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Profile of Tom Brennan, Audiologist

Intro: Have you ever considered a career in speech and language pathology or audiology? Have you wondered whether it would be possible to pursue such a career without vision? To find out how this career can be performed, read on!

The Story: I am congenitally totally blind. That is not the most important thing I can say about myself but it probably is the best reason to continue reading this piece if you have gotten this far and are blind yourself. I am an audiologist, licensed in Texas, and I also hold registration to fit and dispense hearing aids in Texas. In addition, I am a licensed speech-language pathologist. I am certified in both of these fields by the American Speech-Language-Hearing Association (ASHA), the national certifying body for audiologists and speech and language pathologists. I am in private practice and have been for nearly twenty years.

There are very few blind speech pathologists and, so far as I know, no other blind audiologists in the United States. This is a situation that I feel should change, so I have decided to write a bit on how I have handled such things as testing clients, modifying tests and therapy materials so that I can use them, scoring tests, using inaccessible equipment, and coping with other daily chores.

Originally, I did not intend to become involved in speech and hearing. In fact, other than having some vague idea that speech therapists worked with people who stuttered and did hearing tests in school when the school nurse wasn't available I didn't know much about the field. I was doing post graduate work in psychology and needed a couple hundred hearing tests to be performed on experimental subjects. To my chagrin, I found that nobody was willing to do these tests for me. I decided that I would just take an audiology course and do the tests for myself. The rest, as they say, is history. I took the course, did the tests, and thanks to my mentor, Dr. Bernard-Thomas Hartman, became hooked on speech and hearing.

With my first course, I discovered that the administrative people at the university (department heads, for example) were not going to be of any help to me. This was before the ADA had been passed, so I had to rely on the good will of professors in the department. It was almost entirely Dr. Hartman who got me through both my audiology and speech pathology programs. In fact, he also supervised my required internship in speech pathology. I most sincerely recommend that any blind person (undergraduate or graduate) intending to become involved in speech pathology or audiology courses find a mentor willing and able to spend extra time with you and one who is willing to help you modify both equipment and materials, as necessary.

I rapidly discovered that there are no tests on the market that have been modified for administration by blind people and very few specifically designed or norm-referenced for administration to blind people. Because of the nature of tests, no modifications that I made could in any way visibly alter the test as far as the client could tell, and my administration of the test had to conform to that expected of sighted clinicians. I soon discovered the joys of brailling extensive scoring tables and sets of test questions, designing matrix information for administering block design tests, labeling pictures, and the like.

I also discovered for myself that certain tests such as the Goodenough Draw-A-Person test cannot be scored by a blind person because you have to see the drawings to score them. Certain other tests that require the use of pictures or the manipulation of objects were also very difficult and sometimes impractical for me to administer.

I was fortunate enough to have someone all the way through graduate school and for several years beyond to help me with these tasks. I highly recommend the use of a sighted assistant but only if that assistant can be well trained and available for an extended period of time. Several states have laws that require an assistant to be licensed, which makes them a potentially expensive commodity. While it is possible to do good speech and hearing work without sighted help, it requires skill and a great deal of time. I would never recommend that a blind person attempt to start out without at least some sighted help. As with readers, the key to this process is to train your help yourself.

Client examinations are somewhat problematic. Sighted clinicians look at a client and immediately see things like posture, facial tics, color of skin and fingernails, general dress, movement, and a host of other things. For a blind person to do this requires touching the client. The very act of touching someone can alter much of what you wish to find out about, so this requires practice and the development of some skill.

Sighted clinicians do not teach techniques of touch as a part of their clinical work, or not generally anyway. Touch will be taught as "palpation" to feel for specific things like tumors or muscle tone but not generally for much more. Two things are important for the blind clinician. First, anatomy must be learned well. This means spending extra time with whomever is teaching the classes and it also means volunteering your friends to practice on. This included both male and female friends. When you're learning bones and muscles, don't hesitate to use dogs and cats or any other being which comes to hand.

When you are doing your clinical work you will also need to prevail upon your friends again to keep in practice with the anatomy. While a sighted person can look in a book to see a disorder, we as blind people do not have access to that shortcut to learning. We must actually get our hands on disorders quite literally. Work with clients who are experiencing as varied a group of disorders as you can find. Examine other clinician's clients for disorders. See if you can spend time with practicing clinicians in town to see some of their clients. Remember that people must be your textbooks if you are to do anything but memorize dry facts.

One particular examination that sighted people generally say cannot be done by a blind person is the oral/peripheral examination. This is an examination of the lips, tongue, oral cavity, teeth, gums, and related structures. This can be done with practice but will require patient friends upon whom to practice. You will need to wear gloves for this and they must be surgical gloves that are as thin as possible so you can feel any small differences.

I have made pieces of equipment over the years or have had them made for me. One is an infrared reflectometer which I use for examining ears. A blind person cannot use an otoscope to look in a client's ears because this tool is essentially a flashlight. The reflectometer uses an otoscope tip, which has an infrared light in it along with an infrared light sensor. It is connected to electronics that squeal at different pitches according to how much light is reflected back from the client's ear canals or eardrums. I had to train myself to use this by finding lots of examples of all sorts of normal and abnormal ears to check out. Remember that with any clinical assessment it is as important to know the range of what is considered normal as it is to know normal from abnormal.

Another piece of equipment I have specially built is a passive ultrasound unit. This is similar to the device used to listen to the fetal heartbeat in the mother. This device allows me to listen to swallowing, laryngeal (voice box) movements, tongue movements, movement of the temporomandibular joint (the joint where the bottom jaw is attached to the head just in front of the ear), and other similar joint and muscle movements. This equipment also required that I train myself to use it.

Most of the modifications I have done involved putting braille labels on dials, labeling different colored cords, labeling the color of earphones for hearing testing (there is a definite left and right), putting forms on the computer to be filled out from the keyboard, and other similar tasks. One set of tasks more specific to audiology which I have not yet conquered is related to digital equipment. It used to be that equipment had knobs that clicked when you turned them and multi-position switches. Today equipment of all sorts is digital and much of it contains its own computers so screen readers cannot be used. In particular, the programs for hearing aid adjustment that can be run from a computer are graphical in nature, so they cannot be operated by a blind person. At present, this kind of equipment often requires sighted assistance for at least initially setting it up. It may or may not require continued sighted assistance. When a great deal of sighted help will be necessary with a particular piece of equipment it may well be better to refer that particular job to a sighted colleague.

Recently a computer program called The vOICe has become available. This program converts a camera image to sound using the sound card in a PC. This has created the potential for reading x-rays, reading abr and eeg traces in real time, examining graphs in books, reading strip charts as they are printed, and a host of other things. This program's potential may well open up a whole new world to blind clinicians.

ASHA has been largely unhelpful to me as a blind clinician. Their journals are inaccessible as are most of their other materials. They have been nearly completely unresponsive concerning this matter. Any blind person considering audiology or speech pathology should be aware that ASHA's professional material is nearly all inaccessible and often does not scan well. With the Internet, ASHA has developed a number of listservs, which have alleviated this problem in part.

Reading back over this material I find it all a bit depressing. I had not intended it to come out that way, but writing anything less than an honest account of how the past nearly twenty years of clinical work have been for me would be unfair to other potential blind clinicians. When I began my first internship, I quickly discovered that it was going to be very difficult to be hired as a blind person, so I opened my own practice. My supervising clinician (Dr. Hartman) was very supportive and helped make this work for me. I kept that practice and used it for my second internship (the one in audiology) and maintained the practice beyond that internship. I have done contract work for home health agencies and state health departments among other things. All this has not made for an easy time of things but has forced me to learn everything from how to do an oral examination of a client to how to file tax information to both state and federal agencies. I have done everything from advertising to therapy with infants to cleaning bathroom floors as a part of running my practice. I wouldn't trade it for the world but potential clinicians need to be aware that being blind will create some special problems that are well worth overcoming.

At the beginning of this piece I mentioned that I had needed to get several hundred hearing tests done. I did end up doing all the tests myself and finishing my project, which happened to be on electronic travel aids. Unfortunately, I never did much with the project results but did follow up the speech and hearing coursework end of things, so I would say I probably got the better end of the deal.

The Contact: Tom Brennan.

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