Rehab Audiology: Test I flashcards |

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Outline 3 Areas of HLAA "Purchasing a Hearing Aid: A Consumer Checklist"

Testing
Dispensing
Full Disclosure

Testing

a.) were you given a hearing screening or a full hearing exam? - (were you given a copy of your audiogram)
b.) were you told what type of hearing loss you have?
c.) were you asked about the effect of hearing loss on your home, work, school life?
d.) did a significant other have the opportunity to express the effect of your hearing loss on them?

Dispensing

a.) do you know why a particular type of hearing aid was recommend?
b.) were hearing aid features explained to you?
c.) do they fit comfortably? Were you able to insert the hearing aids yourself?
d.) were all the controls explained to you? Was the care of hearing aids and earmolds explained to you?
e.) did you receive written material or helpful resources?
f.) were you asked to evaluate any improvement on the effect of hearing loss on your life?
g.) were group hearing aid orientation sessions provided?
h.) did you receive any information on using telephones or assistive listening devices?

Full Disclosure

a.) did you receive a written contract detailing the services to be provided?
b.) did your dispenser check your insurance status?
c.) did the dispenser provide information about hearing aid manufacturers he or she works with?
d.) did the dispenser provide written info on any warrantees?
e.) did the dispenser provide written info about the trial period and refund policy?

Two Main Areas of Activity in Audiology

Diagnostics - literally Audiometry, the measurement of hearing

Rehabilitation/Habilitation

Audiology's Core Values

-Hearing Conservation (Prevention) - Prevention is the best "rehabilitative" measure
-Early Identification
-Early Intervention (which follows Identification)

Rehabilitation vs. Habilitation

Rehabilitation - restoring a lost skill

Habilitation - developing a skill that was never present (usually referring to children)

Problems Affecting an Adult with Hearing Loss

-Affect social life in the family and the community
-May cause vocational vulnerability
-Has implications for psychological and emotional consequences

-Affects quality of life overall

Problems Affecting Children with Hearing Loss:

-Auditory Deprivation - esp if prelingual or perilingual at time of onset - will not hear all acoustic events; sound localization difficulties; not link sounds to events/causes/sources

Problems Affecting Children with Hearing Loss - Contd.

-emotional adjustment differences
-social isolation
-academic learning difficulties
-education achievement vulnerability
-vocational achievement vulnerability
-reduced quality of life

Critical Period Hypothesis

-If a child is not exposed to language within first 5 years of life will not be competent in all aspects of language

Problems Affecting Parents of Children with Hearing Loss

-parents have to make choices
-siblings and family members are affected
-costs associated with hearing loss

Three Fundamental Concepts in AR

1.) Communication is primary, it is public, and it breaks down

2.) AR is the non-medical management of the person with hearing problems and needs.

3.) Persons with hearing problems and needs are a heterogenous group that vary across several categories of variables

Concept #1: Communication is primary

Communication involves a person and therefore any problems or inefficiencies with communication are a social/community/public problem.

Levels of Communication:
-Intent (sender)
-Message
-Transmission
-Reception
-Comprehension
-Response

When does a communication breakdown occur?

When there's a problem at ONE or MORE of the levels of communication.

Emphasis in AR?

improving and enhancing communication

associated AR terms: communication function, communication breakdown

Concept #2: AR is non-medical mangement

typically the person doesn't realize that they have problems/needs or they won't accept that they have problems/needs

Concept #3: people with hearing loss are heterogenous

organic characteristics - of hearing loss itself; age when HL developed; nature/extent of HL; presence of other disabilities

personal characteristics - person's attitude; reaction to their condition; reactions of others; influence on expressive communicative ability;

environmental factors - the person's communicative needs; the environment; activity limitations and participation restrictions

type and quality of management - amount and success of previous intervention; how successful they have been

How to Achieve Success in AR (Audiologist/Speech Professional)

1.) Facilitate positive action - overcome barriers to care, such as denial
2.) Understand that the recipient of the services may not appreciate you and may view you as part of the problem
3.) Have appropriate technical skills
4.) Have measurable goals
5.) Have and impart realistic expectations
6.) Expose your own biases

Purposes of AR

1.) to assist in realizing a person's optimal potential in communication, regardless of age

2.) to improve the communication function of persons with hearing problems

3.) to overcome the problems imposed by the organic condition and by the environment and to enhance participation in life and society

Activities in AR

- evaluation and fitting of amplification devices
- counseling
- communication training (auditory and visual)
- support for family members/sig others
- referrals as needed
- consultant
- non-medical management of tinnitus

Challenges and Opportunities in AR

1.) increase demand for services by/for older adults
2.) increase in # of cochlear implants
3.) increase in fragile pediatric population
4.) changing and increasing technology
5.) development of a multicultural society
6.) changes in health care delivery cost-shifting, cost-cutting, accountability
7.) shortfall in # of audiologists (esp. in CA)

Components of the Communication Model

1.) Sender (talker)
2.) Signal (message)
3.) Environmental Influences
4.) Receiver (listener)

Conditions for Optimal Function for Person w/HL

1.) Distance from sound source is within 6 feet
2.) Reverberation ("echo") is minimal
3.) Background noise is minimal
4.) Talker speaks directly --> clear speech
5.) Topic (context) of message is known
6.) Visual cues are available
7.) Active/Alert/Assertive/Anticipatory Listener

How can we optimize function for a person with HL?

1.) Get within 6 feet of speaker
2.) Minimize reverberation
3.) Minimize background noise
4.) Practice using visual cues
5.) Use inherent redundancy/predictability of communication
6.) Use hearing aid or some other form of amplification

Differences between prelingual onset of HL and adult-onset hearing loss

Adults:
- will affect social life in the family and the community
- may cause vocation vulnerability
- has psychological and emotional consequences
--> the sooner the adult accepts their condition and takes positive action the better their life will be.

Children
- auditory deprivation - leads to increased challenges in learning an auditory based language system
- inadequacy of a functional communication system.
- emotional adjustment
- social isolation
- academic achievement vulnerability
- vocational vulnerability
- reduced quality of life
- burden on the parents to make a choice regarding hearing amplification, burden on the family, it is an additional cost.

Identify Key Parts of Hearing Aid

Two most important options: microphones and telecoils

Microphone - converts from acoustic to electrical signal
Amplifier - increases or amplifies signal
Loudspeaker/Receiver - converts electrical signal to acoustic signal - delivers signal through tubing or earmold
Batteries - power source

Two General Principles regarding Amplification and AR

1.) Amplification is the primary tool in AR - helping people minimize their hearing problems

2.) Amplification devices (HA) are always an incomplete and imperfect solution to a complex condition

Purposes of Amplification

1.) to amplify SPEECH to a level that is audible yet comfortable to the listener

2.) to help in sound localization

3.) to help in sound detection

4.) restore a range of loudness experience

5.) if auditory-oral is focus of development, to help the child develop speech and spoken language

Types of Amplification Systems

1.) Personal Hearing Aids (PHA)
2.) Assistive Listening Devices (ALDs)
3.) Group/Classroom Amplification Systems
4.) Cochlear Implants or other implantable hearing devices

Amplifier

processor; functionally it increases signal

amount of energy added is called gain; output - input = gain

Disability

umbrella term covering impairments, activity limitations, and participation restrictions

implication of a disability is change, loss, or reduction in function

Impairment

a problem in body function or structure

example: bilateral sensorineural hearing loss

Activity Limitation

a difficulty encountered by an individual in executing a task or action

example: receiving spoken message in communication; difficulty receiving high-frequency sounds; difficulty hearing distant sounds

Participation Restriction

a problem experienced by an individual in involvement in life situations

example: does not participate in social functions; avoids caring for young children - unable to hear needs; unable to attend favorite sporting events

Consequences of Auditory Deprivation for a Child with HL

*Major consequence of auditory deprivation: increased challenge in learning an acoustic-based language system

can lead to issues with...
-emotional adjustment
-social isolation
-academic learning difficulties
-educational achievement vulnerability
-vocational achievement vulnerability
-reduced quality of life

Components of Auditory Deprivation for a Child with HL

1.) Reduction in reception of acoustic events in their environment
2.) Reduced perception of auditory space - will have localization difficulties
3.) Reduced recognition of acoustic events - will likely not link sounds to events/causes/sources

Positive Changes in Amplification

1.) Customization led to greater awareness of individual differences and variability.

2.) PHA fitting and assessment can be sophisticated and is evolving (probe tube microphone and outcomes measures)

3.) Better quality of care with more audiologists involved in PHA dispensing

Challenges Facing Contemporary Amplification

1.) Environment still causes problems - background noise

2.) No single best way to get a hearing aid - lots of competition

3.) Cost is significant barrier to many users ($1500 - $4000)

4.) Cosmetics continues to be a major factor

5.) No universal defined goals - no definition of benefit in the law - no requirement to do any test to demonstrate benefit

6.) No correspondence of benefit to anything (does it mean they are satisfied? No) Many domains of outcome

7.) Majority of people who could benefit from PHAs don't have them and don't want them!

Advantages to PHA

1.) Portable
2.) Custom fit and adjusted

Disadvantages of PHA

1.) Signal to Noise problems
2.) Unrealistic expectations

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