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

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

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 <<

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 “

Kemampuan diskriminasi kata PRESBIKUSIS & Kemampuan diskriminasi kata Jenis Presbikusis Presbikusis sensorik 56% Presbikusis neural 36% Presbikusis strial atau metabolik 80% Presbikusis koklear konduktif 72% Skor Diskriminasi kata Incidens

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

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

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 <<

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

REHABILITASI PENDENGARAN

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

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

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

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

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

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

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

ALAT BANTU DENGAR

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

ALAT BANTU DENGAR INPUT AMPLIFIKASI OUTPUT sfaisa

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

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

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

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

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

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

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

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

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

Assistive Listening Device / ALD

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

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)

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

Kesimpulan

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

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

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

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

References : Montgomery,AA: Management of the Hearing-impaired Adult.In: Rehabilitative Audiology : Children and Adults. Alpiner and McCarthy (Ed) 2nd ed. 1993 . pp 311-327 2. Kasten,RN : Amplifications for Elderly individuals. 1981. In : Hearing Aid Assessment and use in Audiologi Rehabilitation. 2nd ed. Hodgson,WR & Skinner,PH ( ed ). Wiiliams & Wilkins. Baltimore pp 226-233 3. Stephen,SDG : Adult Audiologial Rehabilitation. M.Sc Course in Audiologial Medicine. University College London 1989-1990 4. McKenna,L. 1987: Goal Planning in Audiologial Rehabilitation. Brit J.Audiol 21 : 5-11 5. Goldstein,DP and Stephens SDG .1981. Audiologial Rehabilitation .Audiol 20 : 432-452

6. McCarthy,PAA : Rehabilitative Considerations with Geriatric Population. In: Rehabilitative Audiology : Children and Adults.2nd ed. 1993. Alpiner and McCarthy (ed) Williams & Wilkins. pp 331-357 7. Hull,RH : Hearing Evaluation of the Elderly. In : Handbook of Clinical Audiology. Katz,J ( ed) 2nd ed. 1978. Williams & Wilkins USA. Pp 426-441 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. 1993. Williams & Wilkins USA.pp 441- 468 9. Montgomery,A.A : Management of the Hearing-impaired Adults.In:Rehabilitative Audiology : Children and Adults. 2nd ed .1993 ( Alpiner & McCarthy (ed).pp 311- 327

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. 1993. Williams & Wilkins USA.pp 441- 468 11. Muller,HG and Brimes,AM : Hearing Aid Selection and Assessment. In: Rehabilitative Audiology : Children and Adult. 2nd ed. 1993. Alpiner JG and McCarthy PA (ed). Williams & Wilkins .Baltimore. pp 284 – 308 12. Sanders,DA.1971: Aural Rehabilitation. Prentice Hall inc. pp 349