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Rehabilitation of the Deafened Adult

The Department of Health has given high priority recently to improving the services for the physically handicapped including the hearingimpaired. The advisory structure has been reorganized, and a multidisciplinary group has been set up to advise about the development of services for the hearing-impaired. It is important to try and identify the way in which the service for the deaf needs to develop, resources permitting. Let us now consider the principles which might govern the development of rehabilitation services for the hearing-impaired adult. I will borrow a classification developed in the social medicine field of primary, secondary and tertiary prevention. Primary prevention is concerned with preventing a disease or handicap occurring at all and will not be further mentioned. Secondary prevention is concerned with the earliest possible recognition of disease and its prompt treatment by the best available methods. Ideally the outcome of secondary prevention is cure. Tertiary prevention is concerned with ameliorating any handicap persisting after the initial clinical intervention, and this is the concept particularly applicable to deafness and other chronic disorders for which so often little can be done to cure. In discussing secondary prevention, it might be helpful to ask whether the hearing-impaired come forward sufficiently early for assessment; when they are assessed, are hearing aids prescribed at a sufficiently early stage? Does the health service offer a sufficiently wide range of hearing aids for use by the hearing-impaired? In tertiary prevention we are concerned with a wide range of understandable reactions to persistent and severe deafness, the recognition of which is all important in the management of the deaf person's handicap. This includes maladaptive behaviour, the first sign of which may be difficulty in coping with everyday life, followed by the social withdrawal. In turn this may lead to depressive illness, which is so common among the deaf, or more rarely the development of paranoid states, as has been described recently (Garside & Roth 1974). Both are preventable to some degree. There are of course many other handicaps of a less serious nature than mental illness which may arise in the course of severe and persistent deafness, such as apparent inattention, or failure of voice control which may be misinterpreted as obtuseness, eccentricity, confusion or even dementia in the elderly. These manifestations are highly susceptible toameliorationifrecognized for what they are and properly dealt with by experts.