Michelle: Great. Thanks everyone for joining us for this course today. Our focus will be sensory technologies in the context of preparing for the RESNA Assistive Technology Professional Examination. In this course, we will be covering people who are hard of hearing or who have no hearing, and technologies that can be helpful to accommodate for those impairments. We will then be discussing people who have low vision or no vision, or at least no functional vision, and technologies that can be helpful for them. Finally, we will touch on deaf and blind technologies. This is part of a series of courses designed to prepare the participant for the ATP certification.
Assistive Technology Professional (ATP) Certification
The ATP certification, or Assistive Technology Professional, is offered through RESNA. RESNA is the Rehabilitation Engineering and Assistive Technology Society of North America. It is the largest professional organization that is dedicated to assistive technology. The ATP is designed to demonstrate a basic level of competence in the general practice area of assistive technology. Right now, over 4,000 people hold this certification. This series is designed to include information to help prepare the candidate for the exam, but there are other prerequisites as well, and certainly other ways of preparing.
For occupational therapy practitioners with either a bachelor's or a master's degree, 1,000 hours of work experience is required over a six year period of time. The link to the website above provides further information about those prerequisites.
Many clients who use assistive technology have multiple impairments; motor, cognitive, and/or sensory impairments. The assistive technology professional has to address all of these needs when providing interventions. Clients who solely have a sensory impairment are typically seen by professionals who are very specialized in this area. It is important to identify those resources in your area. For example, I might see a child with cerebral palsy. This child may have motor limitations, secondary to that diagnosis. That client may also have some cognitive limitations. Additionally this child could have a cortical visual impairment, a very common visual concern in people with that diagnosis. I need to keep all of that in mind when I am providing interventions such as powered mobility or a communication device. However, if I am working with a client who only has visual issues, particularly a client who is blind, then I will refer them to someone who is specialized in that area. I have my ATP, but this is not an area that I specialize in as it is very specialized. Sometimes these services are even available through the manufacturers of some of this equipment. Many of those children are going to already be affiliated with programs, such as a specialized school. Over the years, children with disabilities have become more and more integrated into the classroom. One area where this is not always the case is children who have no vision, no hearing, or a combination of the two. Those students often go to a very specialized school because it requires a certain level of expertise. Our goal today is to know enough to be helpful to our clients who have multiple impairments and be aware of some of the technologies out there. Additionally we need to know when it is appropriate to refer a client. Let's begin with hearing.
Now, there are various terms you might hear in the arena of hearing. First, you use the term hearing impaired. Hearing impaired describes any degree of hearing loss. This term may be deemed offensive to people who are hard of hearing or deaf. Typically the preferred term is hard of hearing. When working with clients who have hearing impairments, it is appropriate to use this term, hard of hearing. Hard of hearing, technically, refers to people who have mild to moderate hearing loss, whereas deafness refers to very little or no functional hearing whatsoever. This is a unique area of intervention because it can involve a lot of our mainstream population. This is a little easier for us to relate to, because almost all of us know someone who has some hearing loss. Just about every single one of us, as we age, will lose some of our hearing. Many of these interventions and devices will seem familiar.
Types of Hearing Loss
There are different types of hearing loss. This is important to know both for the ATP exam and just when working with clients. There is conductive hearing loss, sensorineural hearing loss, and then some clients have a mixture of each of these.
Conductive. In the ear, we have an outer ear canal, that tube, and then we have the eardrum itself. On the opposite side of the eardrum, we have the middle ear. In the middle ear, we have little bones called the "ossicles" that vibrate and transmit sound waves to our brain through nerves, where it it then interpreted. With conductive hearing losses, sound is not conducted efficiently through that outer ear canal to the eardrum and to those ossicles. Functionally, the ability to hear sound is reduced in terms of volume. It might seem that the volume has been turned down, and that can affect one's ability to hear more faint, quieter sounds. Conductive hearing loss can often be corrected, either medically or surgically.
Sensorineural. Whereas in sensorineural hearing loss, there is actual damage to the inner ear, the cochlea, or to the nerves that lead from the inner ear to the brain. In conductive hearing loss, we have more of an external problem conducting sound through the ear canal to the middle ear. In sensorineural, we have more of an inner ear, or nerve to brain problem. This is the most common type of permanent hearing loss. It reduces the ability to hear faint sounds, like conductive hearing loss, but sometimes, with this particular type of hearing loss, even if the volume is turned up, it might sound unclear or muffled.
When we hear things, there are both volume and clarity issues. This is a challenge with this type of hearing loss. And again, we might see clients who have some of each of these issues.
Goals of Hearing Technologies
If someone is having difficulty hearing, it is important that they are able to communicate with people around them. It is also important that they can access information. We rely on our hearing to do both of these things. A lot of the information we receive is auditory.
Hearing aids either fit inside or over the ear, and their primary function is to make everything louder or to amplify that sound.
Figure 1. Hearing aids.
If someone has a conductive hearing loss, where everything seems to just be too quiet, this turns up that sound. There is an additional feature on many hearing aids, which makes them quite complex, called an "electroacoustic" system. This transforms all of these sounds in our environment to make them more intelligible or comfortable. This is called sound processing.
As an occupational therapist, I need to be aware that if someone is hard of hearing and strategies that can help them to with their activities of daily living. Hearing aids can help someone to participate and socialize more, and to be safer. I am certainly not going to prescribe that hearing aid. An audiologist is going to do a very thorough hearing evaluation, and then determine the best type of hearing aid for that individual. Again depending on the type of hearing aid, it can make things louder, filter out background noise, and also process sound so that it is more clear.