IDEA DISCIPLINE RULES ENSURE CONTINUED SCHOOLING FOR VIOLENT STUDENTS
Sunday, April 19, 2009
Outlining the new rules during the American Federation of Teachers' QuEST '99 Conference, Quinn noted the rules require a school district to continue educating a suspended student in an alternative setting if the suspension lasts longer than 10 days. The students must get all services required for them to continue progressing under their individualized education plans, and any therapies prescribed in the IEP must also be provided as scheduled, the rules state.
The continuation of services rule, as well as several other complexities in the new regulations, helped draw dozens of teachers and other faculty members to hear Quinn speak at the four-day teachers' conference. As deputy director of the Center for Effective Collaboration and Practice, Quinn and her staff have studied the new regulations and consulted with government officials and attorneys to clarify the new rules and help school districts implement the changes. The center also offers extensive information about IDEA '97 and other special education issues on its Internet site: www.air-dc.org/cecp/.
Defining the Problem
Among other confusing issues: determining whether the student's conduct is a manifestation of his or her disability and whether the conduct is part of a larger pattern. For the purposes of determining how a school district can discipline special ed. students who exhibit violent behavior, those questions can determine whether the student is treated like a mainstream student or one who is not accountable for his or her actions. For example, if the student's action is deemed not a manifestation of his or her disability, the student can be suspended for as long as school policy says a general ed. student would be suspended. The difference, however, is the special ed. student must receive educational services after the first 10 days of the suspension.
If the student frequently or repeatedly breaks rules, even if they seem like different rules and separate incidents, the student may be exhibiting a pattern of behavior that calls for a change in his or her IEP, Quinn noted. One red flag that could indicate such a pattern is the repeated suspension of the student. While special ed. students may be repeatedly suspended for up to 10 days at a time for various rule violations, they must be reevaluated if those suspensions constitute a pattern of behavior.
Getting to the Root of the Problem
If a special ed. student is removed for more than 10 cumulative days from school, a functional behavioral assessment must be conducted, according to the law. However, IDEA does not specify what the assessment should be, Quinn said. CECP offers what it calls "best practices" or guidelines to reevaluating students. Quinn also argued IEP teams should take the assessments seriously rather than consider it another mandatory set of forms to fill out to keep a child in school. "If you have to do a functional assessment, you might as well do it to the point where you are actually going to get information you can use from it," she told the teachers. "It's a long process, but it does yield very good information that will make your lives as teachers infinitely easier."
Posted byDoc Junhel at 3:35 AM 0 comments
SPED Acronyms
Posted byDoc Junhel at 3:08 AM 0 comments
What’s Special in a Diploma?
Monday, April 13, 2009
Importance of Education
“Strive not to be a success, but rather to be of value.”
In the many years of our existence, we’ve oftentimes wandered into this notion. Come to think of it, education was non-existent since the beginning of time, correct? Adam and Eve never bothered to go get a book, researched, or even deciphered brain-crushing calculus problems and trigonometric equations, right? Wrong! Through the course of time, we have evolved and part of that evolution is adaptation (which the Philippines is currently striving but makes up for in labor exports). The very basic concept of education is learning and teaching. The previous, being readily conceivable when one has attained a change in attitude and the latter being in effect efficiently after application is perceived. How do you think Fleming discovered penicillin (Alexander and not Ian)? How did Einstein formulate the theory of relativity? Will the discovery of the Kuiper’s belt and the eventual distal placement of Pluto be fathomable without education? Or will the magnificent and profound gauge of Picasso’s works and Jay-Z’s (Mrs. Beyoncé) semantics still be appealing without education? Survival, appreciation, contentment, bridging gaps, settling differences and being able to make the world a happier place to live in for all are just some of the reasons for education. As for some, they study to get a better grasp of life and the deeper meaning that it conveys (what’s your reason?). Wouldn’t you want to understand why you are where you are right now?
Diploma vs. Certificate
“You have to learn the rules of the game. And then you have to play better than anyone else.”
The Diplomas are intended to provide the essential knowledge and skills for young people to operate confidently, effectively and independently in life and work (and eventually money—yeah baby, yeah!). The Diploma prepares young people for a range of progression routes. These can be within the sector they have studied, within another sector or in general education. By following the curriculum program for a Diploma, learners can develop the knowledge, skills and attributes expected by both employers and higher education (usually agencies and employers prefer credentials obtained in a University rather than some College). Certificates are generally different than diplomas because they are given out to students who have passed a particular course of study not necessarily related to a philosophical cognition of the course requirements (it takes lesser time to finish). Certificates show that students have mastered a particular skill usually associated with a job requirement. In simple analogy, a Diploma equals a Certificate plus more.
Diplomas can offer you:
high-quality, credible, industry-related learning
real opportunities to practice the skills you will need for employment and higher education
diversity, opportunity and inclusion for all learners
Most migration agencies or law firms at the instance of seeing that you only have a certificate course in some college will immediately sever your application. Most if not all accrediting bodies in countries like Australia, Canada, United Kingdom, and America are looking for Diploma Courses (a Bachelor’s degree as they aptly calls it) rather than a Certificate Course (which will do you no good when you realize that you have to take a battery of tests to qualify for accreditation). This is just a heads-up on things to come for those who are planning to take that extra mile for a greener pasture (hypocrite?). Granted that you somehow passed the screening with a weak set of credentials, are your skills enough for your line of work?
Extraordinary Learning
“Education is what remains after one has forgotten what one has learned in school.”
After 6 courses (Health Science, Dentistry, Orthodontics, Nursing, Care-giving, Professional Education), I am down to lucky number 7 (Special Education). In my many years of studying I have never felt an authentic sense of a family, academic achievement, love for knowledge, and fulfillment than now. If education will be quantified, we could define it as an art that encompasses all the sciences in the world and a portal for philosophy for logical explanation.
Initially I studied in the paths of Professional Education to understand better the complexities of life, man’s behavior, society, and the quest for the true meaning of intelligence. The rest is history. There are a lot of people nowadays that are taking up special education (especially doctors and even nurses). The very thought of it is cliché (I think I need an even stronger word). At first, I didn’t have a good idea of what to expect but just an erroneous concept of a field dedicated to teaching the abnormal. We are the second batch of Diploma in Special Education Program students in the Southwestern University and are composed of passionate, enthusiastic, and charismatic mix of professionals in various fields (ESL teachers, primary teachers, social workers, HRM professionals, biologists, nurses, dentists, and administrative executives). We have various reasons but we are geared towards one pursuit.
It is best to know the program that I forehand didn’t have the slightest idea on what it really offers:
SUBJECT CODE TITLE DESCRIPTION
SPED 101 Introduction This is where you will learn the basics, history, and concepts of SPED
SPED 102 Arts & Crafts A subject dedicated to the propagation of creativity & expression
SPED 103 Current Trends Keeps us updated and informed on the trends of SPED
SPED 104 Methods & Materials Tackles on the ways & means on how to dynamically present the lesson
SPED 105 Dynamics of Learning Distinguishes and correlates the different learning disabilities to their appropriate learning or teaching strategies
SPED 106 Hearing & Visually Impaired Learn sign language & Braille
SPED 107 Remediation Discusses possible interventions in math & reading remediation
SPED 108 Assessment A step-by-step series on how to assess and delegate SPED students into the system
The whole program’s duration runs for 2 semesters. The first semester is allocated to the 8 subjects (theoretical aspect) and the second semester (15 days) is allotted for the practice teaching (practicum aspect). For most of us, every weeknight was a time to look forward to. We have come to discover that we share more similarities than differences. That common ground gave us the chemistry to conquer all odds despite the rigorous challenges that the program bestows on us. There are a lot of activities to look forward to when enrolled in this diploma course. Laughter, enjoyment, and camaraderie are regular commodities. These are some of our activities:
1. Learning the American Sign Language
- We had the opportunity to communicate with people with hearing impairments personally; after we learned enough concepts to really communicate with them, we had the opportunity to interview deaf & mute students.
- The method of instruction was so practical, concise, and purpose-driven that after our first lesson we could already sign several concepts.
- In one of our sponsored seminars, we were privileged enough to perform the Lord’s Prayer, Lupang Hinirang, and SWU Hymn.
- You can view our performance at:
http://youtube.com/swusped
2. Learning Braille
- As if learning the sign language wasn’t enough, we had ample time to be adept with the Braille system of communication.
- Actual Braille slates are used to write words, then phrases, and eventually paragraphs.
- An internet based flow of instructions was used that keeps us at par with the international standards.
- One of our internet resource for Braille can be visited at:
http://www.afb.org/braillebug/
3. Making Tons of Artworks
- From papers to crayons, watercolors, and crafts; you name it we made them.
4. Series of Seminars
- There are a lot of seminars that we attended and produced for our batch alone; here are some:
Faces of Autism Seminar
Multicultural Education Seminar
Physical Education in SPED Seminar
Pre-Practicum & Post-Practicum Seminars
5. Visits and Demo Teaching at affiliated SPED Centers
- SWU Teacher’s College is affiliated with several SPED Centers that make the demo teaching or the practicum experience a painstakingly hassle-free one.
- We had the opportunity to visit these SPED centers:
DSWD
Guardian Angels Foundation
Adam Jennie’s Catholic Foundation for Special Children
K.E.E.P.
- What’s good and interesting to notice is that, when we were tasked to do our demo teaching for the first time, we had no apprehensions because we are well prepared.
- Another aspect worth noticing is the availability and hospitability of most SPED Centers to SWU Practicum students; the affiliation of SWU to lots of SPED Centers makes it comfortable and creates a good learning experience for its students.
6. Practicum Teaching
- A good quality of the practicum teaching or the whole Diploma Program is its flexibility, which is very crucial and important to students who are also working such as us.
- We can even do it to the extent of having it at our most convenient place where everything is accessible. This is especially important nowadays when the cost of living is high and at a time when we could really feel the worldwide crisis affecting us.
- This is the real deal and even though we have some minor glitches, our program has really prepared us on how to manage a special education class in particular and a special education program in general.
If we can answer the question: “What makes special education (SPED) special?” If we can unravel the answer then we have arrived at the answer to our ultimate question: “What’s special in a Diploma?” In the very first day of our lesson in Special Education, our subject teacher asked us this question. By now we know that what makes Special Education special is four-fold:
The Learner
The Individualized Instruction
The Teacher
The Curriculum
So the Diploma that you acquire can only be special depending on how it is obtained.
Is your diploma special?
You can visit us at http://swusped.blogspot.com to see more of our experience.
Posted byDoc Junhel at 1:52 AM 0 comments
'Eugenic Abortion’: With Pre-Natal Testing, 9 in 10 Down Syndrome Babies Aborted
Monday, October 13, 2008
Megan Talbot, 19, who has Down syndrome, pins a boutonniere on a friend before the pair went to their high school prom. (Photo courtesy of Lucy Talbot.)
The practice has been described by one physician as “eugenic abortion.”
Down syndrome, which occurs in individuals who have three rather than two copies of the 21st chromosome, causes distinct physical characteristics such as low muscle tone and upward slanting eyes. It also causes mental retardation, which can range from mild to severe.
With the advent and increasing use of pre-natal testing, according to studies in the United States and United Kingdom, a diagnosis of Down syndrome has led to as many as nine out of 10 women choosing to abort the child.
A 2000 anonymous survey of 499 primary care physicians in the United States, published by Georgetown University, indicated that only 4 percent of physicians who attend women whose babies are pre-natally diagnosed encourage them to continue the pregnancy and allow the baby with Down syndrome to be born.
Thirteen percent of doctors attending pregnant mothers whose babies are discovered to have Down syndrome, this survey said, “emphasize” the negative aspects of Down syndrome and 10 percent said they “urge” the mothers to terminate the life of the baby.
Sixty three percent reported they “tired to be as unbiased as possible when delivering a pre-natal diagnosis” and 10 percent indicated they “emphasize” the positive aspects of Down Syndrome.
A 1998 study by the Department of Newborn Medicine at Brigham and Women’s Hospital at Harvard Medical School, published in Genetics of Medicine, concluded that in 1972, 1 in 1,000 babies were born with the extra chromosome that causes Down syndrome.
“There was no pre-natal detection between 1972 and 1974,” said the report, which then measured how many women aborted their Down syndrome babies between 1972 and 1994.
“Between 1972 and 1994 the percentage of infants with Down syndrome who were liveborn decreased dramatically,” the report said. “In the early 1980s, this decrease reflected the impact of amniocentesis among women 35 and older.
“By the late 1980s, pre-natal detection was common among women younger than 35 years and detection was by several modalities including AFP screening, sonography and amniocentesis. When the (Down syndrome) diagnosis was established before 24 weeks of gestation, 86% to 87% of the parents chose elective termination of the pregnancy,” it said.
Another 1998 study by Wayne State University published in the American Journal of Genetics concluded that almost 90 percent of Down syndrome babies were aborted between 1987 and 1997.
“In conclusion,” the report said, “our data confirm that most patients referred to a tertiary care center are likely to choose termination of pregnancy after the diagnosis of Down syndrome, even in the absence of severe ultrasound abnormalities.”
The 2004 annual report of the Down Syndrome Cytogenetic Register at the Wolfson Institute of Preventive Medicine in London found an even higher number of abortions were done after a pre-natal Down syndrome diagnosis in Great Britain. In 2003, 91 percent of cases with known outcomes resulted in abortion. The same percentage was recorded in 2004.
ACOG Wants More Testing
Studies show pre-natal testing for Down syndrome has become increasingly common over the last three decades, however, the American College of Obstetricians and Gynecologists (ACOG) in January 2007 called for even more testing.
“All pregnant women, regardless of age, should be offered screening for Down syndrome,” according to the new Practice Bulletin issued (Jan. 2, 2007) by the ACOG.
“ACOG also advises that all pregnant women, regardless of their age, should have the option of diagnostic testing,” the Bulletin states. “ACOG recognizes that a woman’s decision to have an amniocentesis or CVS is based on many factors, such as a family or personal history of birth defects, and the risk of pregnancy loss from an invasive procedure.”
But Dr. Will Johnston, president of Canadian Physicians for Life, reacted to ACOG’s pre-natal testing endorsement as another step toward eugenics.
“The progress of eugenic abortion into the heart of our society is a classic example of “mission creep,’ ” Johnson said in an article posted on the group’s Web site in February 2007. “In the 1960s, we were told that legal abortion would be a rare tragic act in cases of exceptional hardship. In the ‘70s abortion began to be both decried and accepted as birth control. In the ‘80s respected geneticists pointed out that it was cheaper to hunt for and abort Down’s babies than to raise them. By the ‘90s that observation had been widely put into action. Now we are refining and extending our eugenic vision, with new tests and abortion as our central tools.”
Today, women of all ages who seek pre-natal care with an obstetrician are offered screenings that can estimate the mother’s risk of carrying a Down syndrome baby.
These screenings include a blood test to find certain “markers” associated with the genetic condition and sonograms, which doctors can use to measure the fluid in the neck of the baby, or nuchal translucency, which also can indicate that the developing baby has Down syndrome.
If the results of these screenings indicate there is a higher risk that an unborn child might have Down syndrome, doctors offer the mother additional diagnostic tests, including amniocentesis, which requires inserting a needle into the womb to draw amniotic fluid so the chromosomes of fetal cells can be examined.
Another test, Chorionic villus sampling, or CVS, collects fetal cells from the placenta via the cervix. Both tests are almost 100 percent accurate in detecting Down syndrome in an unborn child.
Because they are invasive, however, both tests can cause a miscarriage. According to ACOG and the federal Centers for Disease Control and Prevention, for example, between one in 400 and one in 200 women have a miscarraige after amniocentesis. Other complications that can arise from amniocentesis include injury to the developing baby and infection.
The risk of miscarriage after first-trimester amniocentesis may be three times higher than the risk after second-trimester amniocentesis, according to the results of the Canadian Early and Mid-Trimester Amniocentesis Trial Group, which were published in The Lancet in 1998.
Results of a 2004 study published in Obstetrics and Gynecology suggested that early amniocentesis may also increase the risk of the deformity called clubfoot.
According to the Royal College of Obstetricians and Gynecologists (RCOG) in London, the additional overall risk of miscarriage from amniocentesis is approximately one percent. In other words, about one in every 100 women who have amniocentesis under ultrasound guidance after 15 weeks will miscarry.
RCOG also claims that the additional overall risk of miscarriage from CVS is approximately two percent. In other words, about two in every 100 women who have CVS under ultrasound guidance after 10 weeks will miscarry.
Dr. Lewis B. Holmes, a geneticist at Massachusetts General Hospital who participated in the 1998 study on pre-natal testing at Brigham and Women’s Hospital, said that some patients refuse pre-natal screening.
“The (patients) who have strong religious or cultural leaning … don’t take the test,” Holmes told CNSNews.com. “So they make their choice very easily.”
But many, Holmes said, use the pre-natal diagnosis of Down syndrome as a reason to end the pregnancy.
“Even though you encourage, ‘take your time, take your time,’ they usually display a real sense of urgency,” Holmes said.
Post-Test Resources
Some parents of children with Down syndrome told CNSNews.com that when they got their diagnostic test results, they did not get the information they needed about the condition and the resources that are available to them and their children.
Lucy Talbot, the mother of a Down syndrome child, is president of Families Exploring Down Syndrome, a support group of some 200 families in Michigan that have children with the genetic condition.
Talbot said her group’s Changing Lives program, developed by the National Down Syndrome Society, is designed to teach medical professionals how to give a compassionate diagnosis and provide the resources and support that parents need.
“(The doctor) says, ‘Your baby has these characteristics, we think your baby has Down syndrome,’” Talbot said. “They say, ‘We’re going to do some blood work,’ and they walk out of the room.”
“You’ve just changed a person’s life forever,” she said.
Dr. Holmes said he offers detailed information about Down syndrome to parents, as well as giving them the option of speaking with parents who have children with the genetic condition.
But Brian Skotko, a resident physician at Children’s Boston Hospital, said Holmes is the exception, not the rule. Skotko cited the results of a questionnaire sent out to 1,105 ACOG fellows and junior fellows in 2004.
Among the 60 percent that were returned, 80 percent said they felt qualified to counsel patients about genetic issues and pregnancy, but 45 percent rated their residency training regarding prenatal diagnosis as “barely adequate” or “non-existent.”
Skotko, who has a sister with Down syndrome and serves on several boards of Down syndrome advocacy groups, said pre-natal testing has put the fate of unborn children in their parents’ hands.
“Current testing affords couples to learn, if they so desire, pre-natally whether or not their fetus has Down syndrome,” Skotko said.
“I encourage all parents to think about and answer two essential questions, which I think can be their guideposts through all pre-natal testing that’s available during pregnancy. One, they need to answer for themselves when does life begin and then answer the question, what forms of human life are valuable?” he added.
“The first question will determine for them when life starts,” he said, “so what testing done at certain times may determine for them whether or not termination is allowable in their own moral compass.”
“And then once life begins, they then need to answer the other question, what forms of human life are valuable?” said Skotko. “Some people say, once life begins, all forms of human life are valuable--others say, once life begins, only certain characteristics are valuable.”
New tests Could Increase Abortions
Now, a new pre-natal blood test that could check a baby’s DNA has been developed by researcher Dr. Stephen Quake and his team at Stanford University. Quake said a broader test is needed.
Carol Boys, chief executive of the Down’s (sic) Syndrome Association in Great Britain, told the BBC that the less invasive blood test will make pre-natal testing safer and more common.
“There is no question that these non-invasive tests will be introduced in the next few years,” Boys said. “It’s therefore incredibly important that potential parents are given accurate information on Down’s (sic) syndrome before they make a choice about whether to terminate or not.”
But Alison Davis of the No Less Human group that is a part of the British Society for the Protection of Unborn Children said in an article on lifenews.com that the new test wasn’t a positive development.
“"The new non-invasive test for Down's syndrome will inevitably mean more pre-natal testing, leading to more abortions of babies with the condition. Describing this as a 'breakthrough' is offensive to people who live with Down's syndrome, and to all who recognize the equal right to life of disabled people,” she said.
Posted byDoc Junhel at 5:21 PM 0 comments
SEMINAR: Faces of Autism
Monday, August 25, 2008
You are cordially invited to the SWU's seminar on Faces of Autism: Early Intervention & Developmental Evaluation. Please see attached image for details.
For more information you can contact:
Dr. Carmelita Diamos
Cell No: 09209094771
e-mail: 0b75em80@gmail.com
Ms. Jessica Dela Cerna
Tel. No: 2562743
e-mail: vp.academics.swu@gmail.com
Dr. Deletah Polinar
Tel. No: 4155555 loc. 319
e-mail: polinar_d@yahoo.com
Posted byDoc Junhel at 5:34 PM 611 comments
How to Download from Youtube?
Sunday, August 17, 2008
Lecture presentations or report works are best presented with animation or video clips to liven up the discussion. As such, the need for video files is imminent. How do we do it?
There are different ways. You can check these sites for details:
Posted byDoc Junhel at 5:57 PM 0 comments
SWU DSPED 08 List of Requirements
I. SPED 101 - Introduction
- (2) Reports
- (1) Portfolio containing:
- Class Reflections
- Others
- (1) Portfolio containing:
- (10) Paper Art
- (10) Crayon Art
- (10) Water Color Art
- (10) Craft Art
- Art Demo
- (1) Report
- (1) Portfolio containing:
- Given Hand-outs
- DSWD Visit
- Adam Jennie's SPED Center Visit
- Ideal School Organization
- Written Report
- (2) Movie Reaction Paper
- Lesson Plan Criticizing
- Nursery Rhymes
- Visual Aides
- Teaching Demo
- Movie Reaction Paper
- Report
- Report
- Demo
- ASL Book or Photocopy
- (3) ASL Songs - Slow, Average, Fast
- (1) ASL Poem - 3, 4, 6 Stanzas (Filipino / English)
- (1) Describe a thing or tell a story
- (1) Case Study
- (1) Movie Reaction Paper
- (1) Report
- (1) Psycho-Educational Assessment
- (1) IEP
NOTE: This information is correct as of Monday, August 18, 2008 pending further changes. Please keep up-to-date with the requirements and frequently update with this website.
Posted byDoc Junhel at 4:26 PM 0 comments
Hearing Impairment
Thursday, August 7, 2008
A hearing impairment or hearing loss is a full or partial decrease in the ability to detect or understand sounds. Caused by a wide range of biological and environmental factors, loss of hearing can happen to any organism that perceives sound.
Sound waves vary in amplitude and in frequency. Amplitude is the sound wave's peak pressure variation. Frequency is the number of cycles per second of a sinusoidal component of a sound wave. Loss of the ability to detect some frequencies, or to detect low-amplitude sounds that an organism naturally detects, is a hearing impairment.
Loudness, frequency, and discrimination deficiencies
Hearing sensitivity is indicated by the quietest sound that an individual can detect, called the hearing threshold. In the case of people and some animals, this threshold can be accurately measured by a behavioral audiogram. A record is made of the quietest sound that consistently prompts a response from the listener. The test is carried out for sounds of different frequencies. There are also electro-physiological tests that can be performed without requiring a behavioral response.
Normal hearing thresholds are not the same for all frequencies in any species of animal. If different frequencies of sound are played at the same amplitude, some will be loud, and others quiet or even completely inaudible. Generally, if the gain or amplitude is increased, a sound is more likely to be perceived. Ordinarily, when animals use sound to communicate, hearing in that type of animal is most sensitive for the frequencies produced by calls, or, in the case of humans, speech. This tuning of hearing exists at many levels of the auditory system, all the way from the physical characteristics of the ear to the nerves and tracts that convey the nerve impulses of the auditory portion of the brain.
A hearing impairment exists when an individual is not sensitive to the sounds normally heard by its kind. In human beings, the term hearing impairment is usually reserved for people who have relative insensitivity to sound in the speech frequencies. The severity of a hearing impairment is categorized according to how much louder a sound must be made over the usual levels before the listener can detect it. In profound deafness, even the loudest sounds that can be produced by the instrument used to measure hearing (audiometer) may not be detected.
There is another aspect to hearing that involves the quality of a sound rather than amplitude. In people, that aspect is usually measured by tests of speech discrimination. Basically, these tests require that the sound is not only detected but understood. There are very rare types of hearing impairments which affect discrimination alone.
Types and causes of hearing impairment
Hearing impairment comes from different biologic causes. Most commonly, the ear is the affected part of the body.
Conductive
Conductive hearing loss occurs when sound is not normally conducted through the outer or middle ear or both. Since sound can be picked up by a normally sensitive inner ear even if the ear canal, ear drum, and ear ossicles are not working, conductive hearing loss is often only mild and is never worse than a moderate impairment. Hearing thresholds will not rise above 55-60 dB from outer or middle ear problems alone. Generally, with pure conductive hearing loss, the quality of hearing (speech discrimination) is good, as long as the sound is amplified loud enough to be easily heard.
A conductive loss can be caused by any of the following: Ear canal obstruction Middle ear abnormalities: Tympanic membrane Ossicles Inner ear abnormalities: Superior canal dehiscence syndrome
Sensorineural hearing loss
A sensorineural hearing loss is due to insensitivity of the inner ear, the cochlea, or to impairment of function in the auditory nervous system. It can be mild, moderate, severe, or profound, to the point of total deafness. This is classified as a disability under the ADA and if unable to work is eligible for disability payments.
The great majority of human sensorineural hearing loss is caused by abnormalities in the hair cells of the organ of Corti in the cochlea. There are also very unusual sensorineural hearing impairments that involve the VIIIth cranial nerve, the Vestibulocochlear nerve or the auditory portions of the brain. In the rarest of these sorts of hearing loss, only the auditory centers of the brain are affected. In this situation, central hearing loss, sounds may be heard at normal thresholds, but the quality of the sound perceived is so poor that speech can not be understood.
Most sensory hearing loss is due to poor hair cell function. The hair cells may be abnormal at birth, or damaged during the lifetime of an individual. There are both external causes of damage, like noise trauma and infection, and intrinsic abnormalities, like deafness genes.
Sensorineural hearing loss that results from abnormalities of the central auditory system in the brain is called Central Hearing Impairment. Since the auditory pathways cross back and forth on both sides of the brain, deafness from a central cause is unusual.
Typical causes are discussed in following subsections.
Long-term exposure to environmental noise
Populations of people living near airports or freeways are exposed to levels of noise typically in the 65 to 75 dB(A) range. If lifestyles include significant outdoor or open window conditions, these exposures over time can degrade hearing. The U.S. EPA and various states have set noise standards to protect people from these adverse health risks. The EPA has identified the level of 70 dB(A) for 24 hour exposure as the level necessary to protect the public from hearing loss and other disruptive effects from noise, such as sleep disturbance, stress-related problems, learning detriment, etc. (EPA, 1974).
Noise-Induced Hearing Loss (NIHL) typically is centered at 3000, 4000, or 6000 Hz. As noise damage progresses, damage starts affecting lower and higher frequencies. On an audiogram, the resulting configuration has a distinctive notch, sometimes referred to as a "noise notch." As aging and other effects contribute to higher frequency loss (6-8 kHz on an audiogram), this notch may be obscured and entirely disappear.
Louder sounds cause damage in a shorter period of time. Estimation of a "safe" duration of exposure is possible using an exchange rate of 3 dB. As 3 dB represents a doubling of intensity of sound, duration of exposure must be cut in half to maintain the same energy dose. For example, the "safe" daily exposure amount at 85 dB A, known as an exposure action value, is 8 hours, while the "safe" exposure at 91 dB(A) is only 2 hours (National Institute for Occupational Safety and Health, 1998). Note that for some people, sound may be damaging at even lower levels than 85 dB A. Exposures to other ototoxins (such as pesticides, some medications including chemotherapy, solvents, etc.) can lead to greater susceptibility to noise damage, as well as causing their own damage. This is called a synergistic interaction.
Some American health and safety agencies (such as OSHA and MSHA), use an exchange rate of 5 dB. While this exchange rate is simpler to use, it drastically underestimates the damage caused by very loud noise. For example, at 115 dB, a 3 dB exchange rate would limit exposure to about half a minute; the 5 dB exchange rate allows 15 minutes.
While OSHA, MSHA, and FRA provide guidelines to limit noise exposure on the job, there is essentially no regulation or enforcement of sound output for recreational sources and environments, such as sports arenas, musical venues, bars, etc. This lack of regulation resulted from the defunding of ONAC, the EPA's Office of Noise Abatement and Control, in the early 1980s. ONAC was established in 1972 by the Noise Control Act and charged with working to assess and reduce environmental noise. Although the Office still exists, it has not been assigned new funding.
Most people in the United States are unaware of the presence of environmental sound at damaging levels, or of the level at which sound becomes harmful. Common sources of damaging noise levels include car stereos, children's toys, transportation, crowds, lawn and maintenance equipment, power tools, gun use, and even hair dryers. Noise damage is cumulative; all sources of damage must be considered to assess risk. If one is exposed to loud sound (including music) at high levels or for extended durations (85 dB A or greater), then hearing impairment will occur. Sound levels increase with proximity; as the source is brought closer to the ear, the sound level increases. This is why music is more likely to cause damage at the same output when listened to through headphones, as the headphones are in closer proximity to the ear drum than a loudspeaker. With the invention of in-ear headphones, these dangers are increased.
Genetic
Hearing loss can be inherited. Both dominant gene and recessive genes exist which can cause mild to profound impairment. If a family has a dominant gene for deafness it will persist across generations because it will manifest itself in the offspring even if it is inherited from only one parent. If a family had genetic hearing impairment caused by a recessive gene it will not always be apparent as it will have to be passed onto offspring from both parents. Dominant and recessive hearing impairment can be syndromic or nonsyndromic. Recent gene mapping has identified dozens of nonsyndromic dominant (DFNA#) and recessive (DFNB#) forms of deafness.
- The most common type of congenital hearing impairment in developed countries is DFNB1, also known as Connexin 26 deafness or GJB2-related deafness.
- The most common dominant syndromic forms of hearing impairment include Stickler syndrome and Waardenburg syndrome.
- The most common recessive syndromic forms of hearing impairment are Pendred syndrome, Large vestibular aqueduct syndrome and Usher syndrome.
Disease or illness
- Measles may result in auditory nerve damage
- Meningitis may damage the auditory nerve or the cochlea
- Autoimmune disease has only recently been recognized as a potential cause for cochlear damage. Although probably rare, it is possible for autoimmune processes to target the cochlea specifically, without symptoms affecting other organs.Wegener's granulomatosis is one of the autoimmune conditions that may precipitate hearing loss.
- Mumps (Epidemic parotitis) may result in profound sensorineural hearing loss(90 Decibel|dB or more), unilateral (one ear) or bilateral (both ears).
- Presbycusis is a progressive hearing impairment accompanying age, typically affecting sensitivity to higher frequencies (above about 2 kHz).
- Adenoids that do not disappear by adolescence may continue to grow and may obstruct the Eustachian tube, causing conductive hearing impairment and nasal infections that can spread to the middle ear.
- AIDS and AIDS-related complex|ARC patients frequently experience auditory system anomalies.
- HIV (and subsequent opportunistic infections) may directly affect the cochlea and central auditory system.
- Chlamydia may cause hearing loss in newborns to whom the disease has been passed at birth.
- Fetal alcohol syndrome is reported to cause hearing loss in up to 64% of infants born to alcoholism|alcoholic mothers, from the ototoxic effect on the developing fetus plus malnutrition during pregnancy from the excess ethanol|alcohol intake.
- Premature birth results in sensorineural hearing loss approximately 5% of the time.
- Syphilis is commonly transmitted from pregnant women to their fetuses, and about a third of the infected children will eventually become deaf.
- Otosclerosis is a hardening of the stapes (or stirrup) in the middle ear and causes conductive hearing loss.
- Superior canal dehiscence, a gap in the bone cover above the inner ear, can lead to low-frequency conductive hearing loss, autophony and vertigo
Medications
Some medications cause irreversible damage to the ear, and are limited in their use for this reason. The most important group is the aminoglycosides (main member gentamicin).
Various other medications may reversibly affect hearing. This includes some diuretics, aspirin and NSAIDs, and macrolide antibiotics.
Extremely heavy hydrocodone (Vicodin) abuse is known to cause hearing impairment. There has been speculation that radio talk show host Rush Limbaugh's hearing loss was at least in part caused by his admitted addiction to narcotic pain killers, in particular Vicodin and OxyContin.
Physical trauma
- There can be damage either to the ear itself or to the brain centers that process the aural information conveyed by the ears.
- People who sustain head injury are especially vulnerable to hearing loss or tinnitus, either temporary or permanent.
- Exposure to very loud noise (90 Decibel|dB or more, such as jet engines at close range) can cause progressive hearing loss. Exposure to a single event of extremely loud noise (such as explosions) can also cause temporary or permanent hearing loss. A typical source of acoustic trauma is an excessively loud music concert.
Categories of hearing impairment
Hearing loss is categorized by its severity and by the age of onset. Two persons with the same severity of hearing loss will experience it quite differently if it occurs early or late in life. Furthermore, a loss can occur on only one side (unilateral) or on both (bilateral).
Types
As discussed above, there are three major types of hearing loss: neural/sensorineural, conductive, or a combination of both. Treatment depends upon the type of hearing loss that is present.
Quantification of hearing loss
The severity of hearing loss is measured by the degree of loudness, as measured in decibels, a sound must attain before being detected by an individual. Hearing loss may be ranked as mild, moderate, severe or profound. It is quite common for someone to have more than one degree of hearing loss (i.e. mild sloping to severe). The following list shows the rankings and their corresponding decibel ranges:
- Mild:
- for adults: between 25 and 40 dB
- for children: between 20 and 40 dB
- Moderate: between 41 and 55 dB
- Moderately severe: between 56 and 70 dB
- Severe: between 71 and 90 dB
- Profound: 90 dB or greater
The quietest sound one can hear at different frequencies is plotted on an audiogram to reflect one's ability to hear at different frequencies. The range of normal human hearing (from the softest audible sound to the loudest comfortable sound) is so great that the audiogram must be plotted using a logarithmic scale. This large normal range, and the different amounts of hearing loss at different frequencies, make it virtually impossible to accurately describe the amount of hearing loss in simple terms such as percentages or the rankings above.
Measuring hearing loss in terms of a percentage is debatable in terms of effectiveness, and has been compared to measuring weight in inches. Though in specific legal situations, where decibels of loss are converted via a recognized legal formula, one can infer a standardized "percentage of hearing loss" which is suitable for legal purposes only.
Another method for determining hearing loss, is the Hearing in Noise Test (HINT). HINT technology was developed by the House Ear Institute, and is intended to measure an ability to understand speech in quiet and noisy environments. Unlike pure-tone tests, where only one ear is tested at a time, HINT evaluates hearing using both ears simultaneously (binaural), as binaural hearing is essential for communication in noisy environments, and for sound localization.
Age of onset of hearing impairment
The age at which the hearing impairment develops is crucial to spoken language acquisition. Post-lingual hearing impairments are far more common than pre-lingual impairments.
If the hearing loss occurs at a young age, interference with the acquisition of spoken language and social skills may occur. Hearing aids, which amplify the incoming sound, may alleviate some of the problems caused by hearing impairment, but are often insufficient. Cochlear implants artificially stimulate the VIIIth Nerve by providing an electric impulse substitution for the firing of hair cells. Cochlear implants are not only expensive, but require sophisticated programming in conjunction with patient training for effectiveness. People who have hearing impairments, especially those who develop a hearing problem in childhood or old age, require support and technical adaptations as part of the rehabilitation process.
Pre-lingual deafness
Prelingual hearing impairment exists when the impairment is congenital or otherwise acquired before the individual has acquired speech and language, thus rendering the disadvantages more difficult to treat because the child is unable to access audible /spoken communication from the outset. It is important to note that those children born into signing families have no delay in language development and communication. Most pre-lingual hearing impairment is due to an acquired condition, usually either disease or trauma; therefore, families commonly have no prior knowledge of deafness.
Post-lingual hearing impairment
Post-lingual hearing impairment where hearing loss is adventitious after the acquisition of speech and language, usually after the age of six. It may develop due to disease, trauma, or as a side-effect of a medicine. Typically, hearing loss is gradual, and often detected by family and friends of the people so affected long before the patients themselves will acknowledge the disability. Common treatments includes hearing aids and learning lip reading. Loneliness and depression can arise as a result of isolation (from the inability to communicate with friends and loved ones) and difficulty in accepting their disability.[citation needed]
Hard-of-hearing
People who are hard of hearing have varying amounts of hearing loss but usually not enough to be considered deaf. Many people who are deaf consider spoken language their primary language and consider themselves "hard of hearing".[citation needed] How one classifies themselves relative to hearing loss or deafness is a very personal decision and reflects much more than just their ability to hear.
The phrase hard of hearing, normally used as an adjective or adverb, can also be used as a noun, referring to people with hearing impairment as the hard of hearing. People who consider themselves culturally deaf, prefer the term "hard of hearing" or "deaf", and perceive "hearing impaired" as an insult.
Hearing impaired persons with partial loss of hearing may find that the quality of their hearing varies from day to day, or from one situation to another or not at all. They may also, to a greater or lesser extent, depend on both hearing-aids and lip-reading. They may perhaps not always be aware of it, but they do admit to it being important to see the speaker's face in conversation.
Many people with hearing loss have better hearing in the lower frequency ranges (low tones), and cannot hear as well or at all in the higher frequencies. Some people may merely find it difficult to differentiate between words that begin with consonantal sounds such as the fricatives or sibilants, z, or th, or the plosives d, t, b, or p. They may be unable to hear thin, high-pitched or metallic noises, such as birds chirping or singing, clocks ticking, etc. Often, they are able to hear and understand men's voices better than women's.
Others will find their condition so much worse if circumstances in their immediate environment affect the way they are able to use their hearing aids, or prevent them from employing their speech reading skills. A room with a high ceiling and a lot of reverberation will affect the sound of a speaker's voice adversely. The position of the listener, too, sitting at a right angle to the speaker at a long seminar table, thus being able to hear only with one, maybe the ineffectual ear, can make a difference. Difficulties can also arise for the listener trying to lip-read, if the speaker is sitting with his back against the light-source and is in this way obscuring his face. A rule of thumb is that bright lighting is to the hearing-impaired what noise is to the hearing; a source of distraction.
The speaker's accent; the topic under discussion, possibly with many unfamiliar words; the softness of his voice; possibly his having a speech impediment; a habit of holding a hand in front of his mouth or turning his face away at times: all these tendencies cause problems to the hard-of-hearing, especially when they have to rely on lip-reading. The rustling of papers, and notebook pages being turned are precisely the noises that will be the first thing hearing-aids pick up.
Noisy situations are especially difficult, because hearing loss affects not only the ability to hear sounds, but also the ability to localize and filter out background noise.
Unilateral hearing loss
People with unilateral hearing loss (single sided deafness/SSD) can hear normally (or better) in one ear, but have trouble hearing out of the other ear. Problems with this type of deficit is inability to localize sounds (ie. unable to tell where traffic is coming from) and inability to process out background noise in a noisy environment, such as in a restaurant.
Social impact
Pre-lingual impairment
See also: Prelingual deafness
In children, hearing loss can lead to social isolation for several reasons. First, the child experiences delayed social development that is in large part tied to delayed language acquisition. It is also directly tied to their inability to pick up auditory social cues. This can result in a deaf person becoming generally irritable. A child who uses sign language, or identifies with the deaf sub-culture does not generally experience this isolation, particularly if he/she attends a school for the deaf, but may conversely experience isolation from his parents if they do not know sign language. A child who is exclusively or predominantly oral (using speech for communication) can experience social isolation from his or her hearing peers, particularly if no one takes the time to explicitly teach her social skills that other children acquire independently by virtue of having normal hearing. Finally, a child who has a severe impairment and uses some sign language may be rejected by his or her deaf peers, because of an understandable hesitation in abandoning the use of existent verbal and speech-reading skills. Some in the deaf community can view this as a rejection of their own culture and its mores, and therefore will reject the individual preemptively.
Post-lingual impairment
Those who lose their hearing later in life, such as in late adolescence or adulthood, face their own challenges. For example, they must adjust to living with the adaptations that make it possible for them to live independently. They may have to adapt to using hearing aids or a cochlear implant, develop speech-reading skills, and/or learn sign language. The affected person may need to use a TTY (teletype), interpreter, or relay service to communicate over the telephone. Loneliness and depression can arise as a result of isolation (from the inability to communicate with friends and loved ones) and difficulty in accepting their disability. The challenge is made greater by the need for those around them to adapt to the person's hearing loss.
Many relationships have suffered because of the anger that occurs when there is general miscommunication between family members. Generally, it's not only the person with a hearing disability that feels isolated, but others around them who feel they are not being "heard" or paid attention to, especially when the hearing loss has been gradual. Many people opt not to choose hearing aids for fear of looking old, since hearing loss is usually associated with old age, which equals ineffectiveness in some societies. Family members then feel as if their hearing loss partner doesn't care about them enough to make changes to reduce their disability and make it easier to communicate.
Medical treatments
Approaches
In addition to hearing aids there exist cochlear implants of increasing complexity and effectiveness. These are useful in treating the mild to profound hearing impairment when the onset follows the acquisitions of language and in some cases in children whose hearing loss came before language was acquired. Recent research shows variations in efficacy but some promising studies [4]show that if implanted at a very young age, some profoundly impaired children can acquire effective hearing and speech.
Views of treatments
There is controversy in the culturally deaf community as to whether cochlear implants address wellness concerns, the overall health and psycho-emotional well-being of prelingually deaf children at all.
Gene therapy
In 2005, there was success of the regrowth of cochlea cells in test subjects by a research team led by Dr. Yehoash Raphael from the University of Michigan. This study was conducted using guinea pigs as test subjects.[5] It is important to note however, that the regrowth of cochlear hair cells does not imply the restoration of hearing sensitivity as the sensory cells may or may not make connections with neurons that carry the signals from hair cells to the brain.
A team led by Dr. Stefan Heller from Stanford University are pioneering stem cell research in the prospect of regrowth in cochlea cells.[6]....
Adaptations to hearing impairment
Many hearing impaired individuals use certain assistive devices in their daily lives. Individuals can communicate by telephone using telecommunications devices for the deaf (TDD). This device looks like a typewriter or word processor and transmits typed text over the telephone. Other names in common use are textphone and minicom. A videophone can be used for distance communication using sign language. In 2004, mobile textphone devices came onto the market for the first time allowing simultaneous two way text communication. In the U.S., the UK, the Netherlands and many other western countries there are Telecommunications Relay Services so that a hearing impaired person can communicate over the phone with a hearing person via a human translator. Wireless, internet and mobile phone/SMS text messaging are beginning to take over the role of the TDD. Other assistive devices include those that use flashing lights to signal events such as a ringing telephone, a doorbell, or a fire alarm. Video conferencing is also a new technology that permits signed conversations as well as permitting an ASL-English interpreter to voice and sign conversations between a hearing impaired and hearing person, negating the need to use a TTY or computer keyboard. In addition, there are many new Telecommunications Relay Service technologies including IP Relay and captioned telephone.
Resources
Many different assistive technologies, such as hearing aids, are available to people who are hearing impaired. People with cochlear implants, hearing aids, or neither of these two devices also use additional communication devices to reduce the interference of background sounds, or to mediate the problems of distance from sound and poor sound quality caused by reverberation and poor acoustic materials of walls, floors and hard furniture. Three types of wireless, one-way wireless exist along with hard-wired devices. A wireless device used by people who use their residual hearing has two main components. One component sends the sound out to the listener, but is not directly connected to the listener with the hearing loss. The second component of the wireless system, the receiver, detects the sound and sends the sound to the ear of the person with the hearing loss. The three types of wireless devices are the FM system, the audio induction loop and the infra red system. Each system has advantages and benefits for particular uses. The FM system can easily operate in many environments with battery power. It is thus mobile and does not usually require a sound expert for it to work properly. The listener with the hearing loss carries a receiver and an earpiece. Another wireless system is the audio induction loop which permits the listener with hearing loss to be free of wearing a receiver provided that the listener has a hearing aid or cochlear implant processor with an accessory called a "telecoil". If the listener doesn't have a t-coil or telecoil, then she must carry a receiver with an earpiece. The third kind of wireless device for people with hearing loss is the infra red (IR) device which also requires a receiver to be worn by the listener. Usually the emitter for the IR device, that is, the component that sends out the signal, uses an AC adaptor. The advantage of the IR wireless system, is that people in adjoining rooms cannot listen in on conversations, and thus it is confidential and necessary for situations where privacy and confidentiality are required or chosen. Another way to achieve confidentiality is to use a hardwired amplifier which sends out no signal beyond the earpiece that is plugged directly into the amplifier. That amplifier of the hardwired device also has a microphone inside of it or plugged into it.
- Hearing dogs, a category of assistance dogs, are trained to help those with hearing impairments.
- The advent of the internet's World Wide Web and closed captioning has given the hearing impaired unprecedented access to information. Electronic mail and online chat have reduced the need for deaf and hard of hearing people to use a third-party Telecommunications Relay Service in order to communicate with the hearing and other hearing impaired people.
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