WSU AUD 5420 week 10 auditory training & group therapy

auditory training

aural rehabilitation method designed to maximize use of residual hearing by structured practice in listening, environmental alteration, hearing aid use, and so forth; variable from patient to patient, takes a long time

post-fitting rehabilitation

for the majority of patients, appropriately fitting hearing aids & audiologic management are sufficient to improve communication gaps caused by hearing loss, but some may benefit from auditory training and speech reading

speech reading

maximizes use of visual cues while using residual hearing

DDIC

hierarchy of auditory development: detection, discrimination, identification, comprehension

auditory deprivation

patients with hearing impairment have been deprived of normal sound input for some time and need to re-learn and adapt to the sounds provided to them through amplification

LACE

listening and communication enhancement; computer-based interactive auditory training program for adults; works the hearing system like physical therapy works weakened muscles

auditory training settings

individual therapy (most common) or group therapy (less common)

group aural rehabilitation (AR)

benefits include it being a safe environment, communication partners, it works, but majority of patients don’t invest enough time

focus of group AR

clinicians focus on communication strategies, conversational fluency, while pts focus on real world events

suggested structure of group AR

small groups of less than 10 people including family members, do not need to match degree/type of hearing loss, activities involve both the hearing impaired & the listening partner; 8-12 sessions 1-2 times per week; 60-90 mins w homework assignments

topics to cover in group AR

basics of normal vs impaired hearing, general understanding of audiograms, hearing aid basics, hearing assistive tech, effective communication strategies

counseling

patients are individuals & react differently; degree/configuration of hearing loss; associated concerns like tinnitus/vertigo; personality; emotional acceptance of hearing loss; management of communication problems to improve quality of life

counseling - providing information

general info on hearing loss, hearing evaluation results, hearing loss management options, resources like support groups

counseling - adjustment to hearing loss

reducing negative impact of hearing loss, develop positive self-image, develop positive attitude toward hearing loss, empower patient to succeed

visual communication - lipreading

identifying a spoken message by watching a speaker’s lip, tongue, and mouth movements; pioneered by Spanish monk Pietro Ponce in 1600s (first known successful lipreading teacher); visual interpretation of what is being said plus facial expressions & gestures; approx. 60% guesswork, only 1/3 of speech is visible on the lips

visible components of visual communication

lips & jaw

partially visible components of visual communication

tongue tip & cheek muscles

invisible components of visual communication

tongue body, velum, vocal folds, oral & nasal airflow

McGurk effect

an auditory illusion that occurs when a visual component of one sound is paired with the auditory component of another sound

speech reading

includes lipreading PLUS auditory input, facial expressions, hand gestures, body language; best when used along with amplification

visual communication variables

sender, receiver, message, environment/stimulation

sender variables

facial characteristics, expressions, familiarity, clarity of speech, speaking rate, dialect/accent

receiver variables

visual acuity, perception, residual hearing, attention, familiarity, assertiveness

message variables

linguistic complexity & redundancy, simple vs complex, shorter vs longer, familiarity of topic, etc

environmental variables

visible obstructions, distance between listener & speaker, lighting, competing noise

assessment

actively listen to the patient’s concern, use patient questionnaires to assess areas of communication difficulties, discuss areas of difficulty, show empathy

empathy vs sympathy

empathy is the ability to understand another person’s feelings by putting oneself in another’s shoes, while sympathy is the ability to have pity or show compassion to someone

teaching speech reading

syllable drills, sentence-length stimuli plus contextual cues, emphasizes ability to visually recognize speech info

perceptual closure

identification of message elements (words/parts of words)

conceptual closure

recognition of message meaning

message synthesis

perceptual closure & conceptual closure

viseme

smallest observed element in speech reading; visual equivalent to a phoneme

learning to recognize visemes

different consonants paired with vowels (CV, VC, CVC); add graduated skills to build speech reading abilities, plus anticipatory & repair strategies

communication training

first adult aural rehabilitation developed in hospitals for veterans of WWI; instruction in effective communication strategies like speech reading & auditory training

factors affecting success in aural rehab

group leader, participants, family members; value and results vary greatly between participants

validation study by Mayo clinic

self-rated questionnaires of patients in group therapy showed a decrease in the impact of hearing loss on their lives and an increase in hearing aid use and proper communication strategies - 90% said it increased a lot