Download - Ch20
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Chapter 20
Assessment of Sensory Acuity
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Why Assess Sensory Acuity?
• Student impairments do not always require extensive assessment– Seemingly complex academic and behavioral
problems may be rooted in sensory difficulties
• Most common sensory difficulties– Vision– Hearing
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Vision Difficulties
• Types of visual impairment– Visual acuity• Clarity or sharpness of vision (20/20 v. 20/10 vision)
– Field of vision• Tunnel vision• Scotoma
– Imperfect color vision• Discrimination between hue, saturation, and brightness
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Visual Acuity
• Most serious as an educational problem if impairment occurs prior to age 5
• 5-33% of students are considered to be along the broad spectrum of “visually handicapped”– Blind– Low vision– Visually limited
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Visual Acuity
• Signs of visual impairment – Frequent headaches, dizziness, sensitivity to light,
blurred vision– Obvious physical signs (e.g. red, swollen, or crossed
eyes; haziness in pupils)– Behaviors:
• Holding books too close to face while reading• Abnormal tilting of head• Poor alignment of words• Reluctance to participate in games requiring distance vision
or visual accuracy
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Vision Screening and Assessment• Screening
– Standard Snellen Wall Chart• Limitations with school-age population• Referral rule of thumb:
– 20/40 in either eye for K-3 children– 20/30 in either eye for older children
– Snellen E Test• Used with children who are unable to rea
– Keystone Telebinocular• Both Snellen tests are somewhat restricted in focus• Assesses 14 different visual skills
• If visual assessment done by trained professionals indicates a deficiency, schools must engage in tests to inform intervention
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Vision Screening and Assessment• Low-vision results from differing visual disabilities– Disabilities interact with:
• Individual differences• Environmental differences
– A need for more comprehensive and informative vision assessments
• Clinical low-vision exams• Functional-vision assessment• Learning-media assessment – Developing tools for reading and writing)
• Braille Assessment Inventory (BAI)– Developed to assess need for Braille instruction
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Hearing Difficulties • Signs of hearing loss
– Failure to pay attention or frequently ask to have things repeated
– Both may not occur in a quiet context – Frequent medical problems– Demographic risk variables:
• Low SES• Cleft palate or Down syndrome • Native Americans and Eskimos
• Educators should be quick to screen for hearing difficulties if any warning is given– If a problem is detected, further referral is necessary
• Otologist: Expertise in physical examination of ears• Audiologist: Expertise in hearing assessment and rehabilitation
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Screening and Assessment • Modes of hearing– Air conduction – Bone conduction
• Screening tests tend to measure air conduction while diagnostic tests may measure both
• Types of screening– Three components:
• Initial screening• Follow-up hearing threshold tests• Referral
– All states have laws for screening school-age children; however, pre-K programs are not required to screen
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Screening and Assessment
• Hearing screening– Objective– Conducted individually – Screening should include:
• Case history and visual inspection of ear
• Pure-tone hearing screening• Tympanometry
• Hearing-threshold screening– More detailed– Used to determine the
lowest hearing level at which the child can respond to a minimum of 2 of 3 pure tones
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Screening and Assessment
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Screening and Assessment
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Screening and Assessment
• Tympanometry Screening – Better control over some extraneous variables– “Middle-ear screening”– Goal is not to identify educationally significant
hearing loss, but to identify children with middle-ear disorders• E.g. children with middle ear disorders may be able to
function normally in an educational setting
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Other Hearing Tests
• Multiple tests are often needed to identify the type of hearing loss
• Two additional tests might include:– Speech Recognition Threshold (SRT)– Word Recognition Score (WRS)
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Types of Hearing Loss
• Conductive hearing loss– Bone conduction hearing is normal but air
conduction hearing is impaired – May be due to build up of wax or fluid; build up of
fluid in middle ear is most common in children• “Otis media”
• Sensorineural Hearing Loss– Dysfunction of the inner ear– May be due to noise exposure, inheritance,
ototoxic drugs, mumps, measles, or head trauma
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Types of Hearing Loss
• Mixed hearing loss– Combination of conductive and sensorineural
• Central auditory hearing loss– Children may pass many typical hearing exams– Problems filtering out background noise and/or
with short- and long-term auditory memory• Likely to be educationally significant
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Hearing Loss
• Determining severity– Insert Figure 20.7 [there is no such figure in book]
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Speech Understanding and Hearing Loss
• Conductive hearing loss– Hear normal conversational speech, but at a very
reduced level
• Sensorineural hearing loss– Hearing loss tends to decrease as the sound
frequency increases• May hear low-frequency vowel sounds but struggle to
hear high frequency consonant sounds• Particularly problematic in noisy environments