Auditory processing problems caused by brain injury

Discussion of the article that appeared in the July 2017 issue of the Dutch Journal of Speech Therapy.

SOUNDS ARE NOT THE SAME ANYMORE
Acquired brain injury and auditory processing from a patient perspective

The article describes the results of a study conducted in 2016 by two speech therapy students in the fourth and final year of their training as a speech therapist at Windesheim Flevoland University of Applied Sciences.

The students interviewed ten patients with acquired brain damage, all of whom had age-appropriate normal hearing. They also interviewed thirteen healthcare providers within residential care settings.

Mentioned auditory problems
In the interviews with the patients, the emphasis was first on complaints such as:

• difficulties understanding speech in complex listening situations with a lot of background noise;
• ability to determine where a sound comes from;
• inability to properly fill in missed auditory information;
• difficulty following verbal instructions;
• hypersensitivity to sound, a different experience of music.

The patients told that, in addition to the above complaints, they had several other problems with noise, including:

• being sensitive to (a certain type of) sound,
• noises in the background are disturbing,
• no longer being able to listen and perform a task at the same time.

Noise sources in the person's environment can have consequences for work and hobbies and for the ability to have a conversation with someone else.

Emotional problems in combination with other consequences of the brain injury play a role in communication with others.

Still too little knowledge about this disability

It has become apparent that people in the environment of patients (both privately and in, for example, a healthcare context) still lack knowledge regarding the way in which noise can influence the lives of people with brain damage.

The authors state that speech therapists can play an important role both in raising awareness of possible auditory processing problems in those affected and their environment and by advising everyone how auditory processing problems can be taken into account.

The authors mention the small number of interviewees and the fact that, for example, patients with a severe form of aphasia could not be interviewed as limitations of the study.
Since disability and health are currently viewed from the ICF model*, it is appropriate to pay more attention to the development of auditory processing problems.

Existing theory emphasizes implications for communication. The research showed that sound perception and auditory processing have much more influence in everyday life.
The problems experienced and their effects are different for those affected by brain injury and depend on the environment. In other words, they are also context-sensitive.

Collaborators on this research
The following people contributed to the creation of the article: Dr Kitty Jurrius, associative lecturer in customized Brain Injury care, affiliated with the Customer Perspective in Support and Care Lectorate; drs Sofie van Wessel, MA, speech therapy training coordinator and university lecturer in speech therapy at Windesheim Flevoland, José van Haastrecht, company doctor n.p. involved in the research line as researcher/advisor, the students Nadieh Fernhout and ThamarSteenmeijer, both of whom have now graduated as speech therapists.

*ICF is the abbreviation of International Classification of Functioning Impairments.
This classification was adopted by the WHO in 2000, alongside the International Classification of Diseases (ICD).

Auditory processing problems occur in the ICF. Its description is tailored to children who have been known to have hearing problems from an early age. The Dutch Position Statement Children with Listening Problems was recently published in the Netherlands by the Federation of Dutch Audiological Centers that are primarily concerned with hearing problems. This publication concerns children who, despite normal hearing, appear to have difficulty hearing and understanding, which appears to be comparable to what was found in the above-described research for adults with acquired brain damage.

Attention especially to children
Elsewhere in the world as well, attention has so far mainly been focused on children in similar situations in terms of hearing, understanding and listening.

However, the British Society of Audiology recently called for more research into the described problems among adults.

* Note from this website: Overstimulation is broader than this auditory processing disorder, although there are clearly similarities. See our page on overstimulation. 

The article (in Dutch) can be downloaded below.