case study hearing impaired students

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A case study of interventions to facilitate learning for pupils with hearing impairment in Tanzania

Tron v. tronstad.

1 Digital Department, SINTEF, Trondheim, Norway

Bjørn Gjessing

2 Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway

3 Department of Otorhinolaryngology, Lovisenberg Diaconal Hospital, Oslo, Norway

Ingvild Ørland

Tone Øderud, cosmas mnyanyi.

4 Department of Psychology and Special Education, Faculty of Education, Open University of Tanzania, Dar Es Salaam, Tanzania

Isaack Myovela

5 Department of Hearing Impairment, Patandi College of Special Needs and Inclusive Setting, Arusha, Tanzania

Jon Øygarden

Associated data.

Data sharing is not applicable to this article as no new data were created or analysed in this study.

Hearing is essential for learning in school, and untreated hearing loss may hinder quality education and equal opportunities. Detection of children with hearing loss is the first step in improving the learning situation, but effective interventions must also be provided. Hearing aids can provide great benefit for children with hearing impairment, but this may not be a realistic alternative in many low- and middle-income countries because of the shortage of hearing aids and hearing care service providers.

In this study, alternative solutions were tested to investigate the potential to improve the learning situation for children with hearing impairment.

Two technical solutions (a personal amplifier with and without remote microphone) were tested, in addition to an approach where the children with hearing impairment were moved closer to the teacher. A Swahili speech-in-noise test was developed and used to assess the effect of the interventions.

The personal sound amplifier with wireless transmission of sound from the teacher to the child gave the best results in the speech-in-noise test. The amplifier with directive microphone had limited effect and was outperformed by the intervention where the child was moved closer to the teacher.

This study, although small in sample size, showed that personal amplification with directive microphones did little to assist children with hearing impairment. It also indicated that simple actions can be used to improve the learning situation for children with hearing impairment but that the context (e.g. room acoustical parameters) must be taken into account when implementing interventions.

Contribution

The study gives insight into how to improve the learning situation for school children with hearing impairment and raises concerns about some of the known technical solutions currently being used.

Introduction

Globally, there are about 466 million people (6.1% of the world’s population) with hearing loss (HL), of which approximately 34 million are children (World Health Organization 2020 ). Nearly 90% of people with HL live in low- and middle-income countries (LMICs), often lacking the resources and services to address HL (World Health Organization 2018 ).

Hearing loss may be mild, moderate, severe or profound and can affect one or both ears. Without a systematic approach of detecting HL, only those with more severe HL are detected, often by the community (guardians, teachers, health workers and peers). This means that persons with mild to moderate HL often go undetected, even if such HL still leads to difficulty in hearing conversational speech (World Health Organization 2020 ). As listening is a main form of learning, children with HL often have lower school performance than children without HL (Flexer, Millin & Brown 1990 ; Lieu et al. 2010 ). In many LMICs, children with HL and deafness are vulnerable to dropping out of school, not achieving expected learning goals or never going to school, with girls being more at risk of dropping out or never attending (Njelesani et al. 2018 ; UNICEF n.d. ; World Health Organization 2020 ). Lack of education affects adult life with respect to obtaining and maintaining employment.

Public awareness about childhood HL in LMICs is often poor and often aggravated by negative attitudes, superstition, traditional customs and cultural beliefs (Swanepoel, Störbeck & Friedland 2009 ). Children with disabilities, including HL, are therefore more vulnerable to physical, social, emotional and sexual abuse and even murder (Njelesani et al. 2018 ; Olusanya, Neumann & Saunders 2014 ). As undetected HL is an ‘invisible’ impairment, children are often misunderstood as slow learners or impudent when they do not respond to questions or requests. This was exemplified by Dr Olusanya in an interview given in 2019. She was born in Nigeria with a mid-frequency HL that was not detected until she was an adult. She remembered growing up angry because of frequent and unjustified punishment for not doing as she was told, even though she always did everything that she could hear (Cousins 2019 ).

In an ongoing project in Tanzania, the prevalence of HL among school children was assessed. In 2019, the prevalence was found to be between 7% and 17% of school children in Kilimanjaro, Tanzania (Solvang et al. 2020 ). A review of prevalence studies from 1993 to 2012 in a range of African countries reported similar numbers (3% – 21%), indicating that the situation had not changed for decades (Mulwafu, Kuper & Ensink 2016 ). The prevalence of HL in children in LMICs is substantial, and establishing hearing care services for these children can help millions to achieve a better education.

An estimated 75% of HL in children under 15 living in LMICs is preventable (World Health Organization 2020 ). This was supported by the Kilimanjaro study mentioned here, where 58% of the children with HL had impacted earwax or foreign bodies in their ears and 31% had ear infections (Solvang et al. 2020 ). The literature review by Mulwafu et al. ( 2016 ) also reported that the most common cause of HL was middle ear disease (36%), followed by undetermined causes (35%) and earwax blocking the ear canal (24%). Unfortunately, in most LMICs, including Tanzania, children are not screened for HL and preventive measures are rarely accessible.

In the ongoing project reported in this article, the goal is to develop a sustainable hearing screening programme for school children in Tanzania. Identifying children with HL is the first step towards improving their learning situation. However, it is important to observe that detection alone is not sufficient to solve the problem. A study in Malawi found that only 3% of the children found with HL attended their referral appointment with an ear and hearing service (Bright et al. 2017 ). The most common causes for not attending were found to be transport difficulties, lack of information regarding the referral and financial constraints. The indirect cost associated with, for example, transport and food has been found to be a substantial barrier to persons attending healthcare sessions, even in countries with free medical care (Bright et al. 2017 ; Mahande et al. 2007 ). A follow-up of the Malawi study found that counselling by a trained community health worker and an ‘expert mother’ (i.e. a mother of a child who had previously attended a referral appointment), using information booklets and SMS reminders, was effective in improving the uptake (Baum et al. 2019 ).

It is known that children with permanent HL may benefit from assistive hearing technology, for instance hearing aids, personal sound amplifiers or other ‘over-the-counter’ amplification products. Hearing aids are the best solution but need to be fitted properly to the user’s ears and hearing. The user must also be followed up with counselling and adjustment during the first period of use, and the hearing aid might need technical servicing, including change of batteries. All these components are known to be important for a successful introduction to wearing a hearing aid; thus, it is essential that hearing centres are readily available to achieve a good implementation. This is not the case in most LMICs; hence, hearing aids are not the most suitable technology.

Personal sound amplifiers do not need to be fitted individually, and therefore do not need the availability of local hearing centres to the same extent. Some studies also indicate that persons with mild to moderate HL might benefit from such equipment, even though an individually fitted hearing aid outperforms most personal sound amplifiers (Brody, Wu & Stangl 2018 ; Cho et al. 2019 ; Choi et al. 2020 ). It is known, however, that long reverberation times (RTs) and high background noise can compromise the sound quality from such devices (Wilson et al. 2011 ). Bad classroom acoustics have also been reported for several decades (Berg, Blair & Benson 1996 ; Fidêncio, Moret & Jacob 2014 ; Nábělek & Pickett 1974 ; Saravanan, Selvarajan & McPherson 2019 ; Wilson et al. 2020 ), and especially in LMICs, there is a lack of regulations and resources to improve the situation.

If treatment of common causes of HL (e.g. ear wax and infections) and simple interventions can be provided locally, either at the schools or in distributed centres, this could improve the situation for the children with preventable HL. The children with non-preventable HL will not benefit from such interventions and need other actions. To shed light on this, a study has been performed looking at three low-cost interventions to improve the learning situation for children where hearing aids are not a realistic alternative.

This project supports the United Nations (UN) Sustainable Development Goals: 1 (poverty), 3 (good health), 4 (quality education), 10 (reduce inequality) and 17 (partnerships for the goals). It also ensures user involvement and promotes the philosophies of ‘leave no one behind’ and ‘nothing about us without us’.

Research methods and design

This study aimed to measure speech reception abilities in children with mild to moderate HL in their ordinary learning environments. As a result of the limited sample size, the study used a quasi-experimental design with within-group comparison of interventions. The study took place in the Kilimanjaro region in north-east Tanzania during two weeks in March 2020. Three schools (School A, B and C) were selected based on previous collaboration in the project. To gather sufficient information, each of these children were given a speech reception-in-noise test in a classroom with and without assistive hearing devices and in different positions in the classroom, according to the placement of a loudspeaker.

Participants

A total of eight children participated, four girls and four boys, with mild to moderately severe HL from the three schools. These comprised all the children with permanent hearing impairment in the classes included in the study.

The children were selected through a basic hearing screening that consisted of otoscopy and air conducted pure tone audiometry. Children with impacted earwax or foreign bodies (e.g. insects, impacted sand and pebbles) in the ear canal and children with visible acute middle ear pathologies or pain were excluded from the study and referred to an ear specialist. All children had to be able to interpret and write numbers on a form to be included. Thresholds exceeding 25 hearing loss in decibels (dB HL) were considered a HL and both unilateral and bilateral losses were included. The children with hearing impairment had no previous experience with assistive hearing devices. The pure tone average (PTA4) for the eight children included in this study can be seen in Table 1 . The audiograms for each child can be seen in Appendix 1 .

Pure tone average for the frequencies 500 Hz, 1 kHz, 2 kHz and 4 kHz.

dB HL, hearing loss in decibels.

Control group

In addition to the children with hearing impairment, the teachers were asked to gather a control group of students at each school to fill the classrooms. The criteria for these students were to have no report of hearing problems and to be from the same academic year as the children with hearing impairment. In addition, they also had to be able to interpret and write numbers on a form to be included. These children were included in creating a situation closer to a normal class session, to normalise the acoustics and to be able to study how these students performed on the speech-reception test. These groups consisted of 40, 25 and 35 children at the three respective schools (A, B and C). All children were year 5 students, but their ages varied between 9 and 15 years.

Testing environment

School A was a public school with approximately 400 boys and 360 girls. School B was a private Catholic school with approximately 150 boys and 130 girls. School C was a public school with approximately 260 boys and 290 girls and differed from the others by not having any electricity. The classroom construction was very similar in all schools, where the walls were made of cement blocks with a rendered paint finish and the floors were made of concrete. The roofing of all schools was angled, with corrugated iron sheets. Two of the schools (A and B) had flat ceilings made of fibreboard material, while one (School C) had corrugated iron roofing that had been left bare without any ceiling material.

Technical interventions

Two assistive listening devices were used in this study where both had a simple volume and tone control.

The first device was a Mino from Bellman & Symfon (called personal amplifier in this article), used with a pair of supra-aural headphones. It is possible to switch between omnidirectional and a directional microphone-mode with this device, but only the directional mode was used in this study because it is assumed to work best in reverberant conditions. The amplifier with the built-in microphone was placed on the child’s desk pointing at the speaker.

The second device was a Domino Classic from Bellman & Symfon (called RM-system in this article), which consists of a transmitter with a microphone that is worn by the teacher and a receiver with a pair of supra-aural headphones worn by the student. For the speech reception testing the microphone was hung around the loudspeaker and bags filled with fabrics were used to simulate a torso. This was carried out because the microphone is meant to be hung around the neck of the user.

The children were given the equipment the day before the speech-reception testing to try out and become familiar with the equipment. All children were given instructions on how to use it and could freely adjust the controls during the testing.

Speech recognition in noise-test

The children’s speech reception in the classroom was assessed using a beta-version of the digit triplet test (DTT) in Swahili. This test was developed during a bachelor thesis (Gjessing, Glesnes & Ørland 2020 ). The DTT is a closed-set audiometric speech test where digit triplets (e.g. 2-5-1) are presented in speech-shaped noise.

A loudspeaker that is designed to simulate a human talker was used to play the test signal (NTI TalkBox). The loudspeaker was placed in the middle of the front wall on a loudspeaker-stand about 1.5 m from the blackboard and 1.35 m above the ground pointing away from the blackboard. The speech-shaped noise was played back through a consumer radio (MusicBaby IPA-318) positioned on the floor pointing towards the blackboard. This was performed to let the noise signal be distributed as evenly as possible in the classroom.

The calibration of the loudspeakers was carried out with the sound level meter in one position, 1 m in front of the speech-signal loudspeaker. The DTT speech material, with silent intervals edited out, was used to calibrate the speech-signal loudspeaker. Calibration of the speech-noise loudspeaker was performed using the noise itself.

The speech signal was fixed at 65 dBA, which is a level between ‘normal’ (60 dBA) and ‘raised’ (66 dB) vocal effort, according to ISO 9921 ( 2003 ). This is in line with the results found by Sato and Bradley ( 2008 ) and Astolfi and Pallerey ( 2008 ), who investigated both female and male teachers’ vocal effort over a working day and found the average level to be 65.3 dBA. Bottalico and Astolfi ( 2012 ) found the level to be 62.1 dBA for female teachers. Two sound levels were used for the speech-shaped noise. Half of the DTTs used a noise level of 65 dBA and the second half used 70 dBA. This was carried out to avoid flooring and ceiling effects.

The children with hearing impairment performed one test list (22 digit triplets) while sitting in the front row centre in front of the loudspeaker without any personal hearing devices. Next, they all moved to the outermost seats in the classroom, either to the front row right or in the back row centre or left. In this position they performed one test list with the personal amplifier, the RM-system and without any amplification.

The children with normal hearing also participated in the testing and were used as a control group – one group in each classroom. These children were sitting in the same position for the whole test except for the children who swapped seats with the participants with hearing impairment. All participants responded nonverbally by writing down all the digits in the digit triplet that they could perceive on an answer sheet.

Measurement of the room acoustics

Acoustical variables measured in the classrooms included RT, background noise and speech transmission index (STI). The RT was measured following the guidelines of the engineering method described in ISO 3382-2 ( 2008 ). Six different combinations of microphone and speaker placements were recorded and used to calculate mean RT for all frequencies. To get a single value for each classroom, a mean was calculated using the six 1/3 octave bands between 400 Hz and 1250 Hz.

The background noise was measured using a Norsonic NOR-140 sound level meter placed in the middle of the classrooms. The measurements were performed in empty classrooms during a normal school day while normal classes were being held in the rest of the school.

The speech transmission index was measured following the recommendations in the standard IEC 60268-16 ( 2020 ) for measurements using the Speech Transmission Index for Public Address Systems (STIPA) method. The loudspeaker was placed in the same position as in the speech recognition in noise-test. Four positions in each classroom were measured: front row right and centre and back row left and centre, viewed from the teacher’s perspective. A mean was calculated using the results from these four measurements. The classroom was empty during the measurements.

With the physical measurements of the rooms and the results from the RT measurements, each classroom’s critical distance was calculated. The critical distance is the point in a room where the level of the direct sound from the sound source and the level of the reflected, reverberant sound is equal (Crandell & Smaldino 2000 ).

Data analysis

The statistical analysis was performed using the Statistics and Machine Learning Toolbox in Matlab (MathWorks 2021 ). A paired t -test was used to compare the results from the DTT for the different interventions. A Bonferroni correction was applied to the p -value limit.

Ethical considerations

This study was approved by Norwegian Centre for Research Data (reference number 58283) and the National Institute for Medical Research (NIMR) in Tanzania (reference number NIMR/HQ/R.8a/Vol.IX/3009). The head of school at each school was introduced to the project and signed a consent form on behalf of the participating children’s guardians. The mandate to do this was given by the district’s education officer. It was voluntary to participate and the children were free to withdraw from the project at any given time.

A description of the classrooms in the study can be found in Table 2 , including dimensions and the acoustical parameters.

Classroom description.

STI, speech transmission index; s.d, standard deviation.

Table 3 shows the mean DTT scores for the students with normal hearing (two sequential desk-rows with two students at each desk) in different positions in the classrooms. As expected, the mean SRT score for the front row centre position had the highest mean with the smallest spread of scores in all three schools. A less obvious finding was that front row right position had a lower mean than the back row centre position in schools B and C. The distance between the loudspeaker and the student’s desk in the back row centre position was longer than between the loudspeaker and the front row right position in all three schools, which highlights that the angle between the talker and the listener influences the speech perception. In both schools B and C, the back row left position had the lowest mean score.

Digit triplet test scores for students with normal hearing in different positions in the classrooms at the different schools. The results are the mean value of four children in each position, with standard deviations in brackets.

Because of differences in the room acoustics between the classrooms used in the experiments, the DTT results collected at the different schools were analysed separately.

Figure 1 shows the DTT score for each of the eight students with hearing impairment. With the RM-system, all test subjects scored 100%, except one who scored 97% on the test, regardless of the position in the classroom. Because of this saturation, the RM-system was removed from the statistical comparison of groups, but this intervention outperforms all the others with close to full score for all the children with hearing impairment.

Digit triplets test scores for the eight students with hearing impairment at the three schools.

A paired t -test showed that when the students were seated in the outermost seats in the classroom, the use of personal amplifier ( M = 54.0, s.d. = 16.52) did not improve the results from the situation without an assistive listening device ( M = 50.9, s.d. = 22.62); t (7) = –0.6434, p = 0.54. When the student moved closer to the speaker ( M = 85.6 s.d. = 20.02), there was a significant improvement compared with no personal amplifier: t (7) = –11.50, p < 0.001 and compared with personal amplifier: t (7) = –8.28, p < 0.001.

Limitations

Even though this study aimed at preserving an ecologically valid situation, where the children performed a speech reception test in a familiar context of the classroom surrounded by their classmates, there are several limitations.

Firstly, the number of participants with hearing impairment was small (only eight children). This makes it difficult to draw any strong conclusions, and the results should be viewed as indications. Nonetheless, the statistical analysis did show significant improvements of the speech recognition for two of the interventions.

Next, all the children with hearing impairment had the possibility to adjust the volume and tone control of the devices during the test. The settings were not inspected, so it is possible that some of the children had misadjusted their devices. This is, however, a realistic scenario for these devices. Both devices were also found to have at least 5 dB – 10 dB amplification (not shown here), even on the lowest volume setting, so all children had at least some amplification during the testing.

Furthermore, inclusion of the children with hearing impairment’s classmates who participated was based on self-report and no audiologic testing. This means that the children in the control group could also have some degree of HL without knowing it. If so, the DTT scores for the control group could be somewhat higher.

Finally, the acoustical differences in the testing environments make it difficult to compare data collected in the different classrooms. However, the acoustical properties of the classrooms were measured and are reported.

In this study, speech recognition using a DTT in Swahili was used to measure the effect of different interventions that can be implemented in schools to improve the learning situation for children with hearing impairment. The three interventions studied are presented here.

Firstly, the simplest measure, where the student is moved closer to the teacher, can improve speech perception and therefore can lead to a better learning environment. All the children improved their results with this intervention, and six out of eight got a score above 90%. This will, however, only work if the teacher is aware of the challenge and tries to be close to the student(s) with hearing impairment during teaching. A challenge is that teachers often have to move around in the classroom and therefore cannot maintain a close distance all the time. Another challenge is that it can be difficult for the students with hearing impairment to hear the other students who are not sitting close to them; this can lead to exclusion from dialogues.

Secondly, the use of a simple personal amplifier has clear limitations in classroom settings with bad room acoustics. As a result of the long RTs, the amplifier will only work when the user is within the critical distance to the speaker. This distance was calculated to be from approximately 0.91 m – 1.23 m, which is very short. As we found that moving closer to the speaker will improve the situation by itself, it is not obvious that a personal amplifier will give any additional benefit. This is something that should be studied further.

Thirdly, the RM-system gave the best speech recognition among the interventions that was tested. That an RM-system outperforms personal amplifiers, hearing aids and cochlear implants in gaining increased speech perception in classroom situations has been demonstrated previously (Zanin & Rance 2016 ); this indicates that RM-systems also can provide benefit to children with mild to moderate HL. Because of the wireless transmission of the speech, the student will hear the teacher regardless of where they are seated in the classroom. The teacher must, however, use the microphone for this system to work, and both the teacher and the user must also have the competence to use the device. Rekkedal ( 2014 ) has looked at factors affecting the use of technical interventions and found that the teachers’ attitude towards microphones was most important. She also found that the teachers in her study felt they needed more knowledge about hearing impairment. This means that training is essential and knowledge of the significant benefit this can give must be clearly stated to promote usage.

There are also some challenges associated with RM-systems. As the signal is provided to the user using a microphone, other students in the class also must have microphones to be heard. This can be solved by having one or more handheld microphones that can be passed around the classroom to the talker, but this further complicates both the use and the technical competence needed. Even if some of the RM-systems also have microphones in the device that can be switched on if needed (for instance when other students are talking), the long RT in the classroom will also affect these. This is the same challenge as with the personal amplifier mentioned here.

Common for all the interventions is that education must be given to ensure that they are implemented in the best way. This information must contain both general information about the challenges associated with HL and also guidance on how the people around (i.e. teachers, other students, guardians) can accommodate it. For the technical devices, training of both the user and the technical staff providing service of the devices is also necessary.

It must also be observed that only mild to moderate hearing impairments were looked at in this study and that the HL was quite different among the children. The speech recognition results also had little correlation with the severity of the HL. A reason could be that some of the children had other disabilities, such as cognitive impairment, but this was neither screened for nor investigated any further. Two of the eight participants did not achieve the same benefit as the others. These two children were those who scored the lowest on all tests, indicating that they had greater challenges with speech perception than the others. Even if this could be related to other impairments, these children came from School B, where the control group also scored lower than the other schools. This could indicate that the room was more challenging than the other rooms.

The study did not look at personal amplifier use in the position close to the speaker, and therefore it is not possible to say if this could further improve the listening situation for the children. It does, however, show that if personal amplifiers are introduced in a school setting, the teachers must be given knowledge on how to best utilise these devices. If the children were provided with such a device and seated in the back or at the side of the classroom, these results indicate that there is a chance that the students will hear better without the equipment.

Mealings ( 2016 ) reviewed national and international standards and recommendations of classroom acoustic conditions and found recommended noise levels ranging from 25 dBA to 50 dBA, recommended RTs ranging from 0.3 s to 0.9 s and STI values ranging 0.6–0.75 for developing children. For children with hearing impairments and language delays, the recommended values were noise levels lower than 20 dBA – 35 dBA and RTs shorter than 0.3 s – 0.7 s.

The room acoustical measurements in this study showed that none of the classrooms met recommendations from international standard. Two of the classrooms had RTs above 1.3 s and clearly show a major challenge for learning in these schools. This affects all students, not only those with hearing impairment, but those who also have hearing challenges will suffer more. An observation made from the control group results is that School B did worse than School A on the DTT, even though the acoustical conditions were measured to be better in School B. If this observation is true, it might be a challenge for acoustical treatments of classrooms and something that should be studied further.

To further elucidate the potential in these low-cost interventions, more research is needed on the effect. Student performance after different interventions should be studied and cost–benefit analysis should be performed to appraise them.

This study, although small in sample size, showed that personal amplification with directive microphones gave little to no effect in assisting the children with hearing impairment. One of the main reasons is the challenging acoustical conditions in the classrooms that compromise the sound quality in such equipment. The best speech perception was achieved using an RM-system that circumvents the bad acoustical conditions by using microphones close to the speaker and transmitting the sound wirelessly to the user. Interestingly, the results also indicate that the children with hearing impairment could get good benefit simply by moving closer to the teacher. This is a low-cost alternative but will require proper training of both the child with hearing impairment, the teacher, the other students and the guardians in order to work. The effect of such intervention must, however, be studied further.

Acknowledgements

The authors would like to give special thanks to Prof. Hamisi M. Malebo from the National Commission for UNESCO of the United Republic of Tanzania for assisting in the process of getting the ethical approval. They also want to thank Mr Lucian E. Segesela, the principal at Patandi Teachers’ College for Special Needs Education, Tanzania, in addition to his teachers and staff. Tov Glesnes is also acknowledged for his contribution to the bachelor’s thesis that laid the groundwork for this article and Prof. Vinay Swarnalatha Nagaraj from the Norwegian University of Science and Technology (NTNU) for his supervision. Finally, they also like to express their gratitude to the teachers and the children at the three schools involved in the study. Without their assistance and participation this study could not have been carried out.

Competing interests

The authors have declared that no competing interest exists.

Authors’ contributions

T.V.T. was responsible for the conceptualisation of the study and writing of the manuscript. B.G. was responsible for the conceptualisation of the study, data collection and writing of the manuscript. I.Ø. was responsible for the conceptualisation of the study data collection and writing of the manuscript. T.Ø. was responsible for the conceptualisation of the study and writing of the manuscript. C.M. was the principal investigator in Tanzania and responsible for the conceptualisation of the study and planning of the data collection and review of the manuscript. I.M. was the project coordinator at Patandi Teachers’ College and responsible for planning and implementing the data collection and review of the manuscript. J.Ø. was the study supervisor and responsible for the writing of the manuscript. All authors provided critical feedback and helped to shape the research, analysis and manuscript.

Funding information

The fieldwork in this study was carried out in collaboration with SINTEF’s project ‘I Hear You’. ‘I Hear You’ is a tablet-based application that is still under development in a project funded by the Research Council of Norway (grant no. 267527 NRC) as part of the Vision 2030 programme.

Data availability

The views expressed in this article are solely the authors’ and not an official position of the institutions associated or the Research Council of Norway.

Appendix 1: Results from the pure tine audiometry for all test subjects.

How to cite this article: Tronstad, T.V., Gjessing, B., Ørland, I., Øderud, T., Mnyanyi, C., Myovela, I. et al., 2022, ‘A case study of interventions to facilitate learning for pupils with hearing impairment in Tanzania’, African Journal of Disability 11(0), a974. https://doi.org/10.4102/ajod.v11i0.974

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Article Contents

Barriers to and facilitators of the use of hearing technology, analysis model, materials and methods, the respondents’ hearing technologies, limitations, conflicts of interest.

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Assistive Hearing Technologies Among Students With Hearing Impairment: Factors That Promote Satisfaction

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Ann Mette Rekkedal, Assistive Hearing Technologies Among Students With Hearing Impairment: Factors That Promote Satisfaction, The Journal of Deaf Studies and Deaf Education , Volume 17, Issue 4, Fall 2012, Pages 499–517, https://doi.org/10.1093/deafed/ens023

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Hearing technology can play an essential part in the education of deaf and hard-of-hearing children in inclusive schools. Few studies have examined these children’s experiences with this technology. This article explores factors pertaining to children’s use of and attitudes toward hearing technologies, such as hearing aids, cochlear implants, teacher-worn microphones, and student-worn microphones. The study included 153 deaf and hard-of-hearing students. All students communicated orally and were in inclusive schools from grades 5–10. The results suggest that males view hearing technology more positively than do females. Having severe hearing loss also promoted positive attitudes toward hearing aids and cochlear implants, but not toward microphones. The students with positive self-descriptions tended to be more satisfied with hearing aids or cochlear implants than the students with negative self-descriptions. The main factors promoting the use of hearing aids were severe hearing loss, positive attitudes toward hearing aids, and the sound quality of hearing aids.

Assistive technology can be a key factor that enables individuals with disabilities to participate in daily life and be included in society ( Schneidert, Hurst, Miller, & Üstün, 2003 ). However, this technology has a double-edged nature in that it is both a tool for achieving independence and a visible sign of disability ( Scherer, 2002 ). Assistive technology that is seen as a tool or as one way of achieving desired activity is more likely to be assimilated into the user’s life. Alternatively, technology seen as a visible sign of a disability can reinforce the stigma associated with the disability. Because individuals with the latter view of technology may avoid or resist using this technology, they may avoid meaningful activities and suffer both social and physical isolation ( Polgar, 2010 ).

Hearing technologies for deaf and hard-of-hearing (DHH) individuals include personal amplifiers (e.g., hearing aids [HA] and cochlear implants [CI]), which are typically worn on the head or on the body and assistive listening devices that are not used on the head or body, such as classroom sound field amplification systems ( Dillon, 2001 ). Specialized hearing technologies may reduce the impact of barriers that DHH students experience in schools, such as classroom noise, rapid rate of discussion, rapid change of topics, and large numbers of people engaged in conversation, all of which can prevent DHH students from participating in teacher–student and student–student communication ( Luckner & Muir, 2001 ; Stinson & Antia, 1999 ). Although DHH students and their teachers report that the use of hearing technology is essential for ensuring effective inclusion ( Eriks-Brophy et al., 2006 ; Luckner & Muir, 2001 ), the equipment is sometimes used irregularly because of the stigma associated with assistive technologies.

The majority of DHH children in the western part of the world attend inclusive schools, but few findings have examined how these children view their hearing technology or how the technology is utilized. The children are infrequently asked about their experiences with hearing technology and their views on using it; scholarly attention has mainly been concentrated on the impact of personal aids on speech perceptions ( Anderson & Goldstein, 2004 ; Beadle et al., 2005 ; Iglehart, 2004 ; Loy, Warner-Czyz, Tong, Tobey, & Roland, 2010 ; Odelius, 2010 ; Yoshinaga-Itano, 1999 ). Qualitative studies on the subject have focused more on personal amplifiers and less often on assistive listening devices ( Kent & Smith, 2006 ; Preisler & Tvingstedt, 2005 ; Wheeler, Archbold, Gregory, & Skipp, 2007 ). In research on the use and nonuse of HA among children and the sense of stigma associated with HA, the respondents group have included teachers, parents, and hearing peers but not the DHH children themselves ( Blood, Blood, & Danhauer, 1978 ; Brimacombe, Danhauer, & Mulac, 1983 ; Clarke & Horvath, 1979 ; Cox, Cooper, & McDade, 1989 ; Dengerink & Porter, 1984 ; Haley Stephen & Donna, 1986 ; Ryan, Johnson, Strange, & Yonovitz, 2006 ; Silverman & Klees, 1989 ; Strange, Johnson, Ryan, & Yonovitz, 2008 ; Vesterager & Parving, 1995 ). In contrast, numerous studies have examined adults with hearing disabilities and their attitudes, feelings of stigma and qualities of life in terms of using or not using HA ( Arnold & MacKenzie, 1998 ; Bertoli et al., 2009 ; Bisgaard, 2008 ; Cameron et al., 2008 ; Cohen, Labadie, Dietrich, & Haynes, 2004 ; Laplante-Levesque, Hickson, & Worrall, 2010 ; Öberg, 2008 ; Wong, Hickson, & McPherson, 2009 ). Children who are fitted with HA or CI in early childhood may integrate such aids into their daily lives ( Preisler & Tvingstedt, 2005 ). If so, this trend might explain why there is less focus on children’s use of HA and CI compared with adults who have acquired hearing loss.

The hearing technology offered to DHH children in inclusive schools can consist of assistive listening devices, including teacher-worn microphones and student-worn microphones used by hearing classmates. Teachers and students must make daily use of the equipment. Their attitudes toward hearing technologies may affect the degree of usage and, accordingly, the level of participation in school. This article presents DHH children’s attitudes toward the different hearing technologies offered and explores predictors that can affect the children’s attitudes toward these technologies and their utilization. A comprehensive understanding of the factors affecting the utilization of HA can improve rehabilitation interventions provided by health personnel and itinerant educators both at school and at home.

Factors that can improve attitudes toward and the use of hearing technology have been related to DHH individuals themselves, the environments, and the technology ( Coniavitis-Gellerstedt, 2006 ; Craddock, 2006 ; Eriks-Brophy et al., 2006 ; Vesterager & Parving, 1995 ; Wennergren, 2008 ; Winn, 2006 ).

Personal factors, such as psychosocial factors, gender, age, and degree of hearing loss, are highlighted as important issues. Several research projects have pointed to stigma as an essential factor affecting DHH persons’ refusals to wear HA ( Bisgaard, 2008 ; Blood, Blood, & Danhauer, 1977 ; Hétu, 1996 ; Hétu, Jones, & Getty, 1993 ; Öberg, 2008 ). Individuals with HA are evaluated more negatively by teachers, parents, and hearing peers on dimensions such as intelligence, achievement, and personality through a phenomenon known as “the hearing aid effect,” which has been confirmed by a number of research studies ( Blood et al., 1978 ; Brimacombe et al., 1983 ; Cameron et al., 2008 ; Cienkowski & Pimentel, 2001 ; Cox et al., 1989 ; Dengerink & Porter, 1984 ; Haley Stephen & Donna, 1986 ; Johnson et al., 2005 ; Ryan et al., 2006 ; Silverman & Klees, 1989 ). The feelings of shame and guilt attached to hearing loss can lead to a fear of disclosing one’s hearing impairment ( Hétu, 1996 ).

In line with the stigma concept, Kent and Smith (2006 ) argue that the feeling of “being normal” is fundamental. Students who are able to perceive their use of HA in a given context as a normal phenomenon are likely to use them more frequently. Conversely, if HA use is perceived as abnormal, usage is often disguised or negated. Consequently, DHH students who express high levels of personal adjustment and willingness to use assistive hearing devices are found to have a strong sense of “being normal.” Students who struggle to participate and are reluctant users of HA, tend to view themselves as “not normal.” The study comprised 16 hearing-impaired children, between 12 and 17 years of age ( Kent & Smith, 2006 ). The normality aspect also appears in studies of children’s views of CI; Preisler and Tvingstedt (2005 ) concluded that the majority of the children in the study considered their CI to be natural parts of their lives. Wheeler et al. (2007) produced similar results and described the children as being completely depended on CI to hear; the researchers reported that the children would feel bereft if the CI could not be used.

Other psychosocial characteristics of successful hearing aid users include self-confidence, self-esteem, extroversion, and locus of control ( Brooks & Hallam, 1998 ; Cienkowski & Pimentel, 2001 ; Garstecki, 1996 ; Garstecki & Erler, 1998 ; A. S. Helvik et al., 2006 ; Humes, Wilson, & Humes, 2003 ; Kricos, Erdman, Bratt, & Williams, 2007 ; Lockey, Jennings, & Shaw, 2010 ). DHH individuals with high self-confidence, self-esteem, or extroversion are more likely to be constant HA users.

Studies have also pointed to gender as a central factor but the results have been divergent. According to Garstecki and Earler (1998) , females seem more likely than males to acknowledge their hearing loss and to use personal amplification devices. Similar conclusions were produced by studies undertaken in Switzerland and in the United Kingdom; women tended to use HA more regularly ( Bertoli et al., 2009 ; Smeeth et al., 2002 ). A Swedish study also found that, in a sample population of 595 students, girls seemed to use HA to a greater extent than boys ( Coniavitis-Gellerstedt, 2006 ). In contrast, a Norwegian study concluded that elderly males tended to experience fewer barriers to HA use than elderly females ( Solheim, 2011 ).

The degree of hearing loss has been found to predict use or nonuse of HA ( Bertoli et al., 2009 ; Clarke & Horvath, 1979 ; Kochkin, 2009 ; Smeeth et al., 2002 ; Solheim, 2011 ). According to two older studies, children with profound or mild hearing loss make less use of HA than children who have moderate or severe hearing loss ( Clarke & Horvath, 1979 ; Vesterager & Parving, 1995 ). Vesterager and Parving’s study included children with profound hearing loss who were using HA. A newer study by Kochkin (2009 ) drew a similar conclusion; based on a sample of 5000 DHH adults and children, moderate or severe hearing loss was a common characteristic of the HA users.

In addition, older DHH students seem to be less willing to use HA ( Clarke & Horvath, 1979 ; Coniavitis-Gellerstedt, 2006 ; Wennergren, 2008 ; Winn, 2006 ). Wennegren’s (2008) study concluded that nonuse of HA appeared only among the oldest students, who comprised 165 members of the sample. Winn (2006 ) found that among the 60 participants in his study, there was a progressive decline in the use of HA starting from elementary school and continuing through high school. In a research project involving students ranging from 13 to 19 years old, few HA users were found in high schools, whereas a higher number of HA users were seen in elementary schools ( Coniavitis-Gellerstedt, 2006 ). Older students also tended to use assistive listening devices less frequently than their younger counterparts ( Kent & Smith, 2006 ; Wennergren, 2008 ; Odelius, 2010 ). According to Kent and Smith (2006 ), older students have developed enhanced listening strategies and no longer need microphones.

The age of onset is also claimed to influence the utilization of HA. Early intervention is said to promote more frequent wearing of HA later in life ( Gillies, 1997 ). Another finding supports this claim, which suggests that students fitted with HA early in life appreciated their use more than those who were fitted with HA later on ( Rekkedal, 2007 ). A study of adolescents using CI showed that 38% of those implanted with CI later in life did not wish to be implanted again if their systems failed. None of the adolescent undergoing early intervention with CI shared this view ( Wheeler et al., 2007 ). In contrast, Vesterager and Parving (1995 ) did not find a relationship between early interventions with HA and use of HA, among the 76 children who participated in their study where the maximum age of onset was 10 years.

Environmental factors such as type of school attended have been associated with the utilization of HA ( Clarke & Horvath, 1979 ; Vesterager & Parving, 1995 ). Students attending special schools for DHH children use HA more irregularly than DHH children in ordinary schools ( Clarke & Horvath, 1979 ). The form of communication preferred by DHH children, such as sign or oral language, has also been related to the utilization of HA ( Cameron et al., 2008 ). Another factor reported by Kent and Smith (2006 ) is the level of support provided by friends and families. Those who perceived affirming or accepting attitudes in their relationships with family and friends were more comfortable with wearing hearing aids.

Technological factors, such as outdated technology or technology in poor working order, seem to hinder utilization ( Eriks-Brophy et al., 2006 ; Luckner & Muir, 2001 ; Wennergren, 2008 ). A Swedish study reported that 14% of inductive loop controls did not function properly ( Björklund & Sundelin, 2010 ). Similar results were found in a Norwegian study; approximately 14% of the listening devices were either out of order or used incorrectly ( Rekkedal, 2007 ).

The type of technology and sound quality are also discussed. The past decade has brought tremendous advances in hearing technology ( Lockey et al., 2010 ). As analogue technology has given way to the digital revolution, the arrival of digital HA makes it possible to individually tailor hearing devices to meet individual needs ( Banerjee & Garstecki, 2003 ). Multiple programs are available for diverse listening situations and offer advanced noise reduction strategies as well as reduction of acoustic feedback. CI have also benefited from this technology. However, studies indicate that sound quality still poses a problem. An Australian study, using a sample of 57 young adults with severe to profound hearing loss, revealed that the degree of contentment with the sound quality of HA was significantly related to the utilization of HA ( Cameron et al., 2008 ). Approximately 50% of the nonwearers were dissatisfied with the sound quality, whereas only 13.8% of regular hearing aid wearers felt the same. Bertoli et al. (2008) also found that noisy and disturbing sounds were the most frequently reported problems by adults. This finding indicates that despite advances in digital hearing aid technology and noise suppression algorithms, amplification may fail in a subgroup of HA users.

The option of a direct audio input in new digital HA/CI makes it possible to connect miniature FMs (called MLx receivers) to HA and CI via an audio shoe. Using general induction loops connected to the telecoil in HA and CI, FM technology (with use of MLx receivers) has become a more common practice. In addition to these two sound transmission systems, sound field amplification in which the entire classroom is amplified through the use of one, two, or four wall- or ceiling-mounted loudspeakers ( Crandell, Flexer, & Smaldino, 2005 ) is now offered to DHH students. According to Crandell et al. (2005) sound field amplification improves the learning environment for all students by enhancing the listening conditions. In addition, it can lead to improved student attention spans during teaching sessions ( Rosenberg et al., 1999 ). Because sound field systems improve the learning environment for all students, they may also lessen the embarrassment for DHH users.

Critical technological aspects also include cosmetic issues such as visibility and design. Invisible assistive hearing technologies appear to be preferred over visible ones, both in the case of personal amplifiers and assistive listening devices ( Cameron et al., 2008 ; Kent & Smith, 2006 ; Luckner & Muir, 2001 ; Preisler & Tvingstedt, 2005 ). In particular, older girls preferred less noticeable head-worn CI processors over those worn on the body ( Preisler & Tvingstedt, 2005 ). The potential spotlighting effect of body-worn FM receivers has been seen as a barrier; they were not stylish and singled out hearing-impaired students from their hearing classmates ( Luckner & Muir, 2001 ). Even miniature FM devices have been considered conspicuous and unattractive ( Kent & Smith, 2006 ).

The aim of this study was twofold. The main purpose was to explore predictors that could explain the differences in the dependent variable (i.e., students’ “uses of HA and CI”). The second purpose was to explore predictors that could impact students’ attitudes toward the following: (a) the sound quality of HA and CI, (b) the use of HA and CI, (c) the use of student-worn microphones, and (d) the use of teacher-worn microphones. Because the students’ attitudes toward the personal amplifiers were expected to be related to their use (or nonuse) of HA or CI, their attitudes toward the aides were investigated. The intention was to examine how different independent variables simultaneously affect attitudes toward hearing technology and the use of personal amplifiers among DHH children. Use of microphones was not explored, as this factor also depends on the teacher’s utilization of the equipment.

Three categories of independent variables including personal, technological, and environmental aspects were analyzed. Some variables were common to all of the hearing technologies, whereas others were specific to personal amplifiers or to assistive listening devices. The personal variables: (a) gender, (b) age, (c) hearing loss, and (d) students’ self-description were the common variables measured for the users of all hearing technologies. “Age of intervention with HA/CI” was only measured for the HA and CI users because not all students using microphones wore HA or CI. The personal variable “students’ view of the school” was explored for those with assistive listening devices but not to personal amplifiers because the latter are used during the entire day and are not limited to the school environment.

The technological variable that measured the attitudes toward “the sound quality” of the personal amplifiers were based on the type of equipment used (HA or CI). It was expected that the use of either an HA or CI could affect the perception of sound quality. The technological variables tested in terms of the assistive listening devices were the following: (a) technical problems with the microphones and (b) use of a sound field system. Often, technical problems with the microphones negatively impacted the attitudes toward microphones, whereas the use of a sound field system was assumed to be a positive influence, as this system can improve the listening environment for all students, not just for the DHH student ( Crandell et al., 2005 ). Unfortunately, technological aspects, such as the design and visibility of the hearing technologies, were not included in this study, even though several studies have shown that visible technology is more preferable over visible forms ( Cameron et al., 2008 ; Kent & Smith, 2006 ; Preisler & Tvingstedt, 2005 ).

The variable related to the environmental aspects was primarily students’ interaction with other DHH children, which was measured among the users of each hearing technology. The support experienced by DHH students from their families and friends is reportedly important ( Kent & Smith, 2006 ), but is not measured here. However, this study assumed that frequent contact with other DHH children could provide support leading to positive acceptance of one’s own hearing loss and bringing about positive attitudes toward the use of hearing technology.

In addition, the study investigated the factors influencing students’ reported use of HAs in terms of frequency. This analysis included two independent variables, attitudes toward HA/CI and sound quality in HA/CI, as well as the six previously listed independent variables related to attitudes toward HA/CI.

Subjects and Procedures

The participants in this study were children with mild to profound hearing loss between 10 and 16 years old. The participants had no intellectual impairments and were educated in inclusive schools. Most DHH students in Norway are in inclusive schools because of the “one school for all” principle. All students, including those with learning difficulties or exceptional abilities in certain areas, are supposed to meet challenges corresponding to their abilities; individual adaptation is regarded as essential targets to providing schooling of equal value, as specified by Norway’s educational authorities.

The participants were recruited from the Assistive Technology Centers (ATCs) and the National Resource Centers for hearing disabilities (NRCH). In each of Norway’s 19 counties there is one ATC that provides assistive technologies free of charge to people of all ages whose functioning in everyday life is considerably and persistently reduced. The associated costs are funded by social security. A different system operates in the case of HA and CI, as these provisions are the responsibility of hospitals ( Ravneberg, 2009 ). Six NRCHs take on the task of helping families, local schools, and municipal authorities to include DHH students in local schools. These centers offer supervision and guidance to individual children and their families as well as programs for municipalities, local schools, and child guidance services ( Simonsen, Kristoffersen, Hyde, & Hjulstad, 2009 ).

Twelve of the 19 ATCs contributed. Because five did not have the capacity to contribute four NRCHs replaced them. Two counties were omitted because they had taken part in a pilot project. In 2009, the ATCs and NRCHs were asked to list all DHH children born between 1992 and 1998 who had been supplied with assistive listening devices. The centers did not have the ability to identify the DHH students who attended special classes or those with concurrent intellectual disabilities. In all, 557 children were identified, which is fewer than the 790 children estimated to have hearing loss in those counties. Estimates suggest that 0.25% of all children and young people under 20 years old have hearing disabilities, with 10% of those suffering from profound hearing loss ( Kunnskapsdepartementet, 2001 ).

In spring 2009, invitations were sent to the 557 parents. The invitation gave details about the survey and the criteria for participation: (a) no intellectual impairment, (b) use of oral language, and (c) inclusive class enrollment. The subjects could respond with a paper questionnaire, with an Internet-based questionnaire, or in face-to-face interviews with the author. In addition, to information regarding the confidentiality of the research findings, the parents were informed that one child participant could win 130€ and that two children could win 65€. Of the 557 parents only 187 replied to the informational letters and permitted their children to participate. Ten parents responded that their child did not meet the participation criteria. The author contacted all 187 families, to determine the preferred participation method (i.e., paper questionnaire, Internet-based questionnaire, or face-to-face interview). The study also obtained additional information such as the type of hearing loss (e.g., unilateral deafness) and the age at which the hearing loss was ascertained.

Data were collected from May to December of 2009, and 153 children completed the questionnaire. The distribution of the responses was as follows: 46.8% by paper questionnaire survey, 34.4% by Internet-based questionnaire, and 18.8% through face-to-face interviews. Approximately 65% of the students who had completed the questionnaire online or in paper form stated that they had received help with filling out the form, whereas 35% responded independently. No significant differences (in terms of school grade or degree of hearing loss) were found between those who were assisted versus those who were unassisted. However, fewer students in the Internet group (51%) reported receiving help from their parents, whereas 68% of the students in the paper group were assisted by their parents. The chi-squared test for independence indicated significant associations ( x2 = 9.466, p =.009) between the groups. The majority of the students in the 5th and 6th grades responded either by paper or through face-to-face interviews, whereas the students in the 7th–10th grades more often answered via the Internet. The chi-squared test for independence indicated significant associations ( x2 = 10.955, p =.004) between the students in grades 5 and 6 compared with the students in the upper grades. In addition, slightly more students with severe hearing loss tended to be in the paper and face-to-face groups than found in the Internet group, however, the chi-squared test for independence revealed no significant differences ( x2 = 8.705, p =.069).

The final participation rate was low (28.1%). Information on gender, school grade, degree of hearing loss and family conditions was collected to identify potential biases. Table 1 shows the distributions for school grade, gender, and degree of hearing loss. Fewer students were in secondary schools than in primary schools, and slightly more boys than girls took part in the study. The majority of the students reported being able to hear speech from a distance of 1 m without using an HA, and none of the students selected the fourth category (cannot hear speech from a distance of 1 m while using an HA or CI). A smaller group of students characterized themselves as unable to always hear speech from a distance of 1 m while using an HA or CI, as seen in Table 1 . The number of CI users represented approximately 10% of all respondents.

A total of 76.2% of the students lived with both of their parents and 23.8% lived with one parent. According to Norwegian statistics, 75% of all children aged between 0 and 17 years old live in two-parent households ( Statistics Norway, 2010b ). Research on children with disabilities and family structures found that a slightly higher number of such children live with both parents compared with the general population ( Lundeby & Tøssebro, 2008 ). Of the students, 8.5% reported using a second oral language (in addition to Norwegian), and 6.5% reported using both sign language and spoken Norwegian. The remaining 85% communicated orally and in Norwegian only. First-generation immigrant children and Norwegian-born children with immigrant parents account for 9% of the population between the ages of 0 and 17 in the participating counties ( Statistics Norway, 2010a ).

The respondents represented 16 counties in Norway, including both rural and urban areas. The majority of the students (61.8%) were located in the eastern region and in the west coast of Norway. Others resided in southern Norway (14.5%), central Norway (13.9%), and northern Norway (9.8%). When compared with Norwegian statistics on the demographics of the general population, the findings were broadly similar, with the exception of northern Norway (slightly fewer students) and southern Norway (slightly more students).

All data were collected by the author. A pilot trial was first conducted with 2 hearing educators and 12 students (one student was in 2nd grade and the other students were in the 5th, 6th, or 7th grade). The paper questionnaire was expected to take approximately 30–60min for each participant to complete. The durations of the face-to-face interviews ranged from 30 to 90min, including short breaks for the youngest cohort of students. All face-to-face interviews took place in the home environment, with the exception of two sessions that were conducted at school.

Three types of sound transmission systems are provided to DHH students in Norway: (a) microphones combined with an inductive loop system, (b) microphones combined with an FM system, and (c) microphones connected to a sound field system. Each DHH student can be provided with one of the following: (a) a teacher microphone only, (b) a teacher microphone and a limited number of student microphones (1 microphone for every 3–7 classmates), or (c) teacher microphone and a high number of student microphones (1 microphone for every 1–2 classmates). During conversations classmates must press the microphone switch; handheld microphones are most commonly used, but desk microphones are used as well. Both teacher and student microphones must be regularly charged.

Table 2 presents the distribution of assistive technologies used by the children. The number of CI users was low (18). From 1988 to 1998, only 41 children received CI in Norway, in contrast, from 1999 to 2009, this figure reached 382 ( Bunne, 2009 ). The participants in this study were born between 1992 and 1998. One group of 43 students did not use any personal amplifiers; they all classified themselves as having mild to moderate hearing loss. In addition, unilateral deafness was reported by 20 students, and 16 had stopped using HA.

The distribution of the students (%, N = 153)

Note. CI, cochlear implants; HA, hearing aids.

Use of assistive hearing technology (%, N = 153)

The majority of the students were supplied with teacher microphones (cf. in Table 2 ). Most students used loudspeakers as the only sound transmitters, whereas the others used either inductive loops or FM systems both with and without loudspeakers. Approximately 31.3% used only FM or inductive loop systems. These numbers were in line with what the ATC had reported in telephone interviews regarding the systems delivered. Approximately 42% of the ATC reported delivering a sound field system only, an inductive loop, or an FM system only, whereas 23% of the centers could combine sound field amplification with an inductive loop or FM system. Because a relatively high number of centers (35%) had not started to distribute sound field systems either an inductive loop or FM system was the only system utilized. Most students were also supplied with student microphones; whereas the majority had one microphone per one or two classmates, others had one microphone per three to seven classmates (cf. in Table 2 ).

Table 3 presents the distribution of ages of intervention with HA or CI. Most children received their first HA between 3 and 5 years of age, but a relatively large percentage received their first HA after school age. Of these children 65% characterized themselves as having mild to moderate hearing loss, and 35% reported severe hearing loss. The modal age range for receiving CI was also between 3 and 5 years of age. The age for CI fitting has been reduced during the last 10 years, and the modal age range is now between 1 and 2 years old ( Bunne, 2009 ).

Age of onset with hearing aids (%, n = 114) and age of onset with cochlear implants (%, n = 18)

The survey questions were developed following a review of the relevant literature and information gathered from a pilot project. The dependent variables were the attitudes toward the following: (a) the sound quality of HA and CI, (b) use of HA and CI, (c) use of teacher-worn microphones, (d) use of student-worn microphones, and (e) students’ utilization of HA and CI. The independent variables were organized into the following areas: (a) student-related, (b) environmentally related, and (c) technically related.

Dependent Variables

Satisfaction with the sound quality of HA/CI . The sound quality of HA/CI was measured using the statement I like the sound in my HA/CI. The students responded using a 5-point Likert scale (totally agree, agree, neither disagree/nor agree, disagree, and totally disagree).

Satisfaction with HA/CI . Three attitudinal statements regarding the use of HA/CI were formulated. The statements were as follows: (a) I feel embarrassed when using HA/CI , (b) I am so used to my HA/CI that I do not mind what others think , and (c) I try to hide my HA/CI as much as possible. The rankings for the response options were the same as those for “satisfaction with the sound quality of HA/CI.” Item 2 was recorded with a positive rank. The three items were added to one variable (Cronbach’s α = .84).

Satisfaction with student microphones . The respondents experiences with student microphones were measured with five attitudinal statements: (a) I hear my classmates more clearly when using the microphones, (b) I feel embarrassed when my classmates use the microphones, (c) I like that my classmates use the microphones, (d) It is easy for my classmates to use the microphones correctly, and (e) I think that my classmates often joke around with the microphones. The response categories were the same as those for “satisfaction with the sound quality of HA/CI.” Principal component analysis (PCA) based on Kaiser’s criterion was implemented. The KMO did not reach the recommended value .60, but did reach .59. The Bartlett test result was significant. The PCA suggested two factors (eigenvalue = 2.39; 1.03; percent of variance = 47.91; 20.64). The first three items were suggested as one factor with a Cronbach’s α of .73, and represent the dependent variable analyzed here (items 1 and 3 were recorded as a positively ranked value). Items 4 and 5 were suggested as the second factor, but Cronbach’s α proved unsatisfactory. Thus, the items were treated as single independent variables that could affect “satisfaction with student microphones.”

Satisfaction with teacher microphones . The scales for measuring attitudes toward teacher microphones were similar to the first three statements used in the student microphones category, but the teachers were referred to instead of classmates. The response options were the same as those for “satisfaction with the sound quality of HA/CI.” A PCA suggested only one significant factor (eigenvalue = 2.07; percent of variance = 50.68). The Cronbach’s α of .73 was acceptable for the three statements.

Utilization of HA/CI . The utilization of HA and CI was assessed through two variables: How often do you use the HA or CI in the class ? and How often do you use the HA or CI during the school breaks ? The answer choices included never, seldom, sometimes, almost always and always. The two variables were added together and treated as one variable (Cronbach’s α = .84).

Independent Variables

Gender . 0 = males and 1 = females.

Age . Age was measured through school grade and transformed into a dichotomous variable (0 = secondary school, including grades 8–10, and 1 = primary school, including grades 5–7).

Hearing loss . The degree of hearing loss was recorded based on the student self-assessments. Table 1 presents the four response categories. The variable was transformed into a dichotomous variable. The first response category formed one group, and the second and third response categories formed the other group. No students selected the fourth response category.

Age of onset with HA/CI . Age of HA/CI fitting was split into six discrete categories: (a) 0–2 years, (b) 3–5 years, (c) 6–7 years, (d) 8–9 years, (e) 10–11 years, and (f) more than 12 years. The variable was transformed into a dichotomous variable (0 = more than 6 years and 1 = 0–5 years).

Self-description . The “Self-description Questionnaire” (SDQ II; Marsh, 1990), which was adapted and translated into Norwegian by Skaalvik in 1997, was used in this study ( Kvello, 2006 ). The scale consists of eight items with a Cronbach’s α of .81. An example item is I like myself as I am . The response alternatives were true, slightly true, slightly untrue and untrue.

Views of school . A scale developed by Rutter et al. (1979) was adapted and translated into Norwegian by Ogden (1995 ). It contains 10 items and represents three dimensions: (a) views of schools, (b) social well-being, and (c) further education ( Nordahl, 2000 ; Ogden, 1995 ). An example of an item on this scale is I usually like to go to school , which measured on a Likert scale with five response alternatives (totally disagree, disagree, neither disagree/nor agree, agree, totally agree). Only one dimension was included in the survey (views of school). The Cronbach’s α of .56 on view of school suggests unsatisfactory reliability and is also lower than the .63 score produced in Nordahl’s study. Nevertheless, the dimension was incorporated into the analysis.

Quality of teaching . This variable contains 4 items and has a Cronbach’s α of .71, it was adopted from the Quality of School Life scale developed by Karatzias, Power, and Swanson ( Våge, 2007 ). The scale consists of 14 dimensions, but only the Quality of Teaching dimension was included. An example item is I like the way I am being taught . The response categories were similar to those used for “the views of school” variable.

Interaction with other DHH children . Interaction with other DHH children was measured with two variables. The first was How often have you participated in student courses with other DHH children ? This variable had response alternatives of never, once, 2–3 times , and 4–5 times . This variable was transformed into a dichotomous variable (never/once = 0 more than 2 = 1), and labeled “ participated in courses.” The second variable asked the respondents How often are you together with other DHH children ? The response options were seldom or never, once a year, several times a year, several times a month, several times a week , and daily . The variable was renamed “contact with DHH children.”

Technical problems with teacher microphones . Tech nical problems were measured using the statement There is often something wrong with the teacher microphone. The response categories were arranged on a 5-point Likert scale (totally agree, agree, neither disagree/nor agree, disagree, and totally disagree).

Technical problems with student microphones . These problems were assessed using the teacher microphone questions, but “student microphones” was used in place of “teacher microphone.”

Sound field system . 0 = no sound field system, 1 = sound field system.

Use of HA or CI . 0 = HA, 1 = CI.

All of the statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 18.0 for Windows (SPSS Inc., Chicago, IL, USA, 2003). The statistical significance level was set at 0.05. Principal component analysis and reliability testing were conducted to evaluate data reduction for the two dependent variables (satisfaction with teacher and student microphones) and the composed independent variables. Cronbach’s α was computed to estimate the internal consistency of all instruments used.

Descriptive statistics, including means and standard deviations, were calculated for the continuous variables. Hierarchical multiple regression analyses enabled the study to explore the variables affecting all of the dependent variables (i.e., satisfaction with HA/CI, satisfaction with the sound quality of HA, satisfaction with teacher microphones, satisfaction with student microphones, and utilization of HA). Prior to the multiple regressions analyses, bivariate regression analyses were performed and only the predictors with significant effects on the dependent variables were included in the multiple regression analyses. Missing data were treated using pairwise exclusions.

Data Screening and Collinearity Diagnostics

Data screening revealed negatively skewed distributions on all of the dependent variables, but this study decided not to transform the variables. The use of collinearity diagnostics in the multiple regression analyses indicated no collinearity on “satisfaction with HA/CI” (tolerance: 0.73–0.99; variance inflation factor (VIF): 1.00–1.36). The Durbin–Watson test results fell within the boundaries of acceptance (Durbin–Watson = 1.69). Similarly, an interpretation of residuals was found to be acceptable (Cook’s distance <1). The Durbin–Watson test, collinearity diagnostics, and interpretation for the residuals on “satisfaction with sound quality of HA/CI” also fell within acceptable boundaries (Durbin–Watson test: 2.12; tolerance: 0.60–0.86; VIF: 1.09–1.64; Cook’s distance <1). The following scores on the variable “satisfaction with teacher microphones” were obtained: Durbin–Watson test: 2.21; tolerance: 0.77–0.99; VIF: 1.00–1.29; Cook’s distance <1. The scores for the variable “satisfaction with student microphones” were as follows: Durbin–Watson test: 2.19; tolerance: 0.72–0.97; VIF: 1.02–1.38; Cook’s distance <1. The figures also lay within the boundaries of acceptance for the variable “utilization of HA” (Durbin–Watson test: 1.82; tolerance: 0.75–0.92; VIF: 1.10–1.32; Cook’s distance <1).

The independent variables were related to personal, environmental, and technological aspects. Some of the personal variables, such as “age of onset with HA/CI” were evaluated only in terms of satisfaction with HA/CI. Similarly “views of schools” were investigated in terms of satisfaction with microphones.

Hierarchal multiple regressions were used to assess the effectiveness of the measures in predicting levels of satisfaction with assistive hearing technologies. Table 4 analyzes the respondents’ satisfaction with the hearing technologies, and Table 5 analyzes utilization of HA. The predictors with insignificant effects on the dependent variables in a preliminary bivariate regression analysis were not included in the multiple regression analyses; in these cases, the cells appear blank, as seen in the tables. Differences emerged with regard to the predictors that had significant effects on particular dependent variables. Finally, the analysis of “utilization of HA” is presented.

Multiple regression analysis predicting attitudes to assistive hearing technologies

Note . B, unstandardized beta coefficients; CI, cochlear implants; DHH, deaf and hard-of-hearing; HA, hearing aids; SE, standard error. Predictors lacking statistical significance in the bivariate analyses on dependent variables are not given.

* p < .05, ** p < .01.

Multiple regression analysis predicting utilization of hearing aids (HA)

Note. *p < .01, **p < .01.

Satisfaction With the Sound Quality of HA/CI

The independent variables assumed to affect satisfaction with the sound quality were gender, age, use of HA or CI, hearing loss, age of onset with HA/CI, self-description, contact with DHH children, and participation in courses. In the bivariate regression analyses age of onset with an HA/CI, hearing loss, use of HA or CI, contact with DHH children, and participation in courses appeared to be significant predictors and were implemented in the multiple regression analysis.

With regard to the multiple regression control model for the other variables as seen in column 1 of Table 4 , the significant predictors were use of HA or CI (β =.185, p < .05), hearing loss ( β = .201, p < .05), and age of onset with an HA/CI ( β =.290, p < .01). The students who used a CI tended to be more satisfied with the sound quality and contributed to distributions of 3%. In addition, the students with severe hearing loss or who started using HA before school age were more likely to be satisfied with the sound quality than the students with mild to moderate hearing loss or who were fitted after school age. This unique distribution corresponded to 3% and 7%, respectively, of the total adjusted R 2 . “Participation in courses” and “contact with other DHH children” was insignificant in the multiple regression analysis.

Almost all 18 students wearing CI were satisfied with the sound quality, except for one who stated “both” because of a new CI in the other ear. Figure 1 illustrates the students’ respective satisfaction levels with the sound quality of CI and HA. A small subset of the students who used HA did not agree with the statement I like the sound in HA , whereas a relatively large group stated “both/or” and the majority agreed. An independent sample t test was conducted and showed significant differences in the sound quality scores of the users of CI ( M = 4.72, SD = 0.57) and HA ( M = 3.64, SD = 1.11, t (104) = −4.01, p = .01). High scores indicate positive attitudes.

The clustered bar chart of the distribution of I like the sound in my HA/CI between HA users and CI users ( n =112). Frequencies = n .

Satisfaction With HA/CI

The independent variables measured in the bivariate regression analyses for “satisfaction with the sound quality of HA/CI” were also used in the bivariate regression analyses for “satisfaction with HA/CI.” In addition, “satisfaction with the sound quality of HA/CI” was assumed to explain the differences in satisfaction HA/CI. The bivariate analyses showed that gender, hearing loss, age of onset with HA/CI, self-description, and satisfaction with the sound quality of HA/CI were all significant. These factors were all included in the multiple regression analysis.

Column 2 of Table 4 shows that three predictors hearing loss ( β = .231, p < .05), gender (β = .278, p < 0.001), and self-descriptions ( β = .227, p < .05) were found to be significant when each factor was controlled for in the analysis. The students with more severe hearing loss appeared to feel more positively towards HA/CI than the students with mild to moderate hearing loss, and contributed to 4% of the adjusted R 2 . The boys also tended to be more satisfied with HA/CI than the girls, and the distribution for gender was 7% of the total adjusted R 2 . In addition, the students with positive self-descriptions seemed more satisfied than the students with negative self-descriptions, and comprised 4% of the adjusted R 2 . No associations were found between this dependent variable and the degree of “satisfaction with sound quality of HA/CI” or “age of onset with HA.”

Satisfaction With Teacher Microphones

The regression analyses using “satisfaction with teacher microphones” as a dependent variable included the same independent variables as the analyses using “satisfaction with HA/CI” as a dependent variable, except that “age of onset with HA/CI” was not included. In addition, the analysis of “satisfaction with teacher microphones” included the independent variables of “views of school,” “quality of teaching,” “technical problems with teacher microphones,” and “use of a sound field system.” The preliminary bivariate regression analyses showed that gender, self-description, views of school, quality of teaching, and technical problems with teacher microphones were significant predictors. Thus, these factors were incorporated into the multiple regression analysis.

For the multiple regression analysis, three variables were significant, as shown in column 3 of Table 4 . These variables were gender (β = .212, p < .05), views of school ( β = .202, p < .05), and technical problems with the microphones ( β = .169, p < .05). The boys tended to be more satisfied with teacher microphones than the girls. The distribution of gender was 4% of the total adjusted R 2 . The students who had more positive views of school and who had experienced few problems with the equipment indicated greater satisfaction with teacher microphones. These two variables contributed to a unique explanation on 3.5% and 3%, respectively, of the total adjusted R 2 . The two other variables “self-description” and “quality of teaching” became insignificant when the study controlled for the other predictors.

Satisfaction With Student Microphones

The variables assumed to impact the students’ satisfaction with student microphones were parallel to those affecting teacher microphones satisfaction. In addition, the independent variable “I think that classmates often joke around with the microphones” was measured. The predictors with significant effects, as shown in the bivariate regression analyses, included gender, self-description, views of school, quality of teaching, errors with the student microphones, and “classmates often joke.” Hence, these predictors were included in the multiple regression analysis.

Column 4 of Table 4 shows the multiple regression analysis for “satisfaction with student microphones.” Significant predictors were gender, views of school, and technical problems with the microphones. In terms of teacher microphone and HA/CI, the boys ( β = 196, p < .05) appeared to feel more positively toward student microphones than the girls and comprised 3.3% of the variance in the dependent variable. Similar to satisfaction with teacher microphones “views of school” ( β = .305, p < .001) was a central predictor that corresponded to approximately 8% of the adjusted R 2 . Technical problems with the student microphones ( β = .246, p < .001) also impacted the students’ satisfaction. Fewer technical problems with the microphones led to higher satisfaction with the student microphones and explained 5.5% of the adjusted R 2 . When these predictors were controlled for the “self-description,” “classmates often joke around . . .” and “quality of teaching” variables became insignificant.

Utilization of HA/CI

Almost all of the students with severe hearing loss and the CI users constantly wore their personal amplifiers in school; consequently, only the students with mild to moderate hearing loss were evaluated with regard to utilization of HA. The mild to moderate hearing loss group using HA comprised 46 students. Approximately 44% of them irregularly or never wore HA during lessons and breaks, whereas 56% almost always or always used them. The main predictors anticipated to affect utilization of HA were satisfaction with HA and satisfaction with the sound quality of the HA. In addition, the independent variables of gender, age, age of onset with HA, self-description, contact with other DHH children, and participation in courses were presumed to have direct effects. Although the preliminary bivariate analyses showed that the girls used HA more regularly than the boys, this difference was not significant. Aside from the students’ satisfaction with HA and their sound quality, only the variable of “self-description” appeared significant in the bivariate regression analyses.

Table 5 shows the multivariate linear regression model, which predicts the outcomes of the dependent variable. All of the variables appeared significant (“satisfaction with wearing HA,” β = .404, p < .01, “satisfaction with the sound quality of HA,” β = .445, p < .001, and “self-description,” β = −.315, p < .05). The students satisfied with wearing HA and with the sound quality seemed more willing to use HA constantly. The prevalence of the two variables was 14% and 17%, respectively, of the adjusted R 2 . The analyses showed that self-description had the opposite effect compared with the students’ satisfaction with HA, low self-description led to greater use of HA whereas high self-description promoted greater satisfaction with HA. This variable explained approximately 7% of the total adjusted R 2 .

The present investigation of DHH children’s opinions of hearing technology aimed to explore the factors influencing students’ satisfaction with hearing technologies and utilization of HA. On the basis of findings from other studies, it was assumed that personal, environmental, and technological factors could explain the variations in the dependent variables.

The findings here indicated that all students who wore CI were satisfied with the sound quality of their CI. The students with HA who had severe hearing loss or who were fitted with an HA/CI prior to school age tended to be more satisfied with the sound quality of the HA than the students who had mild to moderate hearing loss or who were fitted after school age. According to several studies, students with CI have integrated them as natural parts of their lives ( Preisler & Tvingstedt, 2005 ; Wheeler et al., 2007 ). In addition, students with severe hearing loss may be strongly dependent on their HA, which can explain why both groups tended to be more satisfied with the sound quality. The reasons explaining why the students who are introduced to HA later on became unsatisfied may be connected to the information provided by their parents; for many of the students the hearing loss was first discovered after school age. Hearing loss diagnosed later can have particular implications; sound signals that do not reach the brain will be forgotten over time and can only be reproduced through conscious effort. Furthermore, within the first year, infants experience a reduced ability to perceive differences among phonetic contrasts that are not used or heard in their linguistic environment ( Bisgaard, 2008 ; Olaussen, 2010 ). Consequently, children who are diagnosed late may not adapt as easily to the sound provided in the HA compared with children who are diagnosed early. Although newborns can now be screened for hearing loss, universal newborn screening protocols do not target hearing loss in the minimal to mild ranges ( Johnson et al., 2005 ), and children with minimal to mild degrees of hearing loss are still not likely to be identified until approximately 5 to 6 years of age ( Tharpe, 2007 ).

The students’ satisfaction with the HA/CI appeared to be related to hearing loss, gender, and psychosocial dimensions. Having severe hearing loss seemed to make students more content with their HA/CI, as other studies have revealed ( Bertoli et al., 2009 ; Clarke & Horvath, 1979 ; Smeeth et al., 2002 ; Vesterager & Parving, 1995 ). In addition, the boys tended to be more positively oriented toward personal amplifiers than the girls. These results contradict those of other studies, where females are reported to accept their hearing loss and to use HA to a greater extent than males ( Bertoli et al., 2009 ; Coniavitis-Gellerstedt, 2006 ; Smeeth et al., 2002 ). However, the results of this study are in line with Solheim’s (2011) findings, which found more positive attitudes toward HA among elderly males than among elderly females. Nevertheless, the male effect here may be specific to the young group of children. Furthermore, consistent with other studies that have pointed to psychosocial dimensions as central explanations for attitudes and the use or nonuse of hearing technology, high levels of positive self-description was positively related to the students’ satisfaction with their HA/CI ( Cienkowski & Pimentel, 2001 ; Garstecki, 1996 ; A. Helvik, Jacobsen, & Hallberg, 2006 ; Kent & Smith, 2006 ).

The boys also tended to be more satisfied with both teacher and student microphones than the girls. In addition, the psychosocial dimension measuring the students’ “views of school” was related to satisfaction with the microphones. Interestingly, the students with positive attitudes toward the school were more content with the microphones than the students with negative views. Although hearing loss was related to satisfaction with HA/CI, no differences were found between the students with mild to moderate hearing loss and the students with severe hearing loss in terms of the students’ satisfaction with the microphones. Both teacher and student microphones seemed to be valued by both groups of students. Self-description was not related to satisfaction with the microphones or the “classmates often joke around with the microphones” variable when the other variables were controlled for, even though it would be reasonable to presume that the latter one would have a negative effect on satisfaction with the student microphones. The technical equipment such as sound field systems was thought to promote satisfaction with the assistive listening devices because it may feel less embarrassing for DHH students. However, it did not appear to be associated with the students’ satisfaction with the microphones. Use of the microphones is limited to classrooms, where the students’ hearing loss is probably well known, whereas personal amplifiers are commonly used in daily life, including settings where the students’ hearing loss is unknown; in such situations, the HA/CI may be commented upon by the students’ peers. Kent and Smith (2005) describe two different strategies for handling comments; by ignoring the comments (which would have a constructive effect) or by perceiving the situation as an unwanted and stigmatizing teasing episode. Inherent in stigmatization is a perceived risk of being identified as abnormal, which may impact children’s self-descriptions, as the current study demonstrates; low self-descriptions impacted the students’ satisfaction with the personal amplifiers, but not toward the microphones. Consequently, the type of environment in which the hearing technology is used seems to be essential. However, the assumption that frequent contact with other DHH children could be supportive and lead to positive attitudes toward hearing technologies was not associated with the students’ satisfaction. Accordingly, because the students seemed to appreciate the microphones frequent technical problems with the microphones contributed negatively to the students’ satisfaction. In total, 30% of the respondents stated that there were often technical problems with the teacher microphones, and 20% stated the same for student microphones. The frequency of technical problems is challenging and should be further explored.

This study revealed that only the students with mild to moderate hearing loss were infrequent HA wearers. Consistent with the findings of other studies, all students with CI used them constantly, and nearly all students with severe hearing loss used their HA regularly at school ( Clarke & Horvath, 1979 ; Vesterager & Parving, 1995 ). The students with severe hearing loss clearly have less choice concerning the use of their HA. The students in the group with mild to moderate hearing loss who were comfortable with wearing HA (in the sense that they felt less embarrassed or cared less about what other people thought about their HA) were more likely to use them. According to Polgar (2010) , individuals who see technology as a visible sign of disability reinforce the stigma associated with disability. Consequently, they avoid using the technology, as these results indicate.

The students satisfied with the sound quality also tended to be consistent wearers of HA. This study revealed that several HA users were more dissatisfied with the sound quality than the CI users, nearly all of whom were satisfied with the sound quality. Cameron et al. (2008) reported similar findings and found that approximately 16% of 57 young adults were dissatisfied with the sound quality of their HA, 30% were unsure, and 53% were satisfied. Others have also pointed to sound quality as the most frequently reported problem by adults ( Bertoli et al., 2009 ). This study seems to support Bertoli et al., who claim that, despite the advances in digital hearing aid technology and noise suppression algorithms, amplification may fail in a subgroup of HA users. In Heeney’s (2007) study, the young participants proposed two recommendations that could improve their satisfaction with personal amplification systems; better access to information regarding hearing aid options and better sound quality in HA. In line with this finding, 43% of the students in the pilot study reported being unfamiliar with their HA options, including the number of applications and what they represented ( Rekkedal, 2007 ). In addition, Heeney reported that several of the adolescents had negative attitudes toward the hearing service providers, with only 64.9% of the respondents feeling that their audiologists cared about their hearing. These issues were not touched upon in this study, but because the sound quality posed a problem for DHH children and impacted their uses of HA, this issue would also benefit from further consideration and investigation.

Surprisingly, although the boys were more positive toward the use of HA, this perception did not seem to have any bearing on their use of HA. Instead, the girls appeared to use HA more regularly, even though they did not appreciate using them. Consequently, the effect resulting from the boys’ satisfaction with the use of HA became unimportant. Although, positive attitudes toward HA influence their use, the psychosocial aspect of self-description had the opposite impact, whereas positive self-descriptions indicated positive attitudes toward HA, a negative self-description predicted constant use in this case. The cause for this relationship is unclear but may be related to gender. The girls generally appeared to have significantly lower self-descriptions that the boys, who rated their self-descriptions higher. Other studies concerning self-esteem and self-descriptions among adolescents describe parallel differences in gender; girls generally rank themselves lower than boys ( Gadbois & Bowker, 2007 ; Moksnes, Moljord, Espnes, & Byrne, 2010 ). Because the girls in this group tended to use HA more frequently, a lower self-description may be related to constant use; thus, gender can be an underlying factor in understanding DHH students’ uses of HA. The group also differed from the total sample regarding independent variables with impacts on “satisfaction with HA”; gender did not predict any significant differences, whereas “age of onset with HA” appeared to be significantly related in this group. In addition, the number of respondents was low and therefore more difficult to analyze.

A relatively large portion of the students (i.e., approximately 38%) received their first HA after starting their compulsory education. Still, the findings here did not support the argument that having students fitted early on with HA directly influenced their utilizations of HA: rather to a certain degree, the results supported the findings of Vesterager and Parving (1995 ), who did not find differences between students fitted early and those fitted late, which may disprove Gillies’s (1997) findings that implicate age of intervention as a main factor. However, age of intervention seemed to have an indirect effect on the utilization of HA in this group; the students who received later interventions with HA tended to feel more negatively about the sound quality of their HA and less satisfied with the HA. This finding indicates that children fitted later with HA may be a group at risk that requires follow-up by professionals.

Students with mild hearing loss are reportedly more often ignored by teachers because they are believed to function more easily and have less need for support services than students with severe hearing loss ( Convertino, Marschark, Sapere, Sarchet, & Zupan, 2009 ). However, poor listening conditions in classrooms can create considerable difficulties for students with mild hearing as well ( Antia, Jones, Reed, & Kreimeyer, 2009 ). In addition, previous findings indicate that these students’ academic levels lag behind their hearing peers’ academic performance ( Daud, Noor, Abd Rahman, Sidek, & Mohamad, 2010 ). Accordingly, professionals should be attentive to this group, as these students use HA more irregularly at school, which may further reduce their abilities to understand classroom communications.

Several studies have pointed to children’s ages as an explanation for the differences in students’ views of and willingness to use HA ( Clarke & Horvath, 1979 ; Coniavitis-Gellerstedt, 2006 ; Wennergren, 2008 ; Winn, 2006 ). The findings here did not show any differences between students in primary and secondary school on students’ satisfaction with assistive hearing technologies or the use of HA. Some studies have shown that the main decrease in use of HA occurs after the transition from elementary to high school ( Gellerstedt, 2006 ; Winn, 2006 ). In this study, no students at the high school level participated, which may explain the absence of similar findings.

Because the study had a low response rate, care should be exercised in the generalizing these findings to the total population of hearing-impaired children. There was a particular focus on the following set of dimensions: (a) personal factors, such as age, and self-description; and (b) technical factors, such as type of equipments, sound quality, and technical problems. These may offer likely explanations for the variances seen in the respondents’ attitudes towards the hearing technologies. If the study had included data on specific audiograms, design, visibility, types of HA and microphones, fuller explanations could have been obtained. Because the effects and causes of the students’ utilizations of HA were difficult to construe care should be exercised in the generalization of these findings. Access to the audiograms may perhaps have improved the explanation of the predictors of students’ utilizations of HA.

No conflicts of interest were reported.

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National Association of the Deaf v. Harvard & MIT

Status Past Case

Practice area Civil Rights & Employment

Court U.S. District Court for the District of Massachusetts

Case number 3:15-cv-30023, 3:15-cv-30024

On February 18, 2020, the National Association of the Deaf, C. Wayne Dore, Christy Smith, Lee Nettles, and other deaf and hearing-impaired plaintiffs announced a landmark civil rights settlement with the Massachusetts Institute of Technology that establishes one of the most comprehensive sets of online accessibility requirements in higher education and ensures that MIT will provide high-quality captioning services for all of its university-sponsored online content for individuals who are deaf or hard of hearing. On November 27, 2019, the National Association of the Deaf announced a similar landmark settlement with Harvard University. (The consent decree with Harvard was approved by the court on February 26, 2020. The court order granting final approval of the MIT settlement was issued on July 21, 2020.)

Together, the injunctive relief of both settlements, which, respectively, require both institutions to provide high-quality captioning services for all online content, including online courses, pod-casts, and certain live-streamed events, which are accessible to the public through all university and university-sponsored online platforms, such as YouTube, Vimeo and SoundCloud, is not only the most comprehensive in higher education, but ground-breaking and historic in scope for academia and business – worldwide. MIT and Harvard research tools, seminars, case studies, books, and periodicals, including Harvard Business Review, are among the most highly sought-after education tools for students, professionals and businesses world-wide. Such injunctive relief sets a precedent for other academic institutions and businesses to make similar accommodations for deaf and hearing-impaired people and to reevaluate their compliance with the Americans with Disabilities Act (ADA) and Rehabilitation Act, generally. Similarly, such immediate accommodations by Harvard and MIT will likely open new career doorways for deaf and hearing-impaired students and professionals, while establishing new frontiers in academic and professional learning.

Cohen Milstein was co-counsel in this class action, working alongside of Disability Rights Education & Defense Fund (DREDF), Civil Rights Education and Enforcement Center (CREEC), and the Disability Law Center (DLC), and the National Association of the Deaf.

Case Background

The two putative class actions were each originally filed on February 12, 2015 before the United States District Court for the District of Massachusetts. Both putative class actions against Harvard and MIT, alleged violations of the ADA and the Rehabilitation Act because of the universities failure to provide closed captioning in their online lectures, courses, podcasts and other educational materials.

Plaintiffs allege in both cases that Harvard and MIT make available a variety of online content on their websites that have received, to date, millions of visitors. The institutions make thousands of videos and audio tracks publicly available for free to anyone with an Internet connection, on broad-ranging topics of educational or general interest.

Plaintiffs further allege that while Harvard and MIT claim that their respective online content – which constitutes important services, privileges and advantages that it provides to the general public – is, in Harvard’s case part of its “commitment to equity” which “calls on [it] to create effective, accessible avenues for people who desire to learn but who may not have an opportunity to obtain a Harvard education,” and in MIT’s case is “open and available to the world,” both institutions have largely denied access to this content to the approximately 48 million Americans who are deaf or hard of hearing, many of whom require captioning to meaningfully access the audio component of online audiovisual and audio content. Specifically, plaintiffs claim, much of Harvard and MIT’s online content is either not captioned, or is inaccurately or unintelligibly captioned, making it inaccessible for individuals who are deaf or hard of hearing.

By not providing captioning, plaintiffs allege, Harvard and MIT deprive deaf and hard of hearing individuals the benefits of its online content, benefits afforded to nondisabled individuals, thereby increasing the sense of isolation and stigma that Title III, as well as Section 504, were meant to redress for individuals with disabilities.

Accordingly, plaintiffs seek injunctive and declaratory relief to ensure that deaf and hard of hearing individuals have equal, effective, and timely access to Harvard’s publicly available online content.

On June 25, 2015 the U.S. Department of Justice filed a statement of interest in both putative class actions against Harvard and MIT, supporting plaintiffs’ position that the universities’ provision of free online video content to the public discriminates against Deaf and hard of hearing individuals, “Plaintiffs’ claim falls squarely within the protections afforded by the ADA and Section 504. Both the ADA and Section 504 currently obligate (MIT and Harvard) to provide effective communication to ensure equal access to its online programming services, and resolution of Plaintiffs’ claim involves a straightforward application of longstanding statutory and regulatory requirements.”

In February 2016, Magistrate Judge Katherine A. Robertson denied both of the universities’ motions to stay the lawsuits pending the DOJ’s issuance of regulations governing website accessibility, stating that such a stay would only further compromise the ability of plaintiffs to access and use their websites.

The case names are:

National Association of the Deaf et al. v. Harvard University et al.; Case No. 3:15-cv-30023; U.S. District Court for the District of Massachusetts, Western Division

National Association of the Deaf et al. v. Massachusetts Institute of Technology, et al.; Case No. 3:15-cv-30024; U.S. District Court for the District of Massachusetts, Western Division

• Complaint (Harvard) - February 12, 2015
• Complaint (MIT) - February 12, 2015
• U.S. Dept. of Justice Statement of Interest - June 25, 2015
• Report & Recommendation on Defendants Motion to Stay - February 9, 2016
• Memorandum & Order on Defendants Motion for Judgement on the Pleadings - March 28, 2019
• Motion for Preliminary Approval of Settlement (Harvard) - November 27, 2019
• Motion for Preliminary Approval of Settlement (MIT) - February 18, 2020
• Consent Decree (Harvard) - February 26, 2020
• Order - Final Approval of Settlement (MIT) - July 21, 2020
• Joseph M. Sellers
• “MIT Has Agreed to Make Its Website and Online Educational Videos More Accessible to People Who Are Deaf and Hard of Hearing,” NPR National
• MIT to Caption Online Videos After Discrimination Lawsuit
• Landmark Agreements Establish New Model for Online Accessibility in Higher Education and Business

EDUCATIONAL PRACTICES AND CHALLENGES OF STUDENTS WITH HEARING IMPAIRMENT IN ARBA MINCH COLLEGE OF TEACHERS EDUCATION, SOUTH ETHIOPIA

• Tesfaye BASHA Hawassa University, Department of Special Needs and Inclusive Education, Ethiopia https://orcid.org/0000-0003-3750-9671
• Tadesse ENGIDA Arba Minch University, Department of Special Needs and Inclusive Education, Ethiopia https://orcid.org/0000-0002-9296-3394
• Muluken TESFAYE Arba Minch University, Department of Special Needs and Inclusive Education, Ethiopia https://orcid.org/0000-0002-5608-6726

This study was aimed at assessing educational practices and challenges of students with hearing impairments in Arba Minch College of Teachers’ Education in SNNPR, Ethiopia. In order to obtain a comprehensive understanding academic practices and challenges and ways of improving that impede students with hearing impairments in integration setting. Qualitative research approach of case study design was used to analyze the data. Purposive sampling was employed to select a total of 28 participants; 6 students with hearing impairments, 4 hearing peers, 12 instructors, 4 department heads and 2 college deans. The qualitative data were obtained via interviews, focus group discussion and observation. The finding revealed that there is high communication barrier between teachers and students with hearing impairments. This communication barrier contributed for poor academic performances. The findings of the study revealed that, there is academic achievement gap between students with hearing impairments and hearing students. In addition, limitations of sign language skills, lack of planned financial fund and material support, absence of sign language interpretation, lack of hearing aids were the identified practice and challenges of students with hearing impairments. The study suggested that college administration and teachers can play a critical role in enabling students with hearing impairments to become meaningful participants in education system and society.

Keywords: Educational practices, Challenges, Integration, Hearing impairment

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Machine Vision and Augmented Intelligence pp 539–551 Cite as

Assistive Technology for Blind and Deaf People: A Case Study

• Kondaveeti Aashritha 40 &
• V. M. Manikandan 40  
• Conference paper
• First Online: 01 May 2023

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1 Citations

Part of the book series: Lecture Notes in Electrical Engineering ((LNEE,volume 1007))

As per the details from the World Health Organization (WHO), visual impairment affects 285 million individuals globally. The total number of deaf people is also extreme all over the world. This paper shows the major issues, worries, and obstacles that blind people face, as well as the numerous ways that technology can assist them. This manuscript discusses recent advancements in the domain of assistive technology for blind and deaf people and also aims to give an overview of the assistive technologies available for the blind and deaf so that the researchers can work on this domain to come up with new solutions, or they can improve the existing products. Various research challenges in this domain are also briefly discussed in this manuscript.

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Kondaveeti Aashritha & V. M. Manikandan

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Department of Computer Science and Engineering, National Institute of Technology Jamshedpur, Jamshedpur, India

Koushlendra Kumar Singh

Department of Computer Science and Engineering, IIITDM Jabalpur, Jabalpur, India

Manish Kumar Bajpai

Leeds Beckett University, Leeds, UK

Akbar Sheikh Akbari

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Aashritha, K., Manikandan, V.M. (2023). Assistive Technology for Blind and Deaf People: A Case Study. In: Kumar Singh, K., Bajpai, M.K., Sheikh Akbari, A. (eds) Machine Vision and Augmented Intelligence. Lecture Notes in Electrical Engineering, vol 1007. Springer, Singapore. https://doi.org/10.1007/978-981-99-0189-0_42

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Challenges faced by Hearing Impaired pupils in learning: A case study of King George VI Memorial School

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The study analysed the challenges faced by schools when imparting prevocational skills to learners with hearing. The mixed methods design was used. Data was collected from a representative sample of 10 teachers and 30 learners with hearing impairments using questerviews and focus group discussions respectively. The results showed that The major challenges faced included poor communication and language skills, lack of proficiency in sign language, shortage of resource materials to use and the negative attitudes by staff members. For improvement it was suggested that teachers and students all need to learn sign language as it is now one of the official languages in Zimbabwe. There is also need for specialists teachers to act as sign language interpreters when the need arises. In addition students need to be provided with hearing aids to enhance their hearing and improve their participation in class. Lastly it was recommended that the acoustics of classroom settings be improved so as to minimize environmental noises and other sounds that may interfere with the amplification of sounds.

Simeon Gwayi

Article History Received: 26 March 2020 Revised: 1 May 2020 Accepted: 29 May 2020 Published: 22 June 2020

International Journal of Scientific and Research Publications (IJSRP)

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Tichaona Mapolisa

Children with hearing impairment have experienced discrimination from regular education. In the past, such children were institutionalised in separate classes or schools. According to Vayrynen (2000), most schools have been failing students with disabilities by denying them access to appropriate facilities. Children with hearing impairment have the right to be included in a least restrictive environment. Foster (1990) argues that to deny any child the opportunity to learn with their age mates age-mates and peers on grounds of an impairment is tantamount to jeopardising their later opportunity of living fully in a multi-cultural society. The Education Act (1987) in Zimbabwe stipulates that children with disabilities should be accommodated in ordinary schools for the purposes of learning. However, most teachers in Zimbabwean schools did not receive training on the teaching of children with impairments. It is on account of this that this present study attempts to gain insights into how children with hearing impairment benefit from learning in an inclusive environment with children whose hearing has no challenges. This article draws on a qualitative inquiry of teachers' experience in handling children with hearing impairment in their classrooms. A small sample of twenty (20) teachers comprising of ten (10) males and ten (10) females at Gomadoda cluster was chosen using purposive sampling. An interview schedule was used to collect data. Responses from respondents were captured and summarised to discern common patterns and then analysed and discussed. The study revealed that there are various problems met by children with hearing impairment in ordinary schools. The findings affirmed the assumption that most regular teachers lacked the necessary expertise and did not have adequate resources to handle children with hearing impairment. The study recommends that regular teachers undergo in-service programmes on how to effectively handle children with hearing

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The study explores the communication challenges faced by teacher trainees in teaching deaf learners and the opportunities that they present. A critical disabilities study approach within the qualitative paradigm was employed to collect interview data from 14 trainee teachers (6 were men and 8 women) and 5 of their specialist mentors (all of them were women) at 3 special schools in Zimbabwe. The trainees were aged 28-45. Data were analyzed using theme identification methods. Results showed that all the mentors and trainees without deaf assistants tended to teach using spoken language and even though they had no prior experience with them, they were suspicious of the use of deaf assistants, whom they saw as synonymous with sign language. Scepticism about using sign language was based on the idea that it was inadequate, would interfere with spoken language development, and would not enable learners to be included in a nondeaf world. It was also established that most of the mentors and ...

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One is learning when he is increasing the probability of making a correct response to a given stimulus. One has learned only when he is capable of giving an appropriate response. The 8.4.4 Curriculum of Education is followed in education of hearing impaired in special schools and units. Hence just as the case in regular education, the hearing impaired are expected to learn and perform well academically. Statement of the Problem was that children with hearing impairments are typically not educationally managed well to permit them compete satisfactorily in the society. The study aimed at investigating factors hindering effective learning of children who are hearing impaired in one special primary school and units in Meru North District in Eastern Province of Kenya. Education being a basic human right, children who are hearing impaired successful learning, needs to be emphasized and factors hindering it to be addressed. Literature was reviewed on trends in the education of children who...

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Nicolay, William L. "The Use of Efficient Information Systems for Information Acquisition by the Hearing Impaired: A Case Study." PDXScholar, 1989. https://pdxscholar.library.pdx.edu/open_access_etds/1128.

Tso, Amy, and 曹莉莉. "Consonant production in integrated hearing impaired primary children: evaluation of training." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1990. http://hub.hku.hk/bib/B38627103.

Bell, Diane. "Investigating teaching and learning support for students with hearing impairment at a university in the Western Cape." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/80004.

Tsang, Lai-yuen Lance, and 曾麗婉. "Perceptions of students, parents and professionals towards supportive remedial services and integration." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1997. http://hub.hku.hk/bib/B31959854.

LaLonde, Kirsten M. "Teaching Music to the Hearing Impaired." Thesis, Minot State University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10684252.

Elementary music teachers often have students who are hard-of-hearing participating in their classes. Teachers need to be aware of what hearing impairments are and how these hard-of-hearing students have entered the music classroom. The present text explores assistive hearing technology, general music education for students with hearing loss, adaptations for the general music classroom, instrumental music for students with hearing loss and a brief explanation of song signing. The author attempts to better understand which strategies can be used to improve the music education of hard-of-hearing students.

Yuen, Siu-wah. "Policy and practice on special education : a comparison of education for the hearing impaired in Hong Kong and Macau /." Hong Kong : University of Hong Kong, 1998. http://sunzi.lib.hku.hk/hkuto/record.jsp?B2005791X.

Fernandez, Mary Ann Z. "A CASE FOR DANCE IN THE EDUCATIONAL EXPERIENCE OF THE HEARING IMPAIRED." Thesis, The University of Arizona, 1987. http://hdl.handle.net/10150/276431.

Carson, Kerrie, University of Western Sydney, of Arts Education and Social Sciences College, and School of Education and Early Childhood Studies. "The inclusive education of students with a hearing impairment : a case study inquiry." THESIS_CAESS_EEC_Carson_K.xml, 2001. http://handle.uws.edu.au:8081/1959.7/50.

Chan, Kwok-kuen Ernest, and 陳國權. "The self-esteem of the hearing-impaired junior secondary pupils in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1990. http://hub.hku.hk/bib/B38625994.

Carson, Kerrie Patricia. "The inclusive education of students with a hearing impairment : a case study inquiry /." View thesis View thesis, 2001. http://library.uws.edu.au/adt-NUWS/public/adt-NUWS20030514.135321/index.html.

Gomes, Mariana Szymanski Ribeiro. ""Plano de ação participativa para a identificação da deficiência auditiva em crianças de 3 a 6 anos de idade de uma comunidade de baixa renda"." Universidade de São Paulo, 2004. http://www.teses.usp.br/teses/disponiveis/5/5160/tde-29092005-230328/.

Yuen, Siu-wah, and 阮兆華. "Policy and practice on special education: a comparison of education for the hearing impaired in Hong Kong andMacau." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1998. http://hub.hku.hk/bib/B31960625.

Dempsey, Donna Jean. "An experimental analysis of opportunity and communication response form in a child with autism and hearing impairments." Thesis, University of North Texas, 2007. https://digital.library.unt.edu/ark:/67531/metadc5188/.

Sayre, Carol I. "Using a Computer Program to Influence the Expectations Senior Adults have Regarding Hearing Aids." PDXScholar, 1995. https://pdxscholar.library.pdx.edu/open_access_etds/5052.

Whiteley, Teresa Michelle. "The Effectiveness of a Self-directed Inservice Program to Educate Teachers about the Classroom Needs of Students with Hearing Impairment." PDXScholar, 1996. https://pdxscholar.library.pdx.edu/open_access_etds/5141.

Melander, Hilary Ann. "An Evaluative Case Study of a Mathematics Program at a Deaf School in Ghana and an Ecological Explanation for Challenges Preventing Deaf Students Access to Quality Education." Diss., CLICK HERE for online access, 2008. http://contentdm.lib.byu.edu/ETD/image/etd2669.pdf.

Santos, Ednalva Pereira dos. "O processo de inclusão do aluno surdo no ensino regular : estudo de caso." Master's thesis, 2019. http://hdl.handle.net/10437/9532.

Silva, Izabel Cristina de Vasconcelos e. "A prática metodológica na alfabetização de estudantes surdos inclusos em escolas regulares : um estudo de caso." Master's thesis, 2016. http://hdl.handle.net/10437/7419.

Oliveira, Anisio José Moraes de. "Políticas públicas relacionadas à formação de professores que atuam na educação de surdos em Belém do Pará." Master's thesis, 2016. http://hdl.handle.net/10437/7194.

Silva, Polliana Barboza da. "A inclusão do estudante surdo no ensino superior: das percepções de estudantes surdos e seus professores às práticas de sala de aula. Estudo de caso." Master's thesis, 2015. http://hdl.handle.net/10437/6904.

Negash, Kahsay Hailu. "The inclusion of visually-impaired learners in Ethiopian secondary schools." Thesis, 2017. http://hdl.handle.net/10500/23484.

Van, Horn Denny Allen Francis Mondrágon Jack. "Processes and patterns of dialog between deaf and hearing siblings during play." Thesis, 1999. http://hdl.handle.net/2429/10126.

Van, Horn Dennis. "Processes and patterns of dialog between deaf and hearing siblings during play." Thesis, 1999. http://hdl.handle.net/2429/10126.

Madungwe, Louise Stanley. "Opportunity to learn Mathematics : the case of visually impaired secondary school students in Zimbabwe." Thesis, 2018. http://hdl.handle.net/10500/25011.

Erradu, Jordan. "Learner support to foundation phase learners who are intellectually impaired : a case study." Diss., 2012. http://hdl.handle.net/10500/7735.

Constantinidou, Elena Standley Jayne M. "Five case studies 1. CT scanning with hearing impaired children ; 2. Music therapy for Parkinson's, Alzheimer's and stroke patients ; 3. Music therapy for non-patients in a hospital setting ; 4. Review of pain assessment forms and their applicability to music therapy ; 5. Guitar instruction with a practicum college student /." Diss., 2003. http://etd.lib.fsu.edu/theses/available/etd-12162003-174915/.

Havelková, Pavlína. "Nedoslýchavý člověk v procesu edukace." Master's thesis, 2017. http://www.nusl.cz/ntk/nusl-355874.

Ramos, Rosane Malcher. "A gestão do centro de apoio pedagógico que realiza atendimento a educandos cegos no Estado do Amapá." Master's thesis, 2018. http://hdl.handle.net/10437/10382.

Tinoco, Joana Margarida Machado da Silva Ribeiro. "Comunicação em matemática com alunos com deficiência auditiva: estudos de caso numa turma do 2.º ciclo do ensino básico." Doctoral thesis, 2019. http://hdl.handle.net/1822/64911.

Trindade, Francisco Benicio Santos de Moraes. "Educação inclusiva : os desafios e práticas dos professores do ensino médio de alunos surdos da Escola de Teresina - Piauí." Master's thesis, 2016. http://hdl.handle.net/10437/7878.

Sousa, Gracinda da Cruz Machado de. "O aluno com deficiência motora e a acessibilidade arquitectónica no Ensino Básico : um estudo de caso : o concelho de Guimarães." Doctoral thesis, 2009. http://hdl.handle.net/10437/1167.

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In some classrooms in Senegal, deaf and hard-of-hearing students now study alongside everyone else

Mouhamed Sall, who is deaf, attends class at the Guinaw Rail Sud public high school in Pikine, Senegal, Monday, March 18, 2024. Sall and three other students are part of a new approach in a small number of schools in Senegal that seat those who are deaf and hard of hearing with the rest of the class. (AP Photo/Sylvain Cherkaoui)

Mouhamed Sall, who is deaf, sits on the steps of the Guinaw Rail Sud public high school in Pikine, Senegal, Monday, March 18, 2024. Sall and three other students are part of a new approach in a small number of schools in Senegal that seat those who are deaf and hard of hearing with the rest of the class. (AP Photo/Sylvain Cherkaoui)

Mouhamed Sall, who is deaf, communicates by sign with his classmates at the Guinaw Rail Sud public high school in Pikine, Senegal, Monday, March 18, 2024. Sall and three other students are part of a new approach in a small number of schools in Senegal that seat those who are deaf and hard of hearing with the rest of the class. (AP Photo/Sylvain Cherkaoui)

Mouhamed Sall, who is deaf, communicates using sign language at the Guinaw Rail Sud public high school in Pikine, Senegal, Monday, March 18, 2024. Sall and three other students are part of a new approach in a small number of schools in Senegal that seat those who are deaf and hard of hearing with the rest of the class. (AP Photo/Sylvain Cherkaoui)

Mouhamed Sall, who is deaf, communicates by sign with his mother Khadiatou Koundio as he arrives home from school in Pikine, Senegal, Monday, March 18, 2024. Sall and three other students are part of a new approach in a small number of schools in Senegal that seat those who are deaf and hard of hearing with the rest of the class. (AP Photo/Sylvain Cherkaoui)

Mouhamed Sall, who is deaf, and known for his talent for drawing and manual activities, paints a small house he built in Pikine, Senegal, Monday, March 18, 2024. Sall and three other students are part of a new approach in a small number of schools in Senegal that seat those who are deaf and hard of hearing with the rest of the class. (AP Photo/Sylvain Cherkaoui)

Mouhamed Sall, who is deaf, walks home after school in Pikine, Senegal, Monday, March 18, 2024. Sall and three other students are part of a new approach in a small number of schools in Senegal that seat those who are deaf and hard of hearing with the rest of the class. (AP Photo/Sylvain Cherkaoui)

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PIKINE, Senegal (AP) — Mouhamed Sall stepped to the chalkboard with a glance and quick question in sign language to an assistant. Then he solved the exercise to the silent approval of his classmates, who waved their hands in a display of appreciation.

Sall and three other students are part of a new approach in a small number of schools in Senegal that seat those who are deaf and hard of hearing with the rest of the class.

Some classmates at the sun-washed Apix Guinaw Rails Sud school in a suburb of the capital, Dakar, have embraced the chance to learn sign language in the months since Sall arrived. The class is lively and cheeky: “No teachers allowed in this room,” graffiti scrawled above the chalkboard says.

“I have no problem communicating with some colleagues I went to primary school with,” Sall said as his mother spoke. “The new colleagues don’t know sign language but we still play together.”

“We’ve been friends, so it was easy to learn sign language,” said classmate Salane Senghor, who also knew Sall in primary school. New classmates were curious, looking to the assistant to find out what he was saying.

The United Nations children’s agency says about 60% of children with disabilities in Senegal are not going to school. But the government lacks comprehensive data on the issue and counts only children who are formally registered as having a disability.

“We’re looking for progress from the government to ensure every child, regardless of ability, has the opportunity to learn,” said Sara Poehlman with UNICEF Senegal.

Senegal lacks a national strategy for inclusive education, but it is developing one. Recent political instability in the West African nation has hindered progress.

The challenges are compounded by a stigma that some in Senegal associate with disabilities. Some parents hide their children and prevent them from participating in society.

But attitudes are changing. In 2021, Senegal’s football team for deaf and hard of hearing players won the first African football championship for such teams and played in the world championship, to the congratulations of Senegal’s president. During the recent election, the National Association for the Promotion of the Deaf in Senegal and the International Foundation for Electoral Systems organized a workshop to teach hard-of-hearing voters over 100 election-related terms in sign language.

Now there’s more visibility in classrooms.

The organization Humanity and Inclusion last year began partnering with Senegal’s education ministry for mixed classes in four public secondary schools with inclusive education practices. Apix is one of them. Humanity and Inclusion funds the hiring of assistants who can communicate in sign language.

“We see that all children are on an equal footing, and that’s why we make an inclusive class or school by harmonizing with the hearing pupils,” said Papa Amadou, one assistant.

Sall is receiving education free of charge, a big advantage in a part of the world where school fees can be a constant source of stress for parents.

Until now, Senegal has had mostly specialized schools for children with disabilities, but they are often private and expensive.

Sall’s mother, Khadija Koundio, at first paid about $17 every month for him to attend an activity center for children with learning challenges in their neighborhood. Then he was able to enter primary school with the support of a similar Humanity and Inclusion program created several years ago in a small number of schools for younger students.

Omar Diop, head supervisor at Apix, praised the new secondary school program but said challenges continue.

“It’s their first year for the teachers, so that poses a problem because the children come with a much higher level of sign language,” Diop said.

Mamadou Konte, the Apix school director, emphasized the need for more teacher training. “We’ve seen success at our school, but this model needs to be replicated nationwide,” Konte added.

Mouhamed Sall, who is deaf, communicates using sign language at the Guinaw Rail Sud public high school in Pikine, Senegal, Monday, March 18, 2024. (AP Photo/Sylvain Cherkaoui)

Challenges remain for students and families, too. Koundio, president of the parents’ association for the school’s deaf and hard-of-hearing students, said some of her son’s classmates live farther away and struggle with the cost of commuting.

Poehlman with UNICEF highlighted government initiatives like the Carte de l’Égalité, which provides financial assistance to families so children can access specialized schools, but she stressed the importance of programs implemented in public schools.

Jandira Monteiro with Humanity and Inclusion urged collaboration between Senegal’s ministries of health and education to ensure holistic support for children with disabilities.

Sall said he feels accepted by his peers. The teachers at Apix commend him on his intelligence and his artistic talents in crafting bright models of houses and traditional boats called pirogues.

His mother wants him to pursue his passions, including art.

“One day, when I’m gone, he’ll have enough to support himself,” she said.

Ndeye Sene Mbengue in Dakar, Senegal, contributed to this report.

The Associated Press receives financial support for global health and development coverage in Africa from the Bill & Melinda Gates Foundation Trust. The AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org .

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US Court of Appeals for the Fourth Circuit holds hearing at USC Joseph F. Rice School of Law

The Karen J. Williams Courtroom was standing room only on Thursday morning, March 28 for oral arguments heard by Chief Judge Albert Diaz, Judge A. Marvin Quattlebaum, Jr. ‘89, and Judge William B. Traxler, Jr. ‘73 of the U.S. Court of Appeals for the Fourth Circuit.  

The three cases dealt with issues of social security, criminal charges, and insurance. On the docket were Donna Ard v. Martin O'Malley; United States of America v. Herbert Diaz; and Koppers Performance Chemicals, Inc. v. Argonaut Midwest Insurance Company.  

University of South Carolina Joseph F. Rice School of Law students were given the opportunity to attend arguments and after the hearings could ask the judges questions. Students were interested in the judges' opinions on presentation style, how they approach their decisions, and how to succeed in the legal profession.  

Traxler reminded future lawyers to spend adequate time preparing their cases so they can confidently and directly answer any questions.   

“Look for experiences to get on your feet. Some of those things are hard to come by,” Quattlebaum said. “When you get to a firm look for opportunities, like pro bono work, to improve your craft and develop your skills.”  

Diaz concluded the session by thanking Dean William Hubbard for hosting the hearing and acknowledging the appropriateness of the venue given its namesake, the Honorable Karen J. Williams ‘80.  

“It’s fitting that we heard arguments in the courtroom named for our colleague,” Diaz said, referring to Williams, who was the first woman to sit on the 4th Circuit, as well as their first woman Chief Judge. “She left an indelible mark on the legal profession and we’re grateful to be here today.”  

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