IHS Patient Counseling and Rehabilitation 3 — Questions and Answers
Question 1: Which of the following is an example of a 'repair strategy' used in communication rehabilitation?
- Asking a speaker to slow down or rephrase after a misunderstanding (Correct answer)
- Positioning oneself to optimize visual cues before a conversation begins
- Choosing a quiet environment for important discussions
- Turning up hearing aid volume proactively
Correct answer: Asking a speaker to slow down or rephrase after a misunderstanding
Repair strategies are reactive—they are used after a communication breakdown has already occurred to restore understanding.
Question 2: A patient in their first week of hearing aid use reports that background noise sounds 'overwhelming.' The counselor's BEST response is to:
- Immediately reduce the hearing aid gain
- Explain that the brain requires an acclimatization period to relearn how to process amplified sounds (Correct answer)
- Switch the patient to a different hearing aid brand
- Refer the patient back to the audiologist for new testing
Correct answer: Explain that the brain requires an acclimatization period to relearn how to process amplified sounds
Auditory acclimatization typically takes weeks to months; normalizing this experience reduces patient anxiety and improves adherence.
Question 3: The COSI (Client Oriented Scale of Improvement) is used in rehabilitation to:
- Measure word recognition scores in quiet
- Identify patient-specific listening goals and track outcomes over time (Correct answer)
- Determine candidacy for cochlear implant
- Calculate the speech intelligibility index
Correct answer: Identify patient-specific listening goals and track outcomes over time
The COSI is a patient-centered outcome measure where individuals nominate their own goals and rate improvement after intervention.
Question 4: When discussing realistic expectations with a new hearing aid user, the clinician should emphasize that hearing aids:
- Restore hearing to normal levels in all environments
- Improve hearing but cannot fully replicate normal auditory function (Correct answer)
- Eliminate the need for communication strategies
- Work best without any adjustments after fitting
Correct answer: Improve hearing but cannot fully replicate normal auditory function
Setting realistic expectations reduces disappointment and improves long-term satisfaction and adherence to hearing aid use.
Question 5: A spouse accompanies a hearing-impaired patient to a counseling session and frequently answers questions directed at the patient. The clinician should:
- Allow the spouse to continue as it saves time
- Gently redirect questions to the patient to preserve their autonomy (Correct answer)
- Ask the spouse to leave the session
- Document the behavior and take no action
Correct answer: Gently redirect questions to the patient to preserve their autonomy
Preserving patient autonomy is a core ethical principle; the clinician should facilitate direct communication while acknowledging the spouse's supportive role.
Question 6: Which environmental modification is MOST effective for improving speech understanding for a person with hearing loss at home?
- Painting walls a lighter color
- Adding soft furnishings like rugs and curtains to reduce reverberation (Correct answer)
- Installing brighter lighting
- Increasing room temperature
Correct answer: Adding soft furnishings like rugs and curtains to reduce reverberation
Soft furnishings absorb sound reflections, reducing reverberation time and improving speech clarity for people with hearing loss.
Question 7: What is the recommended counseling approach for a patient who is in the 'pre-contemplation' stage of readiness to change regarding hearing aid use?
- Immediately fit hearing aids and schedule follow-up
- Raise awareness of the impact of hearing loss without pressuring action (Correct answer)
- Refer for psychological evaluation
- Discharge the patient and reappoint in six months
Correct answer: Raise awareness of the impact of hearing loss without pressuring action
In pre-contemplation, patients are not yet aware of or concerned about their problem; motivational interviewing techniques raise awareness without creating resistance.
IHS Patient Counseling and Rehabilitation 3
Which of the following is an example of a 'repair strategy' used in communication rehabilitation?