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162 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What would be a good measure to use before and after tinnitus retraining therapy
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Tinnitus Handicap Inventory
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. Do you want a lower or higher score on theTHI after therapy?
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You want the score to become lower, indicating that the tinnitus is having a smaller impact on life.
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What emotion/attitude will help us best recognize our similarities with our patient and then develop rapport?
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Empathic Understanding
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How do psychotherapy and personal-adjustment counseling vary and which kind of counseling should we be doing?
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The goal of psychotherapy is to explore a reorganization or reinterpretation of the personal conflicts the patients have within themselves. Operates with the premise that the patient is ill….in contrast Personal-adjustment counseling is based on a well-patient model and deals more exclusively with the problems at hand.
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. What is the Content Trap and how do we as audiologist “fall” into it?
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The content trap occurs when we fail to recognize the underlying motive to a patient’s question
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Give examples of a content/confirmation/affect based questions and how you would answer them
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Content Questions – seek further information or clarification
Confirmation Questions – seek to confirm an opinion or position the asker holds Questions with an Affect base – rooted in emotions |
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. What does it mean if an audiologist has self congruence and in what form of therapy is this discussed and why?
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An audiologist who feels competent in their abilities allow the patient to remain at the center of the discussion and doesn’t feel the need to present himself/herself as all knowing. It allows them to look past the “content” of the question to the reason for the question.
Person-centered counseling |
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What type of counseling are we using when we gradually guide our patients to a desired behavior through successive approximations
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Behavioral Counseling Theory
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What counseling approach holds the notion that “forward movement in rehab is impeded by basic irrational beliefs that yield self-defeating thoughts and behaviors”
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Cognitive counseling therapy
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What is another name for cognitive counseling theory?
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rational emotive behavioral therapy
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. Give examples of changes to constrictive language that might help a patient reframe their experience
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What is the worst thing…
Anything is possible, we make choices Changing from “but” to “and” statements Changing from “I am” to “I did” or “I have done” Changing from “I should” to “I want to” or “I don’t want to” |
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When should you make a referral to an outside counselor?
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When patient or parent has unremitting guilt that leads to abandoning other family, professional or personal responsibilities.
Parent or spouse needs a referral if they remain intolerant of residual communication difficulties within the family after treatment. Parent or spouse needs are referral if they become emotionally withdrawn from person with hearing loss. Parents with unrealistic expectation (high or low) |
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. What are Engle’s three stages of grief?
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Shock and disbelief
Awareness recovery |
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What are the 5 stages of the grief cycle that start after the initial impact/shock?
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Denial (defensive reaction)
Anger (personal questioning) Bargaining Depression or mourning Acceptance |
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Which of these stages are we least likely to witness as audiologists
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Bargaining (associated feelings – panic desperation shame and loneliness)
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What kinds of denial might we see in an audiology practice and how can we help a patient/parent work through this denial
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Denial that hearing loss exists
Denial of the implications of the hearing loss Denial of the permanence of the hearing loss |
(feelings might include alienation, tension, impatience and frustration)
Acknowledgement of the denial and the fears that may underlie it. “What would it mean to you if the diagnosis is correct?” |
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How should we respond to depression/mourning from out patients/their parents?
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Be present and supportive through an empathic understanding demonstrated by a willingness to listen
Allow patient/parent to feel less isolated as they confront their own fears, frustrations and sense of helplessness. |
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Bristor indicates that there is a stage where patients are “transcending the loss”. In what stage does this occur and where does it lead?
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Acceptance
Efforts to establish new goals and using one’s strengths and abilities to contribute to the quality of one’s life. |
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What is reaction formation and how might it be manifested?
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Unconsciously redirect emotions in an effort to avoid confrontation with a diagnosed handicap
Overprotecting the child or over-acceptance of the handicap Person rejects HA trial/potential benefits stating cost - may actually be unwilling to confront the personal perception of the handicap associated with the HA De-emphasize listening difficulties/blame others for communication problems |
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What are emotional projections and how can they be displayed by patients or audiologists?
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Projections of one’s past feelings into a current situation
May project feelings towards past authority figures onto audiologist (trust/distrust/dislike/admiration) Audiologists may carry prejudices and immaturities from our pasts (develop attitudes and negative feelings toward certain patients – elderly, infirm, multi-handicapped, obese) |
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. What are barriers to empathy?
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Habituation (I’ve heard this all before)
Generalization (all patients with this type of hearing loss experience generally the same types of problems.) Comparing (this sounds like my other patient) Being right (I know more than you) Multi-tasking (doing other things when we should just be present with the patient) |
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What has research shown is one way that audiologists are perceived?
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Insensitive and indifferent
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Why is good listening important?
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aids comprehension
reduces misunderstandings enhances critical thinking aids understanding of both verbal and nonverbal messages helps determine a person’s real needs/concerns |
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What are the 4 social styles and describe them?
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Driver
-Task orientated -Assertive -Holds emotions and feelings in check - Telling and controlling Expressive Assertive -Openly displays feelings -Emphasis on relationships -Intuitive -Telling and Emoting |
Amiable
-Openly displays emotions -Emphasis on relationship building - Asking and Emoting Analytic Low assertiveness level High control of emotions Information gatherers Ask and Control |
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What is our role in Grief work?
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We stand beside the one grieving
We are not someone behind trying to push one along We are not infront trying to pull one through their grief We don’t have to fix it Become a companion through the process Our job is to meet the person where he/she is in the process and to acknowledge difficulties |
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Define content counseling
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Content counseling – explains, defines and gives direction. Avoid jargon
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Define personal adjustment counseling
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Personal adjustment counseling – builds upon renewed perceptions of encountered difficulties. what we do day to day in our reactions. Can be done as an ongoing thing.
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Define person-centered counseling
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Person-centered counseling – we can not use it in Audiology. Guiding person to make their own decision without input from us.
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Define cognitive counseling
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Forward movement towards rehabilitative goals may be impeded through basic irrational beliefs. Eg- the world is flat, individual who thinks they can not use the FM system
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Define behavioral counseling
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Behavioral counseling – counter-conditioning program to achieve environmental changes that may produce positive behavioral change. Based on operant conditioning (hear a tone, drop the block) the patient has already conditioned themselves
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What are the attributes a good counselor possesses?
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Congruence of self – know who we are. Do we feel comfortable with them
Unconditional positive regard – Empathic Understanding/Empathic listening – really try to understand |
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What are the variables that that will contribute to the degree of comfort in the majority culture?
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length of residence within an adopted country
the concomitant support system an individual has developed socioeconomic statues as it impacts acceptance of Western medicine rehabilitative services level of formal education living environment age of the individual seeking services gender of individual seeking services |
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What is valued and admired in Western cultures which is not in others? Name some nationalities that do not hold these in high regards
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Time is valued and punctuality is admired.
Hispanic, Native American, African American and Indonesian gives punctuality a low priority |
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Many non-Western cultures are more orientated towards the present and the past. What differences does this make when treating an individual with hearing loss?
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they place greater value and respect for age than in our youth prized western culture.
Goals which are geared towards the here and now are more likely to be understood and accepted rather than long term goals. Goals should be focused on the here and now by stressing the benefits of amplification in reducing frustrations and family discord. |
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What is proxemics and what is a normal proximity for social interactions/everyday communications in western cultures?
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one and one-half feet to 4 feet for everyday interactions.
Can extend to 12 feet for social interactions. |
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List 5 of the do’s and don’t of effective interaction with culturally diverse populations.
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do be open to alternative forms of intervention as an adjunct to your treatment. Discarding another’s beliefs in the benefits of folk remedies, prayer, or nontraditional treatments gives a message of nonacceptance and many impede your own efforts.
Do not put heavy reliance on written communications for intake materials or take-home supplements that are written in English with those who may not be proficient in the language. Do not be informal in your greetings. Use appropriate titles and learn the correct pronunciation of names. Learn some common words and greetings in your patient’s native language Do acknowledge a desire to understand the patient’s problems from the perspective of his or her own culture and seek the patient’s input in this regard Do not expect an open desire to share all of the information you would like. Many cultures are uncomfortable divulging personal information or displaying their emotions. Do identify resources within the community for those who may find their won search efforts difficulty due to language barriers. Do learn about your patients’ cultural background so that you can adopt your approach to their beliefs and behaviours. Do not assume that a given culture is without its own internal diversity Do give time for patients to express themselves without feeling rushed. Ensure understanding of your own message by slowing your rate, articulating clearly and avoiding sentence complexity. Allow extra time for an unhurried visit. Obtain a translator if needed. |
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How do the culturally Deaf view hearing loss?
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They view deafness as a difference and not as a pathology or defect that needs treatment.
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True or False:
Many people can be considered part of the Deaf community, even if they are not deaf themselves. |
True: if individuals are active proponents of the deaf community and work with Deaf people to achieve their goals, they can be considered part of the Deaf community. One is considered a member of the Deaf culture not on the basis of their audiometric profile, but rather on the basis of their chosen identity through adoption of its language, its values and its practices.
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List 5 of the do’s and don’ts of relating to culturally Deaf people:
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Do not break eye contact when communicating with Deaf people. Lack of eye contact is considered with communicating with a visually-oriented communicator.
Do be facially expressive when communicating Do not take offense at direct questions regarding qualifications or personal life. Direct questions between one Deaf person and another Deaf person are culturally quite common and can spill into interactions with hearing people with no attempt to be rude. Do get a Deaf person’s attention by tapping the shoulder, waving your hands in the person’s line of sight, blinking the lights, etc. Do not touch the hands while a person is signing. Do not talk with another person in the presence of a Deaf person without signing or ensuring a clear line of sight for speechreading. Do be conscious of hearing loss terminology. Within Deaf culture the norm is profound deafness and a mild hearing loss may mean to the deaf person “very hard of hearing” Do not refer to the Deaf as hearing impaired, as such a label implies a defect. Do define Deaf person by their abilities rather than their disabilities Do not use the term “oral” as it implies oral ideologies, rather use the term “spoken English” or “spoken communication”. Do attempt to use sign language with the Deaf. Any attempt is appreciated, although if one is not fluent the services of an interpreter should be attained. |
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What are some academic risks for the Deaf individual when using manual deaf education or when attending a residential school?
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results in an fourth grade average reading level
1 in 3 will drop out of high school 1 in 5 who start college will finish with a degree High unemployment rate Their income level is 30 percent less than the general population |
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What is the fear around the cochlear implant and science?
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The Cochlear Implant robs children of their birthright and that science will someday wipe out an entire culture.
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True of false: We should not hesitate to make all parents aware of the variety of options that may be available to their children.
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True – we should give them all the options and let the parent decide the best choice for them.
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What are some important issues to remember when making a first impression with a patient?
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Don’t be too informal
Don’t use “elderese” Display professional confidence Avoid unimportant interruptions Keep small talk short and focus on problem |
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Where should the “locus of control” be?
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Patients need to learn to be self reliant rather than dependant on the provider. The social relationship between the provider and patient should not be one-sided. The interaction should move toward mutual participation
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Give an example of an open and closed question. Which is better to use with patients?
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It depends on the response that you are looking for. If you want a specific detail or short clarification than a closed question should be used. But, often you can gain more information using an open question. The open question allows the patient to dictate the specific area to be discussed.
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What is the difference between a neutral and leading question?
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A neutral question is free of the providers bias which allows greater latitude in the response given. Neutral questions are most appropriate while trying to obtain a case history or getting an idea of a person’s feeling about something.
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A leading question usually guides a patient to a desired response.
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Honest response
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Do not give false hopes or half truths.
May have to admit your own limitations You may not have all the answers and it’s ok to admit that to the patient. |
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Hostile response
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Usually comes out due to frustration
Patient’s hostility is often met with the provider’s hostility Confrontation should increase the patient’s confidence and not the audiologist’s |
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Judging response
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Comes when we pass judgment on a person’s feelings, actions or concerns
We may project how we think the patient should act or feel Patients feel less assured of themselves |
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Probing response
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Encourages further information, expansion, or clarification
Be careful of the direction these questions may lead May sidetrack the intended care |
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Reassuring response
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Reassurance may deny a patients real emotions
Could hamper the resolution of the emotions May serve to protect the audiologist’s feelings rather than the patient’s |
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Understanding response
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Helps foster a strong relationship between patient and provider.
Need a high degree of empathy Success depends on the unconditional acceptance of patients and their feelings |
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Silent response
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Sometimes viewed as uncomfortable gaps, but may be helpful in the clinic
Helps the clinician not to rush through the session Should respect the silence initiated by the patient |
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Nonverbal response
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Positive eye contact and gestures is important but can lead to patient discomfort if the eye contact is too intense.
Non verbal cues can be culturally dependent |
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When should counseling begin?
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From the initial exchange
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Why are self-assessments important and how can we use them in the clinic?
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Used to obtain a patient’s subjective impressions about their quality of life
Open a door to communication |
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What’s wrong with having the attitude of “don’t worry, be happy”?
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Dismissive of patient’s feelings
They feel less understood |
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When might clinical silence be necessary?
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Patients feel overwhelmed with emothion
May begin to cry, or trying not to cry Interrupting the silence may enforce the patients perception that it’s the audiologist’s job to fix the problem May be disruptive to patient’s attempts to gather their thoughts |
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What is cost-benefit analysis, and how can we use it in our counseling?
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Patients must see that the benefit outweighs the cost
Social costs may be greater than the literal cost of a hearing aid Audiologist may need to focus on the personal concerns of the patient |
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What are some good guidelines for sharing bad news with parents?
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Ensure privacy and adequate time
Assess parents’ understanding of the situation Encourage parents to express their feelings Respond with empathy and warmth Give a broad timeframe for action Arrange for a follow-up appointment Briefly discuss treatment options Provide information Document information conveyed |
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Extroversion vs Introversion
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Extroversion
Speak loudly speak rapidly overstatement repetition more talkative |
Introversion
speak softly speak slower hesitate understatement aloof and reserved must ask the right questions to get information |
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Sensing vs Intuition
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Sensing
examine components look at specifics focus on what is what can be is unsettling focus on A/R process |
Intuition
look for meaning gather random information focus on what can be what is is depressing look toward the A/R outcome |
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Thinking vs Feeling
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Thinking
seek to understand feelings seek objective clarity apply dicisions uniformly consider the cause/effect do A/R because it makes sense |
Feeling
seek to experience feelings seek harmony with people situational and subjective do A/R for others |
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Judging vs Perceiving
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Judging
remain more focused on topic built in time clock focus on one method/product offer decisive opinions |
Perceiving
easily change topics no concept of time or schedule generate/tolerate alternatives answer questions with questions |
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The following are issues to consider when working with SJ patients
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Intense need for the clinician to maintain control of situation;
Usually very cooperative, active participant in A/R process; Values and appreciates authority, but has high expectations; If adjustment is slow, can get very bored with the process; Easily follows detailed instructions and will organize priorities; Take responsibility for their own rehabilitative program; Prefer a detailed, practical, step-by-step approach (ie, “nitpicker”); Prefer specific objectives, but over analyze minor details; Need to be on time for appointments; fear of losing control. |
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Tendencies of Sensing-Perceiving (SP) Clients
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They want short explanations, and have a “please fix me” attitude;
No time for the hearing impairment; Just jumps into the process and may not follow your directions; If it appears to be not successful, these patients will give up; No time concept, distractible, avoid discomfort and decisions; Easily follow detailed instructions and will organize priorities; Constant drive to fix their “broken” hearing; Must consider the program a valuable use of time; May not read any of the materials unless absolutely necessary; Prefer a detailed, practical, step-by-step approach (ie, “nitpicker”); Intense need for the “spotlight,” communication is essential; Very prone to denial of the severity/impact of the hearing loss; No real long-term satisfaction, more likely to say “this never worked”; A/R program (fittings) must be immediately relevant; Pragmatic, concrete program—not interested in theory; Do not prepare, and prefer to just see what happens. |
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Tendencies of Intuitive-Feeling (NF) Clients:
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Respond best to positive reinforcement;
Intense need for communication with others; Set clear goals and expectations, do not oversell benefits; Feeling of obligation to others to do well in the A/R process; Are doing this for someone else, but want to be “good clients”; When unsuccessful, patients can become rigid and demanding; They will not give much positive feedback; Talk is cheap, just give them results; Usually very cooperative in A/R process and work very hard; Often have well-developed coping behaviors; Worry that they could have done a better job. Prone to self criticism; Never quite satisfied, always want a bit more; If unsuccessful, it will be their fault |
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Tendencies of Intuitive-Thinking (NT) Clients
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Likes detailed explanations, not impressed with credentials;
Over analyzes everything, but once convinced works very hard; Can present as aloof, intimidating, argumentative, and arrogant; Often impatient with the A/R (fitting) process; Sometimes complains about very small problems; Does not respect authority and pursues self improvement; When unsuccessful, may change program on their own; Most particular and independent of all types; Constantly thinking of how they can improve the procedure and your A/R program; Skeptical and often require lots of references and rationale for a fitting or A/R program; Tend to over-analyze the problem and try to fix it themselves. |
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Considerations for SJ Clinicians
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Do not expect every patient to be on time.
All patients do not want an organized step-by-step program. Do not be practical for everyone, especially the NT Patients. Do not focus on the procedure, especially for SPs and NFs. Do give clear objectives and prepare for situations. Have options when one treatment program (or hearing aid) does not work. |
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Considerations for SP Clinicians
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Do put up with long procedures when they are necessary.
Try to focus more on the overall outcome rather than the process. Accuracy of a particular adjustment or procedure may be more accurate than you think. Be tolerating of patient difficulties. |
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Considerations for NF Clinicians
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Be aware that you will never make all of your patients happy.
Good clinicians need to disagree with their patients sometimes. Focus and concentrate on boring rehabilitative treatment tasks. Do not expect everyone to care as much as you do. |
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Considerations for NT Clinicians
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Perfection is not always necessary.
Most patients need to have things simplified. Most patients do not require long presentations including the background for each procedure. |
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Why has there been an emergence of Father Support Groups that are separate from parent support groups?
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Often men experience a blow to their self-image when their child is not as perfect as they envisioned.
-They may have difficulty accepting their parental role -Their own views of societal roles may make it difficult for them to acknowledge that they are lost and unsure of what direction to take. -A fathers group provides an opportunity to express emotions and explore areas of discomfort that fathers may be reluctant to face openly with their spouses. |
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. Why is it disconcerting that the traditional hearing aid dealer’s format has been adopted by most audiologists?
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Most audiologists are fitting hearing aids in 3 to 5 appointments with no further rehabilitation.
More audiologic rehabilitation is needed! Rehabilitation encompassing group interaction geared toward enhanced recognition of, and intervention for, those variables within the environment, or poor speaker or listener habits, that impede successful communication. |
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Who can benefit from Adult-Group Intervention?
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Patients fit with amplification for the first time
Patients who decline hearing aid recommendations Patients who have been wearing hearing aids for years |
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What is the primary benefit to group intervention?
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It provides an avenue for peer support and interchange.
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What are the potential benefits to audiology clinics that provide group hearing-help classes?
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Happy patients = great word of mouth marketing
Fewer troubleshooting appointments Lower return for credit rates |
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Why is it a good approach to advertise classes as “Better hearing workshops”?
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Potential participants may be reluctant to sign up for a class labeled “therapy”.
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Why do parents in grief perceive being more on a rollercoaster than in a cycle?
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Because the grief is chronic, never ending. There will never be acceptance of their child’s hearing loss and the loss will always bring on new challenges in all stages of her/his life
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Why can’t parents process all the information provided right after the audiologist breaks the news?
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Because the amigdala, in times of distress, initiates hormonal responses that prevent activation of the frontal cortex.
Frontal cortex = part of the brain responsible for learning, processing, understanding, and remembering information. |
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How does gender impact the emotional responses to hormonal stimuli?
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Men: “flight or fight “response
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Women: “Tend or befriend” response
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What is it meant by “Communication mismatch” between audiologist and parents?
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When the audiologist delivers the news to the parents he is using his/her “thinking mind” and focusing on providing all the relevant information.
After receiving the news, the parents are usually in their “feeling mind”. They are unable to process the information and would be better assisted by providing support. |
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True or false:
A study from Dr. English (2000) showed that Audiology students can be sensitized towards the recognition of content vs. affect-based questions and can improve in recognizing them appropriately. |
True.
Pre- and Post-test responses of the students in judging the type of questions, changed significantly after taking a counseling class. Students more effectively identified affect-based questions hidden beneath content questions. |
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What is different today with respect to the past in the model of diagnosis? How does this difference increase the possibility of communication mismatch?
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Past: “Parent-initiated” model of dx. The hearing loss was first suspected by the parent that then started the process of diagnosis. Already in the mindset that something might be wrong. Confirmation and counseling may provide relief.
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Present: “Institution-initiated” model of dx (UNHS). Parent is unprepared to receive the news and counseling is more challenging in this situation (inability to process, denial, hostility).
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10 main steps in counseling when breaking bad news:
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1. The diagnosis should be given by the audiologist who administered the test and/or will be managing child’s aural habilitation
2. Ensure privacy, adequate time, absolutely no interruptions. 3. Listen for parents’ understanding of the situation + follow their lead (don’t overwhelm them with details unless they ask). 4. Acknowledge parents’ feelings 5. Respond with empathy and warmth |
6. Give a broad time frame for action staying sensitive to their preferences
7. Provide parents with concrete activities while awaiting next appointment 8. Immediately arrange for priority follow-up 9. At follow-up appointment: ask them what their questions are (review test results and treatment options, explain reasons for urgency, provide information about available support) 10. Document all information given. |
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Dr. English states we need not to focus only on a child’s ears. What did a study show about the psychosocial concerns for children with hearing loss?
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The children perceived themselves as shy, less likeable, and socially isolated.
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. Why talking about “speech and language development” to parents might not be a good idea? How should we word our counseling instead?
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Because parents might not understand what is it that we are talking about.
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We should mention aspects of communication that are more relevant to them. E.g.:
Your daughter will learn what you teach her about life She will be able to understand when you are talking seriously and when you are joking. She will hear your love in your voice. |
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Counseling has developed from the rational and logic clinical method originated in Europe during the Age of Reason. What are the implications of such a method?
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Counseling tends not to keep into account emotional responses to the news, life events, relationships, and environmental challenges.
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Briefly mention how do different paradigm shifts attempted to change medical care (and counseling) for the better.
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By developing common ground between patient and clinician;
by attending also to the patient’s emotions; by considering the social domain of the patient; by developing a “patient-centered” and “patient-provider relationship-centered” model of care. |
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How is a relationship-centered approach beneficial in audiology?
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Patients are more likely to stick to the program when they have a favorable relationship with the audiologist. When disappointments arise due to the mismatch between expectations and actual HAs benefit, the relationship with the audiologist supports patients by bridging the disappointment.
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Patients will better accept the limitations and recognize the benefits
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In the interaction between an audiologist and a family: how is counseling different if s/he feels responsible or if s/he is being responsive?
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Responsible: audiologist takes on responsibility for the solution, s/he knows what should be done, and s/he would focus on details and performance.
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Responsive: audiologist focuses on the dialog with the family and the choices they are comfortable with, respecting their multiple perspectives and focusing on the process.
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Define Self Concept and Discuss the I and Me concept
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Defined as the perceptions of one’s traits, attitudes, abilities and social nature – the way one describes oneself
Me is the objective self described by the following characteristics Physical and activity characteristics (age, gender, physical features, work or student status) Social characteristics (roles, relationships, personality) Cognitive characteristics (how one learns; intellectual interests;choices) |
I – Subjective Self An awareness of one’s effects on life’s events (a conviction that one actively structures one’s own experiences) An awareness of the uniqueness or individuality of ones’ life (no other life is quite the same) An awareness of one’s personal continuity or stability (by I, we mean “something always the same) |
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Discuss the stages of the development of self-concept?
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The four stages of “early self” development
An emergent self (birth to 2 months) or Here I am A core self (2-7 months) “Hey Look at Me, social smiles, vocalization, and eye contact emerge. A subjective self (7-15 months) During this stage, the child is aware that he has wants and feelings that are not apparent to others unless he expresses them but he has limited expressive skills. It therefore behooves the parent to try to “read baby’s mind” or more accurately, his body language A verbal self (15-18 months) The child’s language begins to develop, providing all the more opportunity for parents to convey understanding and acceptance of “who I am” with their verbal interactions. |
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How does a hearing loss affect the parent’s role in shaping a child’s development?
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Research has not provided an answer to this question
Hearing mothers of deaf children were found to be less responsive to their infants communication efforts Hearing mothers interactions were more directive, and their responses Deaf mother were far more responsive to their baby’s focus of visual attention |
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How can audiologists help parent’s in the area of self-concept?
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The idea of directly helping families develop their child’s self-concept is beyond our scope
WE can talk about self-concept informally during routine appointments We can approach these conversations from the immediate concerns that arise, and also mention “the longer view |
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How may the process of setting up parent support systems be unique to each community:
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Parents may initiate organize and run the entire process
They may ask for different levels of support from the audiology community and other agencies The minimal arrangement would involve maintaining a list of parents who are willing to talk and meet with other parents More involved arrangements might include regular group meetings with guest speakers and other forms of support |
Two key principles
Parents must decide how support will be given Providers must provide support only on request Hands and Voices |
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Discuss what the NIMH identifies as critical early school year characteristics and include those that hearing loss affects?
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Confidence
Friendliness Good peer relationships Ability to tackle and persist at challenging tasks Age-appropriate language development The ability to listen to instructions Attentiveness |
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What is the “Hearing Aid Effect”?
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Describe other peoples reactions to hearing aids
Study – 50 College students with normal hearing to view a set of photographic slides When the instruments were seen, individuals were given lower scores in the following categories Intelligence Capability Attractiveness Personality |
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How is emotional development of children with hearing loss directly related to concommittant delays in language development?
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When language skills do not develop at an age-appropriate rate, children have fewer experiences in self-expression, and therefore a delay in understanding their own emotions
Children with hearing loss may be less accurate in identifying others emotional states than children without hearing loss They may have a poorer understanding of affective words |
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Discuss the I Start/You Finish counseling activity?
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Set of open-ended statements
Ask the child to complete them This format is frequently used to encourage self-expression The evaluator looks for patterns of stress or personal outlook Seating arrangements can be side-by-side or at right angles in chairs. It is not recommended face to face on either side of desk or table Make sure child understands it is not a test Used to encourage self-expression Table 5.1 |
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What is the most unhelpful roles an audiologist can assume? And why?
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hearing aid police”
If our relationship with children is only to monitor the use of amplification, to scold noncompliance, and to reward compliance with offers of pizza we have created an unproductive dynamic We have not helped children obtain practice in considering options, making decisions, or testing the consequences. We have also not established ourselves as part of their support system They would only see us as the bad guys |
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Discuss the developmental tasks of adolescence?
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What kind of person am I.
Am I normal? Teens are scrutinizing their self-concept and deciding to accept or reject it They are beginning to establish their adult identity and when they have a hearing loss they must incorporate that disability into this new identity often without role models How do I fit in with my friends? Pressure to be like one’s peers is great |
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What are the three suggestions discussed for counseling teens with hearing loss?
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How would you answer these questions? - Survey
What would your best friend say? A good way to facilitate conversation with a teen is to include a good friend and to use a questionnaire as a springboard for discussion. Practicing Cost-Benefit analyses-Set up a discussion on the costs and benefits of one’s decision. The first step is to ask the students if they agree or disagree with benefits and costs of disclosing oneself as a person with hearing loss. Make up a blank version and have them fill in the blanks |
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Discuss the Me and I concept in adult patients
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The ME
Physical characteristics now include being hearing impaired Social characteristics, relationships, roles and personality have changed because the patient does not hear well Cognitive characteristics may affect successful rehabilitation |
The I
Awareness of ones effects on life’s events “I can be passive or I can make changes to affect my quality of life Awareness of one’s uniqueness of one’s life “My hearing loss has unique ramifications on my life” Awareness of personal continuity I am no longer a person with normal hearing |
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How might an audiologist handle working toward increased motivation for an adult patient to wear hearing aids? And which instrument might be useful in working towards this?
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It can be helpful to provide an environment psychologically conducive to exploration
Talking about how hearing loss affects ones life may not be easy for some patients We can use existing self-assessment measure as a springboard Quantified Denver Scale can help patients talk about self-concept concerns – 25 questions, four subsections |
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How is a hearing loss a chronic stressor?
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Because it is a persistent life difficulty concomitant with social strain and the potential to threaten or alter one’s self-concept. The strain of ongoing hearing problems could explain a great deal of the frustration, anger, and even despair expressed by patients
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What are two strategies people use to cope with chronic hearing loss and discuss them?
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Vigilance- living with a hearing loss requires a patient to maintain a high level of mental and physical vigilance to detect, process, and respond rapidly to unpredictable or hard-to-perceive auditory input. Because of the energy it takes to be vigilant, patients typically employ a range of strategies to gain respite or relief
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Respite- temporarily withdraw from social interactions or even turning off or removing amplification systems. Taking a break!
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How does aging affect the stress level of patients with hearing loss?
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Older patients can have multiple health problems
Among the elderly patients, hearing loss is frequently only one of a long list of chronic conditions with which they have to contend with Tainted view of the aging process |
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What are the 5 Rs of emotional well being in old age?
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Review
Reconciliation Relevance Respect Release |
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Discuss caregiver stress?
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Older patients lose their independence
Stress spreads downward to adult children Children become primary caregiver High stress if parent moves in with children Decrease social outlets and sometimes near social isolation that caregivers can experience only adds to the experience of caregiver stress Caregiver stress is beyond the professional purview of audiologists however we need to be aware of it |
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Discuss how hearing loss can lead to isolation
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Fully withdraw at times
Isolation can be both physical and emotional Physical isolation sometimes is respite as discussed before however emotional isolation is not a preferred state for human beings Patients with hearing loss at times describe this emotional isolation even just sitting in a room with people Strain on marriage |
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What is a good tool to use with adult patients that can serve as an invitation to discuss patient’s emotional responses to hearing loss?
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The Hearing Handicap Inventory for Adults
HHIA 25 questions twelve addressing a patients emotional response to hearing loss Three point scale, yes sometimes, no |
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What is important for an audiologist to keep in mind in working with patients with tinnitus? And how should an audiologist handle tinnitus counseling
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Important to keep in mind that a patient may be experiencing a loss of hearing and a resultant decrease in communication proficiency
The goal of any successful tinnitus program is reduction of either the tinnitus itself or the patient’s perception of or annoyance related to the tinnitus Audiologists working with tinnitus sufferers need to gain as great an insight as possible into how their patients perceive the disorder through a complete tinnitus interview which should include some self-assessment measures |
Of the patient’s primary concern does not lie with the tinnitus itself but rather with worry that has developed over what the tinnitus may represent
Once a full evaluation has ruled out the existence of any underlying medical pathology, misconceptions may be allayed. |
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List some important aspects of the physical location for this counseling session.
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Privacy
Seated side by side Not on opposite sides of table No phone No distractions No computer, no clutter, nothing on table No interruptions Dr. Hall is not reading from a file/chart No results present at all |
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Overall, in the APD video what type of counseling was being utilized? Why?
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Content/instructional Counseling
Dr. Hall did most of the talking Relaying test results to mother Mother rarely talked at all He was the teacher/professional He talked, she listened For the most part |
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) How many questions did Dr. Hall ask the parent? Were they “closed” or “open” questions? Give examples please
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About 5 questions
Mostly “closed” questions What grade is he in? Is he getting special services in school? Who referred him to us? Do you have other children? Really only 1 “open” question...stretching it Were the school people having some concerns about him? Really closed, but implies that she should give some details in her answer |
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In what way did Dr. Hall address the “hearing aid effect”?
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“we know that's very important and we know it will help him but we've also got to come up with a way for him to use it. Because some children don't want to stick out in the crowd so we're going to have to work on that.”
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In what way did Dr. Hall intend to involve other professionals?
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Dr. Hall discussed:
The IEP meeting knowing that the school committee will need to be on board Speech/Language Pathologist To work on phonological awareness Classroom Teacher handling/using the ALD's |
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How did Dr. Hall attempt to reinforce a positive self-concept for the child?
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Early on he discussed
How child is bright, but having difficulty learning Begin to think something wrong w/me, I'm not as smart as other kids Feel frustrated, angry, may act out in class Called it self esteem/psychosocial function |
At the end he asked mom
We want to make sure we build up self confidence Please tell him, driving home, we think he did really well and we have ideas to help him in school and make it easier for him to perform well in school |
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) In what ways did Dr. Hall demonstrate that he was an “active listener” with reassuring, “empathic understanding”?
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Good eye contact, head nodding, good posture
Reassuring comments Thanks for bringing him in, this is the right place to come, that's very common (in response to mom's statement), I'm glad you brought that up, I'm really glad you brought him in when he's in first grade..., that's another good thing that you brought him in early, that ties in perfectly with our results, like you say, etc. Repeating parts of her comments They're different kids, different strengths and weaknesses, like you say.. |
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What two treatment methods does Dr. Hall recommend?
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Classroom FM system
Teacher mic Receiver either headphones, speaker on desk, or entire classroom wired for speakers |
Earobics
Computerized “games” to improve auditory skills and phonologic awareness, reading comprehension and reading proficiency. |
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Why does Dr. Hall give the patient so much information on tinnitus before he really discusses the patient’s own tinnitus?
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to reassure the patient:
the other drs statements that he will have to learn to live with the tinnitus are false; we do know a lot about tinnitus; tinnitus is common-in fact everyone has some level of tinnitus |
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What are the simple steps that Dr. Hall gives the patient?
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think about tinnitus in a way where you know it’s not a danger signal, it’s just another sound
read the pamphlet of information on tinnitus. The more you know about tinnitus and the more you understand it, the more you understand your particular tinnitus the better you'll be buy a sound device for about $20 that produces sounds like a rushing water, falling rain, a mountain stream, sounds like that. Find a sound that you consider very relaxing and soothing and always have that sound on in the background. at night you can either have this device on as you go to sleep or you can get a pillow that connects to the device so that when you put your head on the pillow you’re hearing this same relaxing sound |
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What percent of patients see their problem solved by following these steps?
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80%
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Who is the typical tinnitus patient?
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male
around 50 years old a little bit of high frequency hearing loss that looks like it may be due to noise and the cause is the inner hair cell problem |
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How long does it typically take for a patient to see results?
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within six months but may be within six weeks
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. List some uncomfortable professional conflicts.
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“What is our ethical responsibility to the adults that we see?”
“What is our ethical responsibility to our pediatric patients?” What is our ethical responsibility to parents, spouses, and the adult children of the older adults that come in?” “Who is our patient when family issues conflict with patient desires?” |
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As audiologists, where do we often fail in the difficult situation between an elderly patient and their frustrated care givers, usually their adult children?
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we have to acknowledge the feelings with that patient
sometimes we can propose a solution-would you be willing to do something to lessen the communication frustration, use ALDs; adult day care; |
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What did Van Riper say?
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“Perhaps the most important of all the clinical skills…is the clinician’s ability to motivate his clients.”
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What are we trying to do when we reflect a patient’s feeling?
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Open up a dialogue
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What are 3 ways to use self-assessment measures in your clinic?
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to structure discussion about the impact of hearing loss
as a validation tool to build motivation |
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What is the Omega Strategy?
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Recognition of approach/avoidance-I want to do it for these reasons; I don’t want to do it for these reasons
Addressing the approach side attempts to win one over-celebrity endorsements, compelling arguments, added incentives; doesn’t work so well Need to look at negative side & address the avoidance. That reduces their resistance. |
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What does Dr. Clark say about literature?
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Literature from the manufacturer is promoting the manufacturer, the product.
We want to promote ourselves. We are the person who can help you for these reasons. So the literature you want to give them is explanatory of what their problem is, gives them further information to reflect on and is promoting you as the person they can come back to. |
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What’s the driving force behind any coping process people with hearing loss have?
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The goal is to avoid being looked at as a deviant person because I have hearing loss.
Social incompetence is consistently felt to be a more tolerable negative identity than being viewed as someone with a hearing loss. |
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If normal hearing is a full glass of water, and hearing loss is an empty glass of water (regardless of the degree of the hearing loss, empty is hearing loss), and hearing aids are going to fill your glass half way, what will get that glass of water filled ¾ of the way?
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aural rehab component-communication training
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Why don’t we do communication training?
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no reimbursement
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Why should we?
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lower return for credit means
money in your pocket fewer trouble shooting appointments word of mouth advertising |
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What are the 3 causes of communication breakdown?
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speaker factors,
listener factors, environmental factors |
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Speaker Factors
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Voice loudness
Rate of speech Clarity of speech Conflicting facial expression Foreign accents/ dialects |
Facing away from listener
Objects in the mouth Distracting mannerisms Emotions: e.g., anger, upset, etc |
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Listener Factors
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Degree of hearing loss
Type of hearing loss Improper use of hearing aids Failure to pay attention Fatigue Bothersome tinnitus |
Distracting sensations
Distracting thoughts Emotions Poor speech reading skills Unrealistic expectations |
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Environmental Factors
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Background noise
Poor lighting Poor acoustics Line of sight Visual distractions Room temperature |
Lack of ALDs
Lack of visual aids Distance factors Poor angle of vision Poor room ventilation |
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What is WATCH?
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W- watch the talker’s mouth
A-ask specific questions T-talk about HL/tell them what you need C-change the situation H-helpful gestures |
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What does Dr. Clark suggest that significant others do to aid communication? (slide 73)
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C-clear speech
A-attention first R-rephrase E-expectations |
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What 2 forms of prevention related to tinnitus did Dr. Hall mention?
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Prevention of damage to the inner ear
Prevention of deteriorating quality of life brought on by persistent tinnitus |
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In addition to noise exposure, what other risk factors are associated with the onset of the perception of tinnitus?
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ME problems-pressure behind TM due to ET dysfunction; sinus disease;
TMJ disorders; some chronic diseases (arthritis); high levels of personal stress; ototoxic drugs; often when 2 or more of these present simultaneously, tinnitus appears |
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What does a person w/ tinnitus need to know?
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It’s a symptom, not a disease
As much as possible about their hrg-documentation about the HL validates their concerns about tinnitus & provides an explanation for the tinnitus |
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. People with tinnitus should avoid _____ and, instead, surround themselves with ______ _____.
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People with tinnitus should avoid silence and, instead, surround themselves with pleasant sound.
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What does Dr. Hall suggest to achieve this?
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An inexpensive device to generate a constant, low level pleasant background sound.
Also a sound generating pillow might be good. |
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Why does this work?
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In the presence of the soft background sound, the brain must work harder to detect tinnitus
Since the background sound isn’t important or meaningful, the brain will gradually tune it out & along with it the tinnitus |
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Define resilience
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The ability to withstand and rebound from crisis and adversity”. (p 293)
“Resilience is that human potential to emerge from a shattering experience scarred yet strengthened.” (p 296) |
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What are the common characteristics of a resilient individual?
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High level of self-esteem
Realistic sense of hope and personal control Happy, easy-going temperament Higher intelligence Ability to feel deeply involved in the activities in their life Anticipation of change as an exciting challenge to further development Optimistic |
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What type of family relationships support individual resilience?
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Warmth, affection, emotional support, and clear-cut, reasonable structure and limits.
If not provided by parents, may be offered by older siblings, grandparents, or extended family. |
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How does a family resilience approach alter how we view families?
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Views families as challenged by a crisis or change, rather than damaged by it.
Families are viewed in context, rather than judging them against a so-called “normal” family. |
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What family processes are necessary for healthy family functioning?
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Cohesion
Flexibility Open communication Problem-solving skills |
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What is the difference between resilience and crisis management?
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Resilience involves multiple, recursive processes over time (approaching an impending crisis, during it, and in the long-term aftermath)
Crisis management focuses narrowly on an immediate response |
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How can community groups encourage a family’s resilience?
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Financial security
Practical assistance Social support Basic sense of connectedness |
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What differentiates a family systems counseling approach from a mere individual approach to problem resolution or adaptation?
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the focus on context - seeing the family and the problem through the eyes of each of its members.
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Challenges to resilience may range from expectable strains of normative life-cycle transitions to more prolonged strains. Name some strains in each category
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Normative: retirement, divorce, remarriage, sudden job loss, untimely death. Prolonged: migration or inner-city violence.
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What 3 characteristics do hardy personalities possess?
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(a) the belief that they can control/influence events, (b) an ability to feel deeply involved in or committed to the activities of their lives, (c) anticipation of change as an exciting challenge to further development
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What are the stages of family development?
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unattached adult, newly married, childbearing, preschool-age child, school-age child, teenage child, launching center, middle-aged adult, and retirement.
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According toFroma Walsh, what are the family resiliency factors for families function best?
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ü Cohesion within family unit
ü Flexibility in family structure ü Open communication between family members ü Problem-solving skills possessed by family members ü Extended family/ community support ü Affirming belief systems ü Capacity to make meaning of crisis experience |
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Relational resilience involves: _______________, _______________,______________,and ____________.
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Organizational patterns, communication and problem-solving processes, community resources and affirming belief systems
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