker (Virvan, 1991).
CAN may or may not be feasible in a K-8 classroom situation. Again, no research is available that documents the technique's use with hard of hearing children. Educators should consider students' reading levels as well as the fact that CAN does not provide a verbatim transcript of what is said. Another consideration is the availability of a full-time notetaker who is skilled in processing spoken language into a written format. There are advantages to using CAN in the classroom. If the notes are saved and printed out, a student can get a hard copy of the day's lessons, allowing the student to concentrate more on what is being said instead of trying to take notes and listen to the teacher at the same time. Several colleges and universities have expressed an interest in exploring CAN for their students. A university setting might be more conducive for this type of support service (Virvan, 1993).
The Technology Assessment Program (TAP) at Gallaudet University and the Rehabilitation Engineering Center (REC) at the Lexington Center in Jackson Heights, New York, are collaborating on a project to test the feasibility of remote CAN for meeting and lecture situations. For remote notetaking, a notetaker would provide notes without having to travel to the location of the meeting or lecture. The notetaker would hear what the speaker is saying through a telephone link-up. The notetaker's computer would be connected to a modem so that the notes could be transmitted for display. This would address the issue of finding a skilled notetaker in a given locale.
Unlike CAN, real-time graphic display (RTGD) is a computer-based system that converts phonetic shorthand into print in real-time. Stinson et al. (1988) surveyed hard of hearing and deaf college students enrolled in classes using RTGD along with sign language interpreting and paid student notetakers. During lectures, a stenotypist inputs the phonetic shorthand equivalent of what is being said. The system converts the code to print which can be displayed on a television monitor, a projection screen or be printed as hard copy.
Students reported higher ratings of understanding with real-time text as compared to interpreting. The students from a mainstream educational background were more likely to prefer the RTGD compared to students from residential school settings. Their conclusion was that students who are highly skilled in reading, writing and speechreading were more likely to prefer the RTGD over an interpreter. Stinson et al. emphasize that these students are proficient skilled readers. These findings further support the idea that CAN and RTGD are support services requiring higher reading skill levels than those normally found in the K-8 population.
However two of the products used for CAN, the transmissive overhead projector and projection pad, can take on other applications in deaf education. Any computer screen can be displayed onto a projection screen with this equipment. This might be useful for teachers who want to display charts, computer menus, and any combination of text and/or graphics being used for instruction purposes.
The advent of interactive videodisc systems in education has allowed students to become active learners instead of passive learners. Interactive videodiscs are very flexible, providing for random access, endless repetition, and the ability to freeze a single frame while maintaining high clarity. Entire movies, filmstrips, pictures, and books can be stored on one disc. Information can be presented at the user's own pace and level. These characteristics make interactive videodisc ideal for deaf and hard of hearing students who often have difficulty mastering the interactions between language and action. Through the use of this technology, language concepts can be represented visually (Propp, Nugent, Stone, & Nugent , 1981; Jones, 1986; Helsel, 1988).
The equipment necessary for interactive video are a computer processing unit and display monitor, a videodisc player, and an interface card to connect the video machine with the computer. A printer is optional.
The Media Development Project for the Hearing Impaired (MDPHI) at the University of Nebraska was one of the first groups to develop, produce, and evaluate videodisc programs for deaf students. MDPHI's series of discs was designed to teach language development, social studies, and fingerspelling. One of its first discs, "Israeli Boy: Life on a Kibbutz," used multimedia to include teacher guide materials, vocabulary instruction, filmstrip-type sequences and interactive quiz sections. This disc was evaluated with students and teachers at the Iowa School for the Deaf and the Nebraska School for the Deaf. Students reportedly had no difficulty using the technology, and it was concluded that videodisc was an effective tool for education (Propp et al., 1981).
One major benefit of interactive video in deaf education is that it allows for bilingual language instruction for deaf children. American Sign Language (ASL) video can appear with an accompanying English language text. This is the format used with /HandsOn/, one of the newest videodisc programs to combine sign language and English. /HandsOn/ is a joint research venture with IBM's Thomas J. Watson Research Center in New York and the University of California at San Diego. Currently being used at the California School for the Deaf at Fremont, it allows students to go back and forth between an ASL video and English print version of a story. Its design is based on the premise that students work best when presented with options and when allowed to make their own decisions. Students can choose to read a story, watch a story, caption a story or review vocabulary. Results of some initial evaluations of the /HandsOn/ program show students answering reading comprehension questions significantly better after using the program (Hanson & Padden, 1989; Copra, 1990).
Another disc developed by MDPHI was encoded with closed captions. This disc demonstrated the possibility of videodiscs having closed captions. Jones (1986) notes an advantage of captioned interactive videodiscs over captioned videotapes in relation to reading speed and comprehension. It is an accepted fact that one cannot read as fast as one can listen. Despite the push for verbatim captioning, captions are often edited to allow for a comfortable reading level. In an educational setting, this can result in oversimplification, with the student receiving minimal linguistic benefits. When interactive videodisc programs are used, a single frame can be frozen to allow the student to read an entire verbatim caption. The linguistic content is maintained and the student can proceed at his/her own rate.
King (1993) reports that the availability of captioned multimedia programs remains a problem for deaf and hard of hearing people. More entertainment than educational programs are captioned on videodisc. Even when videodisc programs are closed captioned, problems exist when they are used in an interactive environment. Captions embedded in analog video can be garbled or disappear temporarily or permanently when viewed randomly. Sometimes the captions appear over scene changes or are out of sync with the program's audio.
King further states that despite these problems, the future of video is digital, rather than analog. Digital audio is both relatively easy and inexpensive to create. This poses a major obstacle for computer users who depend on visual access and cannot take advantage of digital audio's widespread use. King makes a case for multimedia developers to include captioning in their products. According to the Americans with Disabilities Act (ADA) of 1990, reasonable accommodations need to be made for disabled people. Second, she states that captioning can be helpful to more than deaf and hard of hearing people. Many speakers of English as a second language can read captions to try to improve their English language skills. Captioning is also being used in museum exhibits, and the new decoder chip televisions can be used in bars and other noisy environments to provide access to the spoken word when conditions make it difficult to hear.
King (1993) lists three conditions that are necessary before captions can routinely be included in multimedia programs: "provision of captioning capacity within the multimedia environment, tools for creating multimedia captions, and extensive use of captioning capacities." (p. 8)
C. Auditory Technology
Assistive listening devices and systems (ALD) are used to increase the signal-to-noise ratio in difficult listening situations. Close placement of the microphone to the sound source helps to negate the adverse effects of reverberation, background noise, and distance. The original signal is delivered to the listener's ear. Ross et al. (1982) measured noise levels in 45 classrooms under normal conditions (i.e. children present). They found the average noise level to be 60 dB (A) with a standard deviation of 7 dB. This supports the fact that classrooms can have poor acoustics for optimum listening. When a person with a hearing loss is in this environment, the situation is even worse. Any amplification system that is selected for use with a deaf or hard of hearing child should provide as much as possible of the important acoustic speech features in the highest quality signal.
Induction loop systems consist of an audio power amplifier that is connected to a cable, or loop. The loop is placed around the perimeter of a room, or a section of a room. The amplifier receives the signal via a microphone, tape recorder, or other source. The signal is converted into an electrical signal, amplified, and then sent through the loop. The signal is transmitted in the form of electromagnetic energy that can be received by the telecoil in a hearing aid or by a personal induction receiver. The listener must be seated within the looped area to receive the amplified sound.
Large area induction loop systems can be permanently installed in theaters or churches, or be portable for use in meeting rooms or lecture halls. Small area induction loop systems are also available for use at work to loop a meeting table, or at home to loop an area to watch television.
Some benefits of induction systems are that they are relatively inexpensive, and it is easy to use and troubleshoot. They require a minimum amount of equipment because the listener uses his/her own hearing aid set to the telecoil position. One drawback of an induction loop system is that weak spots in the loop cause the transmitted signal to be inconsistent in strength. Another disadvantage is that the electromagnetic signal travels through walls causing interference in adjacent areas with a loop. This is referred to as spillover. One other weakness of the system is that it does rely on an individual's hearing aid telecoil. Many smaller hearing aids do not have telecoils, and for those that do, it is usually the 'weak link' of the aid. If a person's telecoil is malfunctioning or weak, the loop will not be effective.
Induction loop systems are being used in K-8 classrooms. There is no documentation to support their effectiveness in this situation; all reports are anecdotal. Induction loops are often used in communal areas such as auditoriums and large lecture halls where spillover is not a consideration.
One company, Oval Window Audio of Nederland, Colorado, has addressed the spillover and weak signal problems by developing a 3-D loop system. The cables of the 3-D loop system are embedded in a special mat that is placed under carpeting. Because the three loops are oriented at different angles, the 3-D loop system provides better field uniformity, resulting in a constant and clearer signal. Spillover is minimal allowing adjacent rooms to be equipped with the 3-D loop system (Hendricks & Lederman, 1991).
Another innovative product by Oval Window Audio is the Multisensory Sound Lab. It is an audio system that amplifies sound while simultaneously providing visual and vibrotactile displays. Sound signals from microphones, musical instruments, tape recorders, compact disc players, and other sources are processed and directed to loudspeakers and a specially designed vibrating floor. The floor vibrates slowly or quickly, depending on the sound frequency. Intensity and rhythm are also perceived through the floor. There are two ways to visually display the signal. One is via a spectrum analyzer that displays the harmonic content on a color television as vertical bars, changing in location and height depending on the sound characteristics. The other is via a seven-foot column consisting of three banks of colored lights that respond to different sound frequencies and intensities.
The Multisensory Sound Lab was created to teach the science of sound to deaf students. Other applications, for hearing students as well as deaf and hard of hearing students, include speech therapy, music instruction and science education.
Frequency modulation (FM) systems are the most versatile of all the listening devices. FM systems work on the same concept as FM radio waves. The Federal Communications Commission (FCC) has reserved the frequency band from 72 to 76 MHz for FM use. This allows for 40 narrow-band channels and 10 wide-band channels. With FM, the primary signal is picked up by a microphone, optimally placed six inches from the intended sound source. The signal is then converted into an electrical signal which is modulated and transmitted on a radio wave to an FM receiver. The receiver demodulates the signal into an acoustic signal that the person can hear. FM can be used in conjunction with a personal hearing aid via direct audio input (DAI), a personal neckloop or with headphones.
FM systems have many advantages. They provide high fidelity gain with low harmonic distortion and a high signal-to-noise ratio. There is great flexibility in their electroacoustic fitting. The sound pressure level of the teacher's voice can be controlled. FM systems are portable, which allows for greater student and teacher mobility, and can be used indoors as well as outdoors. Spillover is not a factor with FM systems as it is with induction loops (Pimental, 1981, Berg, 1986).
Many studies have focused on the frequency response of hearing aids when coupled to FM systems (Van Tassel, et al. 1980, Berg, et al. 1983). Hawkins (1984) compared several different hearing aid/FM system combinations with nine school-aged children with mild to moderate hearing losses. He reports an improvement of +12 to +18 dB in the signal-to-noise ratio using an FM system instead of a hearing aid alone. Even with preferential seating, he noted an FM advantage. The preferred classroom hearing aid arrangement was binaural amplification with a directional microphone.
Ross et al. (1982) strongly support the use of FM auditory trainers with all hard of hearing children in order to maximize their speech perception. They cite an earlier study by Ross, Giolas & Carver (1973) where word discrimination scores were obtained on 11 hard of hearing students in two test conditions. The first condition was with their regular monaural or binaural hearing aids. The second was with an FM auditory trainer. Word discrimination scores improved 12%-76% in the second condition. These results present a strong case for the use of FM in the classroom.
Maxon et al. (1991) conducted two surveys to see how FM systems were chosen, used and accepted. Sample 1 was polled during the 1981-82 school year and Sample 2 was polled during the 1988-89 school year. Their questionnaire had three parts, addressing school personnel data, attitude data and child descriptive data. Some key findings of their surveys showed that children and their parents were not included in the decision making process regarding which FM to evaluate and purchase. Once an FM system was deemed necessary, it was often selected by the school administrator based on the lowest bid submitted.
The audiologist was the person responsible for adjusting the electroacoustic characteristics for the FM system, but not responsible for selecting and maintaining the system. This role of the audiologist did increase in Sample 2.
Both samples reported that FM systems were more likely to be accepted by elementary school children than junior or senior high school students. One way to remedy this situation is to set up support groups, as advocated by Leavitt (1991). These groups can be valuable for demonstrating and promoting the use of the assistive technology.
Maxon's survey also showed that full-time FM use declined in Sample 2 as compared to Sample 1. Along with this, daily troubleshooting only occurred 50% of the time. This is a disturbing finding as breakdown can be a major reason for not accepting or using the FM on a full-time basis.
It is obvious that fitting a child with an FM system does not ensure success. In an educational setting, much of the student's success with the device will be based on the teacher's ability to use the device appropriately and correctly. The educational audiologist also needs to be well versed in the technology being used. Annual in-services were reported to be insufficient by Maxon's samples. They requested more frequent training for monitoring malfunctions.
Soundfield amplification refers to the use of a public address (PA) type system to amplify an instructor's voice in a classroom situation. Using this system, the signal-to-noise ratio at the listener's ear can be enhanced by +12 dB, provided the ambient noise level in the classroom does not exceed 60-65
Sarff (1981) describes the Mainstream Amplification Resource Room Study (MARRS) conducted on fourth, fifth, and sixth grade students with minimal hearing loss in southern Illinois. One objective of the study was to determine if the students' educational deficits, as measured by standardized achievement tests, could be corrected in a mainstream school program. One of the intervention strategies used to achieve this objective was a soundfield amplification system. The soundfield amplification system consisted of a unidirectional microphone and a wireless transmitter worn by the teacher. A wireless transmitter receiver, a power amplifier, and two 12-inch loudspeakers were installed in the classroom. This treatment was compared to using the school's standard curriculum in a resource room setting.
While pre- and post-treatment scores showed both treatments to be effective, the soundfield situation was more effective.
The increase in scores was more pronounced with the fourth to fifth grade groups than the fifth to sixth grade groups. Sarff suggests that the use of soundfield amplification may be most effective in younger children.
Some other advantages to using soundfield amplification in the classroom are that all children can benefit from the increased signal-to-noise ratio, not only hard of hearing children. Likewise, hard of hearing children are not singled out from their hearing peers. Teachers also reported liking the system because they did not have to strain their voices to be heard. They said amplification lessened their fatigue and allowed them to move around the classroom more easily.
Jones (1985) also examined the effects of soundfield amplification in kindergarten classrooms. In this study, groups of hard of hearing and hearing students were seated in the middle of a classroom. They were asked to mark multiple-choice pictures in response to the words they heard from a tape recorder. The tape recorded words were presented in three different ways: Treatment A (from a desk in a corner of the room with no amplification provided), Treatment B (from a desk close to the center of the room with no amplification provided), and Treatment C (from a desk in a corner of the room with the sound being delivered to two ceiling speakers through soundfield transmission). The lowest mean listening percentage was obtained from the hard of hearing students in the Treatment A condition. This suggests that listening problems can exist in kindergarten classes when teachers are speaking at a distance from hard of hearing students. These listening difficulties may be diminished by having the teacher move closer to the students when speaking, or by using a soundfield amplification system. Even with preferential seating, however, only 83% of the original signal is received (Leavitt & Flexer, 1991).
Although soundfield amplification has proven to be successful in specific situations, it would not routinely be the educational amplification system of choice. Leavitt (1991) cautions against using soundfield systems to guarantee reception of a high fidelity signal. Leavitt strongly advocates for a distance of six inches between the teacher's mouth and the child's ear. The only way to achieve this is by using an FM system.
D. Recommendations
Listed below are some general considerations when developing quality MMT for deaf and hard of hearing students:
Visual - Be as visual as possible. Present information in picture or graphic form whenever feasible. Text should be presented in simple language and kept at a minimum.
Accessible - Develop MMT that is initially accessible to deaf and hard of hearing students, instead of adapting the technology to fit their needs afterwards. This helps raise awareness and keep costs down.
Affordable - Develop MMT that schools can afford. School budgets are getting tighter, not bigger.
Listed below are some specific recommendations for developing quality MMT for deaf and hard of hearing students:
Microcomputers
- More integration of IBM computers in education
- Include built-in visual indicators
- Continued development of educational software programs containing the following features:
- Game-like formats with high resolution graphics
- Graphics for reinforcing correct answers
- Graphics for positively encouraging correction of mistakes
- Minimum of text and text in simple language
- Menu-driven programs
- Visual cues as to what the computer is doing
- Ability to be modified for use with different skill levels
Captioning Systems
- Develop more user-friendly, open-caption software programs for IBM and Apple computers
- Develop more open-caption software programs designed for use by students
Computer-Assisted Notetaking
- Increase use and applications of existing technology
- For large group applications where notes are being projected onto a screen, develop more word processing programs that have large font sizes and the ability to change sizes and fonts
- Develop user-friendly keyboard expansion software programs
- Develop quieter keyboards and overhead projectors
- Develop overhead projectors that work well when the lights are on
Interactive Videodisc
- Develop more captioned educational videodisc programs
- Continue to develop ASL/English videodisc programs for bilingual education
- Provide digital equipment at affordable prices
- Provide captioning capability within multimedia environment (King, 1993)
- Provide tools for creating multimedia captions (King, 1993)
- Investigate feasibility of developing materials using CD-ROM and related technology (Loeding & Abraham, 1993, Lipton & Goldstein, 1993)
Induction Loop Systems
- Develop standards for induction loop systems and hearing aid telecoils
- Continue to develop innovative products like Oval Window Audio 3-D induction loop system
FM Systems
- Promote development and use of universal cord and boot systems for direct audio input coupling of personal hearing aids to FM system
- Build systems to be more durable, reliable and easy to use and operate
Ross, et al. (1982) and Leavitt (1991) suggest that FM systems contain the following:
- Individual controls for adjusting frequency response and output of system.
- Provide auxiliary microphone input capabilities for movie projectors, multiple microphones, and other sources
- Allow for binaural reception of environmental sounds
- Easy to see and read low battery indicators
- Switch allowing for environmental microphone only, and teacher's microphone only
- Directional microphone for teacher
- For multiple speaker situation, voice-activated microphone mixing system
- Ability to switch between carrier frequency on receiver and transmitter
- Automatic recharging and shut-off when in storage/charging unit.
- Ability to operate on 9-volt battery as well as rechargeable battery
Soundfield Systems
- Install soundfield systems in classrooms to be used as a supplemental listening system
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RECEPTIVE SKILL DEVELOPMENT
Harriet Kaplan
This section of the research synthesis is concerned with the development of auditory skills, speechreading, and related communication strategies. Material is included on orientation to and use of technology essential to optimal use of these skills (hearing aids, assistive listening devices, and cochlear implants).
The following databases, covering the period from January, 1981 to June, l993) were used for this synthesis:
This synthesis deals with deaf and hard-of-hearing children from preschool through grade 8. Not included are children with central auditory processing disorders, auditory learning disabilities, deaf-blindness or other disabilities in addition to deafness.
Although review of the literature revealed essentially no research data on guidelines and criteria for media, materials and technology, there was a considerable amount of expert opinion. Therefore, the following discussion is based largely on expert opinion, including the author's own experience.
Development of Auditory Skills
Development in hearing children
Auditory skills development in hearing children is based on three sequential and overlapping levels of perception (Aslin and Smith, l988). The most basic is the sensory primitive level in which the child becomes aware or detects the acoustic signal. The second level involves development of perceptual representations; the child uses sensory patterns to discriminate differences between sound features. The highest level is the cognitive/linguistic in which the perceptual representations are organized into meaningful units. This level involves the skills of word recognition and sentence comprehension.
Each of these levels contains sub-categories (Laughton & Hasenstab (l993). The sensory primitive level includes not only awareness but also localization of the source of the sound, selective attention to the wanted sound, and sustained attention which allows the child to focus on relevant information for increasing periods of time.
The discrimination level consists of:
According to Laughton and Hasenstab (l993, p. 146),
"Auditory learning requires the integrity and interface of sound detection, auditory processing, and cognition. A breakdown at any of these levels will interfere with or inhibit auditory learning. Hearing loss negatively affects auditory skill development at all levels because learning for deaf or hard of hearing children is organized with partial or absent sound information. Without intervention, deaf and severely hard of hearing children may not be aware that objects, actions and events have auditory characteristics and that events may be symbolized by spoken language. With early and intensive intervention, most deaf and hard of hearing children can develop higher order representation and cognitive/linguistic functions but skills are often delayed. Frequently speechreading and/or sign language provide part of the necessary language input."
Intervention Principles
In order to succeed in a regular classroom, a child who is deaf or hard of hearing must be able to attend to a speaker and try to understand what is said. By fourth grade children are expected to function independently in the use of receptive language (listening and reading) and expressive language (speaking and writing) to support learning in the content areas. Therefore, the child must master the hierarchy of listening tasks described in the previous section on normal development of auditory skills.
Training in auditory skills is an essential component of all types of programs. It is needed by children with all degrees of hearing loss and for optimal use of hearing aids, assistive listening systems, and cochlear implants. Auditory skill development is maximized when combined with speech production activities and oral language acquisition (Paterson, l982; Ling, 1978; Ling & Ling, 1978). Therefore, speech stimuli using linguistic forms and structures appropriate for the child's level of language development should be used for training rather than non-linguistic sounds. However, it is appropriate to include some work on identification of meaningful environmental sound.
Early auditory training programs focused on discrimination between nonverbal sounds such as bells, drums, and whistles and later progressed to speech sounds and words. They tended to exclude the more complex types of verbal communication that children need in life situations. Ling (l986) stressed that discrimination training should not be a primary focus. Instead, real life experiences should form the basis of listening training. Discrimination activities should be used only for remediation when children are unable to succeed at identification and comprehension activities.
All auditory training curricula should include activities in the areas of detection, localization, selective attention, discrimination, auditory memory and sequencing, closed set identification (limited response choices), open set identification (unlimited response choices), and comprehension. In addition, figure-ground activities should be included using a variety of noises, signal to noise ratios, and degrees of reverberation to simulate the difficult listening conditions of most classrooms. Children also need training to monitor their own speech production and to attach meaning to environmental sounds.
Paterson (l982) stressed the need to train students to use prosodic information such as stress and intonation to interpret meaning. Such cues are available to most profoundly deaf students using proper amplification. Children may be taught to differentiate between questions, statements and commands, to recognize differences in meaning conveyed by word boundaries and how syllables are stressed. Prosodic information also conveys affective state. Paterson suggests the use of role plays to teach these concepts.
Auditory skills should be taught in meaningful contexts such as routine daily activities. For example, discrimination of soft and loud sounds can be taught within the context of a cooking activity and accompanied by appropriate language input (Robbins, l990; Erber, l982). Some established auditory training curricula are too narrow in focus, requiring children to listen in restricted contexts, with limited response choices, and with limited use of language and speech skills (Robbins, 1990). Ling (l986) points out that unless auditory training activities occur in meaningful contexts, children will view them simply as exercises and not generalize skills to communication situations in real life.
Some form of assessment must be part of all curricula and intervention programs because deaf and hard of hearing children have a wide range of skills and needs. Individualized programming must be based on assessment of skills. Erber (l982) proposes that auditory detection, discrimination, identification and comprehension skills be assessed with a variety of speech stimuli including speech elements, syllables, words, phrases, and sentences.
Speechreading is an integral part of normal speech perception and is important in production. Therefore, speechreading training should be integrated with auditory skill and speech production development. Some training activities should be unimodal (auditory or visual), while others should be bimodal (audiovisual). The current trend is toward increased bisensory training to facilitate integration of auditory and visual cues.
Edwards (l991) presents principles which should be considered in the development of skills within auditory training curricula:
Activities may be analytic or synthetic in nature. Analytic training, also called "bottom up", uses a step-wise approach from detection to discrimination, using drill-type procedures, to closed set identification to open set identification to comprehension. There is some question about the value of drill-type detection and discrimination activities for improved identification and comprehension of speech needed for everyday listening situations (Doehring and Ling, l971; Erber, l982). Listening for meaning requires learning environments where acoustic cues may be combined with contextual and situational information (Doehring and Ling, l971; Erber, l982).
There is some contention that analytic auditory training is important for speech production. However, authorities agree that learned analytic skills must immediately be used in meaningful language context for generalization to occur (Cole & Paterson, l984; Erber, l982; Ling, l976; Paterson, l982).
Synthetic approaches, also called "top-down" or language based, focus on sentences or connected discourse in meaningful situations and stress conversational interaction. Erber (1982) describes a Natural Conversational Approach that may be used in class throughout the day. The teacher speaks to the child naturally without visual cues, focusing on whatever auditory skill level (eg. discrimination, identification) is appropriate for the child. If, despite situational and contextual cues, the child does not respond appropriately, the teacher uses a remedial strategy that involves presenting the same material using a lower level auditory skill. For example, the teacher might ask a child to identify a picture in a book; if the child is unable to respond, the teacher might repeat the request using a discrimination format such as "Is this picture ______ or ______?"
Erber (l982) describes a second synthetic approach that he calls "Moderately Structured". Identification and comprehension training follow a classroom activity, using vocabulary appropriate for that activity and language structure appropriate for the language level of the class. The Experience Story exemplifies this approach. After the teacher and children talk about an activity, the teacher writes a series of descriptive sentences on the board using language elicited from the children. This language is then used for identification and comprehension activities.
Erber (l982) also describes his concept of "adaptive communication" which may be used for analytic, natural conversational, or moderately structured approaches. It involves expansion which is used if a child is able to perceive speech with no difficulty at a particular level of vocabulary and syntactic complexity. The teacher substitutes new vocabulary or more difficult language structure. If, on the other hand, the child experiences difficulty with the task, a remediation approach is used. The teacher might repeat, clarify or emphasize the original presentation, substitute more familiar vocabulary or simpler language, move to a lower level response (eg. discrimination rather than identification), or use visual cues in addition to auditory.
A program or curriculum can include both analytic and synthetic activities. Analytic training can be used during individual therapy to remediate specific weaknesses or provide auditory support for speech production activities. Synthetic activities can be integrated into the classroom curriculum and individualized using adaptive communication. An optimal training program should include both bottom-up and top-down activities.
The following guidelines and criteria are based on the intervention principles discussed in the previous section:
All auditory training activities are predicated on the proper use of hearing aids. In order to use hearing aids well, children need the continuing and consistent support of teachers and parents who are knowledgeable about their benefits, limitations, use, care, and maintenance. With this support, children can assume increasing responsibility for the use and care of their hearing aids as they become more mature.
Hodgson (l986) describes the components of a good hearing aid orientation program. It should include:
a. insert, replace, and care for batteries
b. adjust the volume control
c. properly use the telecoil
d. insert and care for the earmold
Many researchers have evaluated hearing aids that children bring to school, and have found a high incidence of malfunction (Diefendorf and Arthur, l987; Kemker, McConnell, Logan, and Green, l979; Potts and Greenwood, l983; Hanners and Sitton, l983; Bess and McConnell, l981; Elfenbein, et.al., l986; Busenbark & Jenison, 1986). A number of studies have shown that direct parent and teacher training using lectures, demonstrations, sound/slide programs, and videotapes resulted in significant reduction of hearing aid malfunction (Foust and Wynne, l991; Deifendorf and Arthur, l987; Hanners and Sitton, l974). A workbook entitled "Orientation to Hearing Aids (Gauger, l987) has been found useful for these programs.
Sanders (1982), Berliner & Eisenberg (1985), Davis & Hardick (l981), Von Almen and Blair (l989) recommend that deaf and hard of hearing school children also receive information about effects of hearing loss on communication, hearing aids, and assistive listening devices. Hearing aid orientation objectives and activities should be part of auditory training curricula
Assistive listening devices, primarily FM systems, are used in many schools. Orientation to these systems is similar to hearing aid orientation. In addition to the need to understand benefits and limitations, proper use and care, and trouble-shooting procedures, parents, teachers, and children need to become comfortable with the following special features of FM systems:
Search of the literature revealed no research on orientation to assistive listening devices nor descriptions of orientation programs. There is a need to incorporate objectives and activities on orientation to FM in school curricula and a need for studies evaluating the benefits of such training.
Many auditory skills curricula and hearing aid orientation programs have been developed by residential and public school programs for deaf children (eg. Kendall Demonstration Elementary School, Fairfax County, VA). In addition to curricular materials, programs for parents, teachers and older students, designed to improve use of amplification in the classroom, are available (Gauger, 1987; Hanners & Sitton, 1974, and Nussbaum, l988). Most of the auditory skills curricula follow the model described by Erber in his book entitled Auditory Training (l982). This book is a excellent general reference on development of auditory skills. A few of the auditory skills curricula have been disseminated outside of local school districts and are used around the country. Some have served as prototypes for local programs. Several of the better known curricula are described and critiqued in the following section.
Auditory Skills Curriculum
One of the most widely used programs is the Auditory Skills Curriculum which is part of the Auditory Skills Instructional Planning System (Los Angeles County Superintendent of Schools, l976). This curriculum was developed for and standardized on over 800 deaf and hard of hearing children from ages 3 to 12 with a wide range of sensorineural hearing losses. types of amplification. The children used various types of amplification, and attended total communication, oral, residential and mainstream education programs.
The curriculum is divided into four major areas: discrimination (includes detection and attention), memory-sequencing, figure-ground (difficult listening conditions), and
auditory feedback (use of audition for speech production).
Within each area, long term objectives (called terminal performance objectives or TPOs) are presented in order of difficulty. For each TPO, there is a sequential series of short term objectives (called intermediate performance objectives or IPOs), leading to successful completion of the long term objective. The IPOs are directly measurable because they are stated in behavioral terms and are accompanied by criteria. Activities are presented for each IPO.
Goals and activities follow the developmental model of auditory skills and are sequenced from easy to difficulty based on linguistic redundancy and acoustic similarity of stimuli within a discrimination task. Early activities focus on suprasegmental features, and as skills are developed, increased emphasis is placed on segmental features.
The practice materials for each IPO are referenced to the educational level of the student (eg. preschool, primary, etc.) and teachers are encouraged to develop variations, supplementary activities, and individualized objectives as appropriate. Language level and content of the activities can reflect academic curricula and social communication. There is a preschool supplement designed to meet the needs of deaf and hard-of-hearing children from birth to four years. All activities are presented first in a multisensory mode (signs, speechreading, audition). Visual cues are gradually reduced until the child is successful in the auditory mode. Familiar material may be initially presented in the auditory mode, with remedial strategies applied if the child has difficulty.
The Auditory Skills Curriculum may be used with the Test of Auditory Comprehension (TAC) to suggest the starting place in the curriculum for a child. As an alternative, the child may be placed on the curriculum by assessing IPOs sequentially in each curriculum area until appropriate levels are found.
Developmental Approach to Successful Listening (DASL)
The DASL was developed for deaf children from age 2 through secondary school. It is designed to be used in individual therapy sessions rather than in the classroom. The program is highly structured and analytical, involving a hierarchy of auditory skills. The steps between subskills are very small, minimizing difficulties children might experience moving from one objective to the next. The activities for the subgoals are games, designed to motivate the child. The games and the language can be individualized so that the activities can be used at any age or language level.
Three areas of auditory skills are included in the curriculum. Sound awareness includes care and use of amplification, detection, localization and selective attention. Auditory comprehension includes various levels of discrimination, memory/sequencing, identification and comprehension. Phonetic listening skills help children use their hearing for speech production, thus integrating speech production with auditory skill development. After successfully completing the curriculum, a child may work on any of the subskills in a background of noise or competing signal. Subskills from different sections of the curriculum may be developed concurrently after the child has completed basic goals in the Sound Awareness section.
A DASL Placement test is included with the program. Its function is to identify where the child should begin in the different areas of the curriculum.
Critique
The Auditory Skills Curriculum and the DASL provide goals and activities in the areas of selective attention, discrimination of supra-segmental and segmental features, identification, comprehension, and figure-ground differentiation. Although the Auditory Skills Curriculum follows the normal developmental pattern of auditory skills, little time is spent in development of basic skills such as detection; hearing aid orientation is not included at all. School curricula based largely on the Auditory Skills Curriculum (Auditory Skills Curriculum, Fairfax Co. VA., l984; Auditory and Speech Training Curriculum Guide, Kendall Demonstration Elementary School, 1988) have recognized these deficiencies and have incorporated objectives and activities on detection, localization, selective attention, and hearing aid orientation. The DASL, in contrast, deals well with basic level auditory skills and hearing aid orientation.
Both curricula include goals for voice monitoring and use of hearing for speech production, thereby integrating speech production and auditory skill development. The Auditory Skills Curriculum stresses audiovisual integration, and provides for the strategies of remediation and expansion. The DASL deals exclusively with auditory skills.
Although both programs present activities in sequential order of difficulty, the steps between short term objectives are much smaller in the DASL. Because goals and objectives in both curricula are presented in several areas concurrently, it is possible for a child to work on more than one skill at the same time. Both programs provide assessment procedures.
Both curricula are applicable to a wide