--- title: ทดสอบ Revoice ENG 2 subtitle: date: วันศุกร์ที่ 13 มิถุนายน 2568 เวลา 11.28 น. --- (ข้อความสดจากระบบถอดความเสียงพูดทางไกล) 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