The normal range of hearing for humans range from 20 – 20 000Hz, and to test your hearing it involves you to listen to a series of tones at different intensity (volume) levels measured in decibels (dB) and at different frequency (pitch) levels measured in hertz. Thus normal hearing could also range from -10dBHL to 25dBHL. Zero (0dBHL) does not necessary mean that there is no sound at all, but rather mean it is the softest sound that a person with seemingly ‘normal’ hearing ability would be able to detect at least 50% of the time. Most audiograms begin below 0 (picture from above) as 0dBHL is only the average normal hearing levels, therefore there are plenty of people who can detect sounds below 0dBHL. A Decibel is a unit used to express relative difference in power or intensity. On the decibel scale 10dBHL is 10 times more powerful than 0dBHL. A sound 100 times more powerful than 0dBHL would then be 20dBHL. Thus, as it would make sense that a sound that is a 1,000 times more powerful would be heard at 30dBHL, which makes a drop in your hearing levels from 10dBHL to 30dBHL a big change (Services, 2018).

You are probably wondering, why am I telling you all this?

Well, most people that know me will know that I am profoundly deaf. I am telling you this because in my case, I only start detecting sounds at around 50dBHL (see by picture above), you do the maths. In more simple terms it would mean that the softest sounds that I can hear is just a around ‘normal conversation’ between two people, whereas you with normal hearing would be able to hear the rustling of leaves, chirping birds, or whispers. Luckily with the help of hearing aids, I can hear at around 30dBHL, which still requires much focus and patience from my side to be able to hear conversations and other sounds at that range. Which brings me to my ethical dilemma ~ listening.  

Listening, which is not only to hear to reply, it is to understand and take the other persons opinions or words into consideration, without judgement or being biased and to be able to give honest feedback (Ethical Listening – What is it and how do I do it?, 2017). Due to my hearing loss, I was always intrigued with sounds – with one moment in complete silence and peace to a moment when sound suddenly pops in my ears as I switch my hearing aids on, feeling the magic and power of it. Therefore I made a habit of it to listen intensely to other people when they speak, to be able to hear every single word plus some lip reading also helps a lot. We as therapists are taught to always put the patients first and to listen which is an essential part in finding what is wrong with them, but what can you do when the patients do not listen to you? As in they do everything you ask during a session, but as soon as they go home they either feel too lazy, it is ‘too painful’ or simply just forget, regardless of what we educated them on or the trouble we went through to make it fun or memorable for them. When in the next session they come back and complain that they are not better and expect of you to be able to ‘fix’ them from only the few sessions that you see them. Which in most cases so far in my clinical experiences is 3 times at most, when they are actually in need of daily sessions or twice a week, but because I am so busy I just simply cannot see them as much. I have heard so many times of people talking about how physiotherapists only massages or work with sport injuries (What do physiotherapists do?, 2017), what if my patients think the same? Is that why they do not take my advice seriously? Therefore it frustrates me, because the amount of energy I must use in order to put my patient first and diagnose them correctly and then they are not even meeting me halfway by doing what is expected of them so that their quality of life can be improved.

I think that not only must we, as therapists, be taught about the importance of the patients, but that they must also be educated on our full role and ethics, so that they can understand the importance of what we teach them or the stuff we give them to do. This includes exercises, stretches and education on their specific ailment. Which could make them aware that we put them first and everything we do is to help them, therefore they will take us more seriously and listen more closely when we speak. After some research I found some intervention strategies that could help with patient adherence of home-based exercises. In summary these strategies includes, involving your patient in planning and setting realistic goals for the exercise program, as well as to educate them on as much as possible, but not too much information as it will confuse them, thus leading to discouragement (Adherence to Home Exercise Programs, 2019).  Provide them with pictures and videos of themselves so that they can see their improvement as well as boosting confidence. Positive feedback also seems to have a good influence on having adherence and improving their listening skills as they start to trust and understand your role more (Argent, Daly, & Caulfield, 2018).

– by 3748688

References:

Adherence to Home Exercise Programs. (2019, June 2). Retrieved from Physiopedia: https://www.physio-pedia.com/index.php?title=Adherence_to_Home_Exercise_Programs&oldid=212814.

Argent, R., Daly, A., & Caulfield, B. (2018, March 1). Patient Involvement With Home-Based Exercise Programs: Can Connected Health Interventions Influence Adherence? JMIR mHealth and uHealth, 6(3), e47. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5856927/

Ethical Listening – What is it and how do I do it? (2017). Retrieved August 25, 2018, from Ausmed: https://www.ausmed.com/cpd/articles/ethical-listening

Services, A. N. (2018, October 18). What is the definition of normal hearing? Retrieved August 23, 2019, from Earinstitute: https://www.earinstitute.co.za/what-is-the-definition-of-normal-hearing/

What do physiotherapists do? (2017, March 10). Retrieved August 25, 2019, from HealthTimes: https://healthtimes.com.au/hub/physiotherapy/8/guidance/nc1/what-do-physiotherapists-do/467/