Cochlear Implant Connections: Facilitating the Rehabilitation Journey Cochlear implantation is a journey. For late-deafened adults (LDAs), who have a lifetime of social and cognitive experiences as typically hearing individuals, the journey from hearing to losing hearing to regaining auditory function via a cochlear implant (CI) can be especially challenging. It requires professional instruction and support throughout the ... Features
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Features  |   October 01, 2011
Cochlear Implant Connections: Facilitating the Rehabilitation Journey
Author Notes
  • Denise Tucker, PhD, CCC-A, is an associate professor and director of the PhD program in communication sciences and disorders at the University of North Carolina at Greensboro (UNCG). Her research interests include adult aural rehabilitation, cochlear implants, tinnitus and hyperacusis, and brain mapping of auditory evoked responses. Contact her at datucker@uncg.edu.
    Denise Tucker, PhD, CCC-A, is an associate professor and director of the PhD program in communication sciences and disorders at the University of North Carolina at Greensboro (UNCG). Her research interests include adult aural rehabilitation, cochlear implants, tinnitus and hyperacusis, and brain mapping of auditory evoked responses. Contact her at datucker@uncg.edu.×
  • Mary V. Compton, EdD, CCC-SLP, is associate professor of special education at UNCG, and coordinator of its professions in deafness programs. Her research interests include early intervention, adult aural rehabilitation, itinerant teaching, and personnel preparation. She is a member of Special Interest Groups 7, Aural Rehabilitation and Its Instrumentation, and 9, Hearing and Hearing Disorders in Childhood. Contact her at mvcompto@uncg.edu.
    Mary V. Compton, EdD, CCC-SLP, is associate professor of special education at UNCG, and coordinator of its professions in deafness programs. Her research interests include early intervention, adult aural rehabilitation, itinerant teaching, and personnel preparation. She is a member of Special Interest Groups 7, Aural Rehabilitation and Its Instrumentation, and 9, Hearing and Hearing Disorders in Childhood. Contact her at mvcompto@uncg.edu.×
  • Lyn B. Mankoff, MA, CCC-SLP, is associate professor in the School of Health and Human Sciences and the Department of Communication Sciences and Disorders at UNCG. She is a clinical educator and externship coordinator and member of Special Interest Group 11, Administration and Supervision. Contact her at lbmankof@uncg.edu.
    Lyn B. Mankoff, MA, CCC-SLP, is associate professor in the School of Health and Human Sciences and the Department of Communication Sciences and Disorders at UNCG. She is a clinical educator and externship coordinator and member of Special Interest Group 11, Administration and Supervision. Contact her at lbmankof@uncg.edu.×
  • Ola Alsalman, MS, is an international audiology doctoral student at UNCG. Her research interests include brain mapping, tinnitus, and cochlear implants. Contact her at oaalsalm@uncg.edu.
    Ola Alsalman, MS, is an international audiology doctoral student at UNCG. Her research interests include brain mapping, tinnitus, and cochlear implants. Contact her at oaalsalm@uncg.edu.×
Article Information
Hearing Aids, Cochlear Implants & Assistive Technology / Features
Features   |   October 01, 2011
Cochlear Implant Connections: Facilitating the Rehabilitation Journey
The ASHA Leader, October 2011, Vol. 16, 24-27. doi:10.1044/leader.FTR4.16122011.24
The ASHA Leader, October 2011, Vol. 16, 24-27. doi:10.1044/leader.FTR4.16122011.24
Cochlear implantation is a journey. For late-deafened adults (LDAs), who have a lifetime of social and cognitive experiences as typically hearing individuals, the journey from hearing to losing hearing to regaining auditory function via a cochlear implant (CI) can be especially challenging. It requires professional instruction and support throughout the audiologic rehabilitation (AR) process. The current standard of care for LDAs with CIs focuses primarily on sensory management, in which audiologists, speech-language pathologists, and physicians work to optimize clients’ listening and communication skills by mapping of the external speech processor, based on the results of speech perception testing.
However, sensory management alone is not sufficient to facilitate the CI journey. To ensure LDAs’ satisfaction and success with CIs, the development of self-efficacy (a person’s belief in his or her abilities to obtain a goal or deal successfully with a challenging life situation) and the improvement of quality of life are critical. The journey, therefore, must encompass a process to support clients’ active engagement in their rehabilitation based on client-centered, holistic health care practices.
Current AR models shift emphasis from a medical model, focused on speech perception, to a framework for applying principles of biopsychosocial theories and ecological practices. Many researchers advocate a holistic approach in adult AR that goes beyond sensory management. For example, Bandura (2004) highlights the client’s development of self-efficacy in the medical/rehabilitation process. Erdman (2009a) outlines the role of the clinician’s empathetic understanding during the AR counseling process. Boothroyd (2007) recommends a social-cognitive AR program that includes the areas of instruction, perceptual training, and support/counseling. Gagné and Jennings (2010) organize the AR process by involving clients, clinicians, and significant others in setting goals. There is a critical need for adult AR services that address both listening and biopsychosocial aspects of the AR process. Such a holistic approach to AR services will facilitate LDAs’ journeys to successful use of an electronic biomedical device in their everyday lives.
Mapping the Journey
The University of North Carolina at Greensboro (UNCG) implemented Cochlear Implant Connections (CIC), a multi-disciplinary, biopsychosocial AR group treatment program for LDAs with cochlear implants. This ongoing, research-based program emphasizes goal-setting, group support, sensory management, instruction, perceptual training, and psychosocial counseling. CIC seeks to provide the social-cognitive intervention necessary to promote a high degree of self-efficacy as LDAs learn to use their CIs to manage social communication challenges.
In the initial planning for Cochlear Implant Connections, we adapted a model from social work—the Dennison model (Dennison, 2005, 2008)—as a social-cognitive organizational schema, in conjunction with Boothroyd’s 2007 AR framework (see Figure 1 [PDF]). The Dennison model (DM) integrates components of Yalom’s psychotherapeutic group process model (Yalom, 1995) with a social-cognitive behavioral model used in social work (Rose, 1990). DM encompasses the group process by empowering members to reflect, shape, and direct group-determined goals and problem-solving discussions. In this model, the clinician becomes a facilitator rather than a director.
DM incorporates three phases:
  • Initial phase for building relationships and trust among members.

  • Treatment phase for gaining awareness of problems and exploring possible solutions.

  • Process phasefor acknowledging and reflecting progress and identifying additional resources to support continued progress.

The DM structure provides group members with collaborative opportunities in a supportive environment. They share common experiences and concerns as they discuss strategies to enhance self-management of their specific life and/or health challenges (Dennison, 2008).
As CIC evolved, a logic-model framework provided a conceptual road map for program planning, evaluation, and accountability. Logic modeling helped UNCG researchers conceptualize how CIC activities facilitate clients’ change and the processes by which those changes unfold (Julian, 1997; WK Kellogg Foundation, 2006) The CIC Logic Model (see Figure 2 [PDF]) delineates the inputs (current situation and resources available), outputs (planned activities, personnel), and outcomes (short- and long-term) that constitute the CIC program and displays the overall goal of CIC: to increase LDAs’ successful use of their CIs in their daily lives.
Components of the CIC Logic Model
The left side of the model displays the current life and listening situations and challenges of CI clients. The inputs and outputs of the CIC program are shown in the center columns. Outputs are segmented into AR activities and the personnel who collaborate with clients in these activities.
The short- and long-term outcomes of the CIC program are presented on the right. Short-term outcomes are divided into knowledge and skills/experiences. Through facilitated instruction, CIC clients learn about their hearing loss (disorders) and how the auditory system gradually adapts to the implant stimulation (neuroplasticity). Equal emphasis is given to facilitating clients’ development of self-efficacy with their hearing loss and CI use through shared discussions of communication strategies and common listening challenges, and facilitated conversations on the emotional and social impact of the CI journey.
Underlying the CIC Logic Model is the assumption that LDAs with CIs are motivated to participate in weekly group AR therapy sessions. External factors such as competing interests (e.g., family events), other health problems, technical problems with the CI, and transportation problems are possible mitigating factors to clients’ participation.
Observations
The CIC Logic Model emphasizes that the CI journey is a collaborative venture between clinician and client as well a collaboration among CI clients. New CI users come to the journey with high expectations, high anxiety, and many unanswered questions about their hearing loss and new biomedical devices. Novice and experienced users struggle with post-surgery feelings of isolation, anger, and frustration. During facilitated group discussions, clients discover common challenges and share concerns, support, and resources. These conversations help clients bond and normalize their own personal CI experiences. Group discussions can provide biopsychosocial support and client empowerment during the ongoing CI journey.
In the implementation of CIC, we observed that LDAs are highly motivated to participate in weekly hour-long sessions. Based on clients’ requests, the weekly CIC sessions were expanded to 90 minutes. Many clients prefer daytime sessions because they do not like driving at night.
External factors regarding battery use and speech processor mappings have surfaced during CIC sessions. CI batteries have died during a group session. Consequently, clients are instructed to bring additional charged batteries to CIC meetings. CIC clients—new and veteran CI users—need ongoing (multiple) external speech processor mappings during the course of the AR program, reflecting their expanding adaptation to the device. In recognition of the continual changes in neuroplasticity within the auditory system over time, CIC is specifically designed to provide clients with long-term (one year or more) biopsychosocial support after CI surgery. CIC faculty must work closely with the dispensing audiologist throughout the AR process. Such professional collaboration involves ongoing communication about clients’ progress and need for additional mappings.
The Road Ahead
Speech perception test results alone are insufficient as a CI outcome measure. Measures of quality of life, self-efficacy, and hopefulness should be implemented routinely with these clients. As speech, language, and hearing health care professionals, we must be prepared to work with our CI clients over time to ensure that they reach their highest potential in the effective use of their devices. The CIC program is one example of a holistic, biopsychosocial approach to group AR treatment that can help clients attain greater self-efficacy, communication, and quality of life.
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October 2011
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