State of the Science on Aural Rehabilitation

State of the Science on Aural Rehabilitation - Part 1

by Mark Ross, Ph.D.

Editor: What do you think of when you hear the term "aural rehabilitation"? If you don't really quite know what it means, you're not alone. And that's an unfortunate thing, because aural rehabilitation is very important to people with hearing loss.

Here's Mark Ross' discussion of the recent "State of the Science on Aural Rehabilitation" conference. This article first appeared in Hearing Loss Magazine (January/February 2007), and is reprinted with the author's kind permission.

This is part one of five parts.

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The Rehabilitation Engineering Research Center (RERC) on Hearing Enhancement held a national conference on Aural Rehabilitation September 17 through September 20, 2006 at Gallaudet University. This was designed to be a "State of the Science" meeting, in which the latest information on all aspects of Aural Rehabilitation (AR) was presented to an audience composed primarily of practicing audiologists, researchers, and university professors. The presentations included papers on evaluations, various kinds of training procedures, efficacy of some hearing aid features, and a review of theoretical considerations underlying performance with cochlear implants. The last day was entirely devoted to topics concerning people with dual sensory loss. The scope and sophistication of the papers clearly reflect evidence of a maturing profession, one that is able to examine a topic as amorphous as aural rehabilitation with scientific rigor.

To ensure the inclusion of the human side of AR, a panel was convened daily, and people with various degrees of hearing loss and dual sensory problems had an opportunity to recount the challenges they faced in their lives and the kinds of changes they hoped could take place in the near future. The panelists did not hesitate to criticize what they felt to be inadequate or insensitive professional services. Thus, the audiologists in the audience could hear how "the other side" felt and how they viewed the professional community. The issues and information presented covered the entire gamut of AR, and it would be impossible for me to summarize it all here. Rather, I would like to make some personal comments about the AR process, while referring to just some of the topics and conclusions made in a few of the papers.

It is generally agreed that AR began during and immediately after WW II. Faced with a large number of newly deafened servicemen, whose hearing losses could not be treated medically or surgically, the military services organized AR programs in a few military hospitals around the country. Money was not an issue, or at least not a major one (very different from nowadays!). What "the boys" needed, they got. The military brought together specialists in a number of areas, such as medicine, acoustics, psychology, speech correction, deaf education, and lipreading. These specialists were tasked with the challenge of organizing an optimal AR program. It was basically an "a priori" judgment, since there were only a few people with AR experience with whom these people could consult. Although "schools" and methods of lipreading had existed in the US and Europe since the late 1800s, little or no objective information existed about the efficacy of the various procedures that had been developed. So the specialists used their best judgment and included what, on a logical basis, appeared to be the necessary components of an ideal AR program.

At the time lipreading and auditory training constituted just about the entirety of what was thought to be AR, so these were the areas that were stressed. However, unlike the lipreading programs of earlier years, wearable electrical hearing aids were available in the l940s, and their selection and use was included in the planning and became an important component of the program. The inclusion of hearing aids necessitated the development and utilization of somewhat more sophisticated audiometric tests than those that were generally employed by ENT physicians. Later, the field of Audiology, whose genesis can be traced to the AR programs organized during WW II, would stress this "scientific" aspect of rehabilitation activities more than any other component. The AR component became, and in my judgment has remained, a bit of a professional "step-child" ever since.

These early pioneers did an excellent job and deserve an "A+" for their accomplishment. I can say this on the basis of personal experience. In early 1952, I was a patient in an AR program that had its inception during WW II. We lived at the hospital (the Forest Glen section of Walter Reed) for eight weeks while we attended classes full-time and underwent various audiometric and medical examinations. The selection, use, and care of hearing aids (monaural body aids) was included as an integral component of the program. Most of the time was spent on various lipreading and auditory training procedures, which were extensive and very creative and included memory span exercises, cognitive training, and lots and lots of lipreading practice. Except for some informal evaluations, I do not recall being given any type of objective measure regarding our lipreading prowess. I do know that all of us patients felt that we were learning how to communicate more effectively. I'm confident that the instructors sincerely believed this also. On its face, the AR program clearly had a great deal of merit. I, personally, will always be grateful that I had the opportunity to participate in this program.