Aural Rehab- Week 4

What are the 5 fundamentals of a balanced life and "sanity saving"?

1. self (mind, body, emotion, spirit)

2. support (who they care about and who cares about them)

3. surrounding (connecting with nature, creating a peaceful place for oneself)

4. stimulation (life with purpose, creativity, meaning, curiosity, etc.)

5. savor (taking time to have fun, be present, and appreciative)

T/F: There is no one right way to adapt to a child who has diminished hearing and for whom listening and learning as well as language and speech will be a challenge

True

What did Erikson find about the stability of a family>

the stability of a family hinges on the complicated and sensitive pattern of emotional balance and interchange.

What did Luterman observe with families who have a child/children that possess a disability?

the family as a whole may initially attempt to adjust to the disability without changing the existing family structure

What is the role of the professional with the family?

•Interactions with the Family- The professional's job is to not make decisions for the family, but rather to help the parents become sufficiently informed and comfortable so that they can make their own decisions.

•Counseling- Professionals must be active listeners by encouraging parents to express their emotions and involved listeners by recognizing when questions need a direct, informal response. Being straightforward, yet compassionate and respectful is important so that the family will be able to perceive and accept the professional as a viable and trustworthy partner

•Emotional Responses of Families-This process of parental grieving in a hearing loss situation is different from that of losing a child completely. It is also unlike the discovery that one's child has a more visible disability that may have been obvious at birth.

•Hearing the News-Parents question their ability to parent the child, feel unprepared, and don't know what to do. Explaining that the child comes first needs to be conveyed gently and consistently

•Feelings, Doubts, and Questions-If a professional is giving information, it is crucial that attempts be made to assist the parents in feeling less overwhelmed by making enough time to give information and to answer questions. Use careful explanations and explain unfamiliar words thoroughly.

•Enhancing Communication Between Professionals and Parents- Some of the information presented may or may not be heard or processed, so t is essential to frequently review what has been previously discussed and the possibilities for their children and family.

•Parent Support Groups-Professionals must encourage attendance at parent support groups, and if none exist, commit to starting such a program with one or two interested families.

•Other Family Members-Other children in the family seem to do better when their needs are also recognized, when they are included in family decisions, and when they are spoken to openly and honestly about what has transpired and what is happening in their family. Parents need to be encouraged to provide full, age-appropriate explanations, with emphasis on the feelings the family and siblings are experiencing.

•Parent self care-Encouraging parents of children who have impaired hearing, particularly mothers, to take care of themselves physically, mentally, emotionally, and spiritually is of utmost importance.

What are consequences of language delays associated with hearing loss?

Self Concept:

•Children will allow others attitudes to define themselves to themselves.

• risk for developing a poor self concept due to negative reactions due to their communication difficulties and/or perceived differently

•Can perceive themselves as less socially accepted

•Exhibit higher dysfunction in self esteem

•Preschool children are less likely to hold negative feelings

•Teens are becoming more accustomed to and accepting of hearing aids

Emotional Development:

• Since language is required to understand emotion, children with hearing loss may have limited experience in self expression and a delay in understanding of their own emotions.

•Less accurate in identifying others emotional states.

•Have a poor understanding of words and phrases that describe feelings or emotional reactions.

Family Concerns:

•Parents may have little or no experience with hearing loss

•Parents go through cycles similar to that of "grief" when dealing with the diagnosis of hearing loss-shock, denial, depressed (helpless and they learn to cope), and acceptance.

•Important to recognize that a parent may not be the same person as before going through this cycle and parents may move back in forth through the cycle.

Social Competence

- language delay can cause fewer opportunities for peer interactions

•Difficult to learn social rules associated with communication-eye contact, turn taking, responding

What should a professional do if it appears as if the parents are blocking efforts to initiate an intervention program?

It is important to remember the parents are moving in this cycle and the goal is to find ways to accept the "denial" while still offering the services a child needs.

What does counseling mean?

Developing strategies for coping with life, decision making, and current problems. Supporting personal adjustments to situations.

What is non-professional counseling?

•informational counseling on a particular subject matter.

•Nonprofessional personal adjustment support-becomes a necessity when the emotional crisis is related to the professionals specialty

Professional boundaries

When the professional feels uncomfortable with either the content or the intensity of the interaction-refer to a professional counselor.

Psychotherapy

Effect major personality changes

Do SLPs provide psychotherapy or psychoanalysis?

No, they do not serve as psychiatrists or psychologists

How do professionals perceive counseling?

•May be perceived as explaining. We provide content counseling or informational counseling

•Often this type of counseling is one way-professional talking

•When the patient or parent wants to address psychosocial or emotional concerns-need to change two way conversation-patient will talk more and professional talks less

What is the facilitative process?

•Two way conversation.

•Patient is given the time and permission to talk.

• Centers around what life looks like for them as an individual with hearing loss-patient is the expert of their lives and professional drops assumptions.

What are the steps of the facilitative or counseling process?

1. Help patients tell their story.

2. Help patients clarify their problems.

3. Help patients take responsibility for their listening problems.

4. Help patients establish their goals.

5. Develop an action plan.

6. Implement the plan.

7. Conduct ongoing evaluation.

What is habituation?

the professional assumes to understand the patient's struggles and frustrations

How can professionals help their clients tell their own story?

•Generalizing patient's description of how they feel as a result of their hearing loss makes them feel they are labeled into an impersonal category.

• Avoid "Most people with hearing loss...."'

•Use of self assessments is recommended.

What are a few thing to keep in mind when referring a client?

1. Be prepared and developed a list of qualified professionals-confirm these individuals

understand the implications of hearing loss.

2. Rehearse a few ways to broach the subject-What you are discussing right now is beyond my expertise. I do know someone who is qualified to help you. I'd like to give you that number."

3. Normalize the referral and humanize mental health professionals. (I've known Dr. X for years and she is very helpful.)

T/F: Professional is making recommendations for the patient, but the patient must accept responsibility for the problem in order to commit to the solution

True

•The professional needs to place responsibility on the patient-ask your patients "what are your listening goals?" Once identified, reiterate to your patient that you will support them to attain those goals.

_______ should be used to allow patients to understand their problems before considering solutions

self assessments

What is the Abbreviated Profile of Hearing Aid Benefit (APHAB)?

•24 statements in the areas in the ease of communication and communicating in adverse conditions.

•EX: Self Assessment of Communication-A question is presented-such as "Does Any problem or difficulty with your hearing upset you? Patient can respond between and/or including Almost always to Almost never

What is the pediatric amplification process in order?

1. assessment

2. selection

3. verification

4. orientation

5. outcome evauluation

What is the Joint Committee on Infant Hearing (JCIH)?

- a leader in promoting evidence and best practices for early detection, diagnosis, and intervention for children who are DHH.

- promotes early detection of and intervention for hearing loss in children.

T/F: The JCIH's 2007 Position Statement is currently considered the standard for best-practice in identification of hearing loss in infants

True

What are the JCIH's goals for identification and intervention for infants with hearing loss?

•All infants should receive a hearing screening with a physiological measure (such as auditory brainstem response [ABR] or otoacoustic emissions [OAEs]) by 1 month of age.

•All infants who do not pass the early hearing screening should receive appropriate audiologic diagnostic assessment and medical evaluations by 3 months of age.

•All infants with confirmed permanent hearing loss should be enrolled in a family-centered early intervention program by 6 months of age.

What are two assessment of hearing-objective tests?

1. The auditory brain-stem response (ABR)

2. Distortion Product Otoacoustic Emission Testing

What is the ABR?

• Currently used to estimate behavioral hearing sensitivity in infants and in older children who cannot reliably participate in behavioral testing.

•The ABR is measured by presenting brief tone or click stimuli through earphones while the child is in a state of natural sleep or under sedation.

What is Distortion Product Otoacoustic Emission Testing?

- evaluates function of the outer hair cell in the cochlear and can rule out hearing loss greater than mild in degree by frequency when emission is present.

6 months of age or the developmental equivalent, most typically developing infants can do what in regard to hearing assessments?

sit without assistance and turn their heads to sounds presented via speakers or insert earphones

What is visual reinforcement audiometry (VRA)? what age is it used with?

a technique where sounds are paired with animated video or mechanical reinforcement toys to condition the child to turn and look for the sound when presented- used for babies

What is conditioned play audiometry (CPA)? What age is it used with?

- Used with children around the age of two

- Sounds presented via headphones are paired with conditioned responses to games, such as putting blocks in a bucket or placing pegs in a peg board

- games can be changed frequently to keep the child engaged

What can you do if a young child refuses to wear headphones? What is a con of this?

- can use speakers (sound field) if the child refuses to wear headphones

- does not tell which/if one ear is stronger

Once children reach 4 to 5 years of age, how are hearing assessments conducted?

•conventional audiometric techniques that require patients to raise their hand or press a button when the sound is heard can be used.

What are children around the 4 to 5 or older range more likely to participate in during hearing assessments?

- CPA games because games are more likely to maintain their interest.

Once the type and degree of hearing loss can be approximated through audiologic assessment, decisions about what can be made?

- the type of device that will be used for audiologic intervention

Air-conduction hearing aids (HA) are the most frequently used option with what individuals?

- infants and young children who are DHH

What are air conduction hearing aids (HAs)

- amplify the acoustic energy of the speech signal to make it audible based on the degree and configuration of hearing loss.

What is one way to explore how much of the speech spectrum is audible without amplification and the amount of amplification that a HA provides for a given child?

- by plotting the average speech spectrum with the child's hearing thresholds using an SPL-o-gram

What is an PL-o-gram?

- a plot of the level of speech across frequencies in sound pressure level (SPL)

What are the goals of providing amplification for children who are DHH?

•make the acoustic cues that comprise speech and language audible to children across the variety of communication environments that they encounter on a daily basis.

• ensure that children do not experience loudness discomfort that might limit their ability to use their auditory devices in listening situations with high levels of background noise or reverberation.

What is the main goal of providing amplification for children who need it in general?

- to provide audibility for the acoustic cues that will support communication development.

What are prescriptive targets? What are some prescriptive approaches?

- provide an objective starting point for the amount of amplification that is needed at each frequency to provide consistent audibility

- Desired Sensation Level (DSL)- normally the way to go (louder than NAL)

- National Acoustics Laboratory (NAL)

T/F: Prescriptive targets never plotted on the SPL-o-gram

False- Prescriptive targets are often plotted on the SPL-o-gram to help guide audiologists in the amount of amplification that is needed for a given patient.

Why is prescriptive formulae important for audiologists?

- often provides targets for different speech levels (soft, average, and loud speech) so that audiologists can adjust the HA signal processing to provide consistent audibility across varying acoustic environment and different talkers.

What signal processing features for children should be considered?

(1) amplitude compression

(2) digital noise reduction

(3) directional microphones

(4) frequency lowering

(5) feedback management

What is linear amplification?

- the amount of amplification, known as gain, from the HA was constant regardless of how much sound was in the environment

- In the past, HAs provided linear amplification

What is amplitude compression?

- developed as a method of varying the gain of the HA based on the level of sound in the environment

T/F: Evidence suggests that amplitude compression can be effective in maximizing audibility for soft sounds and minimizing loudness discomfort in school-age children

True

What are digital noise reduction algorithms?

- analyze the acoustic characteristics of sound as it is processed by the HA

If the digital noise reduction system in the HA detects that the input to the HA is steady and does not vary over time, what happens?

- it assumes that the environment has background noise and reduces the gain to the signal

HAs with directional microphones have ______________ or ________________ that are spaced slightly apart on the HA

- multiple microphones; microphone ports

What are directional microphone systems?

- Often provide less amplification to sounds arriving from behind the listener. Amplification for sound sources from the front of the listener will be maintained, giving sounds arriving from the front of the listener a slight advantage over other signals

Frequencies above 4000 Hz contain a ____________________ of speech information compared to frequencies between 500 Hz and 2000 Hz, which convey the _________________ of speech information

- limited amount; majority

Is the information at high frequencies important?

- yes, it carries important information for phonemes such as /s/ (as in sun) that are important markers for the morphemes that signify plurals (cat vs. cats), verb tenses (keep vs. keeps), and possession (Scott vs. Scott's).

Why is frequency lowering used with hearing aids?

- used as an alternative to extending bandwidth

- moves high-frequency speech information to lower frequencies, where hearing loss is often less severe and the HA is more easily able to make sounds audible

What is feedback?

- the whistling or high-pitched sound that can occur when part of the amplified sound from a HA is received by the microphone and reamplified in a loop

What are negative affects of feedback?

- limits the amount of hearing aid gain as well as being annoying to the HA wearer or their companions

feedback management is recommended to be activated for children, as long as what does not happen?

- the feedback management system does not reduce the audibility of the signal

What should feedback management NOT be used for?

- to compensate for a poorly fitting ear mold, since even if feedback is not present, amplified sound that leaks from the ear canal around a poorly fitting earmold can still compromise the audibility of the speech signa

After the HA gain and output are prescribed and the appropriate HA features are selected, the audiologist must objectively verify what?

- that the HA makes speech audible and maintains listening comfort by taking measurements of the HA using a probe microphone system

What is a probe microphone system?

- Uses a small tube that is inserted into the ear canal with the earmold or HA. The probe tube is connected to a microphone that measures the sound level in the child's ear canal

Why is orientation important in families and children who wear hearing aids?

- gives sufficient time during appointments to practice HA care and maintenance skills, demonstrate their competence, and ask questions about challenges that may arise

What does a basic hearing aid care kit include? (part of orientation)

(1) a listening tube or stethoscope

(2) a battery tester

(3) an ear-mold tubing blower

(4) desiccant storage or dry-aid kit

(5) a retention device, and (6) extra batteries.

What are osseointegrated auditory devices (OAD) and bone-conduction HAs are designed to do?

- deliver an amplified acoustic signal through bone conduction via the skull to the cochlea when the amplified signal cannot be delivered via air conduction

When are osseointegrated auditory devices (OAD) and bone-conduction hearing aids most frequently used?

- most frequently occurs when a child is born without a pinna or ear canal, a condition known as atresia, or when a child has other craniofacial abnormalities that prevent the use of an air-conduction HA

What are the components of a hearing aid listening check?

1. visual inspection of aid, tubing, and earmold

2. battery check

3. listening check on the parental ear

4. listening check on the child's ear