Chapter 6
Sensory Impairments: Hearing and
Vision
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Hearing Impairment
• The Individuals with Disabilities Education Act
(IDEA), formerly the Education of the
Handicapped Act (P.L. 94-142), includes
"hearing impairment" and "deafness" as two of
the categories under which children with
disabilities may be eligible for special education
and related services programming.
• While the term "hearing impairment" is often
used generically to describe a wide range of
hearing losses, including deafness, the
regulations for IDEA define hearing loss and
deafness separately.
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Hearing Impairment
• Hearing impairment is defined by IDEA as
"an impairment in hearing, whether
permanent or fluctuating, that adversely
affects a child's educational performance."
• Deafness is defined as "a hearing
impairment that is so severe that the child
is impaired in processing linguistic
information through hearing, with or
without amplification."
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Deafness and Hearing Loss
• Hard of hearing refers to a lesser loss,
but one that nevertheless has a definite
effect on social, cognitive, and language
development.
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Deafness and Hearing Loss (continued)
• Types of hearing loss
– Conductive hearing loss
• A loss in the outer or middle ear
– Sensorineural hearing loss
• A loss in the inner ear (cochlea)
– Central deafness
• A loss in the higher auditory cortex
– Combined loss
• A loss in two or more of the above
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Deafness and Hearing Loss (continued)
• Causes and prevention
– Conductive hearing loss can occur from
frequent ear infections.
• It can usually be aided by amplification systems.
– Sensorineural hearing loss and central
deafness are caused by malformation of the
ear or severe infections.
• A cochlear implant may be needed.
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Cochlear Implant
• Cochlear implants are devices that take the
place of damaged inner ear structures that
cause profound hearing loss.
• In the past, profound hearing loss was
commonly referred to as nerve deafness.
• This was incorrect because the problem was
often not with the hearing nerves, but with the
hair cells that line the cochlea.
• The cochlea is the spiral part of the inner ear
containing nerve endings that carry information
about sound to the brain.
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Cochlear Implant
• A cochlear implant (bionic ear) is a surgically
implanted device for the hearing-impaired. It is
the first medical technology able to functionally
restore a human sense - hearing.
• Unlike a hearing aid that amplifies sound to
make it loud enough for an impaired ear, a
cochlear implant bypasses the damaged area
and sends sound signals directly to the auditory
nerve. A cochlear implant consists of an internal
and an external component.
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Cochlear Implant
• The Internal Component has
two main parts (neither are
visible from the outside):
• A receiver-stimulator [3] placed
under the skin behind the ear
• An electrode array [4] sitting
within the inner ear
• The External Component has
two main parts:
• A speech processor [1] which
may be worn behind the ear or
on the body
• A transmitter coil [2]
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Deafness and Hearing Loss (continued)
• Warning signs
– Tugs on ears
– Used to talk and respond and now does not
– Drops initial consonants
– Seems inattentive
– Looks confused when given directions
– Turns head to one side to hear better
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Deafness and Hearing Loss (continued)
• The impact of hearing loss on
development
– Effect on language development
• A child who cannot hear sounds during the critical
period may never master those sounds.
• Language delays are probable.
• Parents and caregivers may stop speaking to the
child, because he or she cannot hear them.
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Deafness and Hearing Loss (continued)
– Effect on cognitive development
• Language and cognitive skills go hand in hand.
• If children are behind in language skills, they are
more than likely going to be delayed cognitively as
well.
• Children with little or no hearing tend to be years
behind their normally developing peers.
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Deafness and Hearing Loss (continued)
– Effect on social development
•
•
•
•
Shy and withdrawn categorize this child.
These children tend to be socially immature.
They also tend to be impulsive and hyperactive.
Unintentionally, they are often left out, because
hearing is so much a part of our world.
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Deafness and Hearing Loss (continued)
– Effects on family life
•
•
•
•
Frustration
Lack of time to learn new methods
Need for behavior management
Family therapy and counseling
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Deafness and Hearing Loss (continued)
• Methods of communication
– Speech reading—child learns to read your lips
while you talk
– Cued speech—a system of hand shapes and
mouth movements in which the child learns
the combinations to understand the spoken
word
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Deafness and Hearing Loss (continued)
– American Sign Language—a language that
consists of hand movements with or without
speaking
• Signed English
• Finger spelling
– Total communication—combines speech and
hand motions
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Deafness and Hearing Loss (continued)
• Which method?
– It is family preference.
– No one method has been proven to be the
best.
– Total communication leads to more
communication with the outside world.
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Deafness and Hearing Loss (continued)
• Early intervention
– As with all disabilities: The earlier intervention
is begun, the better.
– Children need to learn to use what residual
hearing they have.
– They need to exercise their vocal chords for
speech.
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Deafness and Hearing Loss (continued)
• Guidelines for teachers
– Get down on the child’s level.
– Sit close to the child when talking.
– Make eye contact.
– Use short, simple sentences.
– Use concrete examples.
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Amplification devices
Hearing aids—an
amplification device is
molded to fit the child’s
ear.
• Problems: bad fit, dead
batteries, feedback, on
and off switch, sore
ears
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Amplification devices
FM system—child wears
a receiver and the
teacher wears the
microphone.
• Problems: dead
batteries, on and off
switch
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Blindness and Vision Impairments
• Blind—visual loss is severe enough that it
is not possible to read print.
• Low vision—residual vision is sufficient to
allow a child to read large print or possibly
regular print under special conditions and
to use other visual materials for
educational purposes.
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Blindness and Vision Impairments
(continued)
• Total blindness is the inability to
distinguish between light and dark.
• Most children can see some light and
shadows.
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Visual Impairment
• "Partially sighted" indicates some type of visual problem has resulted
in a need for special education;
• "Low vision" generally refers to a severe visual impairment, not
necessarily limited to distance vision. Low vision applies to all
individuals with sight who are unable to read the newspaper at a
normal viewing distance, even with the aid of eyeglasses or contact
lenses. They use a combination of vision and other senses to learn,
although they may require adaptations in lighting or the size of print,
and, sometimes, braille;
• "Legally blind" indicates that a person has less than 20/200 vision in
the better eye or a very limited field of vision (20 degrees at its widest
point); and
• Totally blind students learn via braille or other non-visual media.
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Blindness and Vision Impairments
(continued)
• Types of vision problems
– Physical abnormalities
• Cataracts
• Glaucoma
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Blindness and Vision Impairments
(continued) Physical abnormalities
• Retinopathy of prematurity
• Cortical blindness (Neurological Visual
Impairment or Cortical Visual Impairment)
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Blindness and Vision Impairments
(continued)
– Visual acuity problems
• Refractive errors
Astigmatism: uneven refraction
Myopia: nearsightedness
Hyperopia: farsightedness
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Blindness and Vision Impairments
(continued)
• Identifying vision problems
– This is rather difficult until a child is in school.
– A few tests are available for the younger child
• Snellen Illiterate E
• Teller Acuity Cards
• Photo Screening
– Children often do not know they have a
problem, because they do not know what they
are looking at.
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Blindness and Vision Impairments
(continued)
– Muscular
abnormalities
• Strabismus: eyes are
not aligned (crossed
eyes)
• Amblyopia (lazy eye):
• Nystygmus
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Blindness and Vision Impairments
(continued)
• Identifying vision problems
– This is rather difficult until a child is in school.
– A few tests are available for the younger child
• Snellen Illiterate E
• Teller Acuity Cards
• Photo Screening
– Children often do not know they have a
problem, because they do not know what they
are looking at.
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Blindness and Vision Impairments
(continued)
– Warning signs
•
•
•
•
•
Rubbing eyes
Closes one eye
Watery or itchy eyes, not allergy related
Inability to see, squinting
Blurred vision
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Signs of Vision Problems
• Holding a book very close
(only 7 or 8 inches away).
• Child holds head at an
extreme angle to the
book when reading.
• Child shuts or covers one
eye; tilts head, thrusts it
forward.
• Child squints, squeezes
eyelids together, frowns.
• Child blinks excessively
or becomes irritable when
doing close work.
• Child is unable to see
distant things clearly.
• Child has crossed eyes or
eyes that each turn
outward.
• Child has red-rimmed,
encrusted or swollen
eyelids
• Child has recurring sties
• Child has itchy, burning,
or scratchy feeling eyes.
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Blindness and Vision Impairments
(continued)
• The impact of vision problems on
development
– Effects on language development
• Child cannot see objects, so they have trouble
learning the meaning of the spoken word.
• Children must be given time to explore concrete
objects to learn meaning.
• Teacher must develop the use of descriptors.
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Blindness and Vision Impairments
(continued)
– Effect on cognitive development
• Delays due to language development problems
• Usually catch up by six years of age
– Effect on motor development
• Children will be delayed because they cannot see
objects to reach for them.
• Children are also afraid to move because they
cannot see what is in front of them.
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Blindness and Vision Impairments
(continued)
– Effect on social development
• The children tend to be quiet and passive.
• They do not make facial expressions when people
talk to them.
• Often they do not even turn toward the sound.
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Blindness and Vision Impairments
(continued)
• Early intervention programs
– Orientation and mobility training
• This is a must.
• It exposes the children to their environment.
• If things are not moved often, the children can
learn independence at play and cleanup.
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Blindness and Vision Impairments
(continued)
• Teaching children with vision loss
– Take advantage of their other senses
– Concrete objects
– Descriptions of objects
– Rich vocabulary
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Blindness and Vision Impairments
(continued)
• Guidelines for teachers
– Use words for everything.
– Be specific.
– Let the children discover through touch.
– Put different textured fabric at each center,
identifying the boundaries.
– Make use of their residual vision:
• Write words extra large and in bold colors.
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