Oticon Alta

Book Excerpt from: Time Out! I Didnt Hear You Solutions for Athletes with Hearing Loss

Editors Note: Every audiologist has his/her grab bag of useful websites or free online publications that they will recommend to colleagues and patients. I am proud to present on Audiology Online and Healthy Hearing an excerpt from one of my favorites, the publication Time Out! I Didnt Hear You. The book is free and gives a wealth of creative solutions to communication challenges that may be faced by athletes who are hearing impaired. The materials are written so that it could be useful to an audiologist, a parent, a teacher or a coach. It includes chapters on how the ear works, assistive technology, legal issues, sport specific communication strategies and stories of famous athletes with hearing loss. I can say that every time a question has come my way that relates to these topic areas I have always found this publication quite helpful. The book was written by Catherine Palmer, Ph.D., Stacy Butts, M.A., George Lindley, PhD. and Susan Snyder, AuD., a group of audiologists at the University of Pittsburgh at the time of publication and published by Sports Support Syndicate, Inc., Pittsburgh, PA.

So that you can get a taste of the type of detail that is in this publication, we are providing a selected excerpt chapter 6 Sports Specific Communication Solutions. Almost every sport imagined is covered so we are only listing the sports listed under D-F.

Time Out! I Didnt Hear You!
Chapter 6 Sports Specific Communication Solutions D-F


Athletes with hearing impairment can participate in diving with a few accommodations and are not greatly disadvantaged by their hearing loss. Communication between the diver and the coach occurs before and after a dive. The rules of diving prevent coaches from communicating with a diver once he/she steps onto the diving board. Practice is where instruction and communication occur most frequently for diving.


Communication regularly occurs on the pool deck before or after a dive in a meet. The coach often offers last minute instruction and encouragement to the diver. Assistive listening devices used only on the pool deck are appropriate in this situation. These devices do not give the diver with hearing impairment an advantage over the other competitors. Use of an FM system would allow the diver with hearing impairment to effectively communicate with his/her coach while giving them the ability to remove the device to dive. The diver may even want to use earphones with the system. Earphones are easily taken on and off instead of inserting and removing hearing aids which may be lost on the pool deck. Further, if the communication will always be one-to-one in close proximity, a less expensive hard-wired system could be used instead of an FM system. The device must be removed before the diver approaches the diving board. Failure to remove the FM system or hearing aids may give the diver a final opportunity to communicate with his/her coach. In addition, these devices may be destroyed if they are submerged in the water.

Simple communication strategies such as looking at the diver when speaking to him/her and talking slowly will aid the diver in understanding the coach with and without the use of an assistive device. This is especially beneficial when the diver has finished the dive and is emerging from the pool. Even though he/she may not necessarily be able to hear what the coach is saying, the diver may be able to read the coachs lips and facial expression. But very little spoken language will be communicated during this time. During a meet, the divers name and a description of the dive to be performed are announced before each dive. It is the coachs responsibility to ensure that the diver knows when it is his/her turn to dive and which dive was announced. The coach can keep a list of the dives that the diver with hearing impairment will perform and point to the appropriate dive that was called. This is not to say that the diver with hearing impairment will not hear the announcement but that the coach should take the appropriate precautions in case the diver does not. At the conclusion of the dive, the scores are announced. Visual signs of the scores should be used. If visual representations of the scores are not available, it is recommended that the coach jot down the scores and relay them to the diver.

Tryouts and Practice

Practice is where the majority of communication occurs in any sport and it is true of diving. With diving, instruction occurs mostly out of the pool. Instruction out of the pool can be over a large distance if the diver is on the diving board and the coach is on the ground. A diver can not use any assistive listening devices including hearing aids in this situation because of the chance that they may forget to remove them before diving into the water. The use of illustrations and demonstrations to help convey the needed information are essential for these reasons. On the pool deck the coach can use a drawing or a demonstration by another diver to inform the diver with hearing impairment of what to perform or modify. Training procedures and work-outs can be fully described and illustrated in a written form for the diver with hearing impairment to follow. Instruction that takes place outside of the pool (including dry land exercises) can be facilitated with the use of the individuals hearing aids or with the FM system described in the competition section. The microphone is worn by the coach and the receiver is worn by the diver with hearing impairment.


Fencing is a sport in which participants use flexible steel blades to engage in offensive actions against their opponent. Some communication occurs during competitions. Auditory cues (either verbal instructions or from a sounding machine) are utilized to signify when to commence or halt fencing activities.


Communication between coaches and fencers is prohibited during competitions. Coaches, trainers, and technicians are not allowed in the enclosed area near the fencers during competitions. Communication is typically between the fencers and the officials. At the beginning of the competition, the president says on guard and asks if the fencers are ready. With an indication of readiness or no indication of the lack there of, the president will say fence. The competition will continue until the president says halt or until an audible signal is sounded. In addition, a verbal warning is announced stating that there is one minute left in regulation time. If the fencer with hearing impairment does not hear these cues, he/she will be placed at an immediate disadvantage. There are two solutions to the communication difficulties that may arise during a competition.

First, visual signals can be used in addition to the audible signals to alert the fencer with hearing impairment to commence or halt fencing activities. The officials should be informed of the presence of the fencer with hearing impairment and the need to place himself/herself in front of this fencer to alert him/her of the standing of the competition. Second, a tactile device that utilizes vibratory impulses can be used to warn the fencer with hearing impairment to begin fencing or to stop. The tactile device can be worn on the wrist. However, placement of the device on the ankle may be a more feasible placement as long as the fencer with hearing impairment can feel the impulses consistently. The battery-operated activating device is controlled by the official.
For electronic scoring, visual signals of scored points are accompanied by audible signals. The officials must ensure that the fencer with hearing impairment is aware of these indicators. The officials can use additional hand signals to notify the fencer of the status of the points scored by or against them.

Tryouts and Practice

Communication between coach and athlete must be free flowing during training and practice of any sport. In fencing, hearing aids and/or FM devices can be worn during practice if the protective headgear is not worn. This will allow the fencer to hear the Coachs instructions. Only the coach can determine if there are appropriate times to practice without head gear. However, if the headgear is worn, the use of hearing aids or an FM system may not be feasible because of the headgear itself. In these cases, it is advised that visual signals and/or demonstrations be utilized for instruction. Frequent use of demonstrations or pictorial representation would benefit the fencer with hearing impairment even with use of amplification devices.

Field Hockey

The fact that field hockey is played on a relatively large field outdoors is the main reason why communication may be difficult for the player with hearing impairment. Many of the strategies that are used with other fast paced sports (i.e., basketball, soccer) also apply to field hockey.


An FM system incorporated into the players hearing aids (built-in BTE FM) may provide a partial solution to communication problems between the player and coach during the game. However, an FM system can only be used if the other members of the team do not have any difficulty hearing the coach. If the players with normal hearing cannot effectively hear the coach, then providing the player with hearing impairment with a personal communication device would provide an unfair advantage. In this case, other methods must be employed to ensure that the player can be updated on the game and her role when it is necessary. Since coaches typically yell from the sidelines to communicate with players during a game, the coach and the other team members could use a signal system to convey necessary information to the player with hearing impairment. A player on the field can tap the player with hearing impairment on the shoulder to inform her to look to the sideline for instruction. Hand motions to show position or who to cover on defense can be used and often already are because of distance and noise impacting communication with everyone. If the player with hearing impairment is on the opposite side of the field from the coach, another player on the same side can obtain the coachs message and relay it to the player with hearing impairment directly or through other teammates. Another solution to this problem could be placing a coach on the same side of the field as the player with hearing impairment to relay and give coaching instructions whenever necessary. Coaches should inform officials that the necessity of having a coach in this position is for the benefit of a player with hearing impairment.

Substitution is another way a message can be relayed to a player with hearing impairment. A player who enters a game as a substitute must report to the official scorer, give her number and the number of the player she is substituting. The official scorer should be given the number of the player with hearing impairment in order to avoid possible confusion if she is the person entering or exiting the game. A player on the field can tap the player with hearing impairment on the shoulder to indicate that she is being substituted. An incoming player also can bring new instructions to the player. She can relay the coachs message easily once she is in the game. During time-outs or when the player with hearing impairment is not in the game, communication in the bench area may be necessary. During time-outs the coach can use illustrations to depict plays and strategies to be used by the team. If verbal communication is necessary, the coach should face the athletes with hearing impairment when talking and should not talk rapidly even though the time-out period is short. An FM or hardwired system can be used during bench time, but must be removed before entering the game.

The officials must be informed that a player with hearing impairment is on the team and what her number is. The officials start and stop play by blowing a whistle. The whistle may not be heard by the player with hearing impairment who may continue to play. The officials should be informed in the pre-game conference that the consistent use of appropriate hand signals is necessary and that repetition of calls may be needed for the player. In instances of the continuation of play by the player with hearing impairment after a whistle is blown, the officials should give leeway to this player due to her inability to hear the whistle. Officials also must be aware that if they call a penalty on the player with hearing impairment and a verbal caution is warranted, they must make sure that the player understands what she has done to deserve the penalty.

Tryouts and Practice

Communication is a fundamental part of tryouts and practice. All players need to hear instructions and directions from the coaches. The use of the other players in relaying information to the player with hearing impairment is as important in practice as it is in a game situation. Additionally, small group explanations are often used to teach fundamentals and give instructions. The coaches should use the same strategies in these small groups as they would in a time-out situation during a game. The use of illustrations in these situations may be beneficial to all members of the team and not just the athlete with hearing impairment. Another way to instruct any player is through the use of frequent demonstrations. Using demonstrations allows the player to view exactly what it is the coach wants them to do.

During practice and tryout sessions, the use of assistive listening devices is appropriate. An FM system incorporated into a hearing aid (built-in BTE FM) can be beneficial during drills, practice games, and any time a coach is giving instructions. A traditional FM pack receiver with wires to couple the signal to the hearing aid may not be satisfactory because of the possibility of other players or sticks tangling in the wires. The player with hearing impairment and the coach should discuss any instances where communication is breaking down and develop custom methods and strategies for remedying the situation.


Football is a team sport that is highly dependent on communication among players and between the coaching staff and the players. Unfortunately, due to the amount of physical contact and the fact that helmets will cause feedback, traditional hearing aids cannot be used easily during a game. In addition, football is generally played in large stadiums where crowd noise can be tremendous. All of these factors can lead to communication difficulty for the player with hearing impairment. Recently, in the National Football League (NFL), players have begun using helmets that receive signals from a transmitter worn by the coach. This technology allows the player to better hear the coachs instructions and called plays under the adverse listening situation already described. Unfortunately, while this technology is becoming more widespread in the
NFL, its use is banned at the high school level.

According to the Football high school rule book, electronic or mechanical devices for communication are illegal and phones and headsets may not be used by players. The rule book states that a team composed of deaf or partially deaf players may use a drum to establish rhythmic cadence following the ready for play signal. Clearly, this strategy would not be appropriate for the mainstreamed student with a hearing impairment as the majority of his teammates will have normal hearing. Therefore, additional strategies must be considered.


If it is determined that the student would like to attempt to use a hearing aid with the helmet, the following solution may work. A hole is drilled in the top of the helmet and the BTE hearing aid is actually secured in the top of the helmet with the microphone situated in the hole. A long piece of plastic tubing connects the earhook of the BTE to the earmold that is situated (as always) in the ear. The athlete will be hearing from the top of his head which is not completely natural but some students may prefer this to being auditorily isolated. Fortunately, much of the communication that takes place in football is dependent on signs and signals. For example, rehearsed plays can have a signal associated with them that can be used when communicating from the sidelines to the quarterback. Different strategies are needed depending on the position played by the player with hearing impairment.


The quarterback with hearing impairment may have difficulty hearing plays that are called in from the sidelines. There are several strategies that may help in this situation. Another offensive player with normal hearing could receive the play and then inform the quarterback. Another option would be to associate a sign with each play, then the quarterback could visually receive the play choice. A third option, due to the unlimited substitution allowed between downs, would be to send the play in with a substitute each down. Regardless of the method, the quarterback with hearing impairment should still be responsible for telling his teammates which play will be run. The quarterback with hearing impairment does not have to worry about hearing the snap count, as he is the player doing the counting. The offensive linemen, however, need to clearly hear the count in order to avoid jumping offside. This may be especially hard for the ends and tackles who are located farthest from the quarterback and closest to the crowd noise.

The offensive lineman is limited in his mobility and for the most part must remain motionless during the snap process. Therefore, he cannot watch the quarterback, or be signaled through touch by one of his teammates. Unfortunately, there is no easy solution to the problem of not being able to hear the snap count and/or quarterback audible (a last minute change in play) short of some major rule changes. This will be a difficult position for an individual with severe hearing impairment. The player with hearing impairment, who is unable to hear the count and any audibles, may want to consider playing a different position. Not knowing when the ball has been snapped has the potential to be dangerous, as he will not know exactly when the corresponding defensive player is coming. This is not to say that a player with hearing impairment cannot play on the outer offensive line, however, it will take an exceptional player who can react very quickly.


The defensive player with hearing impairment is in a slightly more advantageous position than the offensive player with hearing impairment. Not hearing the snap count is less likely to cause the defensive player to jump offside. One strategy used by linemen with hearing impairment is to watch the ball and not try to hear the snap. The defensive player with hearing impairment may not be able to hear the quarterbacks audible which can cause a problem. A teammate may need to tap the player with hearing impairment if a change in the opponents offense occurs since the player may be focusing on the ball.

As with offensive play calls, defensive play calls are generally delivered to the captain who delivers the play to the rest of the defense. Each possible play should have a sign associated with it so verbal communication is not a necessity. Cornerbacks generally look at the person they are covering and do not move until that person moves, hence they also do not need to hear the snap count.

Tryouts and Practice

During tryouts and practice, the use of assistive listening devices is appropriate. Game films generally do not have sound, but it is important to be able to hear the coach as he/she goes over the films. An FM or hardwired system might be helpful in this case.
The coach would speak into the microphone on the transmitter and the player would wear the receiver (coupled to the ear via neckloop and telecoil or direct audio input). Any instruction given while not actually playing can be enhanced with the use of an FM or hardwired system.

During practice and in drills in which physical contact is warranted, hearing aids and/or assistive listening devices should not be worn. Fortunately, much of what is taught in football is learned through demonstration. The teammates of the player with hearing impairment should be responsible for alerting him in the event the coach is trying to get his attention. The teammates also can be responsible for relaying messages during practice. All plays that are practiced and will be used in games, whether offensively or defensively, should have a corresponding sign that everyone knows, not just the player with hearing impairment. Part of practice should include sending and receiving plays; making sure the player with hearing impairment is not having trouble understanding play calls in a rapid, efficient manner. Any taps or touches that will be used with the player with hearing impairment to signify a change in plans also should be practiced.

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