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47 Cards in this Set

  • Front
  • Back
diagnostics
counsel the client through the testing procedures and what should be expected, through the test results, and by encouraging them to tell their story (case history
treatment
potential treatment options limitations of each allow the patient to choose a treatment realistic expectation
counsel
important part of any plan,implemented throughout diagnosis and treatment, accept hearing loss motivate to develop treatment
Parameters of therapy planning
Stimuli, response, condition
Stimuli
• Spondees
• mono-syllabic words
• simple sentences
• multi-syllabic words,
• connected discourse
• numbers
Response
• detection
• discrimination
• identification
• comprehension
Condition
• noise
• rate
• articulation
• distortion
Vary stimuli
• redundant
• familiarity of stimuli
• level of complexity of vocabulary
• length of sentences
• amount of context
• rate of speech
Modify response
• length of response required
• closed/open set response
• require verbal/non-verbal response
• ask for main idea/details
Modify condition
• changing the amount of background noise
• changing the amount of distortion
• change lighting
• change angle from speaker
• change distance from the speaker.
refer for prof. counseling
unrealistic expectations, underlying psychological issues, or if guilt, anger, denial or depression does not lessen with aural rehabilitation
Informational counseling sig other
importance of non-verbals, environmental controls, understand care of HA and use, not to enable, assertiveness training, comm. strategies
Experiential sig other
play a speech reading CD, watch TV w/ volume turned down, attend speech reading training to help with empathy and address any coexisting speech problems
char. of clear speech
• Longer pauses
• Increased durations of speech sounds
• Longer vowels
• Longer sibilants
• Consonant vowel ratio-vowel intensity relative to consonant intensity-in clear speech consonants are produced louder leading to more comprehension
Advantages of clear speech
• More words in the middle of a sentence are understood w/ clear speech
• Inter-word pauses increase
• Fewer phonological modification such as vowel reduction and stop burst deletion.
• Vowel formants tend to achieve ideal values more often
• Intelligibility is increased by 70% in background noise
• More beneficial in an environment with reverb
90 day treatment plan
Functional outcome goals,functional categories, 90 day focus goals, may include pretesting
Functional outcome
o Improve aural encoding and comprehension skills-receptive
o Analytic and synthetic
• Functional categories
o Analytic
 Discrimination
 Identification
 Awareness
 Phoneme viseme correspondence
o Synthetic
o Word recognition
o Context for sentence closure
o Communication strategies
90 day focus/goals
• Behavioral objective: Corrinne will repeat ten spoken words by the clinician without voice in the presence of speech babble with decreasing signal to noise ratio with 80% accuracy over three consecutive sessions.
Levels of hearing aid care
Independent, partial assistance,full assistance,supervised use
Independent use
• Individual knows how to care for hearing aid
• Report own problems
• Replace batteries
• Cleaning
• Storage
• Changing programs for specific situations
• Removal and insertion
Partially assisted use
• Remind when to change battery
• Ask if everything is working okay
• Remind to clean and care
• Offer assistance when struggling
Full assisted use
• Hearing aids kept at a nurses stations
• Staff does everything
o Cleaning
o Battery changes
o Report problems
o Storage
o Removal and insertion
Supervised use
• Hearing aids are only used when someone is there to supervise
• Call company if there are problems
• Only provided when patient needs the hearing aid
Type of long term care facilities
Rehabilitation centers and nursing homes
Rehab center
• Short term
• Seen as a step forward
• Dealing with emotional issues
• Ability to communicate is crucial
• Hearing loss is often overlooked
Nursing home
• Longer length of stay
• Loneliness, other emotional issues
• only 10% of patients who need a hearing aid have one
Why nursing home short HA
no audiologist
• hearing aids get lost
• compliance on part of patient is low. why? already dealing with so many new
• things, he/she does not want to deal with new hearing aids
• little or no family involvement, and no money for hearing aid
• no one to clean the wax out of patient's ear can be a problem
Presbycusis
The decline in hearing associated with various types of auditory system dysfunction that accompanies aging-high frequency sensory neural loss (neural, sensory, metabolic, and mechnical)
Neural presbycusis
loss off neurons in the cochlea results in poor speech recognition
Sensory presbycusis
Loss of outer hair cells and supporting cells in the basal turn of the cochlea-high frequency loss
Metabolic-
lack of oxygen and release of free radicals genetically linked-affects the organ of corti
Mechanical-
causes a stiffening of the basilar membrane
Prevelence presbycusis
25-30% age 65 have some hearing loss, 50% by 70
Population diff presbycusis
Gender differences-Men lose at about 3dB/decade lose as early as thirty-70-80% of nursing home pop.
characteristics of hearing loss that affect communication
Degree of hearing loss
2. Age of onset-this is key because it tells you how much experience the person has
had with language before hearing loss
Psychological impact HL
Denial
Frustration and inadequacy
Rather than confront the problem, some choose to withdrawal
Isolation and loneliness
May lead to depression
Procrastination in diagnosis and treatment
Wait 7-9 years before get hearing test and treat it
Feelings of anxiety
Perception that others will treat one differently if they know the person has a hearing aid
May become withdrawn or arrogant (aggressive)
models of vestibular rehab
Substitution therapy, habituating exercises
Habituating exercise
-help the patient adapt through repetition of the provoking activity-working to retrain the brain by rebuilding neural pathways
• Reaching to get a glass at of the cupboard-start a small levels then move toward the goal.
Substitution therapy
strengthen the balances system help use other systems to compensate for the vestibular problem
• Strengthen proprioception to help compensate for the loss of balance-ie sit on an exercise ball and work to maintain balance
• Strengthen use of vision-walking while maintaining focus on a particular object and using different ranges of head movement horizontally and vertically. Difficulty can be increase by making the client walk on a an unstable surface while focusing on the object. This coordinates proprioception and vision together along with challenging the vestibular system
Physical compensation mechanism
can lead to other problems such as muscle stiffness
• Turn the whole body instead of just the head
• Look at the floor
• Hip sway
Tinnitus retraining therapy-decrease
response to repeated stimuli-retrain brain,annoyance factor,perception
Tinnitus retraining therapy-aid
AVOID silence-sound therapy at night, mod->severe sound therapy all the time, mild-counseling maybe sound therapy
Tinnitus retraining therapy-change
change patient view-understanding auditory system, hearing loss and tinnitus-inc understanding dec fear.
Tinnitus retraining therapy-brain
Remove fear, realistic expectations, remove from consciouness, change view, hyperacoustic/phonaphobic must fix first.
Counsel patient-therapist skills
establish rapport, empathy, expert on normal and disordered, realistic exp.,motivate, enhance clients well being, self concept and social relations
Counsel a patient-help
help w/ accept HL, help adjust to treat and lifestyle, help cope w/ changes and probs that won't go away,