Aural Rehabilitation
Aural Rehabilitation services include a wide variety of things that
help people cope with hearing loss. In most other situations in which a
person loses some important function, rehabilitation is included as a
standard part of treatment. Can you imagine, for example, having knee
replacement surgery without having rehabilitation services to help you
cope with your new knee.
Yet the vast majority of people with hearing loss are never offered
aural rehabilitation, and many of them don't even know what the term
means. We think that's a stinging indictment of our hearing loss
professionals.
As agencies spring up to serve hard of hearing and late-deafened
people, we're starting to see these services become more common. But
we've only just begun!
January 2007 - Here's Mark Ross with his
discussion of the recent "State of the Science on Aural
Rehabilitation" conference.
November 2007 -
Auditory Rehabilitation and the Aging Brain
February 2008 -
Straight Talk
from an Audiologist
March 2008 - Ida Institute
Sets Sights on Easing Patient Journey to Better Healing
June 2008 - Tips for Hearing in Noise
June 2008 -
HLAA Convention: Is group audiological rehabilitation worth the time,
cost, and effort?
July 2008 -
The Economics of Computer-Based Auditory
Training
November 2008 -
Aural Rehabilitation for the Workplace
December 2008 -
Free CI Rehabilitation Tool from Med-El
November 2009 - Mark Ross on Veterans and Aural
Rehabilitation
March 2010 - Are Group Aural Rehabilitation (AR)
Programs Effective?
April 2010 -
Audiologist advocates for adult aural
rehabilitation
May 2010 - Empowering Patients Through Audiologic
Rehabilitation Classes
April 2011 -
A brief treatise on the service of aural
rehabilitation
June 2011 -
Optimizing Your Hearing Aid Experience by
Training Your Brain to Listen
June 2011 - HLAA Convention: Communication Therapy - An Integrated
Approach
August 2011 - Retraining the brain when hearing aids aren't enough
August 2011 - Entertainment overcomes barriers of
auditory training
January 2012 - Verbotonal rehabilitation: Are we doing
enough?
February 2012 - Cochlear Americas
Announces Aural Rehabilitation App
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November 2007
The speech understanding difficulties expressed by
older adults likely arise from multiple sources. From the ear to the
brain, numerous structural and chemical changes coincide with advancing
age (for a review, see Willott, 1991; 1999). Not only can these changes
negatively impact the audibility of sound, physiological changes
throughout the auditory system also affect the way frequency and timing
information (in the incoming signal) is encoded and perceived (for a
review see Chisolm, Willott, & Lister, 2003). Some higher-level cognitive
functions, such as attention and memory, also may decline with age.
Because perception depends upon lower-level sensory as well as
higher-level cognitive processes, it is likely that decreased audibility,
slowed neural conduction time, and a struggle to selectively attend to a
voice in the presence of competing noise all occur when an older listener
tries to understand what is being said (for a review see Pichora-Fuller,
Schneider, Benson, Hamstra, & Storzer, 2006). It therefore follows that
rehabilitation of the older patient involves more than improving sound
audibility, because for many people detecting, discriminating, and
attending to the signal of interest might be compromised.
Full Story
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July 2008
Most audiologists agree that fitting hearing aids
is just the initial step in the treatment of acquired hearing loss in
adults, as there is evidence of the effectiveness of aural rehabilitation
to improve long-term benefit from amplification (Sweetow & Palmer, 2005;
Hawkins, 2005; Sweetow & Sabes, 2006). Some such evidence includes
published reports suggesting that return for credit rates for participants
in group aural rehabilitation (AR) classes is p to three times less than
for patients who opt not to participate in group AR (Northern & Beyer,
1999). Few audiologists offer any type of aural rehabilitation or auditory
training in their daily clinical practice, however, despite evidence
supporting its effectiveness. Historically, AR has failed to become
embraced by the wider dispensing community for a number of reasons. First,
it is viewed as time consuming by many practitioners. Even in the face of
solid evidence supporting its effectiveness, AR has not been widely
embraced because it has taken time away from the more lucrative and
perhaps more rewarding task of fitting hearing aids.
Full Story
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November 2008
At one time, when a still-working adult visited an
audiological clinic complaining of listening difficulties, the audiologist
could guess that the patient worked in a factory, on a farm or
construction site, or in the armed services. Working adults who sought
services were often victims of unremitting noise exposure. With the aging
of the work force and the high noise levels in modern society, more
audiologists now treat patients who work in quieter environments. These
workers often have no health-related issues other than hearing loss. As
members of the "baby boom" generation, they tend to be well-educated and
healthy compared with their counterparts of yesteryear. They expect and
deserve to retain the ability to conduct their daily work-related
responsibilities and to advance within their companies. We recently
conducted a series of focus groups to learn who these workers are, how
hearing loss has affected their job performance, and what they would like
from their audiologists (Tye-Murray, Spry, & Mauzé, submitted). Our goal
was to collect information that could guide counseling, aural
rehabilitation intervention, and self-management of this population.
Full Story
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December 2008
Bob MacPherson of bhNEWS discovered this free,
easy-to-use auditory rehabilitation tool from the folks at Med-El. It's
intended for folks who have recently received a cochlear implant (CI), but
looks like a great tool for hearing aid users who want to practice
listening, as well. Plus it's FUN. And as Bob also encouraged folks,
please check out the other available options on rehabilitation in the left
sidebar. Full
Story
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April 2010
As any audiologist can attest, the adult patient's
hearing rehabilitation journey can be long and treacherous. Patients often
find it difficult to reconcile the emerging view of "self" as someone with
diminished hearing with their previous lifelong view of a "self" who is
complete and whole. The resultant lag in this reconciliation process
contributes greatly to the often-noted 7-year delay between when a person
first suspects hearing difficulties and when he or she seeks assistance.
This delay, of course, is documented only for those who have sought
treatment. Most adults with hearing loss are not yet psychologically ready
to take corrective action toward their hearing loss. Prior to 1977
audiologists were told it was unethical to dispense hearing aids to
patients for profit. At that time, many of us argued that we should be
doing precisely that. Proponents cited the audiologist's comprehensive
education and training that encompassed both the pathologies of hearing
loss and the rehabilitative processes necessary to improve diminished
communicative abilities. We touted ourselves as professionals who could
provide the continuity of care needed to guide patients and their families
successfully along the journey toward improved hearing and enhanced
communication. But soon audiology embraced the same hearing aid dispensing
paradigm that traditional dispensers had followed for years.
Full Story
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April 2011
Aural rehabilitation (AR), in a traditional sense,
comprises a rather vague set of principles that collectively encompass a
wide range of restorative services that are provided on behalf of persons
whose ability to communicate has been compromised as a result of impaired
hearing. The term principles is used in this discussion since principles,
per se, are generally characterized by sets of assumptions that emerge out
of an entity or process for which they were designed. As one observes
aural rehabilitation in a historic sense, the above is correct, since it
seems that there are about as many theories as to what aural
rehabilitation is as to what it is not, and as many models as there are
persons who provide the service. Interestingly enough, as a result of a
survey my colleague and I conducted two years ago, audiologists have not
even reached consensus on what the process of aural rehabilitation should
be called.
Full Story
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June 2011
We don't really hear in our ears; we hear in our
brain. Hearing aids can help a person detect softer sounds, but they don't
necessarily provide good listening skills. There is a fundamental
difference between hearing and listening. Normal hearing alone does not
assure that one is a good listener. We all know people who have normal
hearing but are pretty poor listeners. Conversely, many hearing- impaired
individuals are wonderful listeners. While hearing is a physical function
that requires an auditory system that allows access to sound, listening is
a skill that requires effort, and when a hearing loss is present, that
effort becomes particularly difficult. Good listening skills are one of
the components essential for effective communication. As technically
advanced as modern hearing aids might be, they alone cannot produce the
listening skills needed for communication.
Full Story
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August 2011
When older adults can't hear the phone ring or
their spouses talking to them, hearing health professionals typically
recommend hearing aids that can greatly enhance their auditory signal. But
even with hearing aids, patients may still have trouble making out their
grandkids' mumbling or following a conversation in noisy venues. Often,
hearing-impaired adults require additional assistance to improve speech
comprehension and to cope in difficult listening situations. That's where
auditory training comes in. Auditory training aims to retrain the brain
and ears much like physical therapy assists hip replacement patients in
regaining strength and mobility. Experts have been employing it since
World War II as part of an arsenal of aural rehabilitation services that
military hospitals relied on to assist hearing-impaired veterans returning
from the battleground.
Full Story
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August 2011
Auditory training takes commitment, not just from
audiologists who have to work intensively with patients over long periods
of time, but also from patients themselves who have to spend hours
improving their listening skills. The problem? Many auditory training
programs do not live up to this standard, and patients often do not
complete the program. Now, though, new computer-based programs are
overcoming many of the barriers that have prevented the use of auditory
training, reducing dropout rates and improving the effectiveness of
auditory training. The key has been to make the process more engaging by
using computer programs that provide face-to-face communication in noise
while helping users improve speech comprehension skills.
Full Story
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January 2012
Neuroplasticity allows patients' brains to
restructure themselves when the optimal frequency response (OFR) with
hearing devices and regular auditory therapy are provided. But are we
doing enough to facilitate this restructuring? Verbotonal rehabilitation,
an auditory-based strategy that maximizes listening skills of those with
hearing impairment and other communications disorders, simultaneously
allows the development of intelligible spoken language through binaural
listening. The verbotonal system includes diagnostic therapy,
habilitation, rehabilitation, speech disorders, and foreign languages.
First introduced in 1967 at the University of Tennessee, Knoxville, the
method quickly expanded worldwide due to positive clinical outcomes, but
clinicians still may not be taking advantage of some tools to improve word
understanding for patients using hearing aids and cochlear implants.
Full Story
