Cochlear Implants on Small Kids: Is This Our Best Option?

This series is designed to help parents manage specific aspects of bringing up a child with a different learning path. The next few months we’ll be focusing on parents of deaf and hard of hearing kids. Previous articles include: diagnosis, choosing a language to communicate in (part I and part II), keeping devices on kids, sports and activities.

If you’ve recently found out your child qualifies for a cochlear implant, you’ve probably got a lot on your mind. Parents like you have to make tough decisions for their little ones. The stakes and costs can be high, so we spoke with a doctor and a parent to highlight different aspects of the decision process. Dr Lynne Lim HY from the Lynne Lim Ear Nose Throat & Hearing Centre in Singapore gave us key points from a medical standpoint, and Damien Wee shared his family’s experience with his 4-year-old daughter.

How Do Cochlear Implants Work?

The simplest way to describe cochlear implants (CI) is as a replacement part for a non-functioning ear. In terms of sound processing, there are two parts to a cochlear implant, one external and one internal. The external processor picks up sounds and transforms them into electronic signals which are transmitted to the internal electronic device connected to the cochlear nerve. Thus sound is transmitted to the brain, bypassing many ear pathologies. For a diagram and more, check out this video and article at KidsHealth.

When is the Best Time to Undergo the Operation?

Technically the operation can be done as soon as your child is able to withstand general anaesthesia. “The youngest patient I operated was 6 months old, and the oldest 83 years old,” says Dr Lynne. She sometimes admits waiting until children weigh at least 10 kilogrammes, for medical reasons. But the main time constraint is actually linked to language acquisition.

As mentioned in previous articles, a child’s brain soaks up language from 0-3 years. If children aren’t exposed to an accessible language during that time, they will find picking up any language difficult. The so-called “accessible language” doesn’t have to be speech, it can be signed. But that requires the family and extended social network being fluent enough in sign language for the child to develop diversified and structured language patterns. For a glimpse into what this could mean, read Phoebe Tay’s perspective here (as well as additional links).

Many families can’t commit to signing and want their child access to the hearing world as soon as possible. This was the case for Damien’s family. “We are not familiar with sign language so our initial focus was for our daughter to gain access to sound and be able to communicate using speech,” he says. “As she was born profoundly deaf, she would never have access to sound without the implants,” he explained. In their case, the operation was carried out when their little one was 10 months old.

My Child Isn’t Profoundly Deaf: Is this my Only Option?

This is often the trickiest case, as the operation will usually destroy any residual hearing your child may have (for exceptions, read here). If their residual hearing is good enough, methods might be better suited to developing language. This could entail using hearing aids rather than cochlear implants. To see more, you can revert to these previous articles (part I and part II).

The main difficulty is asserting what your child can really hear. In the words of Dr Lynne, “hearing beeps in a soundproof room with good headphones is much easier than listening in real life situations with competing demands for attention, background noise and poor environmental acoustics. So hearing tests can also underestimate the difficulty a patient has with hearing in the real world.”

Another concern is your child’s ability to communicate what they hear, especially when only a few months old. In Damien’s daughter’s case, they had additional hearing evaluation tests (the Auditory Brainstem Response tests) conducted at two different hospitals. “Doctors put probes into her ear,” he recalls, “and adjusted the volume and frequency of the sounds to evaluate the level of sounds her nerves registered. Both tests showed that the level of sound registered was not enough for her to develop speech with regular hearing aids, hence cochlear implants were the best chance for her to be able to hear.”

Photo credit: gfpeck on Flickr

Last but not least, some types of hearing loss can evolve over time. So it might turn out that your child’s form of hearing loss was mild enough for hearing aids in the beginning but not anymore. Staying watchful during those critical years of language acquisition will ensure you’re able to react fast and adapt.

Are there any Long Term Negatives I Should Know About?

Like all invasive operations, there are risks associated with implanting the devices. Some are related to how the body accepts the implants, to others are linked to the fact that the inner ear is affected over the following days. And parents are sometimes advised to have their child vaccinated against meningitis before the operation, as people with cochlear implants have higher risks of contracting the illness in their lifetime. “Once we had made up our minds, we didn’t think about it too much,” admits Damien. “We concentrated on researching and choosing which cochlear implants would be best.”

Another long-term negative that could affect people with CIs is potentially being unable to benefit from future drugs that might “cure” certain forms of deafness. At this stage, it’s difficult to do more than speculate, but you can read more here.

What’s the Future of CIs?

Dr Lynne says “technology is so advanced, CIs can only get better.” This means smaller, thinner implants and processors, fewer wires, better technology for filtering noise,  and longer battery lifespans. In many cases, accessories for activities like swimming. , are already available. Current innovations are even very high tech and somewhat savvy, like the ability to pick up phone calls. Future CIs may not even need an external component or might be able to deliver medication directly into the ear.

Remember these from a recent post? ListenLid also helps keep CIs dry!

Sometimes parents can be tempted to wait for newer innovations instead of opting for cochlear implants. “It’s difficult to find information on the development of these newer innovations, aside from CIs. Even within the CI industry, the three main producers of Cochlear Implants are competitors, so they aren’t always keen to publicize their development plans and results.” Damien was quite pragmatic: “ We do not know when these newer innovations will be commercially available and how reliable they will be. Cochlear implants have proved to work for many people. We needed to make a decision fast so as not to lose the important first few years of language acquisition for our child.”

What Comes Right After the Operation?

We’ve all seen videos of “wow moments” when a child hears for the first time as their implants are turned on. Each kid’s reaction is different, from wonder to fear at this new sense. We compiled a playlist to give you a glimpse.

It’s important to stress that the implants alone are not enough to fully understand sounds. Following the operation, a lot of hard work goes into training the brain to recognise different types of sound.  “Parents should be aware that all kids have different outcomes,” underlines Dr Lynne, citing other physical factors (like cognitive delay and autonomy of the cochlear nerve), medical history (early or late diagnosis) and psychological aspects, particularly motivation.

Every patient Dr Lynne works with has had their own “wow” moment. There are many highs and lows after the operation, but she’s impressed by the hard work and courage her patients display. Some, like the baby she performed her first simultaneous bilateral cochlear implant on, grow up to become top students in their schools. Meanwhile, Damien remembers how four months after the implants were turned on, his daughter was finally doing really well on the Ling Six Sound test: “I was so moved to see her developing her hearing capabilities.”

Other Takeaways

Damien advises getting more than one medical opinion and also speaking with parents whose children have undergone cochlear implant operations. “Getting another professional evaluation helps verify the hearing test results and makes you more confident with your decision. In addition, talking with parents whose children have cochlear implants will give you a better understanding of the social, emotional aspects of the operation or other hearing options,” he says.

Remember, some of the world’s greatest athletes, like Duck-hee Lee, are born deaf.

At the end of the day, you’re going to be teaching your child to reach their full potential and be confident, so you need to be convinced you are making the best choice possible. His little one now speaks three languages she learned living in a multicultural setting, and thanks to the hard work they have all put in, she’s now thriving in a mainstream kindergarten).

For comments or questions, get in touch!

Disclaimer: these blog posts are intended as exploratory articles for parents of recently diagnosed children. They do not constitute medical advice and cannot replace a medical opinion.

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Parenting Deaf and Hard of Hearing Kids: Choosing a Language (Part II)

This series is designed to help parents manage specific aspects of bringing up a child with a different learning path. The next few months we’ll be focusing on parents of deaf and hard of hearing kids. This article follows a previous article here.  Last time we spoke about deaf kids was here: Diagnosis, Keeping Devices on Kids, Sports and Activities.

Part I focussed on the importance of early language acquisition and briefly reviewed different methods. This article will draw on the experience of three people with different perspectives, to give you more informal insight.

We were very lucky to have input from three experts and parents. Phoebe Tay is a Deaf teacher from Singapore. She speaks of her journey growing up oral in a predominantly hearing society to discovering the Deaf community, where she learned about Deaf culture and Deaf identity. Toshiko Clausen-Yan shares experience as a hearing mother to a multilingual oral son. We also spoke to Joyce Lew, a speech-language therapist and certified auditory-verbal therapist who migrated from teaching using the auditory-oral method to concentrating on auditory-verbal.

A Speech-Language and Auditory-Verbal Therapist on Oral Methods: Joyce Lew’s Experience

Joyce started her career in Singapore at a time when screening tests were rarer, and kids came into her office quite late. “They had already learned how to get by with lip-reading and mostly came from hearing families”, she recalls. Their families didn’t really have the time to learn a whole new language (like signing) to be able to stimulate them soon enough. “Parents were really just desperate to connect with their kids. They wanted activities to do that would teach their kids language, now.”

Joyce initially focussed on auditory-oral methods. “But research [at the time] suggested that if we continued teaching kids language through lip-reading, they would likely plateau in language acquisition because we read and spell based on how words sound.” So she decided to test auditory-verbal methods in her work.

At first, it was difficult for children to accept to learn relying only on their residual hearing. “It felt extremely unnatural at first,” she says “we had to think of all kinds of ideas to bring the focus away from the lips. But within a few months, there were moments of automatic listening and verbal responding while the kids were busy with their heads down in play.”

In some cases, residual hearing can be used to access language.

A few years later, as newborn screening became mainstream and more and more hard of hearing babies arrived with hearing devices, auditory-verbal became a norm. She says “some of the reasons are associated with the relative ease that babies experience in getting used to hearing devices and in learning how to listen without first learning how to lip-read.”

After a decade in her field, Joyce is convinced communication is key to developing language. And that parents tend to communicate more with their child if they are comfortable with the chosen language.

From Oral to Signing and Deaf Culture: Phoebe Tay’s Journey

 

Phoebe’s life changed when she started to use both English and Auslan

Phoebe was born deaf and diagnosed around three and half years old. At the time in Singapore, oral methods seemed to be the only option. Moreover, spoken and written English were expected to be understood by everyone. With the use of hearing aids and residual hearing, Phoebe was able to pick up English. She fared well enough in school and her language skills “started to bloom from upper primary onwards.”

 

Yet communicating wasn’t always easy. “It was okay to communicate in one to one setting”, she says “but classroom and group settings were tough.” Phoebe points out that language development is not just linked to academia, but also to social development. She felt like she couldn’t quite fit into the hearing world. Almost like language was a barrier.

Then she went to Australia, where she learned Australian Sign Language (Auslan). She suddenly discovered a language she could acquire, as well as a whole new culture. “I started to feel more confident, and signing helped me get a better sense of self-esteem.” Realising that she could use both Auslan and English changed her life.

There’s growing evidence that being part of a Deaf community and developing a Deaf identity helps build a child’s resilience. For Phoebe, this effect was palpable even as an adult. “I use aids, but they have their limitations. And they don’t make me a hearing person.” At the end of the day, “some kids will fail at oral methods no matter how hard they try because they simply can’t hear enough”. They still deserve to have a language they can succeed in naturally.

When Cochlear Implants Are Combined with Auditory-Verbal Therapy: A Mother’s Modern Tale

Toshiko’s second son was born profoundly deaf. Her family chose to give him the most mainstream life possible. This was possible according to doctors, who recommended cochlear implants at a very early age: only seven months old! Despite their natural fears regarding invasive surgery and the high cost, they chose this option.

Of course, this meant many years of intense speech therapy. “As soon as he had his cochlear implant, he got the same exposure to language as a hearing child,” she says. Sometimes it can be hard to get children that young to focus on tasks (like speech therapy) and keeping their devices in place, “but you have to keep in mind the long-term goals.”  Over time, her son has been able to learn several languages, including English, Mandarin, Japanese and Norwegian in natural settings.

Implants are getting more and more sophisticated and invisible.

For Toshiko’s son, the implants worked so well he can hear very minute sounds. “The advancement of technology has made this possible and we embrace all advancement that makes life simpler and better,” she says. In fact, he can now pick up calls directly to his implants, which he thinks is pretty neat.

She has a few words of encouragement to parents of children born deaf: surround yourself with people who are supportive and positive. “I did not allow people to cry or feel sad for him in front of him,” she remarks. “Stay positive, and keep your child feeling positive.”

As a brief conclusion

We hope these three testimonials will help you with parenting your child. Remember: each family is different. We hope yours will thrive!

Additional Links

Looking for some of our sources? We used some of these links. Send us more by commenting below!

Disclaimer: these blog posts are intended as exploratory articles for parents of recently diagnosed children. They do not constitute medical advice and cannot replace a medical opinion.

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Parenting Deaf and Hard of Hearing Kids: Choosing a Language (Part I)

This series is designed to help parents manage specific aspects of bringing up a child with a different learning path. The next few months we’ll be focusing on parents of deaf and hard of hearing kids. Last time we spoke about deaf kids was here: Diagnosis, Keeping Devices on Kids, Sports and Activities.

Over nine out of ten deaf and hard of hearing kids are born into hearing families with almost no connections to other deaf or hard of hearing people. Their parents have to quickly grasp the ins and outs of their child’s specific form of hearing loss while making decisions about how to communicate with their little one. Our aim here is to introduce you to different options, without claiming to have a blanket solution for all families.

Back to Basics: Communication vs. Language

If you’re a parent, you probably measure your child’s development against standard milestones. Communication and language skills are often a focal point: they help us understand our child and be understood by him. On a very practical level, it’s such a relief to go from guessing why he’s frustrated or ecstatic, to handing him the glass of water he’s asking for and sharing his joys.

Of course, parents of deaf and hard of hearing kids face the same practical need. But there’s also additional urgency for them. While parents of hearing kids know their child is constantly picking up language (even though they aren’t showing yet), parents of deaf and hard of hearing kids don’t know exactly what their child may or may not be picking up. “Kids are hardwired to learn a language, be it oral or visual,” says Joyce Lew, a speech-language therapist and certified auditory-verbal therapist, “but they need to be exposed to one.”

Babies only have a few years to gain solid understanding of language.

If deaf and hard of hearing kids aren’t exposed to an accessible language, they are at risk for language deprivation. In short, their brains aren’t learning what language is. They must acquire strong foundations in a first language during the critical early years. Those who don’t will have difficulty learning any language in the future, even non-oral languages because their brains haven’t yet formed the necessary connections. “While individual cases vary widely, the younger we see the kids, the more confident we are of the outcome,” says Joyce.  Thus parents have about 4 years to make sure their child is equipped to build a strong foundation in a first language, irrespective of which one they have learnt.

Different Viable Communications Methods

Here’s a brief overview of main communications methods used today.

Auditory-verbal or oral methods focus on using only residual hearing. Therefore children learn how to concentrate on the actual sounds with very little visual help. These methods typically work best for people who can hear across the speech spectrum, using hearing aids and/or cochlear implants.

Auditory-oral or cued speech methods teach children to combine listening with lipreading and visual cues. Cued speech provides additional visual elements for words that look the same on lips. For example, when speaking, hand gestures will specify the first letter of a word, like between “pat” and “bat”.

Manual communications modes include different forms of “sign language”. Many variations exist and some are not considered “languages” in their own right. The easiest way to understand is that Manual English (which includes SEE) is a literal transcription into signs, whereas other sign languages (like ASL for the US, Auslan for Australia, SGSL for Singapore etc) have their own grammar and internal logic.

Girls learning sign language.

Total communication methods allow for the use of all of the above methods in the acquisition of language. The underlying idea is to help kids pick up language with a combination of approaches, which may or may not include sign language, using cues, lipreading and maximising residual hearing.

How to Start Exploring and Choosing

Each case is different. As you explore, you’ll run into advocates of each type of method. Some will focus on making your child’s deafness as invisible as possible, others will want to open doors to Deaf culture and identity. Together they will complement the advice you’re getting from your doctors. How much residual hearing your child has and her prospects of learning sounds are important factors.

You’ll also take into account the community you live in – or want to live in. You need to know you’ll have enough support in your community to go forward with your choice. How much time and resources do you have to invest?  For example, if you are confident you can learn to sign and that your child will have a community of Deaf people to interact with, this will impact your choice.

We’ll be exploring experience from three interviewee’s in part II. Check it out here.

Additional Links

Looking for some of our sources? We used some of these links. Send us more by commenting below!

Disclaimer: these blog posts are intended as exploratory articles for parents of recently diagnosed children. They do not constitute medical advice and cannot replace a medical opinion.

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Sports for Kids with Hearing Loss: Keys to Success

This series is designed to help parents manage specific aspects of bringing up a child with a different learning path. This month we’ll be looking at what parents and specialists have to say on raising children who are deaf or are hard-of-hearing. The previous article in this series can be found here.

“Deaf kids can do anything but hear well”

But apparently some with aided hearing do hear amazingly more than a regular hearing person. But we digress. When we asked Bianca Birdsey, a medical doctor and mother to deaf twins, about extracurricular activities she immediately enumerated her kid’s hobbies. Her children really can do anything: from karate to dancing, including team sports, they are busy!

Duck-hee Lee is an South Korean Teenage tennis sensation

Duck-hee Lee is a deaf South Korean Teenage tennis sensation

Tips for helping kids do sport fall under two main categories. On the one hand, adapting social behaviour and communication patterns, and on the other, finding equipment and technical adjustments. Furthermore, “the challenge is more around socialising,” says Bianca, “especially if people see implants or aids and assume they won’t need to accommodate.”

Adjusting to Deaf or Hard of Hearing Team Members

Listening to Bianca talk about her experience, it seems that many of the adjustments are minor. For example, Bianca explains to coaches that her children will need more eye contact, and lips should not be hidden. These adjustments meet the child halfway, as she learns how to adapt too. As a result, her kids have developed “special powers”, and she marvels at how they can now lip read backwards in a mirror during ballet class.

Tamika Catchings was the star player of the Indiana Fever WNBA team and an Olympic gold medalist. Image courtesy of lovewomensbasketball.com

Tamika Catchings was the star player of the Indiana Fever WNBA team and an Olympic gold medalist.

A good way to make the sports environment more inclusive is to teach coaches, teachers and fellow team members a few words in sign language. Involving the team, by giving them 10 new signs is a great way for them to bond. What’s more, we suspect being able to sign a little might even give them an edge over competitors if they want to share secret information during a match!

Use these Adjustments to teach your Child to Advocate for Themselves

Bianca is very aware that her children will need to learn to advocate for themselves in the future. “What’s important for me is their confidence,” she says, “and I want to model how to advocate in a nice, calm way.” In this respect, a sports environment is a great place for children with hearing loss to realise that asking for accommodations is normal.

In rare instances where coaches put up resistance, Bianca wants her children to see that they are worth fighting for. More than just sports, her children need to know “they are loved unconditionally,” and should not take no for an answer when it comes to their social needs.

Equipment and Technical Adaptations

In some cases, technical gear might be required. Swimming comes to mind, as kids with implants might have a difficult time keeping them dry. Solutions do exist, like the ListenLid Swim Cap, so these children can develop their full athletic potential. In other sports, bigger helmets might be the answer, as well as headbands to hold aids and implants in place. We even saw some creative braiding while surfing for ideas, by the mother of a very athletic teenager.

Terrence Parkin is a deaf olympian swimmer

Terrence Parkin is a deaf Olympic medal winning swimmer

Sometimes technical adaptations are easy for schools and training centres. For example, the dance school Bianca’s children attend turns the base to the floor so they can feel the beats. We bet the experience is also enriching for the hearing kids, who are getting a different approach to dancing.

All Worth the Effort…

Most of all, Bianca is really proud of her dancing deaf children. “They absolutely love their dance concerts, they seem confident and happy. And they have the biggest smiles!” she says. Which goes to show deaf children really can – and should – do anything.

Additional Links

Some additional links for parents looking for more information. Please also suggest more to us, which we can add to the list.

 Final Takeaway

deaf-champions2

 

Photo credits: Duck-hee Lee (L’Equipe), Tamika Catchings (lovewomensbasketball.com), Terrence Parkin (Michael Steele/Allsport/Getty)

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Diagnosing Hearing Loss in Children

This series is designed to help parents manage specific aspects of bringing up a child with a different learning path. This month we’ll be looking at what parents and specialists have to say on raising children who are deaf or are hard-of-hearing. The following article on hearing loss and sports can be found here.

Studies show that over nine out of ten deaf and hard of hearing children are born to hearing parents. This makes identifying hearing loss and adapting very difficult for families. We spoke to two mothers of deaf children who are happy to share some advice.

The Silent Handicap

Hearing loss is invisible. Many children can go years without ever being diagnosed. Bianca Birdsey, medical doctor and mother to deaf twins, recalls being politely hushed when she expressed her concerns. When she noticed oddities in her children, “people would say “it’s their normal!“”  she recalls. “They would think I was paranoid because I worked in paediatrics.” Bianca even asked a day care teacher if they noticed anything unusual about the twins, “and at the end of the day, she said “there’s nothing wrong with them”!

It took a dramatic scene in a public setting, with one twin crying for her mother, who was standing a few feet behind her, for Bianca and her husband to confirm their intuition: the girls just couldn’t hear. Stories like these are apparently quite frequent in South Africa. Bianca says many children there aren’t diagnosed until as late as five or even later.

Of course, diagnosis can differ greatly from one country to another. Tara Teo, founder of Irisada, gave birth to her daughter in Norway, where children are automatically screened. However, after the first check the nurses told them to come back two weeks later, as there might simply be “water in the ears.” The next test was also inconclusive, mainly because her daughter was too agitated to get good readings. It took an additional two months to finally get consistent readings of one ear and discover Heidi was profoundly deaf.

The Language Barrier

Why is an early diagnosis so important? The first two reasons are linked to how the human brain develops at that early age. Firstly, the early months and years of a child’s life are those where the brain learns how to structure language.  If they are diagnosed too late, they may have missed this critical phase and be left with learning difficulties.

Why? Because deaf children can only access language via visual aides until they are taught sign language or have hearing devices (if their family chooses to). Most families don’t sign at home unless there is already a deaf family member. This means that until a child is diagnosed, they often have absolutely no means of communicating and structuring thought with others.

The second very important factor, is that a child’s brains learns early on how to differentiate frequencies, especially to pick out human voices from other sounds. Tara’s daughter was given hearing aids and cochlear implants at a young age, but she needed lots of additional speech therapy to learn what to listen to in a sound. She’s also working hard to reproduce speech sounds, as she wasn’t exposed to them as early on in the belly as other babies.

Follow Your Child’s Lead

Both parents stress the amount of pressure they were under. “You’re making all these decisions for them” says Bianca, and some people have very set opinions on what is best for deaf children. Some of these decisions can be expensive in many countries, which can make it even harder. There can also be an impression that once your child has aids or implants, things will just miraculously get easier. In fact, the operation or “switch-on” is often just the beginning.

The mothers both laughed when they recalled their children’s reactions as the implants were turned on: pure horror! Bianca even jokes that there’s no point spending hours thinking up the first sentence you’ll speak to your child, as they won’t have a clue what the sounds mean! Imagine coming from a world of silence into a world of continuous noise. A great deal of energy goes into adapting to hearing.

Mothers with a Mission

Bianca’s advice is to “trust yourself”. Don’t let yourself get caught up in the politics around deafness, just follow your child’s lead. “There’s no right or wrong choice”, she says “as long as your child is progressing”. In Bianca’s case, meeting and socialising with deaf adults broke the spiral of grief. In part because she came to terms with a realigned vision for her twins’ future, and also because she was able to master sign language faster. Learning to sign, as a family, allowed them to bond like they never had before.

Tara, meanwhile, was frustrated with how difficult it was to get adapted headbands for her daughter as Heidi’s ears were simply too small to keep the devices in place. She spent hours online, searching for something that would keep the implants in place. She realised there was a gap in the market, and how useful it would be to be able to provide a small solution that could have a potentially huge impact. She felt how wonderful it would be if parents free up time they were spending sussing out where to find special products, to spend with their children instead. With this conviction and simple goal in mind, she founded Irisada, the very platform you’re reading on now.

Additional Links

Some additional links for parents looking for more information. Please also suggest more to us, which we can add to the list.

  • Facts about hearing loss
  • Bianca’s blog, on her experience of bringing up three kids with hearing loss
  • A preliminary list of famous deaf people, to get you started with imagining your child’s future
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Assistive Tech Fair in Norway

This week, we were at an assistive tech fair in the far north of the world. So what is interesting over there (or here)?

Mobility and Sports

So the Scandinavians are big on getting out there and nothing can quite get in the way, definitely not a disability. The first section were different types of mobility equipment. There were a lot of unusual ones such as the ones in the picture below. They are much nearer to the ground, good for outdoors and skiing.

Outdoor wheelchairs

A picture with three outdoor purposed wheelchairs. Behind the wheelchairs, there are banners and a screen illustrating the use of the wheelchairs

This can be used on the beach. When not in use, it can float on water. This video shows how a man transferred from it quickly onto a canoe on a beach. https://www.youtube.com/watch?v=iShrnJOTDTg

Hippocampe

An outdoor 3-wheelchair with 2 big balloon rear wheels and a smaller front wheel. The seat is nearer to the ground than a regular wheelchair.

The outdoor wheelchair on the right is interesting as it is highly modifiable for different outdoor needs. A detachable shaft with a waist sling can be used so a parent can pull a child while hiking. Or parts of the frame can be removed and skis can be added to the base.

Fjellgiet

A picture with two outdoor wheelchairs. The one on the left has skis on. The one on the right is much bigger and has two fat bike wheels and a slightly smaller front wheel. The back of the larger wheelchair has two handlebars and what seem like brakes similar to bicycles.

Luis Gran is the first wheelchair user that crossed Besseggen. We have been there and we know that it is not an easy route, some parts of this ridge are pretty steep.

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A picture in the mountains. In the foreground, three persons are helping a person sitting on a outdoor wheelchair along the ridge. One person is in front with waist slings attached to the wheelchair. Two other persons are behind pushing or lifting.

Photo credits: Taken from Aktiv Hjelpemidler AS website

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Picture of a child sized doll standing in an exercise machine with full body support. There are gliders at the base of the foot, braces at the knee level and supports around the hips, waist, chest and head. There is a handlebar above the waist level with a tabletop mounted on it.

A children’s tricycle with a larger seat and supports around. There is a back bar (for mounting different supports), a push handlebar and a basket at the back of the tricycle.

 

The left picture is a children’s bike that has extra support on the back and neck. The picture beside it is an exercise machine with full body support.
The bottom left picture shows a stroller with additional back and neck support. The bottom right picture is a light weight frame that allows kids with severe physical disability to stand and walk. We asked if it can potentially be uncomfortable or not good physically for the person to be on this for long hours. The sales person said that it should not but not enough research has been done in this area but there are some undergoing right now.

img_7157

A stroller with supports on the seat and a inclined footpad.

A picture of a child sized doll standing support by a frame with 4 wheels. There are braces and supports around the child, a handlebar attached to the supports at the back of the child and what looks like brakes on the wheels.

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The device on the left is a frame used to support a child during swimming.

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A tripod frame with a seat in the middle and 3 black buoy like objects around it.

The is an ergonomic wheelchair.

A children’s wheel chair with rounded cushions on the back and seat and foot pads on both sides of the seat.

This amazing bike allows parents to bring their kids out and get a work out too. It is roomy and provides ample support for the child’s head and neck.

img_7164

A tricycle with a big rounded cart at the front which can sit 2 children. One side of the cart has a child seat with supports.

Occupational/ Speech Therapy and Communication

These pads are a training system that responds to the touch of hands and feet. The light responds to the force or weight, allowing therapists to design a custom program to train the child’s motor skills and body awareness.

A lady standing on two different coloured pads that have lights in the front of the pads. Beside and in front of the pads, there are other similar pads of different colours placed near to them.

I like this wallet which has felt pages and symbol cards with velcro can be attached to it. Easy to bring around.

img_7154

There is a poster of symbols at the background of the picture. The foreground shows a ring note book with a symbol showing a person pointing to himself and words that says ‘meg selv’. Beside the notebook is a fabric wallet with fabric pages. On each page are cardboards of signs.

This is a beautiful series of books that talk about feelings and include symbols.

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6 colourful ring bounded books placed in a row overlapping. The first book is titled ‘forelskelse’ with a cartoon of a man with two hearts for eyes and smiling showing teeth

A ring bound book that is opened. The left page shows a heart with a man and a woman looking at each other with a heart between them. The right page shows a broken heart with a girl in tears. Below both pages there is a sentence and above the sentences there are symbols.

 

 

 

 

 

 

 

 

 

Caregivers’ Aids    /  Household Aids
Support arms. The white ones are feeding robots while the black one, though is powered, requires one to use one’s own hand and it provides the additional push.

The bed on the left is a shower trolley, the middle equipment is a multipurpose hygiene chair and the one on the right is also a hygiene chair.

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The sales person is demonstrating how this equipment helps a person get up from a chair and be transferred somewhere else.

This is a simple share on the different solutions out there and is not an endorsement by Irisada on any of the products.

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HOW TO CHOOSE THE RIGHT PUZZLES FOR YOUR HOME THERAPY NEEDS (PART 1)

Abstract: This article is generally talking about the types of puzzles and how to use them for therapy (both speech and occupational) at home for kids with special needs. However, we firmly believe some of the techniques are also beneficial for teaching kids without special needs too. Note: tips here are based on compilation of the cited reference sources and also on our own personal experience of conducting therapy for our own children but they are not a replacement for medical or clinical advice. We combined both speech and occupational therapy tips as we believe both are essential for all types of children with or without special needs so  it would be good to have the other area of concepts at the back of our minds when we are conducting one type of therapy.

Random puzzles

Puzzles

Puzzles and boardgames are frequently used by speech and occupational therapists to teach language and skills to kids with ASD or other developmental delays. As caregivers, we understand that it is not always efficient or economical to bring your child to the therapists since it involves adapting of schedule, travelling time, preparation of meals for the child before, during and after therapy (gotta keep the kiddo in absolute good mood to benefit from the session isn’t it?),  what about time away from your other kids (if you have them) and sometimes, the child is simply not in the mood.

So home therapy is highly encouraged as a supplement to your usual therapy sessions as it reinforces concepts. For those who are somehow unable to access therapy (though we highly recommend getting professional help) it will be an alternative and with enough practice, parents can actually acquire the competence.

Moreover, it is a fun way to bond with the child. See it as a chance to play with your child, albeit withjust a bit more structure.

WHY ARE THEY GOOD?

These articles from Child Development Institute  by Pam Myers and learning4kids have highlighted the different skills and concepts that children can pick up. Here we summarise the important points from the article and provide more information.

  • Hand-eye coordination: When moving, flipping and turning pieces, they can learn about the connection between hands and eyes. This enables the brain to envision how the puzzle needs to look or which piece is required. It facilitates the brain, eyes and hands to work together.
  • Fine motor skills: Small, specialized movements to hold and manipulate pieces. Acquiring motor skills through using pincer movement.
  • Gross motor skills: Stacking and moving larger pieces
  • Problem-solving: Discerning if the pieces either fit or not. Children figure out by looking at the different pieces and can test them out. They learn to solve problems logically.
  • Matching: For some puzzles, kids will have to identify which two puzzles look the same and match them
  • Shape recognition: Learning to recognize and sort shapes is part of an important development in children. Puzzle pieces need to be identified and sorted.
  • Memory: Child needs to remember which exact piece, which piece has a particular size, shape, colour, pattern, that didn’t fit now and places it aside, then picking it back up later when needed again.
  • Setting small goals: Child usually willover time develop a strategy of how to work on the puzzle more efficiently. He or she will then need to set small goals like finding all the corners before achieving the larger goal of completing the puzzle.
  • Socializing and teamwork: Working on puzzles with an adult or friend will help a child learn social skills.
  • Self esteem: When kids complete a puzzle, they feel a sense of achievement and pride. This builds up their confidence and self-esteem
  • Language and speech: As you talk about the different pieces to the child, they learn about the different names of the shapes, colours, images they see. They also pick up different prepositions, verbs, sentence formations, etc

 

WHAT PUZZLES TO CHOOSE?

So here are some of the variations to puzzles. We don’t want to clear out the entire toy store so let’s figure together what some of our preferences are. Well, as expected, mixing things up a little is the best.

  1. Material: wooden, foam, plastic, cardboard, magnetic
  2. Type (According to this article on HubPages by Rose Mary an OT): connecting, non connecting, interconnecting, others
  3. Complexity: number of pieces,
  4. Theme: animals, automotives, food, alphabets and numbers, colours, shapes, cartoons, etc

Wooden ones are typically more expensive, especially if you buy high quality ones. For toy lovers, I would invest in better quality ones as they last longer and have better finishes. Simply for the purpose of therapy, buying cheaper imitations work just as well, but do take note to sand off badly finished pieces as we do not want our kids to get scratched or splinters in their fingers (we have enough to deal with).

Foam ones, like plastic, are easy to bring around. Some kids might like their squishy texture, others not. Plastic ones are the most value for money. Magnetic ones are the most fuss-free as they do not fall all over the place and are easy to store (second favourite after wooden ones).

Cardboards are typically jigsaw puzzles which are just so fulfilling when we manage to complete them. And oh so good for developing patience and focus in our little ones. They can also be matching flashcards.

Mazes (which might or might not require a separate writeup, let’s see) are another type of puzzle that are super fun and great for training fine motor skills and problem solving.

For those who find regular jigsaw puzzles dull, they can add a punch by buying those with 3D effect.

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Thank you.

 

Team Irisada.

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