adult auditory rehabilitation adult auditory rehabilitation marsha kluesing, aud ccc-a assistant...
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Adult Auditory Rehabilitation
Marsha Kluesing, AuD CCC-AAssistant Clinical ProfessorDept. Of Communication Disorders1199 Haley CenterAuburn University, AL 36849Email: [email protected]: 334-844-9600
History of Aural Rehab
World War II and military aural rehabilitation
Audiologists have knowledge skills and tools
Rehab does not begin or end with surgeryCochlear ImplantsImplantable hearing aids
Rehab does not begin or end with technologyDispensing of hearing aidsHearing assistive technology
Speech Pathologists have Knowledge , Skills and Tools
Speech productionVoiceSwallowingKnowledge of psycho social effects of a communication disorder
Address activity limitationsEnvironmental and personal factors that may affect communication
Forming a Group for Clinical Practicum
Clinical Supervisor, ASHA Certified Audiology StudentsSpeech-Language Pathology StudentsHearing Aid Patients
Need to motivate for first time visit Encouraging continued attendance Bring spouse or close family or friend
Importance of Including Significant OthersAccording to Jill Preminger, Ph.D.
• Hearing Impairment can cause – Stress– Tension– Irritation– Frustration, Anger, Resentment – Guilt– Concern
Impact of Includingthe Communication Partner
• Less need to repeat• More participation in social activities• Improvement in communication with person
with hearing loss• Decreased communication burden
Benefits of an Adult AR Group
Patient Centered Model (Adult Audiologic Rehabilitation, 2nd Ed. Ch. 2, from JJ Montano,2011,
ENT and Audiology 20(4).
Consumer Support
Technology
Verification
CommunicationStrategies
Self Assessment
Auditory-Visual Training
Patient Story
Anticipatory Strategies for Better Communication
Related to the speaker:Ask them to speak more slowlyAsk to trim moustacheBecome accustomed to the speaker’s pattern of speechDiscuss not using exaggerationAvoid a difficult speaker in a
bank or store
Communication Repair Strategies
RepetitionRephrasingClarificationKey WordsSpelling and Code WordsOral interpretersUse of amplification system by the speaker
Environmental Adjustments
Spatial RelationshipsLighting
Should be on face of speaker
AcousticsAvoid hard walls, tiled floors
Comfort LevelToo hot, too cold , too drafty
Causes of Hearing Loss
Genetic information: 50%...Age :50 %Noise exposure OtotoxicityTrauma to head or earsInfectionForeign object in ear canal, cerumen
Audiologists say CERUMENEveryone else says:
Wax
Look in ear canal (Otoscopy) HA tube blocked with wax
Inside the Organ of Corti: Inner and Outer Hair Cells with Cilia on Top of Each
Damaged Cilia Resulting in Hearing Loss
Behind the Ear Hearing Aid
Earmolds
The Best Impressions Get the Best Results
In-the-Ear Hearing Aids
Hearing Aids with Thin Tubes and Domes
Hearing Aid Insertion
Maintenance and Care
Otoscopy, cerumen, eardrum condition, etc. Dirt, wax on hearing aidsBroken, missing partsBatteries, dead, inserted incorrectly, wrong sizeWhen to refer to the audiology clinic
Cerumen in ear canalAids do not work with new battery, general cleaning
Batteries
What is a cochlear implant?1. Microphone: Picks up sound from
the environment2. Speech Processor:Selects and
arranges sounds picked up by the microphone
3. Transmitter and receiver/stimulator
4. Electrode Array
,
Cochlear Implant
Courtesy Med El Corp.
3. Transmitter and Receiver: Receives signals from the speech processor and converts them into electrical impulses.4.Electrode array: A group of electrodes that collects impulses from the stimulator and sends to different regions of the auditory nerve.
Middle Ear Implants• For patients who do not receive
benefit from conventional hearing aids
• For patients who are not candidates for cochlear implants
• Mechanically causes the ossicles to vibrate and the amplified vibrations are adjusted to compensate for the hearing loss
• Candidacy: • Sensorineural hearing loss within
a certain range, (up to 80 dB HL) • normal middle ear function,• Stable hearing loss• 18 years of age or older• Realistic expectations
• Tunnel is drilled through mastoid into the middle ear
• Gold wire is crimped to the incushttp://www.medel.com/images-downloads/?titel=Images&
More Information on Cochlear and Middle Ear Implants
NIDCD Information Clearinghouse
1 Communication AvenueBethesda, MD 20892-3456Toll-free Voice: (800) 241-
1044Toll-free TTY: (800) 241-
1055Fax: (301) 770-8977
E-mail: [email protected]
Speech Reading is a Daunting Task
• Explanation provides understanding of why speech reading is difficult– Vowels– Consonants– Manner of speech– Place in mouth where consonant is made
Vowel Triangle
Lips Hump of the TongueFront Central Back
Narrow Opening see suit sit putWide say serve so Opening set up saw sat star
Consonants & Speech Reading
Visible1. /f/ and /v/2. /w/ and /r/3. /p/, /b, and /m/4. /TH/, as in then and/ th/
as in thank5. /sh/, /ch/, /j/, and /zh/ as
in measure
All Other consonants• Difficult to see• Made inside the mouth• Rely on context
Homophenes Make it Difficult
Consonants that look alike• /f/ and /v/• /w/ and /r/• /p/, /b/, and /m/• /TH/, and /th/• /sh/, /ch/, /j/, and /zh/
Words that look alike• File –vile• Rice---rise• Merge---perge• Chirp—germ• Shows—chose• Pay----bay
Hearing Loss and Vocal Strain
With hearing impairment there can be strain on the voice to speak louder to hear one’s own voiceUse of hearing aids may help
reduce this strain
The Mind, Ear, Eye Connectionto Adult Auditory Rehabilitation
Posit Science Brain HQ
Seeing and Hearing Speech
LACE
• Listening and Communication Enhancement• Neurotone.com
Read My Quips
• Speech Comprehension Training System• Process of learning that uses videos and
puzzles– Holistic approach
• Context • Facial expressions• Body language• Adapts to user’s skills
References1. Kaplan, Harriet. Speechreading: a way to improve understanding,
Second Edition Revised 1995. Clerc Books, Gallaudet University Press, Washington D. C.
2. Mancinelli, M.M., & Amster B. (2014) Rethinking clinical education. The ASHA Leader, 20, 6-7.
3. Montano, J. J. (2011) Building relationships: An important component to the aural rehabilitation process. ENT and Audiology, 204 (4), 91-92.
4. http://www.neurotone.com/ LACE5. http://www.brainhq.com/ 6. http://sensesynergy.com/ ReadMyQuips7. Sensimetrics Corporation (2008). Seeing and hearing speech:
Lessons lipreading and listening. Somerville, MA: Sensimetrics.
