The Nature of Aural Rehabilitation by Raymond Hull, PhD, FASHA, FAAA
When my book, “Introduction to Aural Rehabilitation” was first published by Plural Publishing in 2010, I wanted everyone to read the first sentence. To me, it said it all. Those words are, “The aim of aural habilitative/rehabilitative services on behalf of those with impaired hearing is to overcome the handicap”. I felt that it was an all-encompassing statement that covered many aspects of the services that we offer on behalf of those with impaired hearing. However, it was a very general statement that left specifics unanswered. In the current second edition of “Introduction to Aural Rehabilitation”, I continue by saying, “The audiologist works with the patient to assist in remediating the handicapping effects of the hearing loss…to overcome the communicative, educational, social and psychological effects…that may result from impaired hearing”.
Now, the question that has plagued me and many of us during our careers as audiologists is, what do the specific elements of “remediation” actually involve? It is a subject that has been debated extensively over the years, and I have witnessed and been a part of those discussions. During my graduate studies, I was taught that what was in the book, “What People Say” by Ordman and Ralli contained many of the necessary ingredients for a successful program of aural rehabilitation. That approach, of course, has thankfully long passed into history. It seems that for nearly every person who provides services on behalf of individuals who possess impaired hearing, approach their habilitation/rehabilitation in ways in which they feel most comfortable. And, of course, that is appropriate since every audiologist deserves the opportunity to develop their own approaches to serving their patients, whether children or adults.
However, although audiologists generally have differing philosophies regarding the most effective and efficient avenues for serving their patients and assisting them to regain their place in their hearing/communicating worlds, it seems that there are common elements in the process that we all consider to be important in serving our patients. And, from those elements, variations on that theme provide fertile ground for individual approaches that generally take on many different characteristics, including those that I utilize and advocate in the second edition of “Introduction to Aural Rehabilitation” that I edited and share the authorship with other very talented authors.
First of all, the “list” of components that I feel are the most important in aural rehabilitation treatment continues to become shorter. But, even though the list has become shorter, I feel what is contained in that list has become more meaningful both for the patient and in relation to my own feelings that I am addressing the specific needs of the patient. Therefore, it is not a process that I feel somehow compelled to provide because it was “what I was taught in graduate school”.
The following is a description of the process that I advocate for working with adult who possess impaired hearing.
1. First of all, I ask the question that my primary care physician or my dentist or my dermatologist always asks me when I am seen by her. That is, “How are you doing? What can I do for you today?” Those are probably the most important questions that a doctor can ask their patient. And, if I have issues of concern, I tell her about those—a tooth that doesn’t feel well, and I point to its location. If I am seeing my dermatologist, I might say that I noticed a spot on my face and I want you to take a look at it, or for my primary care physician, my left knee has been giving me fits! In the situation involving audiologist and patient, the same questions are also appropriate. If the patient responds with, “Oh, nothing really. I can’t think of anything”. The patient’s spouse may fill in the gaps with, “Oh yes, there ARE problems!” And, we move on from there.
2. Most importantly, I listen to my patients as they tell me about difficulties they have in their own listening environments, and I take notes. I don’t want to hear replies in response to a pre-designed “communication profile”. I want them to tell me about their own listening environments and any difficulties they have in various situations where communication is intended to take place. I may give them prompts that involve typical places of hearing difficulty that I would like to hear about.
3.After my patient has given me a synopsis of why she or he has made the appointment to see me, and we have completed a case history, a thorough hearing evaluation is completed, particularly in regard to speech recognition since that is an important element in the patient’s real world of communication.
4. If warranted, depending upon the specific difficulties the patient is experiencing, appropriate amplification devices may be selected and fit as per the specific difficulties the patient is experiencing in her or his communicative life.
5. My patients and I talk about ways to improve upon their most difficult communicative environments. These usually center on home, job, social environments, church, and meetings. An environment in which the majority of my patients experience difficulty is that of their home, and may be specific to hearing and understanding their spouse or significant other. We talk about the acoustic environment that typical homes offer, since homes can be essentially anechoic chambers in which sound, particularly that of the sounds of speech, do not carry well.
So, above and beyond a hearing impairment, there are other reasons why it can be difficult to carry on a conversation in a home or other environment, particularly when one or both of those who are talking may not speak with the precision or clarity that enhances speech recognition. Hearing aids can certainly help, but they do not improve poor speakers!
6. If warranted and possible, I work with those who communicate most frequently with the patient on their speaking habits, including precision in articulation, voice production, and the use of appropriate suprasegmental aspects of speech. This is critically important on behalf of both adults and children with impaired hearing. My background in public speaking and interpersonal communication assist me in that aspect.
What I have written here is certainly not what I was taught in my graduate course in aural rehabilitation when I was a graduate student, and it is far from the prescribed course found in “What People Say”. But, I feel that what I am doing, and what I am advocating in my book, “Introduction to Aural Rehabilitation” is something that can truly help people, both children and adults, who possess impaired hearing in their personal, educational, occupational and social lives.
*Information on this topic can be found in Hull (2013) “Breaking News: Going Beyond the Basics in Aural Rehabilitation”. Hearing Journal, 66, 14-15.
Raymond H. Hull, PhD, CCCA & SP, Professor of Communication Sciences and Disorders, Audiology/Neurosciences
Department of Communication Sciences and Disorders
School of Health Sciences
College of Health Professions,
Wichita State University
Wichita, Kansas 67260—0075