Chapter 1 Introduction PDF

Chapter 1 Introduction From Foundations of Aural Rehabilitation: Adults, Children, and Their Family Members by Nancy Tye-Murray. Sixth Edition Copyright © 2024 Plural Publishing, Inc. All rights reserved.  Introduction...

Chapter 1 Introduction From Foundations of Aural Rehabilitation: Adults, Children, and Their Family Members by Nancy Tye-Murray. Sixth Edition Copyright © 2024 Plural Publishing, Inc. All rights reserved.  Introduction The consequences of hearing loss impact all aspects of a person’s life. Hearing loss impacts a person’s ability to converse, making it more difficult to establish intimacy and friendship. Aural rehabilitation seeks to restore (or establish) a patient’s ability to communicate; Alleviate the difficulties related to hearing loss and minimize its consequences. The World Health Organization (WHO) and Hearing-related Disability The World Health Organization (WHO) developed the International Classification of Functioning, Disability and Health (ICF). It is a classification system that considers the consequences of a health-related condition within the context of a patient’s environment and circumstances. It is applied to patients with hearing loss, the focus is on how it affects the patient in everyday life and how a hearing-related disability might be alleviated. Hearing-related disability is defined as a loss of function imposed by hearing loss and denotes a multidimensional phenomenon, which may include pain, discomfort, physical dysfunction, emotional distress, and the inability to carry out typical activities.  International Classification of Function, Disability and Health (ICF) Terminology Body structure: an anatomical part of the body (e.gt., cochlea) Body functions: physiological functions of body systems (e.g., hearing) Activity: the execution of a task or action by an individual (e.g., alerting to sound) Participation: involvement in a life situation (e.g., participating in a dinner table conversation) Environmental factors: the physical, social, and attitudinal environment in which a patient lives and conducts his or her life Personal factors: encompass the patient’s age, lifestyle, race, coping styles, attitudes, self- efficacy, habits, preferences, socioeconomic background, and other health conditions Activity limitation: change at the level of the person brought about by an impairment at the level of body structure and function (e.g., a patient cannot easily engage in casual conversation) Participation limitation: an effect of an activity limitation that results in a change in the broader scope of a patient’s life (e.g., a patient may avoid social gatherings)  Components Are Interlinked An example patient, who is a professional musician: Played electric guitar (an activity) Performed in loud concert halls (a participation) Damaged the hair cells in his inner ears (a change in body function) Now can no longer regulate his voice pitch (an activity limitation) Can no longer sing harmony with his band (a participation restriction) Wears earplugs during concerts to stave off further hearing loss (a positive effect on body structures from an environmental factor) Avoids publicity interviews b/c he is a proud man and fears humiliation from not being able to understand questions (a negative effect on participation by a personal factor)  Services Included In The Aural Rehabilitation Plan A typical aural rehabilitation plan can include: Diagnosis and quantification of hearing loss Provision of listening devices and assistive devices Informational/educational counseling Communication strategies training Assertiveness training, psychosocial support, and counseling/instructions for patients and for family and colleagues Auditory and speechreading training Intervention related to speech, language and academic achievement Hearing protection Tinnitus management Where Does Aural Rehabilitation Occur? Aural rehabilitation can be provided in many settings: A university speech and hearing clinic An audiology private practice A hearing aid dealer’s private practice A hospital speech and hearing clinic A school, community center, or nursing home An SLP’s, or otolaryngologist’s office Consumer organization meetings The home, sometimes through web-based communications VA hospital, or military or veteran center  Who Provides Aural Rehabilitation? Audiologists take the lead role in providing treatment for adults. SLP’s often direct treatment for children, especially in school environments. Both must possess a detailed knowledge of auditory system function and disorder. Parameterization Of Hearing Loss  Hearing Loss Configuration reflects extent of hearing loss at each audiometric frequency. Audiograms measure hearing sensitivity at different frequencies.  Descriptors Used To Denote Degree Normal: PTA is 25 dB HL or better; for children, 15 dB HL or better Mild: PTA is between 26 (or 16) and 40 dB HL Moderate: PTA is between 41 and 55 dB HL Moderate-to-severe: PTA is between 56 and 70 dB HL Severe: PTA is between 71 and 90 dB HL Profound: PTA is poorer than 90 dB HL Those with mild, moderate, moderate-to-severe, or severe hearing loss are called “hard of hearing” or “hearing impaired.” Those with profound hearing loss are called “deaf.” Those born deaf, or who live with or grew up with someone who is Deaf, are part of the “Deaf” culture.  Hearing Loss Onset of hearing loss: Prelingual (Acquired before acquisition of spoken language) Perilingual (During acquisition of spoken language) Postlingual (After acquisition of spoken language) Congenital (Present at birth) Acquired; also called adventitious (Prevocational, early working age, later working age, retirement age)  Hearing Loss Causation of hearing loss may be: Conductive: obstruction in either outer or middle ear that prevents sound entry Sensorineural: disturbance in the inner ear, eighth nerve, brain stem, midbrain, or auditory cortex Mixed: combination of both  Hearing Loss Time Course - hearing loss can be categorized as progressive, or sudden. Progressive: occurs over the course of several months or years Sudden: individual loses hearing suddenly, possibly due to an injury, such as head trauma  Unserved Or Underserved Unserved: Patients are not. In developing countries, 97% served as a result of policy, of people with hearing loss are practice, or environmental unserved or underserved (Tucci, Merson, & Wilson, barriers. 2009). Underserved: Patients are Developed and affluent inadequately served. countries also have a shortage of services. The problem of being underserved is especially acute in rural settings.  Service Needs 1.5 billion people worldwide suffer from hearing loss. Patients range from infants to elderly.  Service Needs Infants and toddlers (and parents) Higher survival rate of high-risk babies has led to need for more services. Through parental demands and public policy, there is a great emphasis on early identification, and service provision for young children with hearing loss. School-age children Academics and communication with peer groups are high priorities. Services include: Educational planning Accommodation in the classroom with assistive technology Support in transition from elementary to secondary/postsecondary school settings  Service Needs Adults With appropriate aural rehabilitation services and support, adults can continue to make contributions in workplace and communities. Older persons Baby-boom generation has expanded demand for services. Many want to continue their careers, or desire to communicate with friends and family, and participate in community activities. For many, due to health advances, hearing loss is their only physical restriction.  Service Needs Family and Frequent Communication Partners Frequent communication partners can experience “third- party disabilities” in their own lives. One goal of aural rehabilitation may be to eliminate third- party disability. Techniques are available for optimizing communication with those with hearing loss (i.e. speaking slowly). Some will need support from a speech and hearing professional to better manage relationship with affected friend/family member.  Culture and Cultural Competence Culture Refers to a shared pattern of thinking, reacting, believing, and problem-solving that emerges from interactions between individuals. Cultural competence The ability to understand and honor people who have backgrounds and belief systems that differ from your own.  Culture and Cultural Competence Those who teach cultural competence to health care workers tend to emphasize four key skills: Awareness is consciousness of how a person reacts to other people who are different from themselves and awareness of one’s own world view. Developing a culturally competent attitude requires a willingness to see the world through different eyes and to be open towards understanding those belief and value systems that differ from your own. Knowledge means learning about the different practices and worldviews of your patient caseload. Skills are necessary for practicing cultural competence, including intercultural communication as well as gestures and non-verbal communication, which tend to vary across cultures.  Evidence-Based Practice Clinical decisions for patient care should be based on: Clinical expertise Patient values Best research evidence Not “This is what we’ve always done” Use of well- documented research of outcomes  Evidence-Based Practice The most compelling evidence for selecting services (Level 1) results from meta-analysis. Consists of more than one randomized controlled trial. Results from several studies are synthesized, providing optimum basis for treatment choice. When such analysis is not available, other levels of evidence may be researched, based on credibility. Randomized Control Trial Participants randomly assigned to treatment or control groups Treatmen Control t group group receives receives 8 wks of no AT AT Participants complete a battery of speech recognition tests  Evidence-Based Practice When engaging in EBP, many clinicians follow a five-step approach: 1. Ask a straightforward question 2. Find best evidence to answer the question 3. Critically assess evidence, decide if it applies to patient 4. Integrate evidence with clinical judgment, patient values 5. Evaluate the performance of the plan  Final Remarks The following chapters will cover traditional and cutting-edge practices. Components of aural rehabilitation service delivery model for adults, then children will be reviewed. A number of professional journals are available for aural rehabilitation.