Do school children with hearing loss have preferences

within their use of FM and/or Audio Induction Loop?

Translated into English June 2010 by

Kamilla Regel Poulsen

Studying Master of Arts in Corporate

Communication

at the Aarhus School of Business

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Aïda Regel Poulsen is a hearing consultant

at the Centre for Hearing Loss. She has an

education as a teacher in the folkeskole

from 1983 and got her degree as speech-

hearing-therapist in 1992. Aïda has worked

in the school department at the Centre for

Hearing Loss, Fredericiaskolen, where the

area of experience is teaching pupils with

hearing loss who have a usable remnant of

their hearing for development of a spoken

language. At the same time, signing has

been used, to varying extends, parallel to

the technical equipment.

In 1994, Aïda moved to the department for

counselling at the Centre for Hearing Loss,

where she has been affiliated to the School

Counselling as a hearing consultant ever

since. In the district of the Centre of Hearing

Loss, we do counselling and guidance about

the areas of effort in terms of children with

hearing aids and CI, who are placed in local

schools. A function which we have been able

to watch develop extensively during the last

years.

For a period of time, Aïda worked as a

hearing-therapist at the hearing clinic in

Vejle parallel to working for the School

Counselling, but she is now functioning

solely as a consultant for the local schools,

while also giving courses to both parents

and professionals.

Aïda herself has a hearing loss and knows

from personal experience the equipment

which the kids are presented with as well as

the tasks of getting on as a person with a

hearing loss

Do school children with hearing loss have preferences within their

use of FM and/or Audio Induction Loop?

An enquiry in January 2009 among the pupils at Fredericiaskolen, the

Centre for Hearing Loss, about the advantages and disadvantages in

using respectively FM and/or Audio Induction Loop, also calculated as

to whether the individual pupil is treated audiologically with hearing

aids and/or uses CI.

This enquiry developed into observations of the construction of

communication-technical equipment and commentaries on these with

regards to teaching culture- and tradition and, at the same time, it

became a peep of just how precise and thorough we have to be in the

cooperation with the individual pupil about achieving the best possible

outcome ability communicatively.

Hearing consultant Aïda Regel Poulsen Center for Høretab Fredericia April 2009.

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Table of contents

Table of contents Page 2 Summary Page 3 Introduction Page 3 Terminology Page 4 Description of the Group of Pupils Page 5 Description of Fredericiaskolen Page 5 The Examination Page 5 Dispersion of Age and Gender Page 12 The Arguments Page 12 The Pupils at Bakkeskolen Page 15 Summary of the Pupil’s Arguments and Evaluation Page 15 Which Possibilities Do the Pupils Use With TV/DVD and Telephone? Page 16 What May Be Improved? Page 17 Types of Communication-Technical Equipment in Relations to pedagogical Method Page 18 Discussion Page 19 Conclusion Page 23 References Page 25 References Links Page 25 Additional Page 25 Encl. 1 Page 26 Encl. 2 Page 29

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Summary

In January 2009, an enquiry was made among the pupils at Fredericiaskolen regarding their preferences with regards to the use of FM vs. Audio Induction Loop (Audio-frequency induction Loops (AFILs)) in connection with their hearing aids (HA) or Cochlear Implant (CI) in class. As the multi-frequent FM has been marketed massively during the last years, it was surprising that only nine out of 67 responses showed a preference for using FM, and that only a few pupils with CI preferred FM. At the same time, a surprisingly large number of the pupils chose not to use extra communication-technical equipment at all, and this, naturally, raises questions in the subject fields; what can we do better and what are the reasons that the pupils choose the way they do? At Fredericiaskolen, some classes have parallel equipment (FM and AFILs) set up so that the pupils can choose whichever, they find, works best. The pupil’s responses show that there is typically a great deal of noise and nuisances directly interfering, and some of these pupils can describe only hearing sounds, not speech.

Among the pupils, who chose to use communication-technical equipment in class, it turned out there was a long list of minute considerations they had done individually to be able to utilize the sound as best as possible – in class or in general. Many of the pupils have been highly specific in stating how they set their HA/CI in the specific situation. They fully demonstrated their knowledge of the possible interferences during a conversation and of how the communication-technical equipment can displace their attention. Both communication-technical systems –AFILs and FM – are set up and accessible in every classroom at Fredericiaskolen. It is possible for the individual pupil to choose the technical equipment that he/she is personally most comfortable with. The pupils disperse with their preferences over all the classes. There is a clear predominance of pupils preferring the use of the AFILs (43%). A somewhat smaller group (16%) prefers using the FM. Two pupils use FM/AFILs fifty/fifty depending on the situation. A rather large group (41%) would rather not use any form of extra communication-technical equipment, arguing that the sound bothers, disturbs or outright hurts them. In addition, two pupils have not been able to be audiologically treated, and two pupils have been given HA but have no use of them. These four pupils are not accounted for in the number using the extra communication-technical equipment. In the pupil responses, you can also tell how important it is for the individual pupil to get the necessary help getting the equipment to work optimally in order for the pupil not to feel left alone in the middle of what we expect to be a community on an audio base and on the grounds of the hearing. In the enquiry, the principles of constructing different communication-technical equipment are touched upon as well as how they each support the Danish pedagogical traditions. Focus is placed on the importance of the conversation with the pupils in relations to the choices of the best suitable equipment for the individual pupil so that the technology does not become the goal itself, but the means in the pedagogical process and the social being together, of which the pupil is a part during his/her school life.

Introduction

For a number of years, the communication-technical equipment at Fredericiaskolen (the school department at the Centre for Hearing Loss) has been AFILs-based. ‘The AFILs are double-loop-propped up so that an optimal, homogenous coverage in the individual classrooms is achieved as well as the least possible emission to the neighbouring classrooms. The signal from the AFILs is intercepted by a small telecoil built into the pupil’s hearing aid/CI.’ (Ref. 15: The declaration of Fredericiaskolen. See: technical standards)

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This makes it possible to use AFILs in several classrooms at the same time but the AFILs are, of course, installed in the individual classrooms. With the introduction of the multi-frequent FM system in 2003 and the obvious advantages in a mobile communication—technical equipment, this was launched and gradually implemented in each classroom. There is a wall pilot at the entrance of each classroom, which means that the pupils are automatically synchronised with the right frequency for the specific classroom. During the implementing of the FM system, AFILs were deactivated as the FM equipment was being set up. Meanwhile, the pedagogical personnel had some observations as to the pupils’ use of and reactions to the new equipment, which meant that all classrooms at Fredericiaskolen now have FM equipment and AFILs set up parallel. It is in almost every classroom combined so that the teacher has one microphone transmitting to both the FM system and the AFILs in the classroom at the same time. The individual pupil chooses her- or herself whether to listen via FM or AFILs. (Encl. 2) Parallel with the use of FM or telebased communication equipment, signs are used to different extent in the teaching at Fredericiaskolen. Using signs is – as well as using the communication technical equipment – based on the individual pupil group and their needs. Work is done all the time to secure a safe communication and to make the pupils’ Danish language foundation as basic and secure as possible – this both receptively, in terms of the oral presentation, and, of course, in terms of contents of the linguistic work. This examination is an account of where the pupils’ preferences lie in their choice between FM and AFILs and an attempt to make the pupils’ linguistic expression a part of an evaluation of which offers should be available for the pupils with hearing loss. The enquiry also serves the purpose of creating awareness among the pupils about which choice they each must make and about how the needs may vary both from person to person, but also from situation to situation.

Terminology

Two concepts are important to define in the vocabulary of this examination. I use the expression pupils with hearing loss in preference to hearing-impaired pupils. It follows the inclusive thought that we are able to look at each pupil as people with individual characteristic and qualities/personalities. It is not just the hearing loss that characterises the individual pupil, and so I choose not to use the term hearing-impaired in order to avoid the designation that might be thought to include the personality of the pupil as a whole. I use the term communication-technical equipment rather than hearing-technical aids. The FM- or tele-based equipment used in the classes by the pupils with hearing loss is meant to enhance the communication, support the turn-taking and make possible the conversation of the teaching in praxis, in which it is a basic necessity to be able to estimate direction and distance in one’s hearing in order to qualitatively be a part of the dialogue. Within the term communication-technical equipment lies the responsibility of others than just the one listening. The person speaking is responsible for communication his/her message to everyone involved in the specific teaching situation. That means that focus is on the pedagogical use of the communication-technical equipment, of which the technology is expected to support the choice of pedagogical methods. The technology itself is never meant to be the goal in itself, but a means to an end in the work with and development of the pupils’ thoughts and skills.

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Description of the Group of Pupils

Fredericiaskolen accepts pupils with hearing loss in the classes. Several pupils have other disabilities besides the hearing loss. As this enquiry is carried out, the school department has 76 pupils. The pupils may be treated audiologically with either HA or CI. For some pupils, it has not been possible be treated audiologically; this is an evaluation made at the hearing clinic which the child is assigned. Some pupils have their entire schooling at Fredericiaskolen, while others start out attending school locally in their home commune, after which a change of school is made for Fredericiaskolen at some point. One group of pupils receives teaching at a local folkeskole in Fredericia – Bakkeskoleprojektet (the project Bakkeskolen) – with the support of FM and AFILs-based equipment and personnel skilled in sign language.

Description of Fredericiaskolen

Fredericiaskolen is a special school for pupils with hearing loss ranging wide. Classes within the broad-spectred special teaching are held with the possibility of pupils taking their final tests within the scope of the individual pupil and with the degree of dispensation necessary to each pupil. (ref. 15: The declaration of Fredericiaskolen. See paragraphs: Servicemål & Faglige standarder)

The examination

Out of the 76 pupils at Fredericiaskolen, 67 have returned the questionnaires answered. A response percentage of 88.2 %. An age dispersal from 6 – 17 years. (Encl. 1) Five pupils have their daily school attendance in a class at a local school in Frederica Bakkeskolen. These five pupils’ responses are identifiable in the examination in order to compare, whether the differences in conditions in their daily school attendance might possibly have any influence on the pupils’ preferences in their use of FM/AFILs. Generally, each of the 67 pupils has had the opportunity to discuss the responses with an articulations teacher and/or a class teacher Partly to be able to give a precise description of the used equipment (both HA, CI and communication-technical equipment) Partly to become more minutely aware of what the individual pupil prefers in which situations. Hopefully, the examination has provided an opportunity for discussion amongst the pupils themselves. Of the 67 responses, 43 pupils (or 64%) use HA. 20 pupils (or 30%) use the CI. Two pupils with hearing loss are not audiologically treated. (3%) Two pupils (3%) have been given HA but do not feel that they gain anything from using them. (Fig. 1)

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6% (or four pupils) of the pupils at Fredericiaskolen have not been seen fit to receive audiological treatment/have not have any use of the audiological treatment and are therefore not included in the further research of the preferences regarding the use of HA/CI and extra communication-technical treatment such as FM/AFILs. The two pupils who have not been able to be treated audiologically are now both 12 years of age. The two pupils who do not benefit from using the audiological treatment received are both 16 years of age. The group of pupils with HA 43 pupils (or 64% of the entire group of respondents) use HA. Eight pupils have just one hearing aid (a unilateral HA treatment), while 35 pupils have bilateral HA. Of the group using HA (43 pupils), these two groups divide themselves as such (Fig. 2):

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Out of the eight pupils with each one hearing aid, two state that they prefer the AFILS rather than the FM. The other six pupils declare that they to not find it beneficial to use neither FM nor the AFILs. None of the pupils in this group prefer FM. Of the 35 pupils treated with bilateral HA, 12 pupils have a preference for using the AFILs. Nine state that they prefer FM, while two pupils find that the two extra communication systems function equally well. These two pupils are able to shift according to the situation. 12 pupils state that they would rather do without both AFILs and FM. (Fig. 3)

The nine pupils preferring FM all prefer using the FM on both ears at the same time. Three of these prefer the FM+M setting, while five pupils prefer just FM. One pupil states no preference in this area.

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Of the 12 pupils preferring the AFILs, eight use the telecoil on both ears at the same time. Four pupils say that they only use one ear but do not state on which ear they prefer to listen via the telecoil. Seven pupils prefer being on a clear T setting, while three pupils prefer the MT setting. Two pupils do not state any preference on this question. The pupils were asked about the type of HA. This, apparently, was a difficult question to answer. Some have avoided answering this question completely, others write ‘something Oticon’, ‘Phonak’, or ‘Senso’. Unfortunately, it has not been possible to find out anything further about in this examination about the cooperation between HA and the extra communication-technical equipment (for example about the telecoil or the FM setup). To sum up the statistics about these 43 HA users, this examination shows that 14 pupils prefer using the AFILs. Nine pupils prefer using FM. Two pupils find that FM and AFILs function equally well and are able to be flexible in their use of the two systems according to the situation. All in all, 18 HA-treated pupils (six unilateral HA-treated and 12 bilateral HA-treated) would rather not use any type of extra communication-technical equipment. (Fig. 4)

The group of pupils with CI: Out of the 20 pupils with CI, 13 pupils are unilaterally CI-treated, while seven pupils hare bilateral CI implants. Of the 13 pupils, who have unilateral CI, four pupils have 3G, while nine have Freedom. None of the pupils in this specific group of pupils use CI + HA. (Fig. 5)

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Six pupils have unilateral implants on their right ears, three with 3G and three pupils with Freedom. Seven pupils have unilateral implants on their left ears, one pupil with 3G and six with Freedom. (Fig. 6)

Out of the four pupils who have 3G, two pupils prefer using the AFILs, while the other two pupils prefer doing without extra communication-technical equipment. Of the nine pupils, who have Freedom, four pupils prefer using the AFILs, while the other five pupils prefer doing without extra communication-technical equipment. Also, the enquiry shows that four of the six pupils who have unilateral implants on their right ears choose not to use FM/AFILs.

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Out of the seven pupils with unilateral implants on their left ears, three pupils choose not to use FM/AFILs.

Of the seven pupils with double implants, four pupils have two Freedom devices each, while the other three pupils have 3G + Freedom. (Fig. 8)

All three pupils with double implants of both 3G + Freedom prefer using AFILs. One pupil states which ear, respectively, the Freedom and the 3G are used on, which shows that the pupil prefers the telecoil on his/her Freedom device. The other two do not specify which of the devices they prefer using with the extra communication-technical equipment. Out of the four pupils with double implants with 2xFreedom, three prefer using the AFILs. One is uncertain which to choose having recently received the second CI. One answers FM and has not yet tried anything else. Two pupils bilaterally implanted with CI state that when they use the AFILs, they choose the MT setting; one pupil prefer pure T, while another pupil uses T on the left CI and MT on the right MT (the pupil with 2xFreedom). Conclusively, the research of the 20 CI users show their preferences to be divided into 12

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pupils preferring AFILs, seven preferring not using any type of extra communication-technical equipment, while one pupil is satisfied with FM; one has not yet chosen a preference. (Fig. 9)

As in the group of pupils with HA, it is remarkable that such a large percentage prefer not to use the extra communication-technical equipment during the classes. And it is surprising that so few pupils with CI have a preference for FM. Summed up with the group of pupils with HA, we have, at Fredericiaskolen, 26 pupils (41%) preferring to

use the AFILs. Nine pupils (16%) are most comfortable with the FM. Two pupils (3%) think that FM and

AFILs work equally well, while 25 pupils in total (40%) would rather not use any form of communication-

technical equipment. 1 pupil (2%) is yet undecided. (Fig. 10)

Among the seven pupils who have unilateral implants and do not wish to use any extra communication-technical equipment in class, one pupil is using FM for TV at home.

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Two have so recently gotten their implants that they do not work with neither FM nor AFILs on these pupils yet. The rest, it shows, does not use FM or AFILs for amplified benefits from sound in other situations outside of the teaching environment. Both communication-technical systems – AFILs and FM – are set up to be easily accessible in all classrooms at Fredericiaskolen. It is possible for each individual pupil to choose the technical equipment that he/she is most comfortable with. The pupils divide themselves with their preference over all classes. There is a clear majority of pupils preferring the AFILs (43%). A somewhat smaller group (16%) has a clear preference for using FM. Two pupils use FM/AFILs fifty/fifty dependant on the situation. A fairly large group (41%) would rather not use any type of extra communication-technical equipment, stating that the sound bothers them or outright hurts. In addition, two pupils have not been able to get audiological treatment, and two have been given HA but have no use of them. These four pupils are not accounted for in the statistics of the use of extra communication-technical equipment.

Dispersion of Age and Gender

The dispersion of age and gender in the group of pupils preferring FM/AFILs versus the group of pupils preferring not to use extra communication equipment is as follows: In the group using FM/AFILs, there are 19 girls and 18 boys. There is a dispersion of age from 6 – 17 years with an average age of 12.9 years. In the group not using extra communication equipment, there are 12 girls and 13 boys. One pupil has not stated gender and age. This shows an age dispersion of 8 – 17 years with an average age of 14.2 years. This means that the pupils in the group using extra communication equipment is generally 1.3 years younger that the pupils who do not use any extra communication-technical equipment. The average age difference is estimated not to be significant in terms of a possible discussion of whether the pupils have reached an certain age making it possible to make a connection to, for example, a technological improvement of both hearing aids, CI and extra communication-technical equipment that this group of pupils has not have access to and, thereby, are not trained in using. In terms of gender, there is also no significant difference in what the pupils choose. It has NOT been examined, whether there are more pupils with other disabilities than the hearing loss using or not using communication-technical equipment than in the other group of pupils.

Arguments

All of the children have been asked to state the reasons why they prefer one over the other. 26 of the pupils at Fredericiaskolen, who have participated in the enquiry, choose not to use any extra communication-technical equipment. Still, there are pupils who have experienced benefits from respectively CI or HA in their everyday life. Four pupils with CI Freedom have not given any reasons for choosing not to use FM/AFILs. One, however, is newly treated, which means that there has not yet been further testing done. But it is argued by the rest of the group that: “I don’t like to use FM and T because the sound shifts between light and dark” “I don’t like to use FM and T because the sound whistles and shifts between high and low” “it sounds like it’s windy – it’s as if my ears become different” “the voices change” “FM sounds like a train” Five pupils with HA have not given any reasons for their choice not to use extra equipment. Aside from that, these reasons are given in this group:

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“I’m deaf, I can’t” “I’m deaf, and it only becomes noise in my head. I only use signs, no speech” “difficult because I’m deaf and have tinnitus” “I listen and follow easily without extra equipment, when the group isn’t as big” “I have AFILs at home. It works okay. With FM, I can hear… - and hear noise but it doesn’t always work. The AFILs is okay at school, it doesn’t break. It’s hard for me to understand speech with both AFILs and FM. I only hear sounds.” “no benefits from FM or AFILs. In one-to-one situations conversations are without signing and with good understanding” ”no benefits from using extra communication-technical equipment” “I can’t” “I’m deaf, the sounds disturb me” “it’s disturbing. It makes my head hurt” “there’s too much noise” “noise as when you are out in the desert when the wind keeps coming at you. All the time!” “no support from the extra equipment” “the hearing doesn’t improve and it’s a hassle changing between the programmes” “because it increases way too much because of the others wanting to use CI, wanting to hear it louder and it whistles” Out of the nine pupils preferring FM, eight give these reasons: “increases best” “best sound” “FM is good” “you hear better” “I hear the teacher best” “it’s more powerful than tele and loud and easy” “I can here everything without noise” “hear well” A few pupils state a choice not to use AFILs and the reasons here are that the AFILs crackle. Two of these write that they only use FM with TV and when listening to music – ergo not in the classes! – and they write that they do not like using FM in class, one pupil arguing that “it’s like sitting in a deep basement where it resonates”. The 26 pupils preferring the use of the AFILs all give their reasons for the choices. Two pupils with unilateral CI devices of the 3G type give these reasons: “it makes it easier to hear” “it’s easy and it gives a better sound” Both pupils are set for the MT. Both also state their reasons for not using FM: “FM I bad because it’s noisy and disturbs my CI” “because it’s annoying and I often forget it and it gives a poor sound” Both these pupils are attending Bakkeskolen, and one writes that there is not installed AFILs at Bakkeskolen, which means that they HAVE to use FM (they are working on using neck loops for these children now). Three pupils with double implants of both 3G and Freedom state the following reasons: “it’s the best and I can hear loud... really good!” “because it’s good sound and loud and clear” In the arguments for not choosing FM, it is written that:

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“I only hear “uuu” and “iiii” and “ssss” on FM and FM is unclear. The FM is annoying to listen to” “it’s bad and noisy – it irritates me” “it’s annoying if I have to shift back and forth” One of these pupils also says that the telecoil in the Freedom device is used, which essentially is the ear with the latest implant. This pupil does not use the telecoil in the 3G device. The other two use the telecoil on both ears. All three pupils are set to MT. Pupils with unilateral implants of the Freedom type give these reasons for their choice of AFILs: “it’s easy to use” “because it’s easy and because it’s comfortable to listen to” “because you can here more clearly with the AFILs” “because you hear loudly but once in a while the sound it very poor and, also, it’s much easier to use the AFILs” In the choice not to use FM, these reasons are given: “it’s annoying and I have to remember ‘shoes’” “it’s a hassle to set in on, and T is louder. And FM is heavier and annoying” “FM uses a lot of electricity. It’s bad, I have to shift the programme all the time” “because it uses a lot of battery, it’s inconvenient and the sound is almost always poor and it annoys me a lot” All pupils with unilateral Freedom implants are set to MT. Pupils with double Freedom implants give these reasons: “the AFILs are a little louder than the FM and it’s easier to have on the T” “AFILs are better for music – FM and AFILs are equally good for conversation” “AFILs are louder than FM, so AFILs are better” Here too, the reasons not to choose FM are stated: “FM crackles and uses a lot of electricity” “FM is a little lower, and it has to come off and on and it’s annoying” This group prioritizes differently in the setting of their devices. One sets to MT; one has not yet decided as he has just gotten his implants on the other ear and is working on this, the third sets the right Freedom for MT and the left for T. There are 14 pupils left with HA who prefer the AFILs. Their reasons are as follows: “AFILs are best because the sound is loud and good” “it’s very good” “can hear the other classmates/teachers in the classroom” “it sounds best” “I’m able to hear better” “you hear better – you can concentrate better by hearing the teacher”

“the sound is better”

“because I can hear better”

“I use T”

“AFILs in the class – during dictation, I use FM, the rest of the time I use AFILs”

“I use the AFILs but ONLY during dictation”

“I don’t know why I like the AFILs better”

Two pupils write that they only use the AFILs for TV and PC – not for conversation in teaching situations –

but that they do prefer AFILs for the TV/PC. In the choice not to use FM, following arguments are given by

this group of pupils:

“I don’t know it that well”

“I don’t feel I hear so well”

“it’s annoying only to be able to hear what the teacher says”

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“that it can’t be used on a long distance”

“because it’s too noisy”

“FM makes noise in my HA”

“it’s noisy and scattering in my HA”

“if I use MyLink, it sometimes crackles a lot”

“the device is a little heavy”

“it crackles, if the teacher forgets to turn it off when leaving or moving around”

“FM sounds too loud so that my ears hurt and my FM is always making noise”

“at my old school, I pretended to have my FM turned on. But I couldn’t hear in it at all. Here, I use the

AFILs.

Eight pupils in this group state that they set their HA for pure T. Three set theirs for MT. One writes that it is

different what she sets her for – depending on the situation. And two pupils have not sated any preferences.

Among the eight pupils setting for pure T, one student informs that he does not have the possibility of MT.

The pupils are asked whether there are pupil’s microphones in the classroom as it is assumed that this show

that the pupils in these classes were more prone to choosing FM/AFILs during classes. This does not seem to

be the case when the responses were summed up.

Although we know, of course, that the communication-technical equipment has to be of the highest quality,

that it is important to have a short distance to the microphone from the one speaking, and that the acoustic

conditions have to be optimal, it seems that there also in these classes are children who have a limited

tolerance for working with sound and who may find it necessary to choose not to use the extra support – if

nothing else, then periodically. To choose not to use communication-technical equipment is not linked to the

specific classrooms as such; it spreads over all the classrooms.

The Pupils at Bakkeskolen

A special group of pupils with hearing loss are those five pupils included at Bakkeskolen in Fredericia. The communication technical equipment for this group was, from the outset, exclusively FM-based. This is not the case anymore. Now, they also have the possibility of using neck AFILs. One has recently been CI operated and is not using any form of communication technical equipment – yet. Three of the pupils say that they prefer using the neck AFILs. The fifth pupil in this group admits: “I hope I soon get neck AFILs”. It is not stated which label/product the neck AFILs are. In the classroom, also a Sound Field system has been installed, and the pupils with hearing loss can on MT/FM+M listen both through a lift via the microphone in HA/CI and an optimizing through AFILs/FM. Also, sign interpretation is available during the classes. The acoustic conditions have been adapted and been through aftercare in the relevant classrooms and the adjacent common rooms but there has not, at Bakkeskolen, been done any acoustic adjustments of the possible academic rooms and of the other common areas.

Summary of the pupil’s arguments and estimations

I want to highlight two of the pupil’s statements in particular. Partly, because they themselves can relate to children with hearing loss being included in local schools but also because they pupil statements that give a feeling of the personal consequences it can have to use the equipment which you, when it comes down to it, have no benefits from. These are the statements: “because it amplifies way too much because the others use CI and want to hear it louder, and it whistles” “at my old school, I pretended to have the FM turned on. But I couldn’t hear in it at all. Here, I use the AFILs” The first stamen contains an element of the equipment being used considering the other pupils, but not me. That means that the pupil is left with a feeling of not being part of the group.

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The other stamen contains a message that the pupil has announced his/her problem without getting any help from the adults to get the equipment in order resulting in him/her pretending. Both pupils called out – they both reached out to the world surrounding them but they were not met with a solution to the problem. In a worst case scenario, these situations may result in a feeling of being bullied as the pupil with the hearing loss makes an effort to take part in the class as well as in social activities. And it is quite serious when it happens – especially because the surroundings may not really be bullying but, in fact, are trying their best to use the communications technical equipment properly; then they receive a most unexpected reaction from the pupil with the hearing loss, and it becomes too easy to conclude that the pupil needs to make an effort and put up with certain things. There IS a need for us to look into and examine these conditions, both among the pupils with hearing loss on a special school such as Fredericiaskolen but especially among the pupils with hearing loss who are included in local schools as they have no one in whom to mirror themselves on a daily basis. But otherwise, the pupils at Fredericiaskolen divide themselves roughly into two groups; 41 % of the responses counted in the examination choose not to use any extra communication technical equipment in class, while 59 % choose to use either FM or telebased equipment. In both groups, the primary arguments have to do with how the sound feels, and on the basis of this, each pupil has made his/her own choice. It seems evident throughout the pupil responses that there, in the group of pupils choosing not to use any form of extra communication technical equipment, is an element of it not enhancing and supporting the communicative skills and the linguistic understanding audiologically. Some may not even have gotten this far because they experience too much whistling and other disadvantages in the sound that we as pedagogical personnel expect to be improved. From all of the pupils’ responses, it must be presumed that almost every single one of the pupils have tried, thoroughly, different means of hearing and tried it out in different situations, making a match between the technical opportunities in relations to one’s own learning style and personal strength. Some pupils express not really having tried anything FM but otherwise, it seems each pupil has worked on exploiting his/her hearing as best possible, has tried much – both in the group where the extra communication technical equipment has not been chosen and in the group where a priority of either the FM or the AFILs is stated. Put briefly, you choose the technical aid providing you with the least disadvantages and which you are able, best, to match with your mastering strategies. Above all, the solution is chosen which does not interrupt one’s attention with annoying scattering, whistling and the likes.

Which Opportunities Do the Pupils Use with TV/DVD and the Telephone?

In the entire group of pupils not choosing to use the extra communication technical equipment in class, there are three who have AFILs installed at home and in their pupil’s homes for TV/DVD and use it. One girl with CI has an FM installation which she clearly states that she does not use because she does not like the sound. None within this group have any extra equipment with their phone but three actually state that they are able to carry on a conversation over the phone! All three of them say that they can have a conversation on the cell phones but two of these three are also able to use the fixed-line network. One, however, states that it depends on the sound, which varies from phone to phone. In the group of pupils choosing to use the communication technical equipment in class, nine have AFILs installations at home for use with TV/DVD – one does not have it at home but uses AFILs in the pupil’s home with TV/DVD. One out of the nine tells that there is AFILs installation at home but that it does not work with the new HA!

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Two in this group have FM in their homes for TV/DVD. The responses are not clear on this, unfortunately. However, it does appear that a smaller group uses FM/AFILs with TV/DVD – but do not use it in class. It could be that the pupils have reserves of energy for listening and working with the audiological input of the verbal language, when they do not have to relate to answering/ being part of a dialogue at the same time, and then they might even have to take part in the dialogue on the basis of the spoken language. But it IS a hypothesis, I am proposing here. However, it could be interesting to examine it closer in relations to how many levels each pupil is able to work with at one time. With the phone, one pupils state having the AFILs and says that it works with the cell phone! One pupil with CI has FM for the phone at home but this pupil also clearly states a preference for AFILs in the classroom because the sound is not good enough using the FM. One pupil is able both to use the wire-line network and the cell phone when using its speaker function. All in all, nine pupils prefer using the cell phone for conversation. Four are able to use both cell phone and wire-line network, and three prefer the wire-line network. One states a preference for cell phone and points out that he/she is using text messages. One says that he does not even use the telephone.

What Can be Improved?

Generally speaking, the pupils want Better sound around the high frequency sounds That it becomes easier to understand speech That it becomes easier to hear when there is background noise For the technique not to be out of order so often New batteries with more strength so that you can also hear some of the weaker sounds To be able to hear their own voice and hear language more clearly For the AFILs to be transferrable to the computer That the beeping noises when the CI batteries were not as annoying That it simply works For the FM microphones to have greater connection That the equipment becomes better so that it doesn’t break as easily For it to sound as the CI The best amplification in HA The in-ear aid so that I can have a ponytail ‘the T is too strong’ To try to divide the sound in the equipment in the classroom so that it doesn’t get too loud for me because the others need it so loud Two pupils from Bakkeskolen say that there is noise when the class is working The children have quite many considerations regarding better use of hearing and sound, and two of the statements also refer to background noise. “A hearing loss makes it more strenuous for us to hear. In a similar acoustic environment, we have to work harder which means that the short term memory is put under more strain,” says Håkan Bergkvist. (ref.9, side 5) And our pupils actually take a position on this and express the burden they feel. When asked whether the design in HA/CI have any significance to whether the pupils want to wear it, 12 answer that the design might mean that they choose not to use their HA/CI as well as the communication technical equipment.

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Types of Communication Technical Equipment in Relation to Pedagogical Method

You have to think carefully about the setup of the communication technical equipment that you want to support the classes. We have to be absolutely aware of what Danish pedagogy entails, and what we weight pedagogically, didactically, and ideologically in our schools. Here, there are great similarities to the teaching traditions of other Nordic countries. It you list the setup of communication technical equipment, the thing, which is currently being debated, is the equipment with teacher microphones and several pupil microphones so that the other pupils’ statements also become hearable for the pupil with the hearing loss. This equipment might be both FM-based as well as AFILs-based. But then, there is a difference in how the equipment is built technically. Some systems function merely by the teacher’s transmitter being turned on, so as it is on the entire time. When the pupils have to say something, they simply take a pupil microphone and push the button, making room for the teacher’s transmitter + one pupil microphone in the system at a time, and this makes it possible to listen to dialogue, turntaking which means the possibility of an exchange of opinion at some length of time and a conversation among equal partners. Other pupils are not able to switch themselves in as long as the one pupil is on the system with the teacher. This system functions with handheld pupil microphones or with swan’s neck microphones as in city council halls. The latter provides the opportunity for also supporting with signs, if this is necessary along with the spoken language. This system sends the sound directly to the pupil’s FM receiver or the telecoil in the hearing aid/CI. Another way of setting up a system with a pupil microphone is by letting it be voice controlled. The teacher transmitter is, again, on at all times, and when a pupil takes a pupil microphone and speaks into it, the pupil with a hearing loss is, again, able to hear a dialogue in the equipment, if the teacher is quiet that is. The teacher’s transmitter is the master in this system, and there is a risk that the teacher cuts a pupil’s statement, if the teacher as much as clears his throat, laughs, or makes just a quick remark at another pupil during the conversation. This system is also seen both with handheld microphones and with swan’s neck microphones. Such a system with one single transmitter as the master does not support the equality of the classroom conversation. This system will also transmit the sound directly into the pupil’s FM receiver or hearing aid/CI telecoil. Finally, Sound Field systems are installed in a couple of areas now. They are basically built on the teacher wearing a microphone while speakers around the classroom transmit the teacher’s speech out into the room. As the sound is transmitted through speakers around the room, the sound is not transmitted to the pupil’s FM receiver or to the telecoil in the hearing aid/CI. There may be a risk that the pupil experiences shifts in volume from the teacher’s – now – louder speech in the classroom to a classmate’s statement or remark during a class, and this difference in volume might be too big and difficult to handle. Some places, this may be handled by setting up pupil microphones in connection with the Sound Field system. Finally, we might have to consider carefully whether it is fair for the pupils with normal hearing to get their conditions of hearing changed in the classroom. The classmates, too, will experience shifts in volume and receive a sound experience in their classes that does not further the ability to decide direction or distance to the teacher through sound. It will always be abstract to a teacher with normal hearing using the extra communication technical equipment in class with a pupil with a hearing loss, how the sound really is inside this system. The teacher has to trust that when the equipment is turned on, it is also working, unless the pupil says otherwise. Unfortunately, we experience setting up fancy and expensive equipment for use in the classrooms, and then one or more pupils report that they do not think it is working. If the pupils actually give this message, we can work on improving the conditions but if the pupil chooses to suppress that the equipment is in fact not working or not helping, the teacher is working with a fictitious

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thing in the communication technical equipment – fictitious in the sense that there is an expectation that it works and supports the pedagogical aim but in reality, the pupil is using other mastering skills in order to compensate for the equipment not working. We know that this is happening, and we need to get away from this. Sometimes, also, communication technical equipment is installed but turns out to be noisy. The pupil might not be aware that this noise is to be avoided because the pupil’s maturity of listening may be so tiny that he/she has no experience to compare with. The teacher’s encouragement and expectation of a good result puts the pupil in a position of obligation, and a Rosenthal effect1 occurs. By smiling and being obliging, the pupil has the teacher thinking that the equipment works. In this situation, you may speak of a mutual parallel displacement all the while both the pupil and the teacher think that the auditive approach and teaching are now fully supported. Neither the pupil nor the teacher is conscious in the actual sound room that is real between the pupil and the surroundings in this situation. The latter must never occur! If you do not know your technique, you do not know your pedagogy!

Discussion

Even though this examination is based on a group of children, it is a group characterized by many years of experience with the use of both HA/CI and extra communication technical equipment. The outlines for this examination have been very similar in physical conditions like acoustics and setup of communication technical equipment as well as a firm and stable frame of reference in the professional personnel both technically and pedagogically in terms of the pupils. A rather large group chooses not to use the extra communication technical equipment in class at all even though several of the pupils state that they, one to one and without background noise, are able to follow a conversation based on the spoken language. However, there are general conditions in several situations concerning using sound when you have a hearing loss, and they are of significance to how your everyday life can be handled and mastered with the use of extra communication technical equipment as well as other mastering strategies, communicatively speaking – the direction of one’s look, eye contact, the various uses of sign supported communication dependant on distance and other conditions in the situation. According to Susanne Bisgaard (ref. 6, p. 7), “The main thing is the importance of hearing in order to be part of the social network. But there are big differences in how much people want to hear.” In other words, when you have a hearing loss, this sense is wounded. The treatment may be offering HA and extra communication technical equipment but each child and adult with hearing loss have different limits to what they can tolerate in terms of this extra amplification. Also, some pupils state that they only choose to use the extra communication technical equipment during for example dictation where they need to listen really distinctly in the phoneme-distinction assignments. Therefore, it does not seem that there is ground for concluding on a quantitative study regarding most preferring one option over the other (FM<>AFILs). There is a need for a qualitative examination as grounds for type of treatment, each time taking its starting point in the single HA/CI user’s subjective experiences.

1 The Rosenthal effect (after the American psychologist Robert Rosenthal, b.1933), experiment leader-effect, self-

satisfying prophecy; the phenomenon where a person’s expectations for another person’s performance has a tendency to be fulfilled. Studies have proven that, for example, teachers positive or negative expectations (their bias, prejudices) to the different pupils in the class have an effect on the pupils’ performances regardless of their potential to learn.

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Karen L. Anderson, Ph.D. says: ”At this time there’s not one type of FM system that works best for all children and their educational situations, so it’s important to consider the options with an open mind and to allow the child and school staff to experiment until a truly beneficial arrangement can be determined.” (ref. 4, p. 127) Karen L. Anderson mentions only FM systems where we, in Denmark and other places in the North, express ourselves differently regarding communication technical equipment as we, in our descriptions, express whether the equipment is FM-based or AFILs-based to the person who has to listen through it. Karen L. Anderson, however, mentions the neck AFILs as a possibility and thereby touches briefly upon the fact that it might be necessary to focus more on the technical processes taking place in HA/CI than on the conditions surrounding the teacher’s transmitter. However, Karen L. Anderson’s reference group is pupils with hearing loss included in local school environments. This means that these pupils are often the only one in their class with the special need of getting the sound conditions optimized with regard to their own specific hearing loss. But an important point in Karen L. Anderson’s statement is that it is necessary to be open to different possible technical solutions for the benefit of the pupil with the hearing loss and a piece of equipment which is able to work with the surroundings in the teaching environment, so as you consider both the pupil with the hearing loss and the surroundings. In some places in Denmark, they are also trying out Sound Field systems in the classes for pupils with rather severe hearing loss. Time will tell what the benefits will be for these children. For some years, our professional focus has been on the optimal being dependant on the distance from the sound source to the HA/CI. Another important thing regarding the Sound Field system is that as long as the teacher uses a microphone, the level of sound will vary a lot from the teacher’s speech to a classmate’s speaking without any amplification. Finally, there is an unresolved discussion about the use of the Sound Field system as it provides a sound picture for the entire class affecting all of the pupils in the classroom. We have yet to make a decision on this when it comes to including pupils with hearing loss in local schools. However that might be, a Danish and maybe even a Scandinavian standpoint is has to be/seems to be giving each pupil the opportunity for trying different options. According to Hassan Hadzic, hearing engineer, “It is important to give the pupil a good frame of reference – if the pupil starts off with poor sound, the bar will be set there from the beginning.“ (ref. 12, p. 11) In the pupil group at Fredericiaskolen, there has been test in an acoustic environment that is stable and known by the professionals working within the frames of the school. It makes it more manageable in some contexts for the professionals to instruct and guide the pupils in choice of the most beneficial use of extra communication technical equipment for class. For pupils included in local school environments, it may be more time demanding to choose the equipment best suited for the individual pupil, merely because the acoustic conditions vary more from classroom to classroom; there are more situations that we are not able to take into account. It takes a great amount of empathy with the individual pupil with to decide the exact need and determine what might be a nuisance. The sense of hearing is an abstract thing to word something exact about, and it is difficult for smaller children to express themselves precisely and elaborately. Many times, the child may only be able to relate to whether it is working or not working. It appears from several of the statements made of the Fredericiaskolen’s pupils that they are able to follow a conversation on the foundation of the spoken language when they are in calm surroundings, especially without background noise and on a one-to-one basis where the distance is short. The same seems to be the case for conversation pupils with hearing loss included in local schools. They often manage best in small groups.

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You only use the extra communication technical equipment for teaching in certain situations as it, among other things, takes away the feeling of direction and distance to the classmates when you hear the voices directly through the FM/AFILs in your HA/CI; thereby certain social skills are weakened (for example spontaneity and pace with regard to the boy/girl the pupil sits next to). This means that you always have to weigh out pros and cons in terms of which resources you have intellectually, psychologically, and socially to master your situation in balance with the technical equipment you have been given – this being either HA/CI or FM/AFILs – or the preference not to use any extra communication technical equipment. Regarding CI users, a special condition is apparent in the use of FM with the CI. For now, children in Denmark are only treated with the Cochlear product if the child has had his/her CI implant at a Danish CI center. This is why our experiences are only valid within this product. According to Claire Buxton, “The FM systems used with Cochlear Implants is another area for future research Clinical reports are received by audiologists of interference with FM systems and implants. Phonak recommends certain channels be used for implant patients as to not interfere with the radio frequency of the device. The sound quality of an implant cannot be measured in a test box. This makes patient reports on the perceived clarity of the speech signal even more important. Research can be conducted with adult implant patients in order to receive reliable reports of distortion or degradation of the FM signal. This study began to examine the issue of clarity of the FM signal provided to the listener. Continued research is needed to determine the best method of guaranteeing that not only an advantageous SNR is provided with FM use, but also speech signals that is not affected by distortion.” (ref. 1, p. 32) Claire Buxton wrote this in 2008, and even though the personnel at the Center for Hearing Loss knows which frequencies within FM are best suited for CI, we have to acknowledge that only one in 20 CI users have chosen FM – and this one was uncertain in his/her statement. (ref. 11) CI is still a rather new invention, and the qualitative experience of hearing with a CI and/or a CI either with FM, AFILs, or audio wire still must rely on the user’s own statements. In this area, we can only improve day by day. At the same time, it is remarkable that the group of CI users choosing not to use extra communication technical equipment is this large. With regards to mastering your situation as a person with a hearing loss, it is also striking with several children with bilateral CI that they often master it when one of their CIs is suddenly not working. This shows a great flexibility in their daily lives, probably demanding a great deal of energy. I am referring here to pupils who are included in local schools where no type of support in the form of sign communication is used. Here, it is important to be aware that the children are not fully aware to which extend they have to participate in order to be a real participant and to be able to remember the right things in order to be able to take part in the ongoing course of events both in terms of and socially. It is especially the really young CI users (pre school age) that we have to make sure gain some experience on in terms of what it means to hear and of how to use you sense of hearing critically in cooperation with your memory, attention etc.. In any case, it is – with regard to the commercial campaigns on FM – both remarkable and maybe surprising that this few pupils actually choose FM as their preferred equipment in a study such as this one. But according to Håkon Bergkvist, adults with hearing loss have evaluated in the same manner as the children regarding FM: “It’s noteworthy that compared to the stationary system, the technique entails less dynamic and more noise, and adults with hearing loss have coined the term FM-whistling, describing the increased noise in the technique.” (ref. 9, p. 15) Some speech-hearing-therapists have actually expressed being aware of the fact that the AFILs were so old-fashioned that it was being taken out of production, and the only sure thing for the future was to

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concentrate on FM. For a pupil finding FM a discomfort and no help, this may mean great misunderstandings in terms of the pupil seeming not to accept his/her own situation or to be poorly raised from home, if the pupil consistently chooses not to use the FM. It is obvious that the same might be the case with using the AFILs for some pupils – we must not underrate the burden to the large group of pupils choosing not to use any type of extra communication technical equipment. Whether the individual pupil with a hearing loss is offered FM-based or AFILs-based communication technical equipment, and no matter what the pupil might prefer, it is also through the conversation in class that the pupils need to be supported in wording what they experience in using both HA/CI and FM or AFILs. At the same time, it is necessary seriously to consider how the setup in each classroom is supporting the pedagogy that you wish to signify your teaching and social interaction in you class and the school as a whole. Håkon Bergkvist lists different points of focus regarding pedagogical methods in the development of teaching through time: “We’ve gone from a very controlled and clear turn-taking to methodology using a ‘bee-hive’ setup and spontaneous conversation in the classroom,” (ref. 9, p. 2) and we must expect communication technical equipment that can support this if we wish to include pupils with hearing loss, and the need for the communication technical equipment in the local schools has to be real. It is, out of concern to the individual pupil’s personality development, of severe necessity that we are able to both listen to the messages that the pupil expresses regarding the use of the equipment and to act on the information at hand. Otherwise, we are disregarding the trust that the pupil is an equal conversation partner contributing important information for us to act competently and empathetically in the dialogue that is our common tool and goal. At the same time, it is important that the pupil with the hearing loss both to be able to listen to what is being said during the conversation and to be clear in answering and expressing him-/herself when it is necessary to contribute. That means that the pupil has to be attentively, conceptually and linguistically able to work on several levels with more processes in thought and conversation. It is a hypothesis which I am stating where I find it of extreme importance that we heighten our focus on this angle in order to be able to examine, more closely, among the entire pupil group what it really means to make several processes cooperate in though, language, and action, and to which extend the extra communication technical equipment support – and when it becomes a mere nuisance. If the development of these processes is denied because you just expect the technical equipment to be working and supporting the pupil optimally, we risk that the trust is broken in the relationship with the individual pupil, and that the pupil will, primarily, just pretend that the equipment is working. With different types of behavior not quite matching the situation as understood by others, the pupil with the hearing loss might seem odd. On the occasions, when this trust is broken, pupils with hearing loss will at risk growing up parallel to reality without ever really being a participant – or, even worse, running from a reality that does not seem to be taking shape because the experience of both the teaching and the social interaction become meaningless and absurd. Finally, it is important to be aware of the fact that the access to people with hearing loss in different situations is, in most cases, still most easily solved by providing the AFILs. This being the case in public spaces such as lectures, theatres, and lecture halls. To the extent that we wish to offer kids and young people in Denmark the optimal accessibility, it is necessary also let it be a possibility to use the AFILs. When childes are given the opportunity of choosing between FM and AFILs and for the most part choose to use the AFILs, it shows that we have not yet found a better option for communication technical equipment which fully compensates for the disadvantages that HA/CI users have. It is possible that you, with wireless

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systems, would be able to compensate the disadvantages in the surroundings. But then, it is also possible that the surroundings are taking on a responsibility and a hassle not really meeting the needs of the pupil with the hearing loss – neither at Fredericiaskolen nor in the local schools including pupils with hearing loss, where you would expect the need for extra communication technical equipment to be greater.

Conclusion

The conditions for examining whether the pupils at the Center for Hearing Loss’ school department, Fredericiaskolen, would rather use FM or the AFILs have had its outset in as homogeneous a sound environment as possible for all the pupils. This is the case for both the acoustic conditions and for the setup of extra communication technical equipment. The group of pupils at Bakkeskolen, of course, distinguishes itself in that the acoustic conditions cannot be as beneficial at Bakkeskolen as they can be at the Center for Hearing Loss’ school department, Fredericiaskolen. Also, there are not the same beneficial permanent installations of extra communication technical equipment in ALL of the classrooms at Bakkeskolen, and finally, it must be presumed that there is more background noise here as this group of pupils is part of a class with a larger number of pupils. The pupil group at Bakkeskolen has had the opportunity of trying out the neck AFILs, and largely, they prefer this as it becomes a possibility for them. This group of pupils has the possibility of drawing upon the technical staff at the Center for Hearing Loss as soon as technical breakdowns in the equipment occur, this being a clear advantage for the pupils in being schooled in Fredericia, where also the Center for Hearing Loss is located. The pupils at Fredericiaskolen have to opportunity of individually choosing either FM or the AFILs depending on what each pupil finds the most beneficial to use during the daily classes. Here, the conditions are the same. (The study, however, shows that some pupils have not had the possibility of trying out FM in class.) Also, each pupil has the possibility of contacting the professional personnel – both pedagogical and technical – as soon as any problems arise with the communication technical equipment. In the light of this study, we must assume that the AFILs are still the preferred equipment for at large number of people with hearing loss – 43 % of the responses clearly showed a preference for using the AFILs. A surprisingly small group preferred using FM – 16 % of the respondents stated a preference for using FM. Only one single pupil of Fredericiaskolen’s CI users was found in this group. As individual as the needs are in this area, each pupil with a hearing loss has to be offered exactly what he/she finds more beneficial. Disturbingly, a large number of the school’s pupils clearly express that they do not wish to use any form of extra communication technical equipment – 41 % neither want to use FM nor AFILs. It is only to a small extent argued that the extra equipment does not really support the understanding of language. The primary reasons for choosing not to use the equipment are that the pupils experience whistling, noise, and other audiological disadvantages, and also that many of the pupils are finding the use of FM too much of a hassle. It might be interesting to examine the specific hearing aid manufacturers and models with regards to the preferences among the pupils. The benefits from the AFILs, for example, may vary for different reasons (angle, type of telecoil, screening, etc.), and the same might be the case for the use of FM with different types of hearing aids (whether they are dedicated FM receivers with a close contact to the specific HA, or whether a audio shoe needs to be installed as a link, etc.). Also, it would be interesting to map more carefully which are programmed into each HA/CI that has to cooperate with the extra communication technical equipment. The children do not always know that the chosen feature might not be the most beneficial. The children are learning to hear... and many times, they have not tried to hear normally before being audiologically

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treated. And the children cannot know that they have the opportunity of choosing differently in their HA/CI. Typically, you do not know this until later in your schooling when you have gained a certain amount of experience and maturity in hearing so that you are able to choose for yourself what to use and what not to use in different situations. Another important aspect is the children’s linguistic capabilities and also, in this respect, to which extent you are able to listen while you work on your response, thus handling parallel processes. I just wish to repeat myself from the above: This IS a hypothesis, I am stating. However, it would be interesting to examine it further with relations to just how many levels each pupil is capable of handling at once. A special attention needs to be drawn to the psychological consequences from having to rely on technique that will, from time to time, fail. Or, in a worst case scenario, does not even work to begin with. And here, I wish to repeat this from above: There IS a need for us to look into and examine these conditions, both among the pupils with hearing loss on a special school such as Fredericiaskolen but especially among the pupils with hearing loss who are included in local schools as they have no one in whom to mirror themselves on a daily basis. At the same time, we have to very aware that we choose the equipment that supports the pedagogy in the teaching’s conversations which entails equality between the conversation partners and which offers the possibility of being part of a dialogue and exchange of opinions on a democratic basis. However that may be, it is a big part of the pupils’ daily lives to be able to master all of this equipment – HA, CI, and extra communication technical equipment. Each pupil is making a series of choices on a daily basis as to how best to utilize his/her hearing as it is obviously easier to cope the better you are able to hear. In the instance, a whistling or noise appear in the audiological signal for the individual pupil, it is a disturbance on the attention of the pupil. Whether it is a pupil capable of suppressing this disturbing element or a pupil very distracted by the audiological disturbance, it demands attention from the pupil while the class, learning, and the social interaction are still in progress. Therefore, there is reason to be very aware that we continuously communicate with the pupils with hearing loss on the best possible conditions, and that we do not fail to acknowledge when the pupils express a feeling of discomfort from using the HA/CI and, on top of this, the FM or the AFILs. In cooperation with the pupils, we have to become and be skilled in using HA/CI and communication technical equipment so that the technique, in fact, becomes the aid supporting the pedagogical work. Only when this is achieved, will each pupil come into focus both individually and as part of the community, and through the class conversations, the pupil’s personality is shaped as not being a part of the hearing loss.

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Referencer:

1) Buxton, Claire; A Capstone Project submitted in partial fulfillment of the requirements for the degree of: Doctor of Audiology: “Are distortion levels a problem with digital processing hearing aids and frequency modulation (FM) systems?” Washington School of Medicine, Program in Audiology and Communication Sciences, May 2008. 2) Gustafsson, Arne; hörselingenjör, Auditiv Miljö. Hörselteknik och akustik i specialskolan. Rapport 2007:7, Örebro, Specialskolemyndigheten. 3) Henriksen, Holger; kandidatstipendiat, Undervisningens samtale, Christian Ejlers’ forlag, 1978. (udgået fra forlaget) 4) Luterman, David; D.Ed.: “Children with Hearing Loss – a Family Guide”, Auricle Ink Publishers 2006. 5) Sandrock, Carl; Project Manager and Schum, Donald J; PhD.: ”Wireless transmission of speech and data to, from, and between hearing aids”, The Hearing Journal, Vol. 60, No. 11, November 2007. 6) Scharbau, Irene: “Mennesket skal også tilpasses høreapparatet”, HØRELSEN, nr. 02, februar 2009, udgivet af HØREFORENINGEN, pp. 4 – 7. (interview med kulturantropolog Susanne Bisgaard; se referencer, links). 7) Wennergren, Ann-Christine: ”Dialogkompetens i skolans vardag – en aktionsforskningsstudie i hörselklassmiljö”, doktorafhandling, Universitetstryckeriet, Luleå tekniska universitet, augusti 2007. (www.dialogprojektet.se)

Referencer, Links

8) Axø, Susanne; hørekonsulent, Center for Høretab, Fredericia:

http://www.fredericiaskolen.dk/konference/Artikler/En%20analyse%20af%20h%C3%B8retekniske

%20tiltag.pdf ”En analyse af høretekniske tiltag for at støtte inkluderingen af hørehæmmede elever i folkeskolen”, 2006. 9) Bergkvist, Håkan; hörselteknisk samordnare, Specialpedagogiska skolmyndigheten (SPSM), Örebro: www.barnplantorna.se/page.php?id=71, 2007

10) Bisgaard, Susanne; kulturantropolog: www.uni-frankfurt.de: Doktorafhandling om menneskers oplevelse af at få høreapparat første gang, offentliggøres foråret 2009. 11) Dons, Ole; tekniker og Petersen, Finn B.; tekniker og Poulsen, Aïda Regel; hørekonsulent, Center for Høretab, Fredericia: www.cfh.dk , Nyheder; ”August 2006: Studietur til Sverige”. 12) Hadzic, Hassan; hörselingenjör, Örebro: http://www.gnresound.se/resonans_nr_3_2007_skarp-

2.pdf 2008.

13) Petersen, Finn B.; tekniker, Center for Høretab, Fredericiaskolen:

http://www.fredericiaskolen.dk/Artikler/ se: ”de tekniske rammer”, 2008.

14) Poulsen, Aïda Regel; hørekonsulent, Center for Høretab, Fredericia: www.cfh.dk, Nyheder; Maj 2006: Rummelighed, Inkludering, Salamanca-erklæring, Participation.

Additional:

15) Fredericiaskolens deklaration:

http://74.125.77.132/search?q=cache:a5wb- _s9hpAJ:deklarationer.fredericiaskolen.dk/dokumenter/Folkeskoletilbud.doc+%22Dobbelt+teleslynger%22 &hl=da&ct=clnk&cd=4 16) Link omkring regler for akustisk og lydforhold i undervisnings- og daginstitutionsbygninger: http://www.sbi.dk/byggeteknik/bygningsfysik/lydisolering/lydforhold-i-undervisnings-ogdaginstitutionsbygninger-lydbestemmelser-og-anbefalinger/lydforhold-i-undervisnings-ogdaginstitutionsbygninger/

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Encl. 1

QUESTIONS about hearing aids or CI

- and other technical equipment

Please underline your chosen response for the questions below

1. Do you use...?

Hearing aid(s) or CI Hearing aid CI

2. Do you have...?

2 hearing aids or 1 hearing aid or 2 CIs or 1 CI

3. If you have just one device, which ear is your hearing aid/CI on? Right Left

4. Do you use both hearing aid and CI? Yes No

5. If yes, on which ear do you have you CI implant? Right Left

6. If you have hearing aid(s), which brand and model do you have?

_______________________________________________

7. If you have CI, which model do you have? (Freedom or 3G)

_______________________________________________

8. Do you use extra equipment during class – FM or AFILs? Yes No

9. Do you prefer...? FM AFILs

10. If you have hearing aids or CI on both ears:

Do you use FM/AFILs on both ears? Yes No

11. If no, on which ear do you prefer using FM/AFILs? Right Left

When you use FM or AFILs

12. Do you set in on pure FM or pure AFILs? Yes No

13. Or do you set it on FM+M or M+T? Yes No

14. Are there microphones for both teacher and pupils in your class? Yes No

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15. When you have chosen either FM or AFILs as best, why do you prefer this?

FM AFILs

___________________________________ ____________________________________

___________________________________ ____________________________________

___________________________________ ____________________________________

___________________________________ ____________________________________

___________________________________ ____________________________________

16. What, according to you, are the disadvantages to the product you do not choose (FM or AFILs)?

FM AFILs

___________________________________ _____________________________________

___________________________________ _____________________________________

___________________________________ _____________________________________

___________________________________ _____________________________________

___________________________________ _____________________________________

17. If you shift between using FM and AFILs during class, when do you use FM, and when do you use

the AFILs?

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

18. If you never use neither FM nor AFILs, please explain why you choose not to

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

19. What do you use at home and in the pupil’s home? FM AFILs

20. What do you use with your phone? FM AFILs

21. Do you hear better on a wire-line phone or on a cell phone? Wire-line Cell

22. Please state, when you find it easy enough to follow what is being said – without the support of

signs/sign language

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

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23. Is the design of the technical equipment of importance to you? Yes No

24. If yes, does that mean that you might not use it, if it is not nice looking? Yes No

25. Are there sounds that are annoying in either FM or the AFILs? Which?

Please state whether you are talking about FM or the AFILs

______________________________________________________________________________

______________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

26. How do you think we might improve the sound? (both hearing aids and CI, but also both FM and

the AFILs)

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

27. How old are you? ________________

28. If you have other comments about hearing aids, CI, or other communication technical equipment

that you would like to share, you are welcome to write more – I am very interested in what you

prefer! (Please write on the back of this sheet of paper)

You are also welcome to draw something with sound.

Thank you so much for your help

Best regards,

Aïda

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Encl. 2

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