Health & Human Services/Research in Communicative Disorders
Among the best-kept secrets in healthcare today are the many necessary and attendant services available for hearing impaired patients through their audiologist and/or hearing aid dispenser. These services are essentially value-added in that they do not usually cost extra, and they are typically available to the consumer/patient, without additional charge, secondary to the acquisition of hearing aids.
Aural rehabilitation, when applied specifically to the use of hearing aids, as hearing aid rehabilitation, provides more value-added services for the consumer dollar than any other healthcare service today. Unfortunately, few consumers are aware these value-added services exist, or that they are indeed, an integral part of optimal hearing aid user success.
The provision (or lack) of these value-added services may reveal the quality and professionalism of the dispensing practice from which the hearing aids were (or are) obtained. Additionally, hearing aid rehabilitation programs increase the likelihood of the patients success with appropriate amplification.
Value-added services can be expected through ones hearing healthcare professional, to varying degrees to each consumer and their specific situation. Hence, an effective auditory rehabilitation program that is sensitive to the needs of the consumer will be customized utilizing a combination of the four added-value tools presented below.
When hearing aids are offered with value-added services, quality of life improves, social relationships grow into meaningful bonds, and ones health, happiness and well-being increases.
A word to the wise: Never purchase a hearing aid without these priceless value-added professional services.
Categories of Value-Added Services
Based on my experience, I categorize four distinct value-added services for a truly successful hearing aid experience. The four categories are:
Coping Strategies - These include hearing aid adaptation counseling and wearing schedules, communication repair strategies, third party counseling, and (when indicated) speech reading instruction.
Assistive Devices - These include any technological application that can supplement or enhance the function of a hearing aid, including FM and Infrared systems, classroom sound-field, real-time and closed captioning, TDD/TTY, TDD Relay, amplified telephones, vibrating or flashing alarms of all kinds, and the utilization of computer and Internet skills.
Self-Help Resources - Every hearing aid consumer with a serious hearing impairment should be connected to self-help organizations, including Self-Help for Hard of Hearing People (SHHH), the American Tinnitus Association (ATA), Deafness Research Foundation (DRF), their state Commission for the Deaf and Hearing Impaired, and a host of other local, state and national resources. Also of value are the names and contact information of local otolaryngologists and cochlear implant centers.
- ADA/IDEA Counseling - These and other important federal and state empowerment laws constitute the safety net for the hearing impaired population. No hearing aid rehabilitation program is complete without providing detailed information and counseling for consumers that may benefit from these laws.
Admittedly, not every consumer is going to need or explore every category. The type and degree of hearing impairment, age of onset of hearing loss, the listening circumstance, individual needs and desires and other variables determine which value-added services are necessary to achieve communicative wholeness, or maximal communication.
Hearing Aids, Cochlear Implants & Children: A few notes
It is very important for the teacher and the teaching assistant to know how to change hearing aid batteries and how to assure that the hearing aid is working properly. Of course the teacher cannot be an expert in hearing aid care or maintenance, but a few moments spent addressing very basic issues (is the hearing aid in the ear correctly? Is it in the correct ear? Is it working?) are moments very well spent! Imagine the outcome for the child sitting in the classroom all day with a dead battery in his/her hearing aid?
School children with mild or moderate hearing impairment often present with speech and language deficits, possible psychological issues and a variety of learning disabilities. It is truly amazing how often we find children receiving all kinds of remedial services without benefit of a comprehensive diagnostic audiometric evaluation, or appropriate amplification! Most children with mild and moderate hearing loss will require hearing aids for maximal educational exposure and opportunity. Each child with hearing loss should ideally work with an educational or pediatric audiologist to determine the best technology and hearing management strategies available (and required) for the individual child.
Children with severe and profound hearing losses will typically require hearing aids, FM systems, classroom sound-field and other assistive technologies: Closed caption TV & video, large area listening systems, and perhaps even interpreters of various kinds in some critical listening situations. Training in coping strategies helps the child and others around them make needed accommodations and considerations to assure unimpeded communicative interaction. Again, individual professional consultation is extremely important.
Just as important as hearing, is what the child does with what they hear! Audiologists are often called upon to test children for Auditory Processing Disorders (APD). APD problems can (and often do) occur in children with normal hearing! Children diagnosed with APD require a systematic program of central auditory development training, to better attend to the primary signal (their teacher, a parent, etc) and to better squelch noise and other distractions within their educational and listening environments.
Children with cochlear implants will need assistive devices, coping strategy training, and other support services. School age children are covered under the umbrella of the federal Individuals with Disabilities Education Act of 1978 (IDEA)and subsequent updatesas well as the more general Americans with Disabilities Act of 1990 (ADA). These federal laws afford children a plethora of benefits and advantages to give them every advantage to prepare appropriately to later perform and compete in a hearing world.
Hearing Aids, Cochlear Implants & Adults: A few notes
Hearing impaired adults may require a host of supplementary technologies, strategies, and considerations, besides hearing aids. Hearing aids are often the first and most crucial step in aural rehabilitation, but generally speaking, hearing aids are for conversational speech in quiet or nearly quiet surroundings.
When background noise increases, or the distance from the sound source increases, or when the acoustic environment becomes noisy and distracting, assistive devices are often more beneficial than hearing aids alone. This is especially true for those with severe losses in the high frequencies. Hearing impaired adults have unique and special needs. For these individuals to simply purchase hearing aids and go about their business with no other help would be a travesty!
Professional instruction in coping and repair strategies are a must for many severe loss cases. Some patients will also benefit from speechreading skills training. Likewise, auditory rehabilitative counseling of the family support group is often necessary to assist the patient and their family in developing more effective communication and to repair less desirable communicative patterns.
Consumers with severe, progressive impairments should be provided with information about cochlear implant technology and where to go to get help. The cost-benefit of cochlear implantation has proven to be one of the most effective technologies in healthcare today. Contrary to public awareness on this topic, most private health insurance, state vocational rehabilitation services, and Medicare cover cochlear implants.
Additional Challenges for Older Adults
Older adults (and their families) tend to under rate the need to maintain optimal hearing and communication to make up for other declining abilities in later years. Hence, lost in the debate about the cost-benefit of hearing aids is the even more important need for hearing aid counseling and rehabilitative services.
I suggest that hearing healthcare professionals might need to have a little bit of occupational therapist in them, to consider the special challenges posed for many older adults in their daily home environment:
- Is their home communicatively accessible?
- Do they need infrared or closed captioned TV?
- Do they need special technology for using the telephone?
- Can they hear the telephone ring no matter which part of the house theyre in?
- Will they know when someone comes to their door?
- Do they need assistance at church meetings and in large are listening?
- How do they awaken in the morning? Do they need special alarm/strobe/shake clocks?
Communicative access is so important for this age group that their quality of life and social relationships are directly tied to the quality of auditory performance.
For all ages: More needed than just hearing aids
A hearing program that includes hearing aids only is definitively lacking in the finer points of hearing health care. For many other considerations, strategies and technologies are needed to assure that hearing aidsthe foundation of hearing careprovide maximal results.
This article is a primer on the subject of value-added hearing health services that every consumer should look for when purchasing hearing aids. For more in-depth research on this topic, the reader is directed to the consumer information website www.digicare.org where they will find more than 2,000 pages and growing of articles, monographs, and scholarly presentations on various hearing health topics.
Dr. Chartrand serves as Managing Director at DigiCare Hearing Research & Rehabilitation and as Director for the DigiCare Hearing Health Network, an international consortium of hearing health professionals dedicated to fostering advancements in hearing health care. He may be contacted through: www.digicare.org.