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A University Model: Acquisition of Audiology Knowledge

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Describe constraints associated with teaching audiology within an SLP ... Utilize the cardinal documents of ASHA for establishing a curriculum with a program. ... – PowerPoint PPT presentation

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Title: A University Model: Acquisition of Audiology Knowledge


1
A University Model Acquisition of Audiology
Knowledge Skills for SLPs
  • C. Frederick Britten, Ph.D.
  • Fort Hays State University
  • Hays, Kansas
  • and
  • Colleen M. ORourke, Ph.D.
  • Georgia State University
  • Atlanta, Georgia

2
Objectives
  • Describe constraints associated with teaching
    audiology within an SLP curriculum.
  • Explain the various components necessary for
    establishing a knowledge and skills set for
    entry-level practitioner in SLP.
  • Utilize the cardinal documents of ASHA for
    establishing a curriculum with a program.

3
Burning Issues---
  • What are some specific questions you have that
    you would like to see discussed or that you have
    at this point in this seminar?

4
Student Comments
  • Why do I need to know this?
  • Will this be on the test?
  • Why do I need to take audiology? I dont plan to
    work with people who have hearing loss.
  • Ill just refer any clients with hearing loss to
    an audiologist.
  • SLPs arent allowed to do this, are they?
  • I will never see a patient with a hearing loss.

5
Potential Comments from Faculty within an SLP
Program
  • SLP Scope expanding, so lets cut audiology.
  • Why do our students need audiology courses?
    Theyre going to be SLPs, not audiologists.
  • The undergraduate course gives our students
    everything they need to know about ears and
    hearing.
  • We should just teach students how to screen.
  • Poor funding support for audiology equipment
    within the clinic, yet the income is needed for
    the clinic.

6
Interrelatedness of Communication
7
Data on HOH Individuals by Age
  • Approximately 30 million people have hearing
    loss.
  • Number Who Report Difficulty Hearing
    Conversation
  • 6 to17 Years Old 325,064
  • 18 to 44 Years Old 1,327,726
  • 45 to 64 years 2,877,192
  • 65 years and older 6,158,533
  • Total 10,688,515
  • Source 2002 U.S. Census Bureau

8
Prevalence of Hearing Loss in Adults
  • Hearing loss is the 3rd most prevalent chronic
    condition in older Americans.
  • 25-40 of the population age 65 and older has
    hearing loss.
  • 40-66 of the population age 75 and older has
    hearing loss.
  • 80 of the population age 85 and older has
    hearing loss.

9
Increase in Individuals with Cochlear Implants
  • 60,000 cochlear implants have been placed in the
    past 20 years.
  • Half of the recipients were children, half
    adults.
  • - Are SLPs prepared to work with them?

10
Employment Settings for SLP
  • 55.5 of SLPs are employed in school settings.
  • 35.3 of SLPs are employed in health care
    facilities.
  • Programs need to prepare students for a variety
    of work settings and for a variety of disorders
    including hearing loss.
  • Source 2006 ASHA Member Demographic Profile

11
Caseload Characteristics for SLPs
  • 48 of SLPs in the schools regularly serve
    students with hearing disorders.
  • 60 of SLPs services in health care settings
    were for adults.
  • 90-98 of SLPs services in SNFs and rehab
    hospitals were provided to adults.
  • Sources ASHA SLP School Survey Reports, 2007
  • ASHA SLP Healthcare Survey Reports, 2007

12
Quote from Recent Graduate
  • Your courses have offered me valuable
    information that is important to know as SLPs.
  • This course was great! It is very helpful for me
    when working with clients who have hearing loss.
    Ive already used the resources you gave us!
  • Oh, and just to let you know, share with the
    audiology class this year, I have 8 students on
    my caseload with hearing loss and one with a
    cochlear implant and one about to get one.

13
Student Request -
  • Please send me a copy of the speech banana. I
    seemed to have lost my copy. I need it in order
    to explain to parents the impact of a hearing
    loss on the speech.

14
Distribution of Programs
  • SLP Only Programs Masters 240
  • SLP/Audiology Programs 62
  • UG Only SLP Programs 49
  • Where is audiology being taught?

15
Where are courses taught in the curriculum?
  • Audiology
  • Undergraduate Variable content
  • Graduate Variable content
  • Aural Rehabilitation
  • Undergraduate Typically survey course
  • Graduate Typically theoretical content

16
Sample Course Descriptions Audiology
  • Introduction to instrumentation and assessment
    techniques for the identification of normal and
    disordered auditory systems. Audiology
  • Study of the principles of the management of
    hearing loss in children and adults relevant
    legislation treatment and education options.
    Audiology II
  • This course samples the entire field of
    audiology. Topics include pure tone air and bone
    audiometry, speech audiometry, reading
    audiograms, interpreting audiograms, client
    behaviors, common pathologies of the ear, and
    management of the hearing-impaired client.
    Introduction to Audiology

17
Sample Course Descriptions Aural Rehabilitation
  • Theories and procedures used in the
    rehabilitation of children and adults with
    hearing loss. Rehab. Audiology
  • Introduction to management strategies, exclusive
    of language, for the hearing impaired. Topics
    include impact of hearing loss, hearing aid
    characteristics, assistive listening devices,
    cochlear implants acoustic and visual aspects of
    speech, auditory and visual perception training.
    Aural Rehab.
  • Approaches to aural rehabilitation of children
    and adults. Introduction to educational audiology
    and assistive listening devices. Aural Rehab.
  • Methods of instruction in auditory training,
    speechreading, and hearing aid orientation.
    Aural Rehab.
  • Habilitative and rehabilitative procedures to
    assist the hearing impaired amplification,
    speechreading, auditory training, speech and
    language training psycho-social-educational
    issues. Aural Rehab

18
Undergraduate Student Experiences Coming into
Graduate Programs
  • Never touched an audiometer
  • Never screened except a classmate
  • Only covered hearing science
  • Only covered disorders
  • Review of screening onlyno audiograms
  • Covered screening in aural rehabilitation
  • Knowledge and skills as it relates to the impact
    on speech and language skills

19
Audience Question
  • So, what are the various required knowledge and
    skills in audiology that students who are
    entering the profession of speech and language
    need to have?

20
CAA vs. CFCC
  • The Council for Academic Accreditation (CAA)
    accredits the academic and clinical education
    programs.
  • The Council for Clinical Certification (CFCC)
    sets the standards for certification and
    evaluates the credentials of those applying for
    certification (the CCC).
  • Both have recommendations re what SLPs need to
    know and be able to do.

21
CAA Standards
  • Program must provide opportunities for students
    to acquire and demonstrate knowledge of
  • hearing, including the impact on speech and
    language
  • interaction and interdependence of speech,
    language, and hearing in the discipline

22
CAA Standards
  • Program must provide opportunities for students
    to acquire and demonstrate skills in
  • prevention, evaluation, and intervention of
    communication disorders (includes hearing).

23
CFCC Requirements Std. III-C
  • The applicant must demonstrate knowledge of the
    nature of speech, language, hearing, and
    communication disorders
  • hearing, including the impact on speech and
    language
  • communication modalities (including oral, manual)

24
CFCC Requirements Std. III-D
  • The applicant must possess knowledge of the
    principles and methods of prevention, assessment,
    and intervention for people with communication
    and swallowing disorders
  • - The applicant must demonstrate the ability to
    integrate information about prevention,
    assessment, and intervention over the range of
    differences and disorders specified in Standard
    III-C above (includes hearing).

25
CFCC Requirements Std. IV-G
  • The applicant for certification must complete a
    program of study that includes supervised
    clinical experiences sufficient in breadth and
    depth to achieve the following skills outcomes
  • Evaluation
  • Intervention
  • Interaction and Personal Qualities
  • The applicant must document the acquisition of
    the skills applicable across the nine major areas
    listed in Standard III-C (includes hearing).

26
And there is more..
27
Components of Evaluation (CFCC)
  • Conduct screening and prevention procedures
    (including prevention activities).
  • Collect case history information and integrate
    information.
  • Select and administer appropriate evaluation
    procedures.
  • Adapt evaluation procedures to meet
    client/patient needs.
  • Interpret, integrate, and synthesize all
    information to develop diagnoses and make
    appropriate recommendations for intervention.
  • Complete administrative and reporting functions.
  • Refer clients/patients for appropriate services.

28
Components of Intervention (CFCC)
  • Develop setting-appropriate intervention plans.
    Collaborate with clients/patients and relevant
    others in the planning process.
  • Implement intervention plans.
  • Select or develop and use appropriate materials
    and instrumentation for prevention and
    intervention.
  • Measure and evaluate clients'/patients'
    performance and progress.
  • Modify intervention plans, strategies, materials,
    or instrumentation as appropriate.
  • Complete administrative and reporting functions.
  • Identify and refer clients/patients for services
    as appropriate.

29
Interaction Personal Qualities (CFCC)
  • Communicate effectively, recognizing the needs,
    values, preferred mode of communication, and
    cultural/linguistic background of the
    client/patient, family, caregivers, and relevant
    others.
  • Collaborate with other professionals in case
    management.
  • Provide counseling regarding communication and
    swallowing disorders.
  • Adhere to the ASHA Code of Ethics and behave
    professionally. 

30
And all of this can be done in two undergraduate
courses?
31
Other Practice Guidelines
  • Its not just the CAA and CFCC that provide
    guidance as to the knowledge and skills needed by
    SLPs, but also
  • SLP Scope of Practice
  • SLP Preferred Practice Patterns
  • Additional Guidelines

32
ASHA Resources
  • Scope of Practice in Speech-Language Pathology
    (2007)
  • Preferred Practice Patterns for SLP (2004)
  • Guidelines for Audiologic Screening (1997)
  • Knowledge and Skills for Required for the
    Practice of Audiologic/Aural Rehabilitation
    (2001)
  • Central Auditory Processing Disorders (2005)
  • Clinical Practice by Certificate Holders in the
    Profession in Which They are not Certified (2004)
  • Joint Committee on Infant Screening Statement
    (2007)
  • CAA Accreditation Standards (2008)
  • CFCC Certification Standards (2005)

33
SLP Scope of Practice Hearing
  • Collaborating with other professionals (e.g.,
    identifying neonates and infants at-risk for
    hearing loss)
  • Screening individuals for hearing loss or middle
    ear pathology using conventional pure-tone air
    conduction methods (including otoscopic
    inspection, otoacoustic emission screening,
    and/or screening tympanometry)

34
SLP Scope of Practice Aural Rehabilitation
  • Providing services to individuals with hearing
    loss and their families/caregivers (e.g.,
    auditory training, speechreading, speech and
    language intervention, visual inspection and
    listening checks of amplification devices for
    purpose of troubleshooting, including
    verification of appropriate battery voltage).

35
SLP Scope of Practice Central Auditory
Processing Disorders
  • Collaborating in the assessment of central
    auditory processing disorders and providing
    intervention when there is evidence of speech,
    language, and/or other cognitivecommunication
    disorders.

36
SLP Scope of Practice Collaboration with Others
  • Collaborating with and providing referrals and
    information to audiologists, educators, and
    health professionals as individual needs dictates.

37
SLP Scope of Practice Professional Roles
Activities
  • Promote healthy lifestyle practices for the
    prevention of communication, hearing, swallowing,
    or other upper aerodigestive disorders.
  • Foster public awareness of speech, language,
    hearing, and swallowing, and other upper
    aerodigestive disorders and treatment.
  • Advocate for access to and funding for services
    to address communication, hearing, swallowing, or
    other upper aerodigestive disorders.

38
Knowledge and Skills for SLPs Providing Aural
Rehabilitation
  • Auditory System Function and Disorders
  • Identify, describe, differentiate
  • Developmental Status, Cognitive, and Sensory
    Perception
  • Audiologic Assessment Procedures
  • Conduct screening as appropriate.
  • Describe type and degree of hearing loss
    including pure-tone thresholds, immittance
    testing, and speech audiometry.
  • Refer to and consult with audiologist.

39
Knowledge and Skills for SLPs Providing Aural
Rehabilitation-cont.
  • Assessment of Communication Performance
  • auditory processing
  • Effects of hearing loss on speech perception,
    speech-reading, communication strategies
  • Provide self-assessment of communication
  • Devices and Technologies for HOH
  • Hearing aids, cochlear implants, middle ear
    implants, implantable hearing aids, hearing
    assistive technologies
  • Describe candidacy for hearing aids
  • Monitor use of prescribed amplification systems
  • Describe options for assistive devices
  • Identify need for referral to audiologist
  • Implement HAO in consultation with audiologist
  • Perform visual inspection and listening checks on
    devices

40
Knowledge and Skills for SLPs Providing Aural
Rehabilitation-cont.
  • Effects of Hearing Loss on Individual
  • Intervention and Case Management
  • Interdisciplinary Collaboration
  • Acoustic Environments
  • Appropriate acoustical conditions
  • Provide for screenings for those exposed to
    hazardous noise

41
Preferred Practice Patterns for SLP (2004)
  • Audiologic Screening
  • 20 dB HL at 1000, 2000, 4000 Hz via
    conventional or play audiometry
  • Screen for outer and middle ear disorders
  • Visual inspection, otoscopic exam, tympanometry
  • Screen for disability
  • Interview, case history, questionnaires
  • Maintain equipment in working condition

42
Preferred Practice Patterns for SLP (2004)
  • Aural Rehabilitation Assessment
  • Diagnosis of communication impairment from HL
  • Effects of HL on individuals activities
  • Prognosis for change for successful communication
  • Recommendations for intervention
  • Effects of HL on speech and language

43
Preferred Practice Patterns for SLP (2004)
  • Aural Rehabilitation Intervention
  • Providing information to families/patients
  • Auditory training
  • Speechreading
  • Communication Strategies
  • Education and Counseling
  • Functioning of Hearing aids and Assistive
    Listening Devices

44
SOWhat do we do??
  • How can we ensure that SLP students have the
    knowledge and skills required for certification
    and to meet their Scope of Practice and follow
    practice guidelines?

45
Knowledge SLPs Need
  • Anatomy physiology of the auditory system
  • (peripheral and central)
  • Disorders of the auditory system
  • Acoustics sound and its measurement
  • Speech perception
  • Pure tone audiometry
  • Speech audiometry
  • Audiogram interpretation
  • Otoscopic inspection

46
Knowledge SLPs Need cont.
  • Immittance testing tympanometry reflexes
  • Immittance interpretation
  • Otoacoustic emissions
  • Auditory evoked potentials
  • Pediatric testing techniques
  • Hearing screening protocols
  • Prevention of hearing loss
  • Auditory processing disorders
  • Referrals to audiologists

47
Knowledge SLPs Need cont.
  • Types of hearing aids
  • Hearing aid components
  • Troubleshooting hearing aids
  • Implantable hearing aids
  • ALDs
  • Effects of hearing loss on speech, language, and
    literacy development
  • Effects of hearing loss on communication

48
Knowledge SLPs Need cont.
  • Communication handicap assessment
  • Communication strategies
  • Speechreading
  • Auditory training
  • Assessment and AR planning for adults
  • Assessment and AR planning for children

49
Skills SLPs Need
  • Conduct screening and prevention procedures.
  • Collect case history information and integrate
    information.
  • Visual inspection, otoscopic exam, tympanometry.
  • Screen for disability.
  • Describe type and degree of hearing loss
    including pure-tone thresholds, immittance
    testing, and speech audiometry.
  • Diagnose communication impairment from HL.
  • Determine effects of HL on individuals activities

50
Skills SLPs Need cont.
  • Develop setting-appropriate intervention plans.
  • Implement intervention plans.
  • Measure and evaluate clients' performance and
    progress.
  • Describe candidacy for hearing aids.
  • Monitor use of prescribed amplification systems.
  • Describe options for assistive devices.
  • Perform visual inspection and listening checks on
    devices
  • Refer to and consult with audiologist.
  • Refer clients/patients for appropriate services.

51
SoHow are programs doing this?
52
Sample Course Content
  • EXC 4480/6480 Hearing Science Disorders (GR/UG,
    but primarily UG)
  • Acoustics the nature of sound
  • Calibration Pure Tone Audiometry
  • Speech Audiometry
  • Anatomy and Physiology of Hearing
  • Disorders of Hearing
  • Audiogram Interpretation Referrals
  • Hearing Screening

53
Sample Course Content cont.
  • SLP 658 Audiology (GR/UG, but primarily UG)
  • Sound Measurement and Acoustics
  • Pure Tone Audiometry
  • Speech Audiometry
  • Anatomy and Physiology of Hearing
  • Disorders of Hearing

54
Sample Course Content cont.
  • EXC 7570 Advanced Audiology (GR only)
  • Review A P PT SPCH Audiometry
  • Immittance Measurements
  • Auditory Development
  • Evaluation Issues Newborn Infant
  • Evaluation Issues 7 months-2 years
  • Evaluation Issues Preschool School Age
  • Evaluation Issues Adults Elderly
  • Auditory Processing Disorders

55
Sample Course Content cont.
  • SLP 836 Pediatric Audiology (GR Only)
  • Immittance Screening
  • Continue Interpretation
  • Otitis Media in Children
  • Childhood Hearing Loss
  • Joint Committee on Infant Hearing
  • Otoacoustic Emissions
  • Auditory Brainstem Response..discuss only

56
Sample Course Content cont.
  • EXC 4480/6480 Aural Rehabilitation (GR/UG, but
    primarily UG)
  • Communication Strategies Assessment
  • Speech Perception
  • Hearing Aids ALDs (includes implantable aids)
  • Auditory Training
  • Speechreading
  • AR with Adults Elderly
  • AR with Children

57
Sample Course Content cont.
  • SLP 857 Aural Rehabilitation (GR only)
  • Communication Strategies
  • Auditory Training and Speechreading
  • Hearing Aids and Cochlear Implants
  • Assistive Listening Devices
  • AR with Children Infants/Toddlers/School-age
  • AR with Adults
  • Report Writing

58
Suggested Labs Activities
  • Activities for EXC 4480/6480 Hearing Sci Dis
  • Acoustics assignment to compare frequency,
    amplitude, phase.
  • Listening check on audiometer (competency)
  • Pure Tone Testing on classmates
  • Pure Tone Testing outside of class Test 5
  • Interpretation activities interpreting
    audiograms, drawing audiograms
  • Disorders and types of hearing loss
  • Portfolio based on course learning outcomes

59
Suggested Labs Activities cont.
  • Labs to Accompany SLP 658 Audiology
  • Sound Level Meter and making measurements
  • Acoustics Lab to identify different sounds
  • Listening Check on audiometer
  • Pure Tone Screening on Classmates Test 10
  • Pure Tone Screening outside of class Test 10
  • Interpretation Labs throughout the course
  • Term Paper on an assigned disorder
  • Reactionary Papers for each lab and relate to
    SLOs
  • Report Writing

60
Suggested Labs Activities cont.
  • Activities for EXC 7570 Advanced Audiology
  • Interpretation activities interpreting
    audiograms, immittance results.
  • Immittance screening on classmates and others.
  • Case Studies children adults, appropriate
    evaluation strategies, recommendations,
    referrals.
  • Select one of the following options
  • - Research paper audiology topic of their
    choice
  • - Develop In-Service topic audience of
    choice
  • - Portfolio based on course learning
    outcomes

61
Suggested Labs and Activities cont.
  • SLP 836 Pediatric Audiology
  • Immittance Screening on 10 people with
    appropriate referral status
  • Audiogram Interpretations
  • Preschool Hearing Screening on 8 people
  • OAE Screening Lab on 5 people
  • Journal Article Review

62
For Example Tympanogram Interpretations
63
Suggested Labs Activities cont.
  • Activities for EXC 4490/6490 Aural Rehab
  • Case Studies select appropriate tools to assess
    communication strategies
  • Listening checks on hearing aids
  • Case Studies select appropriate tools to assess
    auditory skills speechreading skills
  • Case Studies plan AR programs for children
    adults
  • Video reviews Deaf culture, CIs, Hrg. Aids, AR
  • Develop Resource Manual materials for
    children/parents adults on hearing/hearing
    loss, impact of hearing loss, Hrg. Aids, CIs, AR
    programs.

64
Suggested Labs Activities cont.
  • Labs for SLP 857 Aural Rehabilitation
  • APD Evaluation
  • Aural Rehabilitation Assessment Lab
  • Speechreading Assessment
  • Self-Perception Assessment
  • Auditory Assessment
  • Hearing Aids/Assistive Listening Devices
  • Materials and Lesson Planning
  • Journal Article Reviews

65
Audiology Textbooks (Not Comprehensive)
  • Martin Clark Introduction to Audiology
  • Bess Humes Audiology Fundamentals
  • Gelfand Essentials of Audiology
  • DeBonis Donohue Survey of Audiology

66
Aural Rehabilitation Textbooks (Not
Comprehensive)
  • Tye-Murray Foundations of Aural Rehabilitation
  • Schow Nerbonne Introduction to Audiologic
    Rehabilitation
  • Alpiner McCarthy Rehabilitative Audiology
  • Hull Aural Rehabilitation
  • Moseley Bally Communication Therapy An
    Integrated Approach to Aural Rehabilitation

67
Anatomy Interpretation - Hearing Aids - Quality
of Life
68
How do we get it all covered?
  • Networking
  • Continuing Education
  • Mentoring
  • Independent Study

69
Your Questions?
  • We may not have all of the answers, but we do
    know what has worked for us!
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