In other words, the goals and objectives of our treatment plan should be clearly evident from the outcomes of our assessment. To efficiently and effectively implement any treatment or aural rehabilitation (AR) plan, it is necessary to use an assessment plan that facilitates the AR plan. In particular, this paper will address assessment procedures that facilitate conversationally based intervention, as well as two elements of intervention that our clients find most useful, acknowledgement scripts and communication repair strategies. The specific focus of this article will be on elements of assessment and intervention that are critical to successful communication for persons with hearing impairment. To facilitate understanding of these less familiar strategies, this paper addresses a conversationally based approach to aural rehabilitation, grounded in the principles of the service delivery models mentioned above. However, Schow goes beyond these familiar audiologic services and stresses the importance of personal adjustment, assertive communication, and conversational repair.įor most hearing health care professionals, notions such as affective counseling, assertive communication (not just assertive listening) and conversational repair strategies may be less comfortable and less familiar processes. Hearing instrument fitting and hearing instrument orientation are included in the CARE portion of the model. The treatment program (CARE) Schow proposes relies on elements of service delivery that are customary and familiar to audiologists. This approach is consistent with the World Health Organization (WHO) definitions of impairment, disability and handicap. Most recently, Schow (2001) has proposed the CORE/CARE model that addresses assessment and treatment relative to the impact of the individual's hearing impairment on activities of daily living. This procedure incorporates listening and conversational strategies to be employed by people with hearing impairment. Similarly, Montgomery and Houston (2000) have proposed the WATCH procedure. For example, Tye-Murray (1998) reviews her considerable work in conversational repair. Recently, several investigators have proposed models of service delivery emphasizing conversational management and the importance of communication as both an input and output process. That is to say, people with hearing impairment should develop strategies as both a listener and as a speaker to enhance their communicative effectiveness. (See, Erber, 1998 Tye-Murray, 1998, Alpiner & McCarthy, 2000 and Schow, 2001 for further discussion.) In other words, we need to address hearing impairment as both an input and an output problem. They define communication as an interactive process that requires periodic role switching by the speaker and the listener and as a process that requires frequent repair. 382)" and, even under the best circumstances, we cannot restore our clients' hearing to normal.Īccordingly, many professionals have stressed the communication needs of hearing impaired individuals should be addressed in a broader context. As Montgomery and Houston (2000) have noted, even "unimpaired communication is not error-free (p. The assumption has been that restoring speech recognition will restore effective communication.Īlthough restoring speech recognition has intuitive appeal, this approach may not address the total needs of our clients. Recognizing that amplification is not a perfect solution to hearing loss, we have augmented amplification with training in visual recognition of speech and manipulation of environmental variables to optimize multi-modal (auditory and visual) speech recognition. Our primary aim has been to improve audibility, equalize loudness, and improve word recognition (Dillon, 2001). For example, attention has been focused primarily upon remediation of the auditory sensory deficit through judicious application of amplification. Traditionally, hearing health care professionals view hearing loss as an input problem. In addition, sales of hearing aids have remained fairly flat over time, while the segment of our population who might benefit from amplification (those over 55 years of age) has been growing (Strom, 2002). Yet, a large number of individuals fit with hearing aids either return them or do not wear them. There is emerging evidence that suggests we are making considerable progress with regard to hearing aid satisfaction (Northern, 2001, personal communication).
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