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  1. Two General Principles regarding Amplification and AR
  2. Identify Key Parts of Hearing Aid
  3. Concept #1: Communication is primary
  4. How can we optimize function for a person with HL?
  5. Purposes of Amplification
  6. Consequences of Auditory Deprivation for a Child with HL
  7. Types of Amplification Systems
  8. Two Main Areas of Activity in Audiology
  9. Challenges Facing Contemporary Amplification
  10. Differences between prelingual onset of HL and adult-onset hearing loss
  11. Amplifier
  12. Components of Auditory Deprivation for a Child with HL
  13. Outline 3 Areas of HLAA "Purchasing a Hearing Aid: A Consumer Checklist"
  14. Critical Period Hypothesis
  15. How to Achieve Success in AR (Audiologist/Speech Professional)
  16. Testing
  17. Emphasis in AR?
  18. Three Fundamental Concepts in AR
  19. Problems Affecting an Adult with Hearing Loss
  20. Advantages to PHA
  21. Problems Affecting Children with Hearing Loss - Contd.
  22. Purposes of AR
  23. Disability
  24. Challenges and Opportunities in AR
  25. Positive Changes in Amplification
  26. Concept #2: AR is non-medical mangement
  27. Impairment
  28. Concept #3: people with hearing loss are heterogenous
  29. Disadvantages of PHA
  30. Problems Affecting Children with Hearing Loss:
  31. Rehabilitation vs. Habilitation
  32. Participation Restriction
  33. Activities in AR
  34. Dispensing
  35. Conditions for Optimal Function for Person w/HL
  36. Audiology's Core Values
  37. Problems Affecting Parents of Children with Hearing Loss
  38. Activity Limitation
  39. Full Disclosure
  40. Components of the Communication Model
  41. When does a communication breakdown occur?
  1. a -Hearing Conservation (Prevention) - Prevention is the best "rehabilitative" measure
    -Early Identification
    -Early Intervention (which follows Identification)
  2. b 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
  3. c 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
  4. d 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!
  5. e improving and enhancing communication

    associated AR terms: communication function, communication breakdown
  6. f 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
  7. g 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.

    - 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.
  8. h 1.) Signal to Noise problems
    2.) Unrealistic expectations
  9. i 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
  10. j 1.) Sender (talker)
    2.) Signal (message)
    3.) Environmental Influences
    4.) Receiver (listener)
  11. k 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
  12. l 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?
  13. m - 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
  14. n Testing
    Full Disclosure
  15. o 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?
  16. p *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
  17. q a problem in body function or structure

    example: bilateral sensorineural hearing loss
  18. r 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
  19. s 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)
  20. t 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?
  21. u 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
  22. v Diagnostics - literally Audiometry, the measurement of hearing

  23. w umbrella term covering impairments, activity limitations, and participation restrictions

    implication of a disability is change, loss, or reduction in function
  24. x -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
  25. y 1.) Portable
    2.) Custom fit and adjusted
  26. z 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
  27. aa When there's a problem at ONE or MORE of the levels of communication.
  28. ab typically the person doesn't realize that they have problems/needs or they won't accept that they have problems/needs
  29. ac -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
  30. ad -emotional adjustment differences
    -social isolation
    -academic learning difficulties
    -education achievement vulnerability
    -vocational achievement vulnerability
    -reduced quality of life
  31. ae Communication involves a person and therefore any problems or inefficiencies with communication are a social/community/public problem.

    Levels of Communication:
    -Intent (sender)
  32. af -parents have to make choices
    -siblings and family members are affected
    -costs associated with hearing loss
  33. ag 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
  34. ah 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
  35. ai 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
  36. aj -If a child is not exposed to language within first 5 years of life will not be competent in all aspects of language
  37. ak processor; functionally it increases signal

    amount of energy added is called gain; output - input = gain
  38. al Rehabilitation - restoring a lost skill

    Habilitation - developing a skill that was never present (usually referring to children)
  39. am 1.) Personal Hearing Aids (PHA)
    2.) Assistive Listening Devices (ALDs)
    3.) Group/Classroom Amplification Systems
    4.) Cochlear Implants or other implantable hearing devices
  40. an 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
  41. ao 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