WHAT WE THINK WE BECOME (BUDDHA) AND WHAT WE HEAR IS WHAT WE SPEAK (Hear Me Speak)

A Session Summary to understand how speech is developed in children with hearing loss!

The first and foremost thing every parent of a child with hearing loss asks is, ‘when will my child start speaking?’

One needs to understand that speaking is directly related to our listening experience.

So when do we start hearing? And what is the difference between Hearing and Listening?

Typically in human beings, the hearing ability is functional by the 20th week of gestation. This means that at birth typical hearing infants have 20 weeks of auditory neural experience, in utero.

So the point to understand here is that in kids with congenital hearing loss, the brain didn’t get access to those sounds which had been presented before birth. Therefore if the hearing loss is diagnosed at the age of six months, the auditory deprivation for the brain has been for ten months already, leading to speech and language delay.

We all hear with the brain; the ears are just a doorway ( Carol Flexor) and the hearing loss restricts the sound from reaching the brain.

Let’s also understand the difference between Hearing and Listening.

Hearing is an act of perceiving sound and receiving sound waves through the ear.

Listening is the act of hearing a sound and understanding what one hears after the brain processes the meaning from words and sentences.

As mentioned above, hearing is first provided and then listening develops followed by development of spoken language.

A typical hearing child speaks four to five words at the age of one year. This speech stage comes when the child has already had a hearing age of sixteen months and good listening environment. For children with hearing loss the stages for speech and language development are the same. Their speech will depend upon the appropriate fitting of the technology whether it is hearing aids or cochlear implants, auditory verbal therapy, good listening environment and the most important thing, the active involvement of the family in the process.

A good voice pattern can only be learned through listening. It improves the child’s ability to self-monitor and self-correct and reduces exaggerated and evident mouth movement.

There is some research done which shows how much practice is needed to influence the neural structure for speech and language development. The Hart and Risley study says that by 4 years of age typical hearing children have hear around 46 million words.

According to Pittman, children with hearing loss require 3 times more exposure to learn new words and concepts and yet they do not have 24/7 hearing.

It is imperative for the parents to understand the significance of language rich environment and providing the same to the kids following the Learning and Spoken Language strategies in a day to day routine.

LSL STRATEGIES FOR SPEECH AND LANGUAGE DEVELOPMENT

Listed below are some of the Listening and Spoken Language Strategies which parents should use in their conversation with the kids having hearing loss:

MOTHERESE/ PARENTESE: It is the sing song voice pattern like lullabies, generally used with babies. It helps to gain the attention of young toddlers and babies towards auditory signal.

REPETITION

It is an indirect or informal language stimulation technique where a targeted sound, word, phrase or sentence is said more than one time. In the first year of hearing, this strategy is very helpful.

 

AUDITORY BOMBARDMENT

Kids are bombarded with specific target words or sounds time and again for maximum auditory exposure.

 

BREAKING UP

Multi syllabic words can be broken into smaller units thus making it easier for the kids, followed by full word exposure e.g., spaghetti, caterpillar.

 

SCAFFOLDING

Build upon new vocabulary and language on already known language so it becomes easier for the kids to comprehend.

 

WAIT TIME

It is the pause used between an adult’s interaction with a child that allows the child time to process the auditory information and formulate a response.

 

It is a very important strategy and should always be remembered by the parents especially in the initial months when auditory memory is building up.

 

AUDITORY SANDWICH

It is useful in almost all the age groups and especially implemented with kids dependent on speech reading.

 

In this, information is presented through listening before the introduction of visual or other support information is given and then auditory input is repeated again.

Its purpose is to encourage comprehension and communication through the child’s auditory abilities.

ORAL MOTOR EXERCISES

Oral cavity and muscles play an important role in speech acquisition and development which is generally not very well developed in kids with hearing loss.

 

Here are some exercises to help for the same

  • Breathing Exercises
  • Blowing (cotton balls, candles, feathers, bubbles)
  • Sucking (with short, long and twisted straws)
  • Chewing
  • Tongue Rotations (licking chocolates, honey and ice creams smudged around the mouth)

 

GAMES AND ACTIVITIES

 

Early intervention is undoubtedly important but without compromising on the chuckling childhood of our little munchkins. So here are some of the fun filled games through which parents can practise speech therapy:

 

  • Build up blocks and knock them down
  • Drop things in water
  • Put Ice cream sticks in play dough
  • Throw balls in a bin
  • Jigsaw puzzles
  • Build lego and house pieces
  • Zooming vehicles down a slide
  • Dropping objects through a pipe
  • Putting candles into a playdough cake
  • Banging things with a toy hammer
  • Pegs in pegboard

Most Importantly: Follow the Child’s Lead.

Although after doing everything, dedicating time and energy, putting in efforts in the right direction sometimes the child doesn’t progress as expected, there is no need to panic but be vigilant and patient.

Check the child’s speech in relation with his aided audiogram

Optimal Hearing aid programming / Cochlear Implant mapping

Be patient and encouraging, learning to listen and speak with confidence is inculcated and is a learning process which needs its own sweet time.

If you have any concerns, never hesitate to question the related Professional.

BELIEVE AND MAKE BELIEVE, CHILD WILL LEARN TO LISTEN AND SPEAK.

 

Session Conducted by: Ritu Nakra (LSLS Cert.AVT)

Session Hosted by: Chetana Misra

Session Complied by: LE Nyla Ahamed

 

 

 

 

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A thumbnail summary of an interactive colloquy session with the renowned and professed ENT specialist and Cochlear Implant Surgeon Dr. Shomeshwar Singh :

1          WHEN TO CONTACT YOUR CI SURGEON?

If there are any signs of inflammation at the implant site i.e. Redness, Swelling, and Pain. In general falls or bumps won’t affect either the external processor or internal implants. Rush to the doctor if there is any bruising or bleeding.

2          WHICH SPORTS TO AVOID?

As general advisory only contact sports with direct impact on implant sites and implants are restricted like Boxing, Wrestling, Kabaddi. Other games like football, basketball, cricket can be played with necessary preventive measures and the adjunct help of advanced accessories.

3          HOW TO TACKLE SWEAT RELATED IRRITATIONS?

Normal powders can be applied for the same after taking out the processors at night time. In general ointments or medicines can be applied on the implant site too if required if there are no signs of cuts or bruise.

4          IN SITUATIONS OF COMMON COLD AND COUGH?

Not only in cochlear implant recipients but in persons with typical hearing too, there is a dip in hearing due to cold, cough and related congestion. Parents of implant recipients need to take aggressive preventive and curative measures though and especially look for any fluid collection or infection. There is no need to panic just being vigilant is the key.

5          IN CASE THE CHILD NEEDS MRI?

All the Implant companies have stipulated well-versed document on MRI- do’s and don’ts and is provided to implant centres clinics and surgeons. MRI, if required, one needs to take a written or printed advisory from concerned surgeon or audiologist and the radiologist can decide accordingly, how to proceed the scan procedure.

6          WHAT IF THE INTERNAL IMPLANT FAILS?

If there is an internal implant failure then a revision surgery is required with ex-plantation and reimplantation of a new Cochlear Implant. As these are happening on the inner ear level it won’t affect the therapy or speech and language development as it occurs on the CNS(Central Nervous System ) level and the brain is already trained. Though any new step has its own start and will take some time to adjust and adapt to normalcy.

7          WHEN AND HOW TO DECIDE FOR UPGRADES?

It is a point to ponder upon as there are many decisive factors like age of the implantee(both chronological and hearing), the requirement of advanced technology and the new features, availability of ongoing processors and accessories on the shelf. Though it’s always good to go hand in hand with the technology but don’t be swayed away by marketing gimmicks.

8          WHAT IS THE RELIABILITY RATE OF A COCHLEAR IMPLANT DEVICE?

Every Implant company have published their own reliability report and is easily available. Nowadays with advanced and enhanced medical technology implants are expected to have a very high-reliability rate over a longer span of time.

 

The recipients and caregivers need to have a confidence in technology with the acceptance of err making human made technology. Problems do come but there are measures to tackle with. Be Argus eyed and patient.

Have A Happy Hearing!

ACKNOWLEDGEMENT:

Host of the event: Chetana Misra

Session compiled by Nayela Ahmed

Course Coordinator: Ritu Nakra

 

 

Advocating Self Advocacy

 

 

Parents having children with hearing impairment are extra cautious around them. The need to be around their children and ensure that no harm comes to them is but natural. However an important fact to keep in mind is that children with any kind of impairment need to be taught to lead normal lives. The fundamental reason behind going for hearing aids or cochlear implants is to enable such children to live fairly independent, normal and regular lives.

This fundamental reasoning is lost if the parents are forever hovering around the child and helping them do basic things. The child needs space to grow and to handle situations by himself. This is possible only if we teach them self advocacy right from the beginning.

What is self advocacy? Self advocacy literally means ‘the action of representing oneself or one’s views or interests.’ Being able to do things independently will give your child a sense of purpose and worthiness.

Self advocacy helps them gain awareness of personal preferences, likes, dislikes, strengths, interests, potential and limitations. It helps them differentiate between wants and needs. It helps them make choices and consider multiple options after calculating the consequences of their actions.

The following points will help you understand the importance of self advocacy and how it will help your child gain confidence to face any situation head on.

Teach them the basics:

Children can be taught the basic workings of their hearing aids or Cochlear Implants and should also be able to recognise when the battery runs out or gets disconnected. Children going to play school (age 2.5yrs-3yrs) can be taught to inform if their device is not working. This differentiation will help them reach out and report to adults as soon as they sense something wrong.

Start Early:

There is no such thing as ‘too early’. Start developing self-advocacy skills in your child as early as possible.

As they grow older children (age 4yrs to 5yrs) should be taught to be more expressive if they fail to hear or understand something. They should be able to judge the distance required to hear better. They should be able to clearly communicate that they require the speaker to talk softer, louder or slowly. Teach them to ask for repetitions if they have not understood something.

Being vocal will help them develop their vocabulary as well. The more words they use, the more they learn pronunciation, sounds, vocabulary and language.

Communicate:

In a new environment, the child must have the confidence to walk up to an adult and inform them about his or her needs.

They should be able to explain to the teacher and find the right spot to sit in class. A shy child might find it difficult to do so, but make them understand that they need to speak up for themselves if they have to learn in class.

Most importantly the child should be made to understand that the hearing aid or Cochlear Implant is meant to help them function like regular children and should not be taken as a mark or symbol of any disability. It is their friend and should be treated as one.

Seeking Help:

If communication is important, then asking for help is equally important. The child should be made to understand that asking for help is not wrong. Asking for help will not lead to them being mocked or laughed at. They can confide in friends and ask them for notes or updates if they miss out on hearing the instructions or lectures in class. This confiding will strengthen their bonds with these friends and will make for a wonderful foundation to a long lasting friendship too.

Mental Preparation:

In a comfortable, known environment with help from family and friends the child will be able to function normally. However, how will the child cope in a new environment without a known person to help or support? Prepare your child for such unaccounted or unplanned situations. What if the child gets separated from the parents in a mall? What if the child has to go to another school for a project or a submission? How will the child deal with such situations if he is not made aware of them in the first place? Mentally prepare your child to face such challenges. Teach him to approach people and ask for help without feeling insecure. Teach him to be confident and importantly encourage him to go out and experience the world first hand by himself.

Maintenance:

Teach your child to keep the hearing aid or Cochlear Implant in a safe place or in the Dehumidifier when they are not wearing it. They should be taught to automatically include ‘wearing of device’ into their morning rituals once they wake up. It should be as natural as brushing teeth.

Final word:

Do understand that children with hearing impairment are like normal children but hear differently. They need to lead normal lives and enjoy all the things that regular children do. They only need a little help in hearing and that is possible with the collective cooperation and support of everyone the child comes across.

Hearing should not be a privilege, it should be a right.

Ritu Nakra

LSLS Cert.AVT