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As printed in Hearing Health, volume 20:3,
Fall 2004
By Nannette C. Nicholson, Ph.D., and Jerome
G. Alpiner, Ph.D.
Successfully managing hearing loss takes patience and
persistence. Many people fiind that aural rehabilitation
provides valuable assistance as they strive to achieve
better hearing.
Aural rehabilitation is a process for lessening the
consequences of hearing loss on your everyday life.
It is composed of an interactive relationship with a
hearing care professional and a continuum of services.
In the past, the main components of the rehab process
were training in lipreading and listening exercises.
Today, the list includes a thorough hearing evaluation,
intervention with hearing instruments and counseling
before and after your selection of hearing technology.
Getting the most from aural rehabilitation is contingent
on your ability to understand the process and to invest
time and energy into it.
Client-Centered or Family-Focused
The two primary approaches in contemporary aural rehabilitation
are client
centered and family-focused. A client- centered approach
begins with a discussion between the hearing care professional
and the person with hearing loss. The client’s
interests set the rehab agenda, whether they include
finding out more about hearing loss or tinnitus, learning
about programmable or digital hearing aids, etc.
An essential part of the process is examining and understanding
the individual’s natural communication environments,
such as family, work and recreational activities, so
that intervention can be aimed at meeting the specific
needs that arise within them. Any decisions about hearing
aids and assistive technology are needs-based and success
is measured by whether or not needs and expectations
are met.
A family-focused approach is frequently used when family
members serve as the individual’s primary communication
partners. The family is identified as the unit for which
outcomes of rehabilitation must be positive. Family
members are included in assessment and intervention
and the success of the rehab process often directly
reflects the entire group’s commitment to creating
an improved communication environment.
Exploring Expectations, Technology
and Communication Skills
Honing expectations is an important part of the aural
rehabilitation process. Determining yours is a crucial
first step. Next is learning how realistic they are.
A little bit of time spent in adjusting expectations
may make the difference in achiveing a successful outcome.
For example, common expectations among people new to
wearing hearing aids are that understanding speech over
the telephone, television and at theaters, churches
and other public gatherings will be easy and that one’s
own voice will sound natural. More realistic expectations
might be that watching speakers’ lips and faces
will remain an important part of communication, some
television programs will not be easy to understand and
it may be difficult to separate one word from another
when listening in the presence of background noise.
Examining expectations before and after you begin
using hearing technology is one way of measuring the
success of aural rehabilitation. Responses on pre- and
post-
fitting counseling questionnaires can be useful for
your hearing care provider in assisting you to achieve
maximum benefit from your new hearing instruments.
The next step is determining which technology will
provide appropriate intervention for your hearing loss
and listening needs. Perhaps special hearing aid features,
such as directional microphones, volume control, a telecoil
or listening programs, would provide helpful solutions.
Your hearing care provider can review the available
options and their potential benefits with you so this
information can receive consideration when choosing
an instrument. Assistive listening devices may be discussed
as a possible addition to address particularly troublesome
yet frequent listening situations.
Finally, you may want to learn new communication skills
through lipreading training and/or listening therapy.
Instruction may be provided by a hearing care professional
or prescribed through local universities or speech and
hearing centers.
You can also learn to use communication strategies
that focus on anticipating likely conversation and listening
situations when preparing for an event and learning
to “repair” communication when a breakdown
occurs.
In sum, aural rehabilitation is an ongoing process.
Patience with the process and a commitment to keep trying
are key. Successfully managing your hearing loss requires
open and honest communication between you and your hearing
care provider.
You also must remain honest with yourself. Be aware
of any change in your
listening needs or hearing abilities and be willing
to promptly seek assistance. Inform your hearing care
provider about your likes or dislikes about the performance
of your
hearing technology and give him/her the opportunity
to make adjustments to ensure your continued satisfaction.
With positive interaction as a foundation, aural rehabilitation
can indeed lead to
better hearing and an improved quality of life.
Nannette C. Nicholson, Ph.D., is an
assistant professor at the University of Arkansas for
Medical Sciences and University of Arkansas at Little
Rock and on the clinical staff at Arkansas Children's
Hospital. Prior to assuming these positions, she worked
for 20 years as a clinical audiologist providing diagnostic
and rehabilitative services and served as a professional
advisor to Self Help for Hard of Hearing (SHHH) groups
in Alabama and Oklahoma. Now the professional advisor
to the Central Arkansas SHHH chapter in Little Rock,
she is also a member of the Arkansas Association for
Hearing Impaired Children.
Jerome G. Alpiner, Ph.D., now semiretired,
has emphasized aural rehabilitation throughout his career
and written numerous texts and articles on the subject.
He has chaired university audiology and speech pathology
departments, served as chief of audiology in several
VA Medical Centers and received the Award of Honor from
the Academy of Rehabilitative Audiology. He resides
in Centennial, Colo., where he is a volunteer probation
officer and the evaluator of hearing aid assistance
applications for indigents at Friends of Man, a nonprofit
organization.
Related Articles:
Aural Rehabilitation
Strategies to Improve Communication
A Technology Tour
with Mary
Conquering
Couple’s Hearing Gap
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