Pemilihan Alat Bantu Dengar & Konseling

Presentasi berjudul: "Pemilihan Alat Bantu Dengar & Konseling"— Transcript presentasi:

1 Pemilihan Alat Bantu Dengar & Konseling
PROGRAM REHABILITASI PENDENGARAN PADA PRESBIAKUSIS Pemilihan Alat Bantu Dengar & Konseling Siti Faisa Abiratno JAKARTA

2 Perubahan fungsi secara alami
Usia Perubahan fungsi secara alami Visus Pendengaran Keseimbangan tubuh Peraba Kekuatan otot Penyakit kronis

3 Fungsi pendengaran perifer & sentral
EFEK USIA Fungsi pendengaran perifer & sentral Ambang dengar > << Pemahaman wicara di tempat ramai dan ruangan yang bergema / reverberasi Kecepatan wicara  persepsi << Menentukan lokasi sumber suara <<

4 Gangguan Pendengaran spesifik presbikusis Gangguan dengar :
SNHL - bilateral Menurun di frekuensi tinggi S/N << Progresif Gangguan diskriminasi wicara PHONEMIC REGRESSION Keluhan utama “ Saya mendengar anda berbicara tapi tidak mengerti apa yang anda katakan “

5 Kemampuan diskriminasi kata
PRESBIKUSIS & Kemampuan diskriminasi kata Jenis Presbikusis Presbikusis sensorik % Presbikusis neural % Presbikusis strial atau metabolik % Presbikusis koklear konduktif % Skor Diskriminasi kata Incidens

6 Kondisi Kesehatan Umum Kognitif Hearing Fungsi Listening Penglihatan
Comprehending Retrokoklear Auditorius sentral Communicating Koklear

7 Presbiakusis Hearing Listening
F U n G S I A D T O R Presbiakusis Ambang dengar >> Dynamic range < Spectral processing < Freq.selectivity < DLI > Temporal processing Detection gap > Hearing Listening Comprehending Identifikasi fonem < Mispersepsi : < deteksi diskriminasi identifikasi Communicating Mispersepsi & interpretasi

8 Presbiakusis Hearing Gangguan binaural processing ggn.pend.perifer
T O R Presbiakusis Hearing Gangguan binaural processing ggn.pend.perifer sentral Deteksi sinyal < ruangan : ramai & reverberasi  << Listening Comprehending Communicating Perception in noise << Lokalisasi sumber suara <<

9 Fungsi Penglihatan Hearing Gangguan visus  ggn. petunjuk visual
D T O R Fungsi Penglihatan Hearing Gangguan visus  ggn. petunjuk visual Artikulasi segmental dan suprasegmental Informasi kondisi lingkungan Listening Comprehending Communicating

10 REHABILITASI PENDENGARAN

11 WHO : ETIOLOGY PATHOLOGY IMPAIRMENT DISABILITY HANDICAP RE /
HABILITATION Active limitation DISABILITY Participation restriction HANDICAP

12 Counseling oriented methodology
REHABILITASI AUDIOLOGI Traditional approach Progressive approach Auditory training Speech reading Counseling oriented methodology Evaluation Remediation Alpiner & Stephens SDG ‘93

13 AUDITORY REHABILITATION
REMEDIATION INSTRUMENTAL NON-INSTRUMENTAL COUNSELING HEARING DEVICE ALD BAHA Middle Ear Implant Cochlear Implant H.A

14 EVALUAT ION COMMUNICATION STATUS A ASSOCIATED B VARIABLES C RELATED
AUDITORY VISUAL LANGUAGE MANUAL PREVIOUS REHAB. OVERALL COMMUNICATION STATUS A EVALUAT ION ASSOCIATED VARIABLES B PSYCHOLOGICAL SOCIOLOGICAL VOCATIONAL EDUCATIONAL MOBILITY UPPER LIMB AURAL PATHOLOGY RELATED CONDITIONS C Stephens,DG

15 COMMUNICATIONTRAINING
ACCEPTANCE UNDERSTANDING EXPECTATION ATTITUDE A REMEDIAT ION AMPLIFICATION ALERT/ WARN OTHER SENS AID INSTRUCTION B INSTRUMENTAL GOALS PHILOSOPHY TACTICS STRATEGY C VOCATIONAL EDUCATIONAL SOCIAL WORK MEDICAL ANCILLARY D COMMUNICATIONTRAINING E INFORMATION SKILL BUILD INSTRUMENTAL II COUNSELING Stephens,DG

16 3 PROSES FUNDAMENTAL  USIA
Proses kognitif Sistem pendengaran sentral Sistem pendengaran perifer Koklea

17 Usia Kognitif Memori jangka pendek – panjang Pengambilan keputusan Atensi Kemampuan belajar sesuatu yang baru Waktu reaksi

18 ALAT BANTU DENGAR

19 Instrumentasi dalam program re / habilitasi fungsi pendengaran
Alat Bantu Dengar Vibrotactile BAHA ; implan telinga tengah ; Implan koklea FM, Alat bantu lain : ALD / Assistive Listening Device sfaisa

20 ALAT BANTU DENGAR INPUT AMPLIFIKASI OUTPUT sfaisa

21 Jenis ABD Tipe : Body worn , BTE, ITE, ITC,CIC Monaural / binaural
Karakteristik : gain dan output Circuit Efek background noise sfaisa

22

23 Pemilihan ABD Tipe Circuit : Compression circuit
Compression limiting ( PC ) Whole range syllable compression APV ASP ( automatic signal processing ) Monaural / bilateral ?

24 ABD Monaural / bilateral ? Bilateral Head shadow effect
Bilateral summation Bilateral squelch Sound localization Unilateral Hemisphere lateralization Right ear advantage

25 Meningkatkan kemampuan  lokalisasi sumber suara Binaural summation :
OTAK BINAURAL Meningkatkan kemampuan  lokalisasi sumber suara Binaural summation : Penjumlahan input dari 2 telinga  menghasilkan peningkatan -> 3-6 dB Squelch effect Speech recognition >>  terutama di lingkungan ramai ( Cocktail party effect ) sfaisa

26 FITTING ALAT BANTU DENGAR UNI / BILATERAL ?
GANGGUAN PENDENGARAN BILATERAL FITTING ALAT BANTU DENGAR UNI / BILATERAL ? BINAURAL HEARING sfaisa

27 EFFEK GANGGUAN PENDENGARAN UNILATERAL
Binaural summation : - Squelch effect : - Efek negatif noise : >> Kesulitan : lokalisasi suara Impact head shadow effect : + sfaisa

28 BINAURAL HEARING Telinga membantu mengetahui keadaan disekeliling kita ( fungsi orientasi ) Dua telinga  > membantu mengetahui arah / posisi / lokasi suara Keseimbangan binaural hearing  sangat penting  mengetahui lokasi sumber suara  otak menilai beda waktu ( ITD ) dan beda kekerasan suara ( ILD ) suara yang masuk ke kedua telinga

29 Dua telinga  membantu otak > fokus pada
BINAURAL HEARING Dua telinga  membantu otak > fokus pada satu suara  mengabaikan suara lain yang oleh otak dianggap tidak penting Gangguan pendengaran bilateral  penanganan  bilateral  manfaat binaural hearing sfaisa

30 Two ears are better than one
BINAURAL HEARING HIDUP DI LINGKUNGAN STEREOFONIK sfaisa

31 Assistive Listening Device / ALD

32 “ The brain hears , the ears convey”
ABD Awal program rehabilitasi “ The brain hears , the ears convey”

33 Kunci sukses pemakaian ABD
Orientasi & Konseling Pemahaman masalah pendengaran & peran amplifikasi Penolakan pemakaian ABD Counseling…… is "the most overlooked aspect of the process of fitting amplification" and the "most important professional service an audiologist can provide for patients and their families“ ( Citron 2000)

34 Konseling: Masalah penyebab/ kausa Mengatasi aspek emosional
Memahami masalah telinga dan fungsi pendengaran Peranan amplifikasi sfaisa

35 Kesimpulan

36 Konseling Neural Auditory processing disorder Phonemic regression
PRESBIAKUSIS Sensorik Neural Auditory processing disorder Phonemic regression << rasio S / N Memori: implisit eksplisit Orientasi Konseling REHABILITASI PENDENGARAN

37 REHABILITASI PRESBIAKUSIS
Pendekatan BIOPSIKOSOSIAL Pemahaman masalah gangguan pendengaran & efek gangguan pendengaran Psikologi Metode amplifikasi : ABD, ALD Variabel komunikasi Strategi program rehabilitasi

38 SASARAN REHABILITASI AUDIOLOGI
Komunikasi interaktif Strategi komunikasi Komunikasi di lingkungan keluarga Informasi  anggota keluarga Atasi masalah spesifik  individu

39 Efektifitas Amplifikasi
+ Proces patofisiologi faktor usia  sistema auditorius & non auditorius

40 References : Montgomery,AA: Management of the Hearing-impaired Adult.In: Rehabilitative Audiology : Children and Adults. Alpiner and McCarthy (Ed) 2nd ed pp 2. Kasten,RN : Amplifications for Elderly individuals In : Hearing Aid Assessment and use in Audiologi Rehabilitation. 2nd ed. Hodgson,WR & Skinner,PH ( ed ). Wiiliams & Wilkins. Baltimore pp 3. Stephen,SDG : Adult Audiologial Rehabilitation. M.Sc Course in Audiologial Medicine. University College London 4. McKenna,L. 1987: Goal Planning in Audiologial Rehabilitation. Brit J.Audiol 21 : 5-11 5. Goldstein,DP and Stephens SDG Audiologial Rehabilitation .Audiol 20 :

41 6. McCarthy,PAA : Rehabilitative Considerations with Geriatric Population. In: Rehabilitative Audiology : Children and Adults.2nd ed Alpiner and McCarthy (ed) Williams & Wilkins. pp 7. Hull,RH : Hearing Evaluation of the Elderly. In : Handbook of Clinical Audiology. Katz,J ( ed) 2nd ed Williams & Wilkins USA. Pp 8. Compton,C.L : Assistive Technology for Deaf and Hard of Hearing People. In: Rehabilitative Audiology : Children and Adults. Alpiner and McCarthy (ed).2nd ed Williams & Wilkins USA.pp 9. Montgomery,A.A : Management of the Hearing-impaired Adults.In:Rehabilitative Audiology : Children and Adults. 2nd ed ( Alpiner & McCarthy (ed).pp

42 10.Compton,C.L : Assistive Technology for Deaf and Hard of Hearing People. In: Rehabilitative Audiology : Children and Adults. Alpiner and McCarthy (ed).2nd ed Williams & Wilkins USA.pp 11. Muller,HG and Brimes,AM : Hearing Aid Selection and Assessment. In: Rehabilitative Audiology : Children and Adult. 2nd ed Alpiner JG and McCarthy PA (ed). Williams & Wilkins .Baltimore. pp 284 – 308 12. Sanders,DA.1971: Aural Rehabilitation. Prentice Hall inc. pp 349