Hearing Aids and Aural Rehabilitation Notes

Hearing Aids (Amplification)

  • This lecture does not endorse any specific products and is not meant as a marketing tool.
  • Images shown are to be instructive regarding hearing aid styles and features that are common across companies.

Who Can Dispense Hearing Aids?

  • Audiologists
    • Doctoral training.
    • Part of scope of practice.
    • Generally, part of state licensure.
    • Some states require separate dispensing license.
  • Hearing Instrument Specialists
    • Education requirements vary by state.
    • Only deals with hearing aids.
    • Must have dispensing license.
    • Some states require dispensers to have certification: Board Certified in Hearing Instrument Services.
  • Over The Counter Hearing Aids (OTC)
    • October 17, 2022 - OTC hearing aids approved by FDA.
    • Candidacy:
      • 18 years or older.
      • Perceived mild to moderate hearing loss.
    • What are they?
      • True hearing aids.
      • Many features of clinically available hearing aids.
      • Provide user controls.
      • Many have apps.
    • Can still be expensive and marketing heavy.
      • Make claims and boasts about features that may not truly be helpful (can overpromise).

Reflection: Why Did ASHA Think That It Was Unethical For Audiologists To Sell Hearing Aids In The Past?

  • Not all insurance companies will cover hearing aids, even for children.
  • Used to be viewed as a ‘conflict of interest’.
    • Caused audiologists to charge higher prices to ‘keep the lights on’.
  • Realized audiologists are the most qualified to sell these but created a code of ethics for how to do it and how to report an audiologist NOT following these rules.
  • How to remain a practitioner with integrity.

Components of a Hearing Aid

  • Case (shell).
  • Microphones
    • Forward facing + backward facing mic.
  • Receiver (speaker).
  • Processor.
  • Amplifier.
  • Volume control.
  • Program button.
  • Battery compartment.
  • Optional FM receiver - replaces battery door
    • Mini radio station - remote mic transmits signal to receiver that will then play it through the speakers.

Behind The Ear (BTE)

  • Traditional: used most with kids.
  • Slim tube: very discrete but can’t fit as much tech into the device.
    • Now we can fit a bit more tech.
    • Deeper impression needed for these earmolds.
  • Receiver in canal: speaker is right where the shell and hook meet.
    • Keeps sounds from leaking out - immittance control.

Earmolds for Traditional BTE

  • Connected to bigger BTE aids.
  • Tube attaches to them and brings sound from earmold into the ear.
  • Custom - putty in ears that hardens into shape of ear.
  • Techniques for deep impression
    • Cotton w/ strings attached and glow light.
    • Fill with silicone based material.
    • Branch of vagus nerve runs in hearing canal (can cause visceral reactions).
    • Typically do one at a time due to sensory deprivation anxiety (especially for kids).
  • Traditional BTEs/earmolds always used for kids because they’re more active.
    • Retention is better with these.
    • Earmolds typically use soft silicone material so less damage would occur to the ear from external issues.
    • Will need to be replaced as growth occurs.
      • Every 2 weeks for young infants.
      • Almost always NOT covered by insurance but can be covered by warranty with earmold companies or grants.
    • Can make a little bigger to anticipate future growth.

In The Ear (ITE)

  • Originals for discrete hearing aids.
  • CIC would have the deepest earmold impressions.

ITE Variations

  • Limitations
    • Choking hazard.
    • Pets can easily eat them (especially dogs) due to scent from earwax.
    • Can be difficult for patients w/ loss of fine motor skills.
    • Smaller sizes can limit tech.
    • Smaller size can limit power.
      • Battery life.
      • How loud they can go.
    • They are custom hard shell.
      • Wax can interfere with receiver.
      • Not interchangeable with growth of the ear - no hearing aid while it’s being adjusted/remade.

Hearing Aid Fitting Workflow

  • Assessment: identify hearing loss and determine candidacy for hearing aids.
  • Treatment planning: review results and options with patient.
  • Selection: matching hearing aid features w/ patient’s needs.
  • Development: formal gold standard prescriptive methods to program hearing aids.
  • Verification: ensure that hearing aids are functioning properly and meeting expected prescriptive targets
    • Object measurement of the hearing aids.
  • Orientation: instruct patient on hearing aid use and care, as well as explain realistic expectations
    • This is where you explain what hearing aids CAN and CANNOT do for you!
      • NOT a cure, it’s a TOOL.
  • Validation: measure patient’s subjective experience, AND some object measurements of benefit
    • Use tools, surveys
    • Huge part of fitting
    • Monitoring experience over time

Candidacy for Hearing Aids

  • Assessment of hearing loss.
  • Resolution/consideration of medical issues related to ear.
  • Consideration of patient interest
    • Retired and watching TV most of the day vs. a young attorney.
  • Audiometric candidacy:
    • Minimum: mild hearing loss in the 500-4000 Hz region.
    • Severity: if hearing loss is too great, may need cochlear implant.
    • Word recognition scores: poor word recognition may impact benefit.
    • Speech in noise testing: results may indicate the need for advanced technologies to help in noise.
    • Loudness discomfort level (LDL)/uncomfortable level (UCL): patient may not be able to tolerate loud sounds
      • Hearing aids amplify loud sounds and force the hearing system to work.
      • Recruitment: need to consider/assess for patients
  • Input and output of a hearing aid.

Basic Hearing Aid Tech

  • Analog:
    • Original hearing aid tech.
    • No computer processing of sound.
    • Sounds collected and amplified.
    • Generic fitting strategies.
  • Digital:
    • Standard of hearing care.
    • Sounds collected and processed.
      • Constantly analyze the environment for a patient’s communication needs.
    • Highly programmable to patients needs.
    • Better features to manage noise.

Hearing Aid Selection - Fitting Range

  • Boxes show range of hearing loss that a hearing aid can be used for.
  • Used to help decide what best meets a need.
  • Smaller ones tend to be weaker.

Digital Features

  • Multiple channels: able to adjust hearing aid output in discrete freq. Regions.
  • Multiple programs: automatic or user-controlled programs based on patient’s needs in various settings.
  • Compression (automatic gain control (AGC)*): 2 functions
    • Limit how loud sounds get and minimize distortion.
    • Gain = volume *
    • Wide dynamic range compression (WDRC): preserve the experience of loudness
      • When all sounds are amplified, how can you tell if what you hear is quiet, medium, or loud?
      • Level of volume boost is different depending on the sound’s unaltered volume.
  • Directional microphones: one forward facing and one rear facing mic
    • Allows the hearing aid to determine location of speech vs noise
    • Processing allows for digital noise reduction
    • Digital noise reduction: reduces background noise based on its freq. Range and location
      • Used frequently on many platforms
  • Feedback reduction: phase cancellation of feedback sounds
    • Whistling sound can occur in hearing aids when sound coming out of the speaker is picked up by the mic
    • Remedied by noise cancelling headphones
  • Linked hearing aids: sounds from one hearing aid can be transmitted wirelessly to the opposite ear
  • Data logging: important!
    • How long hearing aids worn
    • User adjustments to volume and programs
    • Assessment of patient’s environments throughout the day
    • Use a lot when counseling patients

Hearing Aids Part II Contralateral Routing of Signal (CROS)

  • Unilateral profound hearing loss (single sided Deafness)
  • Way to collect sound from the side w/ hearing loss and send it to the better hearing ear
  • One “hearing aid” is worn on the normal hearing ear
  • Mic is worn on the ear w/ hearing loss (looks like hearing aid)
  • Sound from mic is sent to normal hearing ear
  • One ear has profound hearing loss - this ear only has a mic
    • Brings sound across - does NOT amplify sound
  • Normal hearing ear has the receiver and mic
  • Doesn’t always have to be normal hearing on one side - can be mild hearing loss

Frequency Lowering

  • Mic collects more frequencies than the receiver can make (limited output)
  • How can we get this extra information and make it audible for the hearing aid wearer?
    • Squish the extra collected sounds into the range the hearing aid can make
    • Ex. can now differentiate between /s/ and /sh/

Programming

  • Hearing aid output and programs are set using prescriptive methods
    • Standardized prescriptions for how loud sounds should be
    • Prescription is based on hearing thresholds
    • Prescription is given at each freq. (or region)
    • Prescription varies based on level of loudness of input
  • Customized adjustments to outputs can be made for patient preferences
    • Must still be within range of prescription
    • May be adjusted over time
      • Ex. Start a little quieter than targets and increase volume → Introduce new programs over time to decrease sensory overload
        *programming screen - on top red line, there’s frequency ranges (channels); numbers in between - levels of loudness based on numbers on the side (50, 65, 80); numbers on bottom are for really loud sounds (limits of the hearing aid)
  • 50: quieter speech
  • 65: average conversational frequency
  • 80: loud

Verification

  • Just because the programming software says it’s programmed perfectly DOES NOT mean it is set correctly in the real world!
  • Ear acoustics can affect the output of the hearing aid
    • Could over amplify some sounds or reduce the amplitude of others
  • 2 methods
    • Test box
      • Hearing aids placed in sound treated chamber
      • Connected to ear simulator (coupler)
      • Speech sounds are played into the hearing aids
      • Can ESTIMATE how sounds are likely to behave based on programming
    • Real ear measurement: best way to measure hearing aid output (standardized)
      • Mic placed in ear canal
      • Hearing aid placed on ear and turned on
      • Speech sounds are played from a speaker
      • Can objectively measure EXACTLY how sounds are likely to behave based on programming

Speech Map

  • Plus signs are prescriptive targets
    • Soft speech (green)
    • Average speech (pink)
    • Loud speech (teal)
  • Yellow dots
    • Targets for highest output
  • Black asterisks
    • Max output (too loud)
    • Don’t want to get near that!

Orientation

  • Introduce patient to:
    • Parts of the hearing aid
    • Use, care, and cleaning
    • Battery replacement
    • Programming
      • Program navigation
      • Volume control
    • Basic troubleshooting
  • Discuss warranty and repair policies
  • Discuss realistic expectations
    • Takes about 30 days of continuous use to adjust to wearing hearing aids
      • 30 day trial window given if they want to return hearing aid after wearing it - refunded
    • Does not sound normal - noise and wind can still be problems

Batteries

  • Can get lost
  • Dexterity
  • Kids swallowing
  • Need close supervision of hearing aids to prevent people from ingesting these batteries!

Validation - Are The Hearing Aids Helping?

  • Aided testing
    • In a soundfield w/ speech stimuli
      • The Ling 6 Sounds for thresholds
      • Word Recognition in Quiet
      • Speech in noise testing
    • DO NOT use pure tone stimuli or narrowband
      • Hearing aid processor may view as feedback or noise so hearing aid would make them quieter
  • Self-report tools
    • Standardized forms allow to track patient perceptions and progress
      • Client oriented scale of improvement (COSI)
        • Pretest to define goals and manage expectations
        • Filled out over time to determine if goals are met or adjustments needed
      • Abbreviated profile of hearing aid benefit (APHAB)
        • Evaluate patient’s perception of benefit in different listening environments
        • Can do pre and post test
        • Lots of normative values

Hearing Aid Troubleshooting

  • No sound
    • Ask about any recent events
      • Exposure to water, drops, missing
    • Visual inspection
      • Cracks in casing, plugged earmold/canal, loose parts
    • Check the battery
      • Charge, incorrect installation, corrosion
    • Perform a biologic check
      • Weak sound may be present, sound w/ distortion
  • Poor sound quality
    • Biologic check (listening check)
      • Using listening scope, how does it sound?
    • Clicking, distortion, intermittency, crackling, beeping when it shouldn’t (normal to beep when battery is low), internal feedback (whistling sound)
    • Biologic check: The Ling 6 Sounds
      • /a/, /I/, /u/, /s/, /Sh/, /m/
      • Gives a range of sounds that offer multiple test frequencies and phonemic representations
      • Can be used fo threshold test, listening for distortion
  • Battery corrosion
    • Leaks, long-term use
  • Feedback - whistle
    • Output becomes the input
    • Mic is collecting sounds coming from hearing aid
    • Creates a noise called feedback
      • Normal if hearing aid is not in the ear correctly
    • Most common cause: poor fit of earmold/poor insertion depth of hearing aid
    • Other causes: wax, middle ear fluid, programming problem/settings, broken hearing aid
    • Fix: ensure ear is clear, push earmold in further, adjust volume
  • Got wet
    • Place in a container with a moisture absorbing/dehumifying substance
    • Don’t have that? Try dry rice!
    • Can happen with kids dropping them in water, adults who work outside and sweat a lot

Implantable Devices

  • Bone-conduction hearing device (BCHD)/Bone-anchored implant (BAI)
    • Physical vibration of sound to the inner ear via BC
    • Small implant is placed in mastoid bone
    • Hearing process includes osseointegration
      • Bone grows into titanium implant
      • Strong adherence to the skull allows for direct translation of vibrations into the mastoid - really excellent way to provide best sound quality
    • Takes roughly 4-6 weeks for osseointegration to be completed
    • Fully-implanted BCHD
      • Relatively new devices
      • Also sends sound via BC
      • Provide the clearest signal
      • Radio wave transmission between external and internal
    • 2 methods of attaching a processor
      • Percutaneous: an abutment is attached to implant and comes through the skin (direct drive)
        • Provides best sound quality
        • More prone to infection
      • Transcutaneous: a magnet is attached to the implant and is completely under the skin (skin drive)
        • Poorer sound quality (less access to high pitches)
        • Less likely for infection
        • Prone to fall/be knocked off of the head
        • Not usually used for kids - headband usually used for very young kids
          • Sound quality similar to transcutaneous but no surgical risk
  • BCHD candidacy
    • Conductive or mixed hearing loss in at least one ear
      • Air-bone gap of at least 30 dB
      • Mixed: must have sensorineural component of mild to moderate
    • Single-sided Deafness for use as CROS system
      • Profound hearing loss in one ear
      • Normal hearing in the opposite ear
    • Surgical considerations
      • Bone thickness must be 2.5 mm
      • Children not eligible until age 5

Middle Ear Implants (MEI)

  • Transducer is placed on the ossicles in order to increase vibratory action to the inner ear
  • Several components
    • External processor w/ mic
    • Internal implant
    • Prosthesis (some designs)
    • Some devices have special type of mic implanted under the skin
  • MEI candidacy
    • Must have stable SNHL in the moderate to severe range
    • Word recognition greater than 40-60%
    • Unable to wear traditional hearing aids
    • Many devices on the market w/ different designs
      • Candidacy is different depending on the device
      • Surgical candidacy will vary

Hearing Aids V. Cochlear Implants

  • Cochlear implants (CI)
    • Bypass the outer and middle ear and function of the HCs
    • Provides direct stimulation of the auditory nerve
    • Consists of external part and internal components
    • Hybrid CI and hearing aid can drive the natural system and stimulate the nerve
  • Candidacy
    • Basic criteria:
      • Severe to profound bilateral SNHL
      • Little to no benefit from hearing aids
    • Comprehensive team eval: especially important when implanting children
      • Audiologist
      • ENT
      • SLP
      • Psychologist/therapist
      • Social worker
      • Educator
    • CT or MRI
      • Evaluate structures of the inner ear
      • Evaluate nerve presence, formation, and size
    • Audiologic eval - type of implant
      • If low frequency hearing is preserved - hybrid may be appropriate
      • Implants can destroy all remaining natural hearing, though improvements have been made in preserving hearing
    • Single Sided Deafness - CI
      • 5 years of age or older
      • Severe to profound SNHL defined as a 4 frequency PTA at 500, 1000, 2000, and 4000 Hz of > 80 dB HL
      • In the contralateral ear, normal or near normal hearing is defined as a PTA at 500, 1000, 2000, and 4000 Hz ≤ 30 dB HL
      • Unilateral hearing aid trial demonstrates limited benefit via word recognition testing
    • More electrodes - more channels (regions of fake hair cells)
    • Cochlear implant timeline - pre-lingual children
      hearing age: point of activation (profoundly Deaf 9 month old would be 1 day old in hearing age the day they’re implanted

Auditory Brainstem Implant (ABI)

  • An external speech processor is worn similarly to a standard CI
  • Internal receiver stimulator works similarly BUT…
    • The electrode array is not placed in the cochlea
  • A paddle shaped electrode is placed on the brainstem in the area which processes auditory input (mimics tonotopic organization of cochlea)
  • Candidacy:
    • Age 12 months and older
    • Bilateral profound SNHL documented on physiologic and behavioral assessment
    • No cochlea or cochlear nerve hypoplasia/aplasia
    • Inability to place a CI due to fibrous growth from previous CI
      • Ossification of cochlea
      • Neurofibromatosis type 2
      • Acoustic neuromas
    • Meningitis with no benefit from CI
    • Strong family support
    • Reasonable expectations of family - only offers access to sounds
    • Understand that child may not develop oral language but will have improved sound detection and discrimination
  • Exclusion criteria include:
    • Medical contraindications
    • Cognitive or developmental delays that could interfere with progress/performance
    • Anomaly or pathology of brainstem or cortex
    • Tumors of brainstem or cranial nerve tumors
    • Psychological contraindication

Aural Rehabilitation and Hearing Assistive Technologies

  • Aural rehabilitation The goal is to improve access to auditory info by:
    • Improving auditory access
    • Having an expanded repertoire of communication methods
    • Making behavioral changes
    • Developing environmental assessment skills
    • Identifying technologies that enhance access to
      • Media
      • Alerting and emergency
      • Telephone
      • Important services and public programming

What’s The Difference?

  • Habilitation: to provide someone skills they have not previously developed on their own
    • Prelingual or early onset hearing loss
      • Awareness of environmental auditory stimuli
      • Ensuring best access to speech info (visual and auditory)
      • Cause and effect
  • Rehabilitation: to provide someone with previously developed skills the ability to regain function after late onset hearing loss
    • presbycusis/ototoxicity/genetic condition
      • Restore access to environmental auditory stimuli
      • Ensure best access to speech stimuli
      • Provide skills for addressing communication breakdown
      • Create plans for employment

Needs Assessment

  • Creation of a patient-specific profile of listening and communication needs and wants
  • Assessment should reveal key areas in need of intervention through the use of various technological and behavioral means

Communication-Based AR Informational Counseling

  • Knowledge is power
  • Clients need to understand their hearing
    • Audiologic test results (interpret their own audiogram)
    • Understand which sounds are impacted by their hearing
    • Understand the physical mechanism for the hearing difference
  • Clients need to recognize the features of communication difficulties
  • Clients need to recognize the limitations of their equipment
  • Clients need to be aware of the emotions that can come w/ acquiring hearing loss
  • Clients AND clinicians need to know the laws
    • Rehab act of 1973, Section 504 - federal level
      • Disability bill of rights
      • Federal gov cannot discriminate for employment based on ability
      • Services must be accessible to people with disabilities if the provider receives any federal funding
    • Americans with Disabilities Act of 1990 - state level
      • Protection against employment discrimination at non-federal locations
      • Access to public services including telecommunications and entertainment
      • Strongest protections for Deaf and hard of hearing communication rights

Goal Setting

  • All AR is based on the individual’s goals which often revolve around:
    • Improved audibility of wound
    • Noise reduction strategies
    • Articulation of speech
    • Speechreading skills
    • Self-advocacy skills
    • Communication strategies
    • Access to telephone, media, services
    • Work or school accommodations

Speechreading

  • Observation of a variety of visual communication cues:
    • Facial expression
    • Gestures
    • Body language
    • Context cues
  • Relies on language skills to fill in blanks
  • NOT lipreading
  • Requires “synthetic ability”
    • Someone must be able to synthesize the limited information they have, fill in the blanks, identify what was said
  • Analytic ability:
    • When someone tries to identify every sound (lipreading)
    • Counterproductive
  • Things that interfere
    • Problems relating to the speaker
      • Limited facial expressions, body language, rate of speech
    • Problems relating to the environment
      • Distance, lighting, visual distractions
    • Problems relating to the speechreader
      • Lack of attention, unfamiliarity of language, limited knowledge of the topic, attitude and beliefs
    • Problem relating to the nature of speech
      • Most sounds are not visible, normal speech is rapid, many words look the same

Role Playing

  • How can I be a good communicator?
  • What communication behaviors might be difficult?

Speechreading Instruction

  • Teaching context-based strategies
    • Understanding that words look alike (homophenes)
    • Using language and context cues to fill in blanks
    • Identify what you missed
    • Identify the missing information
    • Work to anticipate what will be said
    • Self-advocacy skills

Homophenes

  • Words that appear identical on the lips
    • Pay → bay → may
  • Using these in instruction can be highly valuable
  • Used within the framework of utilizing context This model
    • Single words related to topic
    • Homogeneity
    • Equal syllabic structure
    • High challenge: limited context
  • How to use:
    • Select meaningful topic based on client’s needs
    • Familiarize each words verbally/sign language
    • Say one word at a time and score their responses
    • Set specific goal for trails correct
    • Can be adapted to sentence level
      • Ask to identify key words
      • Ask to provide general meaning of the sentence

Communication Strategies

  • Communication Partner: whoever you are talking to
  • Communication styles:
    • Assertive: tell communication partner that you need their help to understand what was said in a polite manner
      • Goal is to get here!
    • Passive: pretend to understand what was said or don’t tell them that you missed what they said
    • Aggressive: rude and demanding request that your communication partner restate what they said
  • There are a wide number of strategies that can be used to prevent communication breakdown and repair communication when breakdown occurs
    • Strategies
      • clarification/confirmation
      • repetition/rephrasing
        • Can you repeat that?
        • Can you rephrase that?
      • Spelling
        • A as in apple?
      • Code words
      • Visual cues
      • Pre-planning/pre-teaching
        • Common for school age kids
      • Environmental controls:
        • Background noise reduction
        • Lighting adjustments
      • Behavioral modifications:
        • Eye contact
        • Self-advocacy for communication

Self-Advocacy

  • Incredibly hard
  • Requires disclosure of reason for misunderstanding
    • Ex. I have a hearing loss
    • I wasn’t able to catch what you said
  • Requires acceptance of one’s hearing loss

Hearing Assistive Tech and AR Traditional Needs Assessment

  • Adults Evaluate:
    1. Face to face communication
      • Can be one on one or group (large or small)
      • Hearing aids/cochlear implant
      • Personal FM (remote mic-radio waves)
        • Mic is located in the transmitter
      • Minimize background noise
      • Behavioral strategies
    2. Telephone access
      • Improved audition:
        • Telecoil setting
        • FM transmitter with or without Bluetooth
        • Manufacturer transmitters
      • Visual supports
        • Telephone captioning relay systems
          • Voice carry over (VCO) - person themselves is speaking
            • Free service for people w/ hearing loss
            • Call is first answered by a relay caption operator
            • Relay operator calls the desired party
            • Person w/ hearing loss speaks through phone
            • Response from other person is both audible AND captioned
          • Video relay operations
            • Video relay systems (VRS) interpreting
              • Call placed by person w/ hearing loss who uses sign
              • Call intercepted by ASL interpreter
              • Interpreter calls desired party
              • Interpreter signs response from other party
          • Text message relay
    3. Reception of electronic media
      • TV
      • Music
      • Computers
      • Movie theater
        *helpful for older adults who have trouble with really small devices
  • Best access to sound would be FM or other direct system
    • Can be connected to TVs and computers easily
  • Loop systems are easy to install in public places
    • Set up, plug in, instruct users, all set
  • Infrared systems are often used in movie theaters and courtrooms
    • Does NOT transmit through walls
    • Generally not very bright
    1. Reception of alerting signals Signal types to overcome background noise
      • FM: radio waves
      • Magnetic waves
      • Electrical signals
      • Infrared light
        *electrical signals: good for gamers due to optimum latency *infrared: typically used for court proceedings due to ability to maintain privacy

What’s A Telecoil?

  • Older tech
  • Small iron bar wrapped w/ copper wire
  • Detects magnetic waves produced by phone speakers
  • Translates the magnetic waves to electoral signal, then to acoustic signal
  • Eliminates background noise if the mic is off or set to quieter setting

Adult Rehab Needs Assessment for HAT

  • Evaluate deficits and their impact on function
  • Create an action plan to meet needs:
    • Technological interventions
    • Environmental controls
    • Behavioral modifications

Pediatric Habilitative Needs Assessment

  • 2 questions:
    • Why a habilitative approach?
      • To preserve the skills these children are born with early intervention
    • Why do we believe in intervening early?
      • Recovering neuroplasticity to curb the effects of sensory deficits on growth and development
    • Evaluate deficits or risk for deficits and their impact on development and functioning
    • Create an action plan to meet needs:
      • Parent and patient behavioral modifications to provide access
      • Environmental controls
      • Technological interventions

Age-Specific HAT Assessment

  • For an adult, how do you decide which accommodations are needed?
    • Use the job description to determine communication needs
    • How will the individual’s communication profile impact their ability to perform job functions?
  • For a child…
    • Use the job description to determine communication needs (development)
    • Job description is typical development

Developmental Milestones Approach

  • Use developmental milestones to determine the needs at specific age intervals
  • Commonly used and widely published
    • Educators
    • Physicians
    • Nurses
    • Early interventionists
    • Speech therapists
    • Occupational therapists
    • Physical therapists
    • Many more!

Pediatric HAT Needs Assessment

  • How can we integrate developmental milestones and traditional needs assessment?
    • Take into account the tasks and functions of daily living and how they change over time
    • Take into account where they occur (home, daycare, school, etc.)
    • discuss/assess personal safety
      • Stranger safety
      • Playground safety
      • Emergency response

Habilitative Needs Assessment Age-Specific Recommendations

  • Behavioral
  • Environmental
  • Safety
  • Technology
    • Birth - adolescence
    • Concise and easy to implement
      • Work alongside of counseling guidelines
    • Pertinent to milestones
    • Flexible
      • Must be adaptable to patient needs
  • Behavioral Modifications/Com. Strategies
    *6 -11 is where we really need to see independence *at 10, the hope is they’re attending their own IEP meetings and voicing their concerns/needs *as young as 8 and 9, conversation about middle school begins *12 yrs old is when the patient should be spoken to as the patient and the parents are only there for reference/support *12-13 is when kids can begin to feel embarrassed of their hearing aids and advocacy drops - transition planning helps to mitigate this

Positive Listening Space

  • Environment that includes considerations for positive communication exchange
  • May start small
  • Expand within the home
  • Expand principles outside the home
    • Day care/babysitting
    • School
    • Extra curricular activities Parent Responsibility
      *1-2 years: expand positive listening space
      *use captioning so young to get parents used to their child having hearing difficulties and building early literacy skills *alerting: know when doorbell is ringing/flashing lights/vibrating device
      *6 yrs: should be able to wake oneself up - reassessment is common for this age because many developmental milestones have been passed and are coming up

General Device Considerations

  • Effectiveness
  • Affordability
  • Operability
  • Quality/dependability
  • Portability
  • Versatility
  • Mobility
    • Is motion limited by device?
  • Cosmetics - how the device looks and how the patient feels about that
  • Previous experience - we all like to try new things Avoid retrofitting! (don’t add something new to something old)

Help, I’m Lost/Overwhelmed!

  • Going to overwhelmed with information and options
  • Learn one product from each category
    • This month, I’m only going to research flashing doorbells