Improve Your Listening at Home with Multimedia Aural Rehabilitation Tools
Imagine that you just had your knee replaced with a prosthetic device. The surgery is over, the wound is healing well but your new knee remains stiff and you have limited mobility. What should happen next? The answer is pretty clear. You will be instructed to undergo physical therapy, engage in home exercises to strengthen the muscles surrounding your new prosthesis and to train your brain to compensate for the novel physical characteristics of your new knee so that you can take full advantage of the surgical procedure.
Therapy is a well-accepted element of physical rehabilitation. Hearing loss is a sensory deficit rather than a physical injury but both share many similarities. We receive sound in the ear but we process and make sense of that message in the brain. Recent neuroscience discoveries have shown that the brain actually changes based both on new patterns of stimulation and from training. This is called neural plasticity and it has been shown that both a physical injury and a sensory deficit create neural plasticity that can be further modified through prosthetic devices and training. Just as therapeutic training will improve mobility after a leg injury, training will improve speech comprehension after you are fitted with hearing aids or receive a cochlear implant.
There have been many technological improvements in hearing aids. However, we know, for example, that while modern hearing aids may make acoustic signals audible, they do not automatically result in speech comprehension in noise. They also do not correct maladaptive strategies that people who have gone years with untreated hearing loss develop to compensate for hearing and understanding correctly. Just popping in a hearing aid will not produce an instantaneous adaptation of the auditory system and optimal auditory skills – for this you need training.
There are several types of training that might help a hearing impaired person. With analytic (or bottom up) training, you practice specific sounds of speech rather than working with words, sentences or meaning. Most commonly, analytic training includes learning to recognize and tell the difference between consonant sounds. Synthetic (top down) training focuses on gaining the meaning of a message through various communication strategies including improved hearing, attention, use of context and repair strategies. Synthetic training has been proven effective in teaching people with hearing loss to better use active listening strategies which usually translates into improved social and emotional well-being.
Such training on a one-to-one basis can be both time and cost intensive. Fortunately, there are alternatives available in our high-tech world via computerized auditory training. Computerized training is already popular in therapy for other sensory deficits, as well as for cognitive disorders such as aging-associated memory deficits and early-stage Alzheimer’s. Because computerized training can be performed in the privacy of one’s own home, you can proceed at your own pace while your progress is monitored by your hearing healthcare professional.
Computerized programs can be tailored to fit individual needs, including stimulating multiple senses and using more than one modality. For example, auditory training can be coordinated to visual input to improve lip reading skills.
A number of speech perception computer-aided programs have been developed and researched. They include Dynamic Audio Video Interactive Device (DAVID), which contains video presentations of sentences that can be visual only, auditory only or visual and auditory; and Computer Assisted Speech Perception Evaluation and Training (CASPER) which contains sentences and single words, same-different tasks, and nonsense syllables, words and phrases.
Then there are programs to be used with a hearing healthcare professional: Computer Aided Speech-reading Training (CAST), a computerized program for adults that simulates face-to-face communication for the purpose of training speech reading; and Computer Assisted Tracking Simulation (CATS), a program that presents 10 short stories, one paragraph each, read by a female speaker. The subject views a video recording of the stimuli sentence-by-sentence and is asked to repeat the utterance back verbatim. This requires a human observer to decide whether the answer was correct or not. If the answer is not correct at all, the sentence is repeated. As errors occur, the speed is slowed down. If errors persist, sentences are presented at very slow speeds with exaggerated articulation.
Other Programs
Seeing and Hearing Speech is designed for both auditory and visual speech perception training.
Conversation Made Easy offers structured auditory and visual speech perception training, as well as exercises in conversational strategies.
Computerized Laser Video-disc Programs for Training Speechreading and Assertive Communication Behaviors presents analytic and synthetic aural rehabilitation issues, as well as assertiveness training exercises for adults and school-aged children.
Speechreading Challenges on CD-ROM is an interactive computer application using 150 different speakers ranging in age from four to 70. Speakers are shown at different angles and may chew gum, have mustaches or speak with accents. Stimuli are sentences organized by topics and may be presented in visual format only or audio and visual.
Sound and Beyond is designed for individuals with cochlear implants and has modules progressing from perception of tones to word discrimination.
Unfortunately, as of yet, none of these programs enjoy widespread usage. Some computerized auditory training programs designed for children have received widespread attention. Examples of these include: Fast ForWord, a training program developed for children with learning problems, and Earobics, an adaptive, early literacy skills training. It systematically teaches phonological awareness, introductory phonics and listening skills required for learning to read and spell.
A new program for adults, Listening and Communication Enhancement (LACE), includes listening tasks focusing on perception of speech in babble, time-compressed speech, competing speakers, a short-term memory task and identification of missing words in sentences. LACE is based on the concept that even people with normal hearing can be poor listeners. Good listening skills are one of the components essential for effective communication. Other components include rapid thought processing, auditory memory, language skills and interactive strategies. These abilities can be damaged both by hearing loss and by the natural aging process. LACE is designed to enhance the ability to communicate by training the brain to best utilize these skills.
LACE recently underwent testing at five sites and was proven to be effective for improving listening skills in noise, building confidence and enhancing communication strategies.
There is no question that as scientific knowledge increases, there will be more interactive multimedia training tools available for people with hearing loss. One of the biggest challenges, however, will be to convince both people with hearing loss and their hearing care professionals of the need for their involvement in these programs.
