AURE 6301-Lecture 3-QUAZ.pptx

Hearing loss often known as the invisible condition. The Impact can be anything from…. to….but it still invisible. The consequence can have a very broad spectrum on the individual life. It can affect everyday activities, activities that persons with normal hearing take for granted may become effortf...

Hearing loss often known as the invisible condition. The Impact can be anything from…. to….but it still invisible. The consequence can have a very broad spectrum on the individual life. It can affect everyday activities, activities that persons with normal hearing take for granted may become effortful or frustrating for person who have hearing loss. 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: 1. Enhanced conversational fluency 2. Reduced hearing related disability. Conversational fluency refers to how smoothly conversation unfolds and how easily communication patterns can exchange information. WHO and related hearing disability The WHO developed the International Classification of Function, Disability and Health (ICF) Health Condition Body Function and body structure Activity Environmental factors Participation Personal Factors Fig (1): ICF classification frame Many Speech and hearing professionals base their aural rehabilitation plans on the ICF classification frame work Goals  begin with identifying the activity limitations and participation restriction that the patient wants to address and then target the personal relevant factors and environmental factors that impinge on the limitation and restriction. Where does aural rehabilitation occur? Aural rehabilitation may occur in a variety of places. For example, it may be provided in any of the following settings: A university speech and hearing clinic (CAMS clinics) An audiology private practice A hearing aid dispensers private practice A community center or nursing home A school Home, sometimes with the aid of a computer and possibly, web-based communications Military veterans organization, such military hospitals or veteran center. Who provide aural rehabilitation? AR may be provided by an audiologist, a speech –language pathologist, or a teacher for a children who are deaf and hard of hearing. An audiologist usually takes the lead role in developing an adult’s AR plan and coordination the services provided by other professionals whereas a speech-language For example, the speech-language pathologist is most likely to provide speech and language therapy and often is the professional who provides auditory and speech reading training. Whereas the audiologist may fit and maintain a child’s hearing aids and equip the classroom with appropriate assistive listening devices (ALDs) and hearing assistive technology. Family and frequent communication partners A primary goal of any AR plan is to develop and enhance communication between the person with the hearing loss and his/her family and communication partners. This goal suggests that the plan must target not only the individual, but also the people with whom the individual interacts during  For an adults patient, the AR might include those persons in the home/ vocational settings, and the workplace.  For a child, the AR plan might target the communication partners in the school system, social and extracurricular activities, and the home. Adult Vocation al Home Social Child Educatio n Social/ Extracurr icular Home Fig (2): The AR plan and the individual’s communication realms. Audiologist Basic Areas of Knowledge and Skills Audiologists who provide aural rehabilitation services demonstrate basic knowledge in the areas that are the underpinnings of communication sciences and disorders. These include the following: General Knowledge General psychology; human growth and development; psychosocial behavior; cultural and linguistic diversity; biological, physical, and social sciences; mathematics; and qualitative and Basic Communication Processes Anatomic and physiologic bases for the normal development and use of speech, language, and hearing (including anatomy, neurology, and physiology of speech, language, and hearing mechanisms) Physical bases and process of the production and perception of speech and hearing (including acoustics or physics of sound, phonology, physiologic and acoustic phonetics, sensory perceptual processes, and psychoacoustics). Linguistic and psycholinguistic variables related to the normal development and use of speech, language, and hearing (including linguistics [historical, descriptive, sociolinguistic, sign language, second-language usage], psychology of language, psycholinguistics, language and speech acquisition, verbal learning and Special Areas of Knowledge and Skills Audiologists who provide aural rehabilitation have special knowledge in the following areas and demonstrate the itemized requisite skills in those areas: Auditory System Function and Disorders A. Identify, describe, and differentiate among disorders of auditory function (including disorders of the outer, middle, and inner ear; the vestibular system; the auditory nerve and the associated neural and central auditory system pathways and processes). Developmental Status, Cognition, and Sensory Perception Provide for the administration of assessment measures in the client’s preferred mode of communication Verify adequate visual acuity for communication purposes Identify the need and provide for assessment of cognitive skills, sensory perceptual and motor skills, developmental delays, academic achievement, and literacy Determine the need for referral to other medical and Audiologic Assessment Procedures Conduct interview and obtain case history Perform otoscopic examinations and ensure that the external auditory canal is free of obstruction, including cerumen Conduct and interpret behavioral, physiologic, or electrophysiologic evaluations of the peripheral and central auditory systems Conduct and interpret assessments for auditory processing disorders Administer and interpret standardized self-report measures of communication difficulties and of psychosocial and behavioral adjustment to auditory dysfunction Speech and Language Assessment Procedures Identify the need for and perform screenings for effects of hearing impairment on speech and language Describe the effects of hearing impairment on the development of semantic, syntactic, pragmatic, and phonologic aspects of communication, in terms of both comprehension and production Provide for appropriate measures of speech and voice production Provide for appropriate measures of language comprehension and production Administer and interpret appropriate measures of Evaluation and Management of Devices and Technologies for Individuals with Hearing Impairment (i.e., hearing aids, cochlear implants, middle ear implants, implantable hearing aids, tinnitus maskers, hearing assistive technologies, and other sensory prosthetic devices) Perform and interpret measures of electroacoustic characteristics of devices and technologies Describe, perform, and interpret behavioral/psychophysical measures of performance with these devices and technologies Conduct appropriate fittings with and adjustments of these devices and technologies Monitor fitting of and adjustment to these devices Perform routine visual, listening, and electroacoustic checks of clients’ hearing devices and sensory aids to troubleshoot common causes of malfunction Evaluate and describe the effects of use of devices and technologies on communication and psychosocial functioning Plan and implement a program of orientation to these devices and technologies to ensure realistic expectations; to improve acceptance of, adjustment to, and benefit from these systems; and to enhance communication performance Conduct routine assessments of adjustment to and Effects of Hearing Impairment on Functional Communication Identify the individual’s situational expressive and receptive communication needs Evaluate the individual’s expressive and receptive communication performance. Identify environmental factors that affect the individual’s situational communication needs and performance Identify the effects of interpersonal relations on communication function Effects of Hearing Impairment on Psychosocial, Educational, and Occupational Functioning Describe and evaluate the impact of hearing impairment on psychosocial development and psychosocial functioning Describe systems and methods of educational programming (e.g., main- stream, residential) and facilitate selection of appropriate educational options Describe and evaluate the effects of hearing impairment on occupational status and performance (e.g., communication, localization, safety) Identify the effects of hearing problems on marital Identify the need and provide the psychosocial, educational, family, and occupational/vocational counseling in relation to hearing impairment and subsequent communication difficulties Provide assessment of family members’ perception of and reactions to communication difficulties AR Case Management Use effective interpersonal communication in interviewing and interacting with individuals with hearing impairment and their families Describe client-centered, behavioral, cognitive, and integrative theories and methods of counseling and their relevance in AR Provide appropriate individual and group adjustment Provide auditory, visual, and auditory-visual communication training (e.g., speech reading, auditory training, listening skills) to enhance receptive communication Provide training in effective communication strategies to individuals with hearing impairment, family members, and other relevant individuals Provide for appropriate expressive communication training Provide appropriate technological and counseling intervention to facilitate adjustment to tinnitus Provide appropriate intervention for management of vestibular disorders Develop and implement an intervention plan based on the individual’s situational/environmental communication needs and performance and related Interdisciplinary Collaboration and Public Advocacy Collaborate effectively as part of multidisciplinary teams and communicate relevant information to allied professionals and other appropriate individuals Plan and implement in-service and public-information programs for allied professionals and other interested individuals Plan and implement parent-education programs concerning the management of hearing impairment and subsequent communication difficulties Advocate implementation of public law in educational, occupational, and public settings Hearing Conservation/Acoustic Environments Plan and implement programs for prevention of hearing impairment to promote identification and evaluation of individuals exposed to hazardous noise and periodic monitoring of communication performance and auditory abilities (e.g., speech recognition in noise, localization) Identify need for and provide appropriate hearing protection devices and noise abatement procedures Monitor the effects of environmental influences, amplification, and sources of trauma on residual auditory function Measure and evaluate the environmental acoustic Speech-language pathologists Basic Areas of Knowledge and Skills Speech-language pathologists who provide aural rehabilitation services demonstrate knowledge in the basic areas that are the underpinnings of communication sciences and disorders. These include the following: General Knowledge General psychology; human growth and development; psychosocial behavior; cultural and linguistic diversity; biological, physical, and social sciences; mathematics; and qualitative and quantitative research methodologies Basic Communication Processes Anatomic and physiologic bases for the normal development and use of speech, language, and hearing (including anatomy, neurology, and physiology of speech, language, and hearing mechanisms) Physical bases and process of the production and perception of speech and hearing (including acoustics or physics of sound, phonology, physiologic and acoustic phonetics, sensory perceptual processes, and psychoacoustics) Linguistic and psycholinguistic variables related to the normal development and use of speech, language, and hearing (including linguistics [historical, descriptive, sociolinguistic, sign language, second-language usage], psychology of language, psycholinguistics, language and speech acquisition, Special Areas of Knowledge and Skills Speech-language pathologists who provide aural rehabilitation have special knowledge in the following areas and demonstrate the itemized requisite skills in those areas: Auditory System Function and Disorders Identify, describe, and differentiate among disorders of auditory function (including disorders of the outer, middle, and inner ear; the vestibular system; the auditory nerve and the associated neural and central auditory system pathways and processes) Developmental Status, Cognition, and Sensory Verify adequate visual acuity for communication purposes Identify the need and provide for assessment of cognitive skills, sensory perceptual and motor skills, developmental delays, academic achievement, and literacy Determine the need for referral to other medical and nonmedical specialists for appropriate professional services Provide for ongoing assessments of developmental progress *Audiologic Assessment Procedures Conduct audiologic screening as appropriate for initial identification and/or referral purposes Describe type and degree of hearing loss from audiometric test results (including pure-tone thresholds, immittance testing, and speech audiometry) Refer to and consult with an audiologist for administration and interpretation of differential diagnostic procedures (including behavioral, physiological, and electrophysiological measures) Assessment of Communication Performance Provide for assessment measures in the client’s preferred mode of communication Identify and perform screening examinations for speech, language, hearing, auditory processing disorders, and reading and academic achievement problems Identify and perform diagnostic evaluations for the comprehension and production of speech and language in oral, signed, written, or augmented form Provide diagnostic evaluations of speech perception in auditory, visual, auditory-visual, or tactile modalities Identify the effects of hearing loss on speech perception, communication performance, listening skills, speech reading, communication strategies, and personal adjustment Provide for clients’ self-assessment of communication difficulties and adjustment of hearing loss Monitor developmental progress in relation to communication competence Devices and Technologies for Individuals with Hearing Loss (i.e., hearing aids, cochlear implants, middle ear implants, implantable hearing aids, hearing assistive technologies, and other sensory prosthetic devices) Describe candidacy criteria for amplification or sensory-prosthetic devices (e.g., hearing aids, cochlear implants) Monitor clients’ prescribed use of personal and group amplification systems Describe options and applications of sensory aids (e.g., assistive listening devices) and telephone/telecommunication devices Identify the need and refer to an audiologist for Perform routine visual inspection and listening checks of clients’ hearing devices and sensory aids to troubleshoot common causes of malfunctioning (e.g., dead or corroded batteries, obstruction or damage to visible parts of the system) Refer on a regularly scheduled basis clients’ personal and group amplification systems, other sensory aids, and assistive listening devices for comprehensive evaluations to ensure that instruments conform to audiologists’ prescribed settings and manufacturers’ specifications Describe the effects of amplification on communication function Effects of Hearing Loss on Psychosocial, Educational, and Vocational Functioning Describe the effects of hearing loss on psychosocial development Describe the effects of hearing loss on learning and literacy Describe systems and methods of educational programming (e.g., main- stream, residential) and facilitate selection of appropriate educational options Identify the need for and availability of psychological, social, educational, and vocational counseling Identify and appropriately plan for addressing affective issues confronting the person with hearing loss Intervention and Case Management Develop and implement a rehabilitative intervention plan based on communication skills and needs of the individual and family or caregivers of the individual Provide for communication and counseling intervention in the client’s preferred mode of communication Develop expressive and receptive competencies in the client’s preferred mode of communication Provide speech, language, and auditory intervention (including but not limited to voice quality and control, resonance, phonologic and phonetic processes, oral Facilitate appropriate multimodal forms of communication (e.g., auditory, visual, tactile, speech reading, spoken language, Cued Speech, simultaneous communication, total communication, communication technologies) for the client and family Conduct interviews and interact effectively with individuals and their families Develop and implement a system to measure and monitor outcomes and the efficacy of intervention Interdisciplinary Collaboration and Public Advocacy Collaborate effectively as part of multidisciplinary teams and communicate relevant information to allied professionals and other appropriate individuals Plan and implement in-service and public-information programs for allied professionals and other interested individuals Plan and implement parent-education programs concerning the management of hearing impairment and subsequent communication difficulties Plan and implement interdisciplinary service programs with allied professionals Advocate implementation of public law in educational, occupational, and public settings Acoustic Environments Provide for appropriate environmental acoustic conditions for effective communication Describe the effects of environmental influences, amplification systems, and sources of trauma on residual auditory function Provide for periodic hearing screening for individuals exposed to hazardous noise Q1: (reduced speech or symbolic) Lack of social interaction Embarrassment Disorientation of sound Frustration (self and others) Isolation/ detachment from surrounding (people leave him/her and give up listening to him/her because its being irritated to follow speech) Concentration and fatigue Limitation to career options Become more introvert and withdraw from social situations Irritated and depressed (fails to fully express him/her self and understand others speech) Become more dependent on others to get help (need interpreters) Negative effect on his/her career on his life style Q2: (reduce awareness to signals/warnings ) One ear Both ears Short term Long term Problems localizing the source of the sound Raised stress levels Raised anxiety Lack of confidence Enhanced distraction Adapted to rely on there senses Depend to helper or caregiver Restriction on source of the sound (e.g. position of the ambulance confusion + panic) HF attenuation: struggle to hear high pitched alarms or signals rely on others Pressure of significant others Possible social interaction with similar need people Difficulties in workplace/Schools etc. Q2: (continue) Tiredness from concentration (he/she rely on others senses) Heightened anxiety level (e.g. whilst driving hearing sirens others cars) Avoidance of isolated situation (e.g. being alone in public building in case of alarm) Feeling more vulnerable leading to avoidance of outside world Attitude (e.g. other perceive as rude when don’t react to others shouts or verbal warnings) Q3: (reduce auditory background ) Feel cut off from on life (e.g. may not hear object falling, own foot steps) Cut off from surrounding (e.g. traffic noise, foot steps, wind etc.) Reduce feedback on your own actions Isolation Safety (vulnerable/ in-secure) Loss of familiarity (noises at the home) Technologies: Hearing Aids Facts on Hearing Loss in Adults: One in every ten adults has hearing loss and the prevalence of hearing loss increases with age. While hearing aids can help about 95% of them, only 25% use hearing aids. In other words, about one out of five people who would benefit from a hearing aid actually uses one. That is why we need aural rehab! WHY? Stigma associated with wearing a Hearing Aid (HA) Denial about one’s Hearing Loss (HL) High cost (e.g. a pair of basic HA cost around SAR 5,000) Definition of hearing aid Is a device that processes sound in such a way as to make the information it conveys more accessible to the user. It is an integral part of the receptive communication chain, which includes the signal source and listener. It should be seen as only one important part of a programme to minimize disability and handicap arising from hearing impairment by optimizing the partially hearing or deaf user’ access to acoustical information. (Barry McCormick-Paediatric Audiology 0-5 years) Reasons for fitting a hearing aid Significant hearing impairment (monaural/binaural)-both permanent or temporary-SNHL/Conductive/ and Mixed types of loss. What is a hearing aid? A hearing aid is a small electronic device that can be wore in or behind the ear. It makes sounds louder so that a person with hearing loss can listen, communicate, and participate more fully in daily activities. A hearing aid can help people hear more in both quiet and noisy situations. Hearing aids components A hearing aid has three basic parts: a microphone, amplifier, and speaker. The hearing aid receives sound through a microphone, which converts the sound waves to electrical signals and sends them to an amplifier. The amplifier increases the power of the signals and then sends them to the ear through a speaker. Other features of hearing aids  On-off control  Audio input  Telecoil  Volume control In nearly all cases of hearing impairment that are not curable either medically or surgically, there is a requirement for auditory rehabilitation intervention in order to manage the hearing impairment. The aim of this rehabilitation is to enable the hearing impaired person to use his or her residual hearing in an effective manner, and to improve the person’s quality of life by maximising the benefit of using hearing aids. Types of hearing aids Hearing aids come in many different types in terms of their mode of operation, the manner of placement and the mode of presentation. 1) Mode of operation: Hearing aids can be classified by their mode of operation into three types: analogue, digitally programmable analogue, and digital. The final 2) Manner of placement: Hearing aids are available in many styles, shapes and sizes. There are currently five major styles of hearing aids that are available. These are: The body aid: this is the largest type of hearing aid. It has a large microphone, an amplifier and a battery that are enclosed in a case worn on the body. The receiver is usually placed into an earmould, a special custom-made piece of moulded material that delivers the sound to the ear canal. The receiver is usually Behind-the-ear (BTE): this is the second largest type of hearing aid. It is housed in a shell-shaped case that fits behind the ear. The microphone, the amplifier, the receiver and the battery are all placed in the hearing aid case, which is connected to the earmould through a flexible plastic tube. BTEs are very popular because: They can be fitted to any loss from mild to profound They can easily be connected with an FM system A range of modifications to improve the aid's performance can be made to the ear mould, tubing or the ear hook as well as to the aid itself. It is the most common type for children Within the behind-the-ear (BTE) hearing aid category, hearing aids can be further subdivided into:  Receiver-in-the-Aid (RITA)  Receiver-in-the-Canal (RIC) The receiver – or speaker – amplifies sound, which must pass through a tube to the ear canal (in an RITA) or is simply projected directly from a speaker in the canal (in an “RIC”) 40% users. In 2010 the Journal of American Audiology published a study that compared RITA to RIC hearing aids found that RIC models were equal or superior in all measured respects. Specifically: 76% of study participants preferred RIC hearing aids to RITA This preference held both for new hearing aid users (74%) and experienced hearing aid users (80%) In short, the study strongly suggested the superiority of RIC hearing aids for mild to moderate hearing aids. In-the-ear (ITE): the third largest type of hearing aid. It fits directly inside the external ear, placed in the concha area and filling the whole concha and half the length of the ear canal. The microphone, the amplifier, the receiver and the battery are all placed in the hearing aid case. In-the-canal (ITC): the second smallest type of hearing aid. This type of hearing aid fits mostly in the ear canal; a small part of the aid is in the concha, which leaves a portion of the concha free for natural resonance. The hearing aid components – the microphone, the amplifier, the receiver and the battery – are all placed in the hearing aid case. Completely-in-the-canal (CIC): the smallest type of hearing aid. This type of hearing aid fits entirely in the ear canal, making it invisible when it is worn. The aid is attached to a small transparent plastic cord that extends to the concha and helps with placing and removing the aid from the ear. The hearing aid components – the Different styles of hearing aids Many people report that ITE and ITC and CIC aids have a very clear sound and this is thought to be because the microphone is actually in the ear itself. Due to problems with feedback, profound hearing losses cannot be fit with an ITE or ITC or CIC aids. For children, ITE and ITC fittings are also limited by:  the size of the child's ear canal  the need for frequent refitting due to growth  difficulties involved with attaching an FM system. 3) Mode of presentation: Mode of presentation depends on whether the hearing impaired person is fitted with an air conduction or a bone conduction aid, and whether they are fitted with monaural (one side) or binaural (both sides) hearing aids. This all depends on the type of hearing impairment, the degree and the severity of the loss, and whether the loss is unilateral or bilateral. Special Fitting of aid 1- CROS This type is a contra lateral routing of signal or CROS aid. CROS hearing aids are for people who are deaf in one ear and have normal, or near normal, hearing in the other ear. It consist of two parts. The person wears what looks like two hearing aids in one of two styles:  either a behind-the-ear (BTE) aid,  or a in-the-ear (ITE) aid The “hearing aid” on the deaf ear basically consists of The transmitter sends these sounds (either via a cord joining the two “aids,” or more commonly, via radio waves) to the “hearing aid” on the good ear. This second part of a CROS aid system basically consists of a (radio) receiver (if using the wireless system) and an amplifier. It amplifies the sounds it receives from the deaf side, and then feeds these sounds into the good ear via a plastic tube (if a BTE style), or directly into the ear canal (if an ITE style). CROS earmolds are open fit design so they don’t block the sounds the good ear hears naturally. CROS hearing aid (Wired-old style) Wireless CROS Since the person has normal or near normal hearing, the sound doesn’t have to be amplified much. This allows the hearing ear to receive signals from the other side. That is the microphone at the bad ear sends the signal to the good ear. This device prevents the head shadow effect which is the decrease in signal presented to one side of the head when it is measured on the opposite side of the head. Basic concept of CROS 2- BI-CROS This is used for a patient with hearing loss in both ears but worse on one side may benefit from a Bi-CROS aid. Bi-CROS hearing aids are similar in many respects to CROS aids, but have this one major difference. They are for people who are deaf in one ear and are hard of hearing in their other ear. The part that is worn on the deaf ear is identical to the CROS aid. The difference is on the side of the ear with the hearing loss. This part of the Bi-CROS system does the same thing as the CROS system did, but, in addition, it also includes a “regular” hearing aid for the hard of hearing ear. The Bi-CROS unit combines the signals from both ears and then feeds them into the hard of hearing ear via a normal tightly-fitting ear mold, as otherwise there could be problems with feedback. This provides amplification to the better ear as well 3- Bone Conduction Hearing Aids Bone Conduction Hearing Aids are fitted on a headband with a BTE or BW aid adaptation. It is used for a conductive type hearing losses. Fitted to congenital abnormalities/atresia or discharging ears. Disadvantages: Often too large for paediatrics, Limited output, Distorted sound, Poor cosmetic appeal. Bone conduction Hearing Aids BCHA: Soft bands reduces pressure to one part of head 4- BAHA The Bone Anchored Hearing Aid-BAHA it require a surgical intervention to be fitted. The hearing aid attached to an implanted abutment that transmits sound through bone conduction to the cochlea, bypassing the outer and middle ear structures. It is used for patients who need permanent bone conduction amplification. Used with children with Downs Syndrome. BAHA system is consist of three parts: 1. Detachable sound processor 2. Connecting abutment 3. Titanium fixture The device takes sounds and converts them to vibrational energy, sending them through the skull to the good ear, without involving the ear canal on either side. BAHA is made with Titanium, a metal which actually bonds with bone tissue at the molecular level (this is termed osseointegration), and the bone then acts as a pathway for sounds to travel.