midterm Flashcards
clinical barriers that may impact patient outcomes
self image, underestimate importance of hearing health, financial limitations, limited access to healthcare, unrealistic expectations, motivation, perceptions of society and medical professionals responses
what do we mean by perceptions of society? what is included under this?
attitudes of immediate family members, attitudes of friends and cultural norms, practices or ideologies
how can attitude of friends impact hearing health
if there are bad experiences that are shared with out patients that could impact how they view audiologist or how they view getting help regarding their hearing
2 important aspects to understand in terms of cultural norms, practices or ideologies
familism : sense of obligation, the family’s needs are more important than the individual
stigmas : feeling like HL is something to hide because it reflects negatively on the individual
we talked about how medical professionals responded to their patients in regard to hearing, what conclusion can we make about this as a barrier
-many patients will have drop out rates after receiving advice about HL
-the response from medical professionals have shown influence on the patients decisions regarding amplification
-there are higher adoption rates in countries where professionals actively recommend hearing amplification solutions
how are audiologists potentially creating barriers
clinical setting barriers (parking, office convenience, office appearance), quality of experience barriers (wait times, ease of making appointments, staff knowledge), communication mismatch, technocentric barriers (only on product based solutions), focusing only on high end technology and lack of awareness (not discussing comorbidities)
patient centered care (PCC)
allowing the patient to be in the center of care and making decisions together with the audiologist
-conduct a communication needs assessment and develop an individualized AR plan
-use both objective and subjective components
elements of PCC
listen to and respect patients perspective, involve the family, reinforce shared decisions, prioritize free flow of information and demonstrate empathy
individualized audiologic rehabilitation plan specifics include ….
amplification/HAT, perceptual training, communication strategies and communication behaviors
family centered care (FCC)
allowing the family and the patient to work together with the audiologist to create a plan
-include CP input and incorporate the CP in the AR plan
communication partner (CP) self report questionnaire examples
significant other assessment of communication, significant other scale of hearing disability and significant other profile
-assessing the 3rd party disability of the CP
how can FCC be included into the AR plan
promote understanding of the HL impact, opportunities to participate in goal development and incorporating the CPs needs into rehabilitation goals
decision aid
an organizational tool designed to systematically review a set of treatment options
-reviewing all potions allowing for conversations with the patient to help them decide on which treatment options they will begin
the structure of the decision aid
gives information based on the type of option it is with boxes that the patient can check off for if they want to learn more information about it or if they know that they do not want to learn more about it
-include additional pages with more in depth information regarding the various types of treatment options
technocentric model vs. audiologic rehabilitative model
technocentric model entailed that HAs or technology are the only aspect of the management plan while the rehabilitative model stresses the importance of having additional aspects involved beyond technology
compare the components involved in the technocentric and audiologic rehabilitation model
technocentric : audiometry, HAs, HA orientation, real ear verification and accessories
audiologic rehabilitation model : patient story, self assessment of auditory wellness, technology, communication strategies, speech/visual perception training, peer support and validation
multi-faceted rehabilitation approach
this gives patient centered benefits because it focuses on including expectations, rehabilitative process, habituation and involving the whole family
under the multi-faceted rehabilitation approach, how are patient expectations managed
objective/subjective factors are used, explaining habituation and limitations due to auditory damage, helping the patient recognize amplification is just one component and also explaining effective treatment involving the whole family
audiologic rehabilitation (AR)
addresses the challenges and needs of individuals with HL, helping them adapt to and manage their condition effectively
-this should reflect whole person healthcare
-personalized based on the specific needs and preferences of each individual
overarching goals of AR
-reduce deficits related to loss of function, activity limitations, participation restrictions and quality of life
-enhance conversational fluency
-recognize HL imposes a multi-dimensional loss of function (impacts body, mind and social aspects)
when we aim to reduce hearing related limitations, what are the components of this
looking at function, activity, participation and quality of life
-all impacting and impacted by HL
-can all lead to lack of participation and can begin to impact quality of life
technology can help improve activity limitation however, it may not always improve this. given that, how can we assess if HAs are benefiting the patient
observing aided speech both in quiet and in noise, add a component of no visuals as well
how does rehabilitation minimize the consequences of HL
usage of technology, enhanced listening skill training, communication strategies, environmental adaptation, emotional/psychological well being and advocacy/access
quality of life and auditory wellness are important aspects to look at for our patients, how can we observe these aspects
through questionnaires
what benefits do questionnaires offer
serve as a baseline and post fitting assessment in order to quantify benefit, improvement in activity limitations and increased participation
in term of enhancing conversational fluency, what is the goal of this for patients with HL
ability to engage in smooth, effortless and enjoyable communication with others
-includes targets of ease of understanding, active participation, communication strategies and social/emotional factors
addressing the ease of understanding
determining if the patient has the audibility
-what can we do to minimize effort and fatigue
addressing active participation
having the patient participate in the flow of conversation
-working on taking turns smoothly, understanding and responding appropriately to others
addressing communication strategies
utilizing effective communication strategies to naturally ask clarifying questions, using visual cues and to repair communication breakdowns smoothly
addressing social/emotional factors
working towards the patient feeling more confident and comfortable in social situations
-maintaining anxiety and comfortable in social situations
with the optimized use of technology, what is the role
to ensure the signal is loud enough for bottom up processing to occur then once the signal reaches the brain top down information processing can occur
in order to enhance listening skills, the brain needs to …
compare/contrast sound arriving to each hemisphere, analyze the amp/frequency/timing of the signal, process the signal, interpret and apply meaning
overview of how the brain processes an auditory signal
echoic memory is created, pattern recognition occurs, goes to short term memory and then into long term memory
when we hear a sound, a echoic memory is created. what is this and what does it become
replica of the acoustic stimulus
-becomes stored for 250 ms as a synthesized auditory memory that leads to processing spatial location, intonation and intensity
the synthesized auditory memories are compared to stored patterns within long term memory leading to ….
pattern recognition
-impacted by audibility, situational context, attention and knowledge of language
what must happen for us to try and retrieve meaning from our long term memory
must be able to store information for around 2 seconds in short term memory
what aspects impact processing speed
suprasegmental information, complexity of task, allocation of attention and capacity/load
suprasegmental information includes characteristics of speech including loudness variations, pitch variations and duration variations. how do these impact speech
loudness variations : lead to stress changes of syllables leading to words having different meaning
pitch variations : intonation is changing, different meaning
duration variations : to vowels, syllables or sentences conveys different meaning
how does complexity of task impact processing speed
with a more complex task, it can call for more mental effort leading to a difficult time with processing the signal
-with this slowed processing speed it makes it difficulty to retain the acoustic stimuli long enough to understand the meaning
how can allocation of attention impact processing speed
with higher levels of attention it allows us to selectively focus on a limited amount of information helping to block out irrelevant information
how can capacity and load impact processing speed
when there is a greater load than capacity the result is fatigue leading to the processing speed to slow down
-remember capacity is the amount of energy available and load is the total amount of energy that must be expended
what are the 3 changes that happen to the aging auditory system
broader neural tuning curves with diminished frequency resolution, neural recovery taking longer and diminished brain connectivity slows hemispheric transmission
auditory mismatch
the auditory message arriving to the brain is degraded by the auditory system and no longer is matching the auditory memory
-increases within complex listening environments
-the degraded input from the noise or from HL does not match the long term memory of the signal
what are life experiences that can preserve and older adults ability to understand speech in noise
music training and physical activity
what do we know about music training and an adult’s ability to understand in speech
by practicing an instrument, the CNS can identify how to remember a sound and how it is important therefore relating to better performance in SIN
perceptual training
supports positive communication outcomes trough improving age related functions and reducing activity limitations
-including speech perception training, auditory visual training and cognitive brain training
where are areas where we can offer support for enhanced listening
complexity of task, allocation of attention, capacity vs. load, age related biological changes and auditory mismatch
the connection between HL and cognitive decline
it has been shown that HL is associated with accelerated cognitive decline
-HL leads to social isolation/loneliness, HL shifts the cognitive load of the brain and HL accelerates brain atrophy
what do we mean by HL is considered the most important modifiable risk factor for dementia
if the HL is treated and managed early on then we can treat that and therefore help prevent the isolation from occurring, which is to be considered the biggest cause for cognitive decline
what are the two types of intelligence
fluid and crystalized
fluid intelligence vs. crystalized intelligence
fluid : ability to think logically, solving problems in certain situations and to think through challenges
crystalized : ability to use skills, the experiential knowledge and the repetitive activities and skills
what type of intelligence is impacted through decline
fluid
-these abilities tend to be seen with cognitive decline
mild cognitive impairment (MCI)
something that is often seen within older adults when there are mild cognitive decline symptoms but it is not dementia
-often will be undiagnosed in individuals
-increased prevalence with age
what cognitive screening tools can we use for MCI
mini mental state exam (MMSE), Montreal cognitive assessment (MoCA), six item cognitive impairment test and the st. louis university mental state (SLUMS)
-the MoCA and SLUMS are the most sensitive for MCI
what is a problem associated with the cognitive screening tools
they are auditory based so if the patient cannot hear the directions or questions we may get skewed information
what are some strategies that we could implement to enhance information retention in our adult population or those with cognitive decline
give clear/brief instruction, reduce the covered content to what needs to be discussed at the present time, increase the frequency of visits, consider slow release compression and encourage auditory cognitive rehabilitation
why are slow acting compression settings easier to process for patients with cognitive decline
slow acting does not alter the speech envelope whereas fast acting does alter the envelope
-if individuals with cognitive decline have the altered speech envelope signal, they are going to have an auditory mismatch (it is already altered from their HL but with an altered speech envelope it becomes more altered)
on average, how much of a SNR do older adults need despite their hearing status
+3-5 dB
why do older adults need the larger SNR
-due to auditory mismatch resulting from age related HL
-related to a reduction in cognitive variability in neural firing
-occurs with age related changes to the auditory system
aging adults experience increased difficulty with hearing in background noise. what are some factors that contribute to this
prolonged neural refractory times, loss of myelin integrity, decreased brain connectivity and increased variability in neural firing
what age do we mean when we discuss older adults
50 years and over
advanced brainstem encoding
the ability to understand in noise despite age related HL and age related auditory structure changes
what populations maintain advanced brainstem encoding
musicians, tonal language speakers and bilingual language speakers
-musicians show overlap within their brain for speech and music
-tonal language individuals are able to have the subtle variations in lexical and grammatical meanings
-bilingual language speakers have better encoding of the fundamental frequency
why do musicians show better abilities with brainstem encoding as they age
playing music uniquely engages the brain in intricate systems (in other words it engages the brain in more ways than just listening), playing music is shown to increase the activity of the CC, music making advances and relies on mental functions differently than other activities
what is the OPERA hypothesis
proposes that the music experience is unique and it has unique opportunities to change how the brain functions and changes itself
-occurring when networking overlaps, precise acoustic processing occurs, music bringing our emotional, signal is repeated and focused attention
how can we use this idea of advanced brainstem encoding clinically for these patients
these patients may not need all the advanced features within HAs if they have HL and access to speech signals
-can include questions regarding music history into the case history questions
how can we use what we know about the benefits of music therpay associated with speech development and auditory abilities clinically
can integrate musical therapy to help process the signals and can educate people on how music can help with speech and language development as we have seen children with that exposure acquire language faster
what are the research findings that show neural plasticity remains present throughout the lifetime
research shows that we can alter auditory processing
-seen in a study of adults 60 to 86 that had no previous musical experience and after 3 months they reported faster processing speed and improved memory
cross modal reorganization
shows that the brain reorganizes itself when it is deprived from input and then returns once that input happens
-with lack of auditory input, visual input tends to take over the area until the auditory information is received again
how can we use the research findings related to cross modal organization clinically
research has shown that with well fit amplification, this can help promote more typical cortical organization and functioning therefore providing cognitive benefit
speech perception training
an approach to improve auditory processing skills that focuses on enhancing the ability to perceive/understand speech
-improves speech, enhancing listening skills, improves auditory attention and memory
core components of speech perception training
auditory discrimination, auditory closure, auditory memory and auditory attention
what are the 5 types of speech perception training
synthetic speech perception, analytic speech perception, transfer appropriate processing (TAP), meaning based orientation training and active filter hypothesis training
synthetic speech perception
utilizes top down processing to take in and analyzes information without attempting to identify every work or sound
-relying on auditory closure skills by focusing on the key parts then filling in the remaining information
examples of synthetic perception tasks
auditory closure training, speechreading training, communication strategies and effective use of content during communication
analytic speech perception
uses bottom up processing to improve recognition of individual phonemic speech elements
-focuses on the ability to hear every sound in order to maximize the ability to hear speech
examples of analytic perception tasks
sound identification drills, lipreading drills, temporal integration tasks, temporal ordering tasks to improve the ability to maintain proper sequence of acoustic stimuli and binaural interaction
transfer appropriate processing (TAP)
training tasks that match the PHLs desired outcomes into the training to be more effective
-using the communication partners voice as part of the training tasks improves and making the training more effective
meaning based orientation training
use of training materials that activate language processing centers of the auditory cortex just like in real world communication
active filter hypothesis training
recognizes emotional factors block effectiveness of listening skills
-reduced anxiety during auditory training by varying conditions
what are 3 considerations for speech perception training
individualized treatment plans, progress monitoring and home practice
what is the progression for auditory training
beginning with phoneme level exercises going to word level then sentence level and finally discourse level exercises
who can we refer to for speech perception training
SLP that specializes in adult AR, auditory verbal therapist, a computer based speech perception training and potentially a music teacher
research suggests that patient appointments are extended when ….
audiologists avoided addressing psychosocial concerns
-these concerns would often be re-raised
we have the COSI that we can use with our patients, what is an equivalent that we can use during FCC
FOCAS (family oriented communication assessment and solutions)
bottom up processing only supplies ________ whereas top down relies on _________
perception of sound ; a clear amplified signal with low distortion
