Presented in December 2005
Factors which help or hinder lipreading
Whatever the type and/or level of hearing loss, a child is going to need to lipread some of the time. We should never presume that a child will be able to lipread because he/she is deaf or hearing impaired. There is naturally individual variation in the ability to lipread, and as with any skill, competence varies, with level of hearing loss not necessarily predicting ability. Those with a monaural loss may also need to lipread, as may some without a diagnosed hearing loss but with a specific type of processing disorder.
In lipreading, we tend to lip-read part and guess or predict the rest. Lipreading is said to be 80% guesswork.
When considering lipreading, be aware that there is a high incidence of visual impairment within the hearing impaired population. Whether the child is following sign language or spoken communication their visual attention is called into play continually. Regular eye checks are essential.
Amplification also has a significant role - a little sound in addition to lipreading, makes a big difference. Appropriate, functioning hearing aids, worn consistently, do make lipreading much easier. However, problems arise when the child is only wearing his/her aids/implant in school.
To aid lipreading, we also need to be familiar with advice about environmental, personal and presentational considerations as well as general tactics to aid communication with deaf and hearing impaired clients.
Even in the normally hearing population, lip movements influence what listeners hear. An example of this is known as the 'McGurk Effect' - an illusion caused when what you hear someone say doesn't match the lip configuration that you see. This is why watching dubbed movies is a strange experience. My own preference would be to have subtitles rather than dubbed speech.
Early development of lipreading
Lipreading is important from a very young age. When babies as young as three months were shown video recordings of people speaking where the lips are nor synchronised with the audible speech, they quickly lost interest. Their attention was re-established when the synchronisation was returned to normal. So even at this tender age, infants make the connection between what they're hearing and lip movements.
By the age of nineteen months, toddlers can lipread familiar words.
Some general factors which may affect teh ability to lipread
40% of children with a hearing impairment have additional difficulties. This will often impact on their ability to lipread.
Studies have shown that autistic children generally have impaired lipreading skills. The cause is likely to be the fact that their perception of and/or the way that they integrate visual and auditory signals differ.
Age at diagnosis
Congenital deafness in now likely to be identified very early through the Universal Neonatal Hearing Screening Programme and so children are being identified within the first few days of life. This has very positive implications for the early support of hearing impaired children.
Cochlear implants are more widely available and, for the right candidates, at the optimum age, can offer levels of hearing which allow the development of normal speech.
In a 1999 review of cochlear implantation, it was suggested that, for adults to gain maximum benefit from implantation, specific training in developing their lipreading skills would be of benefit (UK Cochlear Implant Group).
Having to adapt and adjust as hearing levels change is a challenge for anyone with a deteriorating loss. Others may not perceive the changes promptly especially in younger children who may not be able to articulate the problem, or in older children who adapt well to the changes.
Early language learning
The way in which parents/carers talk to their child has an effect on their later ability to lipread. Parents need to be educated on the best ways to communicate with their child from the start and with UNHS the right advice should be available within the first few months of their child's life.
Hearing aids, when working properly, can be an aid to lipreading. Even a little hearing, if consistent, can be of benefit. To gain maximum benefit, the speaker needs to maintain natural speech patterns. As a principle, sentences should not be broken down - to break up a sentence destroys its natural rhythm. Speech patterns are the part most easily heard and so it is important not to disrupt them. Those using Total Communication need to be very careful that they are not destroying the natural rhythm of their speech in their attempts to combine spoken language and sign.
People are often unaware of the important contribution of the prosodic patterns of speech.
The quality of hearing aids is much improved and improving further all the time, however there are still a few children who gain little from them.
Ear moulds which don't fit or have split, cracked tubing and faulty hearing aids are a constant problem and the waiting times for repair or replacement can sometimes be unacceptable.
Coping with a number of languages in itself is not a problem, but the level of early language development is significant.
Primary - Secondary
In Primary, children spend the majority of their day in one classroom with one teacher, occasionally moving to other rooms and a different teacher, eg; for PE or music. This makes it easier to check hearing aids/cochlear implants and to be aware of any problems that arise.
This all changes with the move to Secondary. the children need to change classroom and teacher for each subject. Each classroom change means a change of seating arrangement, acoustic characteristics, teacher styles, etc. There can be problems with information sharing amongst staff. Even if a child was willing to wear an assistive listening device during their Primary years, he/she may rebel against it once he reaches an age at which other children's opinions become important - he/she wants to fit in and be like everyone else. This is when they tell you they don't need their hearing aids/FM system! Socialisation and being accepted take precedence over academic achievement. Similarly, a child who wore their glasses in Primary can more easily avoid wearing them in Secondary without detection.
The linguistic level of both written and verbal information being presented at Secondary increases. The vast majority is verbal, with occasional visual aids or demonstrations in class. Notetaking requires a pupil to divide his/her attention which can pose significant problems, even under ideal listening conditions.
Teachers of the Deaf supporting children in mainstream have a massive task. Their valuable support is vital but the amount of support available varies from region to region.
This can interfere with the lipreader's concentration.
Factors which make sentences more difficult to lipread
- background noise
- not knowing the context
- obscurity of context (the more immediate the topic, the easier for the receiver)
- abstract concepts
- colloquial language
- sentence complexity
- sentence length too long
- difficulty in segmenting sentences as receiver (detecting word boundaries)
- unfamiliar or unusual vocabulary
- homing in on 1 word which, if incorrect, affects interpretation of the whole sentence (tendency to lipread part and guess the rest)
- words beginning with a vowel
- non-visual consonants, eg; /s/ /k/, especially at the beginning of key words
- visually confusable consonants, eg; /t/ /d/ /n/
- speed of delivery - especially if too fast or unnaturally slow
- exaggerated speech patterns
- absence of normal facial expression
- use of non-specific gesture
- difficulty at close range focusing on lips and maintaining eye contact - require adequate distance to take in all the available clues
- lack of concentration
Factors which make sentences easier to lipread
- knowledge of context - a lot of words share the same lip patterns. Knowledge of context helps the receiver to predict the vocabulary more easily. Informing children of the context at the beginning of an exchange and then signalling any subsequent changes in topic is essential.
- familiarity of context - the more immediate the context, the easier to follow / predict
- use of visual referents
- appropriate use of gesture
- appropriate use of facial expression
- appropriate speed of delivery
- pre-knowledge of language (semantics/grammar)
- short, concise sentences
- visual consonants, especially at the beginning of key words
- longer words, because of the pattern/rhythm, eg; a beautiful big elephant
- easier to follow if rhythm more obvious, eg; Baa, baa, black sheep....
- absence of distractions
Tactics to assist lipreading
Communication is a two-way process in which both the giver and receiver of the message have an active part to play.
Role of the speaker
The speaker needs to
- consider the needs of the hearing impaired person
- alert others to their needs if appropriate
- use tactics to assist lipreading, eg:
1. Set the topic
Set the topic before giving the message, eg; "I'm talking about
Knowledge of context is very important in cutting down the guesswork involved in lipreading. This is particularly important when you change to a new topic.
The idea of setting the topic occurs naturally in BSL. 'Topic comment structure' makes use of non-manual features to mark the topic (raised eyebrows, leaning forward) - often expressed as a rhetorical question, eg; "You know Mary ?...she went off with the milkman", "The football last Saturday...did you go ?"
2. Use visual referents
Make use of visual referents to assist in establishing the topic.
3. Repeat the message
The message should, in the first instance, be repeated exactly as before. If it is still not understood, other tactics should be used. It is usually best to limit to 2 repetitions and then try another tactic.
4. Use appropriate facial expression
5. Provide feedback
Give feedback re which parts the receiver has correctly identified, eg; "Yes, Edinburgh Zoo" (Original message - "I saw a giraffe in Edinburgh Zoo)
6. Provide a contrast
Provide a contrast where errors occur, eg; "No, not an elephant, a giraffe" and then set it within the original sentence... "I saw a giraffe in Edinburgh Zoo"
7. Change vocabulary/syntax
The vocabulary used should be chosen carefully. Knowledge of the child and awareness of his/her experience should help you in your selection. You also need to be aware of which sounds/words are visually easy/difficult, and which can be easily confused. Then, decide whether your sentence could be altered to make it easier to lipread.
8. Add meaningful gesture / sign
Add meaningful gesture/sign as appropriate.
9. Fingerspell it
10. Write it down
11. Check that the child has understood
Check that the child has understood what was said by watching what they do and asking them to show you what they have to do.
Role of the Receiver
The receiver must
- be prepared to be proactive in informing people that they have a hearing impairment
- any changes or considerations that are necessary
- anticipate what might be discussed in different situations
- maintain a high level of awareness, attention and concentration
- employ tactics to assist lipreading
Ask for clarification
Hearing impaired/deaf children don't always acknowledge that they have not heal understood.
Request clarification, eg; "Did you say giraffe?" (Good time for giver of message to offer a contrast)