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