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

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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.

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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

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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.

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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?

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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

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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

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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.

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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.

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Distribution of Programs

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

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Where are courses taught in the curriculum?

• Audiology
• Undergraduate Variable content
• Graduate Variable content
• Aural Rehabilitation
• Undergraduate Typically survey course
• Graduate Typically theoretical content

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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

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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

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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

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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?

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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.

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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

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CAA Standards

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

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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)

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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).

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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).

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And there is more..
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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.

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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.

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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. 

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And all of this can be done in two undergraduate
courses?
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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

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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)

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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)

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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).

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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.

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SLP Scope of Practice Collaboration with Others

• Collaborating with and providing referrals and
  information to audiologists, educators, and
  health professionals as individual needs dictates.

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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.

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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.

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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

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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

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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

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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

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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

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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?

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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

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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

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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

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Knowledge SLPs Need cont.

• Communication handicap assessment
• Communication strategies
• Speechreading
• Auditory training
• Assessment and AR planning for adults
• Assessment and AR planning for children

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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

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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.

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SoHow are programs doing this?
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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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For Example Tympanogram Interpretations
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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.

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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

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Audiology Textbooks (Not Comprehensive)

• Martin Clark Introduction to Audiology
• Bess Humes Audiology Fundamentals
• Gelfand Essentials of Audiology
• DeBonis Donohue Survey of Audiology

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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

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Anatomy Interpretation - Hearing Aids - Quality
of Life
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How do we get it all covered?

• Networking
• Continuing Education
• Mentoring
• Independent Study

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Your Questions?

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