Aural Rehab Final Flashcards
List four primary sources of communication
breakdown
listener’s speech recognition skills, speaker’s delivery of the message, environment, and message complexity
List the 3 stages of communication repair
detect the breakdown (requiring attention and active listening), choose a course of action, and take a course of action
Specific repair strategies
giving specific information regarding what was missed exactly, both conversation and supportive repair strategies
Nonspecific repair strategies
not adding specific information in for what you did not understand or what you missed
-can be simply saying ‘what’ or ‘huh’
-leading to simple repetition of the phrase
Explain the specific biologic changes of vision which occur with aging and describe recommendations to improve speechreading for this population
harder to focus, eyes are slower to adjust, muscles weaken, rigid lens creates more resistance, less light gets through the lens, light entering the eyes scatters, colors become distorted
How does dual-sensory loss impact the PHL
leads to the individual missing out on visual cues and will be more impacted by their HL due to the dual sensory loss
Describe the specific impact of reverberation on signal clarity (short vs. long)
Slow reverberation is detrimental to a person with hearing loss. Short reverberation enhances speech intelligibility while long impacts clarity.
Causes of reverberation: large rooms, high ceilings, hard furniture or lack of furniture, hard surfaces (glass, stone, hardwood, & tile)
Your understanding of how SNR/noise results in
communication difficulties must move beyond the
concept of masking. Explain how reduced frequency
resolution, temporal resolution, and spatial
processing impact communication in noise. understanding speech in noise
frequency resolution (reduced neural curves leading to sounds do not pop out of the noise), reduced dynamic range, noise that has a masking effect, age related changes (not able to attend to the signal of speech when around noise), temporal resolution (when hard to hear gaps, then the words tend to blend together)
Describe the specific impact increasing distance has
on signal intensity
5-6 feet is ideal
Minimal difference noted at 18 feet however at 23 feet there is a 16% decrease in visual recognition
At 100 feet only 11% of common nouns are recognized
Describe the ideal distance and angle for
improved communication
5-6 feet & 0 degrees (straight)
Define anticipatory repair strategies
explain how this is accomplished
when the PHL prepares for conversational interactions in advance by anticipating conversational content and potential listening environments
Define adaptive repair strategies and prepare recommendations for one to techniques to recommend to the patient use
methods to counteract maladaptive behaviors (emotions) that stem from HL
-can use relaxation techniques or grounding techniques
Maladaptive Strategy
coping behaviors that provide short-term benefits with long-term consequences
-can look like dominating the conversation, ignoring the CP, bluffing, overreacting to miscommunication and withdrawing from social interactions
Facilitative Repair Strategy
an attempt to identify and avoid communication breakdowns from occurring
-including both nonspecific and specific strategies
Instructional strategies
listener instructs the speaker on a specific way to change the delivery of the message
-explanation, specific direction, and positive reinforcement
Message tailoring strategies
listener asks close-ended questions to limit potential answers and the amount of repetition required by the speaker
Constructive Strategies
actions are taken to change an environment for improved communication
-lighting, visual, angles, distance, reverberation, noise, and visual distractions
Lumens
Light output (watts)
Dual sensory disability
loss of vision and hearing
leads to the individual missing out on visual cues and will be more impacted by their HL due to the dual sensory loss
Grounding techniques
techniques to reduce stress
3rd party disability
a disability of family members due to the health condition of their significant other
-describes a range of activity limitations and participation restrictions experienced by the CP
List AR goals for the CP
get PT attention before talking, move closer and face then, use facial expressions and gestures, inform the listener when the subject changes, don’t speak while chewing, be patient
Identify a standardized questionnaire designed to provide insight into CPs needs
hearing impairment impact-significant other profile (HII-SOP)
Describe steps involved in partner goals setting activities
- PHL & CP identify listening situations they both want to improve
- The audiologist asks open-ended questions to let each party reflect on their experiences and consider the other’s POV
- Discuss problems they experience together
- Create a set of achievable goals for each problem
- Audiologist, CP, & PHL brainstorm ideas to achieve each goal
Create a comprehensive list of hearing loss facts to explain to CPs
possible to hear voices but to still have difficulties understanding some words, HL can cause people to be sensitive to loud sounds, trying to understand all day takes effort and is exhausting
Describe research findings related to Clear Speech and the benefit associated with attendance of a formal training program
a 45 minute intervention training session yielded changes in more speech parameters, more stable changes and better speech recognition
-improving intelligibility for both normal and hearing impaired individuals
steps for clear speech training
review communication breakdowns/introduce clear speech, create activities to practice clear speech, practice clear speech using structured conversations and practice in the real world
List ways in which the CP can advocate for the communication needs of the PHL
let people know to speak slower and louder, remind the group one person should speak at a time, sit next to them and tell them the punch line if they miss it, share the topic of conversation when they join a group or if the topic changes fast
Articulation
forming clear and distinct sounds
Linguistic Boundary
a line or area that seperates regions where different dialects are spoken
Elements of Assertive Communication
strategies
telling people your needs or ideas clearly and directly
-not being afraid or shy when explaining what you need
-using “i statements”
-be an eagle and not a turtle
Non-Assertive / Passive behavior (maladaptive communication behavior)
bluffs/pretends to understand, smiles and nods, hides disagreement, puts themselves down, apologizes
difficult time identifying their communication needs & they isolate themselves
What results from being non-assertive
increased anxiety, judged by appropriate responses, dependence due to increased reliance on CP and feelings of helplessness
Aggressive Behavior (maladaptive communication behavior)
believing that your needs are more important than others
-dominating conversations, blaming others for breakdowns, dismissive, defensive
perceived as trampling, CPs may feel hurt, viewed as a bully, alienates friends/family
-this rarely will solve any long term communication problems
Passive Aggressive Behavior (maladaptive communication behavior)
believing that your goals come first but not able to express that
-using sarcasm, withholds responses until needs are met, exhibits stubbornness
Advantages of Group AR program over individual AR sessions
group programs create an atmosphere of peer support with participants that learn from each other, groups become a place for practicing communication skills, group sessions provide a space for people to share/learn from on another’s and group sessions are time and financially efficient
patient benefits from AR
reduced activity limitations/participation restrictions, attainment of communication goals, speechreading benefits were better understood, those who participated employed communication strategies better than those who did not and improved emotional well being
CP benefits of AR
reduces third party disability and improved quality of life
financial benefits of AR
results in fewer returns of HAs and results in less office visits therefore creating a more cost effective treatment
practice benefits of AR
Improved daily rating of HA satisfaction, fewer HA returns, increased patient satisfaction
Describe learning
preferences of adults
motivated/self-directed, bring life experiences to learning expectations, goal-oriented, wanting to be sure what they are learning is relevant to their goals, are practical, they want to feel respected
Define aided validation measurement and describe the purpose and benefits associated with monitoring these healthcare analytics. (when do you do these)
4-6 weeks after fitting. occurs after the patient has adjusted and is used to see if the Pt’s goals were achieved. compare aided assessments to pre-fitting. demonstrates the benefit.
List the four key categories included in post-fitting validation assessments
- assessment of treatment usage/adherence
- measurement of objective aided performance
- self report measurements of subjective benefit
- self report measurement of subjective satisfaction
what are validation measures
the process of assessing the effectiveness of audiological intervention
-demonstrates value of audiological services, improves clinical practice and justifies reimbursement for services
Objective test methods
Aided Quicksin
Subjective benefit assessments
HHIA, APHAB, GHABP, SSQ, COSI
Subjective satisfaction Assessments
DOSO, HASKI-self, IOI-HA, SADL, SHAPI
who are stakeholders
regulatory bodies (FDA), health insurance industry, & consumers
in terms of healthcare analytics, what is the importance for validation
Provides data to insurers, HMOs, state and federal government entities, and other 3rd party payers to determine if money is well spent. Documents audiology services effectively. Shows Pt and family that intervention is beneficial. Validates clinical decisions.
Root Mean Squared Error (RMSE)
the difference b/w the probe-measured output and prescriptive targets, typically used in pediatrics
CPCPT-4 Codes 92626, 92627, 92633, & 92630
92626 - the first hour of evaluation of auditory function for surgically implanted devices, candidacy or post-op status
92627 - the same thing as 26 BUT this is for every extra 15 min
92633 - auditory rehab post-lingual HL
92630 - auditory rehab pre-lingual HL
Be aware of timed-code documentation regulations
most audiology codes are contact based meaning reimbursement doesnt take into account time with the PT
Describe the research findings of the ACHIEVE project
hearing intervention provided significant benefits to a heart-healthy group of subjects
Describe the audiologic rehabilitation methods utilized by audiologists associated with the ACHIEVE research.
training them in managing the listening environment, communication with significant other, strategies for addressing quality of life, hearing protection/noise hazards, and self-advocacy
what is lipreading
watching the lip movements to extract speech information
-relying on visual cues from lip movements
what is speechreading
utilizes visual, auditory, gestural and contextual cues to understand speech
where are phonemic cues gathered from
mouth and lip movements
where are prosodic cues/judgements gathered from
eye area
what sounds are easier to see
those that are created to the front of the mouth
-/f,v/ is easier whereas /k,g/ are harder since they are further back
visemes
sounds that look identical when produced
homophones
words that look identical on the mouth when produced
coarticulation
visible elements will appear different depending on the surrounding sounds
-impacts lipreading by how surrounding sounds impact the current sound both by visual cues and auditory cues
what are some cognitive skills that may predict lip reading abilities
working memory, visual word decoding, lexical identification speed, phonological processing, verbal interference, onset of HL
lexical neighborhood activation model (NAM) of integration
a model that deals with how our brain integrates information of speech into separate groups based on spoken words and visual representation of words automatically
dense neighborhoods
word groups which contain many words that sound and/or look the same
-processing speed slows down
sparse neighborhoods
word groups which contain few words that sound and/or look the same
-processing speech is faster
what helps shift a dense neighborhood to a sparse neighborhood
audio visual integration
-by using what we saw and what we heard, we are able to integrate that to a smaller subset of potential words based on the context
factors that can enhance audiovisual integration
residual hearing, grammatical structure, word familiarity/context, viewing angle/distance and how well you are feeling
what factors can negatively impact speech reading abilities
mumbles, not looking at you, chewing, accents, smiles too much, no facial expressions, shouts, high pitched voices, talking too fast, wearing dark glasses and complicated sentences
evaluation criteria for SII verification
if aided SII falls within the 95% criteria lines, the clients fitting is electro acoustically acceptable
evaluation criteria for RMSE verification
if falls within 5dB or less, that is a strong indication that the fitting is accurate
what is validation with usage
reviewing datalogging to determine patterns of daily usage
-can use any aspects to counsel and talk with the patient regarding their experience with the technology
aspects to look at in terms of usage
does it match recommendations, does patient reset start up volume, look at environmental variations, manual programs, address any unexpected deviations
validation with objective test methods
conducting aided speech assessments within the sound field
-presenting at 50-60dB A typically
-measuring both in quiet and in noise
-comparing results to unaided performance for each condition
checklist to ensure when validating objective test methods
confirm improved audibility, confirm SNR loss did not degrade with omnidirectional, confirm SNR loss improved with directional, confirm improved speech understanding with FL, confirm audio visual integration benefit and discuss any residual performance limitations in noise
what is the purpose of validation with subjective benefit assessment
identifies improvement of activity limitations and participation restrictions
-allow for both pre and post fit measurements
-can include the COSI (allowing to assess the degree of improvement for each individuals goal)
validation with subjective satisfaction assessments
allowing to see how the patient is satisfied within their AR and with their technology
