Technology in Rehabilitation: Audiology Services for Veterans

Transcription

1 Technology in Rehabilitation: Audiology Services for Veterans PAULA MYERS, PH.D., CCC-A JAMES A. HALEY VA HOSPITAL, TAMPA FL APRIL 17, 2018 HLAA SCC CHAPTER

2 DISCLAIMER The views expressed in this presentation are those of the authors and do not necessarily reflect the official policy or position of the US Government. This presentation does not endorse any particular manufacturer or product. There are no financial disclosures.

3 Veterans We Serve Hearing Loss Sensorineural Hearing loss Conductive Hearing Loss Unilateral Hearing Loss Varying Degrees of Loss Tinnitus Vestibular Disorders Polytrauma/Blast Injury Varying levels of comfort with technology use Other medical conditions Pacemaker/defibrillator Dual Sensory

4 Eligibility Veterans must be enrolled in VA s health care system to be eligible for comprehensive audiology services Documented hearing impairment Documented tinnitus Significant functional impairment in communication during activities of daily living Hearing impairment that necessitates amplification to permit active participation in medical care Ability to safely use and maintain the device Stated goals that require the use of assistive technology

5 Assistive Technology for Persons with Hearing Impairment and/or Tinnitus Hearing Aids Cochlear Implants Hybrids Bone-Anchored Hearing Aids Middle Ear Implants Hearables Personal Sound Amplification Products (PSAPs) Assistive Listening Devices Alerting Devices Integrated wireless accessories Devices and Education for Tinnitus Management Apps

6 Amplification

7 Hearing Aids Ear level device that amplifies sound in the environment Digital high-end technology Various styles, colors, and configurations Typically the first method of intervention for hearing loss

8 Hearing Aids Benefits Limitations Easy to use Portable Background Noise Distance of the speaker Can be automatic or Degree of hearing allow for manual control Can add additional technology as needed loss/distortion in the ear Central effects

9 Cochlear Implant and Hybrid

10 Cochlear Implant A cochlear implant is a surgically implanted electronic device that provides a sense of sound to a person who is profoundly deaf or severely hard of hearing in both ears who derives no benefit from hearing aid The implant consists of an external portion that sits behind the ear and a second portion that is surgically placed under the skin

11 Hybrid New technology option for those with mild low frequency HL and profound high frequency hearing loss Hybrid hearing devices uses acoustic amplification to improve the low frequency hearing after surgery, while taking advantage of cochlear implant technology to restore access to hearing high frequency sounds

12 Bone-Anchored Hearing System (BAHA) A bone-anchored hearing aid (BAHA) or bone-anchored hearing device, is a type of hearing aid based on bone conduction For persons with conductive or mixed hearing losses or single-sided deafness who cannot otherwise wear 'in the ear' or 'behind the ear' hearing aids

13 Middle Ear Implant The middle ear implant directly vibrates the small bones in the middle ear It may be indicated for use in adults with a moderate to severe sensorineural hearing loss who cannot tolerate foreign bodies in the ear canal for medical reasons

14 Hearables Hearables or Smart headphones are technically advanced, electronic in-ear-devices designed for multiple purposes ranging from wireless transmission to communication objectives, medical monitoring and fitness tracking

15 Personal Sound Amplification Product (PSAPs) PSAPs use some of the same technology as hearing aids Many provide amplification along with other features normally found in digital hearing aids, including volume control, feedback cancellation & noise suppression But they are not programmable & are not intended to correct hearing loss Rather, they help you hear quiet sounds better even with normal hearing (or mild loss) NOTE: PSAPs are not FDA-approved hearing aids

16 Assistive Listening Devices TELEPHONES TV DEVICES PERSONAL AMPLIFIERS

17 Telephones Florida Telecommunication Relay Service offers free special phones for permanent Florida residents certified as having a hearing loss or speech impairment Or call FTRI at Devices can also be ordered for Veterans through ROES Varying levels of gain Speech Assist with amplified outgoing speech

18 Corded or Portable

19 Large Buttons & Picture Dialing

20 Telephone Options for Deaf Captioned Phones TTY/TDD Texting Secure Messaging in VA Face time allows visual cues to look and listen (or watch hands/signing)

21 Other Text Services Instant messaging Automatic voic transcription services that convert voic to text and send it via texts or . SimulScribe ( CallWave ( Spinvox ( Gotvoice ( Remote transcription More info:

22 Captioned Phones

23 TTY/TDD

24 Speech Assist

25 TV Devices Transmitter sends signal directly to the receiver via Radio frequency Infrared Bluetooth Can adjust volume & tone Reduces environmental noise Cant transmit to Hearing Aids Headphones Ear buds

26 Personal Amplifier Easy to use Alternative to HAs Helpful for clinic use

27 Amplified/Visual Stethoscopes htp:// htp:// htp://

28 Alerting Devices SMOKE DETECTOR CARBON MONOXIDE MONITOR ALARM CLOCK DOOR BELL SIGNALER BABY CRY MONITOR

29 Alerting Devices Designed to alert persons with hearing loss of different events around the home Utilize Loud horns Strobe lights Vibration Standalone vs. full systems

30 Alerting Devices

31 Alerting Devices

32 Integrated Accessories TV STREAMER FM SYSTEMS REMOTE MICROPHONES PHONE CONNECTIVITY

33 TV Streamer Streams TV signal directly to hearing aids or to an intermediary device Reduces environmental noise, can mute hearing aid microphones

34 FM System Improves the SNR Improves hearing at a distance Transmitter sends speaker s voice directly to the receivers Receivers worn at ear level (attached to the hearing aids) or connected to intermediary device worn around the neck (transmitted to aids via NFMI) Directionality Has Bluetooth connectivity built in

35 FM Receivers

36 FM Transmitters

37 Remote Microphones Smaller and more discrete than FM Improve SNR Improve hearing at a distance Easy to use Can connect directly to hearing aids or through intermediary device Some equipped with directionality

38 Remote Microphones

39 Phone Connectivity Bluetooth available from every manufacturer MFi aids only two manufacturers DECT Phone landline phone Easy Call connects to any cell phone

40 Phone Connectivity

41 Devices for Tinnitus Management

42 Tinnitus Management Hearing aids often first method of intervention Sound Enrichment Soothing Sound Interesting Sound Background Sound Can be environmental sound Can be recorded sound Combination instruments are helpful for those with hearing loss and problematic tinnitus

43 Devices for Tinnitus Management Sound generator Pillow speaker ipod HUSH Several commercial tinnitus devices Apps streaming through hearing aids MFi Bluetooth streamer

44 Devices for Tinnitus Management

45 Tinnitus Management

46 Dual Sensory Disorder

47 Dual Sensory Access to sound is critical for persons with both vision and hearing loss. Hearing assistive technology may improve not only their speech perception but also their connection and orientation to the environment, as well as enable greater mobility. Visual, auditory and/or vibrotactile alerting systems Hearing Dog/Seeing Eye Dog Falls management Partner with the VIST Program

48 Vestibular Rehabilitation

49 Vestibular Disorders and Rehabilitation Balance is complex and relies on input from the vestibular, visual, and somatosensory systems. Audiologists perform tests to assess balance function when the following symptoms are present: Rapid, involuntary eye movement (nystagmus) Room spinning sensation (vertigo) Complaints of dizziness Difficulty walking Audiologists work with physical therapists to develop individualized treatment plans to minimize, recover balance, and improve daily functional activities

50 Virtual reality based therapy (VRBT) Persons with vestibular disorders usually complain of dizziness and visual vertigo in visually complex environments Habituation exercises using visually provocative stimuli have been shown to be useful during vestibular rehabilitation Virtual reality based therapy (VRBT) is an emerging technology that can be used in vestibular rehabilitation to provide visual habituation exercises for individuals with vestibular disorders

51 Apps and Into the Future

52 Apps Galore Sound level monitoring Hearing evaluation Hearing enhancement Alerting (vibrate and flash to alert user) Transcribe speech to text ASL Dictionary Translate English to ASL To view closed captioning Tinnitus management Auditory rehabilitation

53 Smartphones as Hardwired Hearing Enhancement Devices Many apps With an app, good earphones and a high fidelity add- on mic, phone becomes a body aid or hard-wired ALD Some are not compatible with Bluetooth headphones etc

54 Audiology Telehealth Through the use of Clinical Video Telehealth, audiology services are provided at some CBOCs by connecting patients with providers at the medical center. Services available through telehealth include hearing evaluations, hearing aid fittings and follow-ups, auditory rehabilitation and tinnitus management. Audiology can also provide services directly into the Veteran s home through computer technologies.

55 Into the Future. Telephone and hearing aid manufacturer partnerships illustrate the critical role that smartphones, and their hosted applications will play in the future Public venues would transmit audio directly to smartphones or hearing aids, avoiding receiver maintenance and coupling issues TV chips for audio transmission directly to the hearing enhancement device (home, nursing homes, etc.) Self-fitting devices research being done; one total communication device with smartphone hub, programmable via an app(s) to meet all needs including hearing protection

56 Conclusion Hearing aids and/or cochlear implants are helpful, but they alone are not always enough More complex environments More active Higher expectations Concomitant disorders Technology can assist with ADLs, help maintain independence and confidence Technology is continually improving and becoming more seamless Partner with your local audiologist

57 Other News: New VA Outpatient clinic in your area ETA 09/19. Caregivers of Veterans with Hearing Loss one hour recorded webinar please share this information with others: vers/webinar-12.html Audiology Same Day Service Tampa VA Outpatient Clinic N 46th Street Tampa FL am to 2:30 pm for hearing evaluations (opens at 7:30 am for hearing aid repairs)

58 Questions?