Professor Louise Hickson

Professor Louise Hickson

In an age of cost-cutting and Internet shopping, buying cheap hearing aids online is an appealing option. But putting on hearing aids is not the same as buying glasses to ‘fix’ a problem. To get the best results, you need auditory rehabilitation, say leading audiologists Louise Hickson and Emma Scanlan.

What is auditory rehab?

The aim of auditory rehabilitation is to make changes in communication skills and strategies to improve the ability to communicate for an individual, their family, friends and others in their lives.

In this age of whiz-bang technology, hearing aids, implantable devices, streamers and other assistive devices, including live captioning – is auditory rehab still needed?

There are a significant number of people who, even with well-fitted devices, may only be able to understand less than 75 per cent of conversation even in quiet conditions. Many factors influence device outcomes, including the degree of hearing loss, speech clarity, additional areas of difficulty such as visual or cognitive impairment, personality, expectations, motivation and available support. Many people will gain additional benefits from other types of training and rehabilitation which can build and maintain communication skills.

One of the ways to provide auditory rehabilitation is to run a training communication education program. This can be as short as one session, or much longer, depending on someone’s needs and goals. Any successful approach should include determining needs, setting goals, implementing strategies and reviewing outcomes. These can be long or short-term goals and strategies.

Reasons to do auditory rehab

Research shows that adults with hearing loss need more help than they receive from hearing devices alone (International Journal of Audiology, 2003), says Louise Hickson, Professor of Audiology at The University of Queensland and President of Audiology Australia. Auditory rehabilitation needs to be individualised and holistic. Education about how to listen and engage in conversation and how to apply communication tactics is very beneficial for both the person with hearing loss and his or her communication partners. People who receive this sort of assistance report improved communication and better quality of life overall, according to a 2007 trial evaluating the Active Communication Education program for Older People With Hearing Impairment.

Communication is a two-way process and there is a great deal to gain by involving family in how to communicate effectively when someone has a hearing loss. It is very common for people who do not have any aural problems to be unsure how they can help those who do. But families often want to help. Professor Hickson says the most important things to do are to decrease the distance between the speaker and the person with hearing loss and turn down background noise. This simple advice should always be included in auditory rehabilitation.

In her own collaborative research, Professor Hickson confirmed that many people with hearing loss do not choose to wear hearing aids, yet they still need help for their hearing difficulties. In these cases, education about communication is even more important. Audiologists can provide a wide range of assistance to people with hearing loss and their families. “Despite popular belief, audiology is not all about fitting hearing aids,” says Hickson.

Emma Scanlan, auditory rehabilitation

Emma Scanlan (left) conducting rehabilitation

Setting your goals

Why is goal setting important? Goal setting in this context serves various functions. It helps everyone involved to know where to start – and when to stop. It is helpful in making sure that expectations are realistic, addressing individual priorities and providing a map to follow throughout the program.

Once the goals have been established it is time to implement strategies. This will usually involve fitting some kind of hearing device using best practice and technology and instructions about management. It may also involve the use of additional devices to assist with particular situations such as streamers or remote wireless technology. For many people, to a greater or lesser degree, and depending on the approach of the clinicians that they see, they will then undertake communication testing and training, to address strategies and tactics.

During the communication assessment, the audiologist will use the person’s test results on speech comprehension to pinpoint areas where improvement might be possible. These results are discussed in detail to make sure that any required training fits in with goals and is relevant. Communication training can be hard work and there is no point putting effort into an area that is not important to you.

The assessment and training conditions should match as closely as possible with the person’s goals. For example, if the goal is to be able to understand in a noisy situation, testing and training for improvement should also be done in noise. Sometimes the goal will be a listening (ears only) goal such as improving on the telephone, other goals will involve eyes and ears where lip-reading and body language cues are available and can be helpful, such as following conversation at a weekly sewing group.

Practice makes perfect

There will often be various elements of the training program depending on those factors listed earlier. The most common elements have some emphasis on listening skills and using listening to the best of one’s ability, listening with visual information available, communication strategies and conversational skills. Many training activities will be as close to real-life as possible and have a major focus on using a range of skills in context.

Communication tactics can be learnt and they are one of the most helpful ways to improve your ability in this area. Because the incorporation of tactics and strategies into daily life usually involves a change in behaviour (for people who don’t have well-developed skills in this area) it takes practice, like anything that is new. The important thing is that the tactic or strategy is explained to the person, then demonstrated and then the person is given the opportunity to practice in a safe environment until the skill is cemented.

One of my favourite activities is a list of questions that the client can ask the audiologist and the client then repeats the answers. Once the communication tactics have been discussed and practised this gives a ‘real-life’ situation in which to try them out. It also gives the audiologist the opportunity to make the answers as complex or simple as required and also to make the communication style easier or more difficult to understand.

By covering the mouth, speaking quickly or mumbling, the client can then be encouraged to use their tactics and strategies to get the clear message that was intended. Sometimes this involves simply asking the speaker for a repeat (“Could you please say that again?”) or a re-phrase (“Could you please say that again using different words?”). At other times it can be useful to repeat back that part of the message you did hear and just ask for clarification on the bit that was missed.

For example, “I heard you say that someone was coming over on Tuesday but I wasn’t sure who you said, did you say Carol?”. This is helpful because it shows the other person you are listening, interested and trying and shares the responsibility of successful communication between the two parties.

Conversational skills can include all forms of non-verbal communication in addition to voice monitoring, turn-taking and conversational cues. The reports of people that have undertaken auditory rehabilitation show they make better use of the information they receive, improve communication skills and are more likely to participate in favourite activities and be more social.

One mum was struggling to hear while chatting with her son and home helper despite wearing well-fitted hearing aids. She worked with principal audiologist Emma Scanlan, of the Australian Hearing Hub at Sydney’s Macquarie University, to achieve three goals. These were to hear her alarm in the morning so her son did not have to wake her, to improve conversation with him as they read together at night and to converse with a home helper twice a week.

The first goal was simply achieved by acquiring a vibrating alarm clock. The other two goals required specific skills and training. “We undertook a program that involved a range of activities to improve one-on-one conversation in a quiet place,” says Scanlan. The distance between the reading mum and her son was reduced from around 4 metres to 1.5 metres and she worked on basic conversational tactics and the importance of lip-reading for consonants, as her assessment showed she found it hard to perceive high-pitched consonants. “We also spent some time discussing and practising anticipation strategies and how to cope with changes in topic,” explains Scanlan. With regular practice and persistence, the mum rated herself as managing ‘much better’ on an improvement scale for both situations and could hear 75 per cent of the time (up from 25 per cent before the training).