European best practices to support children with high potential and to access training for gifted children with disabilities.

– GIFTED (FOR) YOU –

2014-1-RO01-KA201-002957

The present guidebook is addressed mainly to the parents of hearing-impaired children and offers the teachers an insight into the practical means of dealing with the needs of these children.

Coordinators:

• Prof. Univ. Dr. Verza Florin - University of Bucharest, Faculty of Psychology and Educational Sciences, Romania
• Prof. Univ. Dr. Popovici Doru Vlad - University of Bucharest, Faculty of Psychology and Educational Sciences, Romania

Authors:

• Mitran Duţu Liana Maria - Ministry of Education and Research, Romania
• Cozma Romeo Adrian - Bucharest School Inspectorate
• Stoica Florica - „St. Mary” Special Middle School for Hearing Impaired, Bucharest
• Ţîrlui Ileana - „St. Mary” Special Middle School for Hearing Impaired, Bucharest

TABLE OF CONTENTS

Preface

Dear parents and teachers,

The present guidebook is meant to offer information and advice on how we should deal with hearing-impaired children and students, respectively. The richer the information and the better it is presented, the more prepared you will be to work with these children.

The hearing-impaired child is a member of the society and has to remain within the community where he lives. He must also receive support in order to develop according to his abilities.

Hearing is the main sense which contributes to the enrichment of our interior life. A hearing child reacts to the ambient sounds from the very first day of his life and afterwards participates with his own sonorous productions, imitating the sounds around him. By imitation he learns to speak. From the necessity and wish to establish a relationship between himself and the outer world, he builds up his own language which he enriches and improves and uses as an instrument of communication. All this happens because he can hear, because he can attach a meaning to the things around him. The hearing-impaired child lives in a completely isolated world and cannot grasp the significance of the sounds in the outer world.

The urge to speak does not appear in the deaf child, but the need for communication is there, permanently. The deaf child does not receive any sonorous stimulation and has never received any, therefore he does not know what a sound is. He has never received the language by being exposed to the shower of words in his environment; he can acquire the language only through an organized therapy program. The most serious consequence of deafness is the absence of spontaneous language acquisition, but it is not its only one. The whole world of sounds is alien to the deaf child and the absence of sonorous stimulation entails distortions in everything that the child cannot perceive.

We are hoping that this guidebook will prove useful in choosing the best intervention strategy for each child. We believe this guidebook to be particularly helpful to beginner teachers who work with these children, by bringing the necessary clarifications about their deficiency and by suggesting concrete modalities in working with them.

Chapter I. HEARING – ONE OF MAN'S MOST IMPORTANT SENSES

The ear is the organ of hearing and balance. Anatomically it can be split into three parts:

• The external ear
• The middle ear
• The inner ear

The external ear is made up of the helix and the external auditory canal. It is separated from the middle ear by the tympanic membrane.

1. The helix is an ovoid formation, situated on the lateral parts of the head, between the temporal-mandibular joint and the processus mastoid. The helix consists of a cartilaginous skeleton, lined by the perichondrium and covered with tegument.
2. The external auditory canal is a tube of 30 to 35 mm in length in adults. It has an outer fibrocartilaginous part and an inner bony part at the junction of which is the narrowest part of the duct, namely the incus. In the subcutaneous tissue of the cartilaginous part there are sebaceous follicles and wax glands that secret the cerumen. The latter has a protective and cleaning function for the tympanic membrane. The shape of the canal is not straight: there are two curves horizontally and a downward curve vertically.

The middle ear is a system of chambers filled with air, dug into the temporal bone and lined with mucosa. There are three parts to it:

• the eardrum chamber
• the mastoid cells
• the Eustachian tube

1. The eardrum chamber has the form of a cube and is situated between the inner ear and the external auditory duct. It contains the hammer, the anvil and the stirrup. The eardrum is at the end of the auditory duct, in a sloping position. It looks like a well - stretched, transparent gray membrane.
2. The Eustachian tube is an extension of the eardrum chamber, in the form of 3 to 5 cm - long duct connecting the eardrum chamber to the nasopharynx.
3. The mastoid is a bone in the form of a pyramid, its apex downwards, situated behind the external auditory duct and the eardrum chamber.

The inner ear is situated inside the temporal bone and is made up of two separate segments, both anatomically and functionally. The cochlea contains the acoustic receptors, the posterior labyrinth and the semicircular canals with the chamber receptors.There are a bony labyrinth and a membraneous one inside it.

The bony labyrinth is separated at its two ends from the eardrum chamber by the oval window and the round window.

A correct functioning of these windows is important for passing the sounds. Inside the bony labyrinth is the membraneous labyrinth and between them are the perilymphatic spaces containing perilymph. Inside the membraneous labyrinth are the endolymphatic spaces containing endolymph.

The cochlea has a conical shape and is made up of the cochlear canal - a snail-like tube with two and a half coils, around a central axis called columella. From the columella starts the spiral bladebone, which continues with the basilar membrane stretching up to the outer wall of the cochlea.

These two formations divide the cochlea into two levels: the upper level called the Scala Vestibuli and the lower level called the Scala Tympani. On the basilar membrane is the Organ of Corti made of support cells and sensory cells. The acoustic canals are represented by all the nerve connexions between the peripheral organ of hearing and the cortical auditory centres, that is the cochlear nerve leading to the cochlear nuclei in the brainstem.

The sound is explained physiologically as the sensation produced upon the auditory organ by the material vibrations of bodies and transmitted by way of acoustic waves. The human ear is sensitive to the air vibrations with frequencies between 20 Hz and 20 kHz, the maximum auditive sensitivity being around 3500 Hz. This interval depends highly on the amplitude of the vibration and the age and health condition of the individual. Below the amplitude of 20 μ.Pa the vibrations cannot be perceived anymore. The sensitivity span decreases with age, particularly high frequency sounds becoming inaudible.

The helix conducts to the eardrum the vibrations coming from different directions. The external auditory canal, through the resonance effect, causes a decrease of the auditory threshold, especially in the convectional sequences.

The ossicle system has the role of conducting the sound waves from a gaseous medium - the air - to the liquid medium - the endolymph. The difference in density between these two media, as well as the inertia of the ossicle chain, consume a part of the sound energy. This energy is compensated due to the ratio between the area of the eardrum and the area of the oval window, determining a concentration of the sound vibration and its increasing with cca 25 db. The vibration of the eardrum sets the ossicles into a piston-like motion. The eardrum moves forwards and backwards with each change of the air pressure in the external auditory canal. For an optimal passing of the sound, the pressure must be the same in both parts of the tympanic membrane.

All sounds are defined by three qualities:

1. Pitch or frequency defines the sound as being high pitch or low pitch (acute/sharp or profound)
2. Intensity or loudness is determined by the quantity of energy carried by the sound wave and it is expressed by the amplitude of the wave and measured in decibels.
3. Timbre – the difference in quality between the sounds of same intensity and pitch and the emission of different instruments.

For a man to perceive the sound pitch accurately, his ear must receive sound waves for at least 1/100 seconds. By exercise this limit can be lowered, the same as the differential threshold of sound discrimination can be educated.

Chapter II. ETIOLOGY AND TYPOLOGY OF THE HEARING IMPAIRMENT

Classification must be based on a method which would clearly define the mentioned categories. This is imperative for a differentiated classification which would allow comparing the results in the course of time.

II.1. Classification of the hearing impairment

Whatever the criterion of the classification may be, it must ensure the success of the prevention, diagnosis, treatment and training of the hearing-impaired persons.

II.2. Causes of the hearing impairment

There are two main types of causes: hereditary and acquired. The most frequent hereditary causes are:

• the Siebenmann type with damage of the sensory or ganglion cells in the nerve fibers;
• the Sheibe type characterized by the atrophy of the anvil, damage of the sensory cells in the cochlear duct and of the Organ of Corti;
• the Mondini type is characterized by the dilation of the cochlear duct, with atrophy of the cochlear nerve, the Organ of Corti and the ganglia.

The acquired causes are divided into:

• prenatal (that appear before birth) - the most important are the viruses, bacterial infections, ingestion of drugs, maternal alcoholism, maternal diabetes, etc;
• perinatal (that appear during birth) - the blue asphyxia, obstetrical trauma, kernicterus, etc;
• postnatal (that appear after birth) - head trauma, infectious diseases, poisoning due to various chemical substances, chronic malnutrition, inadequate treatment with ototoxic drugs, etc.

II.3. Ear pathology

Ear pathology comprises:

• malformations
• trauma
• presence of foreign bodies
• acute or chronic disease

Malformations of the ear can be localized in any of the three parts of the acoustic - vestibulary analyzer. At the outer ear we can find anomalies of the auricle and the external canal, at the middle ear anomalies of the eardrum, the eardrum chamber and the ossicle chain, and there are anomalies of the inner ear as well. These malformations can be isolated or connected between themselves. The most frequent are: the anotia (absence of the ear), the microtia (small ear) and malformations of the cartilaginous structure or the folds of the auricle.

Complex malformations can occupy the auricle, the external auditory meatus and the middle ear; the inner ear is normal and, upon evaluation of the hearing, is detected a transmission hearing impairment. Symptoms include earache which becomes throbbing ache, accompanied by fever and hearing impairment. If not treated, the condition will worsen, with serious effects upon audition.

Tympanosclerosis is a chronic condition of the middle ear, following an untreated suppuration. The eardrum is perforated in several places, with perforations of various decibel values. The treatment is surgical, an intervention called tympanoplasty.

Otosclerosis is characterized by the appearance of new, softer bone tissue, which replaces the normal bone tissue. It may localize at the level of the stirrup, near the oval window, but it may extend to the level of the cochlea, or the round window. It can be present before the hearing impairment and it can start at any age.

Chapter III. DETECTION OF THE HEARING IMPAIRMENT

SCREENING tests can be applied to babies and we can do them also with our own children at home. Screening - is a mas testing of a certain segment of the population selected according to age, profession, etc.

When a 1 - month old child is taking a mandatory testing, we say that he has been screened. This kind of tests are appropriate also for the detection of auditory problems that can appear as early as one's birth.

There are several requirements that screening tests must meet:

• the criteria for passing the tests should not be too difficult as to become a challenge for the children with no auditory deficit or other.
• on the other hand, the criteria should not be too permissive, too easy to fulfil, so that they wrongly declare normal those children who may have the respective deficiency. An auditory screening should be conceived in such a manner that would detect children with a hearing condition and would exclude those who have not.

The screening test cannot confirm the existence and the degree of a deficiency, but it should be a method of selecting a number of cases from the respective population, which may evince that specific deficiency.

A particular characteristic of this testing is the parents' involvement in the detection of their children's potential auditory condition. It is considered the most efficient method of detecting the children's auditory deficiencies, as parents are the best observers of their behaviour.

All that parents must do is watch their children.

British researcher has made the following questionnaire for parents. If their children do not react according to the requirements presented, the parents are advised to take them to the doctor.

QUESTIONNAIRE FOR PARENTS

• Right after birth the child gets startled, blinks or opens his eyes wide at unexpected loud noises such as the clapping of hands or the banging of a door;
• At age 1 month, the child is alert to unexpected, prolonged sounds, turning his attention and listening to them;
• At age 4 months, the child calms down or smiles when hearing his mother's voice, even when he does not see her and can turn his head or look when she speaks to him from a lateral side;
• At age 7 months, if not caught up in an activity, the child turns at once when hearing his mother's voice or the faint sounds coming from lateral sides;
• At age 9 months, he listens attentively to familiar sounds, searching with his eyes the objects that produce those sounds. He starts cooing and gurgling loudly and melodiously, an activity that he loves doing;
• At age 12 months, he answers when called by his name and also reacts to other familiar words. He answers to NO/YES even when they are not accompanied by gesturing.

SCREENING by means of age and behaviour tests

• For behaviour age 6-18 months are used the tests Distraction of attention and Audiometry with visual backup;
• For behaviour age 18 months - 2 years are used the Test of pointing to the toys with the eyes and the Test of cooperation;
• For ages 2, 5 years and 3, 5 years se are used the Picture test, the Kendell toy test, the Dodds model plate and the Test of execution.

The distraction of attention test is based on observing the baby turn himself in order to localize the sounds perceived at the level of the ear, if they are new to him and if his attention is alert.

Basic requirements of the testing:

1. Age: To ensure successful testing, the child must be old enough to be able to sit upright unaided and turn his head in horizontal plane. This test is repeated periodically with children who have not responded satisfactorily and those who have had a middle ear condition that might lead to an auditory deficiency.
2. Testing environment: a 4x4 m room with good lighting, a relaxing atmosphere for the child and preferably soundproof, so that the background noise should not exceed 35-40 db;
3. Examining personnel: 2 examiners trained to perform this test;
4. Necessary materials: a low table, a selection of sounds in different sequences, a sound meter (to indicate sound level).

Organizing the testing

The child will sit upright on his parent's knees, face forward. The parent will be warned to refrain from reacting in any way when the sonorous stimuli are presented, so as not to give his child any clue about how he should respond.

One examiner will work in front of the child, preferably sitting on his knees, on the other side of the sound. His role is to capture the child's attention and keep it under control so that, at the most appropriate moment when the sonorous stimulus is about to be presented, there should be no other stimuation that might distract his attention.

The role of the second examiner is to present the sonorous stimuli at the right time. He should not be anywhere in the child's sight because he would give him a visual clue and the child would turn his head to him.

The examiner facing the child will draw his attention by playing with a toy on the table (usually a brightly-coloured spinning top). When the examiner considers that the child's attention has reached its peak, he will cover the toy with his hand, making it disappear from the child's sight. In this way, the child is attentive, but he no longer has an object to focus his attention upon. That is why, when the sonorous stimulus is presented and the child can hear it, he will turn his head in the direction of the sound. The examiner behind the child is supposed to present the sound at the appropriate moment. The sound source must be kept at horizontal level, at a distance of about 1 m from the child's ear and out of his sight. The sonorous stimulus will be presented no later than one second after the examiner in the front has covered the toy with his hand. If there is no instant response, then the stimulus is being presented for 10 seconds longer.

As for the intensity of the sounds presented, only low levels of less 35 db will be used. The testing is intended to get responses from the child to the low and high sounds within the interval of speech frequencies.

The sounds presented to the child can be:

• for high frequencies ( consonant S repeated rhythmically ),
• for low frequencies, in case there are no specialized devices for sound emission, we can use the murmur, obtained through rhythmical repetition without articulation, of a nursery rhyme, with a normal voice, not whispered.

CRITERIA FOR PASSING THE TEST

Under screening conditions, the only valid response is the turning of the head in the direction of the sound presented at minimal value (a frequency lower than 35 db). This response must be obtained for all of the three tested frequencies and for both ears. It is considered that a child who has constantly not responded to the sound, has failed the test and is referred for further investigations.

In order to exclude the possibility of the child's insufficient physical development, before testing we will check his capacity of turning his head in horizontal plane, while watching a toy which is being moved laterally. The result of the testing can be recorded in a record sheet like this:

Audiometry with visual backup

The test is based on the child's conditioned response to auditory stimuli, his reward being a visual image.

The child will sit on his parent's knees or he can sit by himself, on a chair, facing a low table. The examiner in front of the child will show him various toys, to capture his attention. There must be no verbal exchange between the two examiners.

The examiner behind will present the stimulus of the testing by means of an audiometer. When the child is ready and fit to participate in the testing, the examiner will ask him to search for a visual reward when hearing the sonorous stimulus.

The necessary equipment:

• two loudspeakers
• visual stimulus
• audiometer
• toys to distract attention

The examiner working with child must keep on a constantly interesting, but moderate activity. He will avoid taking breaks during the test for distracting attention because, in the event of a break, the child may turn his head to see the visual stimulus without having heard any sonorous stimulus.

Conditioning of the child is achieved with sounds of 2000 Hz frequency and an intensity of 65 db. Auditory stimuli are presented at the same time with the visual ones and the examiner will draw the child's attention to the visual stimulus. This procedure is repeated twice. Then, the same sound is presented again at 2000Hz frequency and 65 db, but the reward is delayed. If the child is correctly conditioned on hearing the sonorous stimulus, he will turn his head to the image. If noticed that he has not been conditioned, the conditioning stage will be repeated at higher intensity.

After the conditioning stage we pass on to the actual testing, performed at a 36 db intensity. If two clear responses are obtained at the level of 30 db, the child is considered to hear normally on the respective frequency. Testing is continued on the frequencies of 500 Hz, 1000 Hz and 4000 Hz. If the child is sufficiently grown up, we can use audiometric headphones.

Pointing to the toy with the eyes

This testing method uses 4 toys representing pairs of words: spoon - shoe (for the sound u: ). These toys are taken out one by one and the examiner makes sure they are familiar to the child, that he knows what each toy represents. The toys are placed in an arc, on the table between the examiner and child, at least 20 cm one from another. The examiner asks: "Where is the shoe?" at which the minimum accepted response from the child should be his turning his eyes towards the respective object and staring at that object. If there is no response from the child, he will be given the order: "Look at the shoe!".

After a couple of trials made at the normal intensity of the conversation (60 db), the voice will be lowered to 40 db in order to check if the child can hear also at voice intensity.

The child will pass this test if he identifies the objects correctly and consistently and obtains a score of at least 4 out of 5 correct answers. The child's occasional loss of attention will not be taken into account.

The test of cooperation

This type of test is based on the cooperation between the examiner and the child. The testing materials consist of toys representing paired words or close in phonetic resonance. The words must have the same number of syllables, to make it harder for the child to discriminate between their meaning. At the beginning of the test the toys are placed on the table, assuming that the child knows their meaning. The examiner utters, in a normal voice (60 db), commands that he executes himself, to show the child what he is supposed to do. Then the child is guided to join in the game, holding the toy in his hand and allowing the examiner to lead him when the command is given.

After making sure that the child has understood what he must do, the examiner utters the commands at an intensity of 40 db, in random order, to avoid learning. Testing will be done at a distance of 1 m from each ear, the examiner having to cover his mouth with his hand. The test is considered to have been passed by the child who answers to 80% of the commands.

The picture test

This test is made up of 8 cards bound like a booklet, each card having 4 pictures of objects. The objects are selected according to certain criteria:

• They are named by monosyllabic words, so that their rhythm of uttering may not give any clues to the children;
• All the words on one page will contain the same vowel;
• The respective words should be part of the children’s usual vocabulary.

Initially the child’s conditioning will be done at the normal conversational level and for the testing itself will be used a 30 db voice, with the examiner at a distance of 2 m from the child. At each page, the child must point to the picture corresponding to the word uttered by the examiner.

The Kendell test with toys

The original test is made up of 3 lists of 15 nouns selected in such a way as to contain the usual vowels and diphthongs of the respective language, as well as the most frequent consonant.

Each word is represented by a toy. The examiner is asking the child to point to the toy that he is naming. The test is passed when the child indicates correctly 80% of the toys.

The Dodds plate with shapes

The test uses an insertion plate with various shapes of common objects known by a 3-year-old child. Testing is based on the principle of the child’s choosing the object named by the examiner. What differs is the testing procedure; the objects used represent words that are selected by the same principles as in the previous testing. At first, the child will be accommodated with his task and the commands will be given at an intensity of 60 db, then they will be presented at 35 db.

The execution test

The necessary materials are simple toys which give the possibility of repeating elementary activities. These toys can be wooden circles or balls to be strung together on a stick or a plate with slots in which to insert little things.

The goal of this test is to condition the child to respond to a sonorous signal by introducing the respective circle or ball on the stick. In order to test each ear separately, we will use specific frequencies for the high or low sounds. One of the advantages of this test is that it can be applied without any verbal instruction. At first, the child is given a sound of 60 db and, once he is conditioned, he will be given a stimulus of 35 db. The examiner must stand at a distance of 30-40 cm from the child’s ear, at an angle of 45` to the child.

The test is considered to have been passed if the child responds correctly to 3 high-frequency stimuli and to 3 low-frequency stimuli, consecutively, at an intensity of 35 db.

TESTING OF HEARING

Once there is suspicion about a child’s hearing condition, investigations are mandatory to establish the level of hearing loss, the location of the deficit that has caused the onset of the auditive deficiency.

AUDIOMETRIC TESTING can offer the necessary information on the degree of deficiency, its nature and its possible localisation at organic level. Residual hearing can be detected by technical measures and procedures collectively called audiometry.

Audiometry can be:

• phonic
• tonal
• vocal

Phonic audiometry is represented by the testing of hearing through voice. The child is sitting on a chair, his face turned in the opposite direction of the examiner. The latter is standing at a distance of 8 m from the child, on the floor marked every meter. From the initial distance of 8 m, the examiner utters bisyllabic and trisyllabic words which the child will repeat exactly as he has heard them. At first the words are uttered at the intensity of normal conversation and the tone of normal conversation, then the examiner changes his voice, uttering the words in the range of grave or acute sounds. If the child does not hear the words or he repeats them wrongly, the examiner will advance meter after meter, until the child reproduces the words rightly.

Normal audition is considered to be in the range of 8 to 6 m. We speak of moderate hearing loss between 5 and 2 m, and serious hearing loss at less than 2 m.

Tonal audiometry se is performed with a specialized device called audiometer. By means of tonal audiometry we can accurately establish the degree and nature of the hearing loss, as well as the location of the hearing deficit. Using the audiometer we can modify, by simple commands, the following parameters:

• Sound frequency;
• Frequency range;
• Sound intensity;
• Type of sound.

By means of certain commands, the examiner can change these characteristics of the sound. The audiometer is equipped with three devices for passing the sound: through the headphones, for air conduction – the red headphone is red for the right ear, and for the left ear, it is blue or green. The apparatus is also equipped with loudspeakers for the testing of conductibility, and for the testing of bone conductibility there is a vibrator placed on the mastoid, behind the ear. The results of the tests performed with the audiometer are registered in an audiogram.

The recording of the auditory threshold is done with certain standard symbols:

	for air conduction of the sound in the right ear;
	for air conduction of the sound in the left ear;
	for bone conduction both in the left and the right ear.

Vocal audiometry is performed with the audiometer, air conduction testing by means of the headphones, as well as the loudspeakers.

By vocal audiometry we can test the hearing for spoken language, in a variety of ways.

Chapter IV. THE HEARING AID – IS IT IMPORTANT OR NOT IN THE REHABILITATION OF THE HEARING IMPAIRED ?

The final goal of testing the child is to provide him with an auditory prosthesis. Theoretically, any type of hearing impairment can be aided prosthetically, but the benefits are different according with the degree of deficiency.

Hearing aids are electronic devices that provide help in perceiving speech and learning verbal communication. They cannot correct the deficiency, but can replace or minimize its effects.

Hearing aids difer in design, size, type and manner of amplification, comfort for the wearer or volume control. All hearing aids have common components:

• A microphone through which the sounds are collected from the environment
• An amplifier for increasing sound intensity;
• A receiver through which amplified sounds are passed in the ear;
• Batteries to power the whole system.

By way of positioning the hearing aid to the ear, there are the following types of hearing aids:

• hearing aids placed in the auditory meatus (these are the smallest types, which offer aesthetic advantages) ;
• hearing aids placed inside the ear (these are easy to handle by children);
• hearing aids placed behind the ear / postaural hearing aids (its components are contained in a device placed behind the ear, connected to the hearing piece).

The role of the hearing piece is to keep the hearing aid in place and to conduct the amplified sound through the external auditory duct. The hearing pieces are individual, customized after the mould of the patient’s ear. After the mould is taken, an exact replica will be made, of an extra elastic material (silicone).

Hearing pieces must be replaced periodically, with the child’s age. In conductive hearing loss, a bone vibrator can be attached to the hearing aid, so that the sound be conducted directly to the cochlea.

By way of sound processing, hearing aids can be:

• Hearing aids with analogous, convectional processing of the sound;
• Hearing aids with analogous programming;
• Hearing aids with digital programming.

THE COHLEAR IMPLANT

This is an electronic device which is supposed to recover the auditory sense in the nerve. The device offers a large range of auditory information necessary to the child’s orientation in the environment and recovery of oral language. The cochlear implant involves surgery. The device renders the sounds mechanically.

The component parts are surgically implanted in a device into the temporal bone. The hearing aid has two parts: an outer and an inner one. The outer part receives the sonorous signals from the environment, which it processes, amplifies and conducts by means of radio waves to the inner part, the cochlear implant itself. The sounds are received by the microphone of the outer processor and the digitally-processed signal is transmitted to the inner part through the antenna.

How is the implant done?

A small incision is made behind the ear, resulting in a cavity into the mastoid bone. The part of the implant which is introduced into the cavity is a very flat shape and not visible. Now there is an opening to the temporal cavity, filled with air from the mastoid.

The opening is meant to allow access from the exterior to the cochlea, for the chain of electrodes to be introduced. The incisions are closed with stitches that are eventually absorbed.

The surgical operation lasts about two hours. With some patients were evinced balance problems within a week or so after surgery.

The first turning on of the device is done after 4-6 weeks after surgery. The implants are extra longlife, the patient not needing any more surgery.

Beneficiaries from the implant are dicided into three groups:

1. Children with congenital hearing loss or from early childhood (if the child is detected early and wears hearing aid);
2. Adults with acquired hearing loss;
3. Children over 3 years old and adults who were born deaf and have lived with deafness quite a while.

Success depends on several factors:

• verbal skills;
• wish;
• motivation;
• a program of hearing training.

Chapter V. DOES HEARING LOSS PREVENT THE CHILD’S NORMAL DEVELOPMENT ?

To realize the extent to which hearing loss prevents a child’s normal development, we must compare the way a hearing-impaired child develops his physical and mental characteristics to the way a hearing one does.

Chapter VI. DEVELOPMENT OF LANGUAGE AND COMMUNICATION

The child should be encouraged in all his efforts to communicate and see if he is understood by the people around and is answered in his attempts at emotional approach.

Lest he should experience a retard as compared to his peers, the hearing-impaired child should be taught to recognize and internalize the main linguistic structures by age 3.

This is a social endeavour on condition his parents are totally involved in it.

The requirements regarding his speech must be correlated with his age and the level of his hearing loss.

During speech acts, the child must wear a hearing aid, to allow the forming of auditory representations.

Hearing - impaired persons lack both the visual and the auditory experience linked to verbal communication and the role of the word in expressing the contents of ideas.Their capacity to express themselves is restricted to using a few gestures that symbolize their concrete acting reality.

Verbal speech therapy

This is a very complex activity to fight off mutism, in such a way as to help the hearing-impaired child to be able to use oral language as a means of communication in his social relationships.

Verbal speech therapy has two meanings:

• In a restricted way, verbal speech therapy means the acquisition of the phonetic system of the language, with a basic vocabulary and grammatical patterns, to facilitate oral reproduction;
• In an extended way, verbal speech therapy is the specific activity by which the hearing-impaired person has mastered the oral and written language to such a degree as to be able to use it as a means of communication, to see it as a form of permanent education, to go beyond the phonetic structures and learn the linguistic structures.

LIP READING

Lipreading is the visual perception of verbal speech by the visible movements of the speech organs and the interlocutor’s physiognomy.

Sign language is a special type of language, with its own vocabulary and grammatical structure, used by specific groups. Signing, performed with the hands, has at least four basic components: shape, orientation, position and movement, and it tries to represent notions with a larger meaning than the words of spoken language.

Fingerspelling is frequently used to help up spoken language. There are fingerspelling systems which use the fingers of a single hand and other systems which use both hands.

Fingerspelling is used as a support system of spoken language, to prevent possible misunderstanding, as well as to facilitate lipreading.

Reasons for using finger signs :

• They are an important support in the learning of words and in performing analysis and synthesis operations;
• Learners acquire a much greater number of words in a much shorter time;
• Communication through miming and gesturing is avoided;
• Once the fingersign alphabet is learned, it is much easier to pass on to oral or written expression;
• Notional-verbal thinking is taking shape at the same time with the acquisition of these signs;
• Fingersigns also help the reverse aferentation process.

Reasons against using fingersigns:

• Being a mute fingersign alphabet, it will never help the development of pronunciation;
• This type of communication is not widely known;
• This is an artificial kind of alphabet because, once the hearing-impaired have received verbal speech therapy, they change it for sign language;
• Fingerspelling is done simultaneously with the pronunciation of the respective phoneme and this requires distributive attention;
• The importance of fingerspelling is not so great and neither is its contribution to the development of notional thinking.

Gesturing

The Central Nerve System is responsible for the guidance of the movements of fingers and hands, the articulation movements with the participation of the tongue muscles, the raising and lowering of the uvula, all of which having cortex projections. In order to be felt, these must be practiced by children together with their parents as early as their early childhood.

To help children practise these actions, parents can use common objects and various toys, asking them to string small balls on a stick, to place one cube on top of another, etc.

At an early age the child cannot focus for a long time, therefore we should not insist too much upon these exercises, or the child might get a dislike for these daily routine actions.

There are multiple causes for the existence of gesture sign variations:

1. Causes from within sign language itself;
2. Causes other than sign language, such as:
   • It is in the nature of an individual to invent a sign of his own when he does not know the right sign for a particular object;
   • Teachers who, wishing to relate to their very young hearing-impaired students, make use of certain signs that have no counterpart in sign language;
   • Signs with which a hearing-impaired child comes to school, since he belongs to a hearing-impaired family;
   • Signs borrowed from other student communities: another school, another town, etc.
   • When young hearing-impaired students socialize with other hearing-impaired persons in private meetings;
   • The social-cultural environment at a certain period.

Chapter VII. ADVICE TO PARENTS AND TEACHERS

The first and foremost thing in the teaching profession is the feeling of love that an educator shows to his students. He who loves children knows the way to their hearts and the way to get them feel emotionally close, and he can also influence them profoundly. A teacher who loves his students has a gentle, caring attitude towards each of them, is sensitive to all their attempts and success. To a teacher who cares about them and respects the, students behave with sincerity and openness; to a dull, distant and rigid teacher, they become withdrawn and distrustful.

Optimism is another characteristic feature of a teacher. His belief in students and their possibilities of development, his belief in the success of educational and therapeutical endeavours, lie at the basis of his entire teaching activity.

A teacher acquires and develops his tactfulness, skills and talent needed in his profession just as an expert does. A specialist teacher has to meet several requirements:

• to know the students’ psychological features;
• to know the fundamental principles of pedagogy;
• to be able to adapt and teach the contents according to the students’ individual psychological particularities;
• to know the teaching strategies.

POINTS TO REMEMBER :

• Always stay with face turned to the person you are talking to;
• Your face will be in the light and at a distance of 1 - 1, 5 m;
• Your face will be as well exposed as possible (no beard, moustache or hair fallen on forehead, makeup adequate to the contour of the eyes and mouth);
• Do not chew gum or speak with cigarette in your mouth to a hearing-impaired child;
• Always stay level with the child you are talking to (sit on a chair, on a carpet);
• Speak naturally, neither hastily, nor too slowly;
• Speak clearly, but do not exaggerate; do not shout;
• Use simple language;
• Use only one sintagm or sentence at a time. A full message is too much for a hearing-impaired child;
• When possible, use just one word;
• Lay the accent on the more important word, without taking into account the less important words preceding or succeeding it;
• Keep in hand the object you are talking about or indicate its image in pictures or posters;
• Repeat or rephrase when necessary and check if what you have said was fully understood;
• Be expressive when speaking, but avoid exaggerated facial mimic;
• Avoid the “aah”s or “hmmm”s or the coughing, as they are all devoid of interest to the hearing-impaired child;
• Remember that a hearing-impaired child cannot lipread a word that he does not know yet;
• Establish eye contact with the child – look him in the eye when talking to him;
• Have a dialogue with the child, taking care that he speak the more,
• Ask questions that would open the conversation, not the kind that would close it. For instance: “What is the boy in the picture doing ?”
• The aim of the questions is to give the child the possibility to answer and speak, not necessarily to elicit a correct answer;
• Allow the child enough time to answer. Hearing-impaired children need more time to think. Be patient;
• Encourage the child verbally with “Well done!”, “You’ve made it!”, “Good!”, etc;
• Respond to an incorrect answer of the child by providing him with the correct answer. For instance, “This is a window”, not “This is NOT a door”;
• When the child makes a grammar mistake, repeat the sentence in its correct form;
• Watch yourself in the mirror, imagining that you are supposed to be “read” by a deaf child, or turn off the sound of the TV and try to guess what they are talking about;
• Do not forget that lipreading is a tiring activity and remember this when you are talking to a hearing-impaired child or an entire class.

GLOSSARY

BIBLIOGRAPHY:

[ 1]. http://articole.famouswhy.ro/despre_integrarea_scolara_a_copilului_deficient_de_auz/

[ 2]. https://www.google.ro/search?q=urechea...

[ 3]. Stănică, I/Popa, M/ Popovici , D.V. „Psihopedagogie specială-deficienţă de auz” , Ed. Pro Humanitate, București, 2001

[ 4]. Verza, E. „Metodologii contemporane în domeniul defectologiei și logopediei”, Univer-sitatea București, 1987

[ 5]. Verza, E./ Verza, F. „Tratat de psihopedagogie specială”, Ed. Universităţii din Bucureşti, Bucuresti, 2011

[ 6]. Drăgan, L. Văcărescu, A. “Elemente de surdodidactică”, Ed. Orizonturi universitare, Timişoara, 2002

[ 7]. Wallon, H. „Evoluția psihologică a copilului”, E.D.P., București, 1975

[ 8]. Popa M. „Comunicarea și personalitatea la deficientul de auz”, Ed. Fundației Humanitas, București, 2001

[ 9]. Caraman , L.M. „Metodologia procesului demutizării”, E.D.P., București, 1983

[10]. Mare , V. „Date cu privire la funcția auditivă la elevii surzi”, Probleme de defectologie, vol. IV, E.D.P., București 1970