Aural Rehab Final Review (Comprehensive)

  • Cumulative

  • Multiple-choice, true/false, matching, short answer, and essay questions (to case studies)

    • Choose 2 case studies (synthesize understanding)

      • 1 pediatric

      • 1 adult

    • three questions about scenario

    • More than 1 sentence for each question (2-3 for each)

    • Pay attention to ages (be aware of normal ages for things)

    • Know language hierarchy!

    • 20 pt

  • Few bonus point questins

  • Focus on key concepts, but look over everything

  • Module 1

    • What services might be included in a AR 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

    • World Health Organization (WHO) & International Classification of Functioning, Disability, and Health (ICF)

      • ICF: 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

        • Biopsychosocial approach → person-centered & interdisciplinary

        • Related terms

          • Body structure: an anatomical part of the body

          • Body functions: physiological functions of body systems

          • Activity: the execution of a task or action by an individual

          • Participation: involvement in a life situation

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

          • Personal factors: encompass the patient’s age, lifestyle, race, coping styles, attitudes, self-efficacy, habits, preferences, socioeconomic background, and other health conditions

          • Activity limitation (disability): change at the level of

            the person brought about by an impairment at the

            level of body structure and function

          • Participation limitation (handicap): an effect of an

            activity limitation that results in a change in the

            broader scope of a patient’s life

      • ICF Diagram

    • Phoneme testing: testing that isolates phonetic pronunciations so phonetic errors can be studied

      • Stimuli typically used: phonemes, words, phrases, unrelated sentences, or topically related sentences

      • What results of phoneme testing reveal

        • Indicate that kinds of speech features utilized during speech recognition

        • Results independent of vocabulary level

        • Fine-grain assessment to determine training goals or distinguish between ability

  • Mod 2

    • Narrative therapy: counseling approach that focuses on the narrative, discussing the problem as separate from the patient and explores HL impact on patient and frequency communication partners

      • Used when patient has an overly negative view of their HL

      • Techniques utilized

        • Attach new meaning to an experience or behavior

        • Identify times where there was an exception

        • Clarification

        • Validation

        • Reassurance

    • Explicit categorization: part of informational counseling that categorizes pertinent information to discuss in order

    • Personal adjustment counseling: counseling that focuses on adjustment and acceptance

      • Cognitive approach: modifies thought process by identifying activating event, evaluating event, identify consequences of event, dispute negative feelings, create effective action

      • Behavior approach: modify behavior to unlearn negative behavior, desensitize negative reactions, identify physical systems of stress, introduce relaxation techniques

        • Desensitization: reduce negative reaction through repeated exposure

      • Affective approach: modify emotions by focusing on feelings & finding congruence with self; uses honest person-centered approach, conditional positive regard, empathetic understanding, reflection & clarification point-of-view

  • Mod 3

    • 3 general types of listening devices

      • 1) Hearing aids

        • Mild to severe hearing loss when its effective

      • 2) Implantable devices (cochlear implants, middle-ear implants)

        • Cochlear implants: for those who cannot benefit from a hearing aid, usually because of severe HL

        • Middle-ear implants: for patients who cannot wear an external hearing aid or who choose not to

      • 3) Hearing assistive technology systems

        • Help with face-to-face communication, broadcast and other electronic media, telephone use, noisy environments, and environmental stimuli when other devices are inadequate

    • Fundamental components of hearing aids and general function

      • 1) Microphone: convert acoustic signal to an electric signal

        • Directional microphone: only responds to sound in front

        • Omnidirectional microphone: responds to sound from all directions

        • Automatic directional (ADM): adaptively responds to sound, switching between directional and adaptive modes based on sound characteristics of environment

      • 2) Amplifier: increases the level of the signal

      • 3) Receiver: converts the electrical signal into an acoustic signal

    • Bone-anchored hearing aid: transmits sound through skull via external component coupled to titanium screw

      • Who is a good candidate? Patients who cannot wear an external hearing aid or who choose not to do so

    • General requirements for children vs adult cochlear implant candidacy

      • Children CI candidacy

        • >9 months of age (with some exceptions)

        • Trial period with hearing aids

        • Limited or no benefit from hearing aids

      • Adult CI candidacy

        • Irreversible sensorineural hearing loss, usually severe or profound

        • Good general health

        • Patients most likely to benefit are those who

          • Used aural/oral communication in childhood

          • 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

    • Hearing aid orientation sessions

      • 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.

  • Mod 4

    • Rship btwn hearing loss & perceptual effort: Hearing loss requires more perceptual effort to simply recognize the words in an utterance.

    • Analytic vs synthetic training differences, auditory training

      • Analytic training: focuses on elements of speech and perception of the fine-grained acoustical differences to improve the ability to identify individual speech sounds

      • Synthetic training: focuses on meaning of utterances and perception of the whole message to improve ability to comprehend at sentence levels

    • Auditory training programs for speech reception

      • 4 types: phoneme-based, word-based, sentence-based, cognitive-skill-based

    • Brain plasticity: the brain’s ability to change as a result of experience, behavior, environment, sensory deprivation or stimulation

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

  • Mod 5

    • Lipreading (uses only the visual speech signal and related facial and body gestures to recognize speech) vs speechreading (uses the visual speech signal and the auditory signal and related facial and body gestures to recognize speech)

      • Factors that influence the difficulty of lipreading: cognitive skills, age, type of hearing loss, visibility of sounds, rapidity of speech, coarticulation and stress effects, visemes and homophenes, speaker

      • Factors that influence the difficulty of speechreading

    • Analytic vs synthetic approaches in speechreading

      • Analytic speechreading focuses on identifying individual phonemes and syllables

      • Synthetic speechreading emphasizes understanding the overall meaning of sentences and phrases using context

  • Mod 6 (recorded lecture, helpful for case study)

    • Anticipatory strategies: strategies to deal with HL that focus on anticipating potential vocabulary and conversational content

    • Specific repair strategies: strategies to deal with HL that repair conversation focusing on clarity and specificity; includes asking to:

      • Repeat all or part of the message

      • Rephrase the message

      • Elaborate the message

      • Simplify

      • Clarify topic

      • Confirm message

      • Receive feedback

      • Write or fingerspell

    • Non-specific repair strategies: strategies to deal with HL that may or may not effectively repair conversation; includes saying:

      • What?

      • Huh?

      • Pardon?

      • (Shoulder shrug)

    • Maladaptive strategies: strategies to deal with HL that cope with difficulties in inappropriate manners; bluffing, withdrawing from interactions, dominating conversations, feelings of anger & self-pity

      • Bluffing: pretending to understand communication when in reality there was no understanding

    • Stages of communication breakdown repair

      • Detect communication breakdown

      • Choose course of action

        • Use repair strategy

        • Disregard utterance

        • Bluff

    • Model for communication strategies training

      • Order of steps: formal instruction → guided learning → real-world practice (go back if need be)

        • Formal instruction: learn and practice the types of strategies

          • Activities: group sharing & instruction, courtesy, explanation, direction

        • Guided learning: participants encouraged to use conversational strategies in a structured setting

          • Activities: modeling, role-playing, analysis of videos, attention, continuous discourse tracking

        • Real-world practice: participants encouraged to use strategies in real-world contexts

      • Diagram

  • Mod 7

    • Typical pattern for adult-onset hearing loss

      • Onset: bilateral gradual progressive in the 50s - 70s

      • Type & degree: sensorineural, & usually mild

      • Configuration: down-sloping, loss of high-frequency hearing

    • Patient journey

      • 6 stages

        • Pre-awareness: denial, turning up TV, blaming others for mumbling, fatigue from increased perceptual effort, ignore symptoms

        • Awareness: have to acknowledge symptoms, repeated frustration, increased anxiety, fear of aging, social withdrawal

        • Movement: realization → action, investigating solutions, research, talking to friends, making an appointment

        • Diagnosis: appointment with professional, assessment, receiving diagnosis, emotional reactions like denial or relief

        • Rehabilitation: active engagement with solutions, receiving hearing aids, learning to use assistive devices, attending counseling or lip-reading classes, follow-up appointments

        • Resolution: acceptance of hearing loss & management, improved communication strategies, consistent use of devices, asking others to speak louder or face them when speaking, integrating changes into daily life

      • Presbycusis: hearing loss associated with the aging process; typically high-frequency hearing loss

        • Incidence: affects 30% over 65 y.o., affects 50% 75-79 y.o.

    • Personal variables in older adults: emotional state, mental health, temperament (personality), sense of self-sufficiency, independence, self-concept

  • Mod 8

    • Joint Committee on Infant Hearing (JCIH): national committee that establishes professional guidelines for early detection, evaluation, and intervention for infants with hearing loss, focusing on equitable access to care

      • Early Hearing Detection and Intervention (EHDI): the national practice of screening all newborns for hearing loss to identify hearing loss early to ensure proper language and communication development

      • 1-3-6 guideline: screening by 1 month, diagnosis by 3 month, intervention by 6 months

    • Models for parental greiving for HL

      • Sequential Stage Model of Grieving: shock & disbelief, guilt, bargaining, anger, depression or detachment, acceptance

        • Sometimes stages revisited

      • Circular-Pathways Model of Grieving: outward-focused pathway (top), inward-focused pathway (bottom), external influences (stars)

        • Diagram

    • IDEA Part C (The Program for Infants and Toddlers with Disabilities): federal grant program that assists states in operating a comprehensive statewide program of early intervention services for infants and toddlers (0-3 y.o.) with disabilities and their families

      • Basically makes sure every elligible child can have access to early intervention

      • Goals: reduce educational costs by minimizing the need for SPED through early intervention, minimize likelihood of institutionalization, maximize independent living, enhance capacity of families to meet their child’s needs

    • The Individualized Family Service Plan (IFSP): plan for education of preschool children that includes entire family, with parents playing an active role in development; specifies child’s present capabilities, identifies family’s resources & priorities & concerns, and describe goals for achieving progress

    • Communication modes:

      • Spoken language: multi-sensory system using both vision & hearing to recognize speech; speak messages & use hearing and/or speechreading to receive messages

      • Manually coded English: manual system of communication corresponding to the words & syntax of English that includes speaking simultaneously while signing

        • aka Total communication: the child uses every available means to receive a message, including sign, residual hearing, and lipreading

      • Sign language such as ASL: manual system of communication expressed by the hands through configuration, orientation, location, movement; is a distinct language with its own syntax and semantics

  • Mod 9

    • Historical figures of importance in D/HH education

      • Alice Cogswell (1805), inspiration to Gallaudet to research deaf education

      • Thomas Hopkins Gallaudet: commissioned to learn deaf education approaches

        • Braidwood family in England did not share their teaching methods

        • Abbe Sicard & Laurent Clerc in France shared their manual communication system

      • American asylum for education of the Deaf and dumb founded (1817) by Gallaudet & Clerc, uses manual communication approach

      • Gallaudet University: first college for deaf students (President Edward Miner Gallaudet)

      • Clark School (1867)

        • Established by Mabel Hubbard’s father & Samuel Howe

        • She eventually married Alexander Graham Bell who was a huge advocate for aural/oral education

      • Manual vs oral comm approach

        • Manual communication approach: teaching people with hearing loss sign language to be used for communication

        • Oral communication approach: teaching people with hearing loss to speak and speechread

    • The Individualized Education Program (IEP): plan created for each individual child in school-age needing extra support taking into account their SPED needs, strengths, skills, impact on learning, & goals

      • Includes:

        • 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

      • Professionals part of team: audiologist, SLP, school personnel, parents, psychologist, interpreter, parent/guardian, school counselor

        • Audiologist: test hearing & speech perception, listening devices, assess central auditory function, assess classroom acoustics, provide auditory training, consultation, sign language instruction

        • SLP: assessment speech, language, literacy, & speechreading skills, knowledge of listening devices, speech therapy, consultation, sign language instruction

        • Teacher: academic instruction, educational assessments, modifications to curriculum, manage learning environment, manage student behavior & social skills

        • Psychologist: implement psychoeducational assessment, assess intelligence (verbal & nonverbal, writing, reading, and arithmetic skills), memory, behavior, attention, social-emotional

        • Itinerant teacher: 1:1 instruction, supplements classroom instruction, provides pre-teaching

    • Classroom placement options

      • Self-contained: classroom that places the SPED kid in a different classroom either alone or along with other SPED kids

      • Mainstream classroom: classroom that places the SPED kid in the normal classroom alongside other kids

        • direct & indirect services, accommodations

      • Mixed: SPED kid spending some time in the mainstream classroom and some in the self-contained classroom

        • Part-time self-contained, part-time mainstream

    • Classroom acoustics: access to auditory information in the classroom can be challenging due to these factors: distance, noise, reverberation

      • Distance: more distance between listener & speaker/talker = reduced audibility & intelligibility

        • Greatly affects speech understanding

      • Noise: background noise muffles and distorts speech

        • Unoccupied classroom noise levels should not exceed 35 dBA, however, most unoccupied classrooms have a noise level of 51 dBA & over 60 dBA if they are occupied

      • Reverberation: sound signal is reflected from walls, floor, or ceiling magnifying noise and impacts speech recognition

      • Strategies for reducing classroom noise: carpeting, rubber tips on chair and desk legs, acoustical panels or flannel on the walls and ceilings, window treatments, HVAC modifications, and reduced overall room size

    • Format accommodations: adjustments to academic assignments to accommodate for hearing difficulties or communication breakdowns

      • Examples appropriate: abbreviated assignments, abundant visual aids, content enhancement, content reduction, study partner/classroom buddy, flexible scheduling, language simplification, paraphrasing

    • Auditory training

      • Auditory skill hierarchy: awareness → discrimination → identification → comprehension

        • Sound awareness activities: peek-a-boo, musical chairs, march to the beat, push toy car when clinician says Vrrrm

        • Discrimination activities: play a game with toy animals (the cow says ____, the sheep says ____), Simon says, play same or different game, repeat what you hear

        • Identification activities: Candy Land, sticker games, Go Fish

        • Comprehension activities: read-aloud story and answer questions, I Spy, 20 questions

        • Diagram

      • Psychosocial impacts from HL: lower levels of self-perceived social acceptance, fewer close friendships, self-concept differences

  • Mod 10

    • Characteristic language differences in children with HL:

      • Vowels

        • Neutralization & nasalization

        • Substitutions & diphtongizations

        • Prolongations

      • Consonants

        • Voice/voiceless confusions

        • Substitutions, omissions, and distortions

        • Consonant cluster errors

      • Suprasegmental production

        • Errors in stress, rate, coarticulation, breath common

        • Aberrant voice quality

        • Voice pitch, high or monotone

        • Speech rate is slow

        • Frequent pauses, often at inappropriate semantic and syntactic boundaries

        • Limited coarticulation

        • Errors in intonation, stress, tempo, rhythm, and amplitude fluctuations

        • Hindered ability to convey meaning, reducing overall intelligibility

          • Problems often seen in language include form (syntax), content, pragmatics, expressive & receptive language skills

            • Form: simple sentence structures, overuse nouns & verbs, rarely use adverbs pronouns & prepositions, omit function words, rarely use or omit morphemes, poor understanding of various sentence structures

            • Content: limited vocabulary to common everyday words, cannot identify synonyms antonyms and idioms, understanding of words limited to single meaning, learn more concrete than abstract words

            • Pragmatics: incorrect language use, inappropriate asking of questions, lack of initiation skills, absence of communication breakdown repair, poor turn-taking

              • Why have trouble with pragmatics?

                • Unfamiliar with language structures

                • Reduced vocabulary

                • Few conversational partners

                • Unable to overhear conversations

                • Lack of instruction on rules of communicating

  • Book prezys

    • Main concept of books & primary psychosocial theme emphasized in each book 4

    • A Loss for Words: Deafness in a Family

      • Main concept:The experience of a hearing child with Deaf parents

      • Primary psychosocial theme: personal identity development while existing between two worlds with communication barriers and responsibilities being navigated

    • Train Go Sorry: Inside of a Deaf world

      • Main concept: hearing daughter of principal of deaf school tells the stories of various Deaf students

      • Primary psychosocial theme: Navigating Deafness identity in the world

    • The Art of Being Deaf

      • Main concept: a middle-aged woman with moderate-severe hearing loss reflects on how her parents insistence on oralism and her hearing loss has affected her life

      • Primary psychosocial theme: communication breakdowns can have a big impact on relationships

    • Deaf Like Me

      • Main concept: father along with his family navigates supporting his daughter with severe hearing loss

      • Primary psychosocial theme: oralism vs manualism

    • Understand

      • CODA role

      • language access for communication dev

      • oral-deaf experieicne

      • education setting and deaf development