Today’s post concludes last week’s discussion by Dr. Maurice H. Miller:

Uniting the Profession 

Audiology has unfortunately faltered since Alpiner and McCarthy{{1}}[[1]]Alpiner, J.G. & McCarthy, P.A. (2000). Rehabilitative Audiology: Children and Adults. Lippincott, Williams & Wilkins. [[1]] concluded, in 1973, that there was one common thread that should hold audiologists together: “Their practice and engagement in the aural rehabilitation process.”  Whatever else we do, “rehabilitation of individuals with hearing loss was and must be ‘the uniting goal of the profession.’”

The founders of the profession would have been amazed and disturbed if they had lived today to see how far we have strayed from our rehabilitation roots.

The decline of the initial emphasis on rehabilitation was also influenced by the lack of insurance coverage for such services when performed by audiologists, a situation that exists today under lack of medical reimbursement.

The Importance of Group Experience

Individual audiologic rehabilitation is essential, but it needs reinforcement and supplementation with group experience. The group experience is central since communication is a group activity involving interaction with another or, quite often, several others. But initial therapy must be performed on a one-to-one basis; the audiologic rehabilitationist must determine when the patient is ready for group interaction.

Military Audiologists benefit from having a “captive audience.”

The audiologic rehabilitation clinics established by the military recognized this and led to development of “listening clinics” created to “place these people back into effective communication with their fellows and their environment.” The curriculum included 1) daily individual and group lip reading instruction, 2) counseling including personal, economic or domestic problems, and 3) maintenance of contacts with the patient’s family. In addition it bridged the gap between veterans’ facilities and those civilian agencies that would continue to provide any additional rehabilitation measures that might be needed.  The intensity and necessity of ongoing rehabilitative measures beyond the eight-week course is evidence of the degree to which rehabilitation measures were recognized and considered essential to the recovery process, even in the much younger population than we serve today.  That was in the 1940s, but as Alpiner and McCarthy (2000) stated six decades later: “Even a few hours of post-hearing aid fitting rehabilitation is rare.”

It must be noted that the above approach needs modification for a primarily aging population, but much of the 1940s approach is applicable. Lack of insurance coverage for rehabilitation was not the problem then that it is now, and much of the rehabilitative approach needs radical modification since the Veterans Administration population hardly lacked the motivation of the elderly population that challenges us today.

Motivating the elderly presents special challenges that require the most imaginative, dedicated and insightful audiologic practitioners in the profession.

The military and Veterans Administration clients were a “controlled population” whose schedule could be determined and managed by those in charge. True audiologic rehabilitation precedes, as well as accompanies and follows all aspects of the hearing aid fitting process. It must not be a casual recommendation (e.g., “Come by if you have a problem with your hearing aid or your hearing”), but rather an organized, scheduled set of visits usually over a period of months, especially with the elderly segments of our population.

CONCLUSION

Audiologists must rehabilitate or our future is uncertain and cast with enormous doubt. Long-term individual involvement with the hearing-impaired patient in a rehabilitative structure to which the audiologist is dedicated is essential. Without it, our future is uncertain. With it, there is enormous hope for our profession.

Maurice H. Miller, PhD (Columbia, 1956), is Professor Emeritus of Audiology, New York University Steinhardt School of Culture, Education and Human Development. Throughout his career, he has directed programs in Communication Disorders at some of the nation’s leading medical and academic institutions and spent over 40 years as the Chief Audiological Consultant to the New York City Department of Health. He is the author of five books, over 120 articles in peer-reviewed journals and numerous monographs and chapters in widely used audiology textbooks. Dr. Miller  was the second person to receive the Lifetime Career Award from the American Academy of Audiology.