Rehabilitating the Image of AR
Aural rehabilitation (AR) has been, in recent audiologic history, something of a poor stepsister to hearing testing and hearing instrument selection, fitting, and verification. For example, quite often you will find otherwise exceptional textbooks on fitting hearing instruments that devote only a few pages to AR. This is probably not surprising, as the new digital and computer-driven diagnostic equipment, prescriptive fitting rationales, and amplification products often overshadow AR in a techno-glow of promise. Western civilization in general finds itself embedded (to use a flavor-of-the-month phrase) in a time, much like the early-1800s, when it appears that technological wizardry has the power to solve extremely complex problems quickly and easily.

The re-emergence of AR on the “audiologic radar screen,” as evidenced by the recent ASHA conference and several publications, is another testament to the cyclical nature of events. In the earliest beginnings of the profession of audiology, AR programs were a central focus of efforts to remediate patients’ hearing losses. Frequent HR contributor Mark Ross, PhD, professor emeritus at the University of Connecticut, has written about the 2-month-long AR program that he experienced at Walter Reed Hospital for his own hearing loss during World War II (see September 2001 HR, p. 62). He describes the program as a “Camelot” that cannot be revisited and admits that, in terms of duration, it was probably “overkill.” But it brought servicemen together for intensive group training on a wide range of communication strategies, and it brought about a peer-inspired determination to cope and succeed with their hearing handicap and amplification (at that time, bathed in the techno-glow of new, sophisticated “monopack battery” aids). Ross writes: ““I do believe, however, that we can incorporate some of the lessons that the past can teach us. The most important of these lessons is that we need to conceptualize the selection and dispensing of hearing instruments within a larger framework. While it may sound like a cliché, we do need to keep in mind that we are not working with a pair of ears but with the person to whom the ears are attached.”

Raymond Hull, PhD, of Wichita State University, writes in his book Aural Rehabilitation: Serving Children and Adults (Singular Publishing, 2001, p. 14) that AR is not separated in any way from the assessment of hearing, the determination of the benefits of amplification, and the impact of hearing deficit; rather, AR is an “extension of them. It involves ongoing counseling to facilitate adjustment to the hearing loss, facilitating increased efficiency in communication, including the establishment of client priorities in communication, and developing a treatment program that targets each individual client’s communicative needs” [his italics].

However, consciously or unconsciously, some hearing care professionals are quick to dismiss AR as a “soft science”; AR often delves into the murky depths of a client’s feelings, attitudes, proclivities, and motivations relative to his/her hearing handicap. Again, our techno-culture may be to blame for this attitude, but AR is a lot more than “touchy-feely” stuff. It’s about ensuring that the hearing-impaired client (and his/her spouse, family, friends, etc) has all the right tools for effective communication.

Another aspect of this “soft science” attitude is the mistaken notion that AR cannot be quantified. While the hearing care field may be experiencing some slow sailing relative to certain aspects of this endeavor (see Mark Flynn’s article, “Sailing Out of the Windless Sea of Monosyllables,” p. 24), there is progress being made. Likewise, a raft of measures—from the COSI to the HHIE—can be used to help document the usefulness of AR services and their effects on the communication and quality of life of clients. The continued development, use, and published studies involving AR will help to reaffirm AR’s rightful place in comprehensive hearing health care and, importantly, the appropriate reimbursement for that care.

Karl Strom
Editor-In-Chief