Hearing Loss and Deafness 175communication. Fifth, verbal reasoning should be encouraged. Fi nally, according to Moeller
et al., deaf and hard- of- hearing students benefit from the development of study skills and other
classroom survival activities.
Pichora- Fuller and Schow (2002) describe audiological rehabilitation management for hearing-
impaired adults. These strategies follow a comprehensive assessment model that includes testing
(see earlier) and self- reports. The primary audiological management strategies are summed up
in the acronym CARE: Counseling, Audibility and instrumental interventions, Remediation for
communication activities, and Environmental coordination and participation improvement.
Counseling addresses the factors that predispose, enable, and reinforce a hearing- impaired
person’s positive adjustment to the hearing loss. Audibility and instrumentation intervention
applies to the fit and function of amplification devices, including hearing aids, cochlear implants,
and other assistive listening technologies. Remediation for communication activities involves the
individual’s behavioral changes in hearing- demanding activities to maximize the effects of ampli-
fication. Environmental coordination and participation improvement goals include ensuring that
the person’s social and physical environments support his or her participation in everyday life.
According to Pichora- Fuller and Schow (2002), “In the management pro cess, the rehabilitative
audiologist works together with the individual with hearing loss and his or her communication
partners to find a combination of solutions that will enable listening goals to be attained and main-
tained in a wide range of life circumstances” (p. 355).
Social Implications of Deafness
Controversy exists in the deaf community about whether deafness should be considered a
disability and what types of habilitation and rehabilitation should be used by its members, par-
ticularly children. These issues often center on the oralist, manualist, and total communication
philosophies. The oralists advocate developing speech and speech reading for communication
purposes. Using residual hearing and undergoing extensive speech therapy and aural habilita-
tion and rehabilitation, children learn to produce intelligible speech and to read the speech (lip
read) of others. The speech of many individuals with little residual hearing often has a “hollow”
and nasal characteristic. Although generally thought to be highly accurate, speech reading often
provides far less than perfect understanding for the reader even when the speaker’s lips and face
are unobstructed. Comprehension is reduced because many speech sounds are produced in the
back of the oral cavity and are not vis i ble to the speech reader. Understanding sign language and
using written communication can promote receptive communication. This approach also uses
the person’s residual hearing and amplification to produce the best speech pos si ble. Advocates
for the oralist approach note that being able to interact verbally increases the person’s social and
vocational opportunities.
Manualists believe that American Sign Language (ASL) is the natu ral and preferred language
of the deaf community. ASL, a gestural form of communication, is a rich language unto itself. It
meets the definition of language with its own unique grammar, syntax, and semantic repre sen ta-
tions. The role of language in developing and maintaining cultural and ethnic identity is critical,
and ASL is an example of linguistic diversity. Manualists note the importance of adhering to the
natu ral language of the community to give its members a sense of identity. The role of language in
the human thought pro cess also supports the manualists’ advocacy of ASL for the deaf. Thinking
in one language, using its arbitrary symbols and grammar, is dif fer ent from thinking in another
language, and the grammar and symbolic repre sen ta tions of ASL provide a unique cognitive per-
spective for the user.
The total communication approach integrates the oral and manual methods, maximizing the
person’s speech reading and residual hearing while teaching sign language. Proponents of this