The aural rehabilitation process
-usually requires the management of a number of interventions.
-In the US, AR services are largely privately paid.
-Insurance coverage for hearing aids is usually limited.
AR Assessment
Assess (1) hearing impairment, (2) hearing-related difficulties, and (3) individual factors.
Who is this person? What is their life like? Culture, gender, working or not, conversational needs, economics??
Hearing-Related Difficulties
Interview the patient
Can use self-assessment questionnaires (Table 10.2, page 402; pages 404-407)
Individual Factors
Non-auditory needs assessment (American Academy of Audiology, 2006):
Cognition
Patient expectations
Motivation
Willingness to take risks
Assertiveness
Manual dexterity (can they manipulate a hearing aid?)
Visual acuity (can they see to speechread/lipread?
Informational Counseling
is ongoing and occurs throughout the AR process.
Answer questions and provide information
Examples: explain how to operate a hearing aid, provide communication strategies, or discuss family concerns
Communication Strategies
can be shared with individuals with hearing loss and individuals who need to communicate with individuals who have hearing loss.
Development of an AR Plan
This is an active partnership with the patient.
Solution-centered, problem-solving strategies to alleviate listening challenges
Need to develop specific objectives
Guidelines for Developing Specific Objectives
Specific objectives should be formulated to identify:
All of the individuals involved in implementing the objective
The role and responsibilities of each person involved in the AR plan
The criteria that will be used to evaluate whether or not the objectiv
Implementation
Suppose the AR plan includes
-provision of a hearing aid,
-provision of assistive listening devices, and
-telephone training.
Implementation: hearing aid provision
audiologist determines need, recommends aid and then fits aid. Audiologist may need to make a case for the value of having a patient wear a hearing aid. It takes weeks to get used to wearing a hearing aid.
implementation: provision of assistive listening devices
ALD may be needed to watch television or use the telephone.
implementation: telephone training
may include discussion of useful tips such as using some of these lines while communicating over the phone (The patient may not be able to text or email everything).
I can't listen as fast as you can talk. Please slow down for me.
I'm not good at recogniz
outcomes assessment
Evaluate the outcomes of the AR plan:
Direct measurement of performance
Interviews
Observation of performance
Self-report scales and questionnaires
Daily logs
Goal of Assessment
-Determine the extent to which activity limitations and participation restrictions have been reduced.
-Determine whether additional concerns remain to be addressed.
There is no universal agreement as to how to measure outcomes.
Examples
Using a test battery to evaluate hearing aid including measures of aided speech recognition
Patient demonstrating successful use of telephone
Patient demonstrating good conversational fluency when talking to family or friends.
In one survey, only about one third of audiologists surveyed
reported routinely using formal outcome measures
Follow-up
AR plan should be flexible.
New problems may arise or intervention may prove unsuccessful.
Routine follow-ups may include annual hearing and/or hearing aid evaluations, providing written materials and web addresses, or recommending self-help groups such a
Technology
Use of high-technology devices such as digital hearing aids and cochlear implants does not mean that individuals do not need AR services.
the elderly patient
Elderly represent the fastest growing segment in American society.
More than 35.9 million people in the US are over the age 65 years, 12% of the population.
Within this population, ~18 million people are between 65 and 74 years of age; ~13 million are bet
the elderly patient cont.
By 2030, the number of people in the US over the age of 64 years will increase to 72 million or about 20% of the population.
Older adults tend to be healthier than in the past, more prosperous and better educated.
information to gather
Living arrangements
Social interactions
Vocational status ( are they working?)
Hobbies
Medical data
Strokes, memory loss, vision problems, dizziness, and medications taken; they all can affect patient's ability to participate in AR
Arthritis and muscle weakness; may interact with patient's ability to handle a listening device
medical data cont.
Ambulation, behavioral changes, and other pertinent conditions; may affect the kinds of communication activities in which the patient may engage
Dementia and Alzheimer's disease; patients may require assistance from caregivers or family members to use hea
Some older persons may experience a decline in
auditory processing abilities (understanding speech vs. just being able to hear).
Three physical conditions that may influence dramatically the design and success of an AR plan
include reduced vision, arthritis and dementia
Group aural rehabilitation programs
tend to work well with older patients, especially if they include their frequent communication partners.
Staff at nursing homes and residential facilities need to learn about
about hearing loss, communication strategies, and listening aids.