The Best of 2007статья из журнала
Аннотация: FigureAs I reviewed the 2007 journals looking for audiologic rehabilitation (AR) articles I was struck by the diversity of the offerings. In addition to tried and true research papers and topics, this year's selections include tutorial/review papers and others that hopefully will cause you to think outside the traditional AR box. I hope that this year's selections will also stimulate you to read further in a new area or to revisit a known topic from a different perspective. GREAT FOR THE CLINICIAN Age-related declines in sensory and cognitive abilities are well documented in our literature. In addition, some investigations have reported that males may show greater declines in these areas than females. These reports led Nancy Tye-Murray, Mitchell Sommers, and Brent Spehar to study age and gender effects on lipreading. The authors designed a study to test the hypothesis that gender differences in lipreading among adults increase with age. All participants in the study had normal hearing and vision and the older ones were screened to rule out cognitive impairments. The participants—older females, older males, younger females, and younger males—were all tested on a vision-only speech-recognition test for (1) consonant, (2) word, and (3) sentence stimuli. Results, published in Journal of the American Academy of Audiology (JAAA), revealed that older participants scored lower than the younger participants on lipreading tests and that these differences were consistent across gender. A second finding of the study was that there were no differences in lipreading abilities between genders across stimulus type (consonants, words, or sentences). The authors suggest that the counseling component in an AR program for older adults should address the age-related decline of lipreading ability. A second article that I liked also happens to be by Tye-Murray, Sommers, and Spehar. Writing in Ear and Hearing, they evaluate the effects of age-related hearing impairment on lipreading and audio-visual integration. Two groups of older adults (matched for age) took part in the study. One group of subjects had normal hearing while those in the other group exhibited mild-to-moderate hearing impairments. Both groups were tested under three conditions (auditory only, vision only, and auditory-visual) with consonants, words, and sentences being used as stimuli. All stimuli were presented in a background of multi-talker babble in order to equate auditory-only performance across groups. The overall results show that those with age-related hearing impairment did not perform better on visual or auditory-visual speech perception tasks than the age-matched normal-hearing participants. The authors suggest that assessing all three modalities will assist the clinician in determining a specific modality for intervention in the rehabilitation program. As the demographics of our clinical population change, audiologists are seeing a significant increase in elderly patients in their practices. Many of them exhibit both hearing and vision impairment, a combination that may require different rehabilitation strategies from those commonly employed with patients who have hearing impairment alone. In their article in Trends in Amplification, Gabrielle Saunders and Katharina Echt provide an excellent overview of dual sensory impairment (DSI) by reviewing both its normal age-related causes and effects as well as those resulting from pathologic conditions. The literature they cite suggests that DSI affects psychological, psychosocial, and functional domains and is associated with depressive symptoms, including poor self-rated health and decreased participation in social activities as compared with persons without sensory impairment. DSI is also associated with cognitive decline as measured by the Mini-Mental State Exam. The authors offer useful suggestions as to how rehabilitative interventions should be modified in relation to cognitive function and patient-provider communication. They recommend that careful attention be given to the lighting and acoustics of the rehabilitative environment; that multiple perceptual channels (visual, auditory, and tactile) be used in rehabilitation; that the provider use “clear speech” in communicating; that written materials be clearly printed and geared to appropriate reading levels); and that appropriate assistive listening devices be employed to insure an appropriate signal-to-noise level. In addition, the article gives directions for future research efforts designed to develop more effective rehabilitative protocols for patients with DSI. This article should be required reading for audiologists, particularly those who work with older patients. BEST QUICK READ In the early years of our profession, auditory training and/or speech reading were integral components of most AR programs. But as audiologists became more involved in selecting and fitting hearing aids, time commitments and the lack of quantifiable evidence to support rehabilitative services led to a de-emphasis of traditional AR programs. Recently, though, technological advances and research studies have resulted in a resurgence of interest in auditory and speech reading clinical services. Robert Sweetow and Jennifer Henderson Sabes in Trends in Amplification provide us with a very helpful update on several new and/or modified AR programs, using current technology, that are available for clinical use. They review four programs: Computer-Assisted Speech-Perception Testing and Training at the Sentence Level (CASPERSent), Computer Assisted Tracking Simulation (CATS), Computer-Assisted Speech Training (CAST), and Listening and Communication Enhancement (LACE). The authors describe each approach and draw comparisons among them regarding their purposes and target populations, the mechanisms used to present stimulus materials, and how feedback on progress is presented to each patient. Finally, they provide a very useful discussion of the utility of these types of programs for audiologic practice and of their efficacy. Group audiologic rehabilitation appears intuitively to provide psychosocial benefits, yet the literature on the efficacy of group AR has not been convincing. A review article by Jill Preminger in Trends in Amplification addresses factors that may contribute to the lack of efficacy in this type of AR program. These include procedural variables such as group curriculum/content, length of sessions, number of sessions and the training of the group leader. The author says that measurement variables may also contribute to the variability of the data on group effectiveness. For example, short outcome measures yielding global scores, such as the Hearing Handicap Inventory for the Elderly (HHIE) or the Hearing Handicap Inventory for Adults (HHIA), may be more or less sensitive to particular aspects of the program than instruments that yield several subscales, such as the Communication Profile for the Hearing Impaired (CPHI) or the Short Form 36 Health Survey. Finally, she says, the demographic characteristics of the participants may also add to the variability of group outcome results. Preminger concludes with several helpful suggestions for designing future research to evaluate the psychosocial benefits of group AR. My pick for “Best Quick Read” of 2007 is a JAAA article by David M. Nondahl and colleagues, who describe a population-based study that assessed the impact of tinnitus on quality of life. As part of the larger Epidemiology of Hearing Loss Study, the authors obtained self-reported data via interviews for a cohort of 2749 participants. At both the baseline and 5-year follow-up interview, tinnitus data were based on questions to assess the presence of tinnitus and its maximum severity. At the follow-up interview, participants were also asked about the duration of the noise and the annoyance it caused. Quality of life was assessed by means of the Medical Outcomes Study Short Form Health Survey (SF: 36). The mean age and hearing impairment of the participants are characteristic of what many of us see in an adult clinical practice. The study's results have relevance for AR in that 25% of the participants reported at least mild tinnitus and 9.4% of participants reported moderate to severe tinnitus. In addition, across all domains of the quality-of-life scales, participants' scores tended to decrease with tinnitus severity. NOT READY FOR MEDLINE In this category, I have chosen a Hearing Journal (HJ) Page Ten article offering very useful information for the rehabilitation audiologist. Written by Brian Fligor, it deals with whether the use of iPods may result in hearing loss. I have always believed that prevention should be an integral part of AR, and this article provides valuable summary information that we can pass along to parents and their children. Essentially, personal music players (PMPs) are capable of producing enough output that they can cause noise-induced hearing loss (NIHL). Of course, greater duration and listening levels increase the risk. Education is a key to prevention, and Fligor provides some helpful tips: (1) People listen at higher levels when background levels are higher (e.g., airplane cabins). (2) Those using sound isolation earphones listen at lower levels. (3) A rule-of-thumb for listening to PMPs is to “listen at 60% volume for 60 minutes (or less) for a CD player and 80% for 90 minutes (or less) for an MP3 player during any 24-hour period.” (4) Suggest that your teenager log onto www.listentoyourbuds.org for good information on this topic. My second selection in this category is an excellent article by Anne Marie Tharpe in Audiology Online. She provides a wonderful review of the current pediatric literature on unilateral hearing loss (UHL) and minimal and mild bilateral hearing loss (MBHL). There appears to be renewed interest in these topics, and I found this article very informative and timely. The author begins by clarifying the terminology used to describe these children and then provides current information on the prevalence of children exhibiting each problem. She also reviews the literature on the academic, social, and behavioral outcomes for UHL and MBHL and concludes with an excellent discussion of the audiological management options for each. An extensive reference list is provided for those wishing to take a more in-depth look at any of the topics discussed. This is a “must-read” article for any audiologist in a pediatric or school-based practice. I found another HJ Page Ten article very informative. In it, Louise Hickson describes the Active Communication Education (ACE) program, which she developed with colleagues at the University of Queensland. The program is designed to help older adults with hearing impairment become more effective communicators. The focus is on learning appropriate strategies for communication rather than on hearing impairment. The author suggests that she and her colleagues have learned that didactic programs consisting of lectures on communication don't work as well as programs that actively work at solving the unique problems encountered by group members. Details of the group sessions are outlined in the article. Preliminary research findings from studies evaluating the effectiveness and benefit of ACE are very encouraging. I have a notion that we'll be hearing more about ACE in future publications. MOST THOUGHT PROVOKING Bruce Kent and Steven La Grow, writing in the International Journal of Audiology (IJA), report on a study examining the complex relationship between hope and adjustment to hearing impairment. The 114 participants (mean age 67 years, with predominantly moderate hearing impairment) completed an 86-item questionnaire compiled to obtain data on individual and disability variables, adjustment, and hope. In addition to demographic information about age of disability onset, degree of loss, and use of assistive technologies, this questionnaire includes the Nottingham Adjustment Scale (NAS), which assesses adjustment to an acquired disability, and the Hunter Opinions and Personal Expectations Scale (HOPES), which assesses global personal hopefulness, including hope and despair subscales. The results of this investigation support the theory that degree of impairment is only a small (7% of the variance) component variable that may influence adjustment. Hope, on the other hand, emerges as a much greater influence on adjustment (45% of the variance). The implication for AR programs is that instilling hope in patients may positively influence their adjustment to hearing impairment. After reading this article, I find myself thinking about how we might engender the elements of hope in our AR programs. My pick for the Best of 2007 in the “Most Thought Provoking” category is an article in IJA by Julie Barlow and colleagues in the United Kingdom. It describes a qualitative study designed to gain insight into the experience of living with deafness for persons who had previously functioned in the hearing world. The researchers used face-to-face structured interviews to explore the effects of late deafness on emotions, family relationships, and employment. Their analysis of the transcriptions of the interviews led to several broad themes dealing with the emotional impact of hearing loss, its effects on families and social relationships as well as on employment, and the support received from hearing professionals. Rich quotations from the subjects support the authors' conclusions that late deafness has widespread and negative consequences in many areas of people's lives. Importantly, many participants reported that hearing and social healthcare professionals lacked the essential communication skills, sensitivity, and understanding to deal effectively with their problems. ALL-AROUND FAVORITES Finally, my pick as “All-Around Favorite” is entitled “Adult aural rehabilitation: What is it and does it work?” by Arthur Boothroyd, which appeared in Trends in Amplification. I was immediately intrigued by the title and hoped that AR would be described in clear and meaningful terminology that all audiologists could understand. I was not disappointed. Boothroyd begins the article by presenting the very positive and useful language of the World Health Organization in describing the domains of auditory function. In addressing the first question posed in the title he uses the WHO taxonomy to describe five categories (anatomy/physiology, function, activity, participation, and quality of life) as they relate to hearing and hearing loss. Then he specifically explains how each category may be targeted and addressed through AR. He describes the components of AR (sensory management, instruction, perceptual training, and counseling). The question “Does it work?” is addressed with a presentation of the evidence on the effectiveness of each component. This article presents an excellent description of audiologic rehabilitation and provides a strong rationale for including it in all practice settings.
Год издания: 2008
Авторы: David J. Wark
Издательство: Lippincott Williams & Wilkins
Источник: The Hearing Journal
Открытый доступ: bronze
Том: 61
Выпуск: 6
Страницы: 18–20