Audiologic rehabilitation (AR) is the process by which hearing care professionals maximize the effective treatment of hearing loss by directly addressing patients communication problems and needs, and allowing patients to interact with the professional and with peers who are experiencing the same hearing challenges. Unfortunately, relatively few hearing care professionals have implemented audiologic rehabilitation programs that supplement the traditional, individual counseling and hearing aid adjustment process.
Northern & Beyer1 have documented the practical benefit of group audiologic rehabilitation. They showed a reduction in return-for-credit rate from 9% to 3% as a result of participation in a group audiologic rehabilitation program. Wayner2 described a consistent 3% return rate in a large dispensing practice in a regional medical center. These data, along with continued discussion on the value of counseling techniques, have contributed to a resurgence of interest in AR.
Starting a new AR program, however, can appear to be an overwhelming challenge when schedules are full and professional demands for time are many. This article is intended as a resource for busy hearing care professionals who have considered expanding the rehabilitative aspect of their practice for adult patients but dont know where to start. Some may think that using canned material is not appropriate. However, using existing materials to jump-start a program can give hearing care professionals the experience and confidence needed to modify or develop their own materials to meet the specific needs of their practice and their patients. The rationale for and the pragmatic issues related to implementing such programs have been described elsewhere.3-7 Authors Note: This brief article is a necessarily incomplete overview and not a comprehensive listing. Useful materials are bound to have been inadvertently omitted.
Group vs. Individual Treatment
Group audiologic programs are a cost-effective and important part of hearing instrument fitting and adjustment8,9 since family involvement and peer interactions are as important as the information that is provided. However, some activities require individual treatment. Auditory or auditory/visual training that would be needed after cochlear implantation or fitting with a frequency transposing hearing instrument may be difficult in a group setting, even if one had enough similar patients to make up a group. Most materials designed for group programs can be modified to use with one person, and some individual materials can also be used in groups. Material developed for speechreading or auditory training can usually be modified for the other modality, or for combined auditory-visual presentation. Creativity and flexibility are the keys.
Several references provide excellent and practical information for the practitioner who wants a review of or update to current rehabilitation procedures. Kricos10 provides an overview of the current state of audiologic rehabilitation. Comprehensive overviews can be found in Spitzer, Leder & Giolas11 and Kricos & Lesner.12 Both provide a balance of theoretical framework, practical clinical procedures and assessments. A concise summary of counseling for communicative disorders can be found in Schum.13
The contribution of Norman P. Erber to audiologic rehabilitation has been significant. He provides a theoretical framework for communication and conversational fluency,14 and his Communication Therapy15,16 provides clinical models and procedures. Numerous tables and lists make this reference easy to use. His auditory training text17 remains a classic and continues to provide useful information.
Montgomery18 provides a concise outline and summary for presenting the essence of adult audiologic rehabilitation in an individual one-hour session. If formal rehabilitation programs are not possible, this can be a useful resource for those patients in need of more than the normal informational counseling aspect of hearing instrument orientation.
A discussion of the psychosocial implications of acquired hearing loss can be found in Trychin.19 Written for mental health workers, this handbook can also increase insight for audiologists.
For audiologists working within managed care settings that are traditionally unserved or underserved by hearing care professionals, Johnson & Danhauer20 provide an excellent guidebook. Filled with practical real-world suggestions, it also includes a CD-ROM containing many useful forms that can be downloaded and adapted.
Spitzer, Leder & Giolas11 give methods and sample activities for speech perceptual training, speechreading and voice and resonance training. They include therapy plans with goals, objectives and criteria for success for each area.
Hear Again, Inc., has published two comprehensive manuals. Each contains lesson plans and student workbooks for coping strategies and speechreading group classes, plus additional materials that can either be duplicated to give to patients or used by the clinician for specific topics. Learning to Hear Again21,22 contains lesson plans and a workbook for hearing aid orientation, while Learning to Hear Again with a Cochlear Implant23 contains a Personal Journal and Users Guide.
Hearing Aid Orientation
Learning to Hear Again21,22 contains material for a three-week group hearing aid orientation class. Northern & Beyer1 have published an outline of the three-week group program offered in HearX offices. Electone24 has developed and published a workbook to be used by individuals during the hearing aid trial period. The Hearing Aid Handbook2 also offers instructional materials for hearing aid orientation with a clinicians manual and companion booklets for children and adults. The Hearing Counseling Kit25 provides instructional materials that may be copied for distribution.
Auditory and Auditory/Visual Perceptual Training
Plant has developed numerous programs for training speech perception skills. The Tactaid II Training Program26 was developed for use with a vibrotactile aid, but contains a detailed program for auditory perceptual training that could be used for the hearing instrument (whether traditional or frequency transposing) or cochlear implant user. For those doing serious analytical training, Analytika27 can serve as an invaluable resource. It contains 379 lists of one-syllable word pairs that differ by one phoneme (in Australian English). Each phoneme is contrasted with all other phonemes in a separate 20-item list. This resource is available in printed or floppy disc form. Hear at Home28 is an auditory training program designed for home use that could also be used by the professional for individual training. It is described in the home study section below.
Tye-Murray29 also provides an easy-to use-workbook designed to provide stimuli and instructions for the clinician and printed cues to the patient.
Training to reduce interruptions in conversational fluency and the use of conversational strategies depends on interactions between the hearing care professional and the patient. It is sometimes difficult to lead these therapeutic conversations spontaneously. Erbers QUEST?AR15,16 provides a series of 30 sequential questions that can be used to simulate conversations. Tye-Murray29 also provides printed materials for guided conversational interactions.
Williams30 provides materials for 31 speechreading sessions. Fill-in-the-blank worksheets for closed-set word discrimination, word discrimination in sentences and sentence completion activities are provided and can be duplicated for patient use. This three-ring notebook is available from A.G Bell. Learning to Hear Again22 and Learning to Hear Again with a Cochlear Implant23 contain lesson plans and a class workbook for a five-week speechreading workshop. Additional speechreading materials are included for individual work. Tye-Murrays communication training manual29 also provides speechreading activities. Kaplan, Bally & Carretson31 continues to be a useful resource. Videotapes for home practice are described below. Additionally, A. G. Bell publications offer a variety of traditional speechreading materials.
Erber32 and Castle33 have developed materials specifically designed to assist the hearing-impaired person with telephone use.
Trychin34,35 has produced a series of materials that can be used to stimulate discussion concerning coping strategies and the effects of hearing loss on interpersonal relations. These are described in the videotape section. Learning to Hear Again22 and Learning to Hear Again with a Cochlear Implant23 contain lesson plans and a class workbook for a four-week coping strategies workshop. Erber,15,16 Carmen36 and Tye-Murray29 also contain sections that address coping strategies.
Trychin has made a series of videotapes34,35 that are effective for coping strategies training. Each includes a series of short scenes to be viewed, then the tape is stopped for group discussion. Accompanying workbooks contain transcript of the scenes plus discussion questions. The workbooks allow for independent use of these tapes for home study. These and additional related titles are also available from SHHH Publications.
Several videotape series are available for speechreading practice.37-40 A. G. Bell and Gallaudet Press are sources for these tapes that can be used as home study material from a clinic lending library.
Training of caregivers or members of other professions can be facilitated by video presentation.41 Videos are also an excellent way to inform patients about assistive technology.42,43 They can be shown in a waiting room or added to the lending library.
A Bridge to Healing36 is a useful reference for first-time hearing aid users, with general information about hearing loss and tinnitus, hearing instruments, emotional aspects of hearing loss, and ways to improve listening and hearing. The table of contents allows the audiologist to assign specific chapters based on the individual patients needs.
Electone has developed a 21-day program for hearing instrument adjustment that is an excellent workbook when patients cannot come into the office for repeated visits.24 This has been used successfully in rural areas with follow-up conducted by phone.
For patients or communication partners with reading skills at the high school or college level, Erber14 could provide insight into the effects that hearing loss can have on communication.
Hear Again Inc has published materials to be used independently by cochlear implant users44,45 and hearing instrument users.46
Hear at Home28 by Plant is an auditory training program designed for home study. There are separate three-ring binders for the talker and the receiver, so that the hearing-impaired person and their partner have printed materials to use during ten training sessions. Careful instructions are given in the Talkers Handbook for family members or friends. Word and sentence practice is included. While the intent is to improve the speech reception of the hearing-impaired person during the adjustment to new hearing instruments, talkers also receive training in producing clear speech for the listener.
Hear What Youve Been Missing47 presents information about hearing, hearing loss, hearing technology, intervention options and support services in a question-and-answer format. Likewise, the Hearing Counseling Kit25 and Learning to Hear Again21 provide materials on a variety of topics related to hearing impairment. Sections may be selected based on specific clients needs and duplicated.
Audio tapes can be also used successfully for home training. Books on tape can be used to provide effective listening training. Individuals with poor auditory skills can listen to unabridged tapes while following the printed text. Auditory training tapes with accompanying work sheets are available from Auditec of St. Louis.48 These will be limited by the quality of the tape player used, but can be useful for home practice for selected patients.
A more extensive listing of materials and a table summarizing those materials and how they may be used is presented in table form in Hearing Care for the Older Adult.4 This list has been reprinted by permission in the Learning to Hear Again manuals.21-23
1. Northern JL & Beyer CM: Reducing hearing aid returns through patient education. Audiology Today 1999; 11 (2): 10-11.
2. Wayner DS: Hearing Aid Handbook: Clinicians Guide to Client Orientation. Washington, DC: Clerk Books/Gallaudet Univ Press, 1990.
3. Abrahamson JE: Teaching coping strategies: A client education approach to aural rehabilitation. J Acad of Rehab Audiol 1991; (24): 43-53.
4. Abrahamson JE: Effective and relevant programming. In PB Kricos & SA Lesners (eds) Hearing Care for the Older Adult. Boston: Butterworth-Heineman, 1995.
5. Abrahamson JE & Wayner DS: Group hearing aid orientation promotes patient satisfactionPart 1. ADA Feedback 1998; 9 (2): 7-9.
6. Abrahamson JE & Wayner DS: Group hearing aid orientation promotes patient satisfactionA curriculum. ADA Feedback 1998; 9 (4): 13-15.
7. Abrahamson JE & Wayner DS: Group Hearing Aid Orientation Promotes Patient SatisfactionImplementation. ADA Feedback 1999; 10 (1): 9-12.
8. Abrahamson JE: Patient education and peer interaction facilitate hearing aid adjustment. In S Kochkin & KE Stroms (eds) High Performance Hearing Solutions, Vol. 1: Counseling (Suppl to The Hearing Review, Jan 1997); (1): 19-22.
9. Abrahamson JE: Group audiologic rehabilitation. Seminars in Hearing 2000; 21 (3): 227-234.
10. Kricos PB (ed): Contemporary models of aural rehabilitation. Seminars in Hearing 2000; 21 (3).
11. Spitzer JB, Leder SV & Giolas TG: Rehabilitation of late-deafened adults: Modular program manual, 1993.
12. Kricos PB & Lesner SA: Hearing Care for the Older Adult: Audiologic Rehabilitation. Boston: Butterworth-Heinemann, 1995.
13. Schum R: Counseling in Speech and Hearing Science: NSSHLA clinical series #9. Rockville, MD: ASHA Publications, 1985.
14. Erber NP: Communication and Adult Hearing Loss. Melbourne, Australia: Clavis Publishing, 1993.
15. Erber NP: Communication Therapy for Hearing Impaired Adult. Abbotsford, Victoria, Australia: Clavis Publishing, 1988.
16. Erber NP: Communication Therapy for Adult with Sensory Loss (Second edition). Melbourne, Australia: Clavis Publishing, 1996.
17. Erber NP: Auditory Training. Washington, DC: A. G. Bell Assn for the Deaf, 1982.
18. Montgomery AA: WATCH: A practical approach to brief auditory rehabilitation. Hear Jour 1994; 47 (10): 10-55.
19. Trychin S: Manual for mental health professionals, Part II: Psycho-Social Challenges Faced by Hard of Hearing People. Washington DC: Gallaudet University, 1991.
20. Johnson CE & Danhauer JL: Guidebook for Support Programs in Aural Rehabilitation. San Diego: Singular Publishing Group, Inc, 1999.
21. Wayner DS & Abrahamson JE: Learning to Hear Again: An Audiologic Rehabilitation Curriculum Guide. Austin, TX: Hear Again Inc, 1996.
22. Wayner, DS & Abrahamson JE: Learning to Hear Again: An Audiologic Rehabilitation Curriculum Guide (Second edition). Austin, TX: Hear Again Inc, 2000.
23. Wayner DS & Abrahamson JE Learning to Hear Again with a Cochlear Implant: An Audiologic Rehabilitation Curriculum Guide. Austin, TX: Hear Again Inc, 1998.
24. Electone: The Hearing Adjustment Program. Winter Park, FL: Electone, 1994.
25. Stromberg E: The Hearing Counseling Kit. Stow, OH: Interactive Therapeutics, Inc, 1994.
26. Plant G: Tactaid II training program. Sydney, Australia: National Acoustic Labs, 1991.
27. Plant, G: Analytika: Analytic Testing and Training Lists. Somerville, MA: Audiologic Engineering Corp, 1994.
28. Plant G: Hear at Home: A Home Training Program for Adults with Hearing Loss. Boston: Hearing Rehabilitation Foundation, 2000.
29. Tye-Murray N: Communication Training for Older Teenagers & Adults: Listening Speechreading, and Using Conversational Strategies. Austin, TX: Pro Ed, 1997.
30. Williams CI: See/Hear: An Audiologic Rehabilitation Training Manual. Everett, WA: CI Williams, 1994.
31. Kaplan HF, Bally S & Carretson C: Speechreading: A Way to Improve Understanding (Second edition). Washington, DC: Gallaudet Univ Press, 1985.
32. Erber NP: Telephone Communication and Hearing Impairment. San Diego, CA: College-Hill Press, 1985.
33. Castle DL: Telephone strategies: A Technical and Practical Guide for Hard of Hearing People. Bethesda, MD: SHHH Press, 1988.
34. Trychin S: Did I do that? (videotape and workbook) Bethesda, MD: SHHH Publications, 1987.
35. Trychin S & Boone M: Communication Rules for Hard of Hearing People (videotape and workbook). Bethesda, MD: SHHH Publications, 1987.
36. Carmen R: A Bridge to Healing: Hearing Loss & Hearing Aids. Sedona, AZ: Auricle Ink Publishers, 1998.
37. Greenwald AB: Lipreading Made Easy. Washington DC: AG Bell Assn for the Deaf, 1984.
38. Jacobs M: Survival on the Job & Social Situation Sentences. Washington DC: AG Bell Assn for the Deaf, 1987.
39. Speech & Hearing Technologies: Learning Speechreading. Centerville, OH: Speech & Hearing Technologies, 1989.
40. Speechreading Laboratory, Inc: Read My Lips. Mustang, OK: Speechreading Laboratory, Inc, 1989.
41. Johns Hopkins Center for Hearing and Balance: Beyond Hearing Loss: Doorways to Independence (video). Baltimore, MD: Johns Hopkins, 1991.
42. Compton C: Assistive Devices: Doorways to Independence (video). Washington, DC: Gallaudet University, 1991.
43. New York League for the Hard of Hearing: Assistive Devices for Hearing-Impaired Persons (video). New York City: NY League for the Hard of Hearing, 1987.
44. Wayner DS & Abrahamson JE: Better Communication and Cochlear Implants: A Personal Journal. Austin, TX: Hear Again Inc, 1998.
45. Wayner DS & Abrahamson JE: Better Communication and Cochlear Implants: A Users Guide. Austin, TX: Hear Again Inc, 1998.
46. Wayner DS & Abrahamson JE: Better Communication and Hearing Aids: A Guide to Hearing Aid Use. Austin, TX: Hear Again Inc, 2000.
47. Wayner DS: Hear What Youve Been Missing: How to Cope with Hearing Loss. Minneapolis, MN: Chronimed, 1998.
48. Auditec of St. Louis: Auditory Training Lessons. St. Louis, MO: Auditec of St. Louis, 1982
Judy Abrahamson, MA, is an audiologist at the Olin E. Teague Veterans Center in Temple, TX.