Aural Rehab Final
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. What would you like to do?
What do you do in a hearing aid orientation?
- Counseling session that we do after HA fitting.
- Encourage family members to attend
- Provide written information.
What are the 6 parts of a hearing aid orientation?
- 1. Components
- 2. Check fit
- 3. Telephone use
- 4. Inserting the earmold or tie (canal in first, then concha rim, then helox
- 5. Basic care and maintenance
- 6. Return visit during 30 day trial period
What are the 6 things you check during the return visit?
- 1. too loud?
- 2. whistling (feedback)?
- 3. comfortable?
- 4. is the HA helpful?
- 5. Problem inserting?
- 6. Any other problems
What is APHAB?
Abbreviated proflie of hearing aid benefit.
Describe more basic care and maintenance?
- 1. Damage is water or mosture (even persperation)
- 2. Problem is excessive heat (no hairdryer or sound)
- 3. Dust (not usually a problem)
- 4. Don't take it apart
- 5. Don't drop it
- 6. Extreme cold will not dame it but may cause temporary quit
- 7. Battery may leak or have corosion
- 8. Carry batteries with you
- 9. Don't eat a battery
- 10. Don't spray hairspray or insecticide
- 11. don't expose to xrays or radiation
- 12. Don't clean with alcohol or cleaning solution
- 13. Don't turn volume down to save battery
- 14. Don't keep batteries near metal
- 15. Don't put batteries in fire (they explode)
- 16. Take of every night.
A t-coil on a HA recieves _____ energy from a telephone
Describe phones in terms of the t-coil
- older phones naturally leaked electromagnetic energy
- new phones are designed to produce an electromagnetic signal = hearing aid compatable
- But digital cell phones often produce electromagnetic noise.
- HI consumers should try before buying a cell phone.
Hearing Aid Compatable
What are the T-coil advantages? What is on and off?
- 1. Reduces background noise
- 2. Eliminates feedback
In trouble shooting HAs, describe feedback
- Don't turn volume down
- Check ear mold fitting
- Tubing is old or cracked
- Impacted wax
- Internal feedback (squealing inside case)-send to factory.
When trouble shooting HAs, describe no sound.
- Check battery first
- cord on body aid is broken
- could be progressive HL
When trouble shooting HAs, describe intermittent sound.
- dirty volume wheel
- cord on body aid broken
- internal problem that is factory problem
- weak sound
When trouble shooting HAs, describe distorted sound.
likely internal in causing
You may also do trouble shooting for?
Broken HA case and internal noise
How often should you monitor children's hearing aid?
How much does a hearing aid stethoset cost?
What are the main parts of personal classroom amplificaion devices/trainers.
- Same basic components as a HA (Microphone-amplifier, receiver, power source.
- Key component is a remote microphone
- Remote microphone provides non- transmission of speech from the speaker to the hearing impaired listener
- Teacher wears remote mic and non acoustic transmission
What are the 3 environmental problems that the remote mic overcomes.
- 1. Distance (reduces to 3 inches and provides consistent signal level)
- 2. Noise: improves signal to noise ratio
- 3. Reverberation: virtually eliminates it.
What are the auditory trainer types?
Wire from mic to child. True wire connects it, Inexpensive, no interference. 40 years ago more common, used now in theaters or churches.
Describe Induction loop
electromagnetic energy, wire loop around room. Microphone changes to electromagnetic signal. signal is different around room (non-uniform distribution of signal) Can get spill over through walls- noisy not as clear
Non-acoustic transmission = radio waves
Typically the FM system was___ but now they are ____.
body type but now they are ear level
Describe the advantages?
- Complete mobility, good range
- No spill over if working right
- High quality (fidelity) signal.
Describe the advantages and disadvantages of FM
- Mor advantages or as many as other systems but less disadvantages
- No significant disadvantages.
What is the disadvantage for all systems?
hearing oneself or hearing others around.
- Non-acoustic transmission: light waves
- Newer but not better
Describe the advantages of infrared.
- High quality signal
- no spill over
- complete mobility in classroom but not outside(light admitters in walls and ceiling)
Describe the disadvantages of infrared.
- Non even (uniform)distribution
- can pick up environment noise (windows)
Describe the ideal auditory trainer system?
- remote mic and casing mic
- mic comfortably worn
- amp/receiver unit can be fit individually to student
- electronically flexible
- the binaural (seperate circuit for two ears)
- uniform signal throughout room
- high fidelity
- complete mobility
- no spillover
- cost effective
- simple to use and care for
- trouble lights
- adaptable to use outside classroom
Describe the free field classroom amplification
- teacher wears microphone but signal goes to loud speakers not personal receiver
- Does not overcome distance, noise, and reverberation like personal ATs but does reduce distance, and improves SNR.
- Especially useful when student HLL is slight/ mild
- Student may wear ha in addition
- appears to benefit normal hearing students also
- teachers like them (students attend better and saves teacher voice.)
Describe classroom acoustics and noise?
- 1. Classrooms are notoriously noisy
- 2. Noise disproportionately reduces the skills of HI individuals
- *external noise (traffic on busy street)
- * Internal noise (ventilator in school) -greatest noise source and some teachers turn it off during teaching.
Describe classroom acoustics and reverberation?
- 1. Classrooms are reverberant
- 2. Reverberation disproportionately reduces the skills of HI individuals.
What is the Reverberation Time?
The time it takes for sound level to decrease by 60 dB
What are the 3 ways the issues of classroom acoustics is being addressed.
- 1. legislation- laws concerning construction of school buildings
- 2. Standards = asha and other professional organization developing standards for the classroom listening environment.
- 3. Building codes.
What are the assistive listening devices (ALDS)
- Telephone amplifiers
- Pocket talker
- Personal amplifiers
- Specialty Amplifiers
- Personal amplifyin systems for rooms
Describe telephone amplifiers. what is the symbol.
- Built into telephones (cellphones& others)
- Land-line phones without amplifiers (pocket size unit fits on handset receiver $25)
- In line amplifier ~50
- Commonly 30 dB gain
Symbol = telephone with volume control
Describe the Pocket talker?
- similar to HA
- Microphone, receiver, amplifier
- Useful in Dr. Office to help patient hear dr.
Describe the Personal amplifiers
- Could be used to watch tv
- radio frequency or infrared unit
Describe the specialty amplifiers
Amplifier in stethoscope for nurse/md
Describe personal amplifying systems for rooms (w/ remote mic near speaker)
Theater, church, lecture hall, concert hall, courtroom, training areas (operating room in med school)
Distance, Noise, Reverberation
Know the assistive listening system symbol.
Describe Direct audio imput
- A HA feature to provide a remote mic - hardwire or FM (boot)
- Recommended for children's HA
Describe Alerting devices
- For severe HI Persons
- To signal presence of doorbell, telephone, smoke detector, wake up alarm, waking child, police siren, automobile directional signals.
- Signaling stimuli: flashing lamp, strobe light, tactile stiuli (wrist band bed shaker-fan) louder sound (or modify to frequency they can hear).
Describe Speech Recognition devices
- Can be very expensive
- EX: icommunicator
- Converts speech to text or to video sign language
- Converts text to computer generated voice
- requires speaker training and personal microphone (for consistency)
- Used in the classroom
What is a chochlear implant?
- Replaces cochlea and is as small as a penny
- An electronic device to replace to organ of hearing (needs battery)
How much does a cochlear implant cost?
Cochlear implants are ______.
Children who are fit with CI ______ .
Adults who develop hearing loss
- highly successful (but not with everyone)
- early in life and who receive proper management often develop age appropriate speech and language
- after language acquisition display improved speech understanding
Who are the best canidates for CI?
Describe why cochlear implands are unique and different then a hearing aid or other amplification device
- Bipases organ (cochlea that doesn't work.
- Hearing aid: amplifies filters and otherwise manipulates sound and sends it through to damaged organ.
- Cochlear Implant: Bypasses damaged organ and sends the signal directly to the 8th nerve
- The cI is a tiny computer and used to be pocket but are now ear level.
What are the outside components of the cochlear implant?
- Processor (computer)
- Transmitter (side of head)
What are the Implanted components of the cochlear implant?
- Receiver and electrode wire
- *these are simple and not usually replaced
Describe how the wire is placed?
- goes through the round window
- wind the electrodes in cochlea to get all frequencies ~ 1 full turn out of the 2.5 in cochlea
- Cortex is layed out like cochlea of one side has high frequency and one has low frequency.
Describe the Candidates for a CI- do they apply what are the primary and secondary qualifications.
- The candidates must qualify for CI (insurance pays for cochlear implants).
- Primary qualifications: 1- severe or profound hearing loss in both ears (permanent, cochlear, some auditory neuropathy patients) 2-Little or no benefit from a hearing aid.
- Other qualifications: 1- x-rays;mri 2-physical exam 3- psychological exam (family as well) 4- interview (commitment and appropriate expectations
Describe the degree of benefit from a cochlear implant and how long has it been in use?
- It is not predictable.
- It has been on the increase but not predictable.
- In use ~30 years.
Initially CI were only for _____ but now _____
- children at age 12 months (and younger)
Why is CI especially important for young children?
Because they aid in learning language.
WHen is most language learned?
first 3-5 years of life
Language is critical for
reading, academic performance, social emotioanl adjustment and career.
CI have not been well accepted wher>
In the Deaf community but things are changing
Describe the UW Thesis (1992)
- Survey of the Deaf community members in colorado.
- -47% of respondents indicated no desire to hear or hear better.
- -Although most felt that a cochlear implant should be an option for Deaf people, 82% said that they would not get or probably would not consider a CI
When we started the treatment of children with cochlear implant ________
has sparked particularly fierce controversies.
What is the view in favor of cochlear implants?
- typically the view of parents with normal hearing ~ 90% of deaf children are born to hearing parents.
- Children should be given every opportunity to succeed in the world
- Children should receive a CI at as young an age as possible for maximal language learning.
What is the view opposed to the cochlear implant?
- typically from some members of deaf community
- Deafness is not a disability. it does not need to be fixed. Deaf people are different, not impaired or inferior relative to hearing people.
- Children fit at an early age have no choice in deciding if they want to be deaf or hearing
If deaf children become hearing children through the cochlear implant, ..
deaf culture and the deaf community may eventually disappear.
What is the range of success of CI?
wide range of success: sound awateness only to relatively good speech understanding.
In the case of older children and adults what are the CI results?
best for individuals with previously good speech and language skills.
how many adults and children have been fit with a CI world wide?
how many people have a CI in both ears?
5,000 and increasing in most recent years.
Who regulates CI and who performs surgery?
- Performed by otologist (ear or ear-nose-throat physician) with special training.
Who are the team members on the CI case?
- other medical personnel (nurse etc)
- Speech language pathologist
Team activities for CI team
- determine candidacy
- pre-surgical counseling
- surgery (1 night stay)
- Fit the processor (4-6 weeks after surgery)
- Ongoing processor adjustments
- long term rehabilitation program
resetting electrical signals of the CI to produce stimulation at soft to comfortable loud levels
what is the cost of a CI and who pays?
- Private insurance pays for most CIs.
- Also medicare, medicaid, VA, Vocational rehab services.
What are the risks associated with having a CI (child)
- General risks associated with surgery and anesthesia (infection)
- Slightly higher risk of meningitis
- Risk that cochlea will not be available for more advanced treatments in the future years (one or both ear)
- risk that the CI will not be effective and may delay other habilitation strategies
- Defective CI and more surgery
- related expenses.
What are the risks associated with NOT having a CI?
Child will not achieve his/her potential with regard to language, speech, communication, reading, academic performance, social-emotional adjustment, and career.
Describe the Telephone use with CI
- Telecoils are also available in the CI
- Avoids background noise
What is an Auditory Brainstem Implant and when is it used?
- Electronic device to replace cochlea and 8th nerve
- Used when can't use cochlea or 8th nerve
- Electrode pad inserted adjacent to the cochlear nucleus
How many ABI have been fit and in the US what are they approved for.
- Neurofibromatosis Type II (bilateral tumors)
- Usually placed during removal of NF2 tumors
What is the success of ABI? What is important?
- WIde range of success- some success equivalent to that of CI, others detect sound but cannot recognize words.
- Importance of "auditory contact" with the world.
What is the vestibular Implant?
- Brand new and currently in experimental stage (one human fit as of march 2012)
- desgn and some of instrument are based on CI
- Three tiny gyroscopes in external processor
- Each of the three lines stimulates one semicircular canal
- designed especially for meniers's patients
Describe Tactile Aids?
- provides tactile sensation to sound (feel sound)
- tactile = vibratory or electrical (tickle on skin)
- cost $1000
- trial period
- no risk
- effectiveness: Awareness of sound only
What is a Telephone/communication device?
- tty or tdd
- typed message is coded into electronic pulses, sent through telephone lines, and decoded and displayed for the person receiving the message.
Who uses a telephone/communication device?
- used by deaf persons to communicate by phone (now texting is possible)
- Both parties need to have ttyp or use relay system
Know the symbol for the TTY
What are the features of a Telephone or communication device?
- cell phone connector
- pocket sized also available
- full size keyboard
- 80 character display
Previously the tty was the only method for deaf individuals to have distance communication but now....
- a revolution in communication alternatives
- relay service
- telephone text message
- web cam
- telephone captioning
- video relay
Describe the relay system and what it is called in wyoming?
- Wyoming Relay System
- Communication between a HI person (using a TTY) & a hearing person (no tty) through a relay operator
- HI person can
- A) receive text and
- B) send text or use VCO
What is VCO?
- Voice Carry Over
- Means HI persons speech is intelligible.
A video relay system for computer or handheld device.
Describe telephone captioning service
- CapTel (captioned telephone)
- HI person has telephone with text capability
- go through relay person
- Call HI person & captel the captel person types to the HI person and speaks to the normal hearing person.
- The text display of telephone conversation on a special telephone
- Real-time captioning via captioning secive.
Describe the Captel audio conversation and captions
- Less time delay and more personal than relay
- special telephone with display ~495 (may be available free through wyo relay program) now available on the iphon
- Captioning service, like relay service is not charged to individual user
- English or spanish Captions.
Describe the Web CapTel
Text display of telephone conversation on a computer screen
What was the first area and in what year did they accept text messaging to their 911 call center?
2009- Waterloo, IA
what is closed captioning?
the process by which the audio protion of TV programs is translated with a decoder into captions.
Compare closed and open captioning
- Closed means that decoder is required (not there unless you select captioning)
- Open means that caption always visable
What is the history of closed captioning
- authorized by federal communication (FCC) in 1976
- 16 hrs/week available in 1980
- Beginning in Jan 2006 all new english programs must be captioned.
- Some expections (commercials)
Describe the national captioning institute
- Around for 30 years
- real time captioning
- did all captioning and is still involved
- Live events, news/sports
- Most comedy and drama tv programs are prepared ahead of time not captioned real time
What is real time captioning?
Accurate simultaneous with speaker
What it certified real time reporter
- person typing captioning
- Special keyboard, special training
- well paid
What are the applications that have captioning
- regular tv programming
- movies on DVD
- how to videos
- college courses
- *expensive to caption but sponsers pay for it.
Who uses closed captioning and what does it require
- used by deaf and other hearing impaired individuals and requires at least english literacy (but also being used to learn english and assist in learning reading)
- May not be useful if only know asl
What law requires all tvs that are _____ screen or larger to contain a decoder chip
- Federal law 1990
- 13 inches
Captioning is _____ when the program is recorded.
Web only companies are subject to ______ and what is the example with netflix
American Disabilities Act (ADA) and netflix has agreed to close caption all streaming by 2014
What does a Hearing Dog do?
- Alerts HI person to important sounds
- Has privliges under ADA law
Describe the History of the education of the HI
- 400 years ago no education for HI
- Classified as mentally ill persons
- Got rid of and kept at home so not involved - no rights
- 400 years ago in Europe (wealthy) started hiring people to come in and teach their HI children (sign language, fingerspelling, other means created)
Describe the history of the education of the HI in the 17-18 th century
- 3 schools for Deaf (presidential)
- England - Braidwood
- Germany - Heincke
- Paris, France -eppe
- North america being sttled at this time
- Thomas Gallaudet sent over to europe to learn HI teach strategy
- England oral, france manuel, brought back manuel strategy
- New england teach manuel from gallaudet
- sign was prominent way of teaching HI
- Some education available for deaf kids starting 200 years ago if lived in right place
- one in every state
- choose normal school or school for the deaf.
Describe the education for all handicapped children act 1975
- helped mild to moderate kids get in appropriate spot (didnt qualify for deaf school, had hard time in normal school)
- Least restrictive environment
Describe the individuals with disabilities education act (IDEA)
- Included younger kids from birth
- SLP auds start seeing a lot of younger clients
- must use childs normal mode of communication in regular communication and in evaluations
- School is responsivle for proper function of hearing aids worn in school
- to the maximum extent appropriate children with disabilities should be educated with children without disabilities.
What is the opportunities for education after highschool
- 90% never went beyond high school
- 1850 Gallaudet University (WASH DC)
- National Technical Institute for the Deaf
- (alternative) Rochester NY
What is education now...
There are other colleges and universitities and are accesible now and have class amp and interpreters.
What are the educational placements for HI children?
- Alternatives and issues
- Many placement alternatives
- oral vs manual methods of education
Compare oral vs manual
last 30 years
- Oral: Preparing child to live in the hearing world with the English language and the children focused to learn and communicate through disordered system
- Manual: Easy language learning and communication that is not english and may result in reading and writing deficiencies in english. May have limited function in the hearing world
- Last 30 years: goes back and forth but manual has upper hand.
Describe the act that deals with confidentiality in the schools.
- Family educational rights and privacy act 1976
- Data transport
- data storage
- data destruction
- client access to information
- client right to challenge information
What must you document in the schools.
- Screening and diagnostic test results for each student
- Management program activities (AR, HA, use, etc.)
- Evidence for program modification
- Activities as evidence in disputes regarding services
Proper follow up care is ________
ESSENTIAL (anything after initial screening)
Even though hearing screening is typically accomplished in the schools,
follow up is often not accomplished
Follow up is the stage at which a program of hearing care often breaks down. what do we need to do>
- diagnostic testing following screening failure
- audiometric re-evaluation/ monitoring follwing medical referral to ensure that the HL is resolved
- appropriate classroom management (eg teacher notification, preferential seating, student support services, amplification for chronic HL
- some children with otitis media may experience HL for weeks or months
- Hearing aid evaluation
- ongoing hearing aid function and care
some babies are born listeners...
others need our help
Universal newborn hearing screening has significant implications for _______ of HI cildren.
what is the plan for universal newborn hearing screening and how many are screened in wy
- 1 month of age screening
- 3 Diagnosed by 3 months
- 6 intervention by 6 months
Describe diagnostic audiometry fro infants
- Diagnositc testing is completed as soon as possible, no later than at 3 months of age
- If child has hearing loss, management is initiated immediately
Nationally follow up is ....
Wyoming follow up is ...
What is the first step in the management program for HI infants
Immediate consideration for HAs (funding?)
What is the 2nd step in the management program for HI infants
- Early intervention program
- Research suggest that if HI infants are in intervention by 6 months of age, language will develop at a pace consistent with cognitive abilities, for most HI children this means a normal rate of language development.
What is the 3rd step in the management program for HI infants
- Parent education and counseling
- HA and other amplification
- Acceptance of HAs (both parent and adult)
- Care and maintenance of HAs.
- Device for monitoring daily provided to parent
- Parent support contacts
- Funding options
What is the 4th step in the management program for HI infants
- Additional referrals in conjunction with referring physician (vision, ENT, possible genetic counseling, audiologic evaluation of siblings if genetic casue suspected)
What is the 5th step in the management program for HI infants
ongoing audiologic and hearing aid evaluation as needed.
What is the 1st component of the hospital program for HI patients?
- Identification of HI patients
- At admitting or sticker on file
What is the 2nd component of the hospital program for HI patients?
- Amplification and assistive devices
- portable amplifier (pockettalker)
- telephone amplifier
- Sign language interpreter
- TV captioning
- Nurses have knowledge regarding services and devices.
What is the 3rd component of the hospital program for HI patients?
- In-service training of nurses and other hospital personel
- Information for patients (brochures, posters,direct counseling)
- Public service announcements or advertisements include notification that the hospital provides services for HI patient
What is the 4th component of the hospital program for HI patients?
- support group
- volunteers sharing inforamtion with patients and their families
what are 4 methods used to assist persons with HL in receiving sound track media.
- live interpreter
- super imposed interpreter
What is iCanConnect?
- new in 2013
- Founded by FCC
- Provides communication technology to low income persons with combined hearing and vision loss to allow them to make a phone call, send an email,and access the internet
- must qualify by impairment and financially.
What would you like to do?
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