SLHS 554: Audiologic Rehabilitation
Discuss the decision-making process that a person must consider when selecting wearing one or two hearing aids.
Two hearing aids give binaural advantage (localization, speech understanding in noise, sound quality, listening ease) for most people (Dillon, 2012) But some people prefer one because of binaural interference (Cox et al., 2011)
Discuss the need to clarify expectations regarding HL and HAs.
Clarifying expectations Hearing aids are an important part of the process but do not restore hearing or communication to "normal" Background noise may continue to be problematic Encourage clients to think of a hearing aid as one aspect of improved communication, where comprehensive management includes more: o Collaboration w/ communication partners o Communication strategies o Environmental modifications o Possible use of other assistive devices
Describe Dornan et al. (2010) and their results about AVT as therapy.
Dornan et al., 2010) Kids with hearing loss using AVT compared to typical hearing kids showed no significant differences between the groups for speech, language, and self-esteem.
What is the role of an Educational Audiologist?
EDUCATIONAL AUDIOLOGIST Responsibilities o Hearing conservation o Identification of HL o Assessment of HL and other abilities o Amplification and other assistive technology o Educational planning and support o Direct (re)habilitative services o Family support Qualification Criteria for children 1. Hearing loss 2. Academic need An individualized Education Plan (IEP) is a written document that describes the child's current levels of performance, a statement of annual goals, a recommendation for special education support with an indication of how support will be provided, and objective criteria for evaluating progress. Children with significant hearing loss often have problems in content, form, and pragmatics of language. For instance, many have reduced vocabulary and have mastered fewer syntactic structures than children with normal hearing. Children with significant hearing loss often experience difficulty in learning to read. Many adults never attain better than a 4th grade reading level. Some children with hearing loss can benefit from psychosocial support and social skills training. Social problems may include social isolation, naivete about peer interests and customs, difficulty empathizing, limited understanding about internal states and feelings, feelings of frustration or intimidation about social interaction
Describe the Early Hearing Detection Intervention (EHDI).
EHDI Early Hearing Detection Intervention 1-3-6 (JCIH, 2007) = don't lose out on critical period of learning! 1: screened for hearing loss prior to discharge or within one month 3: referral for complete diagnostic evaluation 6: receive appropriate interventions Even a mild loss can be significant for children (>25dBHL). o At high rish for experiencing academic difficulty (bess, Dodd-Murphy, & Parker, 1998) o Impede a child's ability to perceive speech adequately for language development (Bess, Gravel, & Tharpe, 1996)
Describe the effects of dual sensory impairment on rehabilitation.
Effects of Dual Sensory Impairment on Rehabilitation 21% of people in the U.S. have both vision and hearing loss by age 70 years Most have mild to moderate impairment in both sensory modalities Types of vision loss o Low visual acuity = blurry o Age-related macular degeneration (AMD) = middle gone o Tunnel vision = can only see middle Saunders & Echt, 2007 o Self-report Individuals are at greater odds for depression than those w/ single sensory or no sensory impairment Dual sensory impairment is associated w/ poor health and decreased participation in activities (10% less visiting friends, talking on phone, going to movies, attending church) o Individual is deprived of compensatory strategies that make use of the typically non-impaired sense (i.e., vision loss use hearing to compensate, hearing loss use vision to compensate) o Considerations Small hearing aids difficult to see Hearing aid style, features, accessories Choice of battery (Duracel "Easytab," Energizer "EZ Change") Use of assistive technology in addition to or in place of hearing aids (amplified telephone w/ large buttons) Use of tactile information (vibrating alarm clocks, doorbells, fire alarms) Heine & Browning, 2002 o At age 70, approx 70% of those w/ severe visual impairment have significant hearing impairment o Causes of age-related sensory loss Vision: cataract, diabetic retinopathy, glaucoma, macular degeneration Hearing: presbycusis o Strong relationship btwn sensory loss and a decrease in communication performance o Relationship btwn sensory loss and poor psychosocial functioning has been noted Take into account when creating a rehabilitation program for those w/ dual sensory loss Brennan, Horowitz, & Su (2005) o Self-report measures from the Longitudinal Study on Aging (LSOA) Nationally representative sample of people 70 years or older in 1984, w/ 3 follow-ups every 2 years o Examined relationship btwn dual sensory loss and functional competence among adults Activities of Daily Living (ADLs) Instrumental Activities of Daily Living (IADLs) o Measurement areas: Sociodemographic characteristics, physical health, cognitive status, sensory impairment (severe, moderate, or no impairment), functional tasks (ADL and IADL tasks) o Prevalence: 21% some degree of dual impairment, 13% moderate impairment, 5% mixed dual impairment, 2% severe dual impairment) o Functional tasks: greater age was associated w/ difficulty in activities of daily living o Conclusions Dual sensory impairment increased the risk of difficulty w/ ADL tasks when compared to hearing impairment alone vs. no impairment Older adults w/ dual sensory loss and single impairment in vision are at a higher risk for decreased everyday competence and less independent living These changes in vision and hearing are often considered "typical aging," yet those w/ sensory impairments show poorer QoL ratings Health care professionals should be trained to provide additional services for these individuals Clinical implications o No standardized measurement for these individuals, which makes multidisciplinary involvement in rehabilitation even more crucial o Rehabilitation for those w/ only one sensory impairment should not be generalized to those w/ dual sensory impairment as these individuals will likely have specialized needs o Research is needed w/in this population, esp in regards to rehab programs Clinical applications o Case history should include question regarding vision o Vision screening questionnaire (National Eye Institute Vision Functioning Questionnaire) o Be aware of potential cognitive impairments o Modify demonstration of tasks based on individual's vision loss o Slow rate of speech, avoid jargon o Environment - Well-lit room, do not sit in front of window, wear lipstick and eyebrow pencil to increase facial feature contrast, some individuals may be at higher risk for falling due to dual loss causing disorientation and the lack of vision
List some of the effects of HL?
Effects of HL: physical health, emotional & mental health, family relationships, self esteem, work/school performance
Describe the evaluation process for potential fitting of a cochlear implant.
Evaluation - Pre-implant info and counseling (making initial contact) - Determine candidacy through formal evals and case history a. Audiologic, medical, psych evals, speech-language - Surgery - Risks (meningitis vaccine), rejection, benefits, irreversible, cultural considerations, communication modes, committment - Post-implant activation at 4-6 wks post-surgery - Mapping: determine dynamic range for each electrode (T level = threshold, C or M = comfort) - Follow-up intervention, monitoring (first weekly or monthly, then every 6 mos - 1 yr) **Education, counseling, and peer/family support are vital at each stage of the process
Describe the impact of HL on school-age children.
- HL is considered an educationally significant disability - Profound HL often plateau at 4th or 5th grade reading level (Paul, 1998) - Even minimal has an effect, 37% failed one grade (Bess, Dodd-Murphy, & Parker, 1998) - Poorer communication skills, problems with stress, social support, and self-esteem - Children with unilateral HL are 10x to fail a grade by age 10 (English & Church, 1999) - Federally mandated access to special education (IDEA) "appropriate public education" - Least restrictive environment = where child has most access to academic, social, and emotional support - Does not equal mainstreaming... but it might be. - Hearing screens at kindergarten, grades 1-3, grade 12 - IEP 1. Communication status 2. Overall participation in activities 3. Related personal factors 4. Environmental factors - Interventionists in school 7-18 = teachers, SLP, audiologist, educational interpreter, classroom aides - Assessment 1. GOAL = ecologically valid 2. Teacher questionnaires, classroom observations, standardized tests 3. SIFTER = screening instrument for targeting educational risk
What are the risk factors for older children and adults to experience HL.
1. Older child & Adult Risk factors a. Ear/head trauma b. Family history of hearing loss c. Occupational and recreational noise d. Synergistic effects of tobacco and noise e. Viral infection f. Auto-immune disease g. Ototoxic drugs h. Diabetes i. Menieres disease j. Acoustic tumors k. Heritable conditions associated with late onset hearing loss (otosclerosis)
Provide a general overview of assistive listening technology.
ASSISTIVE LISTENING TECHNOLOGY - ALDs are used to address communication needs related to face-to-face communication, broadcast, and other electronic media, and telephone use. General categories are wireless (FM, infrared, induction loop) and hard-wired. - Hearing assistance technology includes ALDs and devices that facilitate the reception of auditory information that is not speech and that provide auditory information by means other than amplification (like vibrating alarm clocks, flashing doorbell/smoke detector, baby alert system)
Describe auditory development in the womb.
AUDITORY DEVELOPMENT Ectoderm: Inner ear also develops into skin (malformed pinna? Beware of SNHL) Mesoderm: middle ear also develops with heart (beware of defects) Auditory experience begins at third trimester Cochlea is mature at 32 weeks.
Describe the Auditory Learning Guide for Intervention (Walker, 1995).
AUDITORY LEARNING GUIDE for Intervention (Walker, 1995) Framework for development of auditory function 1. Sound Awareness a. Detection, ling sounds, environmental sounds, close range to distance (1 week) 2. Phoneme level a. Perception/imitation of nonsense syllables. Replicate babble-play. Develops auditory feedback system. Brief segments at home (10-20x/day for 5-10 secs) 3. Discourse level a. Perception of connected spoken language in conversational context b. Year 1: imitate motion of nursery rhymes, ID songs, ID last word read in passage, answer common questions c. Year 2: follow a story illustrated by sequenced pics, ID object from several related descriptors (closed set), follow a conversation with topic disclosed d. Year 3: Answer questions about a story (topic disclosed), answer questions (audio story), recall story details, sequence events e. Year 4: retell stories with detail, follow conversation (topic undisclosed), process info with competing stimuli, ID in an open set 4. Sentence level a. Stimulus response context b. ID familiar expressions c. Use imitation as a strategy for facilitation auditory memory d. Critical elements (get dog and sheep, put daddy on the bed) 5. Word level a. Perception of individual words b. Power words c. Vocab development d. Learning to listen sounds (early developing vowels and consonants)
Describe Pollack's (1970) AVT.
AVT (Doreen Pollack, 1970) 1. Emphasize spoken language 2. ID hearing loss early 3. Optimal amplification 4. Intensive SL therapy 5. Caregivers are primary language models 6. Integrate listening into all environments 7. Promotes education in regular schools
Why is audiologic rehabilitation important across the lifespan.
Across the Lifespan: Why? - Early childhood, school age, young adulthood, older adulthood - Developmental differences = wide range of programs and techniques - Age factors: Children with HL turn into adults with HL - Onset differences: o Congenital o non-congenital or acquired (after birth) o adventitious or acquired (later) o genetic - 30 million with bilateral HL - 48 million with either unilateral or bilateral
Using the WHO- ICF system, define the following: activity limitation participation restriction quality of life
Activity Limitation: Difficulties an individual may have in the performance of activities. A change of the level of the person brought about by an impairment at the levels of body structure (e.g., loss of hair cells in the cochlea) and function (e.g., loss of ability to discriminate pitch); for example a patient may no longer be able to engage easily in casual conversation. What can't you do? Participation Restrictions: Problems in the manner or extent of involvement in life situations with people in context. The effect of an activity limitation that results in a change in the broader scope in the patient's life (e.g., a patient may avoid social gatherings). Quality of Life: Psychosocial well-being - Physical and material wellbeing - Adult role fulfillment - Cognitive function - Social role performance - Life satisfaction In reference to objective conditions of existence (environmental stressors/living conditions)
Using the WHO- ICF system, define the following: activity participation environmental factors
Activity: The performance of a task or action by an individual Participation is involvement in a life situation. Environmental Factors make up the physical, social and attitudinal environment in which people live and conduct their lives. Performance qualifier: Describes what an individual does in his or her current environment. Lived experience in actual context. Capacity qualifier: An individual's ability to execute a task or action.
Describe the advantages of Group AR?
Advantages May produce gains in speechreading Allows for group sharing of feelings, emotions, and perspectives Provides an emotionally safe environment Maintains contact with the audiologist during the early stages of hearing aid fitting Self and significant other (Hawkins, 2005) o Reduction in the perception of hearing handicap o Better use of communication strategies and more adaptive personal adjustment o Improved QoL due to a reduction in social, emotional, and occupational withdrawal o Better use of and benefit/satisfaction w/ hearing aids o Fewer returned hearing aids o Increase in perception of audiologist effectiveness o Increased awareness of auditory training and utilization of assistive devices
Describe the Americans with Disabilities Act.
Americans with Disabilities Act 1. Most comprehensive federal civil-rights statute protecting the rights of people with disabilities. 2. It affects access to employment; state and local government programs and services; access to places of public accommodation such as businesses, transportation, and non-profit service providers; and telecommunications 3. All about free access! 4. What is covered? Employment, public entities, public transportation, private entities, telecommunications, miscellaneous a. Employer: Make reasonable accomodations as long as it does not result in UNDUE HARDSHIP. (telephone amplifier, interpreter, ALDs, visual alerting systems, work area adjustments) b. Employers can prohibit someone if there is a safety concern even with reasonable accommodations c. Public: videotext for broadcasts, closed captioning, interpreters, note-takers, written materials, ALDs, TDDs d. Lodging requirements: flashing alarm lights, notification devices, accessible phones, closed captioning e. Telecommunication: Text to speech relay services. Relay operators must be familiar with Deaf culture and cannot disclose content or keep notes, cannot limit length of conversation 5. When is it covered? Substantially limits a major life activity, substantially limited a life activity in the past, or the employer regarded the individual as if it was substantially limiting 6. Determination of "substantially limiting" is made on a case-by-case basis 7. Penalties for non-compliance: up to $50,000 for the first, and $100,000 each time after 8. SLP & AuD might train/setup, be an expert witness, give info about ADA, counsel about self-advocacy
Define audiologic rehabilitation.
An ecological, interactive process that facilitates one's ability to minimize or prevent the limitations and restrictions that auditory dysfunctions can impose on well-being and communication, including interpersonal, psychosocial, educational, and vocation functioning.
Describe assessment of HL in children.
Assessment - Use communication modality of child - Document mode and hearing aid - Reference to norms for kids without hearing loss - Use standardized procedure - Vocab = PPVT, Expressive one-word picture vocab test, expressive vocab test - Better at receptive measures than expressive measures - Language: TOLD, PLS-4, CELF a. For older kids should look at complexity, syntax, semantics, and pragmatics - Articulation: GFTA, BBTOP, SPINE (for kids with HL) a. Similar errors = weak syllable deletion, cluster reduction, stopping fricatives b. Different errors = affrication, epenthesis c. Very different errors = voicing, vowel neutralization, implosive stops, frequent glottal stops, consonants are stopped, consonants are fronted, limited phonetic inventory, poor intelligibility d. Suprasegmental errors = all syllables stressed, very slow rate, hyperconstriction, poor articulation, breathy, nasality, reduced/excessive intensity - Spontaneous language sampling, and analysis of play
What is Auditory Processing Disorder?
Auditory Processing Disorder A range of difficulties with auditory information Includes problems in several listening domains (DeBonis & Moncrieff, 2008) APDs refer to difficulties in the perceptual processing of auditory information in the auditory nervous system as demonstrated by poor performance in one or more of the following skill areas: auditory discrimination, auditory pattern recognition, temporal aspects of audition, auditory performance in competing acoustic signals, and auditory performance with degraded acoustic signals. Individuals suspected of having APD frequently exhibit one or more of the following characteristics: (a) difficulty with speech understanding in adverse listening environments, (b) misunderstanding messages, (c) responding inconsistently or inappropriately, (d) frequently asking that information be repeated, (e) difficulty attending and avoiding distraction, (f ) delay in responding to oral communication, (g) difficulty following complex auditory directions, (h) difficulty with sound localization, (i) reduced musical and singing skills, and (j) associated reading, spelling, and learning problems.
What is Auditory Training?
Auditory Training - Based on premise that children with HL use residual loss - Related to neural plasticity - MAIS scale to address how child uses hearing in everyday life - Blend language and auditory goals - Intervention might focus on increased intelligibility, audibility differences of individual phonemes
What Hz should be measured when obtaining a Pure Tone Average (PTA)?
Average of 500, 1000, and 2000 Hz.
What are the behavioral signs of a problem with a listening device for a person with HL?
Behavioral Signs of a Problem - Decrease in attending or auditory response - Change in frequency of vocalization, voice quality, and/or intensity - Gradual reduction in distance hearing - Increased requests for repetition - Disruptive or withdrawn behavior
Using the WHO- ICF system, define the following: body function body structure impairments
Body functions: Physiological or psychological functions of body systems Body structures: Anatomic parts of the body such as organs limbs and their components Impairments: Problems in the body function or structure such as a significant deviation or loss
What are the features of a hearing aid?
Features - Telecoil = eliminates room mic, signal directly from telephone by induction - Multiple memories - Noise reduction circuits - Feedback control - Directional mics = 2+ mics, sounds from side and behind are reduced. Helps improve speech rec in background noise - Extended bandwidth
Discuss cochlear implant outcomes in adults.
CI Outcomes in Adults - Curved electrode array allows for electrodes to be closer to modiolus which decreases distance signal has to travel, making battery more efficient for speech processing and lowering ABR thresholds a. Make electrodes fatter b. Use a positioner to get it closer c. Memory materials so it curves once placed - (Zwolan et al., 2001)showed 50/56 subjects had statistically significant differences on HINT, CUNY sentences, CNC monosyllables pre-and post-op a. People performed better in quiet than in noise (70% vs. 60% for sentences) - (Chatelin et al., 2004) adults >70 yrs a. Will it work? Concerns about degeneration, presbycusis, cognition, surgical complications b. Surgery well-tolerated, gains not as good as young group (<65 yrs) but still good! - (Schramm, Fitzpatrick, & Seguin, 2002) dolescents who received CIs after 12 a. Results were highly variable, 66% had significant improvement post-op b. Results better for adolescents vs. adults implanted after 19 years due to age (and on-going tx?) - (Vermiere et al., 2005) QOL a. All age groups experienced QOL improvements (decrease in perceived disability, improved speech perception) but more research is needed to determine why and how
What conditions are necessary for a client with HL to benefit from cochlear implants?
COCHLEAR IMPLANTS For people with severe to profound sensorineural loss that won't benefit from HAs Uses electric stimulation NOT acoustic Cochlear lesion Requires intact auditory nerve fibers that are capable of stimulation Bypasses outer, middle, inner ear and stimulates neurons in spiral ganglia directly Brands = Cochlear, Advanced bionics (clarion), Med-el
Describe Communication Options for Children (Gravel & O'Gara, 2003).
COMMUNICATION OPTIONS FOR CHILDREN (Gravel & OGara, 2003) Infants who are hard of hearing or deaf have the same capacity to learn language as non-hearing peers, as well as a desire to communicate Most parents of children with hearing loss have hearing within normal limits and communicate using spoken language (93%) Only 40% of speech sounds are visually distinguishable Therefore developing spoken language through speechreading alone is challenge at best and often unachievable Any degree of hearing loss restricts access to some or all acoustic features of speech Changes in hearing acuity lead to changes in speech information communicated (spectrogram example) Children with <90db HL may acquire language with residual hearing and use of amplification Children with 90+ need a CI Acquisition of age-appropriate language also influenced by other factors o age of ID, early intervention, home communication, parent involvement Less emphasis on method more on ensuring language rich environment Empowers parents to change method of communication throughout childhood A communication option/mode/modality/method is the means by which the child and family receive and express language Needs of families o Recognition of individuality of each child and family o Unbiased, objective information o Direction to multiple resources o Arrange contacts with families who are successful users of either mode Factors impacting selection of Communication option for children o Language used in home o Family involvement o Age of ID and intervention o Literacy o Community resources o Hearing status o Hearing aids and CIs o Speech intelligibility o Presence of additional disabilities o Availability of later education options
What are special considerations for the elderly with respect to HL?
CONSIDERATIONS FOR THE ELDERLY Elderly adults have poorer speech recognition than younger adults Why? Peripheral cochlear pathology, central auditory processing deficit, or cognitive decline Declines in auditory temporal processing and advancing age When audibility is restored 30-50% of variance in speech perception caused by other factors (age, cognition) (Humes, 2007) Even in worse in noise if cognition is bad (Humes, 2007) Factors that affect AR with elderly include o Central auditory system changes, peripheral changes, cognitive decline, economic circumstances, social circumstances, residency, emotional variables, physical variables, dementia Other considerations o Dementia, lost hearing aids, non-functional aids, ears plugged with wax, staff involvement, turn-over at facility, dual-sensory loss
Describe the FDA regulations surrounding cochlear implant candidacy.
Candidacy - FDA Regulations - Bilateral severe-to-profound sensorineural HL in children (2 yrs and older) and adults - Bilateral profound sensorineural HL in infants and toddlers (12 mos to 2 yrs) - Hearing aid trial of at least 10 wks unless meningitis due to ossification - Limited benefit from hearing aids a. 12 mos to 2 yrs: lack of progress in development of auditory skill, high motivation and realistic expectations from family, other medical conditions do not interfere with implant procedure b. 2-17 yrs: lack of progress in development of auditory skills, high motivation/realistic expectations c. Adults: <50% sentence recognition in ear to be implanted, <60% sentence recognition in ear not being implanted or bilaterally, realistic expectations, motivated - Arguments against CIs as early as 12 mos a. Hearing status hard to confirm b. Additional disabilities may not be apparent c. Allow for a time of thought d. Cannot participate in fitting procedure mappi ng and making electrical stimulation thresholds (T levels) and UCLs hard to determine - Arguments for early implantation a. Critical age for speech and language development (Yoshinaga-Itano, 1998)
Describe cochlear implant outcomes in children.
Cochlear Implant Outcomes in Children Variables for Success 1. Age of implantation. 6 mos (Valencia et al., 2007), before 24 mos (Nicolas & Geers, 2007) 2. Oral Communication 3. Nonverbal intelligence 4. Gender 5. Technology 6. Intervention Early Intervention Outcomes - Before age 2, 90% of children who obtain a CI have intelligible speech - Age 2-4, 80% of kids with a CI have intelligible speech - 20% of kids with a profound loss with HAs obtain intelligible speech - (Belzner & Seal, 2009) CI demographics and communication outcomes - (Peterson, Pisoni, & Miyamoto, 2010) Holt and Svirsky (2008) concluded that the capacity for acquisition of receptive and expressive language was significantly diminished after the age of 2 to 3.5 years of age. In clinical practice, early implantation has now become widespread, resulting in better overall outcomes for CI recipients.
Describe Communication Rings.
Communication Rings Ring No. 1 = The center or core represents the person completing the rings Ring No. 2 = The inner circle represents the most important people in the individual's social network - those that the individual shares a lot of time w/ or feels particularly close to Ring No. 3 = The middle circle represents people who are still very important but not as close or important as the people in the inner circle Ring No. 4 = The outer circle is reserved for those individuals who are less important but are present on a regular basis
Describe communication partnerships.
Communication partnerships Focus on the shared responsibility for communication breakdowns 1. Identify important communication partners 2. Identify what can be done to engage communication partners in the rehabilitation process
Compare and contrast the professional roles of an SLP and an AuD in the AR process.
Compare and contrast the professional roles of an SLP and an AuD in the AR process. o SLP: Screening, explain test results, refer o Aud: Screening, evaluation procedures,
What are the components of a cochlear implant?
Components - External portion = microphone, speech/sound processor, transmitter coil, external magnet - Internal portion = Internal magnet, receiver, electrode array (16-24 electrodes)
What are the components of a hearing aid?
Components - Microphone: converts acoustic to electric - Amplifier/processor: increases amp of electric signal - Speaker/receiver: convert electric to acoustic - Switch: on/off - Gain control: volume - Battery: power - Earmold
What are the components of Audiologic Rehabilitation (Boothroyd, 2007)?
Components of Audiologic Rehabilitation (Boothroyd, 2007) AR for adults is the reduction of hearing-loss-induced deficits of function, activity limitations, participation restrictions and quality of life A modern approach to AR (see above for traditional vs. modern comparison) 4 Key components o Sensory management: optimize auditory function o Instruction: In use of technology and control of listening environment o Perceptual training: To improve speech perception and communication o Counseling: to enhance participation and deal both emotionally and practically with limitations Underlying assumptions o Return to pre-loss state will not be automatic or optimal o There is no "cure" o There is individual variation in outome o Holistic approach that goes beyond sensory management
What are the components of a listening check?
Components of a Listening Check - Test battery (battery tester or cup it with hands and listen for feedback ) - Listen to aid: sound quality, volume changes, intermittency - Visual inspection: cracks, corrosion, clogs, moisture, tear/holes - Functional listening (ling sounds): i, u, a, s, sh, m (3 feet, no visual cues)
What are some of the life consequences of hearing loss?
Consequences of HL Communication: Impact of hearing loss on verbal communication Functioning: Additional effects of hearing loss including educational, vocational, psychological, and social implications It might not affect everyone the same!!!!! Degree of hearing loss cannot predict quality of life The impact of hearing loss on an individual may be mediated by that person's use of listening aids, by his or her physical environment, lifestyle, and frequent communication partners, and by individual characteristics such as personality.
Provide an overview of the critical issues in AR for adults.
Critical Issues in AR for Adults 1. Motivation a. Health Behavior Change (Prochaska & DiClemente, 1991): Help clients change their behavior through more effective counseling Coach clients into taking responsibility for their action and making appropriate behavioral changes Attitude Process: Pre-contemplation, contemplation, preparation Behavioral Process: Action, maintenance, relapse, permanent exit The line: Useful when the client appears to be undecided about whether he is ready to embrace the use of hearing instruments. Clarifies where the client sees themselves in the change process. Used in the first AR sessions. Mark along the line. How important is it for you to improve your hearing right now? How much do you believe in your ability to use hearing aids, or communication strategies If high on both, he will have enough motivation to act to improve ability to hear If the score on Q2 is low, clinicians can elaborate on clients elaborations. Don't tell them their concerns aren't unfounded Elaborate on the client feedback and empower then to phrase the reasons for the change of behavior The box: benefits/cost of status quo, potential cost/benefits of change. Used in combination with the line to make client aware of positive and negative issues toward HL and give the clinician a picture of the client's motivation Client fills out box himself Afterward, clinician can ask follow-up questions and encourage the client to elaborate on responses. 2. Adjustment to life with a hearing loss and a sensory aid a. Living WELL with hearing loss b. Forms of counseling (Tye-Murray, 2008) i. Informational: patient learns about hearing loss and technology. Outcome is patient understands HL and technology and is willing to participate in AR 1. Understand audiogram and speech results 2. Make sure client is thoroughly familiar with hearing aid 3. Orientation include: Insert/remove hearing aid, turn it on, switch programs, telecoil, check battery, replace batteries, where to recycle old batteries ii. Rational Acceptance: Patients learns to manage hearing loss and communication difficulties. Outcome is that patient optimally uses communication strategies and structures listening environment. More willing to do AR. iii. Adjustment counseling: Patient works through negative feelings and decreased sense of self-worth. Outcome is that patient begins to view disability as separate from self; more positive self-image; more willing to participate in AR. 3. Assessment of communication abilities o Speech perception assessment: auditory (most common), visual (CI or in AR groups), A+V (CI or groups) AUDIO Syllable recognition (nonsense syllable test) Word recognition (NU-6, CID W-22, California consonant test) VISUAL Syllable recognition (screen for lipreading ability) Sentence recognition (test at the synthetic level, CID everyday sentences, Denver quick test of lipreading) AUDIO-VISUAL Evaluate speech understanding in noise and ability to use context cues Syllables, words, sentences (Hearing in Noise Test HINT sentences, Speech Perception in Noise (SPIN) test - high and low predictability sentences) o Communication self assessment Screening Self Assessment of communication , Significant Other Assessment of Communication, Hearing Handicap Inventory for the Elderly Intermediate Assessment = Diagnostic, aids in establishing goals, used to determine benefit in AR program Hearing Handicap Scale, Denver Scale of Comm Function, McCarthy-Alpiner Scale of Hearing Handicap Comprehensive Assessment = Aids in determining specific goals, gives detailed information across situations and personal perception of disability Hearing Performance Inventory, Communication Profile for the Hearing Impaired Hearing Aid User Self Report Profile of Aided Benefit, Abbreviated Profile of Hearing Aid Benefit, Glasgow Hearing Aid Benefit Profile COSI Self-assessment instrument that may be used to guide an overall aural rehab plan and to assess outcome, and in particular can be used to assess hearing aid benefit. Patient chooses up to five situations in which the client would like to communicate better or cope with. Is specific and ranks them. (Dillon et al., 1987) o Outcome measurements International Outcome Inventory for Hearing Aids 7 items that query the patient about performance, benefit, usage, and satisfaction of hearing aids How many hours do you use your hearing aid in a day? How much have your aids helped in situations over the past two weeks? What difficulty do you still have in that situation? Were your hearing aids worth the trouble? With your aids, how much have your hearing difficulties affected the things you can do? With your aids, how much do you think other people were bothered by your hearing difficulties? Have you hearing aids changed your enjoyment of life? 4. Intervention for communication abilities a. Conversational Style i. Passive (withdraw, bluff, smile, nod), aggressive (blame others), passive-aggressive (smile and nod and then complain), assertive (take responsibility for managing) ii. Provide education about desirable conversational styles b. Repair strategies i. Receptive: repeat, rephrase, elaborate, simplify the message, introduce topic, confirm message, write, fingerspell c. Environmental manipulation i. Facing the person, turn down noise, walk before you talk, turn on a light, tap the person, position the client best, arrange furniture d. Continuous Discourse Tracking i. In any modalities ii. Involves communication dyad iii. Goal is for the receiver to repeat back the discourse verbatim iv. Time for 10 minutes. Word/minute repeated v. Practice repair strategies e. Speechreading i. ANALYTIC 1. Used if the client does poorly on the syllable-level recognition screening 2. Client has poor performance for recognizing correct visemes. 3. Educate client about visual differences 4. Drill ii. SYNTHETIC 1. Face-to-face training, computer training, homework via video
Describe the cultural considerations to keep in mind when working with a Deaf client.
Cultural Considerations Think about if your client is "D"eaf Use an interpreter o Selection They should speak both languages, Use same interpreter, Educational level, Communication style o Prior Meet to prep, Review goals and procedures of test and treatment materials, Confidentiality, Limit nonverbal cues, Validity/reliability, limit rewording, Establish rapport, Remind to take notes, Learn greetings and family name pronunciations o During Describe roles and clarify expectations, Take notes, Short concise sentences, Pause frequently to allow translation, Allow time, Understand some things may not be directly translated, Check to see if you're going to fast, too slow, Talk directly to patient, Be aware of offensive non-verbal body language, No oversimplying important stuff, Written materials in native language, Extra time for session o After Review patient errors, Avoid use of jargon, Discuss and difficulties in testing or interpretation process
Explain one of the key terms from ASHA's definition of AR (e.g., ecological; interactive; process)
Explain one of the key terms from ASHA's definition of AR (e.g., ecological; interactive; process) o Ecological = right environments important to that person (maybe the movies?) o Process = across the lifespan
What are the "Four Levels of Auditory Skills" Model by Erber and Estabrooks?
FOUR LEVELS OF AUDITORY SKILLS MODEL (Erber, 1977, Estabrooks, 1998) 1. Detection = respond to presence/absence of sound 2. Discrimination = perceived similarities or differences in two or more speech stimuli 3. Identification = label by repeating, pointing, or writing 4. Comprehension = understanding meaning of speech by answering questions, following instructions, paraphrasing, or participating in a conversation
Describe the goals and structure of group AR.
GROUP AR Setting: University programs, private practice, military, consumer groups Address: HL, sensory aids, speechreading training, communication strategies Frequency: 1-2 times/week, 1-2 hours/session, 2-8 weeks total A holistic approach to adult AR that goes beyond sensory management (Marrone & Harris, 2012, Perspectives in Aural Rehabilitation and Its Instrumentation) Audiologist's role is as a group facilitator Groups are most successful when the leader is NOT perceived as the sole source of content Value is in the sharing among group members (Kricos, 2000) Goals Counseling-based group AR programs can address residual difficulties 1. Maximize communication 2. Minimize any negative effects of the HL 3. AR reinforces the success of the HA/CI fitting
What are the goals of audiologic rehabilitation?
Goals of AR: alleviate difficulties, minimize consequences (communication, psychosocial, educational, vocational functioning) AR is interactive and changes over time. Role of individual in self management. AL and PR influenced by context.
What are the goals of identification and assessment with hearing loss in young children?
Goals of Identification and Assessment - Early hearing detection and intervention - Screenings in all 50 states prior to hospital discharge within 30 days - Diagnosis degree and type of HL - Determine if HL is contributing to known or suspected developmental delays - Behavioral tests for identifying hearing loss in young children include behavioral/observational audiometry (babies), visual reinforcement audiometry (6 mos-2yr), and conditioned play audiometry (2-2.5) - Minimize the adverse effects of HL on auditory, language, learning, and speech development through intervention, surveillance, and follow-ups
Gravel and O'Gara (2003) outline communication options available for families of infants and young children with hearing loss. Compare and contrast two of these different options.
Gravel and O'Gara (2003) outline communication options available for families of infants and young children with hearing loss. Compare and contrast two of these different options. o Total Communication: Simultaneous use of multiple modalities. (signs, gestures, speechreading, hearing) most widely used in educational settings for deal. Ideally, families would use MCE with speech. o ASL only: "D"eaf community. Not mainstream school. Speech not a component o Similarities Both include signs Both are modes of communication chosen by families based on a variety of factors (language in home, family involvement, age of ID, community resources, hearing status, later educational options, presence of other disabilities)
Describe hearing aid care.
HA Care Clean every night: wipe with Kleenex, brush off holes VIGOROUSLY. Use wax pick if needed Get a wax guard to prevent clogging Protect and store it Avoid shock, temperature extremes, and moisture Earmolds can be removed and washed Replace earmold tubing periodically
When assessing hearing loss, what are the three main aspects of HL to consider when planning an evaluation?
HEARING LOSS Auditory capacity: sensory Auditory capability: perceptual skills Listening demands: Communication situations and communication partners SCREENING = pass or refer DIAGNOSTIC = thresholds, frequency specific
Discuss the benefit HAs provide for people with HL and how a client can be fitted for them.
Hearing Aids ($1/day) Amplification system with acoustic and electronic component Increases the intensity of signals across the frequency ranges May provide more intensity for signals of different frequency Appropriate for anybody with a permanent or variable unilateral or bilateral hearing loss Objectives for listening device are to A) make speech audible without distortion or discomfort and B) restore a range of loudness experience Two major trends are miniaturization and enhanced signal processing Consider degree of loss, user preference, cost, lifestyle, physical status during selection First select, verify, orientation, validation, follow-up HA benefit can be verified through behavioral measures, probe microphones, or self-assessments HA users go through a process of orientation where they are instructed on how to use, handle, troubleshoot, and maintain the aid
Describe pediatric hearing loss.
Hearing Loss - Most common birth defect, 1.86 (or as many as 3) out of 1000 - 50% genetic (70% non-syndrome, 30% syndrome), 25% idiopathic, 25% non-genetic - 50% of kids have OM by 1st birthday, 80% by 3rd birthday - 90-95% of children with HL are born to hearing parents - About 40% of kids with significant hearing loss also have another disability (Roush et al., 2004) - Can be congenital or acquired - 1/100 NICU graduates have loss - Untreated HL has wide-reaching and compounding effects across the lifespan (Noel Matkin) a. Delay expressive/receptive communication b. Language deficit poor academic achievement literacy c. Social isolation d. Poor vocational effects - Factors that affect long-term impact of childhood HL a. Severity of HL b. Time of onset c. Etiology and type of HL d. Age of identification and intervention e. Additional disabilities and general health f. Environmental factors like family nurturing, access to medical and professional services, availability of appropriate tech
How does hearing loss affect communication within social networks?
How does hearing loss affect communication w/in social network? (Hallom et al., 2008; Scarinci et al., 2008) 1. Fear of loss of relationship 2. Pragmatic adjustments to deal w/ hearing loss 3. Managing the adjustments leads to negative consequences for the relationship
How would you apply one of the counseling principles outlined by English (2012) into your clinical practice?
How would you apply one of the counseling principles outlined by English (2012) into your clinical practice? o Let the client tell their story. Go into self-assessment discussion. Let this help establish goals and monitor progress throughout.
In a clinical encounter, who is responsible for defining what hearing loss and its associated consequences are? Justify your answer using specific examples from class readings.
In a clinical encounter, who is responsible for defining what hearing loss and its associated consequences are? Justify your answer using specific examples from class readings. o Defining the loss partly audiologist in terms of physical findings (ASHA) o Effects/consequences depend on the person. They determine how it affects them. Self concept/psychosocial/emotional effects (English)
Describe Infant Hearing Behaviors.
Infant Hearing Behaviors o Infants are active listeners o Aural habilitation for infants is generally designed to increase awareness of sound and facilitate active listening behaviors
Describe Infant Hearing Sensitivity.
Infant Hearing Sensitivity o Worse thresholds. High frequency matures (6 yrs) before low frequency (10 yrs) o More OAEs with larger ampliture o Newborns have elevated ABR threshold by about 15 dB o Masked thresholds - More difficult for infants-10yo to hear in background noise ("broadband listeners" can't selectively attend so use FM system to improve STN ratio) o Frequency discrimination - 4x adult difference (adult difference <1%), important for speech sound discrimin o Temporal integration - Need greater sound durations to integrate sound energy, implications for speech understanding o Binaural hearing - Worse at localization, problems with understanding speech in background noise, needed for echo suppression in a reverberant room
What are the risk factors for hearing loss in infants and young children?
Infants and Young Children a. Caregiver concern re: speech/language/hearing delay b. Family history of permanent childhood hearing loss c. NICU >5 days (10x greater) d. Any of following regardless of stay: ECMO, assisted ventilation, ototoxic meds, loop diuretics, hyperbilirubinemia e. In utero infections: CMV, herpes, rubella, syphilis, toxoplasmosis, STORCH f. Craniofacial anomalies g. Physical findings (white forelock, syndrome) h. Syndromes associated with hearing loss or progressive early onset hearing loss i. Neurodegenerative disorders j. Culture-positive postnatal infections (meningitis, viral) k. Head trauma l. Chemotherapy
What are some general intervention tips for HL in children?
Intervention Tips - Engage in frequent positive contact - Use play, smiles, touch, contact - Use senses - Touching games - Move body and face and hands around in front of baby - Exaggerate face - Emphasize vocal inflections (parentese) - Hand gestures with spoken words - Be responsive and follow child's lead - Match words/signs with what the baby is engaged in - Play and communication, DON'T teach - Pay attention to body movements because they might be communicating through gesture - Don't overstimulate - Give downtime and watch for fatigue - Move object to your mouth - Tap on an object before and after you communicate about it - Tap on the baby to say "Look at me!" - Wait for baby to look up at you and then say something when they do to encourage "active looking" - Repeat words, signs, or sentences several times - Consider finger-spelling - Create a listening environment - Handcue - Acoustic highlighting - Parentese - Acoustic bubble - Work on best hearing side - Direct child to listen - Auditory sandwich (scaffolding by showing visual. Hide-show-hide) - Ask, "what did you hear?"
Describe the "Parent Wish List" by DesGeorges (2004).
Parent Wish List (DesGeorges, 2004) - Information to make well-informed decisions - Help us find answers - Community resources - Their needs may change - Respect their choices
Describe how hearing loss impacts language acquisition in children.
Language Acquisition in Hearing Loss - May have normal developmental sequence and babbling but reduce amount and complexity - Canonical babbling is late - Words are less intelligible - Why is vocal development important a. Precursors to words b. CV syllables in babbling dominant in first words c. Large stock of babbled CVs have advantage in word acquisition
Describe the Braveman & Barclay Life Course Perspective.
Life Course Perspective (Braveman & Barclay) Extends across multiple life stages, typically examining links between early childhood and later adult health understanding how early-life experiences can shape health across an entire lifetime and potentially across generations Life-course research include the notions of critical or sensitive periods, cumulative effects over time, trajectories or pathways, and intergenerational models. o A "critical period" generally refers to a window of time during the life course when a given exposure has a critical or even permanent influence on later health. o "Trajectory" or "pathway" generally refers to the sequence of exposures and outcomes over an individual's lifetime, whereas intergenerational studies focus on the transmission of health or ill health, Health outcomes are multi-factorial (individual, family, community, health policy) Health is shaped by social advantages and disadvantages across lifetimes and generations. A complex interplay of biological, behavioral, psychological, and social Factors contribute to health outcomes across the span of a person's life Protective Factors: Reading, parent's education, discipline, health, pre-school Risk Factors: poverty, lack of health services, family discord
Describe the general guidelines around listening checks for children with HA who wear a listening device.
Listening Checks IDEA requires school to do it, but does not state how often Who should do it??? No one knows... parents, teacher, audiologist, SLP, nurse?? Biggest problems for HA are dead battery or wax in earmold For CI is wrong program then not turned on
List examples of types of listening devices.
Listening devices and related technology - Hearing aids - Cochlear implants - Assistive technology
Describe management of HL in school-age children.
Management Audibility/amplification/AD o Continued consideration of HA use or CI candidacy o FM system o Go get earmolds replaced (2-3mo for <2.5, 4-5mo for 2.5-5) o Wear the device all day o Opportunities for listening throughout daily routine o Monitor the device Learning environment (Crandell & Smaldino, 2000 for classroom acoustics) o Even typical kids have trouble. (Howard, Munro, & Plack, 2010) Demonstrated that considerable listening effort is required when listening at SNRs that are typical of the school classroom. o School is loud o Noise, reverberation, distance o Noise is any competing environmental noise that interferes with speech perception and adversely affects oral communication Competing speech (kids), environmental (heating, vents, traffic, shuffling, papers) Recommended level = 35dBA (classroom), 45dBA (multi-purpose) Typical = >55dBA o Signal to Noise ratio = difference between intensity of oral instruction and background noise + numbers = speech > noise - numbers = speech < noise Recommended = +15 dB for both Typical = -7 to +4 dB Younger classrooms are worse o Reverberation Echo: persistence of sound Time it takes for a signal to decrease 60 dB in intensity Low frequencies have longer reverberation than high frequencies Decreases speech recognition because of overlap and masking effects High freq consonants harder to hear, vowels are low freq Reverberation > .4 seconds = speech is harder to understand for normal Reverberation > .2-.3 seconds = harder for people with HL Recommended = .6 Typical = .4-1.2 Noise + reverberation = TROUBLE! o Distance Critical Listening Distance = distance between talker and listener that is required for successful communication (3ft - 10ft) Varies with room size/acoustics/vocal intensity of talker Small and quiet rooms have a greater CLD Raising voice helps, but vocal fatigue! o Recommendations Reduce/eliminate noise sources within the room or outside the room Use FM system favorable SNR Listening checks Daily checks, malfunction rate is as low as 1% (Langan & Blair, 2000) Wear the device all day Acoustic Room Treatment = drapes, carpet, double pane, double wall, curtains, paneling, bulletin boards But can be problematic, expensive, or inadequate Assistive Listening Device Speech right in ear Direct transmission of signal Advantage for SNR Induction loop, infrared, FM, HA, raise voice Communication and language development o Build on communication strategies by parent and child o Stimulate thinking, problem-solving, active learning o Master question-answer routines o Networks of word meaning o Strengthen reliance of residual hearing, self-monitor Counseling and psychosocial aspects o Have positive attitude o Provide support and don't talk them out of feelings o Good listening Communication & Language stimulation o Functional skills for classroom o Consider strengths and areas of need o Opportunities for self-expression and narrative o Verbal reasoning o Study skills and classroom survival o Literacy affected by Language delays poor phonological skills Poor word knowledge Poor metalinguistic skills
Describe the management process for working with a client with HL who is seeking a listening device.
Management Process 1. Candidacy a. Self-assessment (participation restrictions/limitation), guided interview b. Activity limitation: inability to carry out activities of daily living c. Participation restriction: inability to communication with specific partners in specific situations 2. Selection a. Prefitting = identification of specific listening situations (up to 5) b. Give the COSI (Client Oriented Scale of Improvement) c. Post-fitting = assessment of improvement and final listening ability 3. Evaluation: keep in comfortable listening range (thresholds to UCL) 4. Fitting 5. Maintenance 6. Outcomes Assessment/goal setting technical aspects of treatment orientation/counseling assess outcomes
Compare and contrast participation restriction with activity limitations.
Participation Restrictions = inability to communicate with specific partners in specific situations. Problems you experience restriction involvement in life situations. How is the patient's involvement with others affect by their HL? Activity Limitations = an inability to carry out activities of daily living involving hearing, speech, understanding, and communication. Difficulties in executing tasks. What can't the patient do because of HL?
Describe the WHO model of disability (WHO, 2002).
Models of Disability - Medical model = focus on impairment, individual level - Social model = focus on environment, society level - Biopsychosocial = Focus on interaction between individual and society for health and functioning; broader scope of interventions (individual, interpersonal, society) WHO-ICF Major Principles - Disability is a multidimensional notion (biomedical, person, social, environmental) - Disability and functioning are outcomes of interactions between health conditions (diseases, disorders, injuries) and contextual factors (environmental, personal factors) - Disability is interactive (extrinsic and intrinsic) - Disability is universal human experience - Functioning and disability are not categorical but are continuous phenomena - No assumptions of causal etiology - Neutrality A Framework Shift - Approaches to stigma of hearing loss/disability/aging - Reduces burden on individual level (less guilt, shame, negative psychological impact) - Expands the focus of rehabilitation from the person with hearing loss to include their communication partners and environments - Identifies difficulties in terms of direct impact on people's live
List the symbols used to represent the following tests on an audiogram. Right Ear Left Ear Right Ear, masked Left ear, masked Right Ear, unmasked Left ear, unmasked Sound field
O = right ear X = left ear [ = right ear masked ] = left ear, masked < = right ear, unmasked > = left ear, unmasked S = sound field, tests both ears
What is the purpose of speech recognition testing?
PURPOSE OF SPEECH RECOGNITON TESTING: Determine need for amplification Compare performance with amplification aid and without aid to build patient confidence To compare different listening devices Demonstrate to patients that their ability to recognize speech is diminished Obtain information that might elucidate environment-related listening issues Assess performance longitudinally Determine need for speechreading or auditory training Evaluate the appropriateness of an educational placement Determine If expected benefit is being achieved
What are the principles for Early Intervention in Hearing Loss for children?
Principles for Early Intervention - Family centered: functional, help family advocate, understand strengths and needs - Natural environments - Incidental language - Neuroplasticity is greatest in first 3.5 yrs of life (glow and grow, arboration and pruning) - Development will resemble same-age peers if intervention begins by 6 mos (Yoshinaga-Itano, 1998) - Long-term outcome cannot be predicted from hearing tests - Family should have access to all intervention options, use cultural sensitivity - The acronym IDEA stands for the Individuals with Disabilities Education Act passed by Congress in 1990. It expanded the range of children covered from birth - 21. Amended in 1997 and 2004 (IFSP) - Medical home (Mehl, 2007) An active process, a philosophy of care that emphasizes the role of the primary care physician, particularly for children who have special needs. This physician serves as a focal point not only for the typical primary medical care of the child but also for the support of parents and family, the coordination of specialty medical care, the provision of referrals for various services, the assurance of timely follow-up and the medical interface for educational interventions
What is the psychosocial effect of hearing loss on Parents?
Psychosocial Effect on Parents Stages: Shock/denial/grief guilt/anger acceptance Parents often have difficulty in accepting their children's hearing loss and may pass through a series of psychological stages before acceptance occurs. Primary role of professional is to empower parents to interact with their child and make important decisions about their child's plan.
Discuss the psychosocial/emotional effects of hearing loss, according to the English (2008) model.
Psychosocial/Emotional Effect of HL (ENGLISH 2008) 1 Influence of changes in hearing on self-concept o Self-concept: the way one describes oneself, perceptions of one's traits, attitudes, abilities, and social nature. How you see yourself o We have resources to change and manage self-concept Hearing aid effect = A psychological reaction to the presence of a hearing aid; viewer has negative attitudes 2 Bad emotional development. You can't hear the words, so you can't talk about it. o Affective vocabulary = words to describe feelings and emotions 3 Poor social competence o Can't make friends o Can't think independently o Can't understand feelings/motivations o Frustrated and inflexible Negative experiences o Loss and grief o Shock o Denial o Anger o Bargaining o Depression o Stress o Withdrawal Positive experiences o Integration and growth o Acceptance o Optimism for solving problems o Stephens and Kerr = 40% of people had a positive Reduced disturbance from unwanted sounds Successful communication strategies Affinity to deaf and disabled people Self-development Deafness to self-advantage Communicative support from hearing people Technical aids Avoidance techniques: strategies used to postpone acknowledgment of a difficult situation Client-centered practice o Listen and listen for the right things o Good responding skills o Pick up on nonverbal language and cues o Responds to things we perceive when we perceive them o Monitor our preconceived notions and prejudices o Listen carefully and respond carefully o Self-awareness and reflection o Knowing vs. know-how Counseling Process o Help people tell their story o Help people clarify their problems o Help them take responsibility for hearing problem o Establish, develop, implement plan
What is the purpose of listening devices?
Purpose of Listening devices - Maximize auditory communication - Provide sound access across speech range - Present speech as clearly as possible without distortion - Expand dynamic range - Improve communication functioning through access to sound - Expand environments where listening is possible
What are the different response formats for speech recognition testing?
Response format: Open = free response, Closed = choose from a list (for kids with cochlear implants) Voice Recordings: Live vs. recorder. Live has variability in voicing frequency, intonation, speech rate, clarity Synthesized vs. Altered
Describe the SKI-HI (Clark & Watkins, 1985).
SKI-HI (Clark & Watkins, 1985) 1. 4-7 mos = attending, early vocalizing 2. 5-16 mos = recognizing, locating, vocalizing with inflection 3. 9-14 mos = hearing at distances and levels, producing some vowels and consonants 4. 12-18 mos = environmental, vocal, speech sound discrim and comprehension, speech use
How can AR assist the significant others of people with HL?
Significant others (Preminger, 2003) Better understanding of problems associated w/ hearing loss Realistic expectations Training in how to maximize communication Acknowledgement of emotional issues Peer support Reinforces and emphasizes the partnership concept Greatest reduction in handicap was measured for persons who attended class w/ SO Tendency for adults w/ HL to show improved attitudes and feelings as a result of the group AR class if their SOs participated Conclusion: When an SO participates in the group AR class, it may result in increased benefit for the person w/ hearing loss
What are signs of HL in older children and adults?
Signs of Loss Inability to understand speech in noisy environment Subtle like turn up TV volume, miss words in conversations I can hear you, but I can't understand you Thinks people is mumbling Signification other often frustrated befor affected individual acknowledges loss
Describe the need for audiologic rehabilitation in adults.
Statistics American epidemic of untreated hearing loss (Oyler, 2012) Of the 26.7 million adults over 50 with a significant hearing loss, less than 15% use hearing aids (Chien & Lin 2012) On average, hearing aid users wait more than 10 years after diagnosis to be fit (Davis, 2007) Almost 40 million people over 50 with >25dB unilateral hearing loss
What are the three test conditions to include when performing speech recognition testing?
Test Conditions: Audio Audio + visual ( speechreading?) Visual
Describe Language Facilitation Techniques' impact on development of speech and language in children with HL.
The first finding was that mothers' perceived involvement and self-efficacy in developing their child's speech-language skills were related to the way in which they interacted with their children. Significant positive relationships emerged between mothers' perceived competence and involvement in developing their children's language skills and mothers' quantitative linguistic input (MLU) and qualitative facilitative language techniques (parallel talk and expansion). The second important finding was that mothers' facilitative language techniques were related to children's language outcomes. The use of higher-level language techniques, such as recast was positively associated with children's receptive language abilities, while the use of open-ended questions was positively related to children's expressive language skills. On the other hand, lower-level techniques, such as linguistic mapping, label, and directive were negatively related to children's language abilities. Mother's increased MLU and complexity = good.
What are McBride's Underlying Assumptions (2010)?
Underlying Assumptions (McBride, 2010) Hearing aids and/or CIs are not a complete remediation for HL, but only 1 component of the AR process Speech understanding is a multimodal event Instruction is a key component Practice promotes learning MORE SO than direct lecture Attitudes and behavior can change due to counseling HL is a family affair Individuals need help dealing w/ the psychosocial impact of HL
What are some specific considerations to keep in mind when determining appropriate listening devices for a client?
Things to Consider 1. Hearing loss (type, degree, configuration) 2. Speech audibility (aided and unaided) 3. Non-auditory factors (including: health status, cog functioning, functional needs, manual dexterity) 4. FOR ADULTS: Self-perception of communication needs and goals 5. FOR ADULTS: Motivation. Acceptance. Want to do something about it (the "tipping point")
Describe Werner's 3 Stages of Auditory Development (Werner, 2007).
WERNER'S 3 STAGES OF AUDITORY DEVELOPMENT (Werner, 2007) o 0-6 mos Neural encoding of fundamental sound properties matures. Needs larger changes, fuzzier representation o 6 mos-6 yrs Gather info from the sound stream. Increasing specificity in auditory cues, and greater ability to distinguish sounds through subtle cues o 6-18 yrs Becoming more adult-like in processes and flexibility with sound stream
What is "well being"?
Wellbeing = self acceptance, positive relations with others, ability to manage complex environments to suti personal needs and values, pursuit of meaningful goals and sense of life purpose, continued growth and development as a person, sense of autonomy in thought and action
What are the differences between a screening and a diagnostic audiologic evaluation?
What are the differences between a screening and a diagnostic audiologic evaluation? o Screening = pass/fail o Diagnostic = differential diagnosis. Threshold and configuration, degree/type.
What is meant by taking a "lifecourse perspective" for AR, using Braveman & Barclay (2009) as a reference?
What is meant by taking a "lifecourse perspective" for AR, using Braveman & Barclay (2009) as a reference? o Thinking about how early childhood experiences affect health across the stages of life/generations o E.g. poverty, ethnicity, access, policy, etc. o Health is shaped by social advantages and disadvantages across lifetimes and generations. o Protective factors (mom's education, literacy)
List the components of a listening check kit.
What's in a kit? - HA checklist - Battery tester - Listening stethoscope - Extra batteries - Air blower - Wax pick - Ling cards/toys - Contact info for audiologist
Why don't people use HAs?
Why don't people use hearing aids? High cost Lack of insurance coverage Problems not worthy of treatment, or they are "getting by" okay 50% of people do not seek rehab because they have been told a hearing aid cannot help or that hearing loss is a part of aging (Logan & Hedley, 1988) Services should not just be device driven (Hawkins, 2005)
Why would an audiologist administer a self-assessment questionnaire?
Why would an audiologist administer a self-assessment questionnaire? o Allow the patient to tell story and clarify problem. The degree of hearing loss cannot predict the effect on the individual's life.
Provide an example of an activity limitation, participation restriction, personal factor, and environmental factor for a case example.
o Activity Limitation: What can't you do? Hear someone, watch TV, o Participation Restriction: withdrawal, don't participate o Personal Factor: age, personality, motivation o Environmental Factor: acoustics, number of people in room, restaurant, etc.
Identify and describe possible psychosocial responses to acquired hearing loss as an adult. How does this example compare to what a parent might experience after hearing loss is identified in his or her child?
o Adult: Denial, depression, anxiety, anger, defective. Change in self-concept. Stigma of embarrassment and handicap. Avoidance o Parent with child: loss of self concept of having perfect child. Grieving over loss. Shock, denial, depression, acceptance, resignation, depression, sorrow, confusion.
Describe and discuss the elements of a comprehensive model of AR.
o Diagnostics and quantification of hearing loss o Provision of appropriate listening device o Provision of appropriate ALD o Auditory training o Communication strategies training o Information/educational counseling o Personal adjustment counseling o Psychosocial support o Frequent communication partner training o Speechreading training o Speech language therapy o Inservice training o Minimize or prevent limitations and restrictions that auditory dysfunction can impose on well-being and communication including interpersonal, psychosocial, educational, and vocational functioning.
