Connected audiological rehabilitation: 21st century innovations

Adults who acquire a hearing loss often experience a reduction in their quality of life resulting from the impact of the hearing loss on the person’s ability to understand speech, so communication becomes difficult and stressful. As a result, a person’s participation in social interactions and leisure activities may decrease and they may be unable to enjoy the everyday sounds, which connect them to the world around them (Strawbridge et al, 2000; Arlinger, 2003). Thus, the over-arching goal of comprehensive audiological rehabilitation (AR) intervention for adults is to restore a person’s quality of life (Boothroyd, 2007). In this article, the current state of tele-audiological rehabilitation interventions are described and discussed. As specified in Krupinski (2015), the practice of tele-audiology covers a variety of clinical applications, from testing and diagnosis through therapeutic interventions. AR intervention involves several interrelated components. Typically, it begins with sensory management via the use of hearing aids to optimize access to the auditory world. In some instances, other assistive listening technologies and/or cochlear implants are used. Systematic instruction in use of the technology and about topics such as controlling the listening environment is an integral component of a comprehensive AR program. Some individuals benefit from perceptual training aimed at improving auditory and/or auditory–visual speech perception. Training in the use of communication strategies is also very helpful. Finally, a comprehensive AR program will include counseling aimed at supporting the individual’s emotional adjustment to the hearing loss and coping with any residual participation limitations. Ideally, the hearing-impaired adult’s communication partner will be included in the rehabilitation process (Preminger and Meeks, 2010) so that he/she can better cope with the ramifications of hearing impairment, be educated about how to best communicate with their hearing-impaired partner, and to ensure they have appropriate expectations about the outcomes of AR. The components of comprehensive AR intervention are not new—the processes involved were first used in the programs established to meet the hearing health-care needs of U.S. veterans of World War II. These early military AR programs were provided on an in-patient basis over a period of weeks, and involved the fitting of hearing aids, speech perception training, and vocational and psychological counseling (Bergman, 2002). AR is no different today, except that we have the ability to deliver many of the components in a time-, resource-, and cost-effective manner, using telehealth techniques. In the context of intervention for adults with hearing loss, “tele-audiology” allows for the provision of individualized services from afar, many of which can be engaged in at the convenience of the recipient, and can be completed without the need for a provider. As described in Jacobs and Saunders (2014), there are at least four models of telemedicine that have been applied to tele-audiology: (a) synchronous/real-time data collection—in which face-to-face video conferencing between patients and providers takes place, (b) store and forward telehealth—in which data are acquired and stored by a technician at a remote facility and later forwarded to a specialist for interpretation and diagnosis, (c) remote monitoring—in which mobile devices are used to collect data that can be monitored by health-care providers, and (d) mobile health—in which smartphone applications (apps) or other software are used for self-management of health conditions independent of a practitioner. These have been applied to the components of AR intervention noted above (sensory management, instruction in the use of technology and control of the listening environment, perceptual and communication strategies training, counseling, and inclusion of communication partners) and are described and discussed below.