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Post by Admin on Jul 6, 2020 21:35:53 GMT
Here you will find useful articles to consider when working with people with hearing loss and learning disabilities.  |
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Post by Admin on Jul 7, 2020 12:27:29 GMT
Supporting adults to have a hearing test – tips for carers
Written by Dr Lynzee McShea
Senior Clinical Scientist (Audiology)
Clinical Lead for Complex Adults and Balance Assessment / Rehabilitation
Preparation is key
As an Audiologist, I find it very helpful when a carer supports a person to attend an appointment and brings information that can help us complete the assessment. Our appointments are up to an hour per person, so we have limited time to obtain the information we need, and rely on input from those who know the person best.
Observations from home are helpful (for example, can the person hear better in quiet situations compared to background noise?).
It helps if the carer can think about their own conversations with the person attending the appointment. Do you use gestures to communicate with that person? Do they respond better if they can see your face? Hearing is more complex than it first appears, and can sometimes be difficult to spot without these observations. The people you support may have a significant hearing loss and still respond to lots of everyday sounds.
It also helps us if the person themselves knows what to expect during the assessment. We send information out prior to our appointments that can be helpful. We send photographs of the check-in and waiting area, the Audiology rooms, and staff that the person is likely to meet. We also photograph the different tests we may use. We can arrange a short pre-visit to the department prior to someone’s appointment, to reduce anxiety on the day.
We also try to learn more about the individual’s likes and dislikes prior to attending. Knowing that a person may become distressed by having their ears touched, means we will delay an ear examination in the appointment. Non-audiological information is also helpful. For example, we were asked to see an individual who was often anxious about attending hospital. We knew that he enjoyed music and a song by Wham in particular! By having this information beforehand, we were able to have the song playing in the room when he first arrived, which immediately helped to make him feel more relaxed and comfortable.
Be proactive and get involved
Another key element is involvement during the appointment. It is a great help to Audiology if the carer supporting the person to attend actually knows them! This sounds obvious, but often people are supported to attend appointments by carers who know very little about them. If the individual is unable to communicate their needs themselves, this makes it difficult for us to learn about observations at home or any recent medical history.
There have been many occasions where input from a carer has made it possible for us to complete a hearing assessment. We welcome involvement – even something as small as providing encouragement or sitting close to the person, gives them the confidence to participate. We can be very flexible in Audiology and we appreciate input. If the person has a favourite CD or an object that they like, it may be useful to bring these along. Don’t be afraid to get involved and ask questions!
Share information with others
Once a person has been diagnosed with a hearing loss and issued with high quality hearing aids, the responsibility for their use and upkeep falls to the individual or those who support them. This means it is very important for all those supporting an individual to be consistent and share information.
When we fit hearing aids, we issue Hearing Support Plans, which carers can use as a tool to take back to their teams and share information. These plans are personalised and tell carers what level of hearing a person has, what this means day to day, and all about their hearing aids and how to look after them.
If you support a person to attend an Audiology appointment, make sure that everyone else is aware of the outcome when you return home. Share information in meetings or arrange training sessions if a person is fitted with hearing aids. Consistency is important as this will help the person to get used to their hearing aids most quickly and effectively.
For example, we fitted hearing aids for a man with Down’s syndrome who was support by several paid caregivers. Some encouraged him to wear the hearing aids every day, others didn’t. Staff didn’t communicate about the hearing aids and no information was written down, so sometimes the hearing aid batteries were left for weeks before they were changed. I went to visit this man at home and did a training session for his carers and now he is supported well with his hearing aids, regardless of who is supporting him that day.
Although hearing assessment is important, aftercare is just as important!
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Post by Admin on Jul 7, 2020 12:30:01 GMT
Hearing tests for all
Written by Dr Lynzee McShea
Senior Clinical Scientist (Audiology)
Clinical Lead for Complex Adults and Balance Assessment / Rehabilitation
When I tell people that I work in Audiology, I usually receive one of two responses. Either “What’s Audiology?” or “Is that something to do with hearing?”
Audiology is an exciting profession, with fantastic technology and assessment techniques. The problem is, most people don’t know about this. Most people are shocked when I tell them that I routinely carry out hearing tests on people whilst they are asleep. It is perhaps surprising, but it is possible.
Those who have had experiences of Audiology often describe the hearing tests they have had; sitting in a small soundproof room in silence, wearing a pair of headphones and pressing a response button every time they hear a sound. Yes, this is the most common way of testing hearing, but it is by no means the only way. The problem is, many people do think this is the only way and if a person is not able to do this, then they cannot have their hearing tested.
Unfortunately it is something my colleagues and I hear all too often; “You wouldn’t be able to test their hearing, they have learning disabilities”.
The fact is, many people with learning disabilities can complete a routine hearing test successfully with no adjustments whatsoever. And for those that can’t, we must make reasonable adjustments. Most of the time, these adjustments are small and easy to make, and it is our responsibility to do this.
Reasonable adjustments
Sometimes the little things can make all the difference. I have seen many people with learning disabilities complete a routine hearing test with one or more of the following adjustments:
♦ Allowing the person to sit in a larger test room
♦ Giving the person more time to respond
♦ Playing sounds through speakers first to allow a person to become acclimatised, before rushing to put headphones over their ears
♦ Instead of insisting the person press a button in response to sound, trying an alternative such as raising their hand or saying “Yes.”
Just recently I tested the hearing of a man with Down’s syndrome who was thought to be “untestable” because he wasn’t able to use a response button. However, we completed an easy and fun hearing test, because he was able to clap his hands every time he heard a sound.
We should not define people by what they can’t do, instead we should spend time finding out what they can do.
Alternative hearing assessments
Of course, there will be some individuals who are unable to complete a routine hearing test even with reasonable adjustments.
I am clinical lead in my Audiology department for these adults and we have a specialised service available where we use a range of alternative hearing test techniques. There are many similar services in Audiology departments across the country.
I am Chair of the national Hearing and Learning Disabilities Special Interest Group; a group of professionals who are interested in hearing loss and people with learning disabilities. As a group, we recommend having specialised services like this in place, in order to ensure we meet the needs of those with even the most severe or profound learning disabilities.
However, if your local Audiology department doesn’t have such a service in place, they still have a duty of care and can provide an appropriate assessment as required, using alternative methods.
Visual Reinforcement Audiometry (VRA)
VRA, as the name suggests, involves combining sounds with a visual stimulus. Sounds can be played via speakers into a test room, or through headphones or earphones directly to the person:
Each VRA assessment begins with a conditioning phase. A sound is played at a volume that is expected to be clearly audible to the individual. At the same time, a visual stimulus is presented, which is pointed out to the person. In our clinics, this is a short video clip. The process of playing the sound and the simultaneous visual stimulus is repeated several times until it appears that the person being assessed has made the connection between the sound and the visual stimulus.
Next, the test phase begins. This time the sound is played, but the visual stimulus is only presented once the person has responded without prompting (usually by turning their head to the monitor, glancing with their eyes or pointing to the monitor). Gradually the volume of the sound is decreased which allows us to determine the quietest sounds that person responds to. The full range of sounds used during a conventional hearing test can be tested in this way.
With VRA testing, the individual does not need to be consciously aware of how the test works. The response is almost like a reflex – an instinctive response to the sound, with a visual “reward” for responding. The test is most successful if this reward is interesting to the person. We use a variety of video clips to maintain interest and can tailor them to an individual’s likes and preferences. In some cases, we observe a person’s responses to sound (Behavioural Observation Audiometry) to watch for subtle changes in behaviour, movement or facial expressions that only occur when a sound is being played.
Objective hearing tests
We also have a range of tests that do not rely on a person responding to sound in any way. A simple ear examination is very valuable and allows us to check ears for signs of wax, infection or other abnormalities.
Tympanometry tells us about the middle part of the ear and can be completed in a matter of seconds. It is not painful or uncomfortable and involves placing a soft tip in the entrance of the ear canal:
Tympanometry can tell us if there is fluid and congestion in the middle part of the ear, which people with Down’s syndrome are particularly prone to. We can also check there are no holes in the eardrum (perforations).
Oto Acoustic Emission (OAE) testing is another quick and painless assessment, performed in a similar way to tympanometry. This time, sounds are sent along the hearing pathway to the organ of hearing (cochlea). If the cochlea is working well, when it detects a sound it emits an “echo” in return which can be recorded. Although it is not a test of hearing as such, OAE assessment is often used in hearing screening, and is offered to every baby born in England as part of the Newborn Hearing Screen.
Electrophysiological testing
Increasingly, electrophysiological hearing assessments are being used in Audiology, and again require no active participation from an individual. The most common types used are:
♦ Auditory Brainstem Response (ABR)
♦ Auditory Steady State Response (ASSR)
♦ Cortical Evoked Response Audiometry (CERA)
Each of these tests check hearing pathways using electrical responses. A person has stickers placed on the head and behind their ears and are played sounds via an earphone.
Responses are detected by the stickers, which can be analysed on a computer. Some of these tests (e,g, CERA) work best when the person is awake and engaged in an activity (such as watching a television programme or looking at a magazine) but others (e.g. ABR) require the person to be still and relaxed. Such tests can be performed under natural sleep, sedation or general anaesthetic.
Which test is best?
There is no definite answer to this question, it depends on the individual, their capabilities and the information we need to gather.
In my clinical experience, most adults with learning disabilities can complete some form of hearing assessment in clinic, providing reasonable adjustments are made. Sometimes, we perform home visits if a person is unable to come to our clinic. We do perform hearing assessments under general anaesthetic, but only when all other options have been exhausted and only if it is in the best interests of the individual. We have good multidisciplinary links with other professions and coordinate care as much as possible. For example, last year we were part of investigations organised for a man with Down’s syndrome. With a single general anaesthetic, hearing tests, grommets, a biopsy and dental work were all completed. He was found to have a permanent hearing loss and is now a successful hearing aid user.
Key messages
♦ Anyone can have their hearing tested- judgements and misconceptions should not prevent referral
♦ Many people with learning disabilities can complete a routine hearing test with minimal adjustments
♦ Hearing tests can be enjoyable and personalised to people’s strengths and abilities
♦ Audiology departments have a variety of assessment techniques available
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Post by Admin on Jul 7, 2020 12:32:51 GMT
Supporting adults to have a hearing test – tips for GPs
Written by Dr Lynzee McShea
Senior Clinical Scientist (Audiology)
Clinical Lead for Complex Adults and Balance Assessment / Rehabilitation
People with Down’s syndrome should have regular hearing tests
People with Down’s syndrome are particularly prone to problems with their ears and hearing. These range from treatable problems such as wax occlusion or middle ear fluid, to early onset of permanent hearing loss. It is important that this group have access to good quality Audiology and Ear, Nose and Throat services, who can provide monitoring, treatment and management.
Audiology departments should monitor the hearing of children with Down’s syndrome on at least an annual basis. The Royal College of General Practitioners advise referral to Audiology every two years for adults with Down’s syndrome over the age of 30.
Depending on the cause of the hearing loss, medical management may be suitable. Hearing aids are an excellent option for many people with Down’s syndrome and hearing loss.
Know your local referral pathways
There are several ways to refer an individual for a hearing test and local areas may have different pathways. In some areas there is an initiative called “Any Qualified Provider” (AQP), which allows NHS hearing aid services to be provided in community locations and on the high street. AQP is for adults aged over 55 years with age related hearing loss. AQP providers offer routine hearing assessment pathways. Though some adults with learning disabilities may be successfully assessed on such a pathway, many individuals will not and it is the responsibility of the referrer to ensure an appropriate pathway is chosen.
If an AQP pathway is not appropriate, the individual should be referred via a non-AQP pathway; usually hospital based. Such pathways are open to adults of any age. Some hospitals accept non-AQP referrals directly to Audiology and have specialised clinics for people with learning disabilities or other complex needs. Others do not have specialised clinics, do not have Audiology direct referral and require the individual to be referred to an Ear, Nose and Throat Department first. I am part of a group of professionals who are writing guidelines for the audiological management of people with learning disabilities and we will be advocating for specialised services in Audiology.
If you are unsure, it is worth contacting your local Audiology department to ask about referral pathways and services available. Some services accept paper referrals, others use an electronic system called Choose and Book, where an individual can choose the provider they wish to be referred to.
Generally speaking, if there are hearing concerns only, a referral to Audiology is most appropriate. If there are medical concerns regarding the ears (nose or throat) such as pain or infections, then a referral should be made to ENT. Within a hospital, there should be good communication between the two departments and it should be possible for referrals to pass between them.
Maximise the impact of the annual health check
Annual health checks were first recommended in 2006 by the Disability Rights Commission, to reduce the health inequities faced by people with learning disabilities. However, concerns have been raised by Mencap and others over their coverage and consistency.
Although hearing issues are covered in the health check, a piece of research I completed suggested that this is not adequate for hearing.
What were the issues?
♦ The prevalence of hearing loss was significantly underestimated.
♦ The levels of known hearing loss were much lower than expected.
♦ GPs and practice nurses over-emphasised wax as a cause of hearing loss and did not consider sensorineural hearing loss.
♦ Professionals were unsure how to ask about hearing concerns.
♦ Even if a hearing loss was suspected, negative value judgements were made about the worth of a referral to Audiology.
What needs to be done?
Improved communication between professional groups is important. In our local area we have a multidisciplinary team for Ears and Hearing to raise awareness and share good practice.
It is important to be aware that adults with learning disabilities can have their hearing assessed successfully and can be excellent hearing aid users.
Misconceptions and assumptions should not be a barrier to referral. Improved hearing can change a person’s quality of life dramatically.
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Post by Admin on Jul 7, 2020 12:34:01 GMT
The Learning Disability Specialist Nurse
Written by Sarah Haines
Learning Disability Clinical Nurse Specialist
The learning disability specialist nurse
People with learning disabilities and/or autism can have high health needs which may at times go unrecognised and unmet. This in turn can impact on life expectancy as well as quality of life. It can also mean they are likely to be frequent users of general hospital services.
Evidence suggests that accessing hospital services can be problematic for people with learning disabilities and/or autism. Staff require support to ensure that individual needs are met effectively.
One method of support is specialist nursing input in the form of the learning disability clinical nurse specialist (CNS). Many hospitals now have a learning disability nurse specialist to help support people with learning disabilities and/or autism and their families/carers who may access the hospital for any reason.
The learning disability CNS aims to play a crucial role in raising the profile and status of people who attend the hospital and who have a learning disability and/or autism.
How can the learning disabilities nurse specialist help?
To work directly with patients and their families/carers to assist them with admission to hospital , and to liaise with specialist teams and hospital staff to identify the support required (e.g clinic and pre-operative visits, and co-ordinate discharge planning).
To support and enable acute services to make reasonable adjustments to the way we deliver care for people with learning disabilities and/or autism.
To provide additional support for patients with learning disabilities and/or autism, when they access acute hospital services.
To actively promote the needs and rights of people with learning disabilities and/or autism, including issues of consent, right to treatment and mental capacity.
To raise awareness of the specific health needs of people with learning disabilities and/or autism and provide person centred risk assessments which outline interventions and measures to reduce risks.
To act as an advocate for patients/carers and their families.
To work closely with colleagues in primary care to help patients who are coming in for planned appointments and procedures, preparing them for hospital stay, and making their experience less stressful.
To provide education and training for front-line staff to increase awareness of the needs of patients and learning disabilities and or/autism and how to adapt and plan care for them.
The learning disability nurse specialist can help with the following:
♦ Pre-admission and discharge planning.
♦ Desensitisation planning.
♦ Communication advice.
♦ Service user education.
♦ Carer support and advice.
♦ Liaising with GPs, community teams and relevant organisations.
♦ Capacity and consent advice.
♦ Facilitation of outpatients appointments.
♦ Pre-discharge planning.
♦ Accessible information development.
♦ Advice and support on reasonable adjustments for people with learning disabilities and/or autism when accessing the hospital.
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