Includes the following articles: (1) The Absence of
Hearing Healthcare in a so-called Tidal Wave of
Alzheimer's Cases and (2) Sherlock and Watson
inQuestions may be submitted online to the "contact us"
section of this website or sent directly to: DigiCare
Hearing Research & Rehabilitation, P.O. Box 706, Rye, CO
81069, or faxed to (719) 676-6882. Your name, address,
and telephone number along with your request are
required in order to receive a reply from the Digicare
team.
To view Dr. Chartrand's article, The Absence of Hearing
Healthcare in a so-called ''Tidal Wave of Alzheimer’s
Cases'' please click here.
To view the slide presentation on Alzheimer's: The
Missing Pieces to Rehabilitation & Hearing Loss please
click here.
Sherlock & Watson In…
“The Case of the Missing Brain Cells”
by:
Max Stanley Chartrand, M.A., BC-HIS &
Glenys Anne Denyer Chartrand, AdDipOT
Instructions: The following is from the authors’
“Sherlock & Watson on the Mysteries of Auditory
Rehabilitation” Series lectures. The case history below
is accompanied with audiometric data for an older adult,
from which the reader will prescribe various facets of
an auditory rehabilitation program. There are additional
psychosocial components relative to members of the
family, some of whom feel the patient’s problem is
dementia, not hearing loss. In the quiz section of this
course the reader will find probable solutions for this
case.
The Challenge: The children of 87 years old patient
Georgia Saunders want to sell her property, transfer
assets to other family members, and put her on the state
indigent care program, so that she can be placed in a
nursing facility in a nearby town. This is not of her
choosing, by any means, but she’s defenseless in
explaining why she acts distracted and confused while at
family gatherings. She jumps when someone enters the
room, or a door slams, and she seems to hear “OK” on the
telephone, as long as they speak slowly. So, the
possibility of a hearing loss was dismissed out of hand
by family observers.
Fortunately, her granddaughter, Anne, took her under
wing when she saw your advertisement about a special
consultation with an expert who has published on the
effects of hearing loss and dementia. She brings her to
the event. Shown below, you will find an audiometric
profile indicating a bilateral moderate to severe
sloping impairment.
You find the patient quite spry and alert once she is on
the master hearing aid. She brags that she still plants
and cares for a half-acre garden, and drives herself to
Church each Sunday. She actually embroiders gifts for
grandchildren at Christmastime. However, she does have
difficulty hearing the phone ring, and cannot hear the
doorbell when she is in the kitchen or in her bedroom.
She tends to understand some voices better than others,
and cannot understand speech on television. At church
she is frustrated and stressed out because she cannot
hear the sermon. When at family gatherings, she is
bothered by the noise and feels left out of
conversation, would rather be home where she has better
control of her life.
When she discovers that her main problem appears to be
hearing loss, she is anxious to take your recommendation
for new hearing aids. However, it seems that her
finances are controlled by her children, who are not
interested in her getting hearing aids. So, you must arm
the grand-daughter with sufficient evidence that a
hearing loss could be contributing to her alleged
dementia.
The Clues: Key terms: Alzheimer’s & Hearing Loss,
psychosocial manifestations of unmitigated HL, auditory
sensory deprivation, phonemic regression, H.A.B.R.A.T.
(Gatehouse & Killion’s unforgettable study model titled
“Hearing Aid Brain Rewiring Accommodation Time”),
functional “window of listening”, coping strategies,
speechreading, assistive listening devices (ALDs), aural
or auditory rehabilitation.
Audiometric Profile:
Right Ear:
250 Hz - 30 dB
500 Hz - 35 dB
1K Hz - 40 dB
2K Hz - 60 dB
4K Hz - 70 dB
8K Hz - 55 dB
SRT 55 dB
MCL (HL) 75 dB
UCL (HL) 85 dB
NU-6 66 %
Left Ear:
250 Hz - 40 dB
500 Hz - 40 dB
1K Hz - 45 dB
2K Hz - 55 dB
4K Hz - 60 dB
8K Hz - 65 dB
SRT 45 dB
MCL (HL) 70 dB
UCL (HL) 80 dB
NU-6 78 %
Binaural:
MCL (HL) 70 dB
UCL (HL) 90 dB
NU-6 88 %
On the accompanying quiz, please indicate the items that
you’d recommend for this patient.
CE Quiz-
1. The psychosocial symptoms of Mrs. Sander’s hearing
loss seem to mimic the symptoms of:
A. Ataxia
B. Dementia
C. Schizophrenia
D. Diplacusis
E. None of the above
2. From her case history profile and audiometric data,
which of the following appears to be the primary concern
in designing amplification parameters for this patient:
A. Dexterity
B. Recruitment/Loudness Growth
C. Cosmetics
D. Cost of instruments
E. Battery size
3. Which of the following assistive devices would you
recommend to accommodate her non-hearing aid
limitations:
A. TV infrared system
B. Amplified telephone with multiple- room ringers
C. Extra doorbell speaker in back of house
D. FM listener for use at church
E. Side-view mirrors on her automobile
F. All of the above
4. How would you initiate involvement of the family in
her auditory rehabilitation program:
A. Write them off as disinterested
B. Phone or write a letter explaining her needs, and
requesting a meeting to discuss them
C. Require that principle care-giver(s) or decision-maker(s)
attend a counseling session with her
D. B & C
E. A & C
5. In addition to any products and services you may
provide this patient, what other professionals might you
also involve in her case, (at the request of the family)
during or after the hearing health component has been
addressed:
A. Family physician (PCP)
B. Ear, nose, & throat specialist
C. Rehabilitation counselor
D. Occupational therapist specializing in geriatrics
E. Mental health professional
F. Any or a combination of the above
6. How long would you advise the patient and her family
that it may require for her to regain her optimum
communicative ability with appropriate hearing aids?
A. Same day
B. 30 days
C. 90-120 days
D. 1 year
E. Never
7. What other non-hearing aid considerations might you
consider recommending to her and her family, to make
improve her quality of life and participation?
A. Grouping living room furniture to minimize distance
between her and multiple visitors
B. Improving lighting in listening areas to enhance her
speechreading capability
C. Requesting overly-loud movie theatre productions to
be turned down when she attends
D. Utilizing closed caption in large group video
presentations when available
E. Requesting an infra-red listener when attending plays
and concerts
F. Assure strategic seating for her at family meals and
get togethers
G. All of the above
8. In this case history, which individual best fulfilled
the role of “guardian angel” to the patient?
A. Her children who acquired her assets to “qualify her”
for indigent care
B. Other relatives who were unaware that she was home
when they called
C. Her granddaughter Anne
D. The dispensing professional who tested her hearing
9. What two speech scores indicate this patient’s
functional “range of listening” (as opposed to her
over-all dynamic range)?
A. SRT to MCL
B. MCL to UCL
C. SRT to UCL
D. Discrim score
10. What does the Gatehouse & Killion H.A.B.R.A.T.
represent?
A. Results of a study showing the effectiveness of
directional hearing aids
B. Results of a study showing the effectiveness of
assistive devices
C. Results of a 12-week study on how the ear acclimates
to hearing aids over time
D. Stands for “How Average Brains Recognize Auditory
Trouble”
Answers: 1-B, 2-B, 3-F, 4-D, 5-F, 6-C, 7-G, 8-C, 9-B,
10-C
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