Aural Rehab

Untreated hearing loss is considered a global___

epidemic (a sudden, rapid increase in the number of disease cases in a specific community or region, clearly above what is normally expected).

Q: What are the TWO major goals of aural rehabilitation?

• Alleviate difficulties related to hearing loss.

• Minimize the consequences of hearing loss.

The Negative Effects of Hearing Loss

• Depression/anxiety

• Cognitive Decline/dementia

• Unemployment/underemployment

• Higher risk of falls

• Higher risk of cardiovascular diabetes

1938 Harvard Study

• Studied 700 participants

• Longitudinal study

• DNA Samples in Adulthood

• Brain Imaging Studies

• Longest and most detailed study on human health

→ HEALTHY AND STRONG RELATIONSHIPS MAKE PEOPLE THRIVE

Health Event

Any occurrence impacting physical or mental well-being, ranging from individual issues (like a heart attack or diabetes) to large-scale public health events like pandemics or outbreaks, or even positive interventions, or life changes affecting health coverage.

Downward health spiral

Health Event #1: Causes problems with speech understanding, prohibiting socializing and creating strong relationships, leading to loneliness and depression,

Health Event #2: Mental health decline (due to social isolation and depression)

Health Event #3: Lack of social contact prevents one from partaking in physical activies, causing decline in physical health

Health Event #4: Decline in physical health results in heart disease

Health Event #5: Possible cancer diagnosis, as poor physical health and heart disease make cancer diagnosis even harder to treat (i.e., doctor visits, chemo, etc)

then dementia sets in,)

The fact that there are so many people living with hearing loss costs the world ____ of dollars

billions

Most people go about their lives living with negative affects of hearing loss for ____ years before they do something about it

10

Hearing loss has ____ higher risk of hospitalization and ___ times higher risk of dementia, along with ___ times higher risk of dying

32%, 5x, 2.5x

Hearing loss has a ___ times higher risk of falls as well as cardiovascular disease

3x

For those with untreated hearing loss, healthcare costs are ____% higher

46%

The accelerated risk of cognitive decline for untreated hearing loss is ____

30-40%

Ways. hearing loss can affect communication partners (partners, spouses, children, siblings, and friends)

• The CP may become the communicator or translator, which changes their role in the relationship

• The PHL may deny having a hearing problem, causing the CP to feel resentment

• The CP may feel like they are having to force or coerce the PHL to do something

Hearing loss has been called the ____ condition

Invisible

Aural rehabilitation

is intervention aimed at minimizing and alleviating the communication difficulties associated with hearing loss with a primary goal of enhancing conversational fluency

Conversational fluency

how smoothly conversation goes

hearing-related disability

is a loss of function imposed by hearing loss. The term denotes a multidimensional phenomenon and may include pain, discomfort, physical dysfunction, emotional distress, and the inability to carry out typical activities.

Q: How can hearing loss affect children differently from adults?

A: Children may struggle not only to hear spoken messages but also to interpret and express messages because their language, speech skills, world knowledge, and knowledge of social conventions are still developing.

WHO-ICF (What it stands for and what it is)

World Health Organization (WHO) developed the International Classification of Functioning, Disability and Health (ICF)
- an internationally recognized classification system for describing the consequences of health conditions and for considering the dimensions of health and functioning.

Q: What type of framework is the ICF?

A: A biopsychosocial framework.

Q: Does the ICF focus simply on "fixing" someone's hearing loss?

A: No. It focuses on how hearing difficulties affect the person's everyday life and how hearing-related disability can be alleviated.

WHO-ICF Individual Framework

Health condition ↔ Body structure/function ↔ Activity ↔ Participation

with:

Environmental factors + Personal factors

influencing the system.

What is body structure? + example

as an anatomic part of the body, such as organs (e.g., the cochlea) and limbs.

EX: Loss of cochlear hair cells = body structure impairment

What is body function? + example

A: A physiological function of a body system, including psychological functions.
EX: Loss of ability to discriminate pitch = body function impairment

What is an activity?

A: Execution of a task or action by an individual.

What is participation?

A: Involvement in a life situation; it reflects the societal perspective of functioning.

What is an activity limitation?

A: Difficulty performing an activity at the individual/person level because of an impairment.

Example: Unable to recognize speech over the telephone.

Q: What is a participation restriction?

A: An activity limitation that causes a change in the broader scope of someone's life.

Example: Avoiding social gatherings because understanding speech in noise is difficult.

Can’t understand conversation in a noisy restaurant - what limitation is it?

Activity limitation

Stops going to restaurants because they can't understand conversation - what limitation is it?

Participation restriction

What are environmental factors?

A: Factors external to the patient, including the physical, social, and attitudinal environment.

Examples: background noise, societal attitudes toward hearing loss, communication partners, physical environment.

Q: What are personal factors?

A: Characteristics of the patient, such as age, lifestyle, coping style, attitudes, preferences, socioeconomic background, personality, values, knowledge, and other health conditions.

Q: Can two people with identical hearing losses have different hearing-related disabilities? Why?

A: Yes. Environmental and personal factors influence the magnitude of disability.

Textbook example: A computer programmer who works alone may experience relatively few communication difficulties, while a car salesperson with the same hearing loss may frequently misunderstand customers because their job requires constant communication

Third-party disability

A: A change in another person's life functioning because of a family member's health condition.

Q: Give an example of third-party disability from hearing loss.

A: A spouse stops attending social events because their partner with hearing loss avoids them.

Q: What difficulties may communication partners experience?

A: Difficulty communicating in background noise, excessively loud TV volume, frustration from repeating/clarifying, irritation during conversations, and reduced social interactions.

Q: What is perceived quality of life?

A: How people assess their current life experiences, including enjoyment, meaning, purpose, usefulness, value, freedom of choice, and independence.

Diagnosis

Assessment of hearing loss and speech-recognition abilities.

Listening devices

Hearing aid(s), cochlear implantation/follow-up, etc.

HATS

Hearing assistance technology systems that are either used alone or alongside hearing aids

ALD

Assistive listening device; designed to increase awareness/identification of environmental signals and speech and improve the signal-to-noise ratio.

Tinnitus management

Assess tinnitus disability and provide ways to obtain relief/control.

Tinnitus

Perception of sound in the head without an external cause.

Hearing protection

Means of preventing/minimizing damage from loud sound.

Auditory training →

Structured and unstructured listening instruction/practice.

Communication strategies training

Strategies that enhance communication and reduce communication difficulties, including facilitative strategies, repair strategies, and environmental management.

Informational/educational counseling

Education about normal hearing, hearing loss, listening-device technology, speech perception, and services.

Personal adjustment counseling

Intervention aimed at improving management and acceptance of hearing loss and communication difficulties.

Psychosocial support

Addresses the psychological/social impact of hearing loss on the patient, family, and friends.

Frequent communication partner training

Communication training for spouses, family, friends, partners, or coworkers.

Speechreading training

Speech-recognition training using both auditory and visual channels.

Speech-language therapy

Primarily for children; targets speech production, self-monitoring, vocabulary, syntax, and pragmatics.

Literacy Instruction

Primarily for children; develops reading and writing.

In-service training

Specialized training for other professionals, such as teachers or caretakers

Q: What is aural habilitation?

A: Intervention for people who have not yet developed or are currently acquiring listening, speech, and language skills—especially infants and toddlers.

Q: Why is "habilitation" sometimes preferred for children?

A: Rehabilitation literally implies restoring something that was lost. Young children may never have developed the skill in the first place, so the goal is to develop/habilitate the skill rather than restore it.

Q: What is audiologic rehabilitation?

A: A term sometimes used synonymously with AR, but it may imply greater emphasis on diagnosis/listening devices and less emphasis on nontechnology-based follow-up services.

Q: Where can aural rehabilitation occur?

Many places, including:

• university speech/hearing clinics

• audiology private practices

• hearing aid practices

• hospital clinics

• community centers/nursing homes

• schools

• ENT offices

• SLP offices

• homes

• VA/military settings

• online.

Q: Who can provide aural rehabilitation? ⭐ Who usually takes the lead?

A: Audiologists, SLPs, and teachers/educators of children with hearing loss.

Who takes lead:

Adult AR → Audiologist

Child AR → SLP often takes lead, especially in schools

Very young child → Teacher for children with hearing loss may take lead

Q: What does the audiologist commonly handle for children?

A: Fitting/maintaining hearing aids and providing classroom ALDs/hearing assistance technology.

Q: What does the SLP commonly handle for children?

A: Speech/language therapy and often auditory and speechreading training.

Hearing loss can be categorized along what 4 dimensions:

• Degree - severity

• Onset - when loss began

• Causation - what caused it

• Time Course - how quickly the loss has progressed

What is PTA?

Pure-tone average: average hearing thresholds at 500, 1000, and 2000 Hz.

Degree Range Normal Adults (PTA)

≤25 dB HL

Degree Range Normal Child

≤15 dB HL

Mild hearing loss

26–40 dB HL (text notes 15–40 for children)

Moderate Hearing loss

41–55 dB HL

Moderate-to-Severe

56–70 dB HL

Severe

71–90 dB HL

Profound

>90 dB HL

Hearing loss configuration?

A: The extent of hearing loss at each audiometric frequency, providing an overall description of the loss.

Q: What is an audiogram?

A: Graphic representation of hearing thresholds as a function of stimulus frequency.

Q: What does unserved mean?

A: A person/group needs services but is not receiving them because of policy, practice, or environmental barriers.

Q: What does underserved mean?

A: The person/group receives services, but the services are less than ideal/inadequate.

Q: What is culture?

A: A shared pattern involving thoughts, communication, actions, customs, beliefs, values, learned behaviors, and institutions.

Q: What is cultural competence?

A: The ability to understand and honor people whose backgrounds and belief systems differ from your own.

Q: Why does cultural competence matter in AR?

A: Without it, recommendations may not be accepted or implemented, and the clinician may misunderstand the patient's reactions, activity limitations, and participation restrictions.

⭐ FOUR components of cultural competence

Awareness → recognize your own worldview, biases, stereotypes, and potential judgments.

Attitude → willingness to respect differences, see the world through others' perspectives, develop empathy, and suspend judgment.

Knowledge → actively learn about cultures different from your own.

Skills → effectively communicate and interact across cultures, including verbal and nonverbal communication.

Q: What is evidence-based practice?

A: Clinical decision-making based on:

Best research evidence + Clinical expertise + Patient values

Why can AR research be difficult?

Potential issues include:

• heterogeneous patient populations

• clinician skill influencing outcomes

• disagreement about appropriate outcome measures

• publication bias toward significant results

• ethical problems with withholding beneficial interventions from control groups.

Q: What is an outcome measure?

A: A measure indicating the amount or type of benefit produced by a treatment.

major negative consequences of untreated hearing loss

Social isolation → Depression/anxiety → Reduced activity → Cardiovascular disease/falls → Cognitive decline/dementia

How can untreated hearing loss lead to social isolation?

A:

Untreated hearing loss
↓
Difficult communication
↓
Undesirable interactions + strained relationships
↓
Avoidance

The lecture says the person with hearing loss (PHL) may:

• avoid conversation

• avoid social situations

• stop working/doing enjoyable activities

• stay home.

Q: What may the communication partner (CP) begin doing?

A: The CP may:

• avoid initiating/prolonging conversation

• avoid deep/intimate conversation

• avoid interaction altogether.

So notice:

Hearing loss doesn't affect ONLY the PHL. (third-party disability)

Q: How does untreated hearing loss potentially contribute to depression/anxiety according to the lecture?

A: Hearing-related communication difficulties can contribute to social isolation and loneliness, which are associated with depression and anxiety.

Q: What statement from Dr. Vivek Murthy appears in the lecture?

A: Social isolation is described as being as harmful to health as smoking 15 cigarettes per day.

Q: What protects/promotes health according to the following slide?

A: Healthy and strong relationships help people thrive.

Q: What pathway connects hearing loss/social isolation to cardiovascular risk in the lecture?

A: Reduced social engagement can contribute to:

Less activity → greater cardiovascular-disease risk.

2 Pathways to falls

Pathway #1

Hearing loss/social withdrawal
→ less activity
→ weaker muscles + poorer balance
→ greater fall risk.

Pathway #2: Cognitive Resources

Difficult communication
→ more cognitive resources required to interpret conversation
→ fewer resources available for balance and awareness of surroundings
→ potentially greater fall risk.

Q: Why could hearing loss increase fall risk even if hearing itself isn't directly responsible for maintaining balance?

A: Understanding degraded speech can require increased cognitive resources. That may leave fewer resources available for maintaining balance and environmental awareness; reduced activity can also contribute to weaker muscles and poorer balance.

Q: What pathway does the lecture propose between hearing loss and cognitive decline?

Hearing loss
→ less activity + less interaction
→ fewer opportunities for complex cognitive tasks and cognitive/language processing
→ potential contribution to cognitive decline/dementia.