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Coping Strategies |
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by Garth Brears, M.S., Aud(C) Clinical Audiologist,
Beverly Ortega, M.A., Clinical Audiologist
Coping strategies are at the heart of why most hearing impaired people think they can still hear sounds, particularly when it comes to understanding people talking directly in front of them in a quiet room. In most cases, these skills or strategies are learned slowly because hearing loss develops slowly for most. There are limitations but generally speaking, people maintain their understanding ability and it is through mechanisms that they are barely aware of, at least initially.
Watching someone's face is perhaps the most obvious strategy. If a speaker appears disappointed when speaking, this becomes valuable information as to where the conversation in going. Also, it is true that as hearing deteriorates, the hearing impaired individual may not just look at the face for expression but also the lips for even more detailed information. Lips can give away the sound that they are expressing. Look in the mirror and say "ship" and then "sip". Notice the difference. See how the "sh" in the word "ship" had your lips reaching while the "s" in "sip" had your lips going backwards.
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Situational context is a major helping mechanism if you cannot hear. If a hearing impaired person has some inkling as to what is being said, the ability to follow the conversation is much improved. This is why reading an agenda prior to a meeting can often help hearing-impaired people "understand" during the meeting. I have met many people over the years that claim they can hear at some meeting or occasion while not at all at other occasions. Knowing the context of a future interaction is vital when you are hearing-impaired. Individuals with hearing loss need to figure speakers out rather than just hear them. This means many times they do not actually understand as quickly as someone whom actually hears the speaker. By getting information ahead of time, whether by reading an agenda or thinking about what is most likely to be talked about when entering a conversation, the hearing impaired individual is skillfully cheating his way to understanding. It is a great coping strategy and once you realize you're doing it, you should practice it in your consciousness. For example, before the sermon begins, get briefed quickly by your Pasteur as to what he will be talking about during the church session.
Another form of context is the actual words people use in sentences. Hearing impaired people learn to hate when others speak in only one word utterances. Bank tellers that look down and say the word 'fifty" are very difficult for hard of hearing people. There is no context with a one word utterance. On the other hand, full sentences provide much more context. Here's a visual explanation of the way a hearing impaired person needs many words to understand.
"_im_?" .this is difficult to understand to say the least, the sentence contains one word and very little auditory information. There is absolutely no context to work it out.
Now what if we said the same thing with more words. "Can _u_ g_v_ _e th_ _im_?"
As you are seeing what a hearing impaired person needs to hear, imagine if you could see the speaker pointing at his wrist when he asks the question. At that point, it would be very easy to understand and still have a significant hearing loss to what was actually said. This is what it is to cope a hearing loss. Hearing impaired people borrow from all their senses, including intuition as to what is likely is being talked about.
Closing the gap between speaker and listener is a great strategy to use when you cannot hear all the speech sounds in a speakers voice. That may mean moving from the back of the hall to the front of the hall. It may mean moving from the outer fringe of a person's personal space to the inner fringe of their personal space. It may mean, turning the head to make use of the better ear. In all cases, closing the gap between speaker and listener not only enhances (makes louder) what they could already hear, but more importantly, it may be the difference of picking up a new sound that would not have been possible from a distance. It is these new sounds, that can be heard at these closer distances that can ultimately push the hearing impaired listener to the desired end result, which is "understanding". New sounds at closer distances could be seen as the same thing as more words in a sentence, ultimately it is that extra wafer of brain information that pushes the hearing impaired listener over the edge toward "understanding".
Where possible, carrying on conversations in quiet places is extremely important to the hearing impaired. This is a technique that needs to be practiced. It is so obvious but, from my perspective, often not done. Noise quickly drains the concentration needed to continue to understand a speaker. Once the concentration is broken, lack of understanding is sure to follow. I think of it as this, concentration level is like gasoline level. We have so much in the tank. If we carry conversations on in noise all day, we will drain our ability to concentrate. And it is our ability to concentrate that is the foundation of "understanding". My view is that people that have hearing impairment have lower levels of gas in the tanks to start with. I think this way because from the time they get out of bed, every conversation, whether held in noise or in quiet utilizes vital concentration energy. Therefore there is only so much reserve and this needs to be used effectively and conservatively. If people with hearing impairments and those that they communicate with all day would take the time to turn off distraction before communicating, I believe it would bear fruit. First the hearing impaired person would find the communication much simpler because they are not taxing their coping mechanisms. And second, it will provide for that needed mental reserve for later in the day. The person that thinks they hear better in the morning than in the evening could really benefit from this suggestion. I am convinced that people deplete this valuable mental resource needlessly by communicating in noise when they do not have to. Shutting off the radio earlier in the day may make the difference of understanding in a group later that night. Use your concentration energy up wisely.
Ultimately, it comes down to how well those with hearing impairment use all the above techniques that determines how well they "understand" in conversations.
Additionally, I have also observed a technique that very few display, but in my mind is the ultimate coping mechanism. These people, whether by fluke, practice, or simply by being themselves, have figured out that when they lead a conversation, it narrows down significantly, what comes back to them. In other words, they set the stage for figuring out the responses of others because they set the parameters of the conversation. They are the orchestra leaders, hidden from site, but completely in control of the interaction. A retired physician, whom I have had the pleasure of working with for years, is the epidome of this. He is graceful, he asks many questions, he is a great listener, he is intent, and then when he has set the stage, he will proceed to tell a story. Mostly without my realizing it, he is conducting. We are now in his arena, he knows and I know what the parameters are without pushing or pulling any strings. We are both engaged. If I ask for clarification or make a comment on his story, he knows exactly what I am saying, almost through pure intuition, rather than having heard anything. He is a master and has taught me a lot.
The above techniques are all very positive and fruitful strategies that help to understand what people are saying when individuals cannot hear well. In fact, people with normal hearing will use the same techniques when noise in a room blocks out important speech sounds in others voices. The difference is that hearing impaired people use these techniques every moment of their lives while people with normal hearing use them when noise becomes louder than speech. Because those with hearing loss use them so often they become much more adapt at them, as they say, practice makes perfect. It is also these techniques that are lost, although only temporarily, when people with hearing loss start to use hearing aids. After all, who needs to read a face when you are now able to actually hear the sounds coming out of the speakers lips. But why do people so often say that hearing aids only work in quiet and not in noise? Please read the next article on Hearing Aids Working In Quiet and In Noise.
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