Are Group Aural Rehabilitation (AR) Programs Effective? - Part One

By Mark Ross

March 2010

Editor: You probably know that one of my hot buttons is the tendency of too many audiologists and hearing aid dispensers to treat their clients like a giant ear that needs a hearing aid shoved in it, rather than as a person who needs a complete range of services to help them deal with the effects of hearing loss. I've long believed that group aural rehabilitation programs should be a standard offering of everyone who dispenses hearing aids. But are they effective? Here's Mark Ross to weigh in on the subject.

This article originally appeared in Hearing Loss Magazine, and is reprinted with the author's kind permission.

This is part one of two parts.

~~~~~~~~~~~~~~~~~

We seem to be hearing about more and more people who are undergoing surgery for hip, knee, shoulder, etc. replacement. Almost always (and I have never heard of an exception), this surgery is followed by a prescribed course of physical therapy. It is simply assumed that, post-surgery, the patient will need to be seen by a physical therapist for, at the least, a short regime of follow-up physical therapy. In other words, surgeons do not tell their patients that they've done all they could, schedule one or two future appointments, and then tell them to "call if there are any problems." Rather, physical therapy is conceived as an integral component of the overall procedure, and the assumption is made that patients will follow through with the recommendation.

Now contrast this situation with the most common service delivery model for obtaining hearing aids. After the aids are selected, the clients are routinely scheduled for appointments within the thirty or sixty day trial period, to be followed (possibly) by one or two follow-up appointments within the first year. What they do not generally receive is anything remotely resembling the organized and scheduled follow-up program that people getting replacement body parts receive. Instead, they are given the admonition to "call if there are any problems." This statement is not a substitute for an organized, coherent, and relevant post hearing aid fitting follow-up program.

Without minimizing the profound effect a physical condition will have on someone's quality of life, nonetheless an uncorrected hearing loss can be every bit as debilitating, though different, than such a condition. Why, then, don't people with hearing loss receive the same care and attention as do people requiring hip or knee surgery? We know that a hearing loss brings with it many issues and problems, and not just for the person directly affected but for family, friends, and co-workers as well. Why, then, isn't the hearing aid selection process defined so that a short-term aural rehabilitation (AR) program is recognized as integral to the entire process., much as physical therapy is following restorative surgery? One fundamental reason seems to be that in our society, we tend to trivialize or misinterpret the impact of impaired hearing (except if you or a family member is the one affected!). In other words, it often remains the "invisible handicap" and is not generally taken very seriously. Another reason is that for many people, just using any sort of sound amplification device appears to significantly diminish the hearing loss handicap, often to the point where no further services are apparently required or desired.

In my view, this is a rather specious rationale for several reasons. First, for people who have never worn any sort of sound amplification device, just the experience of hearing sounds louder will often seem to be miraculous; the comparison effects are immediate and apparent and their hearing problems now seems to be "solved." But this optimistic judgment soon fades as they confront the many and varied hearing difficulties in the real-world. To a lesser extent, this also applies to an experienced hearing aid user. What this person is doing is comparing the sounds perceive through their new (and expensive) instruments with their older ones, the very ones they are discarding because they are somehow dissatisfied with them. Of course, the newer instruments sound better, else why purchase them? But will their use be sufficient to resolve the hearing difficulties, to the point where the hearing loss no longer has any significant detrimental effect on their lives? Possibly, I would certainly hope so, but my impression is that too often people settle for less than is possible.

To be sure, I don't want to minimize the positive impact that properly fitted hearing aids can have for hearing aid users. My point, rather, is that even given this fitting (something that cannot be taken for granted), the routine inclusion of a group AR program for adults can provide valuable information and assistance to a participant beyond that available from the hearing aids alone, no matter how well fit the aids may be. Right now the marketing and provision of hearing aids are focused primarily on the presumed power of the new technical developments that keep being introduced. The implicit message that this focus conveys is that a technical cure (i.e., the sophisticated features included in the newer model hearing aids) is now possible; all one has to do is purchase this or that product and "lo and behold" the problem is solved. I may be overstating somewhat, but as I peruse the many marketing appeals published by the various hearing aid companies, I don't think I am overstating by much. Of course, hearing aids are the essential ingredient in reducing the overall impact of a hearing loss, no argument with that, but still that's not all there is.

It should be apparent that the more we know about a condition, particularly one that affects how we interact with others in our society, the better able we'll be to deal with the inevitable consequences of that condition. And we can learn how to do this not only from professionals but from people who experience a similar condition. And that is why I stress a group AR program, one that routinely includes a significant other (SO). The necessity to include SOs rests on the observation that while the affected person will have the hearing loss, it is really the entire family that has the hearing problem (i.e., that also has to deal with the consequences of the condition). These are not exactly new or revolutionary recommendations; twelve years ago the HLAA passed a position paper on this very topic. Unfortunately, it hasn't gotten much traction, which it surely deserves.

The very first and most significant advantage a group AR program offers is intrinsic to the format itself. We have in our society thousands of various kinds of support groups, one for every ailment and condition extant it seems, and their very prevalence offers convincing evidence for their effectiveness. The essence of any group program is listening to and sharing feelings and experiences with people who are in the same boat. For people with hearing loss, this sharing will aid them in acknowledging the reality of their condition, an acknowledgement that is a prerequisite in helping them help themselves. It may seem counterintuitive but because a hearing loss, particularly among older folks, is such a common occurrence in our society, its consequences tend to be underestimated or ascribed to other causes (such as the beginning of dementia, for example). The group format is designed to bring home the important message: You are not alone and you're not going crazy!