The Importance of Aural Rehabilitation: The Therapy Behind the Technology
Ralph Moscarella, MA, CCC-A
ENT and Allergy Associates, LLP
When working with a patient with hearing loss the Aural (Re)habilitation process can be a rewarding experience not just for the Audiologist and patient, but for the family members as well. To take part in the progression of improving the quality of life for another is an amazing and gratifying part of the Audiologist’s career. Any functional progression a patient has no matter how big or small will not only inspire the patient but their family members as well. There will be challenges that will make the clinician rethink your approach with the patient, but when a breakthrough occurs, it can inspire your patient to move forward in their rehabilitation process and to become successful with their hearing aids.
The definition of Aural (Re)habilitation is the helping those affected by acquired hearing loss after speech and language development as opposed to Aural Habilitation which is the initial method of helping children born with paralinguistic congenital hearing loss. Both processes start with the case history, which moves onto the hearing evaluation, once a diagnosis is completed selection and recommendation of a device is provided to the patient (during the Hearing Aid Evaluation). Consideration of the type of Aural Rehabilitation method will take place throughout this process, which will be determined on the needs of the patient as well as the needs of the family members.
During the Audiological Evaluation, I often tell my patients that, “hearing loss not only affects you but the people around you”, meaning it is vital to include their loved ones in this journey if they are to be successful communicators with their devices. I encourage my patient to bring someone to the Hearing Aid Evaluation for support, but more importantly to learn as much as I can about the patient and the way their hearing loss affects them. In this day and age where so much focus is now on hearing loss and cognitive decline inclusion of family and friends during the rehab process is so important. Teaching both the patient and their loved ones about hearing loss, the devices, and how it can improve their quality of life, as well as how to approach each other before interaction begins can lighten the anger and frustration that comes with the communication breakdown which can lead to isolation for the patient. Many times the Audiologist becomes marriage/family counselors, as we are the witnesses to arguments between loved ones over communication breakdown. This is why I have plenty of tissue boxes in my hearing aid room as these discussions can become very emotional.
Aural Rehabilitation does fall into the preverbal cliché “help me help you” and this is indeed true. The hearing aids and the adjustments to these devices are just the first step in the Rehabilitation process. By just listening to the patient’s problems it will grant the Audiologist important perspective of the their communication and listening issues. This will lead to providing communication strategies for all situations to help improve their ability to communicate with others. This will include maintaining eye contact, utilizing proper turn taking, speaking clearly while shorter sentences. We can also make available strategies for challenging listening environments such as restaurants, family gatherings, and house of worship. Asking questions about where they sit, whom they speak with, or positioning during conversations within these environments can open up dialogue to incorporate subtle changes (asking for tables away from kitchens, sit next to people the want to talk to, sitting in a well lit area) that are easy to follow and sustain. Remember, the biggest challenge we face as clinicians is we cannot follow our patents around to remind them to not only wear their hearing aids but to incorporate the strategies necessary to be able the navigate through their world, so we must create an easy approach to motivate the patient and their loved ones to be successful communicators.
In 1967, Helen Keller described hearing loss and deafness as follows: “Deafness is a much worse misfortune, for it means the loss of the most vital stimulus, the sound of a voice that brings language, sets thoughts astir, and keeps us in the intellectual company of people”. Audiologist when utilizing an Aural Rehabilitation approach along with hearing aids play an important role with the quality of life of the patient and their loved ones, by providing these unique services that will help our patient to continue to interact with their world thus greatly decreasing the effects hearing loss has on educational, vocational, psychological, and social functions. The Audiologist must have a solid understanding of the hearing loss and the related technology used by the patient as well as the patient and family’s perception of that technology as part of the rehabilitation process. It is only through this understanding and collaboration with all parties involved that the person with hearing loss will meet maximum success with aural rehabilitation.
In conclusion, get to know your patient and their family, listen to the issues that the hearing loss brings, teach them about communication strategies and encourage them to get out into the world tan challenge themselves. Always be the source of motivation even when they have a bad outing with their devices, it is all a component of the Rehabilitation process that we are so fortunate to take part in.
Northern, J. L. & Downs, M. P. (2002) Hearing in Children (5th edition). Philadelphia, PA: Lippincott, Williams, and Wilkins.