Karen Levin, Ph.D Speech Therapist, Johannesburg

Hearing impairment and deafness

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What is deafness and what is a hearing impairment?

• Deafness results when a person is unable to hear enough sound to be able to communicate with other people using oral speech alone.

• A hearing impairment results in people having some degree of difficulty with communication that can often be changed with the use of adaptations such as changes to the environment, improved lip reading, and/or the use of hearing aids.

 

SPEECH THERAPY AND DEAFNESS

The world of deafness is a very tricky one because it is very politically charged. There is a statement, "there is nothing that Deaf people can't do but hear". At the same time, many people who live with hearing impairments are excluded from the hearing world. My goal as a speech therapist is to work with my clients so that they are fully informed about the dis/ability and can make the right choices. 

 

The politics of deafness

Many people who  are deaf use sign language to communicate, and some are able to use oral language as well. The politics of deafness emerged when hearing people stopped deaf people from using sign language and forced them to use oral language. When I was a student at university, we were taught to teach deaf children to speak. They were not allowed to use sign language at school. This narrow-minded, ill-informed and disablist attitude - which existed all over the world - resulted in many thousands of deaf people being forced into a situation in which they were deprived of the opportunity to learn language.  They did not have oral language and they did not have sign language. As a result, their intellectual development was limited and many remained unemployed, unemployable, unable to communicate and unable to do much. If one is deaf, there is no way that one can learn oral language (easily) and so, by depriving deaf people of sign language, we deprived them of language. Deaf people around the world (as well as hearing people who understood their issues) protested and stood up to this oppression. The result was that deaf people have established themselves as different but not disabled. They cannot hear but they have sign language. They see themselves as Deaf (with a capital D) as a culture and as a community.

 

People with a hearing loss, on the other hand, in the main are able to learn spoken language and oral speech because they have sufficient hearing to do so. They do not need to learn sign language as a necessity.

 

In the old days, if a child was deaf, the ways to bring up the child almost always resulted in a failure to provide the child with language  :

1. We used to force the child to use oral language and the result was a disaster. The child did not learn language.

2. Alternatively, we used to force the child to use oral language and allowed sign language but not necessarily as the primary language. The result was that the child learned sign language but always felt that the sign language was second best, and that they would only succeed in life if they could speak. The positive for some of these children was that many of them could lip read and speak orally and could participate in BOTH the hearing world to some extent, and deaf worlds.

3. Some forward thinking people took all emphasis off oral language and allowed the child to use sign language; in this way, the child was acknowledged, was able to learn language, and was seen as belonging to the Deaf world.

 

Today, the problem is enormous and I don't have any solutions.

No one does. Today, we have technology in the form of cochlear implants that often can give the deaf child or adult hearing that is sufficient to learn to communicate orally and to participate in the hearing world. However, Deaf people protest and feel that by encouraging cochlear implants, we are perpetuating the message that deafness is a disability. Also, not all cochlear implants are successful and there is huge effort involved, as well as huge cost, in using cochlear implants. The decision as to which route to choose is enormous. If any of you are in that position, I suggest that you find a good audiologist, a good speech therapist and a good ENT. By 'good', I mean professionals who are able to give you tons of information and who are not biased. Get more than one opinion.

 

What do speech therapists do with Deaf people who use sign language?

Some deaf people refuse to engage with speech therapists because of our past history with regard to forcing them to speak! Others do not see us as having a role because they do not speak. However, a speech therapist is a professional who works with communication, and so our job is to help people to be able to participate in the world in which they need or wish  to communicate.  We can, and do, play an important role in facilitating the communication of Deaf people with other Deaf people and with hearing people. In the ideal world, a speech therapist who works with Deaf people needs to be able to use sign language and not all of us can. We are trained, however, to work with Deaf people even if we cannot use sign.

 

What is the role of the speech therapist with deaf people who have cochlear implants?

We work with people - adults and/or children - to help them to make the decision about having a cochlear implant, and we work with them to help them to work out how to use them optimally. We work on speech and language development and conservation.

 

SPEECH THERAPY AND HEARING IMPAIRMENT

 The term "hearing loss"  is inaccurate - it implies that hearing was once there and now is lost and that is not always the case ... often it was not there to start with! I prefer to use the term 'hearing impairment'.

 

Hearing impairment is measurable. Audiologists use a variety of technological tests and behavioural observations to determine what a person can and cannot hear, and on the basis of their test findings, are able to help their clients to make decisions about how best to proceed.

 

In many cases, they will offer a hearing aid which will help the person to hear more optimally. Often, though, hearing aids cannot replace hearing and the person may remain with compromised hearing.

 

What do speech therapists do with people who wear hearing aids?

The speech therapist plays an enormous role in the lives of people who wear hearing aids. I sometimes wish that everyone who is fitted with a hearing aid could be referred to a speech therapist. In the old days in South Africa, we all trained as 'speech and hearing therapists' which meant that we were all speech therapists as well as audiologists in one. So, speech therapist/audiologists fitted hearing aids and provided speech therapy services to those clients. Today, the two professions have split and one trains either as a speech therapist or as an audiologist and not as both. This is wonderful because audiology has grown and is a huge profession on its own. The problem is that the therapy side of hearing impairment has fallen away in many contexts.  In theory,  audiologists are trained to, and ought to provide the speech therapy but in reality, it is rare for audiologists to do anything more than fit the hearing aids and make sure the person is hearing more.  Few clients are referred for speech therapy

 

As a speech therapist, I work with hearing impaired people. My goals are as follows:

 

1. To help the client to learn intelligible oral speech, or to help the client who has speech to retain intelligible speech (we call this 'speech conservation'). A person with a hearing loss is often not able to hear his or her own speech production and is therefore unable to monitor it.

 

2. To help the client to learn language. Many children are not able to learn language because they do not hear easily or clearly the language that is spoken to them. In addition, many children are only diagnosed as having a hearing impairment during the years when they should have been learning language, and so they miss out on early language learning. Our job is to help them to learn the language that they have missed out on.

 

3. To help the client to communicate in real world contexts in which their hearing may prevent them from being able to fully participate. We work on things like communicating in noise; communicating on the telephone; communicating with people who talk quietly.

 

4. To work in a team with the audiologist to help the client and/or his or her family to make decisions regarding issues such as learning sign language, having cochlear implants; using alternative or augmentative communication.

 

5. To work closely with the client's audiologist to ensure that the hearing aids work maximally.