Living with Hearing Difficulties: The process of enablement

Living with Hearing Difficulties is a source-book for professionals who encounter and support individuals with hearing difficulties. It will also be of interest to people with hearing difficulties themselves and those close to them. The book highlights the concept of audiological enablement as being an interactive process requiring the active involvement of both clinician and patient. The thirteen chapters encompass four sections which broadly follow the categories of the World Health Organization's ICF (2001): Section 1 addresses types of hearing disorders, the impairments they cause and also the process of help seeking. Section 2 deals with the effects of hearing impairment on communication and psychosocial functioning. Section 3 considers the individual in their environment; their family, work, and leisure. Section 4 elaborates on the process of enablement in a non-prescriptive manner. The authors approach the problems and needs from the standpoint of what the patient/client is seeking. Enablement is seen as a team effort between the professionals, the patient and their family in an ever-changing environment. This entails using any relevant techniques to ensure the well-being of the individual with hearing impairment; that end remains very much their goal. The book also has a companion website www.wiley.com/go/stephens which hosts additional downloadable documents as well as a demonstration of the concept of the signal-to-noise ratio.

Table of Contents:
Foreword viii Preface x Acknowledgements xiii 1 Introduction 1 The need for this book 1 Terminology 2 Layout of the book 4 The World Health Organization classifications 5 Theoretical/management models in the general rehabilitation literature 8 Models of audiological enablement 11 The Goldstein–Stephens model 13 The role of positive experiences associated with hearing impairment 19 Relevant measures in assessing patients’ needs and the outcomes of interventions 21 Development of a preliminary model appropriate to hearing impairment 24 Conclusion 25 2 Seeking help 26 Introduction 26 Becoming aware of hearing difficulties 27 The decision to seek help 31 Referral for hearing help 36 Ethics/philosophy of adult screening 38 Conclusion 42 3 Types of hearing impairment and their consequences 43 Introduction 43 Basic anatomy and physiology and their implications 43 Purposes and process of assessment 47 Types of hearing impairment and their consequences 50 Severity of hearing impairment 54 Unilateral/asymmetrical hearing impairment 55 Age of onset 55 Genetic issues 57 Progressive/sudden onset 58 Conclusion 58 4 The influence of other factors on assessment and goals of enablement 60 Introduction 60 Auditory symptoms 60 General aural symptoms 63 Vision 66 Cognitive and intellectual factors 67 Neuromusculoskeletal problems 68 Conclusion 69 5 Communication 71 Introduction 71 Ecological audiology 71 Ramsdell’s classification 73 Attitudes of the Deaf 81 Conclusion 82 6 Social and emotional aspects of hearing impairment 83 Introduction 83 Participation in life 83 Psychosocial dysfunction 84 Psychosocial consequences of Deafness 90 Demographic factors 91 Conclusion 94 7 Hearing impairment in the family 96 Introduction 96 Impact of hearing impairment on significant others 96 Coping strategies 98 Inclusion of significant others in enablement programmes 100 Hearing impairment arising from genetic causes or with a familial basis 100 Impact of having a family history of hearing impairment 102 Discussion 107 Conclusion 108 8 The process of enablement at work 109 Introduction 109 Statistics 109 Impact of hearing impairment on occupational performance 110 Impact of work-related hearing impairment on significant others 113 Vocational enablement 114 Vocational Enablement Protocol (VEP) 115 Discussion 120 Conclusion 121 9 Leisure and the wider social environment 122 Introduction 122 Prevalence 122 Solitary versus interactive pastimes 123 The role of leisure 123 Opportunities for entertainment and leisure 124 Community life 125 Recreation and leisure 126 Religion and spirituality 131 Human rights, political life and citizenship 132 Conclusion 133 10 The process of enablement 1: Evaluation and decision-making 134 Introduction 134 The evaluation process 134 Integration and decision-making 156 Conclusion 159 11 The process of enablement 2: Short-term remediation 160 Introduction 160 Instrumentation 160 Strategy 174 Ancillary help 178 Conclusion 180 12 Enablement 3: Ongoing remediation and outcome assessment 181 Ongoing remediation 181 Effectiveness of group programmes 194 Outcome assessment 196 Conclusion 201 13 Overall conclusions 202 Appendix: Longitudinal changes in enablement needs of older people with hearing impairment by Louise Hickson 205 References 209 Index 237

About the Author :
Dafydd Stephens FRCP, is Honorary Professor of Audiological Medicine at Cardiff University, Wales, UK. Sophia E. Kramer, PhD, is Senior Researcher and Psychologist at the Department of E.N.T. / Audiology / EMGO Institute for Health and Care Research at the VU University Medical Centre in Amsterdam, the Netherlands.