6Definitions Rehabilitation Services Aural Rehabilitation Communication HandicapImpairmentDisabilityRehab 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 lossCommunication handicap - the psychosocial disadvantages that result from a hearing lossDisability - loss of function imposed by hearing loss
7Impairment The audiogram Poor speech discrimination Dead regions of the cochleaAuditory dys-synchronyEndolymphatic hydropsPoor speech discriminationAbsent middle ear muscle reflexes (acoustic reflexes)Flat tympanogram
8Disability Can’t talk on telephone Poor understanding in a crowd Can’t hear/understand women or children’s voicesPoor understanding of television programsCan’t understand spouse
9Communication Handicap Feelings of isolationChange jobsMarital strainLess socializationMiss information in meetings and with familyDepression
10CraigA 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?
11DixieAn 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?
12SilvestreSilvestre 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?
13Handicap & LifestyleAural 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?
14Psychosocial/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”
15Communication Partners Reciprocal relationshipPretend the hearing loss doesn’t existPlaying down the effects of hearing lossControlling or dominatingSeparating or isolating
16AR Plan Diagnostics/quantification of HL Listening device ALDs Auditory trainingCommunication strategies trainingInformational/educational counselingRational acceptance counselingPsychosocial adjustment counselingCommunication partner trainingSpeechreadingSpeech-language therapyInservice trainingPg 8 in book
17AR ServicesFew professionals provide a broad range of AR services to adults by either Auds or SLPsWhere do you suppose the majority of AR services are directed?
18Where do AR services take place? University clinicAudiology private practiceDealer’s private practiceHospital clinicCommunity center/nursing homeSchoolENT officeSLP officeConsumer organization meetingsEIHome
19Who provides AR services? AudiologistSLPEducator of deaf and HOH childWho serves as the lead in AR services if they need to be coordinated between professionals?
21Mild, moderate, or mod-to-severe PCHard of Hearing (HOH)Mild, moderate, or mod-to-severeHearing ImpairedNot PC anymoreDeafSevere or profound HL“Deaf”Deaf or HOHPC for now
22Onset Prelingual Perilingual Postlingual Progressive Sudden Pre - acquired before the acquisition of languagePeri - acquired during the stage of acquiring spoken languagePost - after the acquisition of spoken language
23Demographics/Incidence Older adults54% over age of 643rd most ptrvalent chronic conditionAdults4.6% btn have hl14% for 45-64Infants1 of every 22 infants born has some kind of hl1-3 per 1000 born has severe to profChildrenFor every 1000 children, 83 have an educationally significant hl
2452,000 live births per year (approx) Oklahoma52,000 live births per year (approx)152 should have hlidentifiedidentifiedidentified
25The cost of a disability Avg % of families with extra out-of-pocket costsOK= %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)
26Cost of Special Education On average, costs 2x as much as a child in a regular classroomNational spending on spec ed was nearly $50 billion compared to $27.3 billion for regular classroomPercent of children served in spec ed has doubled since 1977Nearly 14% of children nationally are identified as having a disability
27The earliest intervention possible, the better. Hearing Loss1-3-6The earliest intervention possible, the better.
29ASHA Appendix 1-1 Basic areas of knowledge and skills by audiologists Basic areas of knowledge and skills by SLPs
30What are some of the rules? ConversationWhy do we have them?What are some of the rules?
31Rules of Conversation Tacitly agree to share one another’s interest Ensure that no single person does all of the talkingParticipate in choosing what to talk about, and participate in developing the topicTake turns in an orderly fashionTry to be relevant to the topic of conversationProvide enough information to convey a message without being verbose.Pragmatics!
32What can happen with someone with a HL? Disrupted taking of turnsModified speaking styleInappropriate topic shiftsSuperficial contentFrequent clarificationViolation of implicit social rules
33Classes of communication strategies Facilitative strategies (talker)Instructing the talker and structuring the listening environment to enhance the listener’s performanceReceptive repair strategy (listener)A tactic used by an individual when he or she has not understood a messageCommunication breakdown (talker & listener)When one communication partner does not recognize another’s message
34Factors that influence reception (talker) MessageEnvironment
35Facilitate (listener) Speech recognition skillsAdaptive - implement relaxation techniquesAttending - pays attention to cues for inferringAnticipatory - preparesCommunication environmentConstructive - structures the environmentCommunication partnerInstructional - askingMessageMessage tailoring - encourage control of topicMaladaptive strategies
36Repair StrategiesWhen a breakdown in communication happens, listeners can request information by using a receptive repair strategyFlow chart pg 54
37Stages of repairing communication breakdown DetectChoose a course of actionImplement
38Repair Strategy or Bluff? Specific Repair StrategiesRepeat (most common repair strategy)RephraseElaborateSimplifyInidcate topic of conversationWriteFingerspellNonspecific repair strategies (What? Huh? Pardon?)Extended repair - use several togetherExpressive repair strategiesBluff - consequences?
39Conversational Styles PassiveTends to withdraw from conversations and social interactions rether than attempt to repairAggressiveMay blame others for misunderstandingAssertiveTakes responsibility for managing communication difficulties in a way that is considerate of comm partners
40Communication Behaviors InteractiveThe use of cooperative conversational tactics, consistent with an assertive conversational styleNon-interactiveCharacteristic of a passive behavioral styleDominatingCharacteristic of an aggressive conversational style