Jean-Pierre Gagné

In order to limit the spread of the coronavirus, several protective measures have been put in place in the community, in private and public residences and in health care centers. Some measures have a negative impact on communication. They include physical distancing, the use of face masks and shields as well as the increased use of telephone and videoconferencing for distance communication. The effects of COVID-19 are particularly harsh on older adults. Consequently, older adults, especially those with hearing loss, are particularly at risk of experiencing communication breakdowns and increased social isolation. Health care professionals should learn about and be encouraged to use communication strategies to maintain good interactions with their patients. This article proposes practical suggestions to health professionals who interact with older adults, especially those who have difficulty understanding speech. The goal of this article is to inform on the prevalence of hearing loss, the hearing difficulties experienced by older adults, the manifestations of hearing problems, the effects of pandemic protection measures on communication and the strategies that can be used to optimize professional-patient communication during a pandemic.

Changes in several domains over the last decade have had a profound effect on how we conceive, organize, provide, and evaluate audiologic rehabilitation (AR) services. Tremendous advances in hearing instrument technologies have made it possible to include digital components of amplification systems in commercial devices that are readily accessible to individuals with hearing loss. Notwithstanding these developments, the hearing aid industry is very aware that services provided to people with hearing loss must extend beyond the fitting of amplification systems. Hearing aid fitting must be accompanied by patient education, counseling, and other non-technological AR services.

A program designed to evaluate the benefits of an audiovisual–frequency modulated (FM) system led to some questions concerning the effects of illumination level and a talker’s skin color on speech-reading performance. To address those issues, the speech of a Caucasian female was videotaped under 2 conditions: a light skin color condition and a dark skin color condition. For the latter condition, makeup was applied to the talker’s face. For both skin color conditions, the talker was recorded while speaking sentences under 7 different levels of illumination: 2, 3, 4, 16, 60, 256, and 600 footcandles (fc). Fifteen participants completed the speech perception task in a visual-only modality. The results revealed a significant interaction of illumination level and skin color. For the light skin color condition, speech-reading performance improved systematically as the illumination level increased from 3 to 16 fc. For the dark skin color condition, no differences in speech-reading performance were observed between the 2-fc and the 3-fc conditions. However, a large improvement in speech-reading performance was observed as the illumination level increased from 4 fc to 16 fc. It is speculated that in addition to an overall effect of illumination level, the contrast in luminance at the level of the talker’s face has an effect on speech-reading performance.

A research program was undertaken to evaluate the efficacy of an audiovisual-FM system as a speechreading aid. The present study investigated the effects of the distance between the talker and the speechreader on a visual-speech perception task. Sentences were recorded simultaneously with a conventional Hi8 mm video camera, and with the microcamera of an audiovisual-FM system. The recordings were obtained from two talkers at three different distances: 1.83 m, 3.66 m, and 7.32 m. Sixteen subjects completed a visual-keyword recognition task. The main results of the investigation were as follows:

In this article we describe the AudiSee system, an audiovisual-FM system designed primarily for use in classroom settings. First, the rationale underlying the development of AudiSee is discussed. Then, the components of the audiovisual-FM system are described. Finally, an experiment designed to evaluate the effects of visual background distractions on speechreading performance using AudiSee is presented. Three aspects of visual background distractions were investigated: (1) the orientation of AudiSee's mini-camera and a video monitor (portrait vs. landscape), (2) the nature of the visual backdrop (neutral/non-obtrusive vs. colorful/distracting), and (3) the magnitude of head movements made by the speaker while producing the test stimuli (none, moderate, and large amounts of head movement). Twenty sentences were recorded under each of the 12 experimental conditions (2 orientations × 2 visual backdrops × 3 head movement conditions). Fourteen subjects completed a closed-set sentence recognition task in a visual-alone modality (speechreading). The results failed to reveal any differences among the 12 experimental conditions investigated. These findings suggest that the visual background distractions recorded by AudiSee's mini-camera do not interfere with speechreading performance.

Changes in service delivery triggered by current conceptualizations of rehabilitation require an accompanying paradigm shift in the approaches used to evaluate the effectiveness of intervention programs in audiological rehabilitation. The present article outlines three fundamental principles of contemporary rehabilitative audiology that have implications concerning the way that audiological rehabilitation services should be conceived and dispensed, as well as the way in which comprehensive evaluative research investigations should be designed and conducted. Traditional treatment efficacy paradigms used to assess the effectiveness of intervention programs in rehabilitative audiology are critiqued. Finally, factors that should guide the development of comprehensive evaluative research paradigms which are consistent with current models of intervention in audiological rehabilitation are outlined.