Habilitation/Rehabilitation

The primary objective of providing habilitation/ rehabilitation training to the hearing-impaired child with hearing aids or a cochlear implant is to develop listening skills to help with continued language-learning and enhanced communication skills. Ensuring that your hearing-impaired child has optimal access to spoken language is just the first step to "listening for learning". Once your child has been fitted with an appropriate amplification device, it can be assumed that he can embark on the journey of making sense of the novel sound provided by his amplification device.

During the early stages of learning to listen (for a child who has not yet learned language) or re-learning to listen (for a child who already has language), the whole body reacts to sound. As a result, the initial sensation of "hearing" or detecting sound may, in fact, be perceived as a tactile sensation vs. an auditory sensation. Over time in using their devices on a full-time basis and when provided with appropriate training, the child will learn to associate and recognize this sensation as hearing. In addition, the child with hearing loss will grasp that sound and speech have meaning and purpose (e.g. make things happen).

Determining Communicative Demands

Critical to determining which of the many training approaches best meets your child's needs is assessing his communicative needs. The demands of a barely talking two year old differ significantly from the demands of a second-grader in a mainstream setting vs. the fifth grader in a primarily self-contained educational environment. Determining what your child requires to comply with the everyday social-communicative demands within your home, school, and community will ultimately assist you in selecting the training approach which is the best match for you and your child.

If you want your child to function within a regular education classroom, it will be necessary for your child to receive and use spoken language. It is well documented that relying exclusively upon audition is the most optimal means of accessing spoken language. When a child cannot hear what is being said, the stronger (or un-impaired) sense of "vision" will become primary and the child will become dependent on speech reading or gestural cues. In this instance, a total communication or manual communication system including ASL [American Sign Language] or SEE [Signing Exact English], or Cued Speech should be considered. However, when selecting either of these approaches, parents must make the commitment to becoming fluent users of the selected visual-based communication system, in order to maximize their child's mastery and functional use of this system. If the family does not learn the communication system, the child will not be able to communicate at home, and the amount of language to which the child is exposed will be limited.

Training Approaches

Auditory-Verbal: Emphasizes the development and reliance upon auditory cues to receive and comprehend spoken language. Underlying this approach is the understanding of interdependency between listening and speaking. As a result, spoken language is expected as the response to being talked to.

Audito-0ral: Like auditory-verbal therapy, this approach emphasizes the development and reliance on auditory cues to receive and comprehend spoken language. However, this approach acknowledges that in some instances emphasis on visual or vibrotactile cues may be utilized. Spoken language is the expected response to being talked to.

Total Communication: This multi-sensory training approach emphasizes the simultaneous or combined use of spoken language in conjunction with a manual communication system (signs) to provide optimal input within a communicative interaction. Sign alone or sign with vocalization are acceptable responses to being interacted with. Typically maintaining English word order is emphasized by service providers implementing this approach.

Manual Communication: (ASL, SEE) This approach emphasizes conveying meaning and eliciting responses based on a formal visual communication system. There are two sign systems typically used: 1) ASL (American Sign Language) which is a formal language with its own syntax and grammar and 2) SEE (Signed Exact English) which follows standard English syntax and marks English grammar forms with a set of endings. Supplemental auditory cues are compatible with SEE, as the word order is English word order and there is a match between what the child sees and hears. In contrast, attempting to provide simultaneous presentation of speech and ASL results in a miss-match, due to the fact that ASL has a different word order from spoken English.

Cued Speech: This training approach provides supplemental visual gestures or "cues" to distinguish between speech sounds that look the same on the lips. It is therefore a phonemic based visual system, which is designed to supplement spoken language until the child has the opportunity to establish more precise auditory skills for distinguishing between similar-sounding or visually similar-looking sounds.

Picture-Exchange Communication System (PECS): This approach involves using picture support to convey meaning and elicit responses, for children who do not have the oral-motor skills to produce spoken language. It is typically used in combination with spoken language. PECS is used frequently with children with severe language disorders but is not usually frequently used with hearing impaired children.

Service Delivery

Ideally, all of the above-cited therapy approaches should be delivered in a parent- child focused setting, especially during the infant, toddler and preschool years. When the child enters a formal educational program, therapy services may be given individually or in a small group setting. Parents should be aware that most hearing-impaired students continue to benefit substantially from individualized school-based services, either on a pull-out basis (taken out of their class) or push-in basis (clinicians go into the classroom to work with the child). Ongoing parent-child programming is less frequently available once a child reaches school age. However, parents should continue to maintain some means of networking with the school staff to ensure that they know what listening and speech-language targets should be emphasized in daily home routines. Often this can be accomplished through periodic parent-education sessions with the school staff or through written communication (e.g. therapy notebooks maintained by home, school and private clinicians when appropriate).

During the early stages of language learning, a minimum of twice a week services for 60- minute sessions is recommended to facilitate your child's optimal mastery of his specific training goals.

Monitoring Progress

Once your child has been fitted with his amplification device, it is expected that he will develop at the same rate as typically developing peers, e.g. one-month growth in one month's time. Formal and informal diagnostic measures should be used routinely to measure such change. This includes quarterly audiological evaluation for preschoolers and semiannual evaluations for school age children. These evaluations should include assessment of speech perception with technology, measuring each ear separately and both ears together. Speech-language evaluations should occur semi-annually in preschool and annually at school age. When progress does not occur at the expected rate, a review should be made of the many variables which might be attributing to your child's progress and appropriate modifications should be made to facilitate your child's maximum growth in meeting the goals of his ongoing therapy programming.