Adult Aural Rehabilitation: Therapy and Goals

This course is an edited transcript of the webinar, Adult Aural Rehabilitation: Therapy and Goals, presented by Lindsey Zombek, MS, CCC-SLP, LSLS Cert. AVT.Learning OutcomesAfter this course, participants will be able to:List a consideration for therapy practice when working with an adult with cochlear implants.List a therapy target for adults with cochlear implants.List an appropriate therapy frequency for adults with cochlear implants. IntroductionThis course is part two of a 2-part series on Adult Aural Rehabilitation. Part 1 is entitled Adult Aural Rehabilitation: Indications and Assessment, and covers what is aural rehabilitation, who should get it, what's the evidence say about it, and how and what to assess during aural rehabilitation.What is Aural Rehabilitation?I'll start today's course with a quick review. Here is a quote from the American Speech-Language Hearing Association that provides a good explanation of adult aural rehabilitation: "If you are an adult, aural/audiologic rehabilitation services will focus on adjusting to your hearing loss, making the best use of your hearing aids, exploring assistive devices that might help, managing conversations, and taking charge of your communication."  Adult aural rehabilitation helps people adjust to hearing loss. It includes ways to maximize their use of hearing aids and cochlear implants, and educates them about assistive devices. It also helps them learn to manage conversations including conversational repair and prevention of conversation challenges. Overall it helps people take charge of their communication. Aural rehabilitation also addresses how to limit the negative effects of hearing loss and on communication in daily life, and how to compensate for hearing impairment. There are a lot of components to aural rehabilitation (or rehab, for short). Aural rehab is strongly about counseling and education and may include auditory training skills, communication skills, environmental modifications, and technology training. Aural rehab is individualized and addresses whatever the adult is struggling with regarding their hearing loss. We look at how we can help them to overcome some of the challenges that they're facing.Evidence for Aural RehabilitationIn terms of evidence for aural rehab, there are studies that show that aural rehab is effective. However, aural rehabilitation is so diverse that there are not studies that will say "Aural rehabilitation works".  Research proves that various target areas within aural rehabilitation are effective. We also know that we can't measure everything that we do in adult aural rehabilitation. So efficacy data is lacking in some areas. We have evidence for different forms of training, for improvement in environmental sounds and sentence recognition, for better consonant and vowel recognition, improved articulation, improved music appreciation, and improved telephone use with adult aural rehabilitation. Refer to the course handout for a list of some of these studies, and refer back to Part 1 of this course where evidence is discussed in greater detail.Special Considerations for Aural RehabilitationBefore we start aural rehabilitation, there are some things we need to consider.What Amplification or Devices to Target?What amplification or devices do we use during therapy? What do we target? Sometimes people get amplification for both ears at exactly the same time; we call this simultaneous amplification. A person may get two cochlear implants, or two hearing aids, or they may get fit with a cochlear implant and hearing aid at the same time. In that situation, we want to still practice each cochlear implant, or each hearing aid. We want to practice the skills with each form of amplification individually to make sure that they are hearing as well as they can from both devices. When we work with both together, all that tells us is what their better hearing side is doing. It's important that we know what both forms the amplification can do, because we never know when batteries will die or when a device will malfunction. We'll want to ensure they hear equally well with each device, or as well as possible. With sequential amplification, a person gets fit with one form of amplification for one ear/side, and then there is a period of time before they are fit with the second device.  In that case, we practice with a new device alone. If you feel that they haven't maxed their potential with the first device, then you can certainly work with that also. Even if they're doing well with the first device, you will work with the second one. When you get a second cochlear implant or a second hearing aid, the experience may be completely different from the first. You still need to develop the neural pathways on the second side. We're seeing more and more people who are getting cochlear implants for single sided deafness (SSD). With SSD, consider either plugging the better ear, using a sound muff, or in some way making it so that the person isn't hearing with their better hearing ear. That way, you can gauge better what they're getting through their new amplification. With a lot of the current hearing aid and cochlear implant technology, there's an option to stream audio or a voice directly to the device.  If streaming is an option, you can send your targets and the practice program right to the cochlear implant or hearing aid without the other ear hearing, so it is a great option for aural rehab for SSD.  It is important to recognize that when people use accessories and assistive listening devices it's okay to practice with them in therapy to give people the best possible listening conditions. At the same time, you can ensure they know how to use the assistive devices. For example, if someone has an FM or DM system (like a microphone and speaker system connecting to the cochlear implant or hearing aid), go ahead and use those during therapy. If you're intentionally trying to test the situation or test that specific auditory skill, then you can try it without the assistive listening device intentionally as a way to worsen the listening conditions and make it a more challenging target as their skill increases.PositioningIn terms of positioning in the therapy room, remember that distance makes things more challenging when you're trying to listen with hearing aids or cochlear implants. Sound intensity decreases with distance, so the further away you are from the person with hearing loss, the less sound there will be reaching them...