Evaluation of communication therapy as aural rehabilitation for adults with acquired hearing loss

This research evaluated the effectiveness of an aural rehabilitation program based on a conversation-based approach espoused by Erber (1988) with working-aged adults with acquired mild-to-moderate hearing losses experiencing communication difficulties with unfamiliar communication partners in their occupational and/or educational environments. This approach is linguistically bases and attempts to improve the hearing-impaired subject's metalinguistic knowledge and knowledge of how language is used in conversation such that the amount of their conversations that they understand improves, thereby achieving more efficient and fluent communication. The current research adapted Erber's program by having an unfamiliar communication partner receive therapy, but not with the hearing-impaired subjects. Two hearing-impaired subjects participated in this research, as well as two unfamiliar communication partners, one who received therapy. This research investigated two aspects of program evaluation. First, it investigated whether or not greater benefit would be derived by the hearing-impaired subjects in their interactions with an unfamiliar communication partner who received therapy compared to one who did not. Second, it appraised the validity of the selected evaluation methods and outcome measures. The results indicated that although the hearing-impaired subjects only received limited benefit in terms of improvement on the proposed performance measures, they did report satisfaction with a change in their attitude or belief system. Both subjects reported increased confidence in terms of their ability to more fully participate in conversations and to manage and prevent communication breakdowns. Two aspects of benefit gained by the hearing-impaired subjects were reductions in listening effort and feelings of miscomprehension. The results did not conclusively indicate that greater benefit was derived by the hearing-impaired subjects in their communication interactions with the unfamiliar communication partner who received treatment than in those with the one who did not receive treatment. Examination of the selected evaluation methods and outcome measures indicated some areas of concern. The communication context of the tracking procedure may not be a valid one for examining changes in use of communication strategies or repair sequences due to the nature of tracking itself. The validity of measuring efficiency in conversations as the rate of information exchange was seriously questioned by this research. Measuring conversational fluency also proved to be problematic. Subjective and objective measures of fluency did not show consistent agreement. Clinical implications generated by this research included: hearing-impaired subjects who experience communication difficulties with unfamiliar communication partners can benefit from such communication-based aural rehabilitation; the evaluation of communication success requires evaluation procedures which reflect a variety of communicative contexts and allow for a variety of outcome measures; consideration of successful therapy in terms of a change in a client's belief system; and, a need for the therapeutic process in aural rehabilitation to be driven by a more psychosocial perspective, rather than the medical model perspective of impairment, disability, and handicap.Medicine, Faculty ofAudiology and Speech Sciences, School ofGraduat