Midterm Examination Flashcards
1
Q
What is aural rehabilitation
A
professional, interactive processes involving the client (and their family, spouses etc.)
2
Q
What are four goals of AR
A
- limit negative effects
- compensate for limitations
- improve communication
- facilitate well being
3
Q
How does AR compensate for limitations?
A
- training or dispensing of devices
4
Q
Why does AR facilitate well being
A
- more holistic
- there are several things that influence your feelings about the problem
- be concerned with their overall health
5
Q
What is the holistic quality of well being?
A
interacts with health, productivity, life satisfaction, emotional state, social connections, resources
6
Q
Why is self-perceived well-being important
A
- may have other conditions that you are not aware of, or parents with other children with other problems
- your well being is effected by how productive you feel, your emotional and psychological feelings and connections, what other resources you have or lack of resources you have, what are you worried about
- you can’t look at a person and tell how they feel about something
7
Q
AR services and activities
A
Assessment Counseling Prescription of sensory devices Orientation of sensory devices Treatment
8
Q
Knowledge needed by service providers
A
- characteristics of hearing impairment
- impact of hearing loss
- AAA/ASHA competencies
9
Q
Early perceptions of hearing loss
A
- deafness seen as a “curse” - sins of the father or mother
- not allowed to participate in worship or inherit properties, couldn’t go to school
- deaf = dumb (unable to speak)
- send them away to some sort of residential home - you certainly can’t take care of them yourself!
10
Q
Birth of Audiology
A
- term attributed to Raymond Carhart (1946)
- distinctly separate from education of deaf
- emphasized aural rehabilitation
11
Q
AR Camelot
A
- servicemen with hearing loss “ordered” to military hospitals
- 8 weeks, 8hr/day, residential - intervention for those with hearing loss
- precursors to today’s VA Hospitals
12
Q
Design of Post-WWII Programs
A
- assessment, individual or group therapy, classroom, hearing aids
- team approach
- trials with 4-6 hearing aids
- speech reading
- auditory training - carhart method
13
Q
Who was involved in the post-WWII programs team approach?
A
acoustic technicians auditory training instructor lipreading instructor speech "correctionist" ancillary personel
14
Q
What is auditory training - Carhart Method
A
- discrimination of broad speech features, followed by smaller and smaller acoustic differences
- bottom up
- gross discrimination - rising and falling pitch, loud and soft sounds
- then you would get more and more specific information
- all of which he trained in 8 weeks
15
Q
Informal Training (Post WWII)
A
- bull sessions, conversations
- coping and communication strategies
- self-acceptance
- more informal, letting the person know that communication breaks down, you have to learn how to handle it and what to do in those situations
16
Q
What’s the potential for benefit from AR?
A
- neural plasticity
- acclimatization: adjustment to amplification
- technological advancements
- effective outcome measures
17
Q
Why does Age have an effect on whether someone is a candidate for AR?
A
- younger kids may not have developed language yet
- some have hearing loss from birth - may need to start working with parents before you are working with the kids themselves
- too old? maybe not, some work in assistive care facilities, nursing homes, etc.
- not really a marker of who we do or do not work with
18
Q
What factors do you consider when you are deciding if someone is a good candidate for AR?
A
- age
- degree of hearing loss
- type of hearing problem
- resources
19
Q
What are the two types of consequences of hearing impairment?
A
- primary
- secondary
20
Q
What is a primary consequence of hearing impairment
A
- expressive and receptive communication
21
Q
what is a secondary consequence of hearing impairment
A
- educational, vocational, psychological, social
22
Q
Why did WHO update their terminology in 2001
A
- globally accepted language
- helps standardize assessments and interpretation of data
- forms framework for evaluating health care
- provides classification system that can help shape legislation and social policies
- consistency in the way that we talk about clients - chart notes from one clinic to another
23
Q
Impairment
A
- Function at the level of the body
- loss or abnormality: physiologic, anatomic, psychological
- Hearing impairment: demonstrated by the deviations from normal pure tone threshold
24
Q
Participation (Formerly “handicap”)
A
nature and extent of person’s ability to be involved in normal roles
- effect of hearing impairment on individual, significant others and community
- includes non-auditory effects: restricted socialization
25
activity limitation
- deviations in normal function: at the level of the individual
- changes in essential characteristics of activity, including duration and quality
- e.g. problems communicating in specific environments or maintaining satisfactory employment
26
Impact of disease/disorder on activities and participation varies with:
- etiology
- onset
- progression
- degree
- age
27
environmental factors affecting AR
physical (architectural)
| social attitudes and customs
28
personal factors affecting AR
age, gender, education
experience with HI
coping style
29
How do we measure and describe HI
behaviorally
| objectively
30
factors affecting impact of HL
- age at onset, identification, intervention
- degree of HL
- permanence of loss
- affected ear(s)
- site of lesion/etiology
- sensory device use/benefit
- extent and type of intervention
- cognitive ability
- other handicapping conditions
- family, culture, socioeconomic status
31
What is the chain reaction of hearing loss
- hearing loss
- communication problems
- social engagement
- self-concept
- mood
32
What is the cycle of grief
- shock, even when diagnosis suspected
- denial
- anger
- bargaining
- depression
- acceptance
- cyclical process - renewed grief
33
Social-Emotional Development demonstrated by:
- attachment
- emotional communication
- self-understanding
- knowledge about others
- interpersonal skills
- friendships
- intimate relationships
- moral reasoning
34
Impact of attachment
o Emotional bond between infant and caregiver (later with familiar people)
o Affected by audition, vision, tactile
• When a child is deaf – there is more relying on the vision and tactile responses to develop attachment between parent and child
o Enhanced by communication competence
o Failure to bond – long term implications
35
Impact of self-regulation and emotional expressiveness
```
Newborn -> infant -> toddler
Develop ability to regulate feelings
- retreat from negative situations
- control negative emotional displays
Need language
- labels of feelings, consequences, shared meaning
```
36
skills needed to develop satisfying relationships:
* Think independently
* Self-direct and self-control
* Understand feelings, need of self and others
* Flexibility
* Tolerate frustration
* Ability to rely on or be relied upon
* Maintaining healthy relationships
37
Impact of social and emotional development
o Inability to mediate experiences and feels with language
o Lack of motivation/initiative (learned helplessness?)
o Low academic achievement
o Underemployment
o Social maladaptation (violence, drugs, alcohol)
38
Impact on Incidental Learning: learning through the passive exposure
o Reduces natural learning
o Puts parent in role of “teacher”
o Learning limited by language, communication skills, experiences
39
Impact during adolescence
```
o Developmental tasks
o Affiliation with peer group
o Identity formation
o Occupational preparation – Post Secondary preparation
o Adjustment to physiologic changes
```
40
Instrumental dependence
seek attention / help from others to satisfy needs / wants
41
Emotional dependence
desire for proximity, approval, affection from others
42
Risks for D/HH during adolescences
- less emotional bonding
- greater aggression
- rejection of amplification
- increased self-consciousness
43
impact on personality
```
emotional immaturity
egocentricity
irritability
impulsiveness
suggestibility
```
44
advantages of deaf child growing up in the deaf community
consistant parenting
effective communication
tolerant social environment
45
what are positive outcomes from a deaf child growing up in the Deaf community
better adjustment
higher educational level
better command of language
higher teacher/counselor ratings (maturity, independence, sociability)
46
adult adjustment to hearing loss affected by
- same factors that affect adjustment among children +
internal responses: cognitive appraisals, emotional reactions
external behaviors: positive and maladative
47
older adult adjustment impacted by denial
most adult onset HI in insidious
problem lies in mouth of speaker
action delayed 7 years or more
limited motivation
48
stereotypes and age-related hearing loss
societal image
geriatric "pictures"
ageism
49
adjustment impacted by stigma
negative perception
different = less than
may be imposed or perceived
50
Hearing aid effect
o Photos of people wearing hearing aids – give them choices of descriptive words
o Intelligence, personality, attractiveness
o Confidence, intelligence, friendliness
o Separate tests with real people – wearing dummy hearing aids, these people were not hearing impaired, they weren’t super visible, still negative reactions
o Varies by cohort
51
potential negative reactions to age related hearing loss
```
anxiety
irritability
frustration
depression
withdrawal
lack of independence
disrupted relationships
paranoia
```
52
Goals of Counseling
```
o Appraise strengths and limitations
o Increase confidence, knowledge, skill
o Reduce stress
o Facilitate access to support
o Promote positive function
```
53
factors affecting adaptation
```
family
personality factors
socioeconomic factors
resources
exposure to hearing loss
```
54
professional counseling
- focus on reorganizing or reinterpreting personal conflict
- effect major personality changes
- explore the subconscious
55
non-professional counseling
- not primary identity
- not trained as a professional counselor
- focus on coping with and adjustment to hearing - related problem
56
hearing loss management counseling
- based on well-patient model
- patient is psychologically normal
- typically short-term and focused on practical changes
57
counseling theories & styles
person-focused - patient knows best
empathic listening
behavior - directive approach
cognitive/rational-emotive - patient learns to identify and modify irrational, self-defeating thoughts
58
Personal social styles effect:
- how patients receive information from us
- how readily patients accept recommendations
- how comfortable patients feel sharing information/feelings
59
driving social style
o Driving- task; oriented; know what they want; assertive, self-controlled
• Characterized by telling and controlling feelings
• Strengths – determined, decisive, efficient, thorough
• Weakness – controlling, dominating, impersonal
60
Expressive Social Style
o Expressive – highly assertive; freely display positive and negative feelings; people – people, rely on “gut” reactions
• Characterized by telling and emoting
• Strengths – personable, enthusiastic, dramatic
• Weakness – opinionated, excitable, attacking
61
Amiable Social Style
o Feelings displayed openly, less aggressive and assertive, appear agreeable and interested in establishing relationships
• Characterized by asking and emoting
• Strengths – supportive, cooperative, dependable, personable
• Weaknesses – retiring, noncommittal, emotional
62
Analytic Social Style
o Low level of assertiveness, have high control of their emotions, ask questions and gather information
• Characterized by asking and controlling
• Strengths – industrious, persistant, systematic
• Weakness – uncommunicative, avoiding, impersonal
63
Counseling Process
o Help patient tell and clarify “story” what do they see as their problem
o Help patient take responsibility
o Help patient set goals
o Help patient develop, implement, and evaluate plan to solve problems
64
Clinician Behaviors and Attitudes that Interfere or reduce effectiveness of counseling
```
o Habituation – “been there”
o Generalization – “everyone”
o Comparison – “just like”
o Being Right – “I know best”
o Multitasking – “I have other things to do”
```
65
clinician behaviors that facilitate communication
o Eye-level communication
o Refrain from multi-tasking (e.g. note taking, setting up equipment)
o Display body language that expresses interest
o Use appropriate vocal inflection, tone and intensity
o Allow for silent reflection
66
Boundaries of Counseling
o Limited to problems related to hearing impairment
o Guided by and supportive of individual and family
o Does not foster dependency
67
What is appropriate for counseling?
- feelings
- information
- concerns about treatment
68
What are borderline issues?
- intense negative reactions or feelings
- problems with relationships
- on-going adjustment problems
69
what is inappropriate
- other medical problems
- chronic unhappiness
- marital problems
- violence and other illegal or maladaptive actions
70
informational counseling
content and information - what we do most in clinic with hearing aids
71
personal adjustment counseling
social-emotional, support
- active listening and responding to emotional needs (ASHA)
- given in an atmosphere of mutual respect and trust
72
problems addressed by informational or content counseling
```
o Description of hearing
o Causes of hearing problems
o Treatment options
o Sensory device options
o Hearing aid problems
o Service options
```
73
problems requiring personal adjustment or emotional counseling
o Acceptance of a HL
o Participation in family activities
o Psychological adjustment
o Social-vocational difficulties
74
institution-driven vs family driven counseling
o Universal newborn screenings result in institution-driven counseling
o Focus should be on family needs and strengths
75
What is important when you are delivering bad news
```
o Privacy & time
o Choosing the words
o Determine what’s understood
o Encourage expression of feelings
o Listen
o Respond with empathy
o Plan what comes next
```
76
Counseling service delivery models
```
o 1-on-1
o Group – professional led
o Group – self-help
o Individual or group with S.O.
o Key: appropriate services that meet the needs of the individual
```
77
Ways to measure impairment
```
Audiometric measure
- maximum potential
- best performance in optimal conditions
- direct assessments
Data logging
Additional Tests
- Quick SIN
HINT
```
78
Patient Tells Her Story: Case History
- most common form of self-report
- first impression
- only as good as the interviewer
- combine specific questions with open-ended questions
79
Self-Reports
o Evaluate communication function (typical performance)
o Determine emotional, social, and vocational well-being
o Augment audiometric information
80
Attempts to Quantify Handicap
o Social Adequacy Index (Davis, 1948)
• Attempt to relate audiometric data to social function
• Based on hearing loss and discrimination loss
o Other attempts to quantify
• % Disability based on degree and affected ear
81
Audiologic Rehabilitation Evaluation - Rehabilitation Model: Adults
o Communication Status
• Auditory, visual, manual
o Associated Variables
• Psychological, sociologic, vocational, educational
o Related Conditions
• Motor, health, cognitive
o Attitude (I = strongly positive; IV = reject HA)
