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iPads and learners with a hearing loss.
The iPad is an incredibly versatile tool for working with sound – for fun, as a fantastic tool to support those with a hearing loss, or for hearing stimulation. In this module, you are going to learn about techniques and apps which can either stimulate, simulate, assess and assist individuals who have hearing loss, with the addition of autism and mild to complex learning needs.
In this module you will learn about
- Using the iPad to understand hearing loss
- Using the iPad to assess functional hearing
- Auditory stimulation using the iPad
- Creating sound friendly environments
- Apps for auditory stimulation
- Using additional speakers (cable and Bluetooth)
- Using the iPad and apps to create sounds and resonance
- Using fun apps for sound
Understanding and simulating hearing loss
Hearing loss, unlike visual loss, may be felt by everyone at some time in their lives, usually only as a temporary state. So a basic understanding of hearing loss is useful. Hearing loss can be either a conductive loss or a sensorineural loss, or sometimes a mixture of both. The most common is a conductive loss, where the route to the ear drum is blocked, impeding the sound waves from reaching the nerve cells. This may be due to a build up of ear wax, or the condition commonly known as ‘glue ear’, which is a result of the mucus from an ear infection being unable to drain away through the Eustachian tube or due to a structural abnormality in the ear. The result of this type of hearing loss is that sounds become quieter, although not usually distorted. With conductive loss, individuals may go from having acceptable hearing to very poor hearing. This often is gradual and not often immediately noticed by carers or parents. Depending on the cause, conductive hearing loss may be temporary (i.e during/after an ear infection) or permanent (i.e structural abnormality in the ear.) Conductive hearing loss is often treated by medical intervention.
A sensorineural hearing loss results from physical damage to the hairs and the nerve endings that transmit sound signals to the brain.This damage to the hair cells within the cochlea or the hearing nerve (or both) is permanent and irreversible. This may occur during complications at birth, trauma to the head, infection (i.e rubella) or the use of ototoxic drugs. As with all sensory skills, the ability of the nerve endings in the ear deteriorates with age,an age-related loss known as presbycusis. Sensorineural hearing loss not only changes our ability to hear quiet sounds, but it also reduces the quality of the sound that is heard.
Occasionally, both sensorineural and conductive loss can co-exist known as a mixed loss. A good example of this would be a child with a sensorineual loss with a ear infection.
Before we start to look at which apps may be useful for hearing and sound stimulation, here is a suggestion for an app which simulates hearing loss. This will give you some idea about what it is like for a learner who has a difficulty hearing. The link to the ‘Starkey Hearing Loss Simulator’ is here.
Identifying and understanding more about hearing loss could be really important if you are working with people with additional needs, including autism. Hearing loss can be very common and can remain completely undetected, so the next app ‘Early Ears’ is a really nice introduction to hearing assessment. Like many assessments on the iPad, it’s results should be treated with care and if you consider that your child/children have an undiagnosed hearing loss, or if there has been a change in a learners hearing, it is crucial to arrange an expert opinion from audiologist. The link to the ‘Early Ears’ app is here.
Assessments are most successful when carried out over time. How consistent are the learners responses to the sounds made? Do these responses clearly indicate pleasure or dislike? Does the individual respond consistently when the sound is presented in front, from the side or from behind? When assessing hearing responses, it is important to record a non verbal learner’s response to the stimuli. Did the sound provoke movement – i.e body movement indicating a searching response or agitation suggesting a dislike? Perhaps for your learner, having a consistent assessor may also be important.
During assessment it is best to use the same sounds over and over again, so that the learners responses are to a consistent set of sound stimuli. In a functional hearing test, practitioners would use real sound making objects (bells, rattles or other sound makers) to look for a response. They would move the sound around the learner, moving backwards/forwards/to the side and make more than one sound at a time. But with real life objects, this can become quite a juggling act! The iPad gives us this consistent sound set we need. The iPad can be made fairly visually uninteresting and then is an ideal tool to help us in our attempts to assess the individual’s functional hearing skills. We have at our finger tips a host of tools to play a range of sounds, of varying complexity. The iPad is portable; we can store and quickly select a range of sounds and, with the addition of a voice recorder app, we can verbally record the learner’s responses without having to find a writing pad or another person to record responses. There are some really good sound effect apps which could be used with pictures with in your photo library or cue cards to either assess hearing or develop auditory symbolic recognition – more about these coming up!
If you would like to see an assessment format for sound have a look at the papers on the Hirstwood Training website. Scroll down after the visual investigation and you will find the Hearing Assessment document. The link to this is here.
When we hear sounds we automatically assess:
• How loud is it
• Is it high pitch or low pitch?
• Where is it coming from?
• Is it moving?
• Is there more than one sound?
• Will it affect me?
• Do I need to do anything about it?
However, these are the abilities that we need to assess in our learners:
- At what volume can they hear sounds?
- What is their range of pitch? Do they miss very low sounds or very high sounds?
- Can they locate the sound?
- Can they track the sound if it is moving?
- Can the learner discriminate between more than one sound?
The answers to these questions will inform the basis of our sound work with the learner. We will be able to identify the best way to present sound to them, as well as being able to identify a learners ideal ‘communication environment’, if we know where to to stand when talking to them i.e to the left or to the right, whether to talk in a high or low tone or whether the individual can discriminate specific sounds from general background noise.
Auditory stimulation with an iPad
As with all our senses, we need to practice with our listening and hearing skills. Even for individuals without any additional needs, discriminating one sound source from a range of background noise is difficult, yet it is a skill we expect our learners to use every day.
By practicing with our auditory sense we want the individuals we are working with to have a better understanding of the sound information that they are receiving. A student with poor auditory skills needs to develop the ability to focus on specific sounds (listening) and monitor sound around them (hearing). Children with poor sensory regulation, often associated with autism, need to focus on specific sounds. The concepts of ‘neural plasticity’ dictate that the more we practice these skills the better we become at hearing and listening.
External portable speakers, or the iPad itself, can be moved to create sound stimulation for the student and to encourage the following skills:
- Awareness to sound at varied volumes
- Awareness to sound at varied pitches
- Sound location (being able to locate the direction a sound is coming from)
- Being able to track moving sound
This module does not cover the subject of auditory training, however here is a short movie which demonstrates some auditory stimulation techniques with an iPad.
Sound location and tracking techniques
A significant aspect of linking the iPad to auditory work, is using the iPad in the right environment or with the right additional equipment. Poor sensory regulation is often associated with individuals with autism and their need to focus on specific sounds, however it can also be a problem for many of our other learners. Cutting down the amount of sound clutter, as well as visual clutter, will really help an individual develop their hearing and listening skills i.e to begin to discriminate between different sound frequencies and volumes.
Creating quick sound friendly environments
Here are some other suggestions for reducing sound ‘clutter’ –
- Work within the confines of screens, which will dampen sound
- Place the iPad in a box in front of the learner
- Create a distraction free zone, like a tent, in the classroom
- Use another room altogether, such as the sensory room
- Use a pair of headphones
- Use additional speakers (other than those built in to the iPad) to improve the quality of the sound, rather than just raising the volume.
A quick note about music
Music is of course very effective to use for auditory stimulation, as you can often find either a favourite or preferred piece of music for the learner to listen to. However, remember – your learner may not agree with your taste in music! Experiment with classical, pop, country and western and other varied styles of music to identify the music preferences for that learner. The other problem you may have with music is ‘age appropriate’ songs. Somebody aged 45 may love ‘Postman Pat’ just as much as a 6 year old and a 6 year old may love classical music just as much as someone of 45! I knew a girl of 12 years old who loved brass band music… why? Because her father played in a brass band. So find to out what a learner likes, ask parents or carers they will often have an opinion. If you would really like to see a demonstration of how powerful music can be, watch this video on YouTube.
Creating sounds on the iPad
The other key to successful auditory stimulation is the right sound apps. I am about to suggest some apps, which may work because of the visual effects linked to the sound and the control the learner can have over this sound. Being able to control and play with the sound could be very important for some of our learners.
If we want to develop learners interaction and sound creation, a good starting point is a suite of sounds found in the app ‘Sensory Sound Box’ by Cognable. This provides twelve different sounds that are played back by swiping the finger across the screen. The screens also have a visual response to reinforce the movement direction. Different screens have different attributes, sometimes changing volume or pitch. The link to ‘Sensory Sound Box’ is here.
Sensory Sound Box from Cognable
Bloom HD plays a constant series of notes in the background then, by touching the screen anywhere, a new note is created which will steadily repeat but at the same time slowly decrease in volume until it disappears. The pitch of the note depends on where the screen is touched. Towards the top of the screen gives high pitched notes, towards the bottom the note is lower. The users can explore the interplay of several notes being repeated by touching the screen in several places at different times. Bloom allows those individuals with limited movement to make sounds and decisions about those sounds, such as whether they like it or if it is to be repeated. One drawback to Bloom is that it is not easy to clear the screen and start again – you need to delve into a written menu to do this. Link to ‘Bloom HD’ here.
There are lots of apps from a company called ‘Smule’ and most are really good quality. One of the best apps that we have found is Magic piano. You can free play the piano or use one of the songs in the app itself. It does require a degree of co-ordinated finger control (fine motor) but this has a feature which enables those with poor co-ordination to play songs which are recognisable. Beware the dreaded ‘in app purchase’ and just use the free songs at first. Link to ‘Magic Piano’ here.
Magic Piano from Smule
The built in iPad speakers are generally unsuitable for good quality hearing exercises, so using an external speaker is going to generate a much better quality sound. Individuals with poor, or developing auditory skills, need to have better quality sound presented in the optimum place for them, generally front and centre to begin with. This is not the time to use speakers mounted near to the ceiling – they generally are too far away. You can easily connect to a cost effective speaker which can be placed directly in front of the individual with an appropriate cable. Let’s look at a great cable speaker,and then we will look at bluetooth speakers with no cables. One of my favourites is the “Wowee” – a small rechargeable speaker available on line at ‘Amazon’.
The Wowee Speaker
The wowee is the best speaker for creating vibration, however the lead can get in the way. So if you are going to use sound for vibration then another option is to use ‘Blue tooth’ speakers that remove the need for a cable and become truly portable. The ‘Jambox’ is typical of Bluetooth speakers, again available on line, and is very good quality but at a cost. Smaller,but less powerful, alternatives like the ‘soundwave 50’ or ‘100’ from Amazon offer lower cost alternatives with reasonable sound quality.
The bluetooth Jambox from Jawbone
Connecting a Bluetooth speaker.
A Bluetooth speaker needs to be ‘paired’ with the iPad so that the iPad knows where to send the sound signal. Generally you will have to follow the instructions provided with your speaker, as all speakers have different ways of initiating pairing. Here is a general guide…
Connecting a bluetooth speaker
To connect most ‘bluetooth’ speakers you will need to do the following.
1. Turn on your bluetooth speaker and put it into pairing mode. This is often done by holding the power button for a few seconds.
2. On your iPad go into ‘settings’ and then find ‘bluetooth’.
3. Slide the switch to switch bluetooth on.
4. After a few seconds your speakers name should be visible in the devices list, with ‘not connected’ at the right hand side.
5. Tap once on the speakers name and the iPad will attempt to pair, if it is the first time you have done this, a message requesting a pin number may pop up.
5. Enter the passcode if prompted. Its often 1234 or 0000 but refer to your instructions for the correct code.
6. Your bluetooth speaker should now show as ‘paired’.
Using sound resonance
Speakers with a gel base, like the wowee and jambox, used on furniture or in boxes will increase their volume and bass response. They are fantastic for creating vibration on different surfaces, so that learners can ‘feel’ the sound with different parts of their body. For somebody with a hearing loss, this can be a fantastic experience or one which is quite terrifying, so start at low volume and watch carefully for a learners responses.
In pre-hi tech days, we could create resonance & vibration using inflatable air beds or lilo’s by placing the speaker underneath. We even used good old fashioned guitar practice speakers, that children could lay their heads against to experience the vibrations! The Resonance Board is much more effective and many schools now have them. a resonance board is a thin, flexible sheet of wood that gives tactile and auditory feedback whenever a child or young adult moves or a speaker placed on the top will causes vibration.
The basic design is simple, but very effective! It is made from a square piece of plywood at least 1/8 of an inch thick. The thickness may vary depending upon who is going to be using it. If the board is too thin it will split when an adult kneels on it, and if it is too thick it will not resonate very well. A good size is 4 feet square, but this can be enlarged or reduced. To encourage learners with a hearing loss, additional feedback to sounds can be provided with a speaker via ‘resonance’ boards. Placing a speaker on the board will increase the vibrational feedback.
Much more information about resonance boards here.
Great apps for sound
Soundala Play is an app which I have used for some time now with great success. It turns sound into light, giving a wonderful visual response to voices or any other sound makers.
Color Band is a great app which allows the learner to make their own sounds by drawing on the iPad screen or utilise the camera and play these in mid air.
Real Fireworks is a video which is featured in the visual module of the iPad training. However watch it now to find out why this could be fantastic for sound.
Thumb Jam is a synthesiser that is well suited to younger learners or those with dexterity problems. It provides 45 instruments from the flute and acoustic guitar to such esoteric sounds as the Wahtooth and the Theremin. The screen displays a series of stripes, each one playing a note on a scale. Sound is made by sliding a finger, hand or stylus up and down the screen. Effects, such as tremolo, can be made by swiping up and down individual bars. Thumb jam also utilises the iPads built in accelerometer, so that by tilting the iPad a pitch shift is created.
Thumb jam also allows you to record music created as a loop, and to combine these loops to play back multi-instrument pieces. This means that a group of learners could combine to create a composition for their own production or as background music to a story.
Hopefully this module you have discovered that the iPad is a tremendous tool for auditory stimulation. There are, of course, hundreds of apps that you could use. However, having a small core set of apps and understanding how to use them well with sound is probably much more important.
In this module you have learned about
- Using the iPad to understand hearing loss
- Using the iPad to assess functional hearing
- Auditory stimulation with the iPad
- Creating sound friendly environments
- Apps for auditory stimulation
- Using additional speakers both cable and Bluetooth
- Using the iPad and apps to create sounds resonance
- Using fun apps for sound
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