being
the professional
s with
the support them
what
are the
essential skills
and know
ledge that
Educators and
therapists
need to help these
children
thrive
we
are honored
to have
Dr basa otman with
us today a
true leader
in
professional development
as
a habilitation
manager
coccia
Asia growth
market and
former program coordinator
for
the professional
certification
it
auditory verbal
therapy
Dr otman
has shaped
the skills
of
countless practitioners
representation
support
ing students with
hearing loss
a guide
for teachers on
transitioning
to school with
auditory verbal
therapy
will
provide inval
uable insights
for everyone
working with children
welcome
Dr basa we're
ready when you are
thank you
very much
Madame chairperson for
the introduction
a
very good afternoon
now
I'll come everyone
s
uh
I'm basa from
Malaysia
and I'm the
habilitation
manager
for
Cochlear
Asia grow
th Market
this
is my
disclaim
er I am
a Cochlear
employee
and my partic
ipation
is this
conference is fully
sponsor
ed by
cochlear Limited
let's
begin by
asking
ourselves
why mainstream
education entry
is
a crucial point
firstly
that
children with
hearing loss
and their families
have the option
whether
going mainstream
or
going for special
education
school or class
before
this recent
decade
it's by default
that
all our children
with hear
ing loss
go to
special education
that's
no longer the case
now
dust
wearing a
device thus wearing cock
imp
lant automatic
ally means
that
they will
suc
ceed in mainstream
you
know the
answer mainstream
is challenging
despite us
ing cock implant
and
these student
s they
need accommodation
in
teaching and learning
they
need extra
assistance in
teaching and learning
of
the biggest
challenge is
learning to read
and
the HS
say that
for listening
sorry
for pre liter
acy skills
to develop
children
20
,000 hours of listening
as
the foundation
now
if you have
a child
who only
just started
listening at 5 year old
6 year old
will
they have
20,000 hours
estia Foundation
as
their basis
for
literacy skills
it's
also reported
that many
of our
children with hearing loss
the
underachieve
in mathemat
ical subjects
the
y frequently fail
to pass the grapes
of
lower educ
ational achievement
and later
unemployment
in life
so
how can
teachers help
audit
ory verbal the
rapy
students but
before that
I
will not assume
that everybody
is familiar
with auditory verbal
the
rapy so
let me give
you
a
1 minute
crash course
on what avt is
audit
ory verbal
therapy
facilitates
optimal
acquisition of spoken language
re
ach through listening
so
it is a
un
ique model way of
acquiring
oral language
and
young children
who
are deaf
or hard
of hearing
it
certainly prom
otes early diagnosis
1 on 1
personal
ized therapy
and the
latest audiologic management
and
the latest technology
1
Hallmark of
audit
ory verbal the
rapy is that
parent
s or car
egivers
need to
actively participate
paid
in the therap
y process
because they
are the prim
ary language facilitate
for
the child at home
and
these can happen through guidance
coaching
and demonstration
of
their audit
ory verb
al therapists
the
goal of
EVT is
for our
child to have
the
access to a
full range
of Academy
social
and
career choices
and must
be conducted
in
adherence
to the
principles of listening
and
spoken language
specialist
in audit
ory verbal therapy
so
that is avt
I'm
sure you've
heard about
clay imp
lant just
giving you
a very
quick
idea
about how
cocka imp
lant work
s very
differently comp
ared to hearing aid
hearing
will
amplify the
sound and
we are
lucky in
the year
2025
the
technology of
hearing a
ids are
so
Advanced that it
is not just
simply meaning
crank
ing up the
volume or
int
ensity of the
sound there
are a lot of
programs that is
dat
a logging in
hearing
aids how
ever 1
thing that hearing aid
can
not achieve
is the am
plification and
the clar
ity of sound
especially
in the
higher frequ
encies meaning that
voiced
sorry unvoiced
positives and
fricative sounds
these
are often
cannot be achieved
the
signal clarity
via
hearing aids
and
that is when
we
need coal
clear impl
ant where the
indication
in Thailand
in Malaysia and
many other
saw
these Asian
country
is from
severe or
Worse hearing level
cock
a incline is not
uh
similar to
hearing
aids in
the way that
it
is an
electrical stimulation
the
implant
happens in the
cochlear
and
therefore when
the COA
is stimul
ated by the
implant
then
the signal
s will be process
ed by the
external sound
ass
et processor
and
this will be
processed
by
the brain
because the
signals that
are sent by the
plant
goes via
the audit
ory nerve
and
go
es to the brain
now
let's go back
to
our students with
avt
before
they enter
our schools
this is what
happened to them
hope
fully and I
know
there are cases
where babies
start
to be
diagnosed
fitted with
Device start
intervention
in
Thailand and
I'm so happy
to hear
that
but this is
an exception
not
yet to be
the norm
let's hope
that this will be
the
norm in
about 10
years from now
so
when these kids
are young between
1 to
3 years old
sorry
between babies
to 3 years
old they
are diagnose
d
they are fitted
with device
or
cock implant
and
then they start
audit
ory verbal
therapy
I
remember my
youngest patient
came in
start intervention
2
and a half months old
and
then as
they grow old
er they go
to kindergarten
mainstream
kindergarten
they we
try we
try and
we try as terrible
pie
ce to work
so hard
so that
these children will
catch up
with
their listening and
spoken
language skills
so that
there are listening
and spoken
language skills
at
or near
each appropriate
it's
not enough for
them to just
talk
but at
which level are they
talking
that
is crucial
because when
enter
mainstream school at
6:07
years old
depending on
what school they go
to
we want them
to
enter school at
each appropriate
language or
at
the very worst
2
years gap of
language
age between their peers
and
their language fun
ctioning level
so
for teachers
of
ten people will
ask
what is the
main thing when
you have
a child who
who
is mainstream
in
the classroom
of
ten we talk about
seating
yes seating
is important
look
at the
access black blue
green and red
red is
a total
no no because
it's near the
corridor
near the window
that
is noisy
we
have other classes
and children
would run
and talk and
whatever
across along the
Corridor that
will be
distracting uh
uh that's not
where
we put our
child
green
that's
good why that's
right at
the front
how
ever the child
who
is sitting in the
green spot
of
what their friends
are doing
it
will be
better if
they are
having more
peripheral
sorry
rather visual
cues
meaning
that blue
is much better
they are still
quite
at the front
and have
the students
at the front
row
to help them
to
get visual cues
black
that
is right in
front of the
teacher's desk
but
how many of
you teach
ers when
you teach in
the classroom
you
are just sitting like
me
at the
teacher
's desk and
do not get
up at all
do
you do that
I
think if you
do that
right
from your
training days
you'll be
disqualified from being
teach
er because you're
supposed to get up
and
be around the
class
so no
black is not
the spot
you want blue
if
you have
any other
seating arrangement
Circle
or round table
is
a good 1
or
have a sem
icircle
or horse
shoe formation
that
is also a good
1
so
that your
child will be
able to
see everyone
as of the
ir visual cue
but
that
alone is
not enough
sitting Arrangement is not the
end
of the story
acoustics
how
many of you
now sitting
in
this haul you really
want to listen
to
me but
the person
next to you
or be
hind you
in front of you are talk
talking
and
you can't hear me
well
don't
put up your
hand I
don't want to
off
end people in the audience
imagine
if you
wear cochlear
implant
and
you try to
listen to
the
teacher
but find it
hard to listen
hard to
understand because
there are noises
so
if possible when
ever possible
identify the source of
of noise
put
it far from
the child
it
can be the
fan
I
can hear some
worrying
not
worry worrying
of machine behind
me
put it behind
the child
and
for Cochlear
brand cochlear
implant
the child can have
forward Focus
where
wherever the child
move
the head
the focus of
the listening
will be
in
front noise
from the back
will be
automatic
ally attenuated
don't
put no
isy student
next to
our student with
avt
you
will know
who is the
noisy
a
bit naughty
and cheek
y student in the classroom
please
put them a bit
away from
our student
with ADT
look
around in the
classroom
if there are
hard shiny
surf
aces these
are the ones that
are
bad for
acoustics
let's
put some
soft material
s be it
curtains
uh
paper posters
cork
boards or something
soft to
absorb
the sound wav
es and
reduce reverberation
if
you are not
sure
reach out to the
audiologist
reach out if
the child is an
plan
user especially
koshia
brand reach out to
tune
our bank card
sorry
our Thailand
country man
ager who
can help with class
from
physical accom
modation for noise
reduction
this
is a little
bit techn
ical but I
need to
say
this that we
need to
understand about
sign
al to noise
ratio
regular
classroom
anywhere in the
world
where the children
are
and
speaking
mainstream class
room the
noise is around
50
to 60
DB SPL
and
when the teach
ers is talking
our regular
voices without
the mind
when
I talk like
this
which you can
not hear of
course
the
best is around
70
decibel but
you cannot
do this
throughout the
day otherwise you
the
abusing your
vocal cord
so
because usually
teachers
voices around 6
5 decibel
class
room noises around
60 DB
the difference
for
the signal
for the teach
er's
voice to reach
the
child's desk is only
class 5
that's
all the increment
of
teachers voice
that arrived
at the
child's device
is
that enough no
student
with normal hear
ing they need
plus 6 decibel
student
s with hear
ing loss
without mini mic
they
need about
plus 15
to plus 20 decibel
for
good signal
to noise ratio
but
is it
realistic to
always tell the
class
be quiet be quiet be
quiet
you
can't do that
it's not
realistic so
remember
there is such
a thing
as
remote microphone
for
Cochlear
brain we have
mini mic
for
hearing aid
users
there's some FM
system or Roger
system
the
mini mic will
help
our student
to
focus to
teachers voice
because they
will hear the voice
directly
going into
their processor
this
will have
to reduce their
auditory fatigue
but
teachers need
to familiar
ize yourself
with the device
either
get help from
the
family the
parents
or again reach out to
tune
Thailand
or
anywhere you
come from
each
country will have
all polar Representatives
and
get help how
do I
teach myself to
familiarize
minim
so
that where
ver you are
in the classroom
your voice will
reach the
child's
process
as
if you are
talking
right next to it
1
thing though
remember to return
the mic
rophone that you
use
to the child
so
that the child
can give the
mic
rophone to the
next
teacher that comes into
to
teach I
have had
some cases
where teachers
wear the mic
rophone
because
they forget to
give
back the
microphone
to the student
where it to
the to
ilet where it
when they go
gossip
ing about their
family
and
our students with
cock
implant
knows all the
speak
in a natural
clear
voice at a regular
and
do this
facing the
class 1 thing that
you need
to be
very very
a
ware is
it is very
hard for
the
child to follow your teeth
if
remember
the traditional
chalk and
talk teaching
the
teacher faces
the child board
and
talk while
writing uh
uh that doesn't
work with our a student
when
the our child
does not
understand
your
sentences
you need to repeat
or rephrase
and
you need to do
this when
other student
s are
commenting or asking
or
speaking you need
to again
repeat or rephrase
what the other
student is saying
to
the class
because you
have the mini mic
but
other students
do not have
the minimum
so
you need to tell
it again
so
your avt
student can hear
hope
fully you have
the chance
when you want to
give new instructions
as the class to
be quiet first
and then
you give instruction
action
and
I've talked about
don't
give your back
facing
the class
when you are
talking because
this will be
hard for
our child to follow
use
what we call
gearing
up to listen
phrases
because
if you start
talking
by
just giving
instruction for example
you
start talking
and you just say
turn
to page 55
and
by the time
the child
wants to listen
to you
the sentence
has already ended
so
you need to have
the gearing
up phras
es like
now everyone listen up
and
you get the
attention
turn to
page 55
so
use this
gearing up phrases
when
child doesn't understand say it
in another way
try
not to
repeat the
same sentence
over and
over
because
the child
may get a
better
idea of what
you are saying
if
you rephrase it
right
key information on
the
board so that the
child can
what
you write and what
they
hear from you
cons
ider having a
body system
put
a friend next
to the
child
who can help
with
rephrasing or
eating
what he said in
the class
Choose Wisely
who is the body
don't
choose a child
who is
the smart
est in the class
who
has the
highest I
Q in the
class because
usually very smart students
since
they are impatient
they
cannot deal
with a lot of
questions
and they cannot
understand
why some people
are so
flow
I
remember my best
friend
in school before
would turn to
me and said
you
are on that question
too I've already
finished
and there were
30 questions
but
she was
still my best
friend she
is still my
best friend until today
so
don't pick
the smartest
student in the
class
don't pick
the weakest
student
either because we
don't want
the weakest
student to be
the
role model for
our AB
student
Peak student
who is
in the middle
with
a lot of
compassion
with
a lot of understand
ing of how
to interact communicate
and
Foster friend
ship with
a friend who
has hearing loss
and
also
what teachers
can do is
orientate your class
orientate
the other
hearing student
s on
how to make
listening and
and communication
easier
for your
ABT students
the
things that I've
mentioned
before about
speaking clearly
and speaking directly
do the same
teach
other students
to do the
same
with their avt friend
when
they want to
talk with
their EVT friend
ask
them to stand
closely don't
shout from
across the room
was
shouting
doesn't help them to
hear it better
if
they want to
talk with
their EV
T friend
tell them to get the attention
first
and
when they're talking
to your
EVT friend
tell them not
to run
while talking
that doesn't help
be still
always
watch
and if they
think
that every friend look
s lost
look
s confused
need
help just
approach him
or her and asked
would
you like me to
help you
this
just doesn't
is not just
for
our EV student
to
have this
accommodation but
these strateg
ies also help
the other hearings
student
s in the main
stream class
to
have more
understanding of
how it
is to live with
fell
ow students
or fell
ow friends
with different abilities
so
what's needed
for successful
mainstreaming
mainstream
ing is not just
about
the child
the teacher and
the school
we
need the team
that
worked with the
child previously
parent
s have to be
there
the the
rapist the
audiologist
If the child had
occup
ational therapist
or physical the
rapist or
special educ
ation specialist
or
the ministry of
or the Ministry of Education
officers
all
these people
need to work
together
and communicate I just
go
straight to the
go straight to The Orange Box
where they
need to
communicate with
each other
does
the child
have undergone
has the child
undergone
Sage appropri
ate goals
through
out the intervention
and
if yes
is this
carried out
continuing when the
child
is in school
this incl
udes current
level of function
ing individualized
go
als prec
ise assessment
and measure
ment across all
aspects of
development
remember
for
the whole
child management
is not just
speaking
and listening
what
about self
-help skills
what about
daily living
activities
about
psychos
ocial development
this
is something
that I must stress
for
a child to
go to
mainstream
they need to
have
age appropriate
language you will hear me
repeat
ing this again
and again
if
it's not
at each level
at least
near age level
because
for them to
access the
curriculum
in a main
stream setting
via
listening
they need
each appropriate
language
and
then needs to be
pre and
post teaching of
Concepts
and
again I
must stress
use stage of
remote microphone
when
teaching and learning
occurs
just
to give you
the idea
of
what is
needed
before
this child
if it student
enters School
they need
the
learning to
listen period
this 1
so
infancy to
pre kindergarten
this what happened
hope
fully when they
have enough
adequate
and good qual
ity of learning
listen
period
then
they can go
to kindergarten
they
enter our
schools with
the skill
s to listen
to learn
if
this doesn't happen
all
this happened poor
ly or
this happened in
a very short period
because
they only start
ed
habilitation or
interv
ention at the age of 5
at
the age of 6
there
isn't enough
time for
them to
learn to listen
what
happened when they
entered
this phase
it's
hard or almost
impossible
for them
to use listen
ing to learn
because listen
ing did not
not exist
let
me share
you some
data from
Malaysia
this
is an old
data because
this
was when I
was still
working with University
the
nearly 400 children
imp
lanted by
you the
university we found
that
60% of
these children use
language
now
compare that
with education placement
do
we have 60
% here
in mainstream
not
quite but
nearly 60
what happened to
the 2
% you ask
the
2% in
the in Special School
cute
speech school or
integrated
School
call in Malaysia integrated School
meaning that
is special educ
ation class
within a
mainstream
school so
that when the
child
in special class
improves
they
can do
semi inclusion
all full inclusion when
the child
actually reach
es the level
that enables
them
to function in
mainstream
so
they don't have to
change School
that
what what this
means is
that
the mode of
communication that we
ch
oose for the child
is
very crucial because
it will decide
where the
child will go
the
second thing that
we
learned is that
just
because the
child uses Auto language
which
doesn't mean that the
child
will be
come mainstream school student
it
is hard
er to be
mainstream
compared to
learning to talk
and
this brings me
to the
second dat
a that I want
to share
again
from Malay
sia when I was
still there
with
every 1 month delay
of cochlear implant patient
the
odds of
our
child to be
able to
speak will
be reduced by
2.6%
you
time this by
12
to
know if
we delay
COA implant
ation by 12 months
or 1 year
then
what
is the
decreased probability
for
this child to talk
usually
you don't delay
by 1 month
some
parents say
oh we need to
look
for money
find
funding and all
that we
don't have
that wonderful
the
Federation
and things like that
like what
you have here
in Thailand
we don't have
such things in Malaysia
somet
imes they delay
by 1 and
a half years
so
imagine how much
red
uction of
probability for the
child to speak
now
to
enter mainstream
school is much harder
everyone
months de
creased sorry
every 1 month delay
of
implantation
the
odds of going
to
mainstream School
will
be reduced
by 3.3%
time
this by 12
how
much red
uction of probability
the
child will have to
go to
mainstream School
if
we delay
the implant
by a year
let
that sink in
for
a second
so
there is
a
Continuum of
how
our children with
hearing loss
communicate
I'm
so happy to
today to
see quite
a number of
people
in
our audience
who use
s sign language
many
of our
children with hear
ing loss
will also
use sign language and
they are here
or here
they
are fully visual
or most
ly visual
communicator
if
they are full
y visual they
go you're signing
only if
they are mostly
visual
they
probably will use
a lot more sign
and
some oral language
will
they be in
mainstream
school without
interpreter
probably
not they
need interpre
ter in school
how many
Bangkok
schools have sign language
inter
preter in
mainstream class
9
the same with Malaysia
children
who use
sign language
cannot be
in mainstream
schools in both Malaysia
and
also Thailand
I know that
so
our
children who
are more visual
despite
using hearing aids
desp
ite using
even cccia implant
they
are here
they are not
supposed to
be in
mainstream
even
with implants
early
in plan really
good
habilitation
then they
most
probably will end
up being fully
audit
ory in communication
they're
listening and speaking
or
maybe mostly
auditory
their
language level
may be not
age appropriate
but just
slightly delayed
about
2 years delay
then this grew
can be
in
mainstream setting
if
you try to put
this group
in mainstream
setting you can
and
then you will
realize
after 6 month
s 1
year
what will happen
they
need to be
replaced
in
special educ
ation setting
you
are set
ting the child
up for
failure
let's
Ponder
on several
points let's take
as something
food
for thought you
just had lunch
you had
food for your
stom
ach now
food for your brain
and
I'm talking
from
the heart
of a
habilitation
list looking after