Is group audiological rehabilitation worth the time, cost, and effort? - Part One

Editor: This is a topic near and dear to my heart, and I bet it is to yours, as well. Audiological rehabilitation is all the stuff besides hearing aids that your audiologist or hearing aid dispenser should provide for you; it's what makes the difference between treating you as a person who needs a range of information and services to deal with her hearing loss, vs. treating you as a pair of giant ears that need hearing aids inserted!

Ingred McBride, Au.D, CCC-A, is one audiologist who gets it. Her clinic (the Arizona State University Hearing and Speech Clinic) provides a FREE 16-hour audiological rehabilitation program for hearing aid users. So here's a question for you: Does your audiologist provide a similar service? If not, why is she still your audiologist?

This is part one of two parts.

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Arthur Boothroyd defines adult audiological rehabilitation (AR) 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."

Mark Ross defines it as "any device, procedure, information, interaction, or therapy which lessons the communicative and psychosocial consequences of a hearing loss."

Both definitions include the concept that the goal of AR is to alleviate the difficulties related to hearing loss, and the notion that it should be all encompassing and comprehensive.

ASHA recommends that all audiologists provide AR services, but many don't do so. HLAA also recommends it, and that's a very powerful recommendation, because it comes from a consumer and advocacy group. So it's the clients telling the providers what they need!

Referring back to Boothroyd's definition, hearing aids and cochlear implants address only the deficit of function (hearing loss itself), but not the other deficits that have such great impact on the lives of people with hearing loss. Too many audiologists consider a successful hearing aid fitting as the end of the process, rather than the beginning.

Successful AR is based on the following assumptions:
- A hearing aid or cochlear implant is only one component of the AR process.
- Speech understanding is a bisensory event. It requires speechreading as well as listening.
- Instruction is a key component. People with hearing loss need to learn about technology, psychosocial implications, communications strategies, etc.
- Practice is very important, more so than instruction.
- Personal adjustment counseling is required to change attitudes and behaviors.
- Hearing loss is a family affair.
- People need help dealing with the psychosocial impact of hearing loss.

Successful AR intervention is the result of a holistic approach. What has been traditionally offered was called aural rehabilitation, and it was characterized by one-on-one practice of lipreading and auditory training.

Audiological rehabilitation evolved from that beginning, and broadened the scope to include:
- Overall communications skills, including communications strategies training and communication partner training
- Assistive technology
- Personal Adjustment Counseling, including training in coping strategies and psychosocial adjustment
- Information and education regarding causes of hearing loss, treatment options, and implications of hearing loss
- Speechreading training
- Auditory training

Group AR is better than individual AR because of the impact of group dynamics. The best groups are those in which the leader is a facilitator, rather than the sole source of information and content. The leader must ensure a good balance of instruction and interaction, keeping in mind that the real value of a group derives from the sharing among members, including:
- high levels of member participation (the more, the better)
- support from others facing the same issues
- members realizing that their experiences are not unique
- participation by family members is especially important.

Dr. McBride mentioned that conventional wisdom has it that people won't attend AR, or that they will go once and not go back. That is not her experience. They offer five classes a year and continue to have a waiting list. Furthermore, many people who miss a particular session want to make it up during the next class!

She presented Luterman's Eight Cohesive Factors in Groups, which address the power that derives from group interaction. They are:
- Installation of hope - members see how others in a similar situation have overcome adversity and realize that they can too
- Universality - members realize that they are not alone, that others share their feelings, perceptions, and experiences
- Imparting of information - Lots of it is exchanged in a group setting
- Altruism - Support and encouragement of other members
- Interpersonal learning - Members feel safe and learn how to be open and accepting of others
- Group cohesiveness - Members of the group trust each other and learn to work together
- Catharsis - Group allows members to release pent-up emotions in a safe environment
- Existential issues - Groups give members the ability to work through a variety of important life issues

Multiple studies confirm that participation in group AR programs provide the following benefits:
- Reduction in the perception of the hearing handicap
- Better use of communication strategies and personal adjustment
- Improved quality of life due to a reduction in social, emotional, and occupational withdrawal
- Better use of and satisfaction with hearing aids
- Increase in perception of audiologist effectiveness
- Increased awareness and use of assistive technology