Child Aural/Audiologic Rehabilitation
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.