State of the Science on Aural Rehabilitation

State of the Science on Aural Rehabilitation - Part 5

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 five of five parts.

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

Various types of group AR programs were directly compared in a project presented by Jill Preminger. This was a very ambitious undertaking that attempted to determine the relative effectiveness of various types of AR programs and to see if any benefit was related to the personal characteristics of the participants. These group programs included structured discussions on emotional aspects of hearing loss, exercises in auditory and auditory-visual perception, communication strategies training, and informational lectures. Different groups of individuals received some combinations of these programs. The results (as measured via several subjective scales) did not demonstrate "robust" differences between the training groups and the control group. However, some individuals did appear to benefit from the training as measured by a clinically significant change on the self-assessment scale used in the study. The challenge is to determine who can benefit most from such training, what combination of procedures to apply, and to develop sensitive and appropriate measures to document any possible changes. It is studies like this that will ultimately lead the way to more refined AR procedures, as we define what does not work as well as what does work.

Among the other features of this conference was a full day devoted to the issue of people with dual sensory hearing loss. This is the first time I've attended a conference in which this topic was addressed at all, much less for a full day. In our focus on hearing, it is easy to forget that many people with hearing loss can also exhibit other difficulties (e.g., visual problems, arthritis). These other conditions may, depending upon their severity, impact upon the rehabilitative process in a number of ways. For example, if someone is unable to manipulate a volume control or a telephone switch, then hearing aids that function automatically in controlling the loudness of the sounds or in accessing the telephone will be required. Or telephones with large number dials would be necessary for those who have visual impairments.

In our focus on the auditory channel (hearing aids, assistive listening devices, auditory training), it is sometimes easy to overlook the vital contribution of vision to the communicative process. For people whose major avenue of communication is vision, then such apparently obvious requirements as the lighting level in the room, distance from the person talking or the screen, and line of sight become critical elements in the communicative process. For those whose primary avenue of communication is audition, the added information provided by the visual sense can range - from helpful to critical.

We've known for many years that people understand speech much better when they can both hear and see a speaker. Whether or not they think they are speechreading, they are to some extent. It doesn't matter which of the modalities is the primary one for a particular person: the contribution of the other modality will increase the total recognition score. For example, as Boothroyd demonstrated in his presentation, audition will increase speech perception even if only the fundamental frequency of a speaker's voice (artificially extracted, of course) is heard. It is not possible to understand any words with such limited acoustic information, but when combined with speechreading the scores increase beyond those obtained with speechreading alone. The reverse is also true and has been demonstrated time and again. A person may obtain a very poor speechreading- alone speech recognition score; but when combined with audition, the total score will exceed (sometimes far exceed) that obtained with audition alone. In short, anyone engaged in the AR process must be sensitive to the presence of visual conditions, whether mild or severe, that may co-exist with the hearing loss. These can include age-related macular degeneration, glaucoma, diabetic retinopathy, cataracts, and retinitis pigmentosa.

In truth, AR involves much more than scientific studies and expositions (necessary as they are); it also requires a commitment by the professionals whose who are responsible for carrying it out. And it cannot be a token or superficial commitment; they have to truly believe in the efficacy of an AR program. Given this commitment, there are a number of things that they can and should do, even within the constraints imposed by economic reality ("time is money"). They can encourage and assist their clients in acquiring and implementing a self-administered training program; in addition to the ones described above, there are a number of others as well. In their hearing aid practice, they can include and strongly encourage their clients to participate in a short-term three- or four-session hearing aid follow-up program, one that is defined as a routine component of the overall hearing aid dispensing process. This suggestion is in accord with HLAA's position on Group HA Orientation Programs. From a purely business perspective, such a program would be a way to build customer loyalty, increase awareness and sales of other types of hearing assistive technologies, and forestall many time-consuming individual "drop-ins." And, frankly, given the current cost of an average set of modern binaural hearing aids, if there were an added expense, it could well be absorbed by the hearing aid dispenser.

I believe that the provision and acceptance of AR fundamentally requires that our society, all of us, understand and treat the reality of a hearing loss with understanding and respect, and not as an occasion to make bad jokes. And, unfortunately, we still have a long way to go in this regard, though I do think that conferences such as the State of the Science Conference on Aural Rehabilitation are an effective way to proceed.