The following correspondence between Juliette Sterkens, an Audiologist and co-owner of Fox Valley Hearing Center in Oshkosh, Wisconsin and Melody Martin, an Audiologist and co-owner of Martin Audiology in Texas and long-time LACE advocate, offers some pointers that could be valuable to virtually all practitioners seeking an effective protocol for integrating LACE into their hearing aid dispensing practice.
I remember talking to you at one of the AAA meetings when you had a poster session. I too own a private practice and I started using LACE about a year ago after that meeting. I offered LACE with binaural hearing aid fittings and also sold the software to my existing users. After about 6-8 months I became frustrated with the low completion rate among my patients. I found that some did very well and enjoyed the tasks, but the majority either did not start and/or complete the program. I kind of gave up on LACE but recently attended one of Dr. Sweetow’s presentations, and became once more convinced that using this program has to be a part of every hearing aid fitting.
How do you manage this?
Do you contact your patients to “encourage” them? Do you make them “offers they can’t refuse”. I guess I am curious as to how you motivate them and how you manage the follow-up.
My second question pertains to patients with more severe hearing loss – those who have a great deal of difficulty understanding sentences, although they can understand when the sentence is up on the display. Do you somehow “screen” your patients before you give them the LACE disc? Have you found that if discrimination is too poor to understand slow, loud speech without some context or lip-reading, they also won’t be able to complete the LACE program? This question came up last week when I saw one of my long-time patients who has a bilateral severe loss with discrim in the 30-40%. She became unsure if LACE would be beneficial when she couldn’t do the demo program in the office.
I received a reprint of your article on the use of LACE in your private Practice, and I hope you don’t mind me contacting you directly to ask these patient-management questions.
Thanks for taking the time to respond to my questions.
Juliette Sterkens, Au.D.
Response from Melody Martin:
I would be glad to answer any questions you might have about LACE.
It is difficult to promote LACE unless you really believe in the program. Fortunately, I have had enough experience with it to be confident that the time spent on LACE is to the patient’s benefit. I tell them:
“You have to trust me that the time you spend on LACE is worth it. We will be tracking your progress and measuring the benefit. You may feel a little frustrated at times with the program, as it can become difficult and even though you feel you are doing better, your scores may drop a little. Don’t be discouraged as the program is designed to be that way. As you improve, the sessions become harder; that is what makes it therapy and not just routine exercise!”
That being said, LACE is an expectation in our offices. From the very beginning, we explain to our patients that hearing aids provide audibility only, and that processing is something altogether different and needs treatment too. Thus, patients begin to realize that there is no quick fix for their hearing problems and that they must be an active participant in the solution. This concept of the need for ‘rehab’ with the fitting is reinforced at every juncture. I have not made offers to the patient. If your doctor told you that you needed physical therapy after surgery, would you expect an ‘offer’ from him or her? Or, would you realize that the doctor was giving you a health recommendation that is in your best interest to comply with, and if you don’t do it, what justification do you really have if you don’t get better?
We have established an internal tracking system on the patient’s progress, and have our staff call to encourage them if they are working on it at home. Also, you can use the notification from Neurotone Pro to track progress and email the patients. Scores of the sessions done to date are printed out and are discussed with the patients during their follow-up appointments. All patients are given the option to work on it in-house in our LACE lab, and we have staff function as a LACE coach to help and encourage patients during the sessions.
Yes, even some of the severe losses benefit from LACE, but I try to encourage them to do LACE in house, or involve a family member for the home sessions. The newest version of LACE (v3) has internal QuickSIN to help gauge progress, but I do outcome measures of my own pre- and post-LACE, and recently even during LACE training if the scores are not coming along and I want to adjust the instruments and measure benefit. Don’t underestimate even a small amount of benefit from LACE. It could translate into a bigger lifestyle improvement.
Do I screen patients? Maybe a little. I am careful about making assumptions about what patients cannot do if managed and motivated. So, Maybe I make exceptions for those patients with memory deficits, those who absolutely positively refuse, those who don’t have access to a home computer and live so far away that they can’t come in (although we have them do multiple sessions whenever they come in for follow-ups). We don’t look for a reason not to do LACE but rather look for a reason to do it.
Yes, patients with poor auditory discrimination can benefit. Do the demo in the office and do a few sessions in-house with the encouragement of a LACE coach. Even completing just a few sessions can provide benefit.
I hope that answers some of your questions. If you have any others, please let me know!
Melody Martin, Ph.D., Au.D