Introduction to AR

1. Introduction to AR Perry C. Hanavan, Au.D. Audiologist

2. TED Talk • Establishing a Sound Foundation • Dr. Karl R. White is a Professor of Psychology at Utah State University and the founding Director of the National Center for Hearing Assessment and Management (NCHAM). • Recognized as one of the world's leading authorities on early identification and treatment of hearing loss in infants and young children. • He has hundreds of publications and presentations at scholarly meetings, and has been invited to more than 30 countries to assist in the implementation of newborn hearing screening and intervention programs. 

3. Case Studies • Newborn identified at birth with connexin 26, severe to profound bilateral hearing loss, normal hearing parents • Newborn identified at 2 years with rapidly progressive bilateral SNHL, parents have a profound loss • Seven year old recently identified with unilateral severe SNHL • Middle school male with normal hearing but auditory processing problem in noise • Fourteen year recently survived bacterial meningitis resulting in bilateral SNHL • Dad, suffered sudden onset mild bilateral SNHL • Grandmother, slow progressive bilateral SNHL

4. Impact of HL on Quality of Life • Physical health • Emotional & mental health • Other’s perceptions of a person’s mental acuity • Social skills • Family relationships • Self-esteem • Work & school performance • Household income by up to $12,000/year

5. Some Historical Landmarks Regarding AR in Audiology • Genesis in WWII (1942) • Audiologists Dispense Hearing Aids (1978) • WHO Classification (1980) • Cochlear Implants (1984 – FDA approval) • Early Newborn Identification (1990 – Joint Comm) • Communication Therapy (1990+) • Neural Plasticity of the Auditory System (1995+) • WHO Classification (ICF, 2001) • Hearing Assistance Technologies (HAT) (2000+)

6. Question AR increases income for persons with hearing loss? Yes No

7. Hearing Loss and Impact on Household Income Kochkin, S (2010).The Hearing Journal. 63(10):19-24,26,28.

8. Treated Vs. Untreated HLImpact on Household Income Kochkin, S (2010).The Hearing Journal. 63(10):19-24,26,28.

9. Mild HL Linked to Brain Atrophy in Older Adults • Early intervention could prevent slide toward speech comprehension difficulties • Research suggests that hearing sensitivity has cascading consequences for the neural processes supporting both perception and cognition

10. Definitions • Auditory Training • Aural Rehabilitation • Audiological Rehabilitation • Speechreading • Lipreading • Communication Rehabilitation • Habilitation • Rehabilitation

11. AR Definition “The assessment, intervention, and management of communicative consequences of hearing loss” (unknown author)

12. ASHA Aural rehabilitation refers to services and procedures for facilitating adequate receptive and expressive communication in individuals with hearing impairment. (ASHA, 1984, p. 37) Audiologic/aural rehabilitation (AR) is an ecological, interactive process that facilitates one's ability to minimize or prevent the limitations and restrictions that auditory dysfunctions can impose on well-being and communication, including interpersonal, psychosocial, educational, and vocational functioning. (American Speech-Language-Hearing Association. (2001). Knowledge and Skills Required for the Practice of Audiologic/Aural Rehabilitation [Knowledge and Skills)

13. David Hawkins Anything that facilitates: 1) hearing, 2) understanding of hearing loss, 3) coping strategies, 4) acceptance of hearing loss, and 5) involving communication partners. (Hawkins, D. 2003)

14. Mark Ross Any device, procedure, information, interaction, or therapy which lessens the communicative and psychosocial consequences of a hearing loss. Ross, M., JARA, 1997

15. McCarthy & Culpepper The purpose of an aural rehabilitation program is to focus on assisting hearing-impaired individuals in the realization of their optimal potential in communication, which is needed in educational, vocational, or social settings. McCarthy & Culpepper, AJA, 1987, p. 305

16. Houston & Montgomery "…the goal of aural rehabilitation for the adult is ambitious – to increase the likelihood, the level, of successful communication over the client’s lifetime." Houston, K.T., and Montgomery, A.A. Auditory-visual integration: A practical approach. Seminars in Hearing, 18 (2), 1997.

17. JP Gagné “Aural rehabilitation is aimed at restoring or optimizing a patient’s participation in activities that have been limited as a result of a hearing loss and also may be aimed at benefiting communication partners who engage in activities that include person with hearing loss.” Gagné JP. Ear and Hearing. 2000, p36.

18. Arthur Boothroyd, Ph.D. “Adult aural rehabilitation is here defined holistically as the reduction of hearing-loss-induced deficits of function, activity, participation, and quality of life through a combination of sensory management, instruction, perceptual training, and counseling. Boothroyd A, Trends in Amplification, 2007, p63.

19. Aural Rehabilitation Intervention aimed at minimizing and alleviating the communication difficulties associated with hearing loss. (Tye-Murray N. Foundations of Aural Rehabilitation, p2)

20. Audiologic Rehabilitation “Any activity, method, resource, technology, and/or device that facilitates and/or enhances communication and participation in activities.” Hanavan, PC, 2010

21. Conversational Fluency “…relates to how smoothly conversation unfolds” “the book’s central theme” Tye-Murray N, Foundations of Aural Rehabilitation, p2. and preface, p ix.

22. Hearing-Related Disability “…a loss of function imposed by hearing loss. The term denotes a multidimensional phenomenon.” Tye-Murray, Foundations of Aural Rehabilitation, p2.

23. Summary of Definitions of ARand WHO 1980 • Often describes approaches rather than objectives/goal • Hearing and communication oriented • Medically oriented: eliminate (treat) prescribe (cure) (International Classification of Impairments, Disabilities and Handicap – ICIDH, WHO, 1980): Adapted from Gagne JP, 2007 ARA Institute, Louisville, KY.

24. International Classification of Functioning, Disability and Health (ICF: WHO, 2001) Health Condition (disorder/disease) Participation (participation restriction) Body Structures & Functions Activities (activity limitation) Environmental Personal FactorsFactors

25. ICF (WHO: 2001) Disabilities is an umbrella term, covering impairments, activity limitations, and participation restrictions. • Thus disability is a complex phenomenon, reflecting an interaction between features of a person’s body and features of the society in which he or she lives.

26. Question Does “hearing impairment” means deaf, only? Yes No

27. ICF (WHO: 2001) Hearing impairment is a broad term used to describe the loss of hearing in one or both ears. There are different levels of hearing impairment: hearing impairment refers to complete or partial loss of the ability to hear from one or both ears. The level of impairment can be mild, moderate, severe or profound; deafness refers to the complete loss of ability to hear from one or both ears.

28. ICF (WHO: 2001) Impairment is 'a loss or abnormality of body structure or physiological or psychological function' Activity limitation is 'the nature or extent of functioning at the level of the person' Participation restriction is 'the nature or extent of a person’s involvement in life situations in relation to impairment, activities, health conditions, and contextual factors’ Health-related Quality of Life is 'the functional effect of an illness and its consequent therapy upon the patient.' Satisfaction is the subjective assessment by the patient that his/her needs or expectations have been met.

29. ICF (WHO: 2001) Psychological factors pertains to attitudes, self-image, motivation and assertiveness, etc. Social factors are the viewpoint of society

30. Model of Hearing-Related Disability Listening aids Lifestyle Hearing Impairment Communication activity limitations Participation restrictions Frequent communication partner(s) Physical environment Psychosocial factors Tye-Murray N, Foundations of Aural Rehabilitation, p4.

31. Services Included in AR Plan • Diagnosis & quantification of hearing loss • Hearing assistance technologies • Auditory training • Communication strategies training • Informational/educational counseling • Personal adjustment counseling • Psychological support • Communication partner training • Speechreading training • Speech-language therapy • Inservice training

32. Question Which is provided by educator of the deaf and/or SLP? • Aural rehab • Audiologic rehab • Physical therapy

33. Aural Rehabilitation vs. Audiologic Rehabilitation • Aural Rehabilitation • Broad breadth of services • Variety of professional providers • Audiologic Rehabilitation • Narrow breadth of services • Audiology professional providers

34. Roles Audiologist: Audiologic Rehabilitation SLP/EDHH: Aural Rehab Evaluating speech/language receptive and expressive abilities Treatment of speech/language disorders • Audiologic diagnostic evaluation • Fitting, dispensing and evaluation of hearing aids • Mapping cochlear implants • Evaluating, fitting and dispensing HAT

35. Rehabilitation vs. Habilitation • Rehabilitation • Restore lost function • Adults • Acquired hearing loss • Habilitation • Develop skill not present beforehand • Infants/children • Congenital or pre-lingual onset

36. AR Service Locations • University/College • Private Practice • Hospital • Community Center • Otologist’s office • Public/Private School • Self-help groups • School for the Deaf • Internet • Home with computer

37. AR Providers • Audiologist • Speech Language Pathologist • Educator of the Deaf • Communication Partner

38. Other Team Members • ENT • Parents • Regular classroom teachers • Psychology • Geneticist • Other specialties as necessary

41. Definition of Terms in Survey

42. Traditional Variables • Time of Onset • Degree of Loss • Type of Loss • Etiology

43. Question Which is not a traditional variable for hearing loss? • Time of Onset • Rapidity of progression of hearing loss • Degree of Loss • Type of Loss • Etiology

44. Other Variables • Progressive • Acceptance • Family support • Time of identification • Time for implementation of AR • Intelligence • Motivation

45. AR vs. Age of Client • Newborns • Preschoolers • Grade school • Middle school • High school • Post secondary • Young adults • Middle age • Old age

46. Hearing Loss Incidence(Onset of Loss) • 32 million persons in US have HL • 4,000,000 babies born in US annually • 1 of every 22 infants has some degree of HL • 1/1000 to 6/1000 born with HL • 1.3% of children who receive special ed services were hard of hearing or deaf • 1 in 25 people under age 45 • 1 in 10 by age 60 • Third most prevalent chronic problem in older persons

47. Hearing Loss Projections Kochkin, S. MarkeTrak VII: Hearing Loss Population Tops 31 Million People, The Hearing Review, Vol. 12(7) July 2005, pp. 16-29.

48. HL Prevalence and Age

49. Time of Onset The Joint Committee on Infant Hearing (JCIH) Year 2000 Position Statement • The American Academy of Audiology, the American Academy of Pediatrics, the American Speech-Language-Hearing Association, the Council on Education of the Deaf, and the Directors of Speech and Hearing Programs in State Health and Welfare Agencies have joined together to endorse universal detection of infants with hearing loss. • The goal is that all infants with hearing loss will be identified before 3 months of age and receive intervention by 6 months of age.

50. Time of Onset • Congenital • Prelingual • Postlingual • Deaf/deaf • Deafened • Adventitious • Sudden • Progressive