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Aural Rehab Midterm Flashcards

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1
Q

Describe the clinical barriers healthcare providers might not realize impact patient outcomes

A

self image, underestimate importance of hearing health, financial limitations, limited access to healthcare, unrealistic expectations, motivation, perceptions of society and medical professionals responses

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2
Q

How can audiologists create hearing-loss friendly offices and protocols to reduce barriers to communication health?

A

train staff to use best communication practices, have the receptionist personally alert patients when it is time for their appointment, keep pocket talkers or other assistive listening devices on hand, provide a written summary for patients after their visit, create a well-lit environment, enable captions on the TV

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3
Q

List the elements involved in patient-centered care

A

listen to and respect patients’ perspectives and values, involve the family, reinforce shared decisions, prioritize the free flow of information and dialogue, & demonstrate empathy and understanding of patients’ points of view

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4
Q

Describe the impact communication mismatch has on patient adherence to treatment plan

A
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5
Q

Describe and reflect on the benefits of addressing a patient’s psychosocial concerns during appointment

A

Addressing their concerns and expressing empathy increases the patient’s satisfaction, enables a better appreciation of the benefits of hearing technology, and increases adherence to rehabilitation recommendations

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6
Q

Familiarize yourself with ASHA’s clinical practice guidelines on audiologic rehabilitation

A

Sensory management: fitting, programming, fine-tuning of hearing aids, cochlear implants, bone-anchored hearing aids, personal sound amplification products, FM systems, or assistive listening devices.

Informational counseling: education regarding hearing loss, amplification, available tools/resources, prevention and conservation, associated symptoms, communication strategies training, range of possible treatments, demonstration, and instruction in the use, care, and management of sensory devices

Perceptual training: to enhance auditory or auditory-visual abilities (speech perception training, lipreading/speechreading training, and speech tracking).

Personal adjustment counseling focuses on the psychological, social, and emotional acceptance of hearing loss and/or related disorders. This includes pre-fitting engagement activities, motivational interviewing, pre-fitting and post-fitting counseling, peer support systems, and other interventions that aim to facilitate acceptance to allow for appropriate management of the stressors commonly associated with hearing loss.

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7
Q

What is communication mismatch?

A

occurs when the audiologist’s approach does not align with the patient’s needs or expectations

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8
Q

What is patient centered care?

A

When the patients wants and needs are the priority. The audiologist and the patient work together to make decisions.

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9
Q

What is family centered care?

A

When the patient & the family work with the audiologist to develop a plan

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10
Q

What is a decision aid?

A

An organizational tool used to review a set of treatment options. This opens up conversations with the patients to help them decide on a treatment option.

gives information for each option and has boxes the patient can check if they are interested in learning more.

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11
Q

Define the technocentric rehabilitative model

A

when we use technology to improve hearing (HA’s)

components: audiometry, HAs, HA orientation, real-ear verification, and accessories

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12
Q

Define audiologic rehabilitation

A

Helps patients with hearing loss adapt to their condition and manage it. It is personalized based on the needs and preferences of each patient. It should also reflect whole-person healthcare. Stresses the importance of having aspects other than technology involved

components: patient story, self assessment of auditory wellness, technology, communication strategies, speech/visual perception training, peer support and validation

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13
Q

What are the overarching goals of audiologic rehabilitation?

A
  1. reduce deficits related to loss of function, activity limitations, participation restrictions and quality of life
  2. enhance conversational fluency
  3. recognize HL imposes a multi-dimensional loss of function (impacts the body, and mind, as well as social aspects)
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14
Q

Audiologic rehabilitation aims to reduce which hearing-related limitations?

A

Function: loss of integrity of the sense organ
Activity: sensory loss limits the ability to understand communication, especially in noise
Participation: limited desire to participate in life
Quality of life: lack of participation leads to isolation and reduction of self-worth

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15
Q

How can we determine if hearing aids are improving the activity limitations the patient faces?

A

We can test them with their hearing aids in quiet and in noise. If we want to increase the difficulty we can also take away their visuals.

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16
Q

Does the technocentric or audiologic rehabilitative model offer more patient centered benefits ?

A

audiologic

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17
Q

Understand the definitions of functional, activity, and participation restricitons. How do these concepts support patient centered care and management of hearing loss?

A
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18
Q

List the benefits associated with the use of standardized questionnaires

A

Questionnaires can be used as a baseline and again after their fitting to analyze the benefit. They can also help us determine the patient’s quality of life & auditory wellness.

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19
Q

Describe how the brain processes an auditory signal to gather meaning

A

An echoic memory of the signal is created (replica), then pattern recognition occurs, then it goes to short term memory, and lastly long term memory

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20
Q

What impacts processing speed?

A

Processing speed is impacted by suprasegmental information, complexity of a task, and allocation of attention, & capacity and load

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21
Q

Explain the role complexity of the taskplays on a persons’s ability to decode signals and determine its meaning

A

As complexity increases so does the amount of mental effort needed. This leads to a harder time processing the signal and makes it difficult to retain the stimuli long enough to understand what it means.

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22
Q

Explain the role allocation of attention plays on a person’s ability to decode signals and determine its meaning

A

higher levels of attention allow us to select a limited amount of information we want to focus on and block out the irrelevant information

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23
Q

Explain the role capacity and load play on a person’s ability to decode signals and determine their meaning

A

when there is more load (amount of energy that must be expended) than capacity (total energy available) it leads to fatigue, causing the processing speed to slow.

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24
Q

Describe changes that occur in the aging auditory system and how this negatively affects communication

A

broader neural tuning curves with diminished frequency resolution, neural recovery taking longer and diminished brain connectivity slows hemispheric transmission

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25
What life experiences preserve an older adult's ability to understand speech in noise?
music training and physical activity
26
How does music training affect an adult's ability to understand speech in noise
Learning to play an instrument teaches the brain to extract critical information. Musicians show better abilities with brainstem encoding because music engages intricate systems in the brain (corpus callosum).
27
Describe the correlation between hearing loss and cognitive decline
Hearing loss is associated with a faster rate of cognitive decline. Hearing loss leads to isolation which is thought to be one of the biggest causes for cognitive decline.
28
Explain the meaning of this statement "hearing loss is considered the most important modifiable risk factor for dementia"
If we can catch hearing loss early we can treat it and help patients from isolating themselves. Isolation is thought to be one of the biggest causes for cognitive decline.
29
Which cognitive screening tools identify MCI?
The Montreal Cognitive Assessment (MoCA) & St. Louis University Mental State (SLUMS) are the most sensitive for identifying MCI. The Mini-Mental State Exam (MMSE) can also be used but is not as sensitive.
30
What is the problem with cognitive screening tools?
They are auditory-based so if the patient can not hear the directions or questions the information you get will not be accurate
31
Why are slow-acting AGC-i compression settings easier to process for patients with poor working memory and cognitive decline?
Slow-acting compression does not change the speech envelope but fast-acting compression does. It retains the speech envelope and the fine temporal cues needed in order to match to long term memory
32
What is the multi-faceted rehabilitation model?
Provides patient-centered benefits because it provides expectations, rehabilitation process, habituation, and involves the whole family. It helps patients recognize that amplification is just one component.
33
What is echoic memory? What does it become?
Creates a perfect replica of the acoustic stimulus. It becomes stored for 250ms as a synthetic auditory memory that leads to processing spatial location, intonation, and intensity.
34
What happens when the synthesized auditory memory is compared to long-term memory?
Pattern recognition occurs. This can be impacted by audibility, situational content, attention, and knowledge of language.
35
What is pattern recognition?
The ability to identify patterns stored in your long-term memory. Audibility, situational context, attention, and knowledge of language assist with pattern recognition.
36
What is a suprasegmental?
Variations in Loudness: changes in stress of syllabes which leads to words having different meanings Variations in Pitch: changes in intonation which leads to different meaning Variations in Duration: changes to vowels, syllables, or sentences to convery a different meaning
37
What is auditory mismatch?
When the auditory signal that arrives to the brain is degraded by the auditory system and therefore does not match the auditory memory. This is more prevalent in complex listening environments.
38
What is perceptual training?
Improves age-related function and reduces activity limitations, supporting positive communication outcomes. It includes speech perception training, auditory-visual perceptual training, & cognitive "brain" training
39
What is speech perception training?
Used to improve someone's ability to perceive and understand speech. It can improve their speech, listening skills, auditory attention, and memory.
40
What core components of speech perception training?
auditory discrimination, auditory closure, auditory memory and auditory attention
41
Who can we refer to for speech perception training?
SLP's that specialize in adult auditory rehab Auditory verbal therapists Computer-based speech perception training Potentially music teachers
42
What are 3 considerations of speech perception training?
Individualized treatment plans, progress monitoring, and home practice
43
What is auditory discrimination?
The ability to distinguish between similar sounds.
44
What is auditory closure?
The ability to fill in missing speech sounds.
45
What is auditory memory?
The ability to retain and recall auditory information
46
What is auditory attention?
The ability to focus on relevant auditory information and ignore background noise.
47
What is fluid intelligence?
The ability to think logically, solve problem, & think through challenges.
48
What is crystalized intelligence?
The ability to use skills, experimental knowledge, and repetitive activities and skills
49
What type of intelligence is most likely to decline with age?
Fluid intelligence is most likely to decline with age
50
What is mild cognitive impairment?
Often seen with older adults when there are mild cognitive decline symptoms but it is not due to dementia. It often goes undiagnosed & prevalence increases with age.
51
What are perceptions of society?
Attitudes of family and friends & cultural norms, practices, and ideologies
52
What are the 2 things that contribute to cultural norms, practices, and ideologies?
Familism - a sense of obligation, the family's needs are more important than mine Stigmatism - HL is something to hide bc it negatively reflects on me
53
How do the attitudes of friends affect the decision to purchase hearing aids?
If their friends have had a bad experience it can change how they view hearing aids and seeing an audiologist
54
What is the goal when attempting to enhance conversational fluency?
We want our patients to be able to engage in smooth, effortless communication with others. This includes ease of understanding, active participation, communication strategies, social and emotional factors
55
What is ease of understanding (conversational fluency)?
Accurately & effortlessly understanding communication, especially in background noise. Minimizing listening effort and fatigue
56
What is active participation (conversational fluency)?
Effectively participating in the flow of conversation. Maintaining topics and contributing meaningfully.
57
What are communication strategies (conversational fluency)?
Asking clarifying questions, using visual cues and gestures, & and repairing communication breakdowns (asking people to repeat)
58
What are social and emotional factors (conversational fluency)?
Feeling confident and comfortable in social situations, and minimizing anxiety and frustration
59
What is the average amount of SNR adults need?
+3-5 dB (greater than the noise) There is a decrease in neural ability as we age - decreased neural firing & longer refractory periods.
60
What is advanced brainstem encoding? Who is usually good at this?
The ability to understand speech in noise despite age-related hearing loss and auditory structure changes. Muscians = in their brain speech & music overlap Tonal language speakers = can identify subtle changes in words that change the meaning Bilingual speakers = better at encoding the fundamental frequency
61
For patients who are still good at advanced brainstem decoding what is our approach clinically?
These patients will not need all the advanced features. Even though they have hearing loss they still have access to speech signals. (could put music history in case history forms/questionaries)
62
What is the OPERA Hypothesis?
Proposes that music facilitates speech encoding when -neural networks for speech & music OVERLAP -music entails more PRECISE processing than speech -music brings strong positive EMOTION -REPETITION in the signal -listening requires focused ATTENTION
63
How does learning music benefit children?
It can help them acquire language faster
64
What is cross-modal reorganization?
When the brain reorganizes itself because it lacks input like vision or hearing, it uses that area for something else. Research shows that if we can fit patients with well fit amplification, we can promote typical cortical function and provide them with cognitive benefits.
65
What is the progression for auditory training?
1. phoneme level exercises = sound discrimination 2. word level = word rec in noise 3. sentence level = sentence repetition tasks 4. discourse level = listening to stories or lectures, following complex instructions
66
When should an appointment be extended?
When the audiologist avoided addressing psychosocial concerns
67
We use the COSI for PCC, which questionnaire would be used during FCC?
The Family Oriented Communication Assessment and Solutions (FOCAS)
68
Bottom-up processing only supplies?
The perception of sound
69
Top-down processing relies on?
A clear amplified signal with low distorion
70
What is synthetic training (speech perception training)?
uses top down processing to take in and analyze info without attempting to identify every word or sound
71
What is analytic training (speech perception training)?
uses bottom up processing to improve recognition of phonemic speech elements
72
What is transfer appropriate processing (TAP) (speech perception training)?
training tasks that match the patients desired outcome
73
What is meaning based orientation training (speech perception training)?
use of training stimuli that activate language processing centers of the auditory cortex just like real communication
74
What is active filter hypothesis training (speech perceoption training)?
recognizes that emotional factors block effectiveness of listening skills

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