Aural Rehab Final Review

What services might be included in an aural/audiologic (re)habilitation plan?

• Diagnosis and quantification of hearing loss

• Provision of listening devices and assistive devices

• Informational/educational counseling

• Communication strategies training

• Assertiveness training, psychosocial support, and counseling/instructions for patients and for family and colleagues

• Auditory and speechreading training

• Intervention related to speech, language and academic achievement

• Hearing protection

• Tinnitus management

What is the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) framework?

(Know terms and definitions within this framework.)

ICF is a classification system that considers the consequences of a health-related condition within the context of a patient's environment and circumstances.

• Framework to communicate information about an individual's disability and function across disciplines

• Traditional model of disability = biomedical

• ICF model = biopsychosocial

• Person-centered

• Interdisciplinary

• Thus, ICF model combines elements of biomedical model with considerations about the impact of a condition on the individual's engagement in activities of daily living

What are the eight factors of the ICF?

- Body structure

- Body function

- Activity

- Participation

- Environmental factors

- Personal factors

- Activity limitation

- Participation limitation

What is body structure (ICF)?

an anatomical part of the body (e.g., cochlea)

What is body function (ICF)?

physiological functions of body systems (e.g., hearing)

What is "activity" (ICF)?

the execution of a task or action by an individual (e.g., alerting to sound)

What is participation (IFC)?

involvement in a life situation (e.g., participating in a dinner table conversation)

What are environmental factors (ICF)?

the physical, social, and attitudinal environment in which a patient lives and conducts his or her life

What are personal factors (ICF)?

encompass the patient's age, lifestyle, race, coping styles, attitudes, self-efficacy, habits, preferences, socioeconomic background, and other health conditions

What is activity limitation (ICF)?

change at the level of the person brought about by an impairment at the level of body structure and function (e.g., a patient cannot easily engage in casual conversation)

(disability)

What is participation limitation (ICF)?

an effect of an activity limitation that results in a change in the broader scope of a patient's life (e.g., a patient may avoid social gatherings)

(handicap)

What kind of stimuli is typically used for phoneme testing?

vowel and consonant sounds; "nonsense syllables."

Why perform analyses of phoneme confusion errors when phoneme testing?

to identify sources errors and to improve the performance of the phoneme recognition system

Test results indicate the kinds of speech features utilized during speech recognition (i.e., voicing, place, nasality, duration, frication, envelope)

What are some advantages and disadvantages of phoneme testing/assessment?

The advantage of phoneme stimuli is that they are relatively independent of vocabulary level and permit fine-grain assessment to determine training goals or to distinguish between ability.

Their disadvantage is poor ecological validity and that they don't indicate a patient's ability to organize streams of information into linguistically meaningful chunks or to process speech rapidly.

When might narrative therapy be used?

Narrative therapy focuses on the problem the patient is having and not the patient themselves. You assess the toll taken on the communication partners, and you look for clarity. This approach is helpful for patients when they are having problems with communication partners etc.

What are the techniques utilized for narrative therapy?

-Focus on the narrative

-Discuss the problem as being separate from the patient

-Explore the influence of the hearing loss on the patient and frequency communication partners

-Attach new meaning to an experience or behavior

-Identify times when there was an exception

-Clarification

-Validation

-Reassurance

What is explicit categorization?

categorize pertinent information to discuss

Identify the components of the three-pronged hearing-related stress model for adults.

problem identification (setting an objective)

problem exploration

problem solution

Identify & Explore

• Identify problem

• Verbalize difficulties for person and/or partner

• Develop objectives to rectify problem

• Work in groups to explore possibilities

• Have group address methods of adjusting communication situation

• Explore through creating scenarios

• Effective in leading discussion regarding own scenario

• Explore through creating self-profiles

• Person describes self to group

Problem resolution

• Define desired outcome of objective

• Identify possible solutions to problem

• Select solution

• Try using solution

• Evaluate solution

• Modify as needed

•Tenets and approaches/techniques for these 3 types of personal adjustment counseling:

1. Cognitive approach

2. Behavioral approach

3. Affective approach

1. Cognitive approach: rationalize the patient in how they are feeling

2. Behavioral approach: works by exposure to desired behaviors/actions to make them less overwhelming

- based on B.F. Skinner "behaviors are learned and therefore can be unlearned"

3. Affective approach: -Focus on feelings

-Find congruence with self - (use honest, person-centered approach)

-Use unconditional, positive regard- (client knows self best and can overcome feelings)

-Employ empathetic understanding - (use reflection and clarification point-of-view)

What are the 3 general types of listening devices?

1. Hearing aids

2. Implantable devices (cochlear implants, middle-ear implants) 3. Hearing assistive technology systems

When should a hearing aid be selected?

hearing aids are typically selected with conductive hearing loss and often are used before other types of hearing technology

When should an implantable device (such as a cochlear implant) be selected?

Cochlear implants are for those who cannot benefit from a hearing aid.

Cochlear implants provide sound sensation by means of directly stimulating the auditory nerve, bypassing damaged/missing hair cells.

Implants are designed to interface with the tonotopic organization of the cochlea.

When should a hearing assistive technology system be selected?

HATS and ALDs are used to address:

Face-to-face communication

Broadcast and other electronic media

Telephone use

Noisy environments (improved s/n ratio)

Environmental stimuli (door bells, fire alarms)

Used when other devices are inadequate

What are the fundamental components of hearing aids (HAs) and their general function?

1. Microphone: Microphones convert an acoustic signal to an electric signal

2. Amplifier: increase the level of the signal.

3. Receiver: A mini loudspeaker, or a microphone in reverse

Who is a good candidate for a bone-anchored implant?

Patients who cannot wear an external hearing aid or who choose not to do so

What are the general requirements for children and adult cochlear implant (CI) candidacy?

Adults:

- The presence of irreversible sensorineural hearing loss and good general health.

- Typically, audiometric thresholds must indicate a severe or profound hearing loss, although criteria have relaxed in recent years.

- Prelingual hearing loss does not preclude candidacy.

- There is no upper age of implantation.

Children:

12 months of age, with some exception (e.g., meningitis)

Trial period with hearing aids

Limited or no benefit from hearing aids

What are some factors associated with positive benefits from CIs in adults?

Those who used aural/oral communication in childhood

Those who used a hearing aid in the to-be-implanted ear up until the time of implantation

Those who experienced a progressive hearing loss

Those with adventitious hearing loss

What are the components of a hearing aid orientation session?

The audiologist describes the function of the hearing aid.

The patient practices inserting and removing the hearing aid. The audiologist reviews basic hearing aid maintenance.

The patient practices using the telephone, using the telecoil switch if the hearing aid has one.

The audiologist reviews realistic expectations and limitations.

The patient and audiologist determine an appropriate wear schedule/use pattern.

The patient learns how to troubleshoot the device.

The patient receives printed details about the aid and warranty.

If relevant, the patient and audiologist review the app that can be used to control and program the hearing aids and how to use the remote control.

Explain the relationship between hearing loss and perceptual effort.

• Increased perceptual effort (associated with hearing loss) just to simply recognizing the words in an utterance (working memory) [Taxes working memory + Causes fewer cognitive resources to be available for processing]

• Hearing loss demands on perceptual effort and working memory may cause poor, inefficient storage of information in long-term memory.

Explain the differences between analytic and synthetic training approaches.

ANALYTIC TRAINING

•Bottom-up approach

•Focus on elements of speech

•Perception of fine-grained acoustical differences

•Improve ability to identify individual speech sounds •Relationship to auditory skills hierarchy

•Skills from awareness to identification

SYNTHETIC TRAINING

•Top-down approach

•Focus on meaning of utterances

•Perception of the whole message

•Do not need to identify and comprehend each word

•Improve ability to comprehend at sentence level

•Auditory skills hierarchy: comprehension

What are the 4 auditory training programs for speech reception?

•Identify the skills being targeted in each approach.

1. Phoneme-based (e.g., nest-net)

2. Word-based (e.g., Show me the top)

3. Sentence-based (e.g., The spine has 24 bones.)

4. Cognitive-skill based (e.g., six, nine, four, three,

What is brain plasticity? How is it relevant to auditory training?

Auditory training helps to "recalibrate" the brain for listening, especially when an individual begins using new hearing device(s).

Brain plasticity is the brain's ability to change as a result of:

o Experience

o Behavior

o Environment

o Sensory deprivation or stimulation

What is the difference between lip-reading and speechreading?

Lipreading: Uses only the visual speech signal and related facial and body gestures to recognize speech

Speechreading: Uses the visual speech signal and the auditory signal and related facial and body gestures to recognize speech

What are some factors that influence the difficulty of lipreading?

• Visibility of sounds

• Rapidity of speech

• Coarticulation and stress effects

• Speaker/talker

• Visemes and homophones

- Visemes are groups of sounds that appear similar on the face (i.e. /b, m, p/).

- Homophones are (sometimes very different) words that appear the same on the mouth (i.e. "grade," and "yes").

What are some factors that influence speechreading abilities?

1. Speaker (Speaker's Use of Clear Speech, speakers behaviors, eye contact, etc lack thereof = neg affects)

2. Listener (Use of residual hearing, Degree and type of hearing loss, Visual acuity, Emotional state, Stress level, Innate lipreading ability)

3. Environment (lighting, background noise etc)

4. Message (the structure is important for comprehension)

Describe analytic vs. synthetic approaches in speechreading.

Speechreading training methods included analytic syllable drills, synthetic exercises, or a combination of both.

What are the differences between:

•Anticipatory strategies

•Specific repair strategies

•Non-specific repair strategies

•Maladaptive strategies

•Anticipatory strategies

• In addition to the classic four types of facilitative strategies, those with hearing loss can anticipate potential vocabulary and conversational content.

• Example: prior to a job interview, a person might become familiar with typical interview questions, as well as the employer's policies or key staff.

•Specific repair strategies

• asking specific questions for clarification in a conversation....what did you say? I heard the part about Sam, but where did her go? etc.

•Non-specific repair strategies

• asking for clarification by saying huh? what? etc.

•Maladaptive strategies

• Cope with communication difficulties in inappropriate manner • Tactics include:

• Bluffing or pretending to understand

• Withdrawing from communicative interactions

• Dominating conversations

• Developing feelings of anger and self -pity

• Maladaptive strategies sometimes yield short -term benefit but incur long -term costs

What are the stages of communication breakdown repair?

1. Detect the communication breakdown

2. Choose a course of action

3. Use a repair strategy, disregard utterance, or bluff

Describe the model for communication strategies training, including the following:

•Order of steps.

•Approaches and activities in each step.

Formal Instruction --> Guided Learning --> Real World Practice

Formal Instruction:

• Participants learn the various types of communication strategies and other listening and speaking behaviors, and are exposed to examples

• Participants can suggest strategies they have found be helpful in each situation

• The group leader can share specific suggestions that were not generated by group members

Guided Learning:

• Participants are encouraged to use conversational strategies in a structured setting

• Activities include:

• Modeling

• Role-playing

• Analysis of videotaped scenarios

• Attention (e.g., clinician draws attention to a behavior that a participant used to promote good conversational fluency)

• Continuous discourse tracking

Real World Practice:

- practice activity = real world practice; go to the store and help them shop etc.

What is the typical pattern for adult-onset hearing loss?

gradual SNHL with high-frequency sound reduced ability to access (40-50 year olds increasingly experience HL)

Patient journey:

•What are the 6 stages?

•What are some behaviors seen in each stage?

Pre-awareness - those around you notice, but you do not

Awareness - you notice

Movement - gather info about help (ave. 7 years to seek help)

Diagnosis - receive diagnosis

Rehabilitation - receive HA or other assistive tech and therapy

Resolution - minimized communication change

What is presbycusis (give the definition and incidence)?

- A global term used to refer to hearing loss associated with the aging process.

- Affects 30% over 65 years of age

- Affects 50% between 75 to 79 years of age

Explain the personal variables in older adults including the relationship between emotions/mindsets and lifestyle changes.

Emotional state

Mental health

Temperament (stable personality traits)

Sense of self -sufficiency and independence

Self -concept

JCIH EHDI Guidelines:

•What are they, and why are these guidelines in place?

Ensure early identification of hearing loss in infants.

• Pass/Refer screening protocol

• False-negative: pass screening, but has hearing loss

• Ideally, UNHS will have 0 false negatives

• Refer for complete audiological exam

• False-positive: fail screening, but pass exam

Models of grieving for parents/families of children with HL:

• Define and identify stages/pathways for each model.

Sequential Stage Model of Grieving

SHOCK AND DISBELIEF

GUILT

BARGAINING

ANGER

DEPRESSION OR DETACHMENT

ACCEPTANCE

*THESE ARE NOT RUNGS IN A LADDER; SOME STAGES MAY BE REVISITED

Circular-Pathways Model of Grieving

- The outward focused pathway

- The inward focused pathway

- External influences

bottom loop:

Meanings -> Protest -> Despair -> Detach

top loop:

- Hope -> explore -> meanings -> invest

IDEA Part C, and IFSP:

•What are these, and who do they apply to?

•Know key provisions.

IDEA (Individuals with Disabilities Education Act) Part C:

- Is a federal grant program that assists states in operating a comprehensive statewide program of early intervention services for infants and toddlers with disabilities, ages birth through age 2 years, and their families.

- States must assure that early intervention will be available to every eligible child and its family.

- Also, the governor must designate a lead agency to receive the grant and administer the program

- Governor also appoints an Interagency Coordinating Council (ICC), including parents of young children with disabilities, to advise and assist the lead agency.

- Currently, all states and eligible territories are participating in the Part C program. Annual funding to each state is based upon census figures of the number of children, birth through 2, in the general population.

IFSP (Individual Family Service Plan)

- Plan for education of preschool children

- Family is at center of approach, build upon its strengths

- Plan is for entire family, with parents playing an active role in development

Key Provisions:

1. Identification

2. Evaluation

3. IFSP

4. Parents

5. Related services

6. LRE

7. Private school

8. Early intervention & schools

9. Due process

10. Advisory board

11. Funds

12. Records

Communication modes:

•Identify and define 3 main communication modalities (for children w/HL).

• Spoken language - speaking verbally

• Manually coded English - Comprised of manual signs corresponding to the words of English, sharing syntactic structures. Person speaks simultaneously while signing.

• Sign of the Deaf Community - use of ASL

Manual system of communication expressed by the hands through: • Configuration • Orientation • Location in space

• Movement

Auditory training for infants and toddlers:

•List auditory skill hierarchy.

•Give examples of activities for each auditory skill.

(easier)

- Awareness [play peek-a-boo]

- Discrimination [play a game with toy animals]

- Identification [play Candy Land]

- Comprehension [listen to a read aloud story and then answer questions about the plot and characters]

(harder)

Historical figures of importance in the early days of D/HH education.

•How did they shape deaf education?

•Are they associated with the manual or oral communication approach?

• Alice Cogswell, born in 1805

• Thomas Hopkins Gallaudet commissioned to learn deaf educational approaches (utilized manual comm.)

• Braidwood family in England

• Did not share oral teaching methods

• Abbe Sicard and Laurent Clerc in France (utilized manual comm.)

• Shared manual communication system

• Alexander Graham Bell • Married Mabel Hubbard • Passionate advocate for aural/oral education

IEP:

•What is it, and what ages does it cover?

•Which professionals are part of the IEP team? (for D/HH children)

•What are their roles and responsibilities?

Individualized Education Plan

It is the plan created for children who have learning disabilities. Each child receives their own plan that allows them to be in the least restrictive environment (meaning closest to the general classroom as they can get)

All professionals providing expertise to IEP conduct evaluation, intervention, and management Professionals include: • Audiologist • Speech-language pathologist • School personnel, including teacher, itinerate teacher, psychologist, resource room teacher • Parents

Included:

- Anticipated duration of services

- Criteria to determine if objectives are achieved

- Procedures to determine if objectives achieved

- Schedules for review

- Assessment information

- Placement justification statement

Classroom placement:

•What are the options for D/HH children?

• School placement:

• Public

• Private

• Day

• Classroom placement

• Self-contained

• Mainstream

• Mixed

Classroom acoustics:

•What are some challenges of listening in the classroom environment?

•Know some ways to improve classroom acoustics.

Classroom environments can have a lot of background noises like chairs screech and squeaking, computers running, projectors running, HVAC systems, other children talking etc. Also classroom acoustics can have echoes and sounds bounces around a lot especially if the ceilings are high and if there is not much in the room to absorb sounds.

Improvements: quieter HVAC systems, pads on the bottom of chairs, rugs, curtains, maybe have bean bags as well...anything that will help absorb sounds

Format accommodations:

•Why are they used?

•Know some examples of appropriate format accommodations for D/HH children.

Format accommodations are used because they make learning and communication more accessible for children with hearing loss.

• Abbreviated assignments

• Abundant visual aids

• Content enhancement

• Content reduction

• Study partner/classroom buddy

• Flexible scheduling

• Language simplification

• Paraphrasing

Characteristic language differences in children with HL

•List some problems often seen in language

•Form

•Content

■ Overall intelligibility, segmental production, and suprasegmental production are usually considered when describing children's speech

■ How well the child coarticulates sounds

■ How well the child produces suprasegmental aspects

■ Vowels

- Neutralization and nasalization

- Substitutions and diphthongization

- Prolongations

■ Consonants

- Voiced/Voiceless confusions

- Substitutions, omissions, and distortions

- Consonant cluster errors

- Visible consonants produced better

■ limited vocab

Why might children with HL (or APD) have trouble with pragmatic skills?

■ Incorrect language use ■ Inappropriate asking of questions ■ Lack of initiation skills ■ Absence of communication breakdown repair ■ Poor turn-taking

■ Unfamiliar with language structures ■ Reduced vocabulary ■ Few conversational partners ■ Unable to overhear conversations ■ Lack of instruction on rules of communicating