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  Hearing Impairment

Core information

Activities

Activity 1

What does it mean to have a hearing impairment?

W H AT  W E  V A L U E   A B O U T  O U R   H E A R I N G

Ask participants to write down: 

•  what sounds we value
• what we value about being able to hear

This can be done individually, then the ideas shared in the main group.

Ask participants to talk about any experiences they may have had with hearing impairment. Does a family member, relative, friend or work colleague have a hearing loss? Discuss how they perceive the hearing loss affecting the person's life.

P R A C T I C A L  E X E R C I S E

It is very difficult to simulate a hearing loss. In most cases, a hearing loss doesn't simply mean that sounds are not loud enough. For most people, having a hearing loss means that sounds are distorted or unclear, and while a hearing aid may make speech louder, it usually will not make speech clearer.

Ear plugs will be used to give participants some understanding of what a mild hearing loss may be like, but the ear plugs will only reduce the volume of speech, not distort it. 

You need:

•  a pair of foam ear plugs for all participants 
•  one or more sets of personal stereos 

What to do:

•  demonstrate how to insert earplugs 
• the facilitator to read a long newspaper article or similar, reading rapidly and using a soft voice and unclear speech 
• if personal stereos are available, participants use these to play background music or speech while trying to follow the facilitator 
• remove ear plugs and discuss difficulties and feelings 

Activity 2

Aim: 

To demonstrate some strategies for communicating with a person with a hearing impairment.

Core Info: 

Hearing loss is an invisible disability and so may not be obvious. People with hearing impairment often won't announce that they have a loss. Communication can be extremely difficult for the hearing impaired person if the speaker's face is not visible, if speech is too rapid or unclear or if there is background noise. However, shouting or over-exaggerating speech are not helpful and are demeaning.

You need: 

a service desk and earplugs

What to do: 

Two people take part in the activity, the remainder observe. One person, with earplugs, is "hearing impaired", the other a worker at the service desk.

The hearing impaired person approaches the service desk where the worker is looking down and writing, and asks a question (for example, how to access some information).

The person behind the desk answers without looking up. The hearing impaired person says "Pardon?" The staff member looks up and repeats but speaks very quickly and mumbles. The hearing impaired person doesnÕt follow, frowns and asks them to repeat. The staff member speaks again with hand in front of mouth (for example, scratching their nose) and gives long and complicated instructions.

The hearing impaired person looks baffled and asks if the instructions can be written down, or if someone could show them where to go. The staff member becomes irritated, impatient and says they don't have time to help. 

Discuss: 

What went wrong in this communication and what could the staff member do to improve the situation?

Discussion should bring out:

• staff member didn't look up when answering (no eye contact, speech not visible and no indication of a response).
• speaks too quickly 
• shows exasperation, impatience (hearing impaired person feels humiliated, devalued)
• covers mouth and commits other mistakes

Participants may also suggest that communication could be improved if hearing impaired person mentions their hearing loss. However, many people with an acquired hearing loss will not do so. 

To consolidate the points made, use an overhead transparency of the communication strategies and/or handout. 

Activity 3

R E C O G N I S I N G  H E A R I N G  LO S S

This exercise involves discussion and brainstorming rather than physical activity. 

Aim: 

To understand that people with hearing impairment often try to hide their loss, and to find ways of recognising hearing loss in members of the public.

Core information: 

Hearing loss is often referred to as an invisible disability. Unless a person wears a hearing aid or other device that is easily seen, their hearing loss may not be readily detected. Today, while society has a greater understanding of hearing loss, it can still evoke a variety of negative feelings in members of the public.

Brainstorm: 

Hearing loss is the most prevalent disability with one in six of the general adult population having some degree of hearing loss and one in three of people over 60 having a hearing loss.

Given the high degree of hearing loss in the community, brainstorm ways in which you might be able to identify people as possibly having a hearing loss.

Responses may include:

• no response if spoken to unless looking at speaker
• wears a hearing aid
• has difficulty hearing on telephone
• cups hand behind ear towards person speaking
• turns one ear towards person speaking
• leans forward and watches person speaking intently  difficulty in communicating in groups and noisy places
• shouts (or whispers) and speech may be unclear misunderstandings and inappropriate responses

Encourage discussion about why deafness is not always detected.

Points which may emerge:

• people with sensori-neural deafness may still respond to sounds, even though they may have difficulty understanding speech

•  they may be able to hear and understand in some situations, for example, when speaking with one person in a quiet place 

• they may lip-read well, so compensating for the hearing loss 

• people may be unaware of a gradually increasing hearing loss some hearing loss is accepted as normal - "What do you expect at your age?"

•  staff may not know what signs to look for
• institutionalisation: people follow others, see visual clues and become familiar with a routine

• misunderstandings, wrong answers, inattentiveness and the like may be put down to other causes such as intellectual disability

• stress the need for alertness and the importance of not assuming that a person has an intellectual disability 

Activity 4

L I P R E A D I N G

Aim: 

To illustrate some reasons why lipreading is difficult and consider how we can make it easier for people to lipread us.

Participants will take part in an exercise in pairs, followed by a general discussion. Ear plugs may be used.

Instructions: 

Ask participants to form pairs. One of each pair is A, and the other B. Give them the relevant instructions and briefly explain the exercise. They should not see each other's instructions.

Participants should take turns to try lipreading, while their partner reads out a list of words or sentences using silent speech (no voice).

They each have three lists to lipread:

• individual words 

• short sentences, without any clue to the topic 

• short sentences, with a clue to the topic

 In their pairs, they should:

• lipspeak each word or phrase once only

• go through the whole exercise before they tell each other the answers

• show each other the answers after completing the whole exercise and spend a few minutes discussing what it shows about lipreading before returning to the main group to share their ideas

 Discussion: 

Allow 15 minutes for the exercise in pairs, then recall participants to the main group. Encourage discussion about lipreading and how we can make it easier for hearing impaired people to lipread.

Ask questions like:

How successful were you at lipreading? 
What helped make lipreading easier? 
What does this show about lipreading?

Points about lipreading:

• lipreading is not easy
• a lot of guesswork is involved
• most people have some ability to lip-read
• some people are better at it than others
• some people are easier to lipread than others
• it is impossible to lipread unless the speaker's mouth and face are clearly visible

some words look alike on the lips, so single words are very difficult to lipread colloquial expressions may be difficult to lipread rhythm and knowledge of the topic helps 

Ways to make lipreading easier:

• the person lipreading must be looking at the speaker

• the speaker's mouth, jaw and eyes must be clearly visible, that is:

- adequate light on face of speaker

- the speaker should be within adequate range and facing towards lipreader

- not obstructed by hands, books, cigarettes, food or other impediments

- eyes not hidden behind dark glasses

• use sentences rather than single words 
• give clues to the subject of conversation
• speak a little slower than usual, keeping the normal rhythm of speech
•  if you are not understood, try rephrasing the sentence
• speak clearly (but don't overemphasise mouth movements)

E X E R C I S E

Instructions for person A: 

Sit comfortably opposite your partner. Read out the following list of words silently, without using your voice and without whispering. Allow time after each word for your partner to write down what he/she thinks each word is. Say each word only once.
List: ship, Jim, chimp, punk, mud, bun, jeer, cheer, jib, chip

1. Now block your ears (using your fingers or earplugs) and try to lipread the words your partner reads out. Write down what you think was said. Don't worry if you find this very difficult.

Next, read out the following short sentences to your partner, again using silent speech. Do not give any clues to the subject and say each sentence once only. Allow time after each sentence for your partner to write it down. 

•  Would you like tea or coffee? 
•  Do you take sugar? 
•  Here's the milk for your cereal. 
•  Would you like more toast? 
•  Do you prefer jam or marmalade?
•  Would you like some eggs?

2. Now block your ears again and try to lipread the list of short sentences your partner reads out. Write down what you think was said.

3. Now give your partner the clue that the sentences are about breakfast. Read out the sentences, again, speaking silently. Use some gesture. Again allow time for him/her to write down what you said. Your partner will now give you a clue about the topic of the sentences before he/she reads them. Block your ears again and try to lipread and write down the sentences.

4. Show each other the words and sentences you read out. Check how many you got right each time and briefly discuss with your partner what this shows about lipreading, then return to the main group. 

Instructions for person B:

Sit comfortably opposite your partner.

1. Block your ears (using your fingers or earplugs) and try to lipread the words your partner reads out. Write down what you think he/she said. Do not worry if you find this very difficult. Read out the following list of words silently, without using your voice or whispering.

Allow time after each word for your partner to write down what he/she thinks the word is. Say each word only once. List: bad, man, pat, bat, sheep, cheese, tea, she, pound, mount

2. Now block your ears again and try to lipread the short sentences your partner reads out. Write down what you think each sentence was. Next read out the following short sentences to your partner, again using silent speech. Do not give any clues to the subject and say each sentence once only. Allow time after each sentence for your partner to write it down. 

• It looks a bit cloudy. 
• It might be quite hot.
• I think we're in for a storm.
• It looks like the wind's getting up. 
• It looks like we're in for a good day. 

3. Next, your partner will give you a clue about the subject of the sentences before he/she reads them. Block your ears again, and try to lipread and write down the sentences. Now, give your partner the clue that the sentences are about the weather. Read the sentences again, speaking silently. Use some gestures. Allow time for him/her to write each sentence down.

4. When you have finished, show each other the words and sentences. Check how many you got right each time and briefly discuss what this shows about lipreading, then return to the main group. 

Activity 5

D I S C R I M I N AT I O N   A N D   D E A F N E S S

In this exercise, we look at some specific ways in which deaf people are discriminated against and disadvantaged by social attitudes and our environment.

Brainstorm ideas on ways in which our society and environment disadvantage and discriminate against deaf people. Use newspaper cuttings included to draw out additional points.

Encourage general discussion. Try to cover the following topics.

Negative attitudes: 

Stereotypical negative views about people with disabilities are "disablist" and are comparable to racism, sexism and ageism; that is, not normal, an object of pity, tragic victim, brave, a threat or menace, less capable, or they assume that someone is confused, senile or "losing his/her marbles".

Labels such as deaf and dumb, deaf mute, deaf without speech, switched off, deaf as a post, stone deaf and impaired tend to reinforce the stigma attached to deafness. These may lead to loss of self esteem and confidence. Some people with acquired deafness do not like to be called deaf due to the association with deaf and dumb.

People with a hearing loss can also be disadvantaged by inappropriate behaviour, for example, impatience, shouting, talking behind the person's back, unclear speech, ignoring the deaf person and the "does he take sugar? " syndrome. We may show negative attitudes by our body language as well as by what we say.

Access and equal opportunities:

We may not think about access in relation to people who are deaf, but access also means access to information, social activities, employment and more - which is frequently denied to people who cannot hear the telephone, TV, radio, alarms, intercom systems, public address systems and church services. This can lead to frustration, social isolation, reduced choice and increased reliance on other people.

Effects on hearing people: 

As communication is a two-way process, hearing people are also handicapped unless they have appropriate skills to communicate with deaf people - perhaps one reason why so many people are embarrassed by deafness.

Hearing people may also be handicapped if they are unable to have a telephone conversation with a deaf friend, colleague or relative or are unable to gain access to the house of a person who cannot hear the doorbell or security intercom. 

True or False? 

In this exercise we look at some of the assumptions and misconceptions that are commonly made about deaf people. The statements illustrate:

• some situations where deaf people are "disempowered"

• some ways in which the environment may be inappropriate, thus denying access

• some negative, "disablist" attitudes towards deaf people

You may wish to select a few of the statements, or allow participants to work through as many as they can cover in the time available.

Give participants copies of the statements. Invite them to divide into pairs or small groups to discuss whether they agree or disagree with the statements, and why.

Allow about 15 minutes then recall participants to the main group. Encourage feedback and general discussion on their conclusions.

True or false? - statements for discussion:

• hearing loss is an inevitable part of ageing and nothing can be done about it ("What do you expect at your age?")

• "She can hear when she wants to!"

• "There is no point in asking him - he's deaf."

• "He/she is too old to cope with a hearing aid."

• deaf people can't expect to enjoy life in the same way as normal people deaf people should be grateful for the equipment and services they receive from the state

• deaf people can be a problem in a fire because they cannot hear fire alarms deaf people are a problem in modern sheltered housing schemes with security intercom systems

• deafness is a devastating personal tragedy deafness isolates people 

Activity 6

S U R V I V A L  E X E R C I S E

Suggested time: 30-40 minutes

Aim: 

The aim of this simulation is to provide a light-hearted revision of how to communicate with people who are deaf. Introduce the exercise, but do not explain its true purpose yet. 

Explain that participants will be working in groups, with a "deaf" person in each group. They are asked to imagine that they are stranded in the desert following an airplane crash and are given the task of quickly ranking a list of items according to the order of importance for survival. They should first decide their individual ranking and then reach a group consensus through discussion. Voting is not allowed.

You need:

Participants instructions (one per person); ear plugs (several pairs, or personal stereos).
Give out participants' instructions and allow five minutes for participants to decide their individual order of ranking.

Ask participants to form groups with five to seven per group. Give one or two volunteers in each group earplugs (or personal stereo) to wear to simulate deafness.

Ensure that earplugs are properly inserted (or personal stereo playing at an appropriate volume).

As discussions progress, remind them of the short time available. Observe the communication and group dynamics.
Background information:

Imagine that the small aircraft in which you were flying has just crashed, deep in the Sahara desert. It is July, the hottest time of the year with daytime shade temperatures soaring to over 40C. It is the dry season when this area may go without rain for months. The pilot was killed in the crash before he had time to radio for help or inform anyone of your position. You are many miles from any permanent settlement.

Before take off, the pilot has to file a flight plan, giving details of the course, speed, estimated time of arrival, type of aircraft, number of people on board and so on. Search and rescue operations will begin shortly after the plane fails to arrive at its estimated time of arrival.

There are 14 items available which may help your survival. You are asked to assess them according to their value, ranking them from one to 14 on the score sheet. Decide your individual ranking first, then discuss them with your group to reach a group consensus.

Ranking sheet:

Cigarette lighter 

• Loaded pistol 
• Compass
• Large sheet of polythene 
• Chocolate (large bar each) 
• Water carrier with five litres of water  
• Torch with batteries 
• Knife 
• A selection of spare clothing
• First aid kit
• Small mirror  
• Air maps
• Newspaper
• Salt tablets

After 15 minutes discussion, recall participants to main group. Encourage general discussion.

Points which may come out of discussion: The communication needs of "deaf" participants may be forgotten due to the time shortage and pressure to complete the task.

Acknowledgement: "Hearing Matters - A Training Pack on Hearing Loss & Older People", 

RNID Coast Project 1990