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by Cochlear Guest Author

Time to rethink adult rehab

March 2, 2021
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Review Prepared by Janette Oliver, Global Outcomes & Rehabilitation Manager, Cochlear Limited, BA., Dip Teach., M.Ed., PG Dip.Ed(Hearing Impaired) Dip.Aud., MA., MAudSA,CCP, Cert AVT

Hearing loss is complex and impacts on every aspect of a person’s life. The aim of aural rehabilitation is to help improve an individual’s quality of life through optimizing hearing function and communication.

To do this in a meaningful way we need to move beyond the assumption that device fitting alone is enough.

This assumption may discourage adult cochlear implant recipients from seeking appropriate aural rehabilitation and is often the reason why passive exposure is commonly recommended to recipients in clinics.

As a result, adult cochlear implant users typically adapt to the implant passively through everyday exposure to routine sounds in order to accurately pair an auditory stimulus to meaning.1

However, while device fitting alone may lead to improved hearing outcomes, a more holistic approach to rehabilitation which also addresses combined perceptual and cognitive skills training, knowledge acquisition and counseling will support broader real-life listening and communication outcomes. 2,3

Holistic care

A holistic approach is also shaped by the requirements of the individual – their needs, abilities, social and physical contexts and preferences.

Several researchers have also argued that hearing loss needs to be managed under a model of care that follows on from the World Health Organisation ICF framework for intervention and treatment of disability.4

This framework not only considers the physical hearing impairment (fitting appropriate technology), but also:

  • The impact it has on the individual in terms of activity limitations (such as inability to perceive speech in noisy environments)
  • Participation restrictions (such as the ability to fully participate in conversational activities)
  • Quality of life (includes such things as enjoyment and independence)5

More recently, Moberly et al (2020) proposed a comprehensive auditory rehabilitation approach along similar lines, incorporating device fitting and management, instruction, counseling and auditory training maximizes the opportunity to optimize speech recognition and quality of life outcomes for adult cochlear implant users.6

The pilot study conducted by this group demonstrated that such an holistic approach is feasible with adult cochlear implant users. A larger-scale trial is recommended by the authors to demonstrate the efficacy of this comprehensive auditory rehabilitation (CAR) approach as compared to current standard-of-care or additional preoperative counselling.

Read more about rehabilitation now!

References:

1. Drouin, J. R., & Theodore, R. M. (2020). Leveraging interdisciplinary perspectives to optimize auditory training for cochlear implant users. Language and Linguistics Compass. https://doi.org/10.1111/lnc3.12394 

2. Boothroyd, A (2007). Adult aural rehabilitation: what is it and does it work? Trends Amplif. 2007 Jun;11(2):63-71.    

3.Ferguson, M., Maidment, D., Henshaw, H., & Heffernan, E. (2019). Evidence-Based Interventions for Adult Aural Rehabilitation: That Was Then, This Is Now. Seminars in hearing, 40(1), 68–84. https://doi.org/10.1055/s-0038-1676784]   

4. McMahon, C, Gopinath, Schneider,J, Reath,J., Hickson,L, Leeder,S., Mitchell, P., Cowan, R. (2013) The Need for Improved Detection and Management of Adult-Onset Hearing Loss in Australia. International Journal of Otolaryngology Volume 2013, Article ID 308509, https://dx.doi.org/10.1155/2013/308509]

5. [https://www.who.int/classifications/international-classification-of-functioning-disability-and-health]

6. Moberly, A. C., Vasil, K., Baxter, J., Klamer, B., Kline, D., & Ray, C. (2020). Comprehensive auditory rehabilitation in adults receiving cochlear implants: A pilot study. Laryngoscope Investigative Otolaryngology. https://doi.org/10.1002/lio2.442.

Author

Cochlear Guest Author

In an effort to keep our content fresh and reflective of a diverse industry, Cochlear Americas features a mix of employees and professional partners to contribute to Cochlear ProNews as Guest Authors.

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TECH Talk: Kali Markle, AuD, discusses how the Cochlear™ Mini Microphone 2+ can help your patients in the classroom and beyond

August 30, 2018

TECH Talks

Pediatric Audiologist, Kali Markle, Au.D., reviews and summarizes her CI2018 lecture “Beyond the Classroom” which features her experiences with the Mini Microphone 2+ (MM2+) as an affordable and portable option for children at home, in the classroom and beyond.

Dr. Markle, says the Cochlear™ Mini Microphone 2+ is a great tool for students with cochlear implants, both inside and outside the classroom. In school, the Mini Microphone 2+ can replace or connect to a traditional FM System in order to keep the child engaged with their teacher, as well as their classmates. The Mini Microphone 2+ can also help keep children of all ages connected to sound in a variety of different situations, such as the car, early intervention sessions and extracurricular activities, to name a few.

Dr. Markle says, “This remote microphone technology is so important because children need at least 45 million words before the age of four to be successful in school and reading and literacy.”1,2

Watch the new TECH Talks video from Dr. Kali Markle and stay tuned for additional TECH Talks from other industry experts!

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References:
  1. Betty Hart and Todd Risley, “Meaningful Differences in the Everyday Experience of Young American Children,” (Baltimore, Paul H. Brooks, 1995).
  2. Betty Hart and Todd Risley, “The Early Catastrophe: The 20 Million Word Gap by Age 3,” American Education (Spring 2003).
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Why telehealth matters: Remote Check

April 19, 2021

By Julie Purdy, Ph.D., CCC-A and Keri Colio, Au.D., CCC-A

Background 

When we work with children with cochlear implants, we are aware of the many appointments that families must juggle. While this is a strain on all of our families, for some it is even a greater challenge if their children are medically fragile or live long distances from the center or satellite centers.  COVID-19 has shined a light on the need for audiologists to move beyond sound booth service delivery. There are few tele-audiology models and most require an audiologist to use a camera or video system to connect to a facility closer to the child’s rural location. We were fortunate to be part of the pre-market release of Remote Check, which allowed us to pilot this new technology. Remote Check allows patients to complete a series of hearing tests from the comfort of their own home from their compatible device using the Nucleus® Smart App.*

Results

We received access to Remote Check in June of 2020.  We then contacted all eligible Cochlear Nucleus 7 recipients and asked if they would like to participate in a Remote Check pilot with our center.  Once a family expressed interest, they were enrolled and guided through this process:

  1. First, the Remote Check feature of the Nucleus Smart App was activated.
  2. Then, we unlocked the activities that we wished for each applicant to use by choosing from the following: impedance check, implant site photos, audiogram, speech in noise test, datalogging and questionnaires.
  3. Once the child and family had completed Remote Check, the results were sent directly to us to review within myCochlear.
  4. Based on the results, we determined if the family needed an appointment which could consist of a tele-audiology appointment, remote tablet programming or in-person services. For the majority of our families, a tele-audiology appointment was sufficient.

We quickly became fans of this technology and made decisions on how we wanted to integrate this wonderful technology into our existing clinical services.

Lessons learned

  1. Don’t send all activities to all families – be specific based on the information to be obtained. For example, there’s no need to send the speech in noise test to a young child! 
  2. Look at the questions that the software flags for review. These questions and answers will direct you towards determining the appropriate follow-up.
  3. Be sure to check progress, or lack thereof, if Remote Check has been completed before. Previous results are available to view on the audiogram, speech in noise testing and questionnaires all within myCochlear Remote Check review.   
  4. Our clinic schedules a tele-audiology appointment to review the test results. Parents are interested and will have questions. 

Case examples

Several families, mainly parents of young children, have requested Remote Check due to head injury and concern regarding the internal device. The ability to measure impedances remotely has saved many families a 2+ hour trip to the clinic to complete a test that takes less than 10 seconds. The families have been extremely grateful to have access to this type of remote care.

Remote Check has also been a crucial tool for our families who have been unable to return to the clinic, or the United States, during the COVID-19 pandemic. We have several families who are unable to cross the Mexico-US border and who are currently living with relatives in other countries. These families have been thankful for the opportunity to test their devices remotely and review the results with their audiologists via telehealth methods.

Conclusion

While many professions have been able to move quickly into providing telehealth, audiological efforts have, on the whole, stalled at institutions around the country. Remote Check is a valuable battery of activities which can effectively be used with our remote/fragile patients to better monitor the functioning of their devices and success of use. 

Read more about Remote Check on Cochlear ProNews or watch this webinar.

Julie Purdy, Ph.D., CCC-A
Julie has been a part of the Diagnostic Audiology team since 2007 and became the manager of audiology in 2014. She earned her doctorate in philosophy at the University of Utah in 1990, specializing in multicultural audiology and aging. Julie received her Master of Science in 1985 and her Bachelor of Arts in 1983, both in communication disorders from Brigham Young University in Provo, Utah. She holds a certificate of clinical competence from the American Speech-Language-Hearing Association, is a fellow of the American Academy of Audiology and is licensed by the state of California. She primarily works at our Main Campus location.

Keri Colio, Au.D., CCC-A, Cochlear Implant Clinical Coordinator
Keri joined Rady Children’s in 2013 and works at the Main Campus location where she serves as the Cochlear Implant Clinical Coordinator. Keri received her doctorate in audiology from East Tennessee State University in 2013 following completion of a four-year residency program. Prior to that, she earned a Bachelor of Arts in audiology from the University of Tennessee. Keri is certified by the American Speech-Language-Hearing Association (ASHA). She maintains an audiologist license from the state of California and serves as a subject matter expert on the Speech-Language Pathology, Audiology and Hearing Aid Dispensers Board. Keri also serves on the Board of Directors for the Society of Ear Nose and Throat Advancement in Children (SENTAC).

* To use Remote Check, a patient requires: latest version of the Nucleus Smart App (Remote Check is part of this App) running on a compatible Apple device (iPhone or iPod Touch); Nucleus 7 Sound Processors with implant models: CI24RE, CI512, CI513, CI522, CI532, CI612, CI622 and CI632; compatible firmware on the Nucleus 7 Sound Processor (4.1.3.3 or later). A clinician requires access to Cochlear’s secure web-based myCochlear.com Professional Portal to access and review patient results. The recommended browser for accessing the Professional Portal is Google Chrome. A clinician also requires Custom Sound 5.1 or later software to upgrade the patient’s firmware to enable access to Remote Check. For sound processor and app compatibility information, visit https://www.cochlear.com/compatibility.

Remote Check does not replace clinical care and does not involve remote programming of the sound processor.

Remote Check is intended for ages 6 and older. The Remote Check feature is only visible and accessible if the feature is enabled by a clinician. Clinicians should consider the suitability of the feature before enabling Remote Check.

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This material is intended for health professionals. If you are a consumer, please seek advice from your health professional about treatments for hearing loss. Outcomes may vary, and your health professional will advise you about the factors which could affect your outcome. Always read the instructions for use. Not all products are available in all countries. Please contact your local Cochlear representative for product information.

 

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