3. HI2 Hearing is a primary sense that helps to access information through the ear and connects us to people and things in our environment. Hearing impairment is a condition in which a child or adult suffers from difficulty in hearing.

4. HI3 n According to the Person with Disability Act of 1995, “Hearing Impairment means a loss of 60 decibels or more in the 60 db is normal conversational range of frequencies (loudness)” 60 db is normal conversational level.

5. HI4 Early signs of Hearing Impairment are n A sleeping infant does not awaken to hear noises n Babbling remains monotonous containing only vowel sounds n Instead of becoming more specific and acquiring meaning, the hearing impaired child babbles less and less over time becoming mute by one year of age n Without the ability to imitate, repeat and associate sounds with meaning, vocalizations decline. n Receptive language also lags

6. HI5 ANATOMY OF EAR n External Ear n Middle Ear n Inner Ear Note :- Please refer ear structure

7. HI6 Major Factors to be considered when talking of hearing impairment include n Age of onset n Degree of hearing loss n Type of hearing loss n Age of onset refers to the age at which the started. It is important to know this, so that a rehabilitation program could be developed n Degree of hearing loss refers to the extent of hearing loss. It could be classified as

8. HI7 n Normal hearing - 0 to 15 dB n Minimal loss - 15 to 25 dB n Mild loss - 25 to 40 dB n Moderate loss - 41 to 55 dB n Severe loss - 71 to 90 dB n Profound loss - 90 dB and above

9. HI8 Types of Hearing loss could be n Conductive Hearing loss n Sensory-neural Hearing loss n Mixed Hearing loss n Central Auditory disorders

10. HI9 Functional Hearing Assessment Why ? n HI passes off as undetected till the age of one or two years n HI can be ‘hidden’ if parents and professionals are not observant n HI in childhood has serious impact on normal acquisition of speech and language

11. HI10 n Standardize test norms may not be appropriate for deafblind population as many items tend to rely on vision and hearing n Medical examination can only tell of potential capacity n Resulting information may not be useful for planning, which may result in delay in intervention n Dual sensory impairments result in problems in speech, communication, motor and cognitive skills

12. HI11 What do we gain from functional hearing assessment n We can identify the current levels of functioning in hearing n This enables us to set goals to develop hearing behavior n Functional hearing assessment helps evaluate efficacy of teaching auditory responses

13. HI12 How to go about functional hearing assessment  Establish reason for testing  Identify sources of information  Ask the parent/caregiver about observations and concerns  Select appropriate tools for gathering information like interviewing, looking at medical records, and observations  Use selected stimuli such as parents/ caregiver’s voice, sound making toys etc. to get responses

14. HI13  Choose a familiar but quiet place to conduct assessment  Place the child in a comfortable position to allow an unobstructed view of his/her possible responses  Position yourself to be able to present sounds at different locations and observe responses or take turns with the parents/caregiver to present sounds and observe responses

15. HI14  Establish rapport and observe the child before presenting sound stimulus to become familiar with his/her typical behaviors  Select sounds and words to which the child has been exposed or which may be developmentally appropriate  Include speech, sound making toys and environmental sounds  Response to a sound stimulus may be observed as a change in

16. HI15  A) Activity level; a startle or sudden movement of the body or limbs, an increase or decrease in movement or vocalization  B) Body posture: head turn, reaching or body orientation  C) Facial expression: Smile or laughter, frowning, eye widening, searching, or blinking  if no responses are observed, it may not mean that the child does not hear, however he may be referred for a formal hearing test

17. HI16 Guidelines for observation can be used n Awareness/reflexive and attention/alerting levels 1 Does the child respond to environmental sounds such as * A door slamming? * A telephone ringing ? * A dog barking? * Sound of mixie/pressure cooker whistle? * Water falling in to a bucket?

18. HI17  Localization  Auditory Discrimination  Auditory Recognition  Describe the child’s responses:

19. HI18

20. HI19 CURRICULUM What is curriculum ? An effective teaching leads a child to function as independently as possible in the world around him. Why we need curriculum ? ¤ A curriculum for children with deafblindness helps to reach the goal of helping the child achieve personal adequacy, social and economic independence.

21. HI20 ¤In other words….. Support him in taking care of his needs such as - ¤ immediate self care needs such as - eating, drinking,bathing,brushing etc. ¤ Moving from one place to another ¤ Search and locate things which he needs ¤ Help him to solve problems that occur in his day to day life

22. HI21 Curriculum for these children includes planned exercises provided by the learning and environment which helps the child to reach levels of performance that are appropriate and planned.

23. HI22 ¤The overall aim of a curriculum is to make the life of a child with deafblindness and additional disabilities happier. ¤ A curriculum increases the child’s interaction with people, objects and actions of the world around him.

24. HI23 Benefits of Learning experiences for children with Deafblindness and Additional Disabilities ¤ Helps the child to identify significant people in his life.(family members) ¤ Helps the child to establish a trusting relationship with family members. ¤ Helps the child to ask for help and support whenever he needs it.

25. HI24 ¤Helps him to achieve economic independence wherever possible in right context. ¤ Helps the child to learn best use of his remaining vision or hearing along with his other senses. ¤ Helps the child in performance of his immediate life and environment.

26. HI25 GROUP DISCUSSION Some questions……… Que :- Why are you doing this particular activity with the child ? Que :- Does the child need to do the same activity when he is not with you? Que :- Would the same activity be important for him to do when you are no longer in his life ?

27. HI26 Know your LEARNERS better… ¤ All Children with deafblindness and additional disabilities differ because….. ¤ May have different levels sensory impairments. ¤ May have various degrees of sensory difficulties.(Tactile defensiveness, Gravitational insecurity) ¤ Existence of other disabilities ¤ May be developmentally delayed or have mental retardation due to brain damage.

28. HI27 ¤ May have serious medical problems and required constant attention. ¤ Impact on their ability to learn and remember due to medical problem.

29. HI28 WHO IMPLEMENTS THE CURRICULUM?  All people who interact with the child on a day to day basis are a part of the team  Often amongst the family members the mother is the only contact person for a long time  Other professionals such as the physiotherapist, occupational therapist, psychologist, speech therapist and others may be involved depending on the needs of the child

30. HI29 LEARNING ENVIRONMENT n Use real life situations and experiences to teach different skills to the child n Give the child motivation and reasons for learning n Provide reactive environment n Keep in mind the child’s emotional and social responses n Give opportunities to develop positive self image through success experiences

31. HI30 Things to remember n Overall aim of the curriculum is to make the life of the child happier n It should help the child achieve personal, social and economic independence n Children with Deafblindness and additional disabilities have unique needs and learning styles n A curriculum increases the child’s interaction with people, objects and actions of the world around him

32. HI31 The person with Deafblindness and additional disabilities remains the focus of any educational decisions and settings Family members play an important role in the educational decisions related to the child A multi disciplinary team approach is an effective way of working with children with Deafblindness It is important to provide a reactive environment to the child Children learn best within their immediate environment

33. HI32 THANK YOU