Chapter II THEORETICAL OVERVIEW 2.1 Introduction 2.2 Causes of Hearing Impairment 2.3 Psychosocial Consequences of Hearing Impairment 2.4 Educational Approaches 2.5 Vocational Provisions of the Hearing Impaired
30 2.1 Introduction Human ear is one of the smallest and the most complex organs in the body, capable of turning the tiniest disturbances in the air molecules into a form, the brain can understand. Hearing impairment is a generic term indicating a hearing disability that may range in severity from mild to profound; it includes the subsets of deaf and hard of hearing (Brill, Mac Neil, & Newman, 1986). A deaf person is one whose hearing disability preludes successful processing of linguistic information through audition, with or without a hearing aid. A person who is hard of hearing generally, with the use of a hearing aid has residual hearing sufficient to enable successful processing of linguistic information through audition (cited in Hallahan & Kauffman, 1997). Educators are extremely concerned about the age of onset of the hearing impairment. The earlier the hearing loss occurs in a child s life, the more difficulty in developing language of the hearing society. For this reason, professionals frequently use the term congenitally deaf, those who were born deaf; and adventitiously deaf, and those who acquire deafness at some time after birth. Two other frequently used terms are even more specific in pinpointing language acquisition are prelingual deafness, deafness present at birth, or occurring early in life at an age prior to the
31 development of speech or language and Post lingual deafness occurring at any age following the development of speech and language. Hearing sensitivity is measured in decibels. Decibels are units of relative loudness of sounds; Zero decibels (0 db) designates the point at which people with normal hearing can just detect sound. Each succeeding number of decibels indicates a certain degree of hearing loss. The following threshold classifications are common: mild (26-54 db), moderate (55-69 db), severe (70-89 db), and profound (90 db and above). These levels of severity according to loss of hearing sensitivity cut across the broad classification of deaf and hard of hearing (Hallahan & Kauffman, 1997). 2.2 Causes of Hearing Impairment Conductive, Sensorineural, and Mixed Impairments A conductive hearing impairment refers to an impairment that interferes with the transfer of sound along the conductive pathway of the outer or middle ear. A sensorineural hearing impairment involves problems in the inner ear. A mixed hearing impairment is a combination of the two. Impairment of the outer ear is not as serious as those of the middle or inner ear.
32 Impairments of the Outer Ear, Middle Ear, and Inner Ear Several conditions of the outer ear can cause a person to be hard of hearing. In some children, the external auditory canal does not form, resulting in a condition known as atresia. Children may also develop external otitis or simmer s ear, an infection of the skin of the external auditory canal. A much less common extreme form is called malignant Otitis external, in which the infection from the outer ear can spread, causing inflammation and eventual permanent damage to the bones and cartilage at the base of the skull and to the cranial nerves, the brain or outer part of the body. Most causes of the conductive hearing impairment are due to either inflammation of the outer ear or middle ear. The most common problem of the middle ear is otitis media- an infection of the middle- ear space caused by viral and bacterial infections. It is primarily a disease of childhood and is not easy to detect, especially in infancy when it often occurs with no symptoms. Otitis media is linked to abnormal functioning of the eustachian tubes. If the eustachian tube malfunctions because of a respiratory viral infection, it cannot do its job of ventilating, draining, and protecting the middle ear from infection (Giebink, 1990). The prevalence of otitis media is much higher in children with Down syndrome. Otitis media can result in temporary
33 conductive hearing loss and, if untreated, can lead to rupture of the tympanic membrane (cited in Hallahan & Kauffman, 1997). The most hearing impairments are associated with the inner ear. Inner ear hearing losses present the greatest problems for both education and medicine. Disorders of the inner ear can result in problems of balance and vertigo along with hearing loss. Some individuals with inner ear impairments may hear roaring or ringing noices. The causes of inner ear disorders can be hereditary or acquired. The most frequent cause of childhood deafness is heredity. Acquired hearing losses of the inner ear include those due to bacterial infections (e.g.; meningitis, the second most frequent cause of childhood deafness), prematurity, viral infections (e.g.; mumps and measles), anoxia (ie, deprivation of oxygen) at birth, prenatal infection of the mother (e.g.; maternal rubella, congenital syphilis and cytomegallo virus), Rh incompatibility, blows to the head, unwanted side effects of some antibiotics and excessive noise levels. Genetic Causes Hearing loss can be inherited. Both dominant and recessive genes exists which can cause mild to profound impairment. If a family has a dominant gene for deafness it will persist across generation because it will manifest itself in the offspring even if it is inherited from only one parent. If a
34 family had genetic hearing impairment caused by recessive gene it will not always be apparent as it will have to be passed on to offspring from both parents. Down syndrome or trisomy 21, caused by a chromosomal abnormality which can express itself in two different ways, conductive deafness often occurs from frequent middle ear infections, and in some cases Down syndrome patients are born with irregularities in the middle and inner ears that can also result in conductive hearing impairment. The relationship between hearing loss and diabetice is relatively a recent discovery. The diabetic s poor control of glucose metabolism results in high level of glucose in blood. This condition is correlated to the incidences of microangiopathy, whereby the basement membrane in capillaries is thickened. So the space inside the capillary is reduced. Microangiopathy occurs in the cochlear vessels of the ear and results in sensorineural hearing loss. 2.3 Psychosocial Consequences of Hearing Impairment The effects of hearing loss are complex and pervasive. The educational achievement, social development, and vocational success of an individual with a hearing loss is influenced by many factors, including the type and degree of hearing loss, the age at which the hearing loss began, the attitude of parents and siblings, the opportunities available for the child to acquire a
35 first language, and the presence or absence of other disabilities (Marschark & Clark, 1998; Paul & Quigley, 1990, 1994).The psychosocial aspects of hearing impairment have been given significant attention. The aspects subsumed under the general term psychosocial typically include the psychological, social, emotional, personality and intellectual variables that are likely to be affected when there is impairment. The dimension of the effect will depend largely on the degree of impairment and the age of onset of the impairment. Adjustment, behaviour, and learning usually go hand in hand. The children who are unhappy and poorly adjusted often fail to learn. Children who have hearing impairment and associated communication problems are unwilling or limited capacity to learn. Hearing impairment may interfere with social interaction between adults and other children in many ways. It is difficult to manage these children with temper tantrums. These children show much more maladaptive behaviour such as lack of concentration, high dependence on adults, restlessness, disobedience and social isolation. Clinical observations showed that hearing impairment may lead to shy and withdrawing personality. Research evidence indicates that deafness restricts what the child can hear and also disrupts social interactive processes which take place between children and adult. These social interactive processes are very crucial in the normal development of the child. The opportunity provided to a hearing impaired child to be with his peers allows him to
36 express his emotions and needs. Thus, communication and interaction permits the hearing impaired child to have better psychosocial development and the better psychosocial adjustment further facilitates the achievement of better academic grades (Kundu, 2000). Hearing impaired people think and behave differently from hearing people in order to make sense of the word. Abstract thinking is more difficult for the hearing impaired children. Severely hearing impaired children are impulsive and socially immature, less able to care for their own needs, lacking self direction, and more dependent on adults than normally hearing peers. They are less motivated to achieve, unable to see other people s point of view, poor at making frienship, restricted in general knowledge and experience, and requiring great adult direction and external control. Deafness not only interferes auditory input but also interferes with social interaction between children and their care takers. This view emphasizes that characteristic behaviour traits in the hearing impaired children are a product of learning experience and may be specific to those situations in which learning takes place, rather than being part of a deaf personality. There are certain behavioral problems which are associated with hearing impairment. They feel invariably inferior and helpless in adapting to circumstances that require verbal communication. They have poor self concept which damages the development of personality. A number of
37 hearing impaired children have additional perpetual motor deficits due to brain damage or cerebral dysfunction. Delay in achieving motor milestones, poor gross motor coordination, delayed hand preference, perseveration, impressiveness, short attention span, emotional liability are some of the characteristics of hearing impaired children. 2.4 Educational Approaches Studies assessing the academic achievement of students with hearing loss have routinely found lag behind their hearing peers. National surveys conducted by Centre for Assessment and Demographic Studies (CADS) at Gallaudet University (Di Francesca, 1972; Gentile & Di Francesca, 1969; Trybus & Karchmer, 1977) reported that students with severe and profound hearing loss were reading at about a fourth-grade level or lower; and their mathematics performance was around the fifth-grade level. Growth in reading achievement was between 0.2 and 0.3 grade levels per year of schooling, for the oldest group of students (16 to 18 years). Most children who are deaf have normal intellectual capacity, and it has been demonstrated that their scores on nonverbal intelligence test are approximately the same as those of the general population. Deafness imposes no limitations on the cognitive capabilities of individuals (Moores, 1996). The problems that students who are deaf often experience in
38 education and adjustment are largely attributable to a bad fit between their perceptual abilities and the demands of spoken and written language. Many special methods and materials have been developed for and used with hearing impaired children. Regardless of instructional approach or method, the primary objective and focus of teachers of children with hearing loss is helping children develop and use language and communication skills. Three classroom methods used for these children are Oral / Aural approach, total communication, and bilingual-bicultural education. Oral / Aural Approaches Educational programmes with oral/aural emphasis view speech as essential for hearing impaired to function in the hearing world. A child who attends a programme with an oral emphasis typically uses several means to develop residual hearing and the ability to speak as intelligibly as possible. Auditory, visual, and tactile methods of input are frequently used. Much attention is given to amplification, auditory training, speech reading and use of technological aids. A hearing aid is an amplification instrument; it functions to make sounds louder. Auditory training programs help children make better use of residual hearing. It begins by teaching awareness of sounds. The first three levels of auditory training-detecting, discriminating, and identifying sounds are important but insufficient for developing the
39 residual hearing. Auditory training emphasizes a fourth and highest level of listening skills-the comprehension of meaningful sounds. Speech reading is traditionally lip reading, but understanding speech from visual cues involves more than simply looking at the lips. Oral education tends to emphasize parent and family environment. Cued speech is a method of supplementing oral communication. It seeks to supply a visual representation of spoken language by adding cues, in the form of hand signals near the chin. Total Communication Educational programmes with an emphasis on total communication advocate the use of a variety of forms of communication to teach language to students with hearing impairment. Practitioners of total communication maintain that simultaneous presentation of manual communication by signs and finger spelling and speech through speech reading and residual hearing makes it possible for hearing impaired children to use either one or both types of communication. Sign language uses gestures to represent words, ideas, and concepts. Those who practice total communication generally speak as they sign and make a special effort to follow the form and structure of spoken language as closely as possible. Several sign language systems have been designed primarily for educational purposes, with the intention of facilitating the development of reading, writing, and other language skills in
40 students with hearing loss. Finger spelling is also used by many people who are both deaf and visually impaired. The manual alphabet can be used at close distance or felt with the hand if the person is totally blind. It is often used in conjunction with other methods of communication. It consists of 26 distinct hand positions, one for each letter. Many educators believe that total communication facilitates parent-child and teacher-child communication and enhances children s self-esteem. Bilingual-Bicultural Approach This model views deafness as a cultural and linguistic difference, not a disability, and recognize American Sign Language (ASL) as the deaf child s natural language. ASL provides a natural pathway to linguistic competence and English is better learned in the context of a bilingual-bicultural education after the child has mastered his first language. The goal of the bilingual-bicultural education approach is to help the hearing impaired child become a bilingual adult who is competent in his first language, ASL, and can read and write with competence in English. Interpreters The role of educational interpreter is signing the speech of a teacher or other speaker for a person who is deaf. The role of the educational transliterator has made it possible for many students with hearing loss to
41 enroll in and successfully complete postsecondary programs. Duties of interpreters vary across schools; they are likely to perform tasks such as tutoring, assisting regular and special education teachers, keeping records, and supervising students with hearing loss (Zawolkow & DeFiore, 1986). Text Telephones The telephone served as a barrier to deaf people in employment and social interaction for many years, but acoustic couplers now make it possible to send immediate messages over conventional telephone lines in typed or digital form. Text telephones (TT) (originally called TTY or TDD systems) enable the user to send a typed message over telephone line to anyone else who has a TT. As a result of the Americans with Disabilities Act, TTs are now available in most public places such as airports and libraries, and every state has a relay service that enables TT users to communicate with a person on a conventional telephone via an operator who relays the messages. Relay numbers are published in every phone directory. Television Captioning Today most regular programming on commercial and public network television, as well as many live newscasts and sporting events, is captioned (printed text appears at the bottom of the screen, similar to watching a film with subtitles), providing access to televised news and entertainment for
42 deaf people. Since 1993, a federal law has required that all new television sets sold in the United Stated be equipped with an internal device that allows the user to position captions anywhere on the screen. Accessing captions on older television sets requires an external decoder. Alerting Devices Some individuals who are deaf or hard of hearing use special devices to alert them to certain sounds or events. For example, to signal the doorbell, a fire alarm, or alarm clock a sound-sensitive switch can be connected to a flashing light or to a vibrator. Hearing ear dogs alert a deaf person to important sounds in the environment. Technological advances are already having a significant impact on the lives of many individuals with hearing loss. In addition to the sophisticated techniques that detect hearing losses and make use of even slight amounts of residual hearing, a number of devices known as speech production aids help person who are deaf monitor and improve their speech (Calvert, 1986). 2.5 Vocational Provisions of the Hearing Impaired Adisehiah s (1973) stated that the impairment would always lead to some psychological problems and the general belief that, the blocks and barriers put up by this condition will result in personality changes, may not always hold good. It will largely depend on the fact as to how impairment
43 has been internalized by the individuals apart from the socio-economic realities associated with each individual s life situation. Life at home and at work of this people will certainly be reflected and affected by their inner world. Inner world would comprise of their attitude, self, aspirations, values, mental health, personality, job satisfaction, etc. One s aspirations in life can be used to gauge one s inner world. Those devoid of aspirations and those with unrealistic aspirations form extreme groups opposed to each other. Very few hearing impaired adolescents go to main stream colleges and universities. They have to content themselves with remaining unemployed, or best, underemployed and underpaid. Lack of higher education and inadequate vocational training is only part of the problem. Unrealistic expectation of the hearing impaired and their families and poor work attitudes are also responsible for their ability to locate jobs. Socio-economic rehabilitation is a must to provide to inculcate self-worth and autonomy to hearing impaired. Intelligence, aptitude and interest are the core triad determining vocational choice. But the infrastructure, built on this base or blue print, is a reflection of vocational training, the availability of jobs and the extent to which a particular vocation is seen as being able to meet the aspirations of the individual. The winds of change have swept across the area of socioeconomic rehabilitation. Rehabilitation remains a myth unless it is translated
44 into a skill or job that permits impaired persons to establish or maintain economic self-sufficiency. In this respect many exciting developments have been taking place in recent years. There has been greater understanding of the ways in which impairment impacts vocational development. There has been concerted efforts on the part of non-governmental organizations (NGO) and Governmental Organizations (GO) to revise and update vocational training programmes by eliminating redundant vocations and including newer areas that are, both more appropriate and more in demand. In Indian context, there appear to be three employment options for the hearing impaired, i.e.,(a) competitive employment, means, no special, ongoing support is provided and the resources are the same as that available for any worker.(b) transitional employment, provide time limited supports and services but are expected to be able to manage on their own after a time.(c).supported employment, provide long term supports such as aids, specialized training and environmental modifications for persons with severe disability. Employment after good education and training is very important for a hearing impaired, since every step forward in their education and training is towards achieving a better placement in life. Any amendments in PWD Act or any other act will not help the hearing impaired unless he is qualified well to meet the challenges facing the unemployment problem of our country. So
45 the hearing impaired youth will be provided quality education and intensive training in specific field (Kundu, 2000). Right to Employment The end product of vocational rehabilitation is the re-settlement or reentry into active economic and remunerative work which is not only suited to his residual capacities but makes the best use of his skills. Disabled persons have the right to education, vocational training, counseling, rehabilitation, placement and other services which will enable them to develop their capacities and skills to the maximum and will hasten the process of their social integration, and comprehensive rehabilitation. International labour vocational rehabilitation (disabled) recommendation act 1955 says that, (a). Disabled persons should be afforded an equal opportunity with the non disabled to perform for which they are qualified, (b). They should have full opportunity to seek suitable work with employers of their choice. Public law 94-142, i.e., education for all handicapped children act and sections 504 and 503 of the rehabilitation act of 1973, highlights that the legislative process has not only been affirmative but has been almost all inclusive in accommodating the needs of the handicapped. The emphasis has been two fold: (a) To ensure that all individuals who are handicapped in
46 their acquisition of an education are covered by public policy. (b) To provide the needed services to them. Therefore, the career development of hearing impaired students has become a priority for educational programme. A sense of urgency and a sense of joy must be felt by all hearing impaired who continue to do hard work and grow with people of similar accomplishments and motivations and take pride in doing a job well.