Deaf Subjects Research Articles

COMPARATIVE ANALYSIS OF THE IMPACT OF LIBRAS ON DEVELOPMENT OF THE DEAF: A CASE STUDY IN A CITY IN NORTHEASTERN BRAZIL

Currently, 9.7 million people in Brazil have some hearing impairment, who use a sign-visual language to communicate, the Brazilian Sign Language (LIBRAS). The discussion about education in an inclusive perspective of the deaf and Brazilian Sign Language has been expanded in recent years by education professionals, as well as by the deaf community itself. In this context, the present study sought to analyze the impact of the Brazilian Sign Language on the development of the deaf in the city of Acopiara-CE, located in the semiarid region of northeastern Brazil, through a case study structured in a descriptive and exploratory research. Data collection was carried out in three stages: visiting the deaf and his family, to explain the study, applying an identification questionnaire and applying a fundamental level I test. Thus, it was possible to analyze the reality of two deaf subjects , residents of the same city, approximate age range, who had their school journey diverging from each other, in which the mastery of the Brazilian Sign Language allowed a greater evolution in the inclusive process of one of the individuals. In conclusion, it was observed that inclusive education is still a subject of discussion, but proficiency in LIBRAS is fundamental to the inclusive process of the deaf.

No Olfactory Compensation in Food-related Hazard Detection Among Blind and Deaf Adults: A Psychophysical Approach

The exposure-driven olfactory compensation associated with sensory loss is likely to be observed in assessment of food-related dangers. Therefore, in the current study we tested the hypothesis that olfactory compensation occurs in the case of protection from food-related hazards. We compared thresholds for detection of an unpleasant rotten food odor (fermented fish sauce) in four groups of subjects: blind subjects (n = 100), sighted controls (n = 100), deaf subjects (n = 74) and hearing controls (n = 99). Overall, we observed no significant differences in smell acuity between the blind and deaf groups and their matched control samples. However, the sensory deprived subjects assessed their sensitivity as higher than did control groups. The present study is yet another example of research among large samples of sensory deprived individuals that shows no evidence of olfactory compensation. This result is consistent with a growing number of studies suggesting no sensory compensation in simple, absolute sensitivity tasks.

Bone Conduction Trial Device to Eliminate the Effect of Transcranial Attenuation: A Prospective Observational Study in Single-Sided Deaf Subjects

Objectives: The contact mini^TM (CM) is a nonimplantable, digital bone conduction device (BCD) consisting of 2 isolated units: an electronic housing, including the microphone, and a vibrator housing. The study investigated whether the CM can be used as an alternative test device for a BCD trial in single-sided deaf (SSD) adults with the microphone placed at the SSD ear and the vibrator at the normal-hearing (NH) ear (i.e., cross position). Methods: Twenty SSD adults (mean age: 50 [±13.2] years) participated in a 2-week BCD trial with the CM on the headband in cross position. Prior to the trial, the subjects performed adaptive speech-in-noise tests in an unaided condition. After the trial, speech-in-noise tests were performed with the CM in cross position (CM_cross) and ipsilateral position, i.e., both units at the SSD ear (CM_ipsi). Five different speech-in-noise configurations were used (S₀N₀; S₀N_NH; S₀N_SSD; S_0°N_NH+SSD; and S_SSDN_NH). Speech reception thresholds (SRT) were analyzed comparing the unaided, the CM_cross condition, and the CM_ipsi condition. Results: Friedman’s test revealed no significant differences in SRTs between the CM_cross, CM_ipsi, and the unaided condition for the S₀N₀, S₀N_NH, S₀N_SSD, and S_0°N_NH+SSD configuration. However, in the S_SSDN_NH configuration, a significant effect was found (p < 0.001). Wilcoxon pairwise comparisons with Bonferroni correction indicated that SRTs in the CM_cross condition were significantly lower (i.e., better speech understanding) than those in the unaided (p < 0.001) and the CM_ipsi condition (p < 0.05). Conclusion: The CM may be a good alternative for patients with SSD, resulting in significantly better speech recognition when noise is presented to the NH ear and speech to the SSD ear. As the speech recognition results are better in the cross than the ipsilateral position, the CM_cross might help to overcome the negative effect of transcranial attenuation during BCD trials.

Self‐rated sensory performance in profoundly deaf individuals. Do deaf people share the conviction about sensory compensation?

AbstractSensory deficits in one modality lead to functional changes of brain structures. Neural reorganization may result in sensory compensation and enhanced performance in sensory sensitivity tests. Many studies investigated how deafness affects functioning of the intact senses. Overall, their results remain inconclusive, mainly due to the statistically underpowered conclusions. A limited number of studies have focused on deaf people's convictions on their sensory abilities. This study compared a large sample of profoundly deaf subjects (n = 74) with hearing individuals (n = 100) in terms of their convictions about own sensory performance. First, participants were screened with speech perception tests. Then, they were asked to rate their own sensory sensitivity using two reference categories: (1) other people and (2) their usual sensitivity. Results show that majority of deaf individuals rated their intact senses (i.e., vision, smell, taste, and touch) as more sensitive than hearing controls. Furthermore, on the day of testing deaf individuals reported increased performance of the intact senses as referred to the usual performance. Explanations of the positive self‐evaluations of sensory abilities focus on the common belief among deaf people about sensory compensation and on using self‐enhancement strategies.Practical applicationsReported study introduces important knowledge about positive self‐views on sensory sensitivity of deaf individuals. Although these positive self‐views are unlikely to reflect the actual sensory performance, presented results are of high significance for the sensory scientists. Functional aspects of self‐views in domain of sensory sensitivity should guide educational programs and product design targeted to deaf individuals.

The reconstruction of discourse objects in Libras

This work analyses the referential process performed by a deaf subject in Brazilian Sign Language (BSL) when facing the anaphoric occurrence in a textual cut from Brazilian Portuguese. Therefore, the methodology implemented hereby has had a qualitative nature. A parallel corpus has been compiled using ELAN (EUDICO–Linguistic Annotator) and following the theories of Corpus Linguistics. From all the referential categories contemplated in BSL, the anaphoric deictic has been the most instrumental strategy for conducting the referential chain of the language, e.g. the construction of the referent at specific points in the signalling space.

SELF-NARRATIVES OF BRAZILIAN DEAF PEOPLE: APPLICATION OF THE HYPOTHESES OF SOCIOANALYSES

The objective of the study is to apply eight hypotheses of the socioanalysis for the interpretation and critical social reading of the "self-narratives" of deaf applicants to Higher Education at the Federal University of Sergipe (UFS-Brazil). It is located in the theoretical-methodological field of Critical Discourse Analysis (CDA), and Deaf Studies (DS). We will analyze a narrative of a deaf subject, corpus collected in 2014, in the college entrance examination for the Brazilian Sign Language Course (LIBRAS), and adopt this methodological guideline, to define object of study; identify areas of interfaces that meet the objectives; select the categories of each area of interface; establish the dialogue between categories; identify the social meanings constructed in the discourse. The result confirms the role of socioanalysis in seeking to unveil how the practice of social relations and (re)construction of their identities in the struggle for citizenship rights articulate in the deaf individual's life.

Tecendo saberes sobre as tecnologias assistivas para o sujeito surdo no ensino superior

Refletir sobre a educação dos sujeitos surdos no Ensino Superior, reporta-nos a encontrar possibilidades junto ao uso das tecnologias assistivas. Esta pesquisa, de cunho bibliográfico, busca analisar como vem sendo regulamentada a acessibilidade do sujeito surdo através de tecnologia assistiva no Ensino Superior e quais dessas podem diminuir as barreiras comunicacionais entre ouvintes e surdos. Traz as principais considerações em uma reflexão sobre a comunidade surda, buscando amparos teóricos para caracterizá-la. Também, abordamos a evolução das tecnologias, realizando uma reflexão sobre a inserção das mesmas no cotidiano, bem como, as principais regulamentações que amparam o cuidado com o sujeito surdo. Ainda, pesquisamos sobre como no campo teórico vem sendo discutida a inclusão dos sujeitos surdos no Ensino Superior e como as IES podem diminuir as barreiras comunicacionais entre os sujeitos ouvintes e os sujeitos surdos. Concluímos que as tecnologias assistivas são instrumentos capazes de facilitar a comunicação entre os sujeitos e que, para haver a inclusão dos sujeitos surdos, precisamos romper as barreiras físicas, metodológicas e atitudinais, visando uma constituir que as IES construam um desenho universal na qual todos se sintam cidadãos com os mesmos direitos para expressarem-se e terem acesso à construção do conhecimento profissional e pessoal.

Analyses of del(GJB6-D13S1830) and del(GJB6-D13S1834) deletions in a large cohort with hearing loss: Caveats to interpretation of molecular test results in multiplex families.

BackgroundMutations involving the closely linked GJB2 and GJB6 at the DFNB1 locus are a common genetic cause of profound congenital hearing loss in many populations. In some deaf GJB2 heterozygotes, a 309 kb deletion involving the GJB6 has been found to be the cause for hearing loss when inherited in trans to a GJB2 mutation.MethodsWe screened 2,376 probands from a National DNA Repository of deaf individuals.ResultsFifty‐two of 318 heterozygous probands with pathogenic GJB2 sequence variants had a GJB6 deletion. Additionally, eight probands had an isolated heterozygous GJB6 deletion that did not explain their hearing loss. In two deaf subjects, including one proband, a homozygous GJB6 deletion was the cause for their hearing loss, a rare occurrence not reported to date.ConclusionThis study represents the largest US cohort of deaf individuals harboring GJB2 and GJB6 variants, including unique subsets of families with deaf parents. Testing additional members to clarify the phase of GJB2/GJB6 variants in multiplex families was crucial in interpreting clinical significance of the variants in the proband. It highlights the importance of determining the phase of GJB2/GJB6 variants when interpreting molecular test results especially in multiplex families with assortative mating.

Percepção da qualidade de vida em crianças e adolescentes usuárias de próteses auditivas

Introdução: Com o avanço da tecnologia, os dispositivos eletrônicos relacionados com a reabilitação auditiva suprem de algum modo as necessidades dos usuários e melhoram a qualidade de vida e as habilidades comunicativas. Qualidade de Vida Relacionada à Saúde (QVRS), por ser um tema subjetivo de difícil mensuração, requer a utilização de questionários para tal aferição. Objetivo: Analisar e comparar a percepção de qualidade de vida de crianças e adolescentes usuárias de próteses auditivas na sua visão e de seus familiares/responsáveis, correlacionando-as com as características audiológicas e escolares. Método: Estudo transversal, quantitativo e descritivo, com entrevista estruturada e questionário. Amostra constituída por 25 sujeitos (crianças e adolescentes), idade entre 08 a 18 anos incompletos, diagnosticados com deficiência auditiva bilateral neurossensorial. Os procedimentos utilizados: anamnese; verificação das próteses auditivas; atualização dos dados audiológicos e o questionário Pediatric Quality of Life InventoryTM (PedsQL) versão 4.0 – Português – Brasil, para análise da percepção da QVRS de crianças /adolescentes e seus familiares/responsáveis. Conclusão: Sujeitos com diagnóstico de deficiência auditiva neurossensorial apresentaram semelhante percepção de QVRS comparada às respostas de seus familiares/responsáveis. As variáveis analisadas no perfil de uso da prótese auditiva não mostraram relação na QVRS dos sujeitos surdos. O grupo dos adolescentes evidenciou uma autopercepção de QVRS inferior à percebida pela faixa etária pediátrica.

Гидровибрационная стимуляция в реабилитации детей с тугоухостью высокой степени

Goals of the study were investigation the perception of vibro-acoustic signals, spreading in water, by deaf patients and the possibility of use hydrovibrotactile stimulation for habilitation of deaf children. In the first part of study 5 experienced cochlear implants (CI) users were involved – 2 adults and 3 children with congenital deafness. Participants were presented modulated tones (100-4000 Hz) and natural sounds (horn, pipe, march melody) though underwater loudspeakers in small swimming pool. Each participant was sitting in the swimming pool without CI during the stimulation. It was shown that deaf subjects are able to detect vibro-acoustic signals, spreading in water, which they feel as a vibrotactile sense. The most vibrotactile sensitivity was between 100 and 400 Hz, while stimuli between 1000 Hz and 4000 Hz didn’t evoke any sensation. In the second part of the study 30 early aged children with severe or profound sensorineural hearing loss without hearing aids or CI experience were participated. It was observed typical oriented behavioral reactions in response to test stimuli in water in 15 children from the experimental group, but there weren’t reactions to the acoustic component of stimuli on air (out of water). Hydrovibrotactile stimulation sessions prior amplification and CI processor fitting accelerated the development of oriented and stable condition motor reflex reactions to sounds in children with hearing aids and CI, including even near-threshold stimuli, in comparison with control group children, who got only traditional lessons with speech-language therapist. As a result, an adequate fitting of hearing aids or CI processor and spontaneous development of hearing behavior in everyday situations were achieved significantly faster.

Show Me a Sign by Ann Clare LeZotte

Reviewed by: Show Me a Sign by Ann Clare LeZotte Deborah Stevenson, Editor LeZotte, Ann Clare Show Me a Sign. Scholastic, 2020 [288p] Trade ed. ISBN 978-1-338-25581-2 $18.99 E-book ed. ISBN 978-1-338-25583-6 $11.99 Reviewed from galleys Ad Gr. 5-8 It’s the early nineteenth century, and Mary lives in Martha’s Vineyard, where the prevalence of hereditary deafness means that locals are bilingual in English and sign. A young scholar visits the island to explore the possible causes of deafness there, and Mary is put off by his condescension and ignorance toward the deaf residents like her. Her wariness proves prophetic: when he leaves for Boston, he secretly abducts Mary in order to have a deaf subject to study at his leisure, leaving her trapped in a city where she can’t speak the language and has no way of getting home. LeZotte, herself Deaf, writes with assurance and clarity of a society where the ability to hear is a difference rather than an assumed norm, and the book also thoughtfully addresses the friction between the English-descended settlers and the indigenous Wampanoag, tacitly paralleling the dehumanization of the non-white residents with the dehumanization of the non-hearing. The book loses its footing, however, when it turns from realism into melodrama with Mary’s kidnapping, including a maritime chase scene and cinematic drowning; additionally, the narrative sometimes takes awkwardly didactic turns into sociohistorical explanation. There’s little out there on the fascinating Martha’s Vineyard history beside Neufeld’s Gaps in Stone Walls (BCCB 4/96), though, and readers will be intrigued by the very different model of disability and the period details. A concluding note gives more information about Martha’s Vineyard, its sign language, the population’s hereditary deafness, and the regional Wampanoag. Copyright © 2020 The Board of Trustees of the University of Illinois

Da AAD-69 ao sinalário

Este artigo tem por objetivo apresentar o processo de produção de um instrumento linguístico, que permite a abertura da possibilidade de leituras da/sobre a análise de discurso de base materialista, pela comunidade surda brasileira. Promove-se, inicialmente, um breve repasso histórico acerca da Análise de Discurso (AD), recuperando a produção teórica de Michel Pêcheux. Em um segundo momento, apresentamos nossa escuta analítica e o modo pelo qual tem se dado a produção do Sinalário de AD. Versamos sobre a proposição de três sinais (Ideologia, Posição-sujeito e Michel Pêcheux) para demonstrarmos nosso movimento de análise e posterior formulação dos sinais. Com base em nossa produção, esperamos que que os sujeitos surdos saiam dos processos de reprodução mnemônica e passem a uma reprodução histórica, em que, como sujeitos, se relacionem simbolicamente com os sentidos produzidos sobre a AD.

The Cross-Modal Effects of Sensory Deprivation on Spatial and Temporal Processes in Vision and Audition: A Systematic Review on Behavioral and Neuroimaging Research since 2000.

One of the most significant effects of neural plasticity manifests in the case of sensory deprivation when cortical areas that were originally specialized for the functions of the deprived sense take over the processing of another modality. Vision and audition represent two important senses needed to navigate through space and time. Therefore, the current systematic review discusses the cross-modal behavioral and neural consequences of deafness and blindness by focusing on spatial and temporal processing abilities, respectively. In addition, movement processing is evaluated as compiling both spatial and temporal information. We examine whether the sense that is not primarily affected changes in its own properties or in the properties of the deprived modality (i.e., temporal processing as the main specialization of audition and spatial processing as the main specialization of vision). References to the metamodal organization, supramodal functioning, and the revised neural recycling theory are made to address global brain organization and plasticity principles. Generally, according to the reviewed studies, behavioral performance is enhanced in those aspects for which both the deprived and the overtaking senses provide adequate processing resources. Furthermore, the behavioral enhancements observed in the overtaking sense (i.e., vision in the case of deafness and audition in the case of blindness) are clearly limited by the processing resources of the overtaking modality. Thus, the brain regions that were previously recruited during the behavioral performance of the deprived sense now support a similar behavioral performance for the overtaking sense. This finding suggests a more input-unspecific and processing principle-based organization of the brain. Finally, we highlight the importance of controlling for and stating factors that might impact neural plasticity and the need for further research into visual temporal processing in deaf subjects.

A diferença entre o falar e o agir: análise do decreto 9.656/2018

A história dos sujeitos surdos é marcada por preconceitos linguísticos e culturais que se desdobraram em inúmeras barreiras comunicacionais e atitudinais. Desse modo, cada documento oficial que aborda a temática da língua de sinais é recebido como uma vitória e um avanço para a comunidade surda. Este trabalho avalia a publicação oficial mais recente sobre essa temática: o Decreto 9.656/2018, que altera o Decreto 5.626/2005. Para tanto, será realizada uma pesquisa qualitativa, de caráter documental. A análise dos dados será ancorada na fundamentação teórica da Análise do Discurso de linha francesa. Os resultados apontam que a publicação permitiu ao enunciador criar a imagem de preocupação com os sujeitos surdos. A análise também evidenciou que algumas das medidas listadas já constavam em legislações anteriores.

Concepções de surdez na voz dos interpretes de libras

Os processos educacional e de inclusão de sujeitos surdos no ensino regular, muitas vezes estão resumidos à presença do intérprete de Libras na sala de aula regular. Tais processos, via de regra, parecem estar desconsiderando as singularidades dos sujeitos surdos, e deixando de lado a importância da valorização da cultura e da constituição de identidades surdas em detrimento de práticas educativas baseadas ainda no ensino da língua como objeto pronto e acabado e do sujeito como ser passivo nesse processo. Discutir as concepções de surdez adotadas por interpretes de Libras que atuam no ensino fundamental. Trata-se de uma pesquisa qualitativa, realizada a partir de entrevistas à intérpretes de Libras que atuam no ensino fundamental, com análise dos dados realizada com base nos pressupostos da análise do conteúdo proposta por Bardin (2011). Provavelmente baseadas em políticas de inclusão para surdos que privilegiam o aspecto linguístico em detrimento ao cultural e identitário, as concepções de sujeito e surdez apresentadas pelos intérpretes de Libras ainda podem ser consideradas reducionistas. Assim, a presença deste profissional no ensino fundamental, como única ou principal alternativa para a educação de sujeitos surdos, não tem possibilitado a constituição de sua identidade e a valorização da cultura surda, não contribuindo para uma educação crítica, responsável e eficaz desses sujeitos. Se faz urgente e necessária a adoção de um modelo educacional que permita o conhecimento e desenvolvimento de relações que, para além do linguístico, valorizem aspectos culturais.

Comparação entre três sistemas de notação da configuração de mão com base em dados da Libras

A configuração de mão é um dos parâmetros articulatórios com base no qual os sinais podem ser analisados. Ela se refere, especificamente, aos diferentes estados das juntas dos dedos, potencialmente distintivos, mas também sujeitos à grande variação intra e intersujeito. Neste trabalho, são comparados três sistemas de notação propostos para esse parâmetro, o de Stokoe, o de Liddell e Johnson e o de Johnson e Liddell, com vistas a demonstrar, com base em dados da libras, que o terceiro deles é mais apropriado para a análise fonética das línguas sinalizadas. Os dados analisados se referem a uma das três produções de 26 dos 60 sinais originalmente coletados por Xavier e Barbosa (2014) de 12 sujeitos surdos (seis homens e seis mulheres) da cidade de São Paulo. O critério de seleção desses sinais foi a presença da configuração de mão em B (dedos abertos e unidos pelas laterais) e da configuração de mão em 5 (dedos abertos e espalmados). Com isso, 185 produções foram selecionadas e analisadas. Os resultados indicam que o sistema de Stokoe tem caráter mais fonológico, o de Johnson e Liddell, um caráter mais fonético e o de Liddell e Johnson, um caráter intermediário entre os dois primeiros.

Specificities of Cortical Processing of Visual Information in Subjects with Hearing Deprivation (Congenital Deafness)

In this study, systemic neurophysiological and neuropsychological mechanisms providing processing of visual information in subjects suffering from auditory deprivation were examined. In 30 men (21 to 25 year old) with complete congenital deafness and 30 control normally hearing men of the same age (groups D and C, respectively), cortical visual evoked potentials (VEPs, photostimulation of the right and left eyes by LED flashes, recording from the O1 and O2 loci) and neurodynamic characteristics of processing of visual information within the go/nogo/go paradigm were analyzed. Under conditions of the respective tests, all indices that characterize processing of simple visual information in deaf subjects (including number of processed stimuli, minimum exposure of the signal, and number of errors) were significantly worse than in the control group. It was also found that median values of the latency of the early VEP components (P1, N1, and P2) in group D were significantly smaller than the respective values in group C. At the same time, median latencies of the late VEP waves (N2 and P3) in deaf subjects were significantly greater than the analogous C-group values. Median values of the peak-to-peak amplitudes of all, with no exceptions, VEP components in group D were significantly (two times or even more) smaller than those in control subjects. Patterns of correlations between the indices of visual information processing and time/amplitude parameters of visual VEPs in the examined groups noticeably differed from each other. Thus, specific brain mechanisms responsible for processing of visual information in persons with auditory deprivation and with normal hearing demonstrate significant dissimilarity; central mechanisms of the visual system in deaf subjects undergo considerable cross-modality modifications.

Spatial Cues Influence Time Estimations in Deaf Individuals.

SummaryRecent studies have reported a strong interaction between spatial and temporal representation when visual experience is missing: blind people use temporal representation of events to represent spatial metrics. Given the superiority of audition on time perception, we hypothesized that when audition is not available complex temporal representations could be impaired, and spatial representation of events could be used to build temporal metrics. To test this hypothesis, deaf and hearing subjects were tested with a visual temporal task where conflicting and not conflicting spatiotemporal information was delivered. As predicted, we observed a strong deficit of deaf participants when only temporal cues were useful and space was uninformative with respect to time. However, the deficit disappeared when coherent spatiotemporal cues were presented and increased for conflicting spatiotemporal stimuli. These results highlight that spatial cues influence time estimations in deaf participants, suggesting that deaf individuals use spatial information to infer temporal environmental coordinates.

Changes in the functional connectivity of auditory and language-related brain regions in children with congenital severe sensorineural hearing loss: An fMRI study

Abstract Early hearing deprivation can affect the development of hearing, language, and vision. Thirty-four infants with congenital severe sensorineural hearing loss (CSSHL) and 20 age- and sex-matched subjects with normal hearing were recruited. The amplitude of low-frequency fluctuation (ALFF) of auditory and language-related brain areas was compared between infants with deafness and control subjects. Relative to subjects with normal hearing, infants with CSSHL had decreased ALFF values in the right Brodmann's area (BA) 22 region and in parts of several language-related regions. As the duration of hearing loss increased, the ALFF values in the left auditory and linguistic brain regions increased. These findings indicate that hearing deprivation affects the functional connectivity between auditory and language-related brain regions and the corresponding sensory and visual functional brain regions and that this functional connectivity decreases as the duration of hearing loss increases. Cochlear implantation performed after 24 months may limit the habilitation of hearing and speech functions due to functional reorganization of the auditory and linguistic brain areas over time.

Reading Skills in Deaf Subjects: Role of Psycholinguistic Factors and Global Influences in Affecting Reading Performance

The present study examined the role of psycholinguistic variables, as well as the presence of a global factor, in modulating reading speed and accuracy in individuals with a severe hearing impairment. Thirteen deaf and thirteen hearing young adults who completed high school and were proficient in both oral lipreading and Italian sign language were examined and compared to a group of control subjects matched for gender, age and education. A wide spectrum of psycholinguistic variables affecting reading were examined, marking visual (letter confusability), sub-lexical (length, grapheme contextuality), lexical (frequency, N-size, stress) and semantic (age of acquisition and imageability) processes. Vocal reaction times (RT) in reading aloud single words were slower in deaf participants with respect to hearing subjects but they were affected by psycholinguistic variables in a very similar way than in the case of controls. Moreover, deaf individuals did not show a multiplicative effect as a function of word difficulty in their reading slowness but only a constant delay. Overall, the deficit shown by deaf participants was relatively limited and not associated to specific cognitive processes. This finding is in keeping with the idea that at least some individuals with a severe hearing impairment may reach reasonably high levels of word decoding.