Preschool teachers' perception and use of hearing assistive technology in educational settings

Parents' experiences of remote microphone systems for children with hearing loss

PURPOSE

Remote microphone systems improve intelligibility in difficult conditions when the performance of hearing aids/cochlear implants is insufficient. The purpose of this study was to explore parents' experiences with remote microphone systems for their children with hearing loss and to determine the advantages and disadvantages as perceived by parents.

MATERIALS AND METHODS

Data were collected by means of semi-structured interviews with parents of children with moderate to profound bilateral hearing loss (2-19 years old). The open coding method and thematic analysis were used. The final sample consisted of 19 mothers and 9 fathers who had experience with remote microphone systems.

RESULTS

Parents listed the advantages of remote microphone systems for their child, for themselves and for other carers, such as better hearing and understanding, a life more similar to that of their peers without hearing loss, safety in road traffic, lower fatigue, vocabulary acquisition, better school results. Some limitations were identified, namely low benefits, technical issues and a reluctance to use the device by children or teachers.

CONCLUSIONS

It is crucial to provide parents with information about assistive devices and the consequences of limited access to hearing speech. Professionals should motivate parents, children and teachers to use remote microphone systems even in situations when the benefit may not be obvious if there is a potential benefit for the child.

IMPLICATIONS FOR REHABILITATIONThe main advantages of remote microphone systems perceived by parents are better hearing and understanding, a life more similar to peers without hearing loss, safety in traffic, lower fatigue, vocabulary acquisition and better school results.The main disadvantages are for parents: persisting hearing problems, low benefits, technical issues and a reluctance to use the device by children or teachers.Sufficient and accurate information is needed about remote microphone systems, but also about the consequences of hearing loss in general.The possibility to try wireless devices before buying and troubleshooting help is appreciated.

The Role of Bone-Anchored Hearing Devices and Remote Microphones in Children with Congenital Unilateral Hearing Loss

Congenital unilateral hearing loss (UHL) represents a contemporary audiologic challenge. Children with UHL can struggle with understanding speech in noise, localizing sounds, developing language, and maintaining academic performance, leading to low self-esteem, anxiety, and decreased social support. Two specific conditions related to UHL in children are single-sided deafness (SSD) and unilateral auris atresia (UAA). This was a retrospective observational study on a group of children with UHL. The Simplified Italian Matrix Sentence Test was used for the assessment of speech reception threshold (SRT) in different conditions: speech and noise from the front (S0N0), speech at 45° from the side of the better ear and noise at 45° from the opposite side (SbNw), and vice versa (SwNb). Each test was conducted unaided, with a bone-anchored hearing device (BAHD), and with a remote microphone (RM) system. The use of a BAHD and RM led to an improvement in SRT in S0N0 and SwNb conditions. The SSD subgroup demonstrated significant benefits with both devices in SwNb, and the UAA subgroup from the use of BAHD in S0N0. In conclusion, the study underscores the potential benefits of both devices in enhancing speech perception for UHL children, providing insights into effective intervention strategies for these challenging cases.

Why do many children who are hard of hearing not use remote microphones to compensate for their hearing loss?

Objectives

The aim of the study is to explore parents' reasons for not acquiring remote microphones that would compensate for their child's hearing loss and why some children do not use these devices even after they are purchased.

Background

The benefit of remote microphones for better understanding speech has been proven by multiple studies. Consistent with the research, there is an official recommendation that all children who are hard of hearing should be considered as potential candidates for remote microphone systems in classrooms in Western countries, but in the Czech Republic, only a relatively small number of children use them. Therefore, it is important to focus on the reasons why parents do not buy such devices for their child and why some children do not use an already acquired device.

Methods

Data from 41 semi-structured interviews were collected and analysed using the DIPEx methodology (personal experiences of health and illness), which involves rigorous analysis of narrative interviews of people with particular conditions chosen to represent the widest practicable range of experiences.

Results

Parents report multiple barriers to buying remote microphones: insecurity about the right moment, financial reasons, a lack of information and the child's refusal to use them. The reasons why children do not use such devices despite their being purchased are the reluctance of children and teachers and the low perceived benefit of remote microphones.

Conclusions

These barriers have to be taken into consideration by audiologists, policymakers and other stakeholders when addressing medical, educational and social systems supporting children who are hard of hearing as well as their families. Socio-political measures, improved systems of support for children who are hard of hearing and direct work with families can reduce these barriers.

Inclusive education: The case for early identification and early intervention in assistive technology

This paper starts by presenting the argument that inclusive education for learners with disabilities is often not possible without their access to fit-for-purpose assistive technology (AT), as the barriers to their education are often environmental.The paper will argue that, if assistive technology is an enabler for learning, then the processes by which children with disabilities are identified as users of assistive technology must take place as early as possible in the lifecycle. Mechanisms associated with Early Identification and Early Intervention (EI/EI) must be outfitted with all necessary resources for identifying and addressing the unique assistive technology needs of each individual child, but also have a prospective view of the use of the assistive technology in order to ensure school-age children start benefiting from assistive technology as early as possible.A further argument will be made that, when adequate identification of the need for assistive technology has not taken place early, education systems must be prepared to - in collaboration with other ministries or departments - identify, assess and provide the necessary assistive technology not only as it relates to education use, but to all-inclusive and holistic use. The argument will be made for adequately resourcing "support services for inclusion" and creating transdisciplinary teams of professionals that can effectively ensure equitable access and participation of all children with disabilities in inclusive education.Throughout, some examples of good practices will support the narrative, and the paper will close with recommendations for stakeholders involved in developing policies and practices for inclusive education.

Comparisons of performance in pediatric bone conduction implant recipients using remote microphone technology

OBJECTIVES

For children with hearing loss, remote microphone (RM) technology can significantly improve access to speech in environments with poor signal-to-noise ratios (SNRs), such as classrooms. Yet, this has never been studied in bone conduction device (BCD) users, a common treatment for children with irresolvable conductive hearing loss resulting from anatomical malformations of the outer ear. The objective of this study was to investigate the benefits of RM technology on speech perception in noise in pediatric BCD users with Microtia/Atresia. A secondary aim was to assess parent and child perceptions of RM technology before and after exposure to RM technology.

METHODS

Participants included 10 pediatric bone conduction implant users with unilateral conductive hearing loss ages 7-17 years, and their guardians. Speech perception in noise for soft and moderate inputs was assessed with and without RM technology. Guardians actively observed the child's hearing performance with and without the RM and were asked to complete a questionnaire assessing their perceptions about their child's performance. Children were also administered the questionnaire prior to and immediately following exposure to the RM technology.

RESULTS

Participants showed improved speech understanding in noise for both soft and moderate speech inputs when using the RM with their BCD compared to their BCD alone. Questionnaire results indicated good parent-child agreement. Further, significant improvements were reported for child understanding speech, parent hearing domains after exposure to the RM. No significant differences were noted for ease of use/likability.

CONCLUSIONS

Significant hearing in noise benefits were observed with RM technology for children using BCDs. Consistent with objective findings, children reported improved speech understanding with the RM. Improved parental perceptions of hearing benefit following exposure to the RM suggests that active participation may serve as an effective strategy to help improve parent understanding of the benefits of RM technology for their child.

Classroom Listening Experiences of Students Who Are Deaf or Hard of Hearing Using Listening Inventory For Education-Revised

Purpose This study examined classroom listening experiences reported by students who are deaf or hard of hearing using the Listening Inventory For Education-Revised (LIFE-R). Method Retrospective electronic survey responses from 3,584 school-age participants were analyzed using descriptive statistics to report student perceptions of listening difficulty in various classroom scenarios, including the strategies students used when they did not hear or understand. Stratified data were used to explore potential differences between grades and across degree of hearing loss or type of hearing technology. Results Average student listening appraisal ratings for 15 classroom, school, and social scenarios was 5.7 based on a 10-point Likert scale (0 = difficult, 10 = easy), highlighting listening difficulties encountered during the school day. This finding can be considered in context with the average rating of 7.2 reported from a previous study of students with typical hearing using the LIFE-R. The greatest difficulties were reported when trying to listen when other students in the class were making noise and in hearing the comments of other classmates. Average listening difficulty was greater for respondents in Grades 3-6 than those in Grades 7-12. Listening difficulty also generally increased relative to degree of hearing loss. When unable to hear, some students took proactive steps to improve their listening access; some reported they did nothing. Conclusions Students who are deaf or hard of hearing can face challenges in hearing and understanding throughout the school day. A functional tool to evaluate and monitor student experiences, such as the LIFE-R, can provide information to make necessary and effective adjustments to classroom instruction and the listening environment.

Assistive technologies as a curriculum component in Jordan: Future special education teachers' preparation and the field status

The purpose of this study was to provide evidence-based information about future special education teachers' perceptions of their preparation for using assistive technology (AT), and the field status with respect to the use of AT. Content analysis was conducted in order to analyze the data from 15 semi-structured interviews and a focus group consisting of 8 participants. The results indicate that overall, the participants were dissatisfied with their preparation programs and the field status regarding the use of AT. Furthermore, the participants reported barriers and ethical considerations regarding the use of AT. Implications and recommendations are provided both for the research community and for decision-makers for special education teacher preparation programs and in the field.

Service Provision for Children Who Are Hard of Hearing at Preschool and Elementary School Ages

Purpose

To characterize preschool and school services for children who are hard of hearing (CHH), we described service setting, amount, and configuration and analyzed the relationship between service receipt and student hearing levels and language scores. Characteristics of professionals providing services were described and then used to predict level of comfort with skills supporting listening and spoken language. The amount of provider communication with children's audiologists was also investigated.

Method

Participants included parents of CHH (preschool n = 174; school n = 155) and professionals (preschool n = 133; school n = 104) who completed interviews and questionnaires as part of a longitudinal study. Children's hearing, speech, and language data were collected from annual testing and analyzed in relation to service data.

Results

A majority (81%) of preschool-age CHH received services. Children were more likely to be in a preschool for children who are deaf or hard of hearing (CDHH) or exceptional children than a general education preschool. By elementary school, 70% received services, nearly all in general education settings. Sessions averaged twice a week for a total of approximately 90 min. Children who no longer received services performed significantly better on speech/language measures than those who received services, regardless of service setting. Professionals were primarily speech-language pathologists (SLPs) and teachers of CDHH. SLPs reported significantly less comfort with skills involving auditory development and hearing technologies and less frequent communication with the child's audiologists than teachers of CDHH. Overall communication with audiologists was more frequent in the preschool years.

Conclusions

As preschool-age CHH transition into school, the majority continue to qualify for services. Congruent with national trends, school-age CHH in the Outcomes of Children with Hearing Loss study were most often in general education settings. Without specialized preprofessional or postgraduate training, SLPs and teachers of CDHH did not report comfort with all the skills critical to developing listening and spoken language. This finding supports the need for increased implementation of interprofessional practice among SLPs and teachers of CDHH, as well as audiologists, to best meet the needs unique to this population.

Remote microphone systems for preschool-age children who are hard of hearing: access and utilization

OBJECTIVES

Children who are hard of hearing (CHH) have restricted access to auditory-linguistic information. Remote-microphone (RM) systems reduce the negative consequences of limited auditory access. The purpose of this study was to characterise receipt and use of RM systems in young CHH in home and school settings.

DESIGN

Through a combination of parent, teacher, and audiologist report, we identified children who received RM systems for home and/or school use by 4 years of age or younger. With cross-sectional surveys, parents estimated the amount of time the child used RM systems at home and school per day.

STUDY SAMPLE

The participants included 217 CHH.

RESULTS

Thirty-six percent of the children had personal RMs for home use and 50% had RM systems for school. Approximately, half of the parents reported that their children used RM systems for home use for 1-2 hours per use and RM systems for school use for 2-4 hours per day.

CONCLUSIONS

Results indicated that the majority of the CHH in the current study did not receive RM systems for home use in early childhood, but half had access to RM technology in the educational setting. High-quality research studies are needed to determine ways in which RM systems benefit pre-school-age CHH.

Systematic Review of the Effectiveness of Frequency Modulation Devices in Improving Academic Outcomes in Children With Auditory Processing Difficulties

This systematic review describes the published evidence related to the effectiveness of frequency modulation (FM) devices in improving academic outcomes in children with auditory processing difficulties. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were used to identify articles published between January 2003 and March 2014. The Cochrane Population, Intervention, Control, Outcome, Study Design approach and the American Occupational Therapy Association process forms were used to guide the article selection and evaluation process. Of the 83 articles screened, 7 matched the systematic review inclusion criteria. Findings were consistently positive, although limitations were identified. Results of this review indicate moderate support for the use of FM devices to improve children's ability to listen and attend in the classroom and mixed evidence to improve specific academic performance areas. FM technology should be considered for school-age children with auditory processing impairments who are receiving occupational therapy services to improve functioning in the school setting.

Long-term functional and behavioral-emotional outcomes in children with early cochlear implants: Parental testimonies

OBJECTIVES

(1) To assess the long-term effects of cochlear implantation (CI) on speech perception and school life, and (2) to evaluate behavioral and emotional development, including social skills, post-implantation.

METHODS

We telephoned caregivers and asked them a standardized questionnaire. We used the data to explore the daily lives (including school life) of children who had undergone CI before the age of 4 years and who had used the device for >10 years. We also evaluated behavioral/emotional development.

RESULTS

Most children used CI devices for virtually all their waking moments and attended mainstream schools. Moreover, more than 75% of them could comprehend common phrases or conversations without lip-reading and carry out a telephone conversation with a person known to them. The mean T-scores for all scales of behavioral/emotional assessment, including those concerning social skills, were within the normal ranges, although scores on the competence scale were lower than those on other scales.

CONCLUSIONS

This long-term study of early-CI children shows that CI improves not only speech perception, but also behavioral/emotional development, including social skills.

Evaluating effectiveness of dynamic soundfield system in the classroom

Research has reported on the use of soundfield amplification devices in the classroom. However, no study has used standardized tests to determine the potential advantages of the dynamic soundfield system for normally hearing students and for the teacher's voice. Our aim was to evaluate the impact of using dynamic soundfield system on the noise of the classroom, teacher's voice and students' academic performance. This was a prospective cohort study in which 20 student participants enrolled in the third year of basic education were divided into two groups (i.e., control and experimental); their teacher participated. The experimental group was exposed to the dynamic soundfield system for 3 consecutive months. The groups were assessed using standardized tests to evaluate their academic performance. Further, questionnaires and statements were collected on the participants' experience of using the soundfield system. We statistically analyzed the results to compare the academic performance of the control group with that of the experimental group. In all cases, a significance level of P < .05 was adopted. Use of the dynamic soundfield system was effective for improving the students' academic performance on standardized tests for reading, improving the teacher's speech intelligibility, and reducing the teacher's vocal strain. The dynamic soundfield system minimizes the impact of noise in the classroom as demonstrated by the mensuration of the signal-to-noise ratio (SNR) and pupil performance on standardized tests for reading and student and teacher ratings of amplification system effectiveness.

Language Outcomes in Children With Unilateral Hearing Loss: A Review

Unilateral hearing loss (UHL) in children is only recently beginning to be widely appreciated as having a negative impact. We now understand that simply having one normal-hearing ear may not be sufficient for typical child development, and leads to impairments in speech and language outcomes. Unfortunately, UHL is not a rare problem among children in the United States, and is present among more than 1 out of every 10 of adolescents in this country. How UHL specifically affects development of speech and language, however, is currently not well understood. While we know that children with UHL are more likely than their normal-hearing siblings to have speech therapy and individualized education plans at school, we do not yet understand the mechanism through which UHL causes speech and language problems. The objective of this review is to describe what is currently known about the impact of UHL on speech and language development in children. Furthermore, we discuss some of the potential pathways through which the impact of unilateral hearing loss on speech and language might be mediated.