Living with Hearing Difficulties: The process of enablement

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