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Amplification 2 > Functional and Communication Needs Assessment: Subjective Tests > Flashcards

Functional and Communication Needs Assessment: Subjective Tests Flashcards

1
Q

Does amplification candidacy include assessments to assist our understanding of patient-specific communication needs?

A

Yes
Only then we can supply appropriate recommendations and realistic expectations of treatment outcomes

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2
Q

What must a functional and communication needs assessment identify?

A

Identify activity limitations & participation restrictions
Identify environmental factors which may impact plan of care
Identify personal factors which may impact plan of care

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3
Q

What is the assessment protocol?

A

A series of subjective assessment questionnaires and non-auditory needs assessments are completed to understand an individual’s needs

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4
Q

What does gathering patient specific information lead to?

A

Identification of appropriate amplification levels, styles, & features
Recognize when additional hearing assistive technology (HAT) needs consideration
Communication strategy recommendations to reduce participation restrictions
Referral to group audiologic rehabilitation, education, or support

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5
Q

What is an example of a subjective assessment?

A

Questionnaires

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6
Q

What are some benefits of questionnaires?

A

Standardization allows comparison to normative data
Questionnaires are completed independently, prior to the scheduled appointment

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7
Q

How should you select a questionnaire to give a patient?

A

Based on the kind of information you are attempting to learn
Screening tests, communication abilities, expectations, experienced HA users, related non-auditory, and patient centered goals

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8
Q

What is the use of the hearing handicap inventory?

A

A quick pre-audiometric intake measure to get an idea of participation restrictions
Generally used as a screening
Assesses the social impact and emotional response that is the result of the loss of function

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9
Q

What are the two versions of the hearing handicap inventory?

A

HHIE for Elderly (HHIE) or HHIA for Adults (HHIA)

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10
Q

What does a score on the HHIE of 0-9 mean?

A

This score suggests there is no hearing loss, or if present, hearing loss is not interfering substantially in life

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11
Q

What does a score on the HHIE of 10 to 24 mean?

A

Mild to moderate impact on an individual’s ability to participate in desired activities

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12
Q

What does a score on the HHIE of 25 or higher mean?

A

Severe impact on an individual’s ability to participate in desired activities

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13
Q

What is the use of the abbreviated profile of hearing aid benefit (APHAB)?

A

Comprehensive identification of activity limitations and participation restrictions

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14
Q

How is the APHAB made up?

A

24 questions categorized into 4 subscales (ease of communication, reverberation, background noise, and aversiveness)

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15
Q

What does the social network index analyze?

A

Looks at how often the patient communicates with others, as well as the communication methods used (face-to-face, or telephone)
Correlates between loneliness and cognitive decline

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16
Q

What is the use of the ECHO?

A

Designed to assess 4 subscales related to patient expectations of amplification
Expected acoustic and psychological benefits, expectations for service and cost, estimates factors that often detract from satisfactory outcomes, and perceptions of self-image and stigma

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17
Q

What is the communication profile for hearing impaired (CPHI)?

A

145 item questionnaire used to find out how hearing loss affects daily life and what problems, if any, a patient is having
3 lists that require responses
1. Rate from important to not important
2. Rate from always to occasionally
3. Rate from strongly agree to strongly disagree

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18
Q

What were the findings related to the ECHO?

A

Patients were more likely to return devices for credit when expectations of hearing aid benefit score were low

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19
Q

What were the findings related to the CPHI?

A

May take the hearing aid home and not use it if they perceive they have better communication performance, poorer use of verbal and nonverbal communication strategies, and more denial of communication difficulties

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20
Q

What is the usefulness of the CPHI?

A

Finding out who is going to use their hearing aids and who isn’t
Informs us how much time we should take fitting them or if we should wait a bit to fit them

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21
Q

What does the hearing aid selection profile determine?

A

Motivation
Performance expectations
General communication desires
Importance of physical appearance
Attitude towards cost of commercial goods
Attitudes towards technology
Physical function and dexterity
Lifestyle

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22
Q

What characteristics are associated with individuals rejecting their hearing aids or returning them? (HASP)

A

They fell at the 20th percentile for the motivation subscale.
They demonstrated greater problems with manual dexterity
They have reduced listening needs (lives in a quiet environment and doesn’t socialize often)

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23
Q

What does the client oriented scale of improvement (COSI) assess?

A

Prioritize patient-centered treatment goals
Ranks perceived importance of up to 5 situations causing the greatest communication problems

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24
Q

What could a patient’s COSI goals be classified as?

A

Cognitive or affective goals

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25
Q

What is a cognitive goal on the COSI?

A

Defines difficult environments that require improvement to reduce the impact of the impairment
Which situations are the most challenging
“Improved conversation with a spouse in a quiet environment”

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26
Q

What is an affective goal on the COSI?

A

Defines desired improvements as they relate to feelings/emotional needs
“Feeling less embarrassment during communication”
“Reduced stress during workday”

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27
Q

How do you develop cognitive goals?

A

Let’s talk about the listening situations that you find most challenging?
Who are you trying to communicate with in noisy situations?
What kind of room are you in when you have difficulty hearing in noise?
How many people are typically in this environment?
Tell me more about what makes that situation difficult?

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28
Q

How do you develop affective goals?

A

How do you feel in these situations?
Who: do you feel this way around all the people or is this a concern with some more than others?
What: does this occur all the time or only in certain environments or situations?
Tell me more about what makes that situation difficult? What might make it better?

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29
Q

How many COSI goals do we want our patients to develop?

A

5

30
Q

What is the clinical usefulness of the COSI?

A

Actively involves patient in plan of care
Focuses on the individual’s needs when planning rehabilitation
Assists with counseling (opens discussions related to advanced technology needs and identifies unrealistic expectations)

31
Q

What are non-auditory factors?

A

Personal factors (general health, dexterity, visual acuity, cognitive decline, prior experience, and personality characteristics)
Environmental factors (occupational demands, recreational habits, and patient support systems)

32
Q

At a minimum, what should adult patients be screened for?

A

General health (GHQ-12)
Manual dexterity (finger sensitivity)
Near vision
Cognitive abilities
Motivation, and prior experience with amplification
Support systems

33
Q

What is the WHO-DAS II?

A

General health assessment
Specific items comprising communication and participation domains

34
Q

Are we sometimes required to do a depression screening for reimbursement?

A

Yes with the PHQ-2 questionnaire
Online tool that automatically scores and supplies advice

35
Q

Are we also sometime required to do anxiety screenings?

A

Yes, with the GAD-7

36
Q

Do chronic visual conditions combine with hearing loss as we age?

A

Yes, they become more prevalent
This is a concern

37
Q

Is dual sensory loss considered greater than the effect of vision impairments or hearing impairment alone?

A

Yes

38
Q

What conditions suggest a dual sensory loss? (audio and visual)

A

Hypertension
Heart disease
Stroke
Diabetes
Cancer
Arthritis

39
Q

What is the purpose of an informal lifestyle interview?

A

An alternative to questionnaires and the COSI
For those who are under time constraints for their appointments

40
Q

How many questions does an informal lifestyle interview have?

A

10

41
Q

What are the questions in the informal lifestyle interview?

A

Do you occasionally have large family gatherings (more than 8 people)?
Do you attend religious services?
Do you attend concerts, musical performances, plays, or movies?
Do you attend sporting events (professional, college, high school, little league, etc.)?
Do you drive an automobile?
Do you sometimes go to large, busy restaurants?
Do you attend group meetings such as civic organizations, local government meetings, school boards, etc?
Are you employed in a job that involves meetings or group discussions?
Do you watch television?
Do you occasionally shop in large, busy stores?

42
Q

How do you score an informal lifestyle interview?

A

By the number of questions they replied “yes” to

43
Q

What are the scoring categories for the informal lifestyle interview?

A

Active lifestyle: If you answered YES to 5 or more of these questions
Casual lifestyle: If you answered YES to 3 or 4 of these questions
Quiet lifestyle: If you answered YES to 1 or 2 of these questions
Very Quiet Lifestyle: If you answered NO to all of these questions

44
Q

How do lifestyle assessments help us serve our patients?

A

It helps us identify which technology level is ideal based on personal needs

45
Q

Does the FDA require a medical examination of hearing test for prescription hearing aids? (adults)

A

No, but the state might require you to visit an audiologist or other licensed professional first

46
Q

Does the FDA require medical clearance for a person used the age of 18 before purchasing prescription hearing aids?

A

Yes
They can also only buy prescription hearing aids (no OTC’s)

47
Q

Does the information on the hearing aid package (OTC’s) indicate whether you need to see a doctor first?

A

Yes

48
Q

What are the FDA packaging warnings of ear disease? (8)

A

Visible congenital or traumatic deformity of the ear
History of active drainage from the ear within the previous 90 days
History of sudden or rapidly progressive hearing loss within the previous 90 days
Acute or chronic dizziness (possibly refer to another audiologist)
Unilateral hearing loss of sudden or recent onset within the previous 90 days
Audiometric air-bone gap equal to or greater than 15 decibels at 500 hertz (Hz), 1,000 Hz, and 2,000 Hz (if new occurrence)
Visible evidence of significant cerumen accumulation or a foreign body in the ear canal
Pain or discomfort in the ear

49
Q

What does heuristic mean?

A

Proceeding to a solution by trail and error or rules that are loosely defined
Much of audiology is based on this kind of decision making

50
Q

What was found regarding audiology technology recommendations in 2015?

A

Technology level recommendations were not based on outcome benefit, but instead on variables such as patient lifestyle as perceived by the hearing professional

51
Q

In the international study, what were the technology level decision based on? (heuristic)

A

Patient’s activity level as perceived by the professional- recommendations of premium technology dramatically increased when professions PERCIEVED patient as active vs. non-active
Hours of use (for experienced users)- Audiologists theorize more use equals more benefit from premium level technology
Patient’s age- entry level or lower-level technology recommendations increases for patient’s over 70
Speech discrimination score- active patients w/ poor speech discrimination only had a 17% chance of being recommended a premium technology while active patients with good speech discrimination increases to 68%

52
Q

Other than heuristic decision making, what is another way to make decisions?

A

Patient preference

53
Q

What is the purpose of patient preference decision making?

A

To examine the most desirable hearing aid attributes as rated by consumers and investigate associations between hearing loss type and preference for technology level

54
Q

Based on a study, what were the 4 most common attributes identifies as extremely or very important?

A

Improved ability to hear friends and family in quiet (75.3%)
Improved ability to hear in noisy settings (88.3%)
Physical comfort (74.3%)
Reliability (85.1%)

55
Q

What were rated as the least desirable hearing aid attributes?

A

Stream audio to landline
Control hearing aid volume
Program using smartwatch
Ability to pick up distant voices

56
Q

What attributes were not deemed important or unimportant, and should be assessed the individual importance of these features during the F&CNA?

A

Ability to stream audio to television
Hearing on landline
Ability to have hands free calls from mobile phone
Visibility
Rechargeability

57
Q

Can you also make technology recommendations based on the degree of loss?

A

Yes

58
Q

What are the patient preferences with mild hearing loss?

A

More likely to rate visibility as extremely important
More likely to rate water/dust resistance as extremely important
More likely to rank volume control through a smart watch as extremely important
Feature driven patients

59
Q

What are the patient preferences with severe hearing loss?

A

Less likely to rate hearing on a mobile phone as extremely important
Morel likely to rank visibility as no important
More likely to rate hearing loop access as extremely important
Less likely to rate rechargeability as important

60
Q

In premium vs entry level HA’s, is there a significant difference in sentence recognition scores?

A

No significant difference if directional mics were available

61
Q

In premium vs entry level HA’s, is there a significant difference in aided loudness?

A

No
Gain and output is going to be the same, just need to keep it below LDL

62
Q

In premium vs entry level HA’s, is there a significant difference between sound quality ratings?

A

No, the rating are very similar

63
Q

In premium vs entry level HA’s, is there a significant difference in user-controlled DSP, streaming, convenience, and connectivity?

A

Premium technology is preferred when these aspects are desired

64
Q

Do premium technology benefits in the lab (intelligibility and localization), translate to the real world?

A

No
Benefits of premium technology may go unnoticed if users are rarely in demanding environments

65
Q

What are two factors that may impact performance, preference, and real-world outcomes?

A

An individuals ability to accept background noise and the listening demands of an individuals environment

66
Q

What individuals is premium technology most beneficial to?

A

Individuals with poor ANL scores (tolerance to noise)
Premium technology improved aided ANL score
Individuals regularly communicating in large group or demanding settings

67
Q

What do frequency shaping bands act as?

A

A frequency specific volume handle to maximize audibility without changing compression

68
Q

Does the number of bands impact the ability to achieve audibility across the frequency range?

A

Yes
Flat or sloping hearing loss: 4 bands provides sufficient frequency-shaping flexibility
Steeply sloping losses: research suggests increasing to 7 bands allows output adjustments to narrower frequency ranges

69
Q

What are compression shaping channels?

A

Adjust compression ratios to shape output into the individual’s dynamic range

70
Q

Do we need a lot of channels to maximize speech intelligibility?

A

No, less is more
Adding more doesn’t add a lot of benefit

71
Q
A

Amplification 2 (13 decks)

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