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Stuart Kamenetsky

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DEAFNESS AND THE TREATMENT 1   Introduction The human experience is defined by the interaction one has with their surroundings based on the five senses, and how these senses adapt to affect the interaction further. A privilege to have, sight, touch, smell, taste and sound shape who we are, chiselling and fine-tuning the mould of the being. The absence of one is sorely missed, and can dramatically impact the affected individual, as sound is necessary for the development of critical skills. With a prevalence of approximately 1 of 1000 live births, profound deafness (PD) is diagnosed with the help of an audiogram which displays substantial loss of use of any frequency audible to humans (Copeland & Pillsbury, 2004). Most cases are due to the loss of hair-cells found in the inner ear, limiting the transduction of sound in the outside environment into neural information (Copeland & Pillsbury, 2004). Unable to hear any significant amount of sound otherwise audible to the normally hearing, these individuals have difficulties in perceiving speech, and potentially learning. Irrespective of the cause, the problem is rooted in the process of learning: the perception of sound is critical in engaging children, which affects the development of language, including understanding, reading, writing and speaking, is directly linked to the perception of sound (Geers & Brenner, 2003). Thus, the success of a child’s literacy is clearly dependent on sound, and any disorders of which should be addressed as soon as possible to prevent developmental delays and difficulties across both the academic and the psycho-social spheres of life: higher rates of mental health problems, poor social competence, poor acceptance by peers, and communication difficulties have been reported (Edwards, Hill & Mahon, 2012; Zheng et al., 2012). Currently, individuals that suffer from PD have a few options for treatment. Cochlear implant (CI) is used to replace damaged cochlea in those with severe to profound deafness DEAFNESS AND THE TREATMENT 2   (Fitzpatrick et al., 2012). Time being of the essence, the placement of a CI before the age of 5 translates into better word recognition, speech production, and greater speech and language scores (Geers & Brenner, 2003; Copeland & Pillsbury, 2004). Furthermore, “the earlier the better” finding is further exemplified by findings illustrating significantly “normal” language acquisition, speech perception, intelligibility, and spoken language if CI is placed in a child before 18 months compared to 19-30 months (Geers & Brenner, 2003). This translates into a significant improvement in the quality of life (QofL) of children in terms of communication, independence, emotional well-being, and acceptance by peers, whether with or without additional disabilities (Edwards, Hill & Mahon, 2012). An alternative treatment is the use of other hearing aids (HAs), mostly used for patients suffering from moderate to severe hearing loss, not as extensive that would require the use of CI (Fitzpatrick et al., 2012). Hearing aids have significant benefit for affected individuals in the development of core language skills, receptive vocabulary, and literacy (Fitzpatrick et al., 2012). However, there have been reports with mixed reviews when comparing HAs with CI, with some reports finding the developmental trajectory of language with the use both devices to be similar, whereas others suggesting CI to be more beneficial (Zheng et al., 2012; Yoshinaga-Itano, Baca & Sedey, 2010). Both have their disadvantages: HAs are noted to be embarrassing (with their physical presence quite evident) and not as effective as CI; whereas CI requires surgery for implantation, possible re-surgery for replacement upon failure, as well as its failure to adequately detect or discern speech with light speaking or in loud environments. Furthermore, the failure of CI is reason for great anxiety due to their dependence on audition for communication (Wheeler, Archbold, Gregory & Skipp, 2007). Regardless, their overall benefits to the development of language skills cannot be denied, and the refusal of such devices to children would inevitably make their future more difficult. DEAFNESS AND THE TREATMENT 3   Educational techniques mainly provided to help the deaf learn are usually dichotomized into oral communication (OC; dependence on speech and audition) or total communication (TC; manual English - ASL - accompanies speech), based on the philosophies of oralism and manualism, respectively (Geers & Brenner, 2003). Evidence indicates that OC programs have better speech perception and production, and language improvement post-CI, compared to TC programs which exhibit better vocabulary improvement (Geers & Brenner, 2003). Furthermore, OC programs allow for children to grow with great potential, allowing them to be included into mainstream education programs easily, and have also been linked to higher IQ scores (Geers & Brenner, 2003). A notable disadvantage of this teaching technique is that it requires PD children to have some form of hearing assistance, disadvantages of which have been mentioned afore. The manualism off-shoot bicultural-bilingual (BB) teaching approach suggests for deaf individuals to learn American Sign Language (ASL) first, followed by English as their second language (Evans, 2004). Intervention with ASL helps facilitate the production of a visual language base, which is then transferred into English literacy, allowing the children to be bilingual, thus sensitive to both the Deaf and non-Deaf cultures (Geers & Brenner, 2003). Children taught with the TC method have higher self-esteem scores, which are positively related to reading level, compared to OC-taught children, possibly owing to the definitive sense of Deaf culture (Geers & Brenner, 2003). However several factors may prevent effective learning: there is no prescribed balance between the use of ASL or English in educational programs, with disagreement in literature about English being spoken or written, compounded with the variety of forms of sign language available, and requires the use of non-mainstream schools (Freeman, 1976; Geers & Brenner, 2003; Evans, 2004). It has been reported that OC allows children to score significantly better on tests measuring the learning of words and sentences (Dettmann, DEAFNESS AND THE TREATMENT 4   Wall, Constantinescu & Dowell, 2013). Further, with the refusal to recognize deafness as a disability, the denial of assistive hearing devices as such, the Deaf advocating manualism may potentially limit the short and long-term development of children (Copeland & Pillsbury, 2004). Therefore, for subject SH, it is suggested that he be given Cochlear Implant, and taught in a mainstream school using Oral Communication to make full use of his CI, after a period of bridging allows him to adapt to his newfound aid. Case Study SH is a native of Lahore, Pakistan; and belongs to a middle-to-upper-class family consists of a father, mother and an elder sister. He is now an 8-year-old boy, who was involved in a catastrophic car accident at the age of 19 months in which he sustained severe damage to his head. In the month following, his parents complained of SH’s unusual unresponsiveness to nd communication, and soon after his 2 birthday, SH was detected to have damaged his inner-ear and auditory nerves, with doctors providing finality with the diagnosis of profound conductive hearing loss. Much of the other neural trauma he had suffered has mitigated since then, as he has found to be developing without any other deficits. At the time of his diagnosis, SH’s parents decided not to have a CI, largely influenced by his father’s acquaintance’s recounting of his unsuccessful experience with surgery to place a CI, adding that it was a waste of money and essentially physical torture (prolonged pains) as there were no results for him. Instead, after involving the Pakistan Association of the Deaf (PAD) to receive guidance to help them with regards to SH’s educational and developmental path, they decided to teach him sign language. Till the age of 4, SH’s family used sign language heavily to communicate with him, teaching him and themselves whatever they could from books made available to them from the PAD. Since the age of 4, SH has been enrolled in a PAD affiliated school based in Sialkot, Pakistan; where he is DEAFNESS AND THE TREATMENT 5   boarding with extended family who has had a hard time learning to communicate with him. The school employs TC techniques for teaching sign language for both Urdu and English, with written Urdu and English their secondary language of instruction. The teachers at this school are all fluent in the languages used in the school. According to his teacher, Bibi Jamila, SH is a below average student overall. In mathematics, she notes that SH has “difficulty distinguishing between the different symbols, especially between multiplication and addition.” Though the signs are very unique, Bibi Jamila explains that SH needs to be reminded repeatedly what the symbols mean, and requires help in performing the task. Currently, due to this reason, SH attends math at the grade 1 level. These struggles are not present when discussing languages studies. His vocabulary, for sign language and written languages, is growing rapidly, though he is not quite able to keep up with children at his expected grade 3 level just yet. Bibi Jamila states, “though he has poor participation, SH keeps up with the class by doing his readings. When he submits his assignments, he has good sentence structure and use of vocabulary.” SH also has difficulty in social settings. At home, he lives with his extended family that only knows basic sign language. The difficulty is extended into the school environment when children that can speak with greater proficiency than SH look down upon him. As Bibi Jamila recalls SH saying to her after being asked why he looked sad in class, “SH started to cry all of a sudden, saying he missed his mom. He said kids pick on him because he cannot talk properly, and that he cannot hear at all; the children with hearing devices tease him by showing him theirs, and making faces, and signing mean things to him. ‘No one likes me,’ I remember him saying.” The last comment is related to the fact that SH only has one friend at school. More recently, SH has had numerous emotional outbursts when asked a question to answer by the teacher, running DEAFNESS AND THE TREATMENT 6   out of class crying several times, each time having needed consoling by the teacher to return. SH’s mother, Zainab, is slowly starting to acknowledge and analyzing the issue but in a dual manner, as Bibi Jamila recalls: “I am not saying our decision for him was wrong for not getting him an impla
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