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If you have any questions, comments, or suggestions related to physical therapists with hearing loss, please contact: Claudia Glenn at physicaltherapy@amphl.org.
Table of Contents
Preparing for and Applying to Physical Therapy School
- Before we begin
- Choosing a School
- "Is this really what you want to do?”
- Can I meet the technical standards of my field of interest?
- How do I maximize my verbal test scores?
- Whether and how to disclose one's hearing status during the application process
- The Interview
- If I suspect discrimination, what am I to do?
Physical Therapy Schools - List of Medical Schools with deaf/HOH student/graduates
- AMPHL's Recommendation
Before PT School Starts
- What Now? Do I need to do anything before school starts?
- Self-Introduction
The Classroom Years
- How do I get the information?
Clinical Internships
Specific Challenges and Possible Solutions
- Communicating with Patients
- Stethoscopes
- Using the telephone or compensating for the inability to use it
The First Job
- Applying for that First Job
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Preparing for and Applying to Physical Therapy School
1) Before we begin
The AMPHL physical therapy (PT) guidelines address a certain group of readers: individuals with a hearing loss who are working as a physical therapist or aspiring to do so. With such an audience in mind, AMPHL addresses "you" as one of these readers and "we" or "us" as the collective group. AMPHL does not exclude those who are interested out of support or curiosity.
Everyone with a hearing loss is different. Some have more hearing than others. Some are very much a part of the Deaf culture, while some have been raised in a strictly oralist fashion. Some have lost their hearing as an adult; others were born with a hearing loss. All of these differences affect who we are and how we approach challenges. It is important to AMPHL that we respect the feelings and viewpoints of people with different experiences. AMPHL strongly encourages others to share their experiences and to give constructive criticism regarding our physical therapy guidelines so that we may continually make improvements.
The most important thing to remember as you read these guidelines is that you can do anything you want to do. Never let anyone else tell you that you cannot do something because of your hearing loss. You should be the one to decide what your limitations, if any, are going to be.
We will not mislead you. For those with hearing losses working in health care fields, our road was not easy. It took courage, perseverance, and strength. Many times we became discouraged and almost gave up. We persevered and succeeded. Because of this, we take pride in what we have accomplished. For us, things turned out to be well worth the effort. We are members of a profession that we love, and we are doing the kind of work we have always wanted to do. Now we want to help others aspiring to follow in our footsteps and encourage them to follow their hearts and their dreams. We are proof that it can be done, and we want to share our experiences with you in hopes that you can learn from the challenges we faced, the obstacles we overcame, and the mistakes we made. We hope that you will not become discouraged from reading our guidelines. We wish to describe our paths and paint a realistic picture. Rather we hope you become inspired and even more determined to pursue your goal of becoming a physical therapist. Remember that you can do anything you want to do!
2) Choosing a School
At this time, the education of physical therapists is in transition. All of the schools offer post-baccalaureate degrees. 64% of the schools have moved from entry level Masters of Physical Therapy (MPT) to entry level Doctorate of Physical Therapy (DPT) programs. In the Midwest, the majority of the schools have transitioned to DPT programs. The type of program is an important consideration. At this time, physical therapy is moving towards a “doctoring” profession, but there is no formal American Physical Therapy Association (APTA) policy or position on doctoral-level professional education. For more information on DPT programs see: [url]http://www.apta.org/education/dpt/dpt_faq [/url]
What factors can be used to decide on a program to attend?
The decision to attend a physical therapy program is a very personal one which must be made on the basis of a variety of factors, such as:
- Geographic location and size of the school
- Cost
- Class size
- Licensure pass rates
- Employability
- Faculty composition and cohesiveness (years working together)
- Degree awarded; design and length of curriculum
In an effort to compare the above factors, you may wish to:
- Survey current students and recent graduates of the program
- Interview employers who hire graduates and ask about program strengths and weaknesses
- Contact the school’s Office for Students with Disabilities to determine
- their programs for access for individuals with a hearing loss
- Contact clinical educators in hospitals & clinics. They often work with students from many schools.
What can students do to enhance their chances of admission to a PT program?
Candidates should have a high overall grade point average (GPA) and a high GPA in prerequisite course work (in 1993, the majority of applicants to PT programs reported GPAs of 3.0 or higher out of a 4.0 score). Admission officers also look favorably on an applicant's volunteer experience as a physical therapy aide, letters of recommendation from physical therapists or science teachers, and excellent writing and interpersonal skills. The physical therapist education program is a full-time commitment.
Other guidelines for admission can be found at this link: http://www.aptaeducation.org/Admiss_Req.pdf. Please note #2 in the list.
3) "Is this really what you want to do?”
You can do anything you want, but are you sure you want to be a physical therapist? These articles will give you an idea of the type of work that physical therapy entails: http://www.apta.org/Consumer/whoareptsptas/profile and http://www.apta.org/Consumer/whatisPT, but you need to have some personal exposure to the profession. Volunteer or find jobs at clinics, hospitals, anywhere you can get valuable hands-on experience. This will help you decide what you want to do and will show the admissions committees that you have tested the waters and are still committed. This experience is often a requirement for admission, although each school has individual guidelines regarding the actual number of volunteer hours are required. In a 2003 survey, almost 60% of the entry level physical therapy schools required volunteer hours for admission.
Use this initial time in the clinic wisely. Look around. Will you have a passion for this profession? Can you see activities that would be difficult because of a hearing loss? Use your imagination and life experience to see if you can come up with a solution to these challenges. On the other hand, as you observe in a clinic can you see activities in which the skills you have would give you an advantage over other applicants? Perhaps you have excellent skills of observation. Keep these thought in mind as you write your application essay or go to an interview. You may also use this time to determine the receptivity of clinicians and patients to your special communication needs. If you find a clinician with exceptional educational skills, inquire if the department has a student program. The availability of quality clinical education sites can be an additional factor when choosing a school. You may be able to arrange an internship in the clinic in which you volunteer.
4) Can I meet the technical standards of my field of interest?
There are often what are known as "technical standards” for schools of physical therapy; these are intended to outline what a person must fulfill in order to succeed as a PT. These usually involve five areas: observation, communication, motor/movement, intellectual/conceptual, and behavioral/social abilities. Examples of technical standards used by some physical therapy schools can be found at [url]http://www.aptaeducation.org/Technical%20and%20Essential%20Functions.pdf [/url]
Admissions committees use technical standards to judge applicants with legal disabilities. Prospective students must be able to meet these technical standards, with our without reasonable accommodations. It could be worthwhile for you to learn about the technical standards of some of the schools you are considering. Be prepared to explain to the admissions committee how you plan to compensate for your disability. The most common concerns that admissions committees have are:
- How you are going to take blood pressure measurements?
- How you are going to communicate with patients, families and physicians in person and over the phone?
- How you are going to obtain the information that is presented in the classroom, in labs, and in the clinic?
- Note: Please see our sections on the classroom and clinical years. Answers to these tough questions do exist, even for those with a profound hearing loss.
5) How do I maximize my verbal test scores?
In the 2003 survey more than 70% of the schools required GREs as a part of the application process. This test includes a section on verbal reasoning skills. Some individuals are fortunate that these tests do not present a problem. However, some individuals with a significant hearing loss occurring at the early stages of language development might not have had exposure to the full range of language complexity. Speech therapy might have trained you to develop strong speaking skills, and your English coursework might have honed your writing skills; but they do not necessarily cover the types of skills being tested on standardized measures. You might need more time to process the verbal reasoning questions. In this case, taking the graduate entry examination, in part or in whole, without time limits is the solution. (The drawback to this is that it will be disclosed to the admissions committee, who may look unfavorably upon it.) For others, an explanation to the admissions committee that the verbal reasoning section does not accurately reflect your language skills would suffice. Consider asking your audiologist or counselor to write a letter on your behalf.
6) Whether and how to disclose one's hearing status during the application process
We all want to be judged on our merits. We do not want a hearing loss to be used against us or for it to be a liability issue. By the same token, if we are not honest with the admissions committee, it could backfire. It is very difficult to hide a significant hearing loss. If the admissions committee finds out about your hearing loss from someone else, it may be a negative reflection on you that you were not direct with them and were unwilling to address the issue. Even if they do not find out, the admissions committee may not recognize that you have to work harder than many of your hearing peers and thus fail to give you credit for your work ethic and discipline. In the end, you are your own best advocate.
For most physical therapy school applications, a personal statement or essay is required. Generally, the applicant is given free rein in how to structure the essay; it is here that applicants are given an opportunity to reveal more about their personal aspects which are often not clear in transcripts or a curriculum vitae. One’s motivation to enter the field of physical therapy is one of the generally expected topics. If you are deaf and would like to disclose it, the essay is an ideal place to do so, as you may explain in detail how you prefer to communicate and possible ideas you may have for how you will carry out your duties as a physical therapy student and in the field after you graduate.
Another option is to include, with your application, an additional letter that describes your hearing loss and how you compensate for it. It may be helpful to have a faculty member, dean, or advisor - someone who knows you well - call those schools and vouch for you. At the very least, talk with the dean of your school about your situation. At the end of your letter, encourage the admissions committee to contact the dean, your advisor, or you with any questions.
The question of disclosing one's hearing loss remains a controversial one. The admissions committee still may wonder if you will succeed in a demanding academic environment. They may feel threatened by the effort and expense of the accommodations you may require. While federal legislation makes discrimination on such grounds illegal, it cannot overturn discriminatory attitudes. The committee may simply rank you lower on its list of candidates and rank other candidates as being more attractive.
7) The Interview
Many interviewers have little or no experience working with individuals who have a legal disability. They may not feel comfortable while interviewing you and may fail to address their reservations with you. By law, a potential employer cannot discriminate against applicants based on disability, so interviewers are discouraged from raising the issue during an interview. But if their concerns are not addressed, their initial bias may lead them away from offering you a position. If you have an obvious hearing loss or one that requires significant accommodations, you might want to set the tone and ask if anyone has any questions related to your hearing. Put them at ease. Describe your hearing in a positive context. Explain how you compensate and how you plan to meet the technical requirements of the program. You may discuss your communication options for classroom work and technical options to overcome potential challenges in the clinic. Such discussion would reflect your ability research and your motivation. You want to come across as being a determined and confident person who would make an excellent addition to their program.
8) If I suspect discrimination, what am I to do?
Ask your interviewer or admissions committee why you were not selected and what you can do to improve your candidacy for other interviews. You may or may not receive useful information, but at least you have a starting point. Ask your dean or advisor to look into the matter. Go to the Disabilities Office on your campus. Contact professionals in your field of interest who have a hearing loss.
PHYSICAL THERAPY SCHOOLS
Below is a list of PT schools which have graduated an individual with a hearing loss or who have such a student currently enrolled in their program. This list is provided due to interest expressed by pre-professional students.
:. University of Indianapolis
:. Midwestern University
:. Marquette University
:. Hampton University
If you know of any other PT schools not listed above, please contact the webmaster with the school name, the name of the student, and the year of graduation.
AMPHL presents this list with several cautions:
- This list is by no means comprehensive.
- Some of the PTs who graduated from these programs, if they are not still students, may have graduated a number of years ago. The programs, faculty, staff, and services may have changed since then.
- We strongly believe that everyone's educational experience is unique. While one person may have felt a program met all their unique accommodation requests, another may have a vastly different experience. For some, a previously graduated therapist with a hearing loss may help pave the road; for others, it may make no difference in their experience.
While this list represents programs that have or have had a student with a hearing loss, it does not represent an endorsement of the program nor a guarantee that they accommodate hearing losses.
AMPHL's recommendation
Contact schools in which you are interested based on factors such as quality of program, location, reputation, etc. Then schedule a meeting with the appropriate faculty member or the Disability Office to discuss your needs related to your hearing loss. Apply to the school that feels best to you regardless of whether they have graduated a physician with a hearing loss.
BEFORE PT SCHOOL STARTS
What Now? Do I need to do anything before school starts?
Be prepared. If you want people to be on your side, you have to reach out to them first. Meet with the school's office of student affairs, the dean of students, the office of disability or diversity (usually found at the affiliated undergraduate campus, if the program has one), as well as the course directors. Introduce yourself and tell them what you need. If needed, write a one-page self-introduction (see below for an example) which explains your needs; review this in person with the staff. If you will need accommodations, you will need to request them, rather than waiting for them to be offered to you. You will need to follow the protocol for your individual school and pay for any testing required to verify that you have a disability, per legal standards. Even if you do not want any special assistance, you should still introduce yourself and mention a significant hearing loss to course directors. Thus, the instructors will not think you are rude for not responding if they talk to you when you are not looking at them; they know that they need to make a special effort to communicate when they call on you in class; and so on.
Know that there are many resources to educate yourself before classes start. Then you can educate the educators! Many instructors may not have personal experience in working with students with a hearing loss. Some of us have found that the instructors are great allies and wish to help in whatever way possible. Others have had more challenges in obtaining accommodations and help from professors. The AMPHL website has a list of articles and websites that you can use as a resources to learn about your rights and responsibilities. As you read them, keep in mind that many are related to baccalaureate education vs. professional education.
Show the staff your assistive listening device, if you use one. Microphones may already be used because lecture halls are sometimes big enough to make them necessary for hearing students as well. No matter what special accommodations you use, it is a good policy to introduce that means of communication early on.
It may be a good idea to tell the faculty that if they feel something is not working or if you are not performing to their expectations, you want to know right away. You cannot afford to wait until the end of class and find out through a bad evaluation. People do not like to say negative things about others, so you may need to reinforce the idea that you are open to all constructive criticism. As the course or rotation progresses, the faculty may have suggestions or ideas for doing things in a better way. Be open to such advice; ask for such ideas if a challenge arises. Be pro-active and research different communication options. AMPHL and the resources of NOISE, can be a good place to start.
The letter below is an example for a student that relies on speechreading and Assistive Listening Devices (ALDs) to communicate. Many of the suggestions, such as repeating questions, will be beneficial to many members of your class. You can modify the letter if you will be using CART (Communication Access Realtime Translation) or sign language interpreters.
Self-Introduction
To: Staff involved with (course/clinical rotation)
From: (your name)
Regarding: Hearing loss
On (date), I will start participating in (course/rotation). As some of you may know, I have a profound hearing loss. I want to make you aware of communication skills which best enable me to interact with others.
1. In order to understand what you are saying, I must be able to see your lips since I rely heavily on speech reading. Please get my attention prior to talking with me so I may be able to fully concentrate on what you have to say.
2. During certain situations, I may utilize an assistive listening device that involves the speaker wearing a small receiver on their belt or pocket with a small attached microphone. This device decreases my need for speech reading and help in situations with large groups and background noises.
3. It is difficult for me to follow group discussions. If you are leading a discussion, rephrasing others' questions or comments is extremely helpful to me since my attention will be primarily on you. Similarly, identifying one person to lead a discussion or give an explanation (rather than several people) is beneficial to me since it takes me a few seconds to locate and reorient on a new speaker. During that lag, I may miss important information.
4. I may need to ask questions of you or my classmates in order to clarify things I have missed. I try to ask such questions at appropriate times.
5. Unfamiliar words are difficult for me to grasp and understand. I may ask you to rephrase the concept with different words or to write the word out for me. Similarly, I will often repeat important information back to you to assure myself that I heard you correctly, such as medication dosages, so that I will not make an inadvertent mistake.
6. Please feel free to approach me with questions or suggestions you may have. This rotation will be an experiment in progress. Several staff members in previous rotations have suggested solutions to problems they perceived that helped immensely and improved my performance/communication ability.
I look forward to this (course/rotation) and working with the staff!
Sincerely,
(your name)
THE CLASSROOM YEARS
How do I get the information?
Notetakers
In PT school, one must absorb a tremendous volume of information. With a hearing loss, there is another challenge: how to listen to a lecture and write down all that information. There are a number of options for note-taking services:
[list][*] Copy your classmate's notes (you can obtain carbon-less copy paper to eliminate the hassle of making photocopies).
[*] The school may hire a fellow student to take notes for you.
[*] Your class may organize a note-taking service where they take turns taking notes for each class and get reimbursed for a small fee (everybody pays $40-$100 up-front and receives very thorough, typed notes).
[*] During the classroom years, many course directors develop pre-printed syllabi which are sold to the students for a fee. These syllabi often contain the lecturers’ Powerpoint slides and relevant graphs or text. Such syllabi can be invaluable to any student, hearing or deaf.
Interpreting services
What if you cannot follow what is being said in the first place? Interpreting services can be very helpful and even necessary for many of us. Sign or oral interpreters are an option. Oral interpreters silently enunciate what is being said with only a little lag time and may use signs to supplement their transliteration. Check with your school to see if has worked with interpreters before. Contact the Registry of Interpreters for the Deaf (RID) to inquire about interpreter referral agencies. The Alexander Graham Bell Association has a national listing of individual oral interpreters, which is not always up-to-date and does not tell you about each person's credentials. There may be local agencies that the university can work with to provide interpreters.
If you encounter resistance when requesting such services, be diplomatic. Explain how interpreting services help you to learn and work effectively, as well as make things easier on those with whom you work. Point out that interpreters are covered under "reasonable accommodations" as stipulated by the American with Disabilities Act (ADA). You can work with the program in several ways:
Help the program determine the criteria by which your interpreters are selected, if possible. When you can, interview interpreter candidates ahead of time. Traits such as willingness to work long hours, ability to master large amounts of vocabulary, and ability to deal with stressful situations and rapid group conversations can be invaluable in the long run. Consider the overall ability of individual interpreters rather than just looking for the highest credentials. Someone who is enthusiastic and willing to work hard may be easier to train and work with than someone who is set in their ways. Look for interpreters who have a science background or have worked in medical settings before. For those who are interested in oral interpreting services, keep in mind that some nationally-certified oral interpreters offer two- or three-day training programs for relatively new interpreters. Be assertive if an interpreter is not working out; a bad interpreter can be a major liability when you are making decisions that affect patient's lives.
Contact faculty and staff members ahead of time to let them know there will be interpreters present and what their role will be. You may find that some of these tip sheets are helpful: http://www.netac.rit.edu/publication/tipsheet/. Ask for copies of syllabi, hand-outs, course packets, and any useful texts for the interpreters so that they know what is going on during a given day and can look for unfamiliar vocabulary ahead of time. Buy them a medical dictionary or vocabulary book. Set up a schedule to go over unfamiliar medical terms with the interpreters on a regular basis. This will allow you to come up with abbreviations/signs for those rapid-fire lectures and discussions where fingerspelling every other word becomes logistically impossible, as well as provide a time where you can fine-tune things such as professional expectations (interpreter code of ethics, etc), positioning during labs, etc.
If you are lucky enough to attend a program where interpreters have been used before, ask around and find out if the student(s) or interpreters have any suggestions.
CART
Another option is real-time captioning (also known as CART (Communication Access Realtime Translation) A stenographer types what is being said into a stenographer machine which is hooked up to a computer; the computer software transcribes the stenographer language into English that is scrolled on the screen. You can read what is being said with only a little lag time. When you have a good real-time captioner, this can be an incredible experience. Check with your school or other students with hearing losses in your area to find out about local CART services. If you do not know where to start, there is a web page for CART reporters, CARTWheel http://www.cartwheel.cc/, which may prove to be a valuable resource. Remote captioning is an option for those who train in areas where there are no local services. In this case, the CART reporter and user are connected through computers over a phone line in conjunction with either another phone line or an internet connection. The CART reporter listens to a lecture with a microphone that is connected to an phone line and his transliteration is transmitted over the modem or network connection to the user's computer.
There are challenges to consider when using interpreters or CART services. The quality of service is variable, given differences in training and accreditation. Currently, there is no national accreditation for CART reporting. The numbers of CART reporters (also known as captionists) are small as the technology is relatively new. Many are court stenographers who want to expand their businesses. Still fewer are specifically trained and certified for CART services for individuals with hearing losses. The interpreter or captionist may have never encountered such a sheer volume of information and complexity of medical terminology. He will have to read the class syllabus or something comparable before each class. The captionist will need to input all new words into his software dictionary so that whatever he types in steno will automatically be transcribed into English for you. As you can imagine, few people have the temperament and work ethic to take on that kind of a job! You may have to try out a number of reporters before finding one who works well with you.
Group conversations/Committee work
Group conversations can be frustrating for those with hearing losses and it is often hard to learn from your classmates in these situations. The person speaking is not always going to be looking in your direction, even if you repeatedly ask the group to try to face you when they are talking. The group is usually pressed for time and cannot slow down to keep repeating things for you. There is usually a lot of background noise which makes it hard for even hearing people to follow the discussion. To make the most of these experiences, you need to become more assertive. Tell people to speak up, to face you as much as possible, and to slow down when necessary. You are not always going to get what you want, but the more persistent you are, hopefully the more people will remember to do those things which will help you. Sometimes when things are happening too quickly and you are lost, a colleague, if asked, will repeat some major points for you.
An FM/microphone system may be helpful in selectively amplifying the conversation of interest over the incessant background noise. When choosing a FM system, you may want to get one that has the option of "zoom" amplification which focuses on just one or a few speaker(s). Also, in a standing group conversation, you might like the option of holding the transmitter/microphone yourself instead of having different speakers pass it around. (Check the web links on various FM/microphone systems.)
Sometimes the group is just too large or the dynamics of the conversation are too much of an obstacle. Perhaps the severity your hearing loss does not allow for benefit from FM systems. Interpreting services, whether signing or oral, may prove to be the solution. Try to find interpreters who have already worked in a hospital setting or have taken some medical experience. The complex medical terminology and the speed of communication are tough for lay persons, let alone for you. If you cannot find someone who qualifies, you may have to do some job training of your own.
Lab Work
Schools present material in a lecture format initially and then in a lab format to get hands on practice for the skills you will need in the clinic. You will learn, among other things, how to analyze gait and movement patterns, joint mobilization, soft tissue mobilization and massage techniques, wound care, use of modalities (heat, cold, electricity) to promote healing and decrease pain and numerous ways to improve function with pediatric, neurological, cardiac and orthopedic patients.
Use this time to problem solve challenges involved with your hearing loss. How will you communicate with a patient that is lying on their stomach? Will you be able to understand when a patient tells you they are in pain or feeling weak when you are standing by their side and teaching them how to use a walker? If you work with one patient while another patient is on a hot pack, how will you know if the hot pack gets too hot and your patient needs assistance? Working on clinical and communication skills in a classroom lab setting with healthy students as your “patients” can be very valuable. Take advantage of this experience! Try different approaches until you find a way that works for you. Keep reading for specific situations that the authors have faced and ways they have successfully dealt with these challenges.
CLINICAL INTERNSHIPS
Each school has different requirements for clinical education, but as schools move towards doctorate entry level, the trend is to increase the number of clinical hours before graduation. Generally, you can expect four to five full time internships which last a minimum of eight weeks.
Physical Therapy is a broad profession. We work in acute care or rehabilitation hospitals, outpatient orthopedic clinics, schools or pediatric clinics, home health, nursing homes and private practice. Schools want their students to have a broad range of experience in their internships. They often require clinical experience in an acute care hospital and orthopedic outpatient clinics and allow student to pick other clinical experiences according to their interests. Each area has its rewards and challenges, especially for a individual with a hearing loss. We will review some challenges and possible solutions below.
The Academic Coordinator of Clinical Education (ACCE) sets up internships from the academic side of the equation while the Clinical Coordinator of Clinical Education (CCCE) works to coordinate these experiences in the clinic and supervises the Clinical Instructor (CI), who will work with you on a daily basis. Communication is vital as you are planning the clinical aspect of your education. Talk to your ACCE about the challenges you anticipate in various clinical settings and how you plan to work through them. In an ideal situation, the ACCE, CCCE and CI all work together as a team to provide the educational experience and support that you need. Once you are in the clinic, you will need to work through specific communication strategies with your CI. If you need additional support, call on the ACCE and the CCCE.
SPECIFIC CHALLENGES AND POSSIBLE SOLUTIONS
1) Communicating with patients
When you are working with patients in the clinic, most communication is on a one-on-one basis. However, the patient will not always be sitting right in front of you. They may be walking next to you, standing, facing away, or laying on their back, side or stomach. If the patient is very old, young, in pain or confused, they may have a family member present. We have listed possible communication challenges and strategies that have worked for the authors.
- Initial evaluation
This is a time when a lot of information needs to be communicated and you are not yet used to the communication style of your patient. Use the strategies you find successful in daily life. Therapists work with patients several times a week. This is the time to set up successful communication strategies that will last for the entire duration of a patient’s time in physical therapy. Some tips:
- As you introduce yourself, let your patient know that you have a hearing loss but you can work together as a team for successful communication. This should not be a long conversation. It can be a mere two sentences. Remember, the focus is on the patient not you.
- “Good morning Mrs. Smith. My name is Miss Jones. I look forward to working with you. I a deaf and would appreciate it if you face me when you wish to talk to me. I am sure we will communicate just fine. Now tell me a bit about why you are here…”
- If you use an FM system, simply hand the patient the microphone (or show them how to clip it to their lapel) with a brief explanation. Often this then becomes second nature to the patient and they will ask for the mike before they start a therapy session.
- If you use a sign language interpreter, explain their role to the patient. They are in the room to facilitate communication, not to act as a PT aide.
- Make this first session positive. Give the patient confidence that you can help them feel and function better. Often the fact that we need to give our patients our full attention to communicate is seen as a positive thing. It is not uncommon for patients to tell therapists that have a hearing loss that they are the best listeners they know!
- Multiple people/multiple conversations during the initial evaluation
- If a family member is present, simply ask that one person talk at a time so information is relayed accurately.
- Treatment sessions This is often when patients will be in a variety of positions. Use strategies that worked for you in the initial evaluation. Accommodations to provide safe, quality patient care are relatively simple but require teamwork. You may need to occasionally remind the patient that you can not understand them if you are writing or they are facing away from you. This may be an individual’s first experience working with someone with a hearing loss. Patience and a sense of humor goes a long way in building a therapeutic relationship.
- If the patient is lying on their stomach or on their side and facing away, set up a simple communication system. “Pound the table if this is hurts and I will ease up on the stretching.” “Give me a thumbs up if this feels fine and a thumbs down if it is tender.” “point to where it hurts” If you use an FM system, you can ask an aide to help with communication. The aide can wear the FM mike and pass on the patient’s verbal comments.
- If you are walking next to a patient and they need physical assistance for safety and stability, you may be able to use an FM system or speechreading from the side to communicate. If that is not possible, you may need to stop occasionally and speak to the patient when they are seated and you can face them. Since the patients hands may be holding onto a walker, crutches, parallel bars or a cane, set up simple head or body movements for safety, so the patient can let you know if they need to sit down.
- You may need to change your position to facilitate communication. If the patient can walk unassisted and you are observing their gait pattern, you can walk backwards to facilitate communication. You can kneel in front of the patient or even get on the floor and look up so you can see a patient’s face.
- Learn to use your powers of observation to read body language. You may be especially sensitive to vibrations. Use these skills to enhance your palpatory skills and you can be ahead of the game. You may be better in these areas than you hearing counterparts. Use these skills to their advantage!
- You need to give a safety switch and a bell to patients on electrical stimulation modalities or hot packs. Check on your patients frequently and ask the aides or other therapists to let you know if the patient rings a bell or sets off the safety switch.
- If you are working with a patient in a gym, other patients may be on a bike nearby. Remember that these can be noisy. Watch you patient for facial expressions that let you know that you need to raise your voice volume.
- Your patient may be willing to write down their symptoms, especially if they have had a long weekend with varied activities and responses.
- Your patient may be interested in learning a few signs. This can be both fun and helpful for communication.
Special clinical situations/special challenges and solutions
- Pediatrics
- Working with young children is often done in the guise of play. You may be on the floor with your patients. Watch their body language and feel for changes in body tone to assess treatment effectiveness.
- Use the above strategies to communicate with your patients’ parents.
- ICU
- Learn the visual aspects of alarm systems on various IV pumps and monitors. Check these monitors every few minutes, reminding yourself with a vibrating timer if needed.
- If a patient has a very weak or no voice, you may find your speechreading skills invaluable.
2) Stethoscopes
With a hearing loss, the use of a stethoscope can be a challenge. Someone with a profound hearing loss cannot hear with a traditional stethoscope, but he can accomplish the desired result in an alternative way. So first ask yourself, "Can I use a stethoscope? If not, what are my options?" Many of us will need to select an amplified, electronic, or special stethoscope. Special stethoscopes include visual display stethoscopes, modified stethoscope setups, and tactile stethoscopes. More information on stethoscopes can be found on the AMPHL stethoscope information pages http://www.amphl.org/. It is recommended that you either borrow an appropriate stethoscope or obtain one on a trial basis from a manufacturer so that you can be sure it is going to work for you before you invest a lot of money into it.
If you cannot hear with a stethoscope, inquire about other equipment which might not be used traditionally in this situation? What types of sounds will you be expected to hear with a stethoscope. It may be helpful to discuss this with the Dean of the School and the instructor.
3) Using the telephone or compensating for the inability to use it
A hospital is a big place. The phone system has become crucial, as one needs to be able to contact others efficiently and effectively. Unfortunately for us, the telephone is a prominent feature in the health care setting. It is frustrating to see other people do something effortlessly that is so difficult for us.
A number of hospitals have phones which are volume-controlled. If not, push for amplified phones in areas where you will be working. You may also need to request telephones compatible with assistive devices such as HATIS or cochlear implant telephone jacks. If you cannot use the telephone, request to have a telecommunication device for the deaf (TDD) placed at suitable locations. Some telephone companies may be willing to cover the cost of one TDD that you select from their regional dealers.
A TDD may be utilized in one of several ways. More traditionally, you may type messages back and forth with someone else who also has a TDD. If the other person does not have one, you need to call an operator in your state's Relay system. The operator calls the person you want to contact, transcribes what she is saying to your TDD digital screen, and if necessary, will voice your typed responses. Thirdly, you may use Voice Carry Over (VCO) where you speak for yourself into the headset but the relay operator still transcribes what the other person is saying to your TDD digital screen. If you have access to conference calling, some medical professionals utilize two-line VCO. In this situation, the operator is more of a silent partner. You can hear what the other person is saying and speak directly to the person you called. At the same time, the relay operator is transcribing what the other person says into your TDD digital screen. If you miss hearing a word, you can then glance down and fill in the blank.
Communication is slower with relay, as you are going through a third party who is unfamiliar with medical terminology. Many people often mistake relay for a telemarketer and hang up. Despite this, most people are very understanding about going through relay and do not have a problem with it. Explain the relay system to hospital staff and patients/clients ahead of time if you know that you will be giving them a call. You may want to take into consideration that using a TDD may take longer than having someone else make a fast call for you or making a quick dash down the hall.
Other relay services are available online, including text relay and video relay. Online text relay services can be accessed with a web browser; the process is identical to TTY relay services except that a computer takes the place of the TTY. Those who prefer sign language might prefer video relay services, which require a computer and webcam. By accessing the proper sites with a browser and turning on the webcam, a video relay interpreter can interpret a call for you. Many video relay services now have VCO capabilities as well. (See our relay links for more information.)
Another way to deal with hospital communication is a text pager. That way your teammates or hospital staff will be able to leave messages with an operator who will transcribe them into a digital read-out on your pager. You also can type short email messages on its built-in miniature keyboard. Please see the next section on pagers for more information.
Interpreters may be able to help you with phone calls too. They may listen for you and interpret what is being said; you may respond directly into the phone headset if you communicate orally or sign to them and allow them to translate to spoken English.
You may also find that using a fax machine can help with your communication needs.
THE FIRST JOB
Applying for that First Job
We already discussed at length the question of whether or not to disclose your hearing loss during the application process. The AMPHL directors understand that there is no one approach to this question. If you have an obvious hearing loss or one that necessitates significant accommodations, you will have to come to a decision on when to disclose this information. Some individuals feel the need to be upfront from the beginning; others will want to avoid negative stereotypes and misconceptions from being formed prematurely. You are screening potential employers as much as they are screening their applicants. If one does not want to work with you, why work with that person?
During the interview, check out the work environment. Can you comfortably hear in the hallways and in the clinic rooms? Is there technology in place that would make it easier for you to institute your accommodations? How many people will you work with at any given time? Request some time to meet staff with whom you will work. How open minded do they appear?
When you have selected a final group of potential employers, become more specific regarding the working details of your job. What will you need to deal with telephone conversations? If you cannot use the phone, can you work out an arrangement that is satisfactory to both you and your potential employer? How will you deal with coverage from home? Can you utilize a text pager? Address as many of the details as possible before you take a job. This makes for better job security later on.
The information related above can also be helpful in your fist job when you are working with patients. Other situations to think about include:
- Safety
- How will you hear fire alarms? Calls for code blue?
- Find out if there are visual alert systems
- Set up a system within your department so coworkers can alert you to alarms and codes
- There may be vibrating systems that can be coordinated with your pager
- Service dogs can be taught to reliably alert a person to alarms
- Inservices and meetings
- Use the strategies that worked for you in school. You will need to formally request accommodations. It may be helpful to review Title I of the Americans with Disabilities Act here
Best wishes in your endeavors!
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