1. Aural Rehabilitation CDIS 4133
JACQUE SCHOLL, AU.D, CCC-A, FAAA
DOCTOR OF AUDIOLOGY

3. What was your writing assignment like?

4. Review of Audiogram

6. Definitions Rehabilitation Services Aural Rehabilitation
Communication Handicap
Impairment
Disability
Rehab services - designed to help individuals overcome the challenges posed by a disability.
Aural Rehab - intervention aimed at minimizing and alleviating the communication difficulties associated with hearing loss
Communication handicap - the psychosocial disadvantages that result from a hearing loss
Disability - loss of function imposed by hearing loss

7. Impairment The audiogram Poor speech discrimination
Dead regions of the cochlea
Auditory dys-synchrony
Endolymphatic hydrops
Poor speech discrimination
Absent middle ear muscle reflexes (acoustic reflexes)
Flat tympanogram

8. Disability Can’t talk on telephone Poor understanding in a crowd
Can’t hear/understand women or children’s voices
Poor understanding of television programs
Can’t understand spouse

9. Communication Handicap
Feelings of isolation
Change jobs
Marital strain
Less socialization
Miss information in meetings and with family
Depression

10. Craig
A young business man has a mild hearing loss and only finds out when he visits his ENT and has a hearing test because of ringing in his ears. He hasn’t notices any difference and is very active and social.
Does he have an impairment?
Does he have a disability?
Does he have a hearing handicap?

11. Dixie
An older woman visits your clinic because she is having trouble hearing in a crowd. Her audiogram shows a mild-to-moderate snhl au. Her family has requested she get her hearing checked. She thinks she hears fine unless she’s in a crowd. If people would speak up and quit mumbling, she could hear them. She stays busy and is very social.
Does she have an impairment?
Does she have a disability?
Does she have a hearing handicap?

12. Silvestre
Silvestre has a moderate-to-sever snhl au. He is having trouble hearing his family and the TV has to be turned up so loud, no one wants to sit with him. He gets together with his family less and less because trying to communicate is so difficult.
Does he have an impairment?
Does he have a disability?
Does he have a hearing handicap?

13. Handicap & Lifestyle
Aural rehabilitation goals will be directly affected by the communication handicap and the lifestyle.
Two people with the exact same hearing loss will function very differently depending on their lifestyle.
How do you find out this information?

14. Psychosocial/Social Factors
Psychsocial factors pertain to the patient’s attitudes toward the disability.
“Sofia”
Social factors are the prevailing viewoints of the society in which the patient lives and operates (cultural factors).
“Alexa”

15. Communication Partners
Reciprocal relationship
Pretend the hearing loss doesn’t exist
Playing down the effects of hearing loss
Controlling or dominating
Separating or isolating

16. AR Plan Diagnostics/quantification of HL Listening device ALDs
Auditory training
Communication strategies training
Informational/educational counseling
Rational acceptance counseling
Psychosocial adjustment counseling
Communication partner training
Speechreading
Speech-language therapy
Inservice training
Pg 8 in book

17. AR Services
Few professionals provide a broad range of AR services to adults by either Auds or SLPs
Where do you suppose the majority of AR services are directed?

18. Where do AR services take place?
University clinic
Audiology private practice
Dealer’s private practice
Hospital clinic
Community center/nursing home
School
ENT office
SLP office
Consumer organization meetings EI
Home

19. Who provides AR services?
Audiologist
SLP
Educator of deaf and HOH child
Who serves as the lead in AR services if they need to be coordinated between professionals?

20. Degree & configuration
Hearing Loss
Degree & configuration
Type
Sensorineural
Conductive
Mixed
Neural
Extent
Bilateral
Unilateral
Fluctuating

21. Mild, moderate, or mod-to-severePC
Hard of Hearing (HOH)
Mild, moderate, or mod-to-severe
Hearing Impaired
Not PC anymore
Deaf
Severe or profound HL
“Deaf”
Deaf or HOH
PC for now

22. Onset Prelingual Perilingual Postlingual Progressive Sudden
Pre - acquired before the acquisition of language
Peri - acquired during the stage of acquiring spoken language
Post - after the acquisition of spoken language

23. Demographics/Incidence
Older adults
54% over age of 64
3rd most ptrvalent chronic condition
Adults
4.6% btn have hl
14% for 45-64
Infants
1 of every 22 infants born has some kind of hl
1-3 per 1000 born has severe to prof
Children
For every 1000 children, 83 have an educationally significant hl

24. 52,000 live births per year (approx)
Oklahoma
52,000 live births per year (approx)
152 should have hl
identified
identified
identified

25. The cost of a disability
Avg % of families with extra out-of-pocket costs
OK= %
Range MI 86.11% - MS 94.24%
Avg yearly extra out-of-pocket cost per family (in dollars)
OK=41 $847.49
(range $ MA GA $971.66)

26. Cost of Special Education
On average, costs 2x as much as a child in a regular classroom
National spending on spec ed was nearly $50 billion compared to $27.3 billion for regular classroom
Percent of children served in spec ed has doubled since 1977
Nearly 14% of children nationally are identified as having a disability

27. The earliest intervention possible, the better.
Hearing Loss
1-3-6
The earliest intervention possible, the better.

28. Professional Journals

29. ASHA Appendix 1-1 Basic areas of knowledge and skills by audiologists
Basic areas of knowledge and skills by SLPs

30. What are some of the rules?
Conversation
Why do we have them?
What are some of the rules?

31. Rules of Conversation Tacitly agree to share one another’s interest
Ensure that no single person does all of the talking
Participate in choosing what to talk about, and participate in developing the topic
Take turns in an orderly fashion
Try to be relevant to the topic of conversation
Provide enough information to convey a message without being verbose.
Pragmatics!

32. What can happen with someone with a HL?
Disrupted taking of turns
Modified speaking style
Inappropriate topic shifts
Superficial content
Frequent clarification
Violation of implicit social rules

33. Classes of communication strategies
Facilitative strategies (talker)
Instructing the talker and structuring the listening environment to enhance the listener’s performance
Receptive repair strategy (listener)
A tactic used by an individual when he or she has not understood a message
Communication breakdown (talker & listener)
When one communication partner does not recognize another’s message

34. Factors that influence reception (talker)
Message
Environment

35. Facilitate (listener)
Speech recognition skills
Adaptive - implement relaxation techniques
Attending - pays attention to cues for inferring
Anticipatory - prepares
Communication environment
Constructive - structures the environment
Communication partner
Instructional - asking
Message
Message tailoring - encourage control of topic
Maladaptive strategies

36. Repair Strategies
When a breakdown in communication happens, listeners can request information by using a receptive repair strategy
Flow chart pg 54

37. Stages of repairing communication breakdown
Detect
Choose a course of action
Implement

38. Repair Strategy or Bluff?
Specific Repair Strategies
Repeat (most common repair strategy)
Rephrase
Elaborate
Simplify
Inidcate topic of conversation
Write
Fingerspell
Nonspecific repair strategies (What? Huh? Pardon?)
Extended repair - use several together
Expressive repair strategies
Bluff - consequences?

39. Conversational Styles
Passive
Tends to withdraw from conversations and social interactions rether than attempt to repair
Aggressive
May blame others for misunderstanding
Assertive
Takes responsibility for managing communication difficulties in a way that is considerate of comm partners

40. Communication Behaviors
Interactive
The use of cooperative conversational tactics, consistent with an assertive conversational style
Non-interactive
Characteristic of a passive behavioral style
Dominating
Characteristic of an aggressive conversational style