From the Director: Taking the High Road

 As our Center ensures availability of our consultations and resources statewide, we are    embarking on a new journey: a mobile unit!

Our mobile unit will be equipped with an audiology soundbooth and equipment as well as a consultation area. We will be taking this unit to a variety of locations throughout Indiana—planning each visit based on the specific needs of that community.

We will partner with local entities—schools, health departments, nonprofit organizations, and universities—coming alongside those professionals in the community. We will collaborate on individual children/students as well as processes and systems in which our staff can be of               assistance.

Our unit will be on the road at the end of 2020, and we look forward to the opportunity to connect with many of you as we plan for this new venture!

 

Teachers' DEN: Welcome Back!

 

This school year is definitely like no other. The Deaf Education team at the Center for Deaf and Hard of Hearing Education has been busy creating continuous learning documents to assist school teams in ensuring that students who are deaf and hard of hearing have optimal access in a variety of educational settings. It is important to have discussions and incorporate those into students' educational plans to ensure smooth transitions should educational platforms change throughout the school year. Each student learns and accesses their environment differently. It is helpful to conduct functional assessments (listening, visual, or both) to gather information on unique student access needs.
 
The following Continuous Learning Guidance Documents can be found on the Center for Deaf and Hard of Hearing Education’s website (www.cdhhe.isdh.in.gov):
· Masks and Face Shields
· Continuous Learning Guiding Questions
· Continuous Learning Educational Interpreter Considerations
· Continuous Learning HAT Considerations
 
Additional technical assistance available on our website (www.cdhhe.isdh.in.gov):
· Audiology Tips and Tricks
· Considerations of Special Factors
· Indiana Deaf Education and Assessments of Language (IDEAL)
· Tips for Interpreters in the virtual setting
· Tips for working with virtual interpreters
 
Please contact the Deaf Education team for more information and resources.
 

Tacklin' Assessment: Function of the Vestibular System

 This is the third part of a series of discussions about the vestibular system. If you remember from the Winter 2020 newsletter, we identified the three main roles of the vestibular system: 1) identify the position and direction of    movement of the head; 2) maintain balance; and 3) keep vision clear while the head is moving (gaze stability).

Many people know that the vestibular system makes a huge contribution to balance, but not many people realize that the vestibular system also plays a large role in vision. While the eye, surrounding eye muscles, and head work   together to help you look around your environment, this system is not capable of keeping your vision clear when the head is moving at very fast speeds. An example of these high-speed movements would be turning your head quickly to look toward a loud, unexpected sound or bouncing up and down while driving on a bumpy road (fast vertical speeds).  Even when you are walking, the impact of your foot hitting the ground causes a subtle high-speed bouncing motion of the head. At these high speeds, the oculomotor system (eye and eye muscles) cannot respond or move quickly enough to keep your vision clear. This is where the vestibular system helps. Through the vestibulo-ocular reflex (VOR), the   vestibular system works with the visual system to move your eyes in the opposite direction of the head and at the same speed as the head so you can keep your visual target in focus. This is an automatic response—you do not think about it at all. As you bounce up, your eyes automatically move down at the same speed so you can still read the street sign clearly. To try to simulate this, hold your arm straight in front of you at eye level. Close your fingers against your palm and keep your thumb straight and pointed toward the ceiling. Keep your hand still while you turn your head side-to-side as fast as you can while looking at your thumb. Your thumb should still appear clear to you because your VOR is helping keep your vision stable. You do not think about moving your eyes to the right while your head turns to the left—the VOR takes care of that. Now hold your head still while you move your arm side-to-side as fast as you can keeping your eyes on your thumb. Your thumb may blur, or you may see two thumbs as you move your hand side-to-side. Your VOR does not help you in the second scenario, which is why you have blurring of your vision. Individuals with low or absent vestibular function will have blurring in both scenarios because their VOR is impaired.

How does this affect deaf or hard of hearing children? Though the numbers vary from one study to another, approximately one-half of children with a severe to profound hearing loss have some degree of vestibular dysfunction.¹  Those with complete vestibular loss will not have a VOR and will experience gaze instability. Those with reduced vestibular function may also have an impaired VOR. This can make it difficult to navigate the environment when walking, running, or driving because of the accompanying visual “blurring” when the head is moving. There is also evidence that individuals with gaze instability have difficulty with reading acuity and require larger print sizes to read effortlessly than children who have a stable gaze.²  While young children’s books use larger print sizes, books for older children and young adults are typically in a smaller print size and may require the student to use extra effort to read. 

 

1.                 Jacot E, Van Den Abbeele T, Debre HR, Wiener-Vacher SR. Vestibular impairments pre- and post-cochlear implant in children. Int J Pediatr Otorhinolaryngol. 2009;73(2):209-217.

2.                 Braswell J, Rine RM. Evidence that vestibular hypofunction affects reading acuity in children. Int J Pediatr Otorhinolaryngol. 2006;70(11):1957-1965.

 

Brain Builders Corner: Making Connections at the National Early Hearing Detection and Intervention Annual Meeting

Our last professional development opportunity face-to-face prior to COVID-19 was at the National Early Hearing Detection and Intervention (EHDI) Annual Meeting. The first few years of a child’s life are so critical to brain development that a national conference is dedicated to making sure that each state meets the 1-3-6 goal of screening hearing by one month of age, diagnosing hearing levels by three months of age, and enrolling families into Early Intervention Programs by six months of age.

Presentations, vender booths, and poster sessions were shared regarding all aspects of the Early Hearing Detection and Intervention process. We learned more about successful strategies for programs and about current research. One of the keynote speakers shared that future directions are going toward building a healthy community centered around supporting and engaging families, incorporating technology, and looking at data systems to inform our programs. Including diversity in our workforce and infusing deaf and hard of hearing leadership in our programs also will ultimately lead to healthy children who are deaf and hard of hearing. 

Would you like to become a Joy ambassador? One of the presentations at the Annual EHDI Conference introduced participants to a movement called Fostering Joy in raising a child who is deaf or hard of hearing. While we hear so much information about the importance of providing interventions and identifying needs, we also need to recognize the importance of making brain connections through positive social and emotional bonds between children and supportive adults in their world.

Check out this website that encourages families and professionals to foster Joy in raising and working with children who are deaf and hard of hearing. Professionals can share the tip sheet and use the PowerPoint template available on the website to share the message. If you are a family member of a child who is deaf or hard of hearing, you can also join their closed Facebook group. 

 

Also, check out these free resources designed to promote communication within families: 

ð Communicating with Baby:  Tips and Milestones from Birth to Age 5 https://identifythesigns.org/communicating-with-baby-toolkit/

ð For ASDC members:  Sign on ASL online practice with a Deaf adult https://deafchildren.org/sign-on/

ð Learn early communication milestone and apply American Sign Language strategies through https://www.gallaudet.edu/asl-connect

ð Free membership with access to on-demand streaming of over 8000 educational videos for families of children who are deaf, hard of hearing, blind, visually impaired or deaf-blind at https://dcmp.org/

 

Sound Advice: Face Masks

Due to the current COVID-19 pandemic, many people are following health guidelines to wear face masks while in public places. These face masks can impact our communication with one another – particularly for individuals who are deaf and hard of hearing.

HOW MASKS MAY IMPACT COMMUNICATION

· Different fabrics and styles of masks distort speech.

· Individuals may not know when others are speaking and may have difficulty understanding what they are saying.

· Masks cover facial expressions that convey grammar and meaning and show mouth morphemes for ASL.

· Masks may get tangled with hearing aids and implants sitting behind the ears and may pull the devices off when removed.

· Masks hide facial expressions that may alert communication partners to  communication breakdowns and confusion.

 HOW INDIVIDUALS WHO ARE DEAF AND HARD OF HEARING MAY BE AFFECTED

· Increased mental exertion required to achieve effective communication

· Increased anxiety and frustration due to miscommunication

· Increased feelings of isolation in group settings

 WHAT YOU CAN DO

· Consider using clear face shields or masks with clear cut-outs instead of traditional masks (see resources below).

· Consider using behind-the-head hooks, headbands, etc.

· Consider masks that tie behind the head instead of the ears.

 HOW TO IMPROVE COMMUNICATION

· Maintain eye contact during conversation.

· Speak as slowly and clearly as possible without changing the intonation and quality of your natural speech.

· Continue consistent use of prescribed hearing technology.

· Alternative forms of communication such as dictation or translation apps may provide a speech to text option

· Consider attaching a directional microphone to your smartphone to improve accuracy and cover greater distance to pick up a speaker’s voice when using speech to text apps

 SPEECH TO TEXT APPS

Ava (can type back, many languages) (iOS, Android)

Google Live Transcribe (can type back, many languages) (Android)

Microsoft Translator (can type back, can translate, many languages) (iOS, Android, Windows)

Otter.ai (English only) (iOS, Android)

Web Captioner (many languages) (universal web page)

 ADDITIONAL RESOURCES

Phonak Blog: Masking Dilemma

Hearing Review: Masks & Speech Understanding

National Deaf Children's Society: Impact of Masks

National Association of the Deaf: Communication Access 

Center for Deaf and Hard of Hearing Education: General Considerations for Masks & Shields