Effectiveness of Hearing Aid Manipulation Training for
Very Elderly Hearing Aid Users
By Max Stanley Chartrand, Director of Research
DigiCare® Hearing Research & Rehabilitation
Abstract
Maintaining independence and control over one’s life are
of great concern to those over 80 years of age. An
important tool in achieving this end is the
amplification they wear for the correction of hearing
loss. In a Likert-like pretest-posttest nonequivalent
control study, we utilized a Hearing Aid Manipulation
Training Protocol (HATP) to find out if elderly hearing
aid users can improve their ability to use their hearing
aids more optimally when exposed to a new user training
paradigm. Participants included 16 elderly hearing aid
users (9 female, 7 male) aged 80-92 years who have had
their hearing aids for a period of three to six months,
and who still have significant difficulty in
proficiently handling and adjusting them. Half were
trained and half were not. After two weeks of HATP
training, the study group realized an average of 41%
improvement in over-all hearing aid manipulation versus
9.6% improvement in controls who did not receive the
VCTP training, giving the study group a net improvement
in performance of 30.4%.
Introduction
Maintaining independence and control over one’s life are
of great concern to those over 80 years of age (Wilken,
Walker, Sandberg, and Holcomb, 2002; Feinberg and
Whitlatch, 2001; Anonymous 1989). An important tool in
achieving this end can be found in the ability to
realize optimal benefits in hearing aid use for
individuals experiencing significant hearing impairment
(Johnson and Danhauer, 2002). This can be particularly
important when one considers that most diagnostic
indicators that threaten an elderly individual’s
independence—for example, in the initial diagnosis of
Alzheimer’s Disease (AD)—are almost entirely based upon
auditory tasks. Hence, for the elderly individual there
is significant risk toward over-diagnosis of dementia,
since most will also have uncorrected or under-corrected
hearing loss (Chartrand, 2001a). So, it becomes critical
for very elderly hearing impaired individuals to not
only receive timely correction of hearing impairment,
but also to be able to utilize such correction
optimally.
Two major challenges present in this population relative
to optimal utilization of hearing aids. The first is
limitations in manual dexterity. If the hearing aid user
cannot properly insert, remove, and manipulate their
hearing aids, they are unlikely to wear them. The second
challenge deals with taking control of the listening
environment. Most specifically this is determined by
whether or not they can manipulate the user volume
control. This is not so much a cognitive issue as an
occupational one (Chartrand, 2000).
On the first challenge (dexterity limitations), a survey
compiled by this author in eleven hearing health
practices during the late 1980s demonstrated that up to
93% of very elderly hearing aid patients can be trained
to manipulate a user volume control. Indeed, this
population was found, as a general rule, to be able to
write proficiently and to utilize fine-motor skills
tasks, such as knitting, sewing, crafts, artwork, and
piano playing (Chartrand, 1993). In that survey, it was
determined that self-confidence was the main issue
relative to hearing aid use, not necessarily dexterity (Chartrand,
1993).
On the second challenge (taking control of one’s
listening environment) the hearing aid industry has
generally responded by influencing the elimination of
the user volume control entirely. In fact, today many
manufacturers list the user volume control as an option
on their order forms, giving the misleading impression
to dispensing professionals that the new digital
technology can automatically adjust for such natural
phenomena as auditory fatigue, Eustachian tube
dysfunction, abnormal loudness growth, fluctuating
cochlear chemistry, and other factors that cause MCL to
vary hour to hour and day to day.
In the process, it is the feeling of this author that
the industry has relegated a critical tool needed by the
hearing impaired to take better control of their
listening environment, as well as overcoming occlusion
and other own-voice complaints (Chartrand, 2003).
Meanwhile, Surr, Cord, and Walden (2001) found that 77%
of hearing aid consumers prefer a user volume control,
once they understand that that option is available.
Experienced hearing aid users with severe losses
especially demand the use of a user volume control
(Ross, 2004; Chartrand, 2001b).
Purpose of this Study
Past studies have established the link between the sense
of hearing ability and cognition (Chartrand, 2001a). It
is understood that, as a general rule, the very elderly
hearing aid user population experiences
disproportionately greater challenges using hearing aids
than other hearing user populations. What has not been
shown to-date is which specific training approach can
best assure greater utilization of hearing aids, and as
a result, promote communicative independence and control
over the listening environment. In short, this is a
human occupation issue, not necessarily a cognitive
issue. The purpose of this study, then, is to find out
if a systematic training protocol for inserting,
removing, and adjusting one’s hearing aid can provide
the skills necessary to sufficiently overcome those
challenges.
Methods
Participants
The population sample consisted of two groups: Group 1
(n = 8), the study group, consisting of four males and
four females, averaging 84.50 of age, SD 3.90, age range
80-92; Group 2, the control group, consisting of three
males and five females, averaging 86.6 years of age, SD
3.70, age range 81-90. Each participant has had two to
six month’s experience with their hearing aids, and
reported varying degrees of difficulty in inserting,
removing, and adjusting their hearing aids. Each has
also complained of still having either situational or
general listening difficulties with their hearing aids
following the standard post-fitting training.
Participants were not filled-in as to the design or
nature of the study, only that they were participating
in a “hearing aid problem-solving study”.
Procedure
Prospective participants were chosen based upon a file
review of patients from the period of July 15, 2004 to
February 25, 2005. Twenty-three prospective participants
were given a preliminary phone interview to 1) determine
if their difficulties in hearing aid utilization were
still serious enough to warrant participation, and 2) if
they would consent to participating in a “hearing aid
problem solving study”. Subsequently, sixteen of the
twenty-three patients met both criteria and were
assigned a date and time for the first visit.
The pretest was administered on a one-at-a-time basis
over a seven-day period in the same designated
consultation room and with the same interviewer. To
assure reliability and stability, each of the nine
questions were read aloud by the interviewer with the
participant reading along. The participant would then be
asked to respond to each question according to the
response that most closely fit their current hearing aid
experience.
After the pretest was administered, those participants
belonging to the control group were allowed to leave.
Those in the study group were then given the first of
two training sessions utilizing the Hearing Aid
Manipulation Training Protocol (HATP). Session I HATP
was administered over a 30-45 minute period, including
instructions for specific exercises to be practiced on a
daily basis until the next training session. Training
Session II of HATP was conducted approximately one week
later for each of the study group participants in a
similar manner. One week later, the posttest was
administered to both the control and study group
participants. A visual illustration of this
pretest-posttest nonequivalent control design is shown
in figure 1 (below).
Figure 1 Visual illustration of this pretest-posttest
nonequivalent control study design.
Materials
Materials used for this study consisted of:
• A pretest-posttest questionnaire (Exhibit A). This
form consisted of nine questions, three questions for of
the three areas of focus: Handling the hearing aids,
adjusting the volume control, and taking control of the
listening environment.
• The Hearing Aid Manipulation Training Protocol (HATP),
which consisted of training given over two 30-45 minute
visits. HATP was designed and tested to expand a hearing
aid user’s understanding about psychoacoustics,
own-voice dynamics, and utilization of hearing aids as a
coping strategy to improve speech-in-noise. During each
HATP session, the participant was given practice of each
exercise until showing improvement in skills. They
practiced each exercise on their own for a minimum of 15
minutes per day or until they felt more confident in
accomplishing the task.
• A silicone replica of the human ear on which to
practice inserting and removing a non-working hearing
aid made specifically for that replica.
• Two heavy-duty aluminum alloy tuning forks (512Hz,
1024Hz) which were sounded to help participants find a
mid-line in binaural cases.
• Reprinted articles pertaining to use of the volume
control (Chartrand, 2001b) for participant home-study.
• Earcharts, visual models and other items utilized for
training.
Measures
To help assure consistency and validity, each question
used in the pretest-posttest questionnaire was tested to
determine relevance to the study question. Scaling was
spaced to avoid overlap or confusion between degrees of
responses. The response scale was made to reflect four
scoring levels (1-4) to reflect easily identifiable
degrees of difficulty, from “not at all” (1) to “once in
a while” (2) to “most of the time” (3) to “all the time”
(4). During the design and preliminary testing of this
questionnaire, it was found that the usual Likert
five-degree scale rendered responses that were too close
together for this population. Therefore, the four-levels
were chosen to reflect a Likert-like scale.
Questions were grouped into groups of three, reflecting
three specific areas of focus:
1. Handling the hearing aids- Inserting and removing the
hearing aids, and opening and closing the battery door.
2. Adjusting the volume controls- Ability to recognize
when volume controls have been adjusted too high (echo
of own voice) or two low (occlusion of own-voice), plus
recognition of auditory fatigue, which happens over the
course of the day, and can affect hearing ability.
3. Taking control of one’s listening environment- The
ability to adjust hearing aid volume in extreme
environments (quiet to noisy) as needed, coping with
difficult listening situations (a dimly lit room), and
strategizing in large area listening as needed.
The before and after steps in the response scale of the
pretest-posttest questionnaire were designed to be
sensitive enough to account for variations in subjective
judgments. Even so, it was expected that there would be
some overlap (confusion) between test sittings given two
weeks apart.
Data Analysis
Overall pretest performance for Group 1 (n=8) was: =
2.51, SD= 0.32, range= 1.00 compared to overall posttest
performance (after HATP training) of: m=1.47, SD= 0.35,
range 1.00. From these calculations, Group 1
demonstrated an overall performance improvement of 41%
before we factor in Group 2 pretest-posttest differences
(See figure 2).
Overall pretest performance for Group 2 (n=8) was: =
2.49, SD= 0.27, range= 0.60, compared to overall
posttest performance at: = 1.48, SD= 0.41, range =
1.40. Hence, Group II demonstrated an overall
performance of 9.6% without taking the HATP training.
Taking the pretest-posttest effect of 9.6% from Group
1’s 41% will result in a real improvement level of 31.4%
for Group 1. (See Figure 3).
Figure 2 Group 1 Pretest-Posttest Data & Scores
Subj ID Sex Age Degree of HL Pre Post
01 F 85 Moderate 2.10 1.60
02 M 83 Mod-Severe 2.20 1.00
03 M 80 Severe HF 2.40 1.60
04 F 92 Severe 2.40 1.70
05 F 86 Moderate 2.50 1.60
06 F 87 Mod HF 2.60 1.00
07 M 82 Mod-Severe 2.80 2.00
08 M 81 Mod-Severe 3.10 1.30
Figure 3 Group 2 Pretest-Posttest Data & Scores
Subj ID Sex Age Degree of HL Pre Post
01 F 87 Mild-to-Mod 2.20 1.60
02 F 89 Mild-to-Mod 2.20 2.00
03 F 86 Moderate 2.20 2.10
04 M 81 Severe HF 2.40 2.20
05 M 81 Mod-Severe 2.60 2.40
06 M 90 Severe HF 2.70 3.00
07 F 90 Mod-Flat 2.80 2.20
08 F 89 Severe HF 2.80 2.50
Results/Discussion
From this study we find significant improvement (41%) in
overall performance in Group 1, all of whom received two
weeks structured training utilizing the Hearing Aid
Manipulation Training Protocol (HATP). This contrasts to
9.6% improvement in overall performance in Group 2, the
(untrained) control group. Utilizing a nonequivalent
control group provided us with greater internal validity
by giving us a more exacting measure of the chance or
pretest effect score. Subtracting out 9.6% (Group 2
overall improvement) from 41% (Group 1 overall
improvement) gives us a net improvement for Group 1 of
30.4%, still a significant result.
Hearing loss is a complex condition which can be made
even more complex with significant overlay from
physiological, psychosocial, emotional, cognitive and
motor factors. In addition, other health conditions,
particularly diabetes mellitus II, artherosclerosis, and
especially otosclerosis of the middle and inner ear.
Therefore, it is often difficult to compare aggregate
outcomes in within group studies in hearing impaired
populations.
The participants chosen for this study had to meet
criteria showing they were still having post-fitting
difficulties even after receiving the traditional
battery of hearing aid training. For that reason, this
study focused upon the learning of concepts attendant to
developing additional motor skills in an effort to ease
anxiety and frustration over handling and manipulating
their hearing aids.
Admittedly, accuracy factors that could not be measured
in this study were subjective impressions over the
actual level of difficulty. These factors can change
from day to day. It is noted, for instance, that in two
of the cases of control participants, they reported
doing better on the pretest than on the posttest.
Perhaps this is a result of other health or cognitive
factors outside the auditory realm. In most cases where
control group posttest item scores were better than the
pretest item scores, participants honestly felt the
problem was not as severe as before. These could be due
to a variety of reasons, namely, rehearsal or raised
awareness from taking the pretest, perceptual changes
occurring over the two week time-span, and, of course,
naturally occurring improvements from practice over
time. These would explain the 9.6% (chance) improvement
rate of the control group.
As stated earlier, HATP was designed to teach three main
concepts. These concepts, at first glance, may appear
more complex than the average elderly patient would be
able to grasp. However, our experience from this study
was that participants exposed to complex topics that are
accompanied with visual models and which relate to
specific learned motor skills achieve more confidence in
manipulating their hearing aids, even when the all
concepts are not grasped intellectually. For instance:
• Model #1 (Figure 4) helps explain the rehabilitative
reinforcement cycle that develops as the hearing aid
user practices carrying out such tasks as inserting and
removing their hearing aids. They begin by watching
their hearing health professional inserting and removing
a hearing aid in his/her (professional’s) own ear. Then,
the user practices with a replica ear and non-working
hearing aid so that they can develop spatial and
eye-hand coordination skills. These skills are then
transferred to inserting a hearing aid into his/her own
ear. As manual dexterity improves, so does
rehabilitation, which, in turn, raises cognitive
awareness. From this study we noted that this cycle
repeated itself with each new skill learned, and
consequently, so did the user’s self-confidence.
• Model #2 (Figure 5) shows a visual depiction of the
three main components of the “own voice” biofeedback
system that is taught during HATP. It helps the hearing
aid user to understand that what is perceived as
“natural” is actually a perception they realize by
hearing via three routes of transmission of their own
voice. Hence, when they hear only the external part of
their voice only, as in a tape recording, their voice
sounds brighter and sometimes more metallic, without the
deepening and softening effects of internal conduction
and taction at the tympanic membrane.
• Model #3 (Figure 6) draws attention to how a user
volume control is utilized to present a balance between
pressure in the throat or occlusion when is turned to
low, to the other extreme, when the amplified sound is
too bright or with a hollow or echo sound realized when
the volume control is turned too high. Also, noted is
the small range between the two extremes where the voice
is perceived as “natural” or “just right”. Of course,
other factors, such as appropriate ear canal resonance
in the amplified signal must be addressed before this
depiction is meaningful (Libby, 1989).
• Model #4 (Figure 7) illustrates the concept that
own-voice perception, as it is adjusted with a user
volume control, can be detected as various levels of the
human head. For instance, in the “just right” volume
control position, the voice is sensed in a physical area
between the lips and the nose. In the “too loud”
position, the voice resonates in the sinuses above the
noise and into the forehead, depending on degree of
over-loudness. Probably even more important to most
hearing aid users is occlusion and when own-voice
speaking is detected as a pressure down into the throat.
In this case, gain level is too low, leaving the
internal aspect of own-voice detection the dominant one.
Carried through the Arnold’s branch of the vagus and
involving other cranial nerves, as well, occlusion is
perceived as a pressure “downward” into the throat or
even in some cases the chest (Chartrand, 2005).
Conclusion
Hearing loss is not a black and white condition, it is
unreasonable to expect normal or even near-normal
hearing correction no matter how sophisticated the
technology. The goal is to improve hearing function
without creating untenable artifacts, such as dexterity,
own-voice, or noise management complaints. In turn,
quality of life should improve.
It is believed that this study demonstrates conclusively
that real quality of life improvements can be realized
in those having greater levels of difficulty when using
the HATP training. Possibly, its use in hearing health
practice may be particularly targeted for those with
demonstrated post-fitting difficulties. With more
refinement, especially in simplifying some of its
complex concepts for hearing aid patients, the HATP
training method may be a valuable tool in resolving
hearing aid problems in the very elderly population.
About the author
Max Stanley Chartrand serves as Director of
Rehabilitation at DigiCare Hearing Research &
Rehabilitation, is profoundly deaf and utilizes a
cochlear implant and assistive devices. A prolific
writer and lecturer in hearing healthcare, he is
currently enrolled in a doctoral level Behavioral
Medicine program at Northcentral University.
Correspondence: www.digicare.org.
References
Anonymous, (1989, October 4). Medical R&D priorities
should be aimed at increasing independence of elderly—A
Congressional Report. The Blue Sheet, 32(40): 9.
Carlson, N.R., (2004). Physiology of Behavior (8th
edition). Boston, MA:Allyn & Bacon. ISBN 0-205-30840-6.
Chartrand, M.S., (2005, April). Identifying
“Neuro-reflexes” of the External Ear Canal.
AudiologyOnline, www.audiologyonline.com.
Chartrand, M.S., (2004). Utilizing Neurophysiology in
Resolving Hearing Aid Fitting Problems. Retrieved on
July 16, 2004 from http://www.digicare.audiologyonline.com.
Chartrand, M.S., (2003, March). Another Elephant in the
Living Room: To VC or Not to VC? The Hearing Review,
10(3): 23-24.
Chartrand, M.S., (2001a, November). Hearing Health and
Alzheimer’s disease. The Hearing Review, 8(11): 26-29.
Chartrand, M.S., (2001b, May-June). In Vigorous Defense
of Volume Control. The Hearing Professional, pp. 9-11.
Chartrand, G.A., (2000, November). Concepts of Aural
Rehabilitation, Part I. The Hearing Review, 7(11):
27-29.
Chartrand, M.S., (1999). Hearing Instrument Counseling:
Practical Applications for Counseling the Hearing
Impaired. Livonia, MI:International Institute for
Hearing Instruments Studies.
Chartrand, M.S., (1993). Training for more effective
volume control use. In Total Hearing Care, a
professional continuing education course, Starkey
Laboratories, Inc., Eden Prairie, MN.
Durrant, J.D., and Lovrinic, J.H., Bases of Hearing
Science, 2dn edition, Baltimore: Williams & Wilkins, pp.
248-250 (1984).
Feinberg, L.F., and Whitlatch, C.J., (2001, June). Are
persons with cognitive impairment able to state
consistent choices? The Gerontologist, 41(3): 374-373.
Johnson, C.E., and Danhauer, J.L., (2002,
September-October). A Transdisciplinary Holistic
Approach to Hearing Health Care. Geriatric Times,
3(5):21-24.
Lansley, P., McCreadie, C., and Tinker, A., (2004,
November). Can adapting the homes of older people and
providing assistive technology pay its way? Age and
Ageing, 33(6): 571-577.
Libby, E.R., (1989, January). Faith in natural systems.
Hearing Instruments, 40(1): pp. 23-25.
Mogey, N., (1999). So you want to use a Likert Scale?
Learning Technology Dissemination Initiative, retrieved
on February 28, 2005, from
http://www.icbl.hw.ac.uk/ltdi/cookbook/
info_likert_scale/.
Murray, D.M., (2004, May 18). Giving up the keys means
giving up part of himself. Boston Globe, pg. C-3.
Otologics, LLC, (2005). Advantages of the MET Ossicular
Stimulator. Retrieved on February 25, 2005, from
http://www.otologics.com/uk/uk_hp_metadv_frm.cfm.
Ross, M. (2001). Developments in Research and
Technology. Pennsylvania SHHH. Retrieved on February 20,
2005, from http://www.pa-shhh.org/ross/ross66.html.
Ross, M., (2004, January-February). The “Occlusion
Effect”- What it is, and What to do about it. Hearing
Loss, p. 16-19.
Surr, R.K., Cord, M.T., and Walden, B.E., (2001).
“Response of hearing aid wearers to the absence of a
user-operated volume control”, Hearing Journal,
54(4):32-36.
Wilken, C.S., Walker, K., Sandberg, J.G., and Holcomb,
C.A., (2002, February). A qualitative analysis of
factors related to late life independence as related by
the old-old and viewed through the concept of locus of
control. Journal of Aging Studies, 16(1): 73.
Willott, J.F., Aging and the Auditory System: Anatomy,
Physiology, and Psychophysics, San Diego: Singular
Publishing Group, Inc., pp. 168-201 (1991)
Exhibit A
Pretest-Posttest HATP Rating Questionnaire
Instructions: From the questions below, please circle
the most appropriate answer to the right that most
closely describes your current hearing aid listening
experience.
Question 1: I have difficulty inserting and removing my
hearing aid(s).
Not at all Once in a while Most of the time All of the
time
Question 2: I have difficulty opening and closing the
battery door on my hearing aid(s).
Not at all Once in a while Most of the time All of the
time
Question 3: I have difficulty adjusting the volume
control on my hearing aid.
Not at all Once in a while Most of the time All of the
time
Question 4: When I turn up my volume controls loud
enough to understand others my own voice echoes.
Not at all Once in a while Most of the time All of the
time
Question 5: I have trouble adjusting my volume
control(s) as the day wears on and my hearing
sensitivity drops.
Not at all Once in a while Most of the time All of the
time
Question 6: When I wear my hearing aid(s) my own voice
feels as if it is plugged up, like I have a cold.
Not at all Once in a while Most of the time All of the
time
Question 7: When going from a quiet into a very noisy
situation I cannot turn my volume control(s) to help me
hear better.
Not at all Once in a while Most of the time All of the
time
Question 8: When I am in a dimly lit room and have
difficulty seeing the other person’s lips, I just sit
there and suffer through the conversation.
Not at all Once in a while Most of the time All of the
time
Question 9: When I attend meetings, such as at church, I
am at a loss in trying to hear the speaker.
Not at all Once in a while Most of the time All of the
time
Exhibit B
The Hearing Aid Manipulation Training Protocol
Introduction: The Hearing Aid Manipulation Training
Protocol (HAMTP) consists of a systematic regimen
designed to accomplish three objectives:
• Help those with dexterity problems feel more confident
in handling and adjusting their hearing aids.
• Train users in resolving own-voice complaints as well
signal-to-use demands by learning a biofeedback approach
to own-voice adjustments
• Learn how to take control of listening environments
through improved utilization of hearing aids, coping
strategies, and assistive listening technology.
Session I Training Guidelines-
1. Explain Model #1 so that patient can understand how
confidence builds with practice of handling and
manipulation of their hearing aid(s).
2. Using the silicone ear replica, demonstrate and
practice:
-How to insert and remove hearing aid
-Open and close battery door
-Adjust volume control up and down.
3. Explain Model #2:
-Explain own-voice perception based on external,
internal, and tactile stimuli
-Give example of hearing one’s voice recorded (absent
internal and tactile cues)
4. Explain Model #3:
-Explain relationship between volume control set too
high (echo, hollow) and too low (occlusion)
-Show range of gain change considered “normal”
5. Explain Model #4:
-Explain relationship between Most Comfortable Level
(MCL) and anatomical position to head
-Have patient practice adjusting hearing aid up and down
while reading aloud until best VC
position found
6. Explain auditory fatigue and need for periodic
adjustments, as well for Eustachian tube and other
fluctuations that may occur from time to time, and how
to adjust for them.
7. Explain coping strategies, such as listening in a
darkened room (repositioning), noisy environment (volume
control adjustment), and in large area listening (use of
assistive devices). Have patient plan and practice for
each eventuality.
Independent Exercises (Minimum of 20 minutes per day):
Practice inserting and removing hearing aid(s) several
times until you feel more confident. Use a mirror is
necessary. If successful inserted, hearing aid(s) should
be feel comfortable without any pinching or soreness.
Open and close mouth a few times to be sure of comfort.
Practice opening and closing the battery door several
times until it becomes easy and natural. You may use a
magnifying glass at first (if needed) to ascertain
battery door edge.
Remove and insert battery into battery compartment
several times. Be sure the positive (+) side is faced
up. Batteries should not be forced, but should be
snapped into place. If the battery door does not close
after inserting the battery, it is likely the negative
(-) side is facing up. Remove and re-install.
While the hearing aid is in your hands, manipulate the
volume control several times. Get a feel for the amount
of fingertip pressure required to turn it where you want
it to go.
Insert the hearing aid(s) into your ear(s) and do
likewise. Note the variations of volume. If you cannot
clearly detect changes in volume, the hearing aid is
either not turned on or you are not applying enough
fingertip pressure to turn it.
As you turn the volume control, read a newspaper story
or other printed item aloud. Note that in off or low
position your voice sounds as if it is down in your
throat. As you increase the volume, your voice will
become louder and more relaxed. You will feel your voice
rise from down in your throat up to the level of your
lips and nose. If you continue to turn up the volume
control(s) your voice will go hollow and bright, until
it begins to echo. Remember to lower the VC back down to
the lips-nose area, where your voice is most resonant
and relaxed.
When in a darkened room either turn up the light, or
move so that the speakers face is in the light and the
light is to your back.
When going from a quiet setting into a very noisy
setting, reduce your volume control position slightly
until you feel more comfortable and have better speech
understanding. Remember that some situations are
impossible even for normal hearing individuals.
When you go to church, a live play, amusement park, a
movie theater, or other large area listening
circumstance, ask for an Infra-Red Listening Device.
Learn how to use this and other devices as needed. Under
the Americans with Disabilities Act (ADA) public
facilities are required to have such devices free of
charge for the hearing impaired.
Session II Training Guidelines:
This session is a “Show & Tell” session, where the
patient demonstrates and explains each of the above
steps. Detailed explanations are only offered on items
that need clarification or rehearsal. The object is not
to achieve perfection in these two settings, but to
demonstrate improvements in confidence and
understanding. Involve third party assistance as needed. |
|
|
|
