Aural Rehabilitation CDIS 4133

1. Aural RehabilitationCDIS 4133 JACQUE SCHOLL, AU.D, CCC-A, FAAA DOCTOR OF AUDIOLOGY

2. Rules of Conversation Tacitly agree to share one another’s interest Ensure that no single person does all of the talking Participate in choosing what to talk about, and participate in developing the topic Take turns in an orderly fashion Try to be relevant to the topic of conversation Provide enough information to convey a message without being verbose. Pragmatics!

3. What can happen with someone with a HL? Disrupted taking of turns Modified speaking style Inappropriate topic shifts Superficial content Frequent clarification Violation of implicit social rules

4. Classes of communication strategies Facilitative strategies (talker) Instructing the talker and structuring the listening environment to enhance the listener’s performance Receptive repair strategy (listener) A tactic used by an individual when he or she has not understood a message Communication breakdown (talker & listener) When one communication partner does not recognize another’s message

5. Factors that influence reception (talker) Talker Message Environment

6. Facilitate (listener) Speech recognition skills Adaptive - implement relaxation techniques Attending - pays attention to cues for inferring Anticipatory - prepares Communication environment Constructive - structures the environment Communication partner Instructional - asking Message Message tailoring - encourage control of topic Maladaptive strategies

7. Repair Strategies When a breakdown in communication happens, listeners can request information by using a receptive repair strategy Flow chart pg 54

8. Stages of repairing communication breakdown Detect Choose a course of action Implement

9. Repair Strategy or Bluff? Specific Repair Strategies Repeat (most common repair strategy) Rephrase Elaborate Simplify Inidcate topic of conversation Write Fingerspell Nonspecific repair strategies (What? Huh? Pardon?) Extended repair - use several together Expressive repair strategies Bluff - consequences?

10. Conversational Styles Passive Tends to withdraw from conversations and social interactions rether than attempt to repair Aggressive May blame others for misunderstanding Assertive Takes responsibility for managing communication difficulties in a way that is considerate of comm partners

11. Communication Behaviors Interactive The use of cooperative conversational tactics, consistent with an assertive conversational style Non-interactive Characteristic of a passive behavioral style Dominating Characteristic of an aggressive conversational style

12. AssessmentChapter 3 Communication demands on everyday life Impact on daily activities Where problems arise Social activities a person is likely to engage How comm strategies are used in different settings Chronical employment responsibilities

13. First things first Audiogram Aided and unaided

14. A A A A X X X X X X

15. Definitions Conversational fluency - how smoothly conversation unfolds Sociolinguistics - a branch of linguisticsthat studies the effects of social and cultural factors Mean length turn ratio (MLT ratio) - the ratio of the MLTs of two speakers in a conversation Mean length (speaking) turn - the avg number of words spoken during a set number of conversational turns Conversational turn - the period during which a participant delivers a contribution to the conversation

16. Word Rec Tests vs. Real Life Competency Word Rec lists are unrelated speech stimuli Patients must repeat back verbatim Real life is ongoing conversation

17. Why Conversational Fluency & Communication Handicap are difficult to assess Varies from setting-to-setting/partner-to-partner Measures vary with the topic of discussion Do not always arise from a conversation No one measure can adequately assess

18. Ways to measure communication handicap Interview Questionnaire Daily log Group discussion Structured communication interaction Unstructured communication interactions

19. Interviews Do not turn away and write Pregnant pauses Use how, what, and when questions more than why Keep them talking Listen Listen without judgement, evaluation or opinion Show your passion

20. Questionnaires Abbreviated Profile of HA Benefit (APHAB) Amsterdam Inventory for Auditory Disability and Handicap Client Oriented Scale of Improvement (COSI) Communication Profile for the HI (CPHI) Communication Scale for Older Adults (Revised) Communication Self Assessment Scale Inventory for Deaf Adults (CSDA) Denver Scale of Communication Function-Modified (DSCF-M) Glasglow Hearing Aid Benefit Profile (GHABP) Gothenburg Profile (GP) Hearing Aid Needs Assessment (HANA)

21. Questionnaires con’t Hearing Attitudes in Rehabilitation Questionnaire (HARQ) Hearing Coping Assessment (HCA) Hearing Disabilities and Handicaps Scales (HDHS) Hearing Handicap and Disability Inventory (HHDI) Hearing Handicap Inventory for Adults (HHIA) Hearing Handicap for the Elderly (HHIE) Hearing Handicap Scale (HHS) Hearing Performance Inventory (HPI) Open-ended Problems Questionnaire

22. Daily Logs Detailed instructions Use active vs passive statements Minimum of prepositional phrases Avoid jargon Limit the number of items to max of 7

23. Group Discussion Encourage everyone to participate Record remarks Do not embarrass anyone Guide discussion by asking questions Be prepared

24. Structured Communication Interactions Simulated conversations used to reflect a patient’s communication difficulty Evaluated on: 1) no. of prolonged pauses; 2) no. of restarts; 3) no. of topic shifts; 4) interrptions of turn-taking; 5) lefel of abstraction and superficiality; 6) prescence of self-consciousness; and 7) degree of understanding

25. Unstructured Communication Interactions Spontaneous Transcription of interaction is analyzed Obtain ratings Computer bases technique called Dyalog