AuD Students + AR Solutions = Clinical Innovation

At the Purdue University Audiology Clinic, graduate students in the AuD program are involved in all aspects of cochlear implant (CI) evaluation, consultation, activation, and re-mapping services. While speech-language pathologists (SLPs) have specific training to provide aural rehabilitation (AR) services, not all adult CI patients have access to that care option. To address this concern and prepare the next generation of audiologists to provide full scope of care for adult CI patients, the Purdue University Audiology Clinic has created a way to include AuD students into introductory, cost-and-time efficient adult CI aural rehabilitation activities that can apply to their future professional practice with the goal of encouraging improved patient outcomes.Figure 1: Training and guidance model for computer-based programs.Adult CI patients who have been post-lingually deafened need AR as studies have shown that patient-driven rehabilitation strategies can positively affect quality-of-life outcomes and, at the very least, auditory training can teach active listening strategies.1,2 While self-driven strategies are available to patients, both audiologists and SLPs have the provision of AR in their scope of practice, although only SLPs are able to bill for this service provision and often possess the greater skill set to be successful in this endeavor.3 It is suggested that for any type of AR to be successful in the adult population, it must be easily accessible, cost-effective, and provide the patient with feedback regarding progress.2 Additionally, a small study by Moberly et al4 found that clinicians guiding the AR process improved quality of life and word recognition scores for adult CI patients. Clinician involvement, providing written instructions in addition to verbal instructions, and following up with patients after sessions have been shown to contribute to successful completion of the auditory training program and optimize patient outcomes.5 When looking at specific AR options, computer-based auditory training has a significant impact on quality-of-life measures when compared to other methods of AR, such as face-to-face or passive home-based training.6 It is crucial to ensure that new CI recipients are able to confidently use this tool. AR OPTIONS FOR ADULT CI PATIENTS While many programs and options exist, the most viable options that meet the criteria of being patient-driven, teaching active listening strategies, and being easily accessible and cost-effective include: Referral to a speech-language pathologist: Identify local or telehealth referral sources that provide the most direct access to an SLP with training and experience in AR. Structured activities via manufacturer-created materials: Avoid reinventing the wheel when resources exist. Use computer-based auditory training tasks or paper-based options to accommodate patients’ needs. Enriched leisure activities: Listen to an audiobook while reading along with a print copy, or watch a pre-recorded show with closed captioning. Guided practice with a caregiver: Demonstrate discrimination of Ling-Madell-Hewitt sounds by having a caregiver deliver them. Instruct the patient and caregiver to have two copies of a printed material that the caregiver reads aloud while the CI recipient follows along. STUDENTS, MEET THE AR CHALLENGE The Purdue University Audiology Clinic presents several AR options to families who can choose one or two for their assignments. The process of implementing and scaffolding task difficulty within the listening exercises can be overwhelming and confusing for patients and families. While patients often understand the importance of wear time, the consistency of working through auditory training activities can be challenging. This need for clinical education created an opportunity for the clinic to design an innovative program to improve clinician involvement and patient guidance. The CI clinicians met with AuD students in the CI rotation clinic to explain the AR options of manufacturer-provided books, guided practice with a caregiver, and computer programs. Referral to an SLP and leisure activities were efficient options to present within the allotted clinic time, as well. At the CI activation, two-week post-activation follow-up, and one month post-activation follow-up, time was allotted after mapping for the AuD students to remain with the patient and caregiver(s) to discuss additional AR options, under the supervision of the CI clinician. Computer-based AR activities were the default preferred method and students were instructed on how to adapt to a paper-based option if needed based on patient comfort with technology and involvement with a caregiver. The student then guided the patient and family through one lesson and assigned homework to be completed by the next follow-up. Because computer-based programs were consistently the most troublesome for patients, the AuD students developed a training and guidance model to address patient needs (see Figure 1). This model emphasizes the program’s goal for AR to be guided practice and not to create additional frustration or quiz a patient or caregiver on computer skill level. AuD students were able to provide families with options that would allow for their needs and encourage their success. This was a unique opportunity for the students to exercise and practice their coaching, scaffolding, problem solving, and flexibility skills with adult CI patients. Clinical educators observed from outside the room as the students led the patients through the exercises, adjusting in the moment, and providing reassurance to patients when needed. Students reflected that they appreciated the opportunity to lead this portion of the appointment, which increased their confidence. The students felt like they successfully learned how to guide patients through the AR process. Patients returned to subsequent appointments having completed the intended homework in most cases and progressed on to the next module when appropriate. TAKEAWAY Audiologists who want to implement AR for adult CI patients have many options to do so. For the model to be intentional and cost effective, consider using students or support staff in addition to a referral to an SLP. Some CI manufacturers provide computer-based materials, handbooks, and guidance materials to support AR activities. Auditory training can be practiced at home via pre-designed programs, but support from an AuD student or audiologist can be game-changing for patients. When working with a computerized program, assess a patient’s likelihood of success, and adjust when needed to reduce frustration. Incorporating AuD students in the process not only teaches them the importance of tailored counseling and scaffolding, but also provides evidence of the importance of motivation and accountability in achieving goals.