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