AURE 6301-Lecture 1-quaz.pptx

Models of disability Two different models offer different ways of understanding what disability is and what it means within our society 1.Medical model 2.Social model Medical model • Views disability as a consequence of a physical 'problem' with the individual caused by an abnormality, illness or...

Models of disability Two different models offer different ways of understanding what disability is and what it means within our society 1.Medical model 2.Social model Medical model • Views disability as a consequence of a physical 'problem' with the individual caused by an abnormality, illness or accident • Cause of disability should be identified and 'corrected’ medically to improve individual's function • Arguably remains dominant view within society and certainly within most health care professions - most policy relating to 'disabled’ people tacitly Social model • Views disability as socially created barriers within the environment create disability • Individuals do not need 'curing' if environment accommodates those whose needs differ from the majority requires policy and cultural response rather than medical correction of the individual • Has links to civil rights movement parallels with other minority groups WHO international classification systems • World Health Organisation publishes systems for classifying aspects of ill-health. • Classifications for diseases • Classifications for consequences of diseases • Provides common language and framework for describing health, states • Allows health care providers to collect information in a standardized way so that comparisons can be made between areas or countries • Classification system can be used as a tool for • structuring research • collating data • clinical assessment • education WHO International Classification of Impairments, Disabilities and Handicaps (1980) • Emphasis of 1980 classification system • cause of ill-health; describing 'what is wrong' with the individual • classifying minority groups with an identifiable aetiology • III-health described in terms of • impairment • disability Definitions IMPAIRMENT: Any loss or abnormality of psychological, physiological or anatomical structure or function DISABILITY: Results from impairment any restriction in ability to perform an activity in a manner considered within the normal range HANDICAP: Resulting from a disability any limitation of a role that is normal for Examples of Impairment-disabilityhandicap Application of 1980 classification to audiology Disease Impairment Disability  Handicap  (loss of physiological function) (loss of ability) (effect on life) Disorder of the auditory system– could be at any level of system from outer ear to auditory cortex Abnormal auditory functioning – could be reduced sensitivity, reduced frequency resolution.. Reduced hearing abilitycould be reduced speech perception, reduce localosation.. Potentially reduced participation in situations where hearing is needed -could become restricted in many aspects of everyday life e.g. cochlear degeneration e.g. bilateral hearing loss e.g. poor discrimination of speech, especially in noise e.g. cannot use public transport, alone, cannot work or socialise in a noisy environment, may not be able to make How can we measure impairment, disability and handicap in audiology? Impairment (loss of physiological function) e.g. Pure tone audiometry, otoacoustic emissions.. Disability  (loss of ability) Handicap  (effect on life) e.g. Performance e.g. Self-report measures like speech measures like GHABP perception testing or other questionnaires (with or without noise) and localisation testing; self-report measures like Glasgow Hearing Aid Benefit Profile (GHABP) How can we minimise impairment, disability and handicap in audiology? Disease Impairment (loss of physiological function) Disability  (loss of ability) Handicap  (effect on life) Prevention hearing protection, genetic counselling? , other methods? 'Cure' underlying problem with surgery or medication Cure often not possible reduce disability with prosthesis such as hearing aids, assistive listening devices.. Minimise impact on life by teaching communication skills, coping strategies, adapting lifestyle, counseling Public health Geneticists GP/ENT Audiologist Social services Audiologist/ hearing therapist Psychological services • • • • • Impairme nt Impaired speech discrimination in noise Reduced Sensitivity Reduced freq. resolution Impaired speech component resolution Impaired intensity processing Disability Disability listening to speech in noise Primary handicap s Anxiety Embarrassme nt • Restricted Social Participation • Reduced quality of social interaction • • Adjustme nt Secondar y handicap -Speech reading -Paying attentio n • • • • - Restricted social participation - Frustration Black = experienced by HI person Red = experienced by sig other Dashed = adjustments that Acting as an interpreter • • • Effort Fatigue Frustratio n burden of support Effort Irritation Reduced quality of social interactions Case Study Lama is a student in speech and hearing program with a mild but progressive hearing loss. She has a difficulty in listening or hearing her lectures properly. Because of this difficulty, Lama’s opportunity to pass her courses became very little. If Lama would consider using a hearing aid in class, she would have an Impairment but not necessarily a disability? -What is Lama’s Impairment? - What is Lama’s Disability? -What is Lama’s Handicap? -What is disability? Lama’s opportunity for overcoming her Does 1980 classification system capture the effect of ill-health? • Experiences of ill-health are complex • Simple impairment/disability/handicap model does not account for interaction between factors • Implies unidirectional relationship • Impairments lead to disabilities • Disabilities lead to handicap • Also does not account for affect of other factors on degree of handicap • Social environment • Physical environment 2001 WHO published a new classification •system Emphasis of 1980 classification system • Cause of ill-health; describing what is wrong with the individual • Classifying minority groups with an identifiable aetiology • Emphasis of 2001 classification system • Focus on impact rather than cause of ill-health • Underlying principles are universality, party and importance of the environment • Parity - impact is not related to aetiology, places all health conditions on an equal footing • Universality - system includes levels of health and functioning experienced by everyone; 'disabled' are not a separate group • Environment - impact of ill-health arises from New classification system - new model of disability • New classification system based on biopsychosocial or integrative model of disability • biopsychosocial  framework implies that biological, psychological (e.g., thoughts, emotions, behaviors), and social factors influence how a health condition may affect human functioning. • Incorporates the 'universal model' which views disability as a continuum which everyone is on, rather than a minority model of disability • Synthesizes medical and social models • Views both models as partially valid but an oversimplification • Views disability as an interaction between individual and context in which they live (physical and social) • Views some aspects as predominantly related to the individual (medical model) • Other aspects predominantly related to the context Biosychosocial model- the basis of ICF The WHO developed the International Classification of Function, Disability and Health (ICF) Health Condition (disease or disorder) Body Function and body structure Activity Environmental factors Participation Personal Factors Fig (1): ICF classification frame International Classification of Functioning, Disability and Health (ICF) • ICF classifies functioning at 3 levels • Disability defined as dysfunction at 1 or more of these levels • Level of body or body part Disabilities at this level are classified in terms of an impairment of a body part (anatomical) or body function (physiological) • Level of whole person Disabilities at this level are classified in terms of activity limitation (activities the individual has difficulty in performing) • Level of whole person within society Disabilities at this level are classified in terms of participation restriction (life situations that the individual has difficulty participating in) • Degree of impairment is rated on a 5-point scale ICF: Disability is influenced by context Contextual factors are both personal and environmental • Personal factors: features of a person that are unrelated to their health but that influence how their health affects their functioning • Environmental factors: features of the social and physical environment that influence how a person's health affects Contextual factors- personal • Age • Gender • Social background • Education • Profession • Personality, coping styles • Past experiences Contextual factors - environmental • Attitudes of society • Family situation • Legal and social structures • Manmade environment -buildings pavements, etc. • Natural environment - climate, terrain, etc. • Availability of technologies and other resources Uses of ICF • Many uses for individuals, institutions and society • Examples include:  Planning treatment/service needs of an individual  Assessing treatment outcome for an individual  Assessing treatment effectiveness and cost-effectiveness on a service level  Defining and assessing eligibility for Audiology in ICF • Body structures  The eye, ear and related structures  Structures of external, middle, inner ear • Body functions  Sensory functions and pain  Hearing and vestibular functions • Activities and participation  e.g. learning, communication, mobility, domestic life, interpersonal relations, social and community life. • Environmental factors  e.g. technologies, support services, physical In class task Identify the ICF in the following case XX is 19-year-old female came to the clinic with her father complaining of sudden progressive SNHL bilaterally since 2021. XX was wearing BTE hearing aids (HA’s) bilaterally. XX reported that she facing difficulty in communicating with her family specially in understanding speech in a noisy environment. This leads to avoid social interaction with friends and family. Currently she only communicate with her father. Audioliogical examination: Otoscopic evaluation indicated clear ear canals with no abnormality bilaterally, tympanometry showed type (A) bilaterally, audiometric evaluation show bilateral severe-toprofound sensorineural hearing loss. Consequences of hearing impairment Ramsdell's three levels of hearing (The psychology of the hard-of-hearing and the deafened adult', D. A. Ramsdell 1947 reproduced in 'Hearing and Deafness Davis and Silverman, 1970) Suggests normal hearing occurs on three levels: 1.Symbolic or speech level - (words are symbols for objects around us and for activities) 2.Loss of signals/warnings - i.e. reduced awareness of surroundings 3.Loss of auditory background: (neither a symbolic of warning sound) but general auditory input that occurs in daily living e.g. tick of a clock, distant Sound of traffic etc Psychosocial effects of acquired hearing • The effects of a congenital HL are likely to loss be very different. • Factors that might affect the range and extent of any psychosocial effects: Age at onset - multi-factorial problems may mean that a HL has a greater psychosocial effect. Severity of loss and residual hearing - likely to effect the outcome of your intervention e.g. success of your HA fitting which will impact on psychosocial effects. What is Aural rehabilitation? Aural rehabilitation Is aimed at restoring or optimizing a patient’s participation in activities that have been limited as a result of hearing loss and also maybe aimed at benefitting communication patterns who engage in activities that include persons with hearing loss. The goal of aural rehabilitation 1. Alleviated the difficulties related to hearing The main outcome of achieving these goals are enhanced conversational fluency and reduced hearing related disability. Conversational fluency refers to how smoothly conversation unfolds and how easily communication patterns can exchange information. Aural habilitation (Not re-) Is used when the person receiving the service is a child (usually) rather than an adult . This is because in the strict sense, rehabilitation means Typical Component of an Adult rehab program Components of an adult aural rehabilitation programme At the simplest level a programme should include: 1.EVALUATION 2.REMEDIATION (See Goldstein and Stephens model, Audiological Rehabilitation:Management Model I, Audiology 20 Evaluation (1) Communication Status: Auditory Case history Comprehensive audiological assess ENT exam - 'heath of the ears’ Visual Glasses Cataracts/glaucoma Lipreading Language Skills/vocabulary Manual communication Previous rehab e.g. existing/previous HA User Evaluation (2) Physical status Mobility Upper limb mobility + manual dexterity Pinna/meatus Related disorders e.g. tinnitus, vertigo Other major health problems Mental status Mental health problems Memory problems Intellectual ability +cognitive skills Sociological Lifestyle factors factors Employment situation Home and social life Significant others Evaluation/Remediation Attitude Acceptance of HL and consequences Understanding the HL Motivatio n Very important Expectati ons Goal setting Assess and modify to a realistic level Need to address the individuals needs See: 'Who prompts patients to consult about hearing loss ?' Mahoney et al. BJA 30 p153-158 (1996) Remediation Selection of hardware Amplification Assistive Listening Devices Education Instruction on how to use hardware Counselin Hearing tactics g Communication strategies/skills • Liaison/referral to other agencies e.g. social services, employment services. Remediation Follow up long-term/short-term and Individual/group/phone/postal evaluation  There is some evidence that up to 30% of users discard their hearing aids in the first year of use (Ross, ASHA. Dec; 29(12):5) Components of a Typical Aural Typical adult rehabilitation sessions BASIC ADULT AUDITORY REHABILITATION - DIRECT REFERAL • Direct Referral is the main route for patients that go to their GP complaining of hearing problems • It is a referral direct to audiology, so the patient does not see an Ear Nose and Throat (ENT) surgeon. Certain criterion must be met to rule out like sinister causes • Minimum of 3 sessions at 6-8 week SESSION 1: Assessment/Reassessment • Refer to ENT if indicated • Take history • Otoscopy, PTA, ULLs, Tympanometry • Discuss results and candidacy (+ age related norms) • Pre-issue counseling and literature. • Choose ear for fitting, Choose aid type and EM type • Take impression(s) • Arrange fitting appointment After the patient session  Package and post impression SESSION 2: Hearing aid Fitting Continue assessment and counseling Fit earmould and hearing aid(s) - check for comfort Verification and adjustment of fitting using REMS Handling skills Listening skills Hearing tactics Cleaning and maintaining aid/earmould Issue aid, instruction booklet for aid presentation box • Supply of batteries and battery and repair book, info on arrangements for repairs, info sheet for first time user • Arrange follow-up appointment • • • • • • • • SESSION 3: Follow-up  General evaluation of progress with hearing aid(s) Areas to evaluate : Own voice quality, feedback, earmould discomfort, aid insertion/removal, operation of controls, battery changing, loudness discomfort (speech or background sounds), sound quality, telephone use, internal aid noise, loudness balance between ears (if binaural) Further information to give: Info on local repair/battery serviceRetubing and check cleaning and maintenance info Instruction on use of loop, telephone, other assistive device Assess need for Social services referral, volunteer visit Assess need for further follow-up After the patient session Other appointment for existing hearing aid patients • Repair sessions-for broken hearing aids, new earmoulds, new tubing etc.. • Reassessments -for patients that feel their existing hearing aid is no longer giving them benefit/their hearing has changed • Referral from ENT for hearing aid