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PROGRAM REHABILITASI

PENDENGARAN PADA
PRESBIAKUSIS
Pemilihan Alat Bantu Dengar & Konseling

Siti Faisa Abiratno


JAKARTA

Usia
Perubahan fungsi secara alami

Visus

Pendengaran
Keseimbangan tubuh
Peraba
Kekuatan otot
Penyakit kronis

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

PRESBIKUSIS
&
Kemampuan diskriminasi kata

Presbikusis
Presbikusis sensorik

Presbikusis neural
Presbikusis strial atau
metabolik
Presbikusis koklear
Incidens konduktif

Skor
Jenis
Diskriminasi kata
56%
36%
80%
72%

Kondisi
F
U
N
G
S
I
A
U
D
I
T
O
R
I
U
S

Kesehatan
Umum
Hearing
Listening
Comprehending

Kognitif
Fungsi
Penglihatan
Retrokoklear
Auditorius sentral

Communicating
Koklear

F
U
n
G
S
I
A
U
D
I
T
O
R
I
U
S

Presbiakusis

Hearing
Listening
Comprehending
Communicating

Ambang dengar >>


Dynamic range <
Spectral processing <
Freq.selectivity <
DLI >
Temporal processing
Detection gap >
Identifikasi fonem <
Mispersepsi : <
deteksi
diskriminasi
identifikasi
Mispersepsi & interpretasi

F
U
n
G
S
I
A
U
D
I
T
O
R
I
U
S

Presbiakusis
Hearing
Listening
Comprehending
Communicating

Gangguan binaural
processing
ggn.pend.perifer
sentral
Deteksi sinyal <
ruangan : ramai &
reverberasi <<
Perception in noise <<
Lokalisasi sumber
suara <<

F
U
n
G
S
I
A
U
D
I
T
O
R
I
U
S

Fungsi
Penglihatan
Hearing
Listening

Gangguan visus
ggn. petunjuk visual
Artikulasi segmental

Comprehending
Communicating

dan suprasegmental
Informasi kondisi
lingkungan

REHABILITASI
PENDENGARAN

WHO :

ETIOLOGY
PATHOLOGY
IMPAIRMENT

Active limitation

Participation
restriction

DISABILITY
HANDICAP

RE /
HABILITATION

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

HEARING DEVICE

COUNSELING

H.A

ALD

BAHA

Middle Ear
Implant

Cochlear
Implant

COMMUNICATION
STATUS

E
V
A
L
U B ASSOCIATED
VARIABLES
A
T
I
O C
N

RELATED
CONDITIONS
Stephens,DG

1
2
3
4
5
6
1.
2.
3.
4.

AUDITORY
VISUAL
LANGUAGE
MANUAL
PREVIOUS REHAB.
OVERALL
PSYCHOLOGICAL
SOCIOLOGICAL
VOCATIONAL
EDUCATIONAL

1. MOBILITY
2. UPPER LIMB
3. AURAL PATHOLOGY

R
E
M
E
DI
A
T
I
O
N

ATTITUDE

INSTRUMENTAL

STRATEGY

ANCILLARY

COMMUNICATION
TRAINING
Stephens,DG

1
2
3

ACCEPTANCE
UNDERSTANDING
EXPECTATION

1.
2.
3.
4.

AMPLIFICATION
ALERT/ WARN
OTHER SENS AID
INSTRUCTION

1
2
3

GOALS
PHILOSOPHY
TACTICS

1
2
3
4

VOCATIONAL
EDUCATIONAL
SOCIAL WORK
MEDICAL

1
2
3
4

INFORMATION
SKILL BUILD
INSTRUMENTAL II
COUNSELING

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

BINAURAL

OTAK

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

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

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

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

Kesimp
ulan

PRESBIAKUSIS
Sensorik

Neural
Auditory processing disorder
Phonemic regression
<< rasio S / N
Memori:
implisit
eksplisit
REHABILITASI
PENDENGARAN

Orientasi

Konseling

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
o Strategi komunikasi
Komunikasi di lingkungan
keluarga
o Informasi anggota keluarga
o Atasi masalah spesifik individu

Efektifitas
Amplifikasi

Proces patofisiologi faktor usia


sistema auditorius & non auditorius

1.
2.

3.
4.
5.

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
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
Stephen,SDG : Adult Audiologial Rehabilitation. M.Sc
Course in Audiologial Medicine. University College
London 1989-1990
McKenna,L. 1987: Goal Planning in Audiologial
Rehabilitation. Brit J.Audiol 21 : 5-11
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