Introduction to Audiologic Rehabilitation

About our authors Ronald L. Schow is coauthor of Communication Disorders of the Aged and six previous editions of this text. He is Professor Emeritus of Audiology at Idaho State University, where he continues to be involved in writing and research. His publications include the 20 most important referred articles, which can be located on Pub Med. He is coauthor of Multiple Auditory Processing Assessment (MAPA), available through Auditec of St. Louis. MAPA is currently in the process of a national normative study by Academic Therapy Publications, Navato, CA. He is a charter member of the International Collegium of Rehabilitative Audiology, in which he has been involved since 1988. Schow received his PhD training at Northwestern University, where his major professor was Raymond Carhart, who named the profession and is considered the Father of Audiology. Michael A. Nerbonne received his PhD at Michigan State University and is Professor Emeritus of Audiology at Central Michigan University. He has published widely in professional journals, is coauthor of Communication Disorders of the Aged, and is coeditor of seven editions of Introduction to Audiologic Rehabilitation. In addition to his ongoing commitment to audiology, Nerbonne is focused on family time and fishing.

1 Overview of Audiologic Rehabilitation 3
Ronald L. Schow,
Michael A. Nerbonne Chris A. Sanford
Introduction 4
Definitions and Synonyms 4
Providers of Audiologic Rehabilitation 4 Education Needs of Providers 5
Hearing Loss Characteristics 5
Degree of Hearing Loss and Configuration 5 Time of Onset 8
Type of Loss 8
Auditory Speech Recognition Ability 10
Consequences of Hearing Loss: Primary and Secondary 11
Communication Difficulties 11 Variable Hearing Disorder/Disability 11
Rehabilitative Alternatives 13
Historical Background 13
Contemporary Issues 16
Current Status 17
Procedures in Audiologic Rehabilitation: An AR Model-;CORE and CARE 19
Rehabilitation Assessment Procedures 22 Management Procedures 22
Settings for Audiologic Rehabilitation 24
Children 24
Adults 25
Elderly Adults 25
Summary and Summary Points 26 Supplementary Learning Activities 27
Recommended Reading and Recommended Websites 28 References 28

2 Hearing Aids and Hearing Assistive Technologies 33
Holly Kaplan
Alice E. Holmes
Introduction 34
History of Amplification 34
Hearing Aid Components 35
Microphone 36

PART ONE: Fundamentals of Audiologic Rehabilitation 1
Amplifier (Digital Processor) 36 Receiver 37
Batteries 37
Hearing Aid Styles 38
Behind-the-Ear 38
Receiver-in-the-Canal 39
In-the-Ear/In-the-Canal/Completely-in-the-Canal 39 Extended-Wear Hearing Aids 39
The Earmold 40
Who Is a Hearing Aid Candidate? 41
Degree of Hearing Loss 42
Degree of Communication Disability 42 Motivation to Use Amplification 42
Hearing Aid Fitting Protocol 42
Selection 42
Quality Control 44
Fitting 45
Hearing Aid Orientation 47 Verification/Validation/Outcome Measures 49
Pediatric Fittings 51
Special Fittings 53
Contralateral Routing of the Signal (CROS) Fittings 53 Bone-Conduction Hearing Aids 54
Bone-Anchored Devices 54
Middle Ear Implantable Hearing Aids 56
Cochlear and Brainstem Implants 57
Hearing Assistive Technology, or When a Hearing Aid May Not Be Enough 57
Types of Assistive Devices 57
The Role of the Audiologist in Assistive Listening/Hearing Assistive Technology Systems 61
Verifying and Validating the Fitting of HATS 61
The Bottom Line: Cost Management and Payment for Hearing Aids and Hats 61
Concluding Remarks 62
Summary 62
Supplementary Learning Activities 63
Recommended Reading and Recommended Websites 64 References 65
3 Cochlear Implants 69
Alice E. Holmes
Introduction 69
How Does a Cochlear Implant Work? 70 History of Cochlear Implants 71 Current
Systems 71
The Cochlear Implant Team 74 Who Is a Candidate? 74
Deaf Culture and Cochlear Implants 79
Treatment Plans for Cochlear Implant Recipients 79 Variables Affecting Performance 83
Bilateral Hearing with Cochlear Implants 83 Auditory Brain Stem Implant 84
Electroacoustic Stimulation 85
Summary Points 86
Supplementary Learning Activities 87
Recommended Reading and Recommended Websites 87 References 88

4 Auditory Stimulation in Communication 93
Michael A. Nerbonne
Ronald L. Schow Kristina M. Blaiser
Introduction 93
A Communication Model 94 Auditory Perception 95
Development of Auditory Skills 95 Basic Perception Abilities 95 Acoustics of Speech 95
Speech Perception and Comprehension 100 Speech
Perception and Hearing Loss 101
The Auditory Training Process 105
Definition and Application of Auditory Training 105 Early Efforts in Auditory Training 105
Current Approaches to Auditory Training 107 Candidacy for Auditory Training 107
Assessment of Auditory Skills 107
Methods of Auditory Training 112
Summary Points 122
Supplementary Learning Activities 122
Recommended Reading and Recommended Websites 123 References 123

5 Visual Stimuli in Communication 127
Nicholas M. Hipskind
Introduction 127
Factors Related to Speechreading 128
Speaker 128
Signal and Code 130 Environment 134
Speechreader 135
Speechreading and Hearing Loss 137
Assessment of Speechreading Ability 137
Visual Assessment and Speechreading Evaluation140
Hearing Loss and Dependence on Vision 140
Traditional Speechreading Methods 141
Recent Trends in Speechreading Instruction 142
Manual Communication 148
Types of Manual Communication 148
Summary Points 153
Supplementary Learning Activities 153 Recommended Reading 153
References 154
Appendixes 157
Language and Speech of the Deaf and Hard of Hearing 167
Kristina M. Blaiser Gabriel A. Bargen
Introduction 167
Communication Options for Families of Children Who Are Deaf/Hard of Hearing 168
Systems Emphasizing Listening and Spoken Language 168 Manual--Visual Systems 168
Systems Combining Visual and Auditory Information 169
Hearing as the Foundation for Speech and Language 170 Factors Affecting Speech and Language Acquisition 174
Language Characteristics of Children with Hearing Loss 176 Impact of Hearing Loss on Language Components 177
Language Assessment 180
Formal Language Measures 180
Language Sample and Narrative Analysis 183
Speech Development in Children with Hearing Loss 183
Speech Characteristics 184
Speech Assessment 186
Summary and Summary Points 188 Supplementary Learning Activities 189
Recommended Reading and Recommended Websites 189
References 190
Psychosocial Aspects of Hearing Loss and Counseling Basics 195
Kris English
Introduction 195
Psychosocial Aspects of Hearing Loss 195 Growing Up with Hearing Loss 196
Acquiring Hearing Loss as Adults 201 About
Being Deaf 204
Deafness with a Capital “D” 204
“Knowing Is Not Enough”: Counseling Basics 205
Important Distinctions 206
What We May Think Counseling Is 206
What Counselors Say Counseling Is 207
The Counseling Process 207
When to Refer 210
Does Counseling Make a Difference? 210 Concluding Remarks 211
Summary 211
Supplementary Learning Activities 211 Recommended Reading 212
Audiologic Counseling 212 Psychology of Deafness 212 Deaf Culture 212
Recommended Websites 212
References 213
Appendix 215
Audiologic Rehabilitation Services in the School Setting 217
Kris English
Introduction 218
Why AR Services Are Required in School Settings: The Educational Consequences of Hearing Loss 218
Hearing Loss and Learning 218 Mandated by Law 219
Key Components of IDEA 220 Least Restrictive Environment 220
The Individualized Education Plan 223 Types of Communication Modalities 223
AR Services Provided in Schools 225
Screening and Assessment 226
Management of Amplification/Audition 226
Direct Instruction and Indirect Consultation 227
Evaluation and Modification of Classroom Acoustics 228
Transition Planning to Postsecondary Placements 230
How Services Are Provided 231
AR Service Providers in School Settings 231
Teachers 231
Audiologists 231
Speech-Language Pathologists 232
Related Support Personnel 232
Services for Children with Auditory Processing Problems 233
Diagnosis/Assessment of APD 234 Remediation of APD 235
“A Day in the Life” of an Educational Audiologist 236 Summary 237
Supplementary Learning Activities 237 Recommended Reading 238
Recommended Resources 238
Software 238
Websites 238
References 238
Appendix 241

9 Audiologic Rehabilitation for Children 247
Mary Pat Moeller
Ronald L. Schow Mary M. Whitaker
Introduction 247
Prevalence of Loss and Level of Service 248
Contemporary Efforts to Strengthen the Evidence Base in Audiologic Rehabilitation 249

PART TWO: Comprehensive Approaches to Audiologic Rehabilitation 330
xiv Contents
Terms and Definitions 250
Profile of the Client 251
Hearing Loss 251
Age 251
Other Disabling Conditions 252
Rehabilitation Settings and Providers 252
Identification and Assessment Procedures with Children 252
Early Identification 252
School Screening 254
Medical and Audiologic Assessment 254
Aspects of AR: Early Intervention for Parent--Infant and Preschool 255
Rehabilitation Assessment: IFSP 255
Management 256
Aspects of AR: School Years 285
Rehabilitation Assessment: Individualized Education Plan 285 Management 286
Concluding Remarks 298
Summary 298
Supplementary Learning Activities 299
Recommended Reading and Recommended Websites 299
References 300
Audiologic Rehabilitation across the Adult Life Span: Assessment and Management 307
M. Kathleen Pichora-Fuller Ronald L. Schow
Introduction 308
Profile of the Adult Client 310
Hearing Loss across the Life Span 310 Help Seeking and Screening 311
Profile of the Older Adult Client 312
Auditory Aging 312
Physical, Psychological, and Social Aspects of Adult Aging 314
Personal and Environmental Factors 316
Retirement, Leisure, and Economic Status 318
Living Environments 319
Model for Rehabilitation 320
CORE Assessment 322
CARE Management 323
Feedback Based on Outcome Measures 324
Importance of the Conceptual Framework to AR Practice 324
Rehabilitation Settings 325
Research and Teaching Settings: Universities 325
Military and Veterans Administration Medical Centers 326
Community Centers, Agencies, and Consumer Groups 326
Hospitals, Medical Offices, Private Practice Audiologists, and Hearing Instrument Specialists 327
Rehabilitation Assessment 327
Assessing Hearing Loss and Consideration of Comorbid Health Conditions 328
Assessing Activity and Participation and Considerations of Social Factors 329
CORE Assessment Summary 333
Rehabilitation Management 334
Counseling and Psychosocial Considerations with a Health-Promoting Approach 335
Amplification and Instrumental Interventions to Achieve Audibility 343
Remediation for Communication Activities 356
Environmental Interventions to Improve Participation 359
Other Important Issues in the Scope of AR Practice 361
Vestibular Assessment and Management 361
Tinnitus Assessment and Management 364
Summary and Summary Points 366
Supplementary Learning Activities 368
Recommended Reading and Recommended Websites 369
World Health Organization (WHO) Resources 369
Consumer Associations and Resources for the Public 370
Websites about AR Tools 370
References 371
Appendix A to G 383

PART THREE: Implementing Audiologic Rehabilitation: Case Studies 393

11 Case Studies: Children 395
Mary Pat Moeller
Catherine Cronin Carotta
Introduction 395
Case 1: Matthew-;Early Intervention, Multiple Disabilities 396
Background Information 397
Intervention Plan 397
Environmental Coordination and Participation 399
Assessment: Postimplantation 399
Psychosocial and Counseling Aspects 400
Assessment and Intervention Postdiagnosis of Autism Spectrum Disorder 400
Communication Rehabilitation Adjustment 401
Summary 401
Case 2: Annie-;Routes to Spoken Language Following Cochlear Implantation 402
Background Information 402
Aural Rehabilitation Plan: Preimplantation 403
Aural Rehabilitation Plan: Postimplantation 403
Intervention Outcomes 405
Summary 406
Case 3: Amber-;Issues Affecting Educational Placement 407
Background Information 407
Assessment Findings 409 Recommendations for Management 410
Follow-Up Assessment 410
Case 4: Greg-;Late Identification of a Child Who Is Hard of Hearing 411
Background Information 411
Communication Assessment 413
Management 415
Intervention Outcomes 416
Summary 416
Case 5: Sam-;Differential Diagnosis through Professional Teamwork: A Tool for Solving Complex Intervention Problems 417
Assessment 418
Management 420
Chapter Summary and Summary Points 423
Supplementary Learning Activities 423
Recommended Website 424
References and Recommended Reading 424

12 Case Studies: Adults and Elderly Adults 427
Michael A. Nerbonne
Jeff E. Brockett Alice E. Holmes
Introduction 428
Case 1: Dr. M.-;Progressive Hearing Loss 428
Case History 428
AR Assessment 429
Management 429
Summary 431
Case 2: Mr. B.-;Hearing Loss, Depression, and Successful Hearing Aid Use 431
Informational Counseling 431
Rehabilitation Assessment 431
Rehabilitation Management 432
Summary 435
Case 3: J.D.-;AR Featuring a Significant Other 435
Introduction 435
Informational Counseling 435
Rehabilitation Assessment 436
Rehabilitation Management 437
Summary 441
Case 4: Mrs. R.:-;Cochlear Implant User 441
First Evaluation 441
Rehabilitation Assessment 442
Second Rehabilitation Assessment 443
Post--Cochlear Implant Rehabilitation Management 444
Summary 445
Case 5: Mrs. E.-;Nursing Home Hearing Aid User 446
Case History 446
Diagnostic Information 446
AR 446
Summary 447
Case 6: Ashley-;New Technology for an Experienced User 447
Introduction 447
Informational Counseling 448
Rehabilitation Assessment 448
Rehabilitation Management 449
Summary 452
Case 7: Ms. C.-;Dizziness Issues 452
Introduction 452
Rehabilitation Assessment 453
Informational Counseling 454
Rehabilitation Management 455
Summary 455
Chapter Summary Points 455 Supplementary Learning Activities 456
Recommended Reading and Recommended Website 456
References 456
Author Index 000
Subject Index 000