We began our day today at Kinder Papillon, an inclusive preschool that educates children with hearing loss (along with some children with other disabilities) and their hearing peers. The children in the school range from about age 2 until pre-kindergarten age, at which point the children are mainstreamed into their home schools. While at Kinder Papillon, we observed the children during snack time, play time, and even their English class! In all of the classes, the children with hearing loss participate along with their hearing peers using listening and spoken language. During the school day, they receive both pull-out (child goes to the teacher of the deaf’s office) and push-in (therapist comes to the general education classroom to provide support) services.
We had the opportunity to watch several therapy sessions with children who had bilateral hearing aids or unilateral implants. Interestingly, while children in Costa Rica usually only receive one implant provided by the government, none of the children with unilateral implants continued to use a hearing aid on the contralateral ear. Some of the therapy sessions focused on conditioned listening, identifying objects in a picture with multiple critical elements (“Where is the big red shoe?”) and discrimination/identification of Learning to Listen sounds. For one session, a parent (mother) was in the room, but the rest were conducted 1:1 with the child and the therapist. One little boy had just had his cochlear implant activated for less than a month, but it was amazing to see how he was already using his new hearing to self-correct issues of voice quality as well as comprehension. Not surprisingly, he was a consistent hearing aid user up until the time of his surgery, and had therapy to grow his listening brain, even before he had optimal access to sound! Another special treat was having the opportunity to see the only (that’s right, the ONLY) child is Costa Rica with bilateral cochlear implants. It was exciting to see how well she was doing, but sad to think that the opportunities afforded to her (because her parents are doctors and because they were able to travel out of the country to receive more than the 1 implant/person that the Costa Rican government will provide) would not be available to all children.
One of the things I most liked about the therapy technique at Kinder Papillon was how the therapist used every activity she led for receptive language as an opportunity to turn the task around, have the child act as “teacher,” and create an situation that required the child to use expressive language as well. For example, after a few turns of the child identifying (by audition only) the item in the picture the therapist was describing, the child would use his or her speech and language skills to ask the same types of questions to the therapist. This therapist used a listening hoop and sat across the table from the child, and it was funny to see the children cover not only their mouths, but their entire faces, when it was their turn to be the teacher. One child decided that he would dispense with the listening hoop when it was his turn, and instead wore it as a hat! We saw some real charmers in therapy today, and I think they all liked having a very appreciative audience!
We also met with the president of the local Lion’s Club. She shared with us her organization’s activities in Costa Rica, and we tried our best to impress upon her the importance of supporting infant hearing screening programs and hearing loss awareness to their activities. I hope something comes of it! The more people who are aware of the positive impact of early identification, amplification, and intervention for children with hearing loss, the better!
After visiting Kinder Papillon, we ate a quick lunch and headed to a local center of Cen Cenai, Costa Rica’s public preschool program/daycare centers funded by their Ministry of Health. There, we performed hearing screenings (both behavioral and OAE), tympanometry tests, vision screenings, and preschool cognition/speech/language screens. Later, we will be compiling the results of these screenings and sending notifications home to the children’s parents, as well as informing the school’s director so that she can ensure that the children receive proper follow-up.
Tomorrow’s schedule includes visiting a school for the deaf that uses sign language, a tour of the local children’s hospital (including their preschool program, which is another Cen Cenai agency open to any child in the community), meeting with developmental therapists (somewhat similar to early interventionists in the US) to discuss listening and spoken language options for children with hearing loss, shopping in a Costa Rican open-air market, and a traditional Costa Rican dinner complete with folkloric dances!