Hearing Better: The Power of Assistive Technology
By Candace Lindow-Davies, H&V Headquarters
Families of children who are deaf/hard of hearing quickly learn the importance of advocating for their child’s access information from the classroom, cafeteria, to the basketball court or driver’s education class. Missing critical information puts a child at risk of falling behind classmates, chipping away at their confidence, and becoming socially isolated. Children who use auditory information, whether or not they also use American Sign Language, Cued Speech or captioning, can benefit from assistive technology (AT). Improving speech perception and clarity can become very important, especially when a child converses with hearing individuals when visual information isn’t always available and background noise is problematic. H&V reached out to an audiologist, a deaf adult and a parent to get their perspectives on using AT to maximize a child’s understanding with hearing aids and/or cochlear implants.
Why (AT) and what is it?
Cheryl Caldwell, Au.D, Clinical Audiologist and Educational Liaison at the Mayo Clinic, says, “The purpose of assistive listening technology is to improve the signal to noise ratio (SNR), to make it easier to access sound/speech when listening situations are not ideal. Examples: when the speaker is not facing the listener, more than six feet exists between communication partners, or when students are listening with background noise. Assistive devices help with all these difficult listening situations by bringing the voice of the speaker directly to the ear.”
Listening assistive technology can be classified in two ways: how the message is sent and the type of hardware it uses. Information can be sent by FM/DM, Bluetooth, streaming and t-coil. You may hear the terms FM/DM used interchangeably. FM systems, which have been around for decades, use FM (Frequency Modulation) radio signals to send between the transmitter and receiver at a distance. Most devices are now using DM, (digital modulation). Some people call FM/DM systems a remote microphone, assistive listening devices, RM-HAT – Remote Microphone Heating Assistive Technology, or just refer to them by their brand name (Phonak Roger or Oticon Amigo/EduMic are two examples.) These systems send the clearest signal across the farthest distance compared to the other three types, but also cost the most (generally $3,000 for bilateral users). Bluetooth allows a wireless connection between an audiovisual device and hearing aids or processors in the same way that earphones connect without wires to a phone to listen to podcasts or music. Bluetooth is often included in new hearing aids and some cochlear implants to connect digitally to a phone or computer, but have a shorter working range (30-60 feet), can drop signals easily, and must be paired with hearing aids/processors. Streamers connect to enable the remote microphone. A T-coil (telecoil) is a small coil of wire inside hearing aids designed to pick up a magnetic signal, cutting out interfering sounds from phones and other devices, including hearing loops, without pairing.
The type of hardware can be is the next piece to understand, and that includes remote microphones (also a piece of hardware as well as the method of transmission), a streamer or a tv link. A streamer is also hardware that uses “streaming” to send info, but a streamer can also be the conduit for a Roger receiver and for a direct cord to a headphone jack. Most hearing aid/cochlear implant companies have an option of a proprietary remote or partner microphone. Like the FM system, it sends a signal from the microphone to the hearing devices but is limited in distance. Some types come as a package with new hearing aids or other devices, and some can be purchased separately. Compatible devices vary across manufacturers, and insurance sometimes lists these as covered benefits. These are much less expensive than FM/DM, usually small and very portable, and connect easily with a single device. They work best in a short range and have more possibility of interference or dropped signals, and are also not commonly covered by insurance.
If a student’s educational plan stipulates AT to access education, families may be able to work with their educational audiologist to be able to bring their systems home during the school year. Because the systems are expensive and owned by the district, the family may have to sign a loaner agreement stating that they are responsible for loss and damage costs.
What is the right age to introduce AT?
“In my opinion, it’s never too early to use connectivity as long as it’s used thoughtfully. It can allow D/HH kiddos access to more music, phone calls, and clearer signals,” according to Dr. Caldwell.
Mariana Barquet, Guide By Your Side Coordinator, Indiana Hands & Voices, shared, “Our son started using an FM system when he was five, a few months before he started Kindergarten. We wanted a training period for him because as a cochlear implant user, only he would notice malfunctions like static, interference or disconnections. We wanted to make sure he knew what it should sound like and could report problems, which takes practice and regular checking-in with young children. We also need to consider his language level when reporting any issues with equipment. Adding advocacy goals to support using the FM with professionals monitoring and ensure benefit for the child is a good idea. To be fully independent using an FM, a child needs to understand his hearing, be able to explain and advocate for the FM system to others, and practice the skills needed to use it. Along the way, we also learned that kids need to know how to take care of their equipment. No swinging the microphone from the neck band, no matter how fun that looks!”
Who sets up the AT?
Barquet explains, “Your child’s clinical or educational audiologist sets up a program to allow the FM system to connect to the child’s technology. This is very simple and just requires a short visit, with different ratios possible for the amount of classroom noise vs. what is received directly through his processors. Getting the input of a district educational audiologist is important if the school uses particular technologies. They can instruct others to how to check if the system is working properly and will perform Functional Listening Evaluations (FLEs) when needed, assessing and meeting your child’s access needs in the school environment.”
What is the child’s role?
Barquet offered her experience: “Jack uses the Roger Touch Screen for equal access to the curriculum. I can’t imagine what his days at school would be like without this amazing technology! It’s his responsibility to get his ‘boots’ (receivers) connected to his processors every morning. Once connected, a resource teacher goes through the Ling sounds with him to ensure his equipment gives him good access to all speech sounds. He gives the microphone to his classroom teacher to wear or place on the tabletop for small groups. He gives the microphone to teachers and substitutes in the Computer Lab, PE class, and Music. He also uses it for lunch time, as he struggles to listen to friends while in the cafeteria. He puts the microphone on the table, and this reduces background noise and allows him to communicate better with his friends while eating his lunch.”
Outside of school, Barquet commented, “We use a system we purchased privately for safety and better communication when we go to crowded places like the Children’s Museum, noisy restaurants, busy playgrounds, and sports events. On long car rides, he can connect to a DVD player/tablet and cancel road noise. He hands the system to his coach for gymnastics class, which has tall ceilings and lots of echo. His sustained attention and participation has grown immensely! I think it helps with listening fatigue, too.
In his hippotherapy sessions (on horseback), he struggled to receive instruction while wearing a helmet over his cochlear implants. The system allows him to participate in challenging listening situations that he would have probably given up on without using AT.”
Deaf/hh adults have other insights to add. Jay Wyant, Chief Information Accessibility Officer for the State of Minnesota, recommends asking what AT or connectivity options are included in purchases of new devices. Also, know your child’s hearing technology’s capabilities. For example, does it have Bluetooth built in? If so, they can connect directly to Bluetooth-enabled devices including phones, and skip the headset and hear better without background noise. Wyant encouraged advocacy, adding, “When taking classes online, be aware of the connection options. Is captioning provided? Can the student connect directly to the audio signal? A student could also call in via relay, and directly connect to the relevant audio source.”
Through the support of parents, professionals and adults who are D/HH with first-hand experience, children can feel encouraged to share what technology works, what challenges they encounter, and what gaps remain. Through this dialogue and discovery, the child’s confidence and advocacy skills grow, while hopefully leveling the playing field with hearing peers, too. ~
Learn More or Apply For Funding Through These Resources
Remote microphone systems Hearing Health Matters , Phonak Blog , Vanderbilt University
FM Systems Supporting Success For Children
Finding Grants United Health Care Childrens Foundation
H&V Communicator – Summer 2020