The Importance of Aural (Auditory) Rehabilitation

While searching online, I found a really interesting article about the importance of aural (auditory) rehabilitation for adults with Cochlear Implants. I think that the topics and ideas presented in this article can be important for rehabilitation after any implant. The article is titled Making a Sound Connection: Rehabilitation for Adults with Cochlear Implants, was written by Mary Koch, MA, CED, and can be found on pg 6 of the following link: http://hearingjourney.com/userfiles/File/BionicBeat_Vol3Iss1_2006_1.pdf

What I found particularly interesting about this article is that we do not actually hear with our ears, we hear with our brains. [info from the rest of this paragraph did not come from this article. this was written by me based off my understanding of how we hear and how hearing loss affects the ear. i hope that it is portrayed accurately (in easy to understand laymen terms) but please refer to the professionals for more detailed information about these topics.] This actually makes sense when you think about how we hear. Sound enters our ears and the frequencies of sound are transformed into electrical signals as they pass through the middle ear to the Cochlea. The Cochlea stimulates thousands of tiny hair-like cells which send electrical signals to the brain to be interpreted. This is where our ability to understand what is being spoken comes into play. For most individuals with sensorineural hearing loss (like myself), the hair-like cells and/or parts of the Cochlea have been damaged which then affects how sound signals are converted into electrical signals and sent to brain. What is great about the Envoy Esteem Implant is that it, in theory, bypasses the damaged parts (i.e., Cochlea and hair like cells) and instead transforms and processes electrical signals through the Esteem processor. Each individuals processor is programed to meet the specific needs of each recipient based on their level of hearing loss. These "altered" and "improved" electrical signals are then send back through the system and to the brain for interpretation. 

As stated in this article, one of the biggest misconceptions of receiving a hearing implants is that the understanding piece of the puzzle will come immediately as we gain more sound and volume. However, while we can hear sound better because of the implant, our brain does not always immediately make sense of these signals right away. Additionally, this article also mentioned that the longer a person is hard or hearing, the more challenging it can be for them to be able to recall and form meaning of sound. In order to bring this understanding piece into play, we must form new auditory pathways as well as the memory skill to be able to retain the sounds. The purpose of Aural (auditory) therapy is to imprint this information in our brain so that these connections can be built more rapidly leading to greater success with the device.

The article also presents Norman Erber’s Heirarchy of Auditory Skill Development, which is essentially the process in which our brain learns to understand.

• The first step in the process is Detection. This is the stage in which we become aware of our capacity to hear, as detected through an audiogram.
• The second step is Discrimination. This is our ability to differentiate between the sounds that we are hearing. This is actually what I am currently practicing through my therapy. 
• The third step is Identification. By going through the sound discrimination exercises, we are essentially imprinting our auditory memory with these sounds so that we are able to recognize and start putting meaning to these sounds.
• The fourth and final step is Comprehension. This is our ability to hear by simply listening and at this level we are finally able to fully engage in conversation. 

These are just a few of the interesting things I found throughout this article. This article also provides some resources for getting yourself started on the aural rehabilitation track (and how those around you can help). Also, I have been exploring websites that provide free online practice tools so will be posting those soon for those who are interested.