Aural Rehabilitation

Early 1800s

Use of ear trumpets as hearing aids.

1600s

Lipreading taught to children and adults with hearing loss.

1947

First academic program in audiology begins.

1966

Journal of the ARA is founded.

1970s

Council on ASHA Code of Ethics is held.

1980s

Approval of CI by FDA.

2000s

Focus on patient-centered care.

Body functions - WHO ICF model

Physiological functions of body systems, including psychological functions.

Body structures - WHO ICF model

Anatomical parts of the body.

Impairments - WHO ICF model

Problems in body function or structure such as a significant deviation or loss.

Activity - WHO ICF model

Execution of a task or action by an individual.

Activity limitation - WHO ICF model

Difficulties an individual may have in executing activities.

Participation - WHO ICF model

Involvement in a life situation.

Participation restrictions - WHO ICF model

Problems an individual may experience in involvement in life situations.

Environmental factors - WHO ICF model

Physical, social, and attitudinal environment in which people live and conduct their lives.

Personal factors - WHO ICF model

Background information about the life and living, including race, ethnicity, age, education, coping style, etc.

Techno-centric model

Focuses on audiometry, accessories, hearing aids, real-ear verification, and hearing aids orientation.

Person-centered model

Focuses on patient story, self-assessment, communication strategies, technology, auditory-visual training, verification, and consumer support.

Medical model

Primary model used in health and health-related disciplines; treatment is successful if disease or symptoms disappear.

Social model

Model for disability being caused by the way society is organized; focuses on removing barriers that restrict choices.

WHO ICF model

A framework used to describe and explain concepts of interest in AR.

Goal setting in AR

Must involve the person in the process and set goals in functional terms specific to the patient's everyday activities.

Consideration of frameworks in AR

Personality
Physical and social environmental factors
Third-party disability

Where does personality fit in the WHO ICF model?

body structure and function

Where does physical and social environmental factors fit in the WHO ICF model?

participation restriction

Third party-disability

Person with normal hearing experiences an activity limitation or participation restriction due to the partner's hearing loss

Stigma

The possession of, or the belief that one possesses, some attribute or characteristic that conveys a social identity that is devalued in a particular social context (Crocket et al., 1998)

Conceptual framework for stigma

1. hearing difficulty
2. deviant behavior
3. judgement of the deviance
4. stigmatizing attitude and behavior
5. shame guilt
6. dual identity
7. withdrawal isolation concealing stress/anxiety

Labeling

Objections to 'deaf' as a label, including 'hard of hearing' and 'hearing impaired'

Stereotypes

Negative characteristics or attributes that are associated with an individual or a group based on a bias or oversimplification

Loss of status

Reduced standing in a social position, which happens in the workplace and can also be experienced in families

Discrimination

Behaviors that reflect prejudicial attitudes, such as difficulty finding work, denial of promotions, and lower income

A method to address stigma clinically

Teach anticipatory strategies and self-efficacy

Self-efficacy

Person's belief in their ability to organize and execute an action that is required to manage a future situation

List components of an adult vocational AR program

Discuss the threat model to explain the cause and costs of stress related to this threat
Create a hierarchy of situations in which the threat occurs
Talk about how the patient copes
Teach new adaptive strategies
Train in a secure environment
Discuss how to implement strategies
Introduce relaxation techniques
Increase the difficulty of situations that require strategies, use reinforcement

steps of transtheoretical model

1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance

Precontemplation? Model?

In denial about hearing loss or be unaware that they have difficulty hearing

Contemplation? Model?

Begins to seek information and/or talk to others about hearing loss and hearing aids

Preparation? Model?

Identifies an audiologist and obtains information about hearing loss and hearing aids

Action? Model?

Audiology appointment is scheduled

Maintenance? Model?

Audiology appointment is attended

steps of health belief model

1. perceived susceptibility
2. perceived severity
3. perceived benefits
4. perceived barriers
5. perceived self-efficacy
6. cue to action

Perceived Susceptibility? Model?

Feel vulnerable

Perceived Severity? Model?

Belief that hearing loss would have negative consequences

Perceived Benefits? Model?

Belief that hearing well is important. Seeking help would have positive outcome

Perceived Barrier? Model?

Belief that it is not a cost (e.g., emotionally, socially, financially) to seek help for hearing loss

Perceived Self-Efficacy? Model?

Belief that they have the knowledge and ability to seek help for hearing loss and that there is a solution

Cue to Action? Model?

Receive encouragement from others to seek help

Health belief models

A framework for understanding how personal beliefs influence health behaviors.

Self-efficacy in AR process

Hearing aid users with mild hearing loss had higher aided listening self-efficacy than those with more severe degrees of hearing loss.

Hearing handicap and attitudes

Those who report greater hearing handicap had more negative attitudes towards hearing loss and felt less confident managing listening situations.

Hearing aid self-efficacy

Those with higher hearing aid self-efficacy are more satisfied with their devices.

Tinnitus management self-efficacy

Patients with high self-efficacy for their tinnitus management were less aware of their tinnitus, less distressed, and less handicapped compared to those with lower levels.

What is an example of a self-efficacy measure related to communication?

Communication Confidence Profile

What self-efficacy measure is used for audiologic rehabilitation?

Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids

What tool from the Ida Institute is used to measure self-efficacy?

The Line tool

What questionnaire assesses self-efficacy for situational communication management?

Self-Efficacy for Situational Communication Management Questionnaire

What measure evaluates self-efficacy for managing reactions to tinnitus?

Self-Efficacy for Managing Reactions to Tinnitus

What questionnaire assesses listening self-efficacy?

Listening Self-Efficacy Questionnaire

Increasing self-efficacy

Can be achieved through mastery experience, vicarious experience, verbal persuasion, and physiological and affective stress.

Mastery experience

A method of learning that includes practice, role-play, skill building based on difficulty level, realistic goal setting, repetition, and homework in real-world settings.

Vicarious experience

Learning through observing others, including clinician and peer models, communication partner models, cognitive rehearsal, instructional videos, and self-modeling.

Verbal persuasion

Encouragement and motivation through self-talk, positive feedback, immediate and specific feedback, patient education materials, and support from frequent communication partners.

Physiological and affective stress

Management of stress through scheduling breaks, creating a calm environment, ensuring distraction-free settings, allowing additional time, multiple appointments, counseling to reduce anxiety, and providing reassuring feedback.

Self-assessment in AR

The process of measuring the effectiveness of a treatment by reaching specified goals after treatment.

Importance of self-assessment

Self-assessment is crucial in the diagnostic process as it incorporates patient experiences and addresses the difficulties they encounter related to hearing loss.

Disease-specific measures

Assessment tools designed for a particular condition, disorder, or disease, such as the Abbreviated Profile of Hearing Aid Benefit, useful for pre-/post-treatment measures.

Generic measures

Assessment tools that allow for comparison across conditions or diseases, focusing on a person's overall health, such as general quality of life measures.

Patient-Reported Outcome Measures (PROM)

Assessment tools used to learn about a health-related condition from the patient's perspective.

List six examples of patient PROMs

Client Oriented Scale of Improvement
Abbreviated Profile of Hearing Aid Benefit
Satisfaction with Amplification in Daily Life
International Outcome Inventory - Hearing Aids
Hearing Handicap Inventory for the Elderly
Hearing Handicap Inventory for Adults

List two examples for FCP PROMs

Hearing Impairment Impact - Significant Other Profile
Significant Other Scale for Hearing Disability

WHO DAS 2.0

An assessment developed by WHO and NIH measuring quality of life and participation in society.

Psychosocial Impact of Assistive Devices Scale

A measure assessing how assistive devices affect psychological well-being and quality of life.

SADL

A tool identifying issues that a patient is experiencing with their hearing aids.

APHAB

A measure used for troubleshooting hearing aid fittings.

PIADS

A measure determining overall psychosocial outcomes related to assistive devices.

Patient expectations (patient factors that can influence hearing aid outcomes)

Preconceived notions about hearing aid benefit affected by help-seeking, satisfaction, and use; disappointment occurs when there is a mismatch between expectations and outcomes; longer use leads to more positive outcomes throughout the first year.

Patient attitude (patient factors that can influence hearing aid outcomes)

Hearing aid use is lower for individuals with negative attitudes towards amplification; counseling about attitudes can increase hearing aid use and/or decrease handicap.

Manual dexterity (patient factors that can influence hearing aid outcomes)

Good vision and manual dexterity are needed; poor manual dexterity is associated with poorer hearing aid outcomes, decreased satisfaction, and lower use; it is the only difference between younger and older patients for dissatisfaction with hearing aids; providing magnetic tools, coloring battery doors, and education of FCPs can help.

Client-Oriented Scale of Improvement (COSI)

Identify up to five specific listening situations; ask the patient to rate the degree of change in hearing ability for each specific situation; ask the patient to rate the final ability with the hearing aid, which can be reported as a percentage or in a box.

Abbreviated Profile of Hearing Aid Benefit (APHAB)

Assesses difficulties with communication and noise in everyday situations; includes four subscales: Ease of Communication, Background Noise, Reverberation, and Aversiveness; benefit is determined by comparing difficulty (unaided) with difficulty (aided).

Expected Consequences of Hearing Aid Ownership (ECHO) / Satisfaction with Amplification in Daily Life (SADL)

Measures expectations of hearing aid use before the fitting; designed to accompany the SADL; includes four subscales: Positive Effect, Services and Cost, Negative Features, and Personal Image; addresses unrealistic expectations and emphasizes counseling patients before hearing aids are dispensed.

Wireless transmission types - Five types used in HATS

FM, electromagnetic, NFMI, 900 MHz, and 2.4 GHz.

FM transmission

Frequency-modulated (FM) transmission that uses a carrier frequency to transmit audio signals.

Benefit of FM transmission

Significant improvements in understanding speech amidst background noise

Electromagnetic transmission

The oldest system since the 1930s where an audio source creates an electromagnetic signal for transmission.

Range of electromagnetic transmission

The range depends on electromagnetic signal strength, categorized as low for neckloop and high for room loop.

What is a benefit of electromagnetic transmission?

Improves speech perception in background noise, in reverberation, and over distances

What is a limitation of electromagnetic transmission?

Can have spillover from nearby rooms

NFMI

Near-field magnetic induction, a transmission method around since 2009 using a carrier frequency of about 3-15 MHz.

NFMI is useful for?

bilateral hearing aids

2.4 GHz transmission

A transmission method set by the FCC for general public use, launched in 2001.

E-health

Digital solutions used for teleaudiology appointments, remote monitoring, and educational content in audiology.

m-health

Mobile health applications that provide digital solutions for clinical practice across healthcare.

Barriers to m-health uptake - Five barriers

lack of evidence for apps
number of available apps
awareness of apps
time for development and updates
privacy concerns

Offline platforms

Platforms such as telephones and DVDs that do not require internet connectivity for audiology services.

Internet platforms

Services or applications provided over the internet, which are highly utilized by older adults.

Auditory training programs

Programs designed to improve listening skills, often provided through internet platforms.

Remote hearing aid fittings

Fittings conducted via internet services to accommodate patients' needs.

Patient education and counseling using e-health

Increase knowledge and awareness of hearing, hearing loss, and amplification

provide support
create peer support groups and online discussion groups