unit 1 Flashcards
Deafness
the absence of hearing
other terms for aural (re)habilitation
auditory and audiologic (re)habilitation
Hearing (re)habilitation
(re)habitative audiology
the success of the child’s (re)habilitation
effected heavily by the support system that they have:
parent
teacher
family
aural rehab goals
-repair their abilities to as good as it can be
-we want to give patients as much intensity as they will allow with their hypersensitivity
education
achieve adequate receptive and expressive communication
person can actualize their own resources to meet their unique life situations
help person accept their condition and residual problems associated with HL
most presbycusis loss patients
are hypersensitive
reasons people wait to get help
thing they’re too young
finances
denial
gradual loss
procedures for meeting aural rehab goals
use of devices to minimize the hearing loss
teach strategies and problem solving to person so he can overcome personal, psychosocial, education and vocational difficulties resulting from the HK
Strategies:
lipreading/speechreading
auditory training
counseling, etc
individual accepts problems associated with hearing lose
services related to, but not part of AR are medical intervention and education
- like 10 year olds with conductive hearing loss
Aural habilitation
remedial effort with children having hearing loss at birth
-need to stress the use of things that will help them hear better
make sure to show the parent that their time matters, that their support is most important
who provides aural rehabilitation
SLP, AuD, caregiver, teachers
all aspects of AD are not performed by one person > team approach
crossover for sounds
at 40-60 decibels
what are the educational needs of AR professionals?
Audiologists (AuD) and SLPs
there is a great need for audiologists (AuD) and SLPs to be well prepared in AR
content areas of competence
need to understand:
-characteristics of hearing impairment
-effect of hearing loss on persons
-communication strategies for hearing impaired persons
-auditory training and speechreading
-amplification (make sure that they understand how it works)
Major professional associations
AAA (american academy of audiologists)
ASHA (American speech-language and hearing association)
EAA (educational audibly association)
ARA (academy of rehabilitation Audiology)
incidents of hearing loss in the USA
14-40 million
why does it vary?
-because children’s hearing loss can be transient because of middle ear dysfunction
(10% of the population- 33 million have clinically significant aka permanent loss)
statistics of deaf children
1 million deaf
3 million children are deaf or hard of hearing
children deaf hard of hearing
what about high frequency HL and conductive HL?
school-aged; pre-k
many with additional disability
-ADHD, speech, developmental delay, autism
fastest growing group with age loss
25-35
4-5% of them have hearing loss
high frequency noise induced
75+ year old
40-50% need help
high correlation between untreated hearing loss and high occurrence of Dementia
6-8 times more likely
the longer that they wait, the harder it is to acclimate to the aid
how many hearing aids in the US
6-8 million users
impact of hearing loss
adults have more trouble with understanding language
children with congenital loss have expressive and receptive issues
it is all dependent on different situations, different circumstances, different outcomes
-how long of a loss
-start of the loss
-comorbitity
how to help adults with hearing loss
get them tested get them aids communicate in well lit areas speak clearly do not shout decrease distance from speaker
how to help children with hearing loss
NEED TO GET AIDED
more global approach, working on everything
hearing loss refers to
degree of hearing loss
hearing handicap refers to
interference in communication that results from a hearing loss
factors impacting hearing handicap
- Degree of Hearing Loss
- Time of Onset of Hearing Loss
- Types of Hearing Loss
- sensorineural is the worst
- -retrochoclear is the worst - Configuration of Hearing Loss
- reverse slop has worst clarity - Speech Recognition Ability
- 80+ is preferred - Attitude of Family
- Motivation of Hearing Impaired Individual
degree of hearing loss
Can make general statements about handicap and probable needs
However, only a guideline
Audiometrically deaf = 80+ dB hearing loss (PTA)
The greater the degree of HL = the greater the degree of hearing handicap
Exceptions:
-But handicap may vary considerably
-Must consider other factors, (e.g. personality, intelligence, motivation, occupation, and environmental conditions)
-Generally, those who rely heavily on communication for their work, may notice significantly greater handicap than those whose jobs are not as verbally demanding
Degree of loss is more critical in the case of young children especially when the loss occurs before the development of language
In profound loss, voice, speech & language are likely to be substantially influenced
Less severe losses have correspondingly fewer communicative consequences
-But there are notable exceptions
time of onset of hearing loss
4 categories: pre-lingual, perilingual, post-lingual, deafened
Congenital vs Acquired Hearing Loss:
Congenital or pre-lingual hearing losses
Have a great impact on language, voice, and articulation, because the individual may not develop these skills normally
-because Individual does not have constant language stimulation or accurate feedback of his own speech
It has a deleterious effect on social, educational, and vocational aspects of a person’s life
It has a deleterious effect on social, educational, and vocational aspects of a person’s life
Acquired loss or post-lingual: (after 5 years of age)
Impact?
May be very little impact on language
Some difficulty in verbal communication and other social, emotional, and vocational problems
time of onset of hearing loss
sudden vs gradual
(Sudden is much worse)
sudden loss is often caused by viral and effects one ear
Psychological impact
-sudden is initially worse
-gradual is worse overtime because you look back and
wonder why you didn’t do something about it
Speech movements & high frequency sibilant sounds:
After awhile, speech movements will tend to become less precise, affecting high frequency sibilant sounds first: not able to monitor articulation effectively
Progressive (gradual) loss:
Person gradually adjusts to loss, while sudden loss, the person may not know how to listen for clues to distinguish speech sounds
high frequencies effected first
type of hearing loss conductive
the least complicated to help Symptoms: Behavioral: Paracusis Willisi Soft voice dental voice Sometimes low pitched tinnitus recruitment Audiometric: BCT better and ACT (by more than 10 dB) BCT < 25 dB HL Good discrimination of speech if it is loud enough Conductive loss in children may have significant long-term effects on language and speech
type of hearing cochlear loss
Symptoms:
Behavioral:
Loud, strained voice (if not amplified)
High pitched tinnitus (can be aggravated, pulsates, come and go)
Recruitment (problem with amplification)
Reduced discrimination, particularly in noise
Normal otologic findings
Audiometric:
BCT = ACT
Both BCT and ACT are worse than 25 dB HL
Possibly hyper-active, frustrated, particularly if a child
Impacts speech & language development of child
type of hearing central loss
Who? -APD -Stroke Symptoms: Normal or near normal hearing Extremely poor discrimination for speech, especially in noisy backgrounds (may be fine in quite) Decruitment Short attention span/behavior problems Delayed &/or deviant language Impacts speech & language development of child
configuration of hearing loss flat
Affects high frequency information most severely & low frequency information least of all
High Frequency (Sloping) Configuration:
Affects high frequency information extremely severely, can hear low frequencies
Extreme difficulty understanding speech, especially in noise
-otitis media, presbycusis
configuration of hearing loss sloping
High frequency information is lost
Understanding speech, especially in noise is poor
-noise and ototoxic meds
configuration of hearing loss rising
Least common configuration
Least impact on speech intelligibility
problems with loudness
-meniere’s disease
configuration of hearing loss cookie bite
Should impact speech intelligibility,
But usually does not impact too much
-congenital
speech recognition ability
This is the clarity of speech: speech discrimination
Speech discrimination of a H of H person is typically better than a person who is deaf
However, things are different, depending on whether or not a CI is used
phonemic regression
This is decreased speech understanding ability, despite near normal hearing
typical of someone with advanced age (central degeneration)
may have had a cognitive event that has effected the processing area of the brain
Attitude of Family & Friends
General Rule:
The more supportive the family and friends, the better are the prospects for effective communication skill building
Motivation of Hearing Impaired Individual
General Rule:
The more motivated is the client to succeed, the better are his/her chances for succeeding in learning effective communication skills
Therefore, degree of handicap cannot necessarily be predicted only from the degree of hearing loss as depicted by the audiogram
Many factors influence
The strategies used in AR focus on the impact of hearing loss on communication
For adults with later onset hearing loss, language function will not be impacted
–However, how each person responds depends on different demands, self-imposed or externally imposed (families, jobs, etc)
For children with congenital hearing loss, language will most likely be impacted
–If deafness is not in the family, parents will be impacted, while in a deaf family, deafness may be more readily accepted
Different situations, different circumstances, different outcomes
impact of child hearing loss Communication Problems
The most devastating effect of HL is impact on oral communication
Children with severe-profound HL, without CI generally do not develop speech & language normally, because not exposed to language
Varying degrees of difficulty
Presence of Other Disabilities:
Other serious disabilities, e.g. blindness, physical limitations, or mental retardation can complicate the situation
Environmental Consequences:
Educational, vocational, psychological, and social implications
Includes barriers and facilitators that function to make things harder or easier for communication to occur
impact of child hearing loss secondary consequences
Educational, vocational, psychological, and social implications
vocational rehab services
Can be another avenue like medicade
can be utilized in school
rehabilitative alternatives
Little can be done to change innate IQ or native abilities
However, there are a number of AR procedures that may have a significant effect on the personal and environmental factors relevant to hearing loss
Number of AR procedures
Interesting facts:
75% of persons with HL do not use amplification
Implications?
these people will struggle to maintain their life, may have problems with education. Their social life is effected
There are many unidentified H of H children
Possible resolutions?
30 seconds to do a listening check
history of aural rehabilitation/deaf education first opinion
Aristotle (355 B.C.):
Very influential
“Those who are born deaf all become senseless and incapable of reason. Men who are born deaf are in all cases dumb; that is to say, they can make vocal noises, but they cannot speak”
Misinterpretation of statement molded the interpretation for deafness for centuries
Hearing impaired were thought to be retarded
They are not!
16th century
Cardano (1501-1576) [Italy]:
No reason why people who are deaf could not be taught; they are capable of reason
Wrote about a deaf man who learned to read and write and could learn and communicate with others
Agricola [Dutch]
Wrote book on how deaf people could learn to read & write
Ponce de Leon [Spanish]
Showed that Hearing Impaired could learn to speak & learn
Started school for affluent deaf children at monastery
17th century
This was a time of development of educational philosophy, intellectual growth, scientific thought
Francis Bacon, Bonet, Bulwer (England)
Wallis and Holder quarreled about the best method for teaching deaf people
This created an interest in deafness
18th century
18th Century:
Great growth in services for the deaf
Pereira (1715-1780) and de l’Epee (1712-1789) [France]
Pereira introduced education of deaf to France
De L’Epee founded first public school for deaf in France (manual method)
Deaf education was a public concern
De l’Epee also founded a school for the deaf & wrote a book and brought positive attention to the potential to learn of deaf children
Used fingerspelling, sign language, and speechreading
Heinicke (1727-1790) [Germany]:
Started school for the deaf in Germany (oral method)
Did research into hereditary nature of deafness
19th century
Development in understanding of hearing loss & deaf education
Thomas Braidwood and Watsons [England]
Operators of nearly all of the schools for the deaf in England:
–oral method of teaching
Braidwood’s grandson, John, came to USA & taught school in Virginia in 1815, but did not succeed (poor health)
Sicard [France]:
Manual approach to teaching language to deaf children
19th century time line
1807: Cogwell [Hartford, Connecticut]
Daughter became deaf from scarlet fever
Convinced friends to send Gallaudet to Europe to learn deaf methods
1815: Thomas Gallaudet (minister)
Went to England to learn deaf education methods, but Braidwood would not share methods
Went to Paris, where welcomed (de L’Epee’s school and Sicard)
Returned to USA with Clerc (student of de l’Epee) and set up own school
1817: The American Asylum (later: American School for the Deaf (first school for the deaf: manual approach)
1818: New York School for the Deaf
1843: Indiana School for the Deaf
1856: Gallaudet College in Washington, D.C.:
only liberal arts college in the world for the deaf
1867: Clark School for the Deaf:
(first oral school in USA)
Alexander Graham Bell
huge proponent for the deaf community
Mother and wife were deaf
Invented telephone, and saw its potential for electronically amplifying sound for the hearing impaired
Received money from the Volta Prize for his work with electricity .
Initiated the Volta Bureau in Washington, DC (1867), which became the Alexander Graham Bell Association for the Deaf