JACQUE SCHOLL, AU.D, CCC-A, FAAADOCTOR OF AUDIOLOGY

Aural RehabilitationCDIS 4133

What was your writing assignment like?

Review of Audiogram

Definitions

Rehabilitation ServicesAural Rehabilitation

Communication HandicapImpairmentDisability

Impairment

The audiogram Dead regions of the cochlea Auditory dys-synchrony Endolymphatic hydrops

Poor speech discriminationAbsent middle ear muscle reflexes (acoustic reflexes)

Flat tympanogram

Disability

Can’t talk on telephonePoor understanding in a crowdCan’t hear/understand women or

children’s voicesPoor understanding of television

programsCan’t understand spouse

Communication Handicap

Feelings of isolationChange jobs

Marital strainLess socialization

Miss information in meetings and with family

Depression

Craig

A young business man has a mild hearing loss and only finds out when he visits his ENT and has a hearing test because of ringing in his ears. He hasn’t notices any difference and is very active and social. Does he have an impairment? Does he have a disability? Does he have a hearing handicap?

Dixie

An older woman visits your clinic because she is having trouble hearing in a crowd. Her audiogram shows a mild-to-moderate snhl au. Her family has requested she get her hearing checked. She thinks she hears fine unless she’s in a crowd. If people would speak up and quit mumbling, she could hear them. She stays busy and is very social. Does she have an impairment? Does she have a disability? Does she have a hearing handicap?

Silvestre

Silvestre has a moderate-to-sever snhl au. He is having trouble hearing his family and the TV has to be turned up so loud, no one wants to sit with him. He gets together with his family less and less because trying to communicate is so difficult. Does he have an impairment? Does he have a disability? Does he have a hearing handicap?

Handicap & Lifestyle

Aural rehabilitation goals will be directly affected by the communication handicap and the lifestyle.

Two people with the exact same hearing loss will function very differently depending on their lifestyle.

How do you find out this information?

Psychosocial/Social Factors

Psychsocial factors pertain to the patient’s attitudes toward the disability. “Sofia”

Social factors are the prevailing viewoints of the society in which the patient lives and operates (cultural factors). “Alexa”

Communication Partners

Reciprocal relationship Pretend the hearing loss doesn’t exist

Playing down the effects of hearing loss Controlling or dominating

Separating or isolating

AR Plan

Diagnostics/quantification of HLListening device

ALDsAuditory training

Communication strategies trainingInformational/educational counseling

Rational acceptance counselingPsychosocial adjustment counseling

Communication partner trainingSpeechreading

Speech-language therapyInservice training

Pg 8 in book

AR Services

Few professionals provide a broad range of AR services to adults by either Auds or SLPs

Where do you suppose the majority of AR services are directed?

Where do AR services take place?

University clinicAudiology private practiceDealer’s private practice

Hospital clinicCommunity center/nursing home

SchoolENT officeSLP office

Consumer organization meetingsEI

Home

Who provides AR services?

AudiologistSLP

Educator of deaf and HOH child

Who serves as the lead in AR services if they need to be coordinated between

professionals?

Hearing Loss

Degree & configuration

Type Sensorineural

Conductive Mixed

Neural

Extent Bilateral

Unilateral Fluctuating

PC

Hard of Hearing (HOH) Mild, moderate, or mod-to-severe

Hearing Impaired Not PC anymore

Deaf Severe or profound HL

“Deaf”

Deaf or HOH PC for now

Onset

Prelingual

Perilingual

Postlingual

Progressive

Sudden

Demographics/Incidence

Older adults 54% over age of 64 3rd most ptrvalent chronic condition

Adults 4.6% btn 18-44 have hl 14% for 45-64

Infants 1 of every 22 infants born has some kind of hl 1-3 per 1000 born has severe to prof

Children For every 1000 children, 83 have an educationally significant hl

Oklahoma

52,000 live births per year (approx)152 should have hl

2004 - 38 identified2005 - 87 identified2006 - 91 identified

The cost of a disability

Avg % of families with extra out-of-pocket costs OK=36 92.98% Range MI 86.11% - MS 94.24%

Avg yearly extra out-of-pocket cost per family (in dollars) OK=41 $847.49 (range $ MA 561.97-GA $971.66)

Cost of Special Education

On average, costs 2x as much as a child in a regular classroom

1999-2000 - National spending on spec ed was nearly $50 billion compared to $27.3 billion for regular classroom

Percent of children served in spec ed has doubled since 1977

Nearly 14% of children nationally are identified as having a disability

Hearing Loss

1-3-6The earliest intervention possible, the

better.

Professional Journals

ASHAAppendix 1-1

Basic areas of knowledge and skills by audiologists

Basic areas of knowledge and skills by SLPs

Conversation

Why do we have them?

What are some of the rules?

Rules of Conversation

Tacitly agree to share one another’s interestEnsure that no single person does all of the talking

Participate in choosing what to talk about, and participate in developing the topic

Take turns in an orderly fashionTry to be relevant to the topic of conversation

Provide enough information to convey a message without being verbose.

Pragmatics!

What can happen with someone with a HL?

Disrupted taking of turnsModified speaking style

Inappropriate topic shiftsSuperficial content

Frequent clarificationViolation of implicit social rules

Classes of communication strategies

Facilitative strategies (talker) Instructing the talker and structuring the listening environment to enhance the listener’s performance

Receptive repair strategy (listener) A tactic used by an individual when he or she has not understood a message

Communication breakdown (talker & listener) When one communication partner does not recognize another’s message

Factors that influence reception (talker)

TalkerMessage

Environment

Facilitate (listener)

Speech recognition skills Adaptive - implement relaxation techniques Attending - pays attention to cues for inferring Anticipatory - prepares

Communication environment Constructive - structures the environment

Communication partner Instructional - asking

Message Message tailoring - encourage control of topic

Maladaptive strategies

Repair Strategies

When a breakdown in communication happens, listeners can request

information by using a receptive repair strategy

Flow chart pg 54

Stages of repairing communication breakdown

Detect

Choose a course of action

Implement

Repair Strategy or Bluff?

Specific Repair Strategies Repeat (most common repair strategy)

Rephrase Elaborate Simplify

Inidcate topic of conversation Write

Fingerspell Nonspecific repair strategies (What? Huh? Pardon?)

Extended repair - use several togetherExpressive repair strategies

Bluff - consequences?

Conversational Styles

Passive Tends to withdraw from conversations and social interactions rether than attempt to

repair

Aggressive May blame others for misunderstanding

Assertive Takes responsibility for managing

communication difficulties in a way that is considerate of comm partners

Communication Behaviors

Interactive The use of cooperative conversational tactics, consistent with an assertive conversational style

Non-interactive Characteristic of a passive behavioral style

Dominating Characteristic of an aggressive conversational style