Most adult CI centers in the United States do not incorporate clinician‐guided AT, likely as a result of poor reimbursement for audiologists for AT services, and a paucity of SLPs with education in AT methods, and even more specifically education in AT for adults with hearing loss. Equally importantly, SLPs are specifically skilled in training approaches and facilitating learning across a variety of communication impairments. In contrast, SLP rehabilitation services are reimbursable, and their services are typically covered by Medicare, Medicare Advantage, and commercial payors. As a result, they are technically not able to deliver and bill for therapeutic CAR services. This clinician is rarely an audiologist in this country: currently the Centers for Medicare and Medicaid Services (CMS) program views audiologists as diagnosticians. In the United States, the third clinician can be an audiologist or a speech‐language pathologist (SLP). This model emphasizes a comprehensive and collaborative approach among surgeons, audiologists, and clinicians who guide AT. : (1) Sensory management (2) Instruction (3) Counseling and (4) Perceptual training or AT. The concept of a CAR approach for adults is not in itself novel,Īnd addresses four main components, outlined by Boothroyd We propose that a comprehensive auditory rehabilitation (CAR) approach incorporating sensory management, instruction, counseling, and clinician‐guided auditory training (AT) maximizes the opportunity to optimize speech recognition and quality of life (QOL) outcomes for adult CI users. Moreover, additional factors like patient motivation, device competence, and psychosocial function may be additional targets for intervention. Some of which can be attributed to patient‐related factors (eg, residual hearing)Īdditionally, neurocognitive functions, such as verbal learning, working memory, and inhibitory control, relate to outcomes.Įvidence for the efficacy of auditory rehabilitation on both auditory processing and neurocognitive functions continues to grow. However, broad outcome variability persists on measures of speech recognition, ![]() ![]() For adults with moderate‐to‐profound sensorineural hearing loss, a cochlear implant (CI) restores auditory input.
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