Speech Therapy related to Hearing Impairment

For children who are d/Deaf or Hard of Hearing, Speech-Language Pathologists are part of a multi-disciplinary team supporting them with amplification systems, if applicable, as well as their speech, language and literacy goals.

Understanding Aural Rehabilitation for Children with Hearing Impairment

Aural rehabilitation is a process that aims to assist children with hearing impairment in the development of vital listening, speech, and language skills[1]. To be clear, these skills may more appropriately be deemed Aural “Habilitation”, as we may be focusing on skills that are not yet present (and therefore cannot be re-habilitated). The essence of aural rehabilitation lies in its timing - early detection and intervention are important to its success[7]. Depending on various factors such as the child's age, severity of hearing loss, type of hearing loss, and the child's preferred mode of communication, the approach to therapy can vary [1].

Amplifying the World of Sounds

One of the most critical tools in aural rehabilitation are hearing devices. Hearing aids and cochlear implants can be essential in amplifying sounds and improving the child's listening experience[4]. These devices work by collecting sounds from the environment, amplifying them, and then sending these amplified sounds into the ear. This process helps in enhancing the child's ability to perceive and interpret sounds.

The types of hearing aids commonly used in children are Behind-the-Ear (BTE) and Receiver-in-the-Ear (RITE) devices[4]. BTE aids consist of a case, an ear mold, and a connecting tube. The case contains the electronic parts of the aid, and the ear mold fits inside the outer ear and directs the sound into the ear. RITE aids, on the other hand, have the speaker built into the ear tip instead of the main body of the hearing aid. Both BTE and RITE devices are designed with the child's comfort in mind and can be adjusted as the child grows.

Speech-Language Pathologists work together with Audiologists and Teachers for the Deaf and Hard of Hearing to support children who are hearing impaired. It is important for the child’s Audiologist and SLP to collaborate so that all educators involved can be aware of how to best support the child’s hearing aids, cochlear implants, or any amplifying technology that is being used.

young girl is fitted for a hearing aid

Speech and Language Therapy: Laying a Solid Foundation

Speech and language therapy is a significant part of aural rehabilitation. It aims to improve speech and language skills and provide necessary support for children experiencing delays in these areas [2]. This form of therapy can involve a variety of strategies and methods, customized to meet the individual child's needs. The American Speech-Language and Hearing Association (ASHA) describes how SLPs can support aural rehabilitation:

Training in auditory perception. This includes activities to increase awareness of sound, identify sounds, tell the difference between sounds (sound discrimination), and attach meaning to sounds. Ultimately, this training increases the child's ability to distinguish one word from another using any remaining hearing. Auditory perception also includes developing skills in hearing with hearing aids and assistive listening devices and how to handle easy and difficult listening situations.

Using visual cues. This goes beyond distinguishing sounds and words on the lips. It involves using all kinds of visual cues that give meaning to a message such as the speaker's facial expression, body language, and the context and environment in which the communication is taking place.

Improving speech. This involves skill development in production of speech sounds (by themselves, in words, and in conversation), voice quality, speaking rate, breath control, loudness, and speech rhythms.

Developing language. This involves developing language understanding (reception) and language usage (expression) according to developmental expectations. It is a complex process involving concepts, vocabulary, word knowledge, use in different social situations, narrative skills, expression through writing, understanding rules of grammar, and so on.

Managing communication. This involves the child's understanding the hearing loss, developing assertiveness skills to use in different listening situations, handling communication breakdowns, and modifying situations to make communication easier.

For children with cochlear implants, Auditory-Verbal Therapy (AVT) is often used. AVT emphasizes the importance of enhancing the child's auditory skills and encourages them to make the best use of their cochlear implant[5]. The therapy focuses on listening and sound awareness and aims to teach the child to listen to and interpret the sounds they hear rather than relying on visual cues[5].

Environmental Modifications

The environment in which a child with hearing impairment grows and learns plays a significant role in their rehabilitation process[2]. Creating an environment that is conducive to learning and communication is key to their development.

One aspect of environmental modification is ensuring good lighting. Good lighting is crucial, especially for children who rely on lip-reading or sign language, as it enables them to clearly see the speaker's facial expressions and lip movements. It can make a significant difference in the child's ability to understand what's being communicated[8].

The positioning of the speaker also plays a role in effective communication. When speaking to a child with hearing impairment, the speaker's face should be towards the listener to enable the child to pick up visual cues that aid understanding[8]. If the child has one ear with a lower level of hearing loss, the child should be positioned so that this ear is directed to the speaker, when possible.

Another important aspect is reducing background noise. Excessive noise can interfere with the child's ability to concentrate on the spoken words and can be particularly problematic for children using hearing aids or cochlear implants[8].

teacher stands in front of class

Communication Strategies

Effective communication forms the core of aural rehabilitation. Certain strategies can help improve interaction with children with hearing impairment. These strategies focus on enhancing the clarity of speech and fostering engagement in conversations[3].

One such strategy is speaking clearly, slowly, and distinctly without shouting or exaggerating mouth movements. When we speak too fast, run words together, or speak very softly, children with hearing impairment may have a harder time understanding what's being said. Therefore, it's important to speak at a moderate pace and volume, with clear pronunciation[3].

Another important strategy is to face the child directly during a conversation. This supports children who rely on lip-reading and can also enhance the understanding of those using hearing devices. Moreover, before starting a conversation, it's essential to get the child's attention. This can be done by lightly touching the child, calling their name, or making sure they are looking at you before you start speaking[3].

girl with cochlear implant draws with chalk on the ground

Inclusive Education

Inclusive education is a crucial part of the rehabilitation process for children with hearing impairment[14]. The idea of inclusive education is not just about physically placing children with hearing impairment in mainstream classrooms, but also ensuring that they receive the necessary support to learn effectively alongside their peers.

Hearing-assistive technology (HAT) systems in the classroom can amplify the quality of sound received by children with hearing loss[14]. These devices, such as FM systems, help in reducing background noise and making the teacher's voice more accessible to the student.

One key aspect is understanding their child's preferred mode of communication. This could be sign language, spoken language, or a combination of both. Understanding and respecting this preference can go a long way in supporting the child's language development and self-esteem[11].

Conclusion

In conclusion, aural rehabilitation (or “aural habilitation”) is a multifaceted process that involves a team of professionals, the child's family, and the child themselves. This comprehensive approach ensures that each child receives the support they need to overcome their challenges and develop effective communication and language skills in the way that they can be most successful.

Links & Resources for Children with Hearing Impairment

  • El Deafo: A Graphic Novel

    El Deafo is the memoir of Cece Bell about growing up with hearing loss. This book is sure to entertain, educate, and make you laugh! Aimed for middle-school-aged audiences, but great for everyone!

    stuttering foundation_drawings and letters from kids who stutter

  • Edmonton Association of the Deaf

    Join the community here. They offer ASL courses for all levels, family and community events, and support for individuals who are d/Deaf or Hard of Hearing.

  • The Listening SLP: Hearing Loss and LIteracy Specialist

    Sydney Bassard is a Speech-Language Pathologist who works in private practice in North Carolina. Find her on instagram @thelisteningslp to learn more about working with students who are d/Deaf and Hard of Hearing.

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