Aural Rehabilitation CDIS 4133

1. Aural RehabilitationCDIS 4133 JACQUE SCHOLL, AU.D, CCC-A, FAAA DOCTOR OF AUDIOLOGY

3. What was your writing assignment like?

4. Review of Audiogram

6. Definitions Rehabilitation Services Aural Rehabilitation Communication Handicap Impairment Disability

7. Impairment The audiogram Dead regions of the cochlea Auditory dys-synchrony Endolymphatic hydrops Poor speech discrimination Absent middle ear muscle reflexes (acoustic reflexes) Flat tympanogram

8. Disability Can’t talk on telephone Poor understanding in a crowd Can’t hear/understand women or children’s voices Poor understanding of television programs Can’t understand spouse

9. Communication Handicap Feelings of isolation Change jobs Marital strain Less socialization Miss information in meetings and with family Depression

10. 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?

11. 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?

12. 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?

13. 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?

14. 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”

15. Communication Partners Reciprocal relationship Pretend the hearing loss doesn’t exist Playing down the effects of hearing loss Controlling or dominating Separating or isolating

16. AR Plan Diagnostics/quantification of HL Listening device ALDs Auditory training Communication strategies training Informational/educational counseling Rational acceptance counseling Psychosocial adjustment counseling Communication partner training Speechreading Speech-language therapy Inservice training Pg 8 in book

17. 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?

18. Where do AR services take place? University clinic Audiology private practice Dealer’s private practice Hospital clinic Community center/nursing home School ENT office SLP office Consumer organization meetings EI Home

19. Who provides AR services? Audiologist SLP Educator of deaf and HOH child Who serves as the lead in AR services if they need to be coordinated between professionals?

20. Hearing Loss Degree & configuration Type Sensorineural Conductive Mixed Neural Extent Bilateral Unilateral Fluctuating

21. 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

22. Onset Prelingual Perilingual Postlingual Progressive Sudden

23. 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

24. Oklahoma 52,000 live births per year (approx) 152 should have hl 2004 - 38 identified 2005 - 87 identified 2006 - 91 identified

25. 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)

26. 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

27. Hearing Loss 1-3-6 The earliest intervention possible, the better.

28. Professional Journals

29. ASHAAppendix 1-1 Basic areas of knowledge and skills by audiologists Basic areas of knowledge and skills by SLPs

30. Conversation Why do we have them? What are some of the rules?

31. Rules of Conversation Tacitly agree to share one another’s interest Ensure 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 fashion Try to be relevant to the topic of conversation Provide enough information to convey a message without being verbose. Pragmatics!

32. What can happen with someone with a HL? Disrupted taking of turns Modified speaking style Inappropriate topic shifts Superficial content Frequent clarification Violation of implicit social rules

33. 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

34. Factors that influence reception (talker) Talker Message Environment

35. 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

36. Repair Strategies When a breakdown in communication happens, listeners can request information by using a receptive repair strategy Flow chart pg 54

37. Stages of repairing communication breakdown Detect Choose a course of action Implement

38. 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 together Expressive repair strategies Bluff - consequences?

39. 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

40. 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