chapter 1 Flashcards
Aural Rehabilitation: Speech/Audio?
“The roles of audiologists and speech-language pathologists in providing auditory rehabilitation services are complementary, interrelated, and overlapping, requiring a breadth of knowledge and skills to meet the communication needs of participants with hearing impairment and their families” (ASHA, 2001)
Auditory vs Aural 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 vocational functioning” (ASHA, 2001)
Aural rehabilitation: services and procedures for facilitating adequate receptive and expressive communication in individuals with hearing impairment (ASHA, 1984)
Rehabilitation Vs. Habilitation
Often with children, aural rehabilitation services would more appropriately be called “habilitative” rather than “rehabilitative.” “Rehabilitation” focuses on restoring a skill that is lost. In children, a skill may not be there in the first place, so it has to be taught – hence, the services would be “habilitative,” not “rehabilitative.“”
Hearing-related disability
Loss of function imposed by hearing loss or an inability to perform an activity
What are some functions that may be lost/made difficult by hearing loss?
Speech perception in adverse conditions
Language and speech development
Literacy
Overall academic performance
Social interactions and relationships
Career opportunities
Self-concept/esteem/confidence
Any daily activity…
Examples
10 year old boy with bilateral hearing loss since birth
Activity limitations?
Participation restrictions?
75 year old female with presbycusis
Activity limitations?
Participation restrictions?
Quality of Life
Third party disability: Effects of hearing loss on communication partner
AR goals may also include limiting effects on communication partner
Frequent communication partners
Spouse
Children
Coworkers
Components of an AR Program
Communication Strategies
Communication Strategies
Informational/Educational Counseling
Personal Adjustment Counseling
Psychosocial Support: social impact
Communication partner Training
Speechreading Training: auditory and visual
Speech-language Therapy
In-service training: School professionals, caretakers,
nurses, etc.
Where does AR occur?
Speech and Hearing Clinic
Audiology practice
ENT Practice
Hospital
School/daycare
Nursing Home
SLP office
Home
VA Hospital
Who provides AR?
Interdisciplinary team work
Depends on the patient needs and age
-Audiologist
-SLP
-Teacher for deaf and hard of hearing
-ENT
-Parents
-Auditory training computer programs and applications
Aural Rehabilitation Plan & Age
Adults:
Counseling
Communication Strategies
Assertiveness Training
Psychosocial support
Counseling/instruction for family members
Managing tinnitus
Hearing protection
Auditory/Speech training
Children
Diagnostics
Amplification/ALDs
Auditory/speech training
Communication strategies
Intervention in academic achievement/speech therapy
Hearing protection (teenagers)
Family/community
Infants/Toddlers
Advances in neonatology increasing prevalence of HL
Early Identification is crucial
Newburn screening
Public Policy
Early intervention (EI)
School-age children
Learning issues related to hearing loss
Social communication
Educational audiology and planning for classroom
Assistive Technology
Adults and Older Adults
Americans with Disabilities Act (ADA)
Baby-boomers
Possible cognitive and linguistic age-related changes
Listening in noise
Changing population of elderly
Cost Effectiveness/Costs
Barrier to Aural Rehabilitation
Hearing aids/ALDs not covered by insurance
Therapy/training not covered for adults
Complex fitting process
Adaptation takes time
Evidence-Based Practice
LWHL’s Top 10 Reasons Hearing Aids Are Not Like Glasses
. They do not restore your hearing to “normal” — things will be louder, but not always clearer, making it difficult to understand speech.
2. They amplify all sounds, including those you don’t want to hear like the hum of the refrigerator and other background noise.
3. They are not seen as fashion accessories, although some hearing aids now come in colors.
4. They often remain shrouded in stigma and shame, unlike glasses which make you look “smart.”
5. They are not regularly covered by insurance making them prohibitively expensive for many.
6. They need batteries to function.
7. They can increase sensitivity to loud sounds.
8. They squeal at inopportune times.
9. They can’t get wet.
10. They are easily misplaced and can sometimes be mistaken for a snack by the dog given their size.
3 parts of the ear
Outer Ear
Pinna
Ear Canal
Tympanic Membrane (eardrum)
Purpose: Conduct sound energy
Middle Ear
Ossicles (Malleus, Incus, Stapes)
Air-filled space
Stapes: Smallest bone in the human body
Purpose: Conduct Sound Energy and Increase sound intensity
Inner Ear
Cochlea
Purpose: Convert mechanical (ME) to hydraulic(cochlear fluid) to electrochmical (haircells) energy
Hearing loss
Type of hearing loss
Configuration of Hearing loss
Degree of hearing loss
Onset of hearing loss
Cause of hearing loss
Time course of hearing loss
Hard of Hearing Vs. Deaf
Common Patterns
Audiograms may demonstrate different patterns for conductive, sensorineural or mixed hearing loss.
Conductive hearing loss: problems with the outer/middle ear
Sensorineural hearing loss: Problems with the inner ear or auditory nerve
Mixed hearing loss: Mixture of Conductive and Sensorineural hearing losses
Conductive Hearing Loss
Possible causes:
Congenital causes
Cerumen
Otitis Media
Often can be resolved with medical treatment
Amplification is effective
Usually up to about 50-60dB SPL
There is a mild loss of air conduction in both ears, but bone conduction is still normal.
Sensorineural hearing loss
Inner ear, 8th nerve, brainstem, midbrain, auditory cortex
Usually permanent
Causes:
Genetic
Infections
Noise exposure
Ototoxic medications
Aging
Sensorineural hearing loss. Air and bone conduction are both equally abnormal.
Mixed Hearing loss
Combination of SNHL and CHL
Mixed hearing loss. There is a gap between air and bone conduction, but neither is normal.
Central hearing loss
Function of the central auditory structures
May have normal hearing thresholds but difficulty understanding speech
ANSD (Auditory Neuropathy Spectrum Disorder)
Degree/severity of Hearing loss
Normal: 0-20dBHL for Adults, 0-15dBHL for kids
Mild: 25-40dBHL
Moderate: 45-65dBHL
Severe: 70-90dBHL
Profound 90dBHL+
Onset of hearing loss
Pre-lingual : Before acquisition of spoken language
Congenital :Present at birth
Acquired: incurred later
Peri-lingual: Before acquisition is complete
Post-lingual: After speech and language
In addition:
Sudden Hearing loss
Progressive Hearing loss
Audiogram
Depicts magnitude and spectral pattern of patient’s hearing loss
Hearing thresholds are based on detection in quiet
Doesn’t necessary reflect the difficulties experienced by the listener
Other testing completed during basic audiology evaluation:
Speech recognition threshold
Word recognition testing
Speech Detection Threshold (SDT) aka Speech Awareness Threshold
Softest level a patient can detect speech is present (Yes/no)
Linguistic competence is not required (no need for interpreters)
Suitable for younger children
What is the difference between detection and discrimination or identification??
Speech recognition = Speech understanding??
Additional Descriptors
Unilateral vs Bilateral
Symmetrical vs Asymmetrical
Fluctuating vs stable
