Aural/Audiologic Rehabilitation for
Children
Often with children, aural rehabilitation services would more
appropriately be called "habilitative" rather than
"rehabilitative." "Rehabilitation" focuses on
restoring a skill that is lost. In children, a skill may not be
there in the first place, so it has to be taught -- hence, the
services would be "habilitative," not
"rehabilitative."
Specific services for children depend on individual needs as
dictated by the current age of the child; the age of onset of the
hearing loss; the age at which the hearing loss was discovered; the
severity of the hearing loss; the type of hearing loss; the extent
of hearing loss; and the age at which amplification was introduced.
The aural rehabilitation plan is also influenced by the
communication mode the child is using. Examples of communication
modes are auditory-oral, American Sign Language, total
communication, Cued speech, and manually coded English.
The most debilitating consequence of onset of hearing loss in
childhood is its disruption to learning speech and language. The
combination of early detection and early use of amplification
has been shown to have a dramatically positive effect on the
language acquisition abilities of a child with hearing loss. In
fact, infants identified with a hearing loss by 6 months can be
expected to attain language development on a par with hearing
peers.
Aural habilitation/rehabilitation services for children
typically involve:
-
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.
-
Managing hearing aids and assistive listening
devices.
Because children are fitted with hearing aids at young ages,
early care and adjustment is done by family members and/or
caregivers. It is important for children to participate in
hearing aid care and management as much as possible. As they grow
and develop, the goal is for their own adjustment, cleaning, and
troubleshooting of the hearing aid and, ultimately, taking over
responsibility for making appointments with service
providers.
Services for children occur in the contexts of early
Intervention (ages birth-3) and school services (ages 3-21) through
Individuals with Disabilities Education Act.
In early intervention, an
Individualized Family Service Plan
is developed and may include audiology services, speech-language
pathology services, the services of teachers of the deaf and hard
of hearing, and the services of other professionals as needed.
When the child turns 3, an
Individualized Education Program (IEP)
is developed. The services provided are designed to maximize the
child's success in the general education environment and
transition to postsecondary education programs (vocational, higher
education, technical). Again, the IEP may specify audiology
services, speech-language pathology services, and the services of
teachers of the deaf and hard of hearing. Each professional has a
role to play in the child's educational achievement and
success.