We hear many success stories from professionals who have added LACE to their practice. In this ongoing series, we will publish new success stories from the hearing healthcare community. Have a story to share or a question about our Professional Services?

• Click Here to contact an account representative

---

Table of Contents

• A Proven Method for Integrating LACE Into a Hearing Aid Practice
  by By Kathy Amos, audiologist and owner of Posey's Hearing Aid Center


• LACE Clinic Edition takes auditory training to a whole different level
  by Mary Beth Wright, MS, F-AAA


• My patients using LACE are delighted to be doing something besides waiting for the hearing aids to kick in
  by Dr. Jane Watson


• Developing a Breakthrough Strategy in LACE Compliance
  by Trisha Ostermeier, A.u.D.


• LACE - a Tool Worth its Weight in Gold!
  by Ross Osborne, B.C.H.I.S.


• Getting Your Patients To Use LACE
  by Juliette Sterkens & Melody Martin


• You Don't Need to Have a Hearing Loss to Benefit from LACE
  by Frank Butts, Ph.D.


• LACE has improved my return rate while taking a ton of work off my plate
  by Crystal L. Chalmers, Au.D

---

A Proven Method for Integrating LACE Into a Hearing Aid Practice

by Kathy Amos, Audiologist and Owner
Posey's Hearing Aid Center

Over the past six months, Kathy Amos, audiologist and owner of Posey's Hearing Aid Center in Walnut Creek, California, has developed a remarkably successful and cost-effective method for integrating LACE auditory training into a hearing aid dispensing practice.

Click Here to download Kathy's complete story and the How-To of her method (PDF file)

"Over the past six months, Posey’s has dispensed over 500 copies of LACE. Out of the 80% who have done at least one LACE session at home, only two have returned their hearing aids. One patient had done two LACE sessions and the other did three. So it would seem from our results over six months with several hundred patients that if the patient gets past the first five LACE sessions, the hearing aids are not returned.
Given that we started the year with over 20% returns, LACE has made a dramatic contribution to our top line revenue. But this contribution to our profitability is not the most important result of implementing LACE. By far the most significant impact of the LACE program is the increase in our patients' communication confidence and, consequently, customer satisfaction."

• Providing patients with low cost incentives and recognition for completing LACE sessions significantly increases compliance.
• Returns were reduced from over 20% to less than 1%.
• Patient compliance with LACE training reached 80%: LACE has been dispensed to 500 patients, and 400 have done at least one session at home. Out of these 400, only two have returned their hearing aids.
• By shifting the patient's focus from the hearing aids (and sometimes repeated adjustments) to their auditory training, LACE reduces the overall practitioner time per patient.

return to top ^

---

LACE Clinic Edition takes auditory training to a whole different level

by Mary Beth Wright, MS, F-AAA
Avada Audiology & Hearing Care Centers

Four months ago our clinic in Mansfield, Ohio started LACE. We chose to start out with the LACE Home Edition (HE), but found that about half of our patients did not have home computers. So we installed the LACE Clinic Edition (CE) in our office, and rapidly discovered some major, unexpected advantages with CE vs. HE. CE gives us more control over the patient doing their listening therapy correctly. Also, the patient has very few distractions or noise in the background, as compared to all sorts of interruptions they face at home.

We have it set up in a separate LACE room, which is bright and cheery, where our patients can do their training on their own. The patients feel like they are getting special treatment in their therapy. We felt close to our patients before we started using LACE CE, but now there's a real family feeling instilled in the patient as they approach completion of their 20th session. It builds rapport between our staff and patients. I would bet they rave about us to their friends. In short, LACE CE takes auditory training to a whole different level.

Ours is a pretty busy practice: we have two practitioners and see about 30 patients/day. The practitioner sits with the patient while they do their first session of LACE, especially to encourage them in going through the first QuickSIN™ test. Our secretary then takes care of the patient for the rest of their LACE sessions. She did LACE herself, and is a strong believer in the value of the training and has become our LACE Coach.

At this time, we have had 40 people perform LACE training, roughly 20 at home with LACE HE and 20 in our clinic using CE. The patients using CE usually come into the clinic three times weekly, sometimes only twice, and take 7-8 weeks to complete their 20 sessions. When patients ask us for our recommendation on whether they should use LACE HE or CE, we encourage them to go with CE as we feel it is a better overall experience. At first we expected pushback from the patients about having to come into the clinic because of gas prices. To our surprise, we have had none whatsoever.

Having all these patients coming in and out every day to do their LACE training makes our already busy clinic look even busier. Consequently, people come in, see the crowds in the waiting room and figure these folks must know what they're doing to have so many patients - it looks good to prospective patients.

As for compliance, 40 patients is not a lot of data but here are our initial results on the average number of sessions completed at the point the patient stops doing LACE:
At home using HE: 13 sessions
In the clinic using CE: 18 sessions

In the clinic, the patient gets to take a reward from the LACE coach's bucket of candy after they complete each session. When they finish their 20th session, they get a rather modest graduation prize. These things may sound silly, but never underestimate the power of recognition. To increase compliance with our patients doing LACE at home, we send notes home and call them occasionally to offer encouragement.

LACE CE has truly changed our entire practice in the last few months - it's a whole different environment. For example, follow-up checkups are much shorter than they were before we adopted LACE. Patients rarely ask for changes to their hearing aids. They understand that it is their responsibility to do their training and improve their listening skills.

This has been such a profound change that we now use LACE as part of our "selling" process. It gets discussed as an integral part of the patient's initial visit, and helps us set their expectations as to what were going to do to improve their communication skills and who's responsible for what.

So if you want your hearing aid patients to become your customers for life and part of the family, I heartily recommend your adopting LACE CE - you will be delighted with the results!

return to top ^

---

My patients using LACE are delighted to be doing something besides waiting for the hearing aids to kick in

By: Dr. Jane Watson
Clinical Audiologist and owner of Audicles Hearing Services, San Antonio Texas

It was only six weeks ago that I started trying LACE in my practice, and I've already become a convert. My motivation wasn't reducing returns, as the return rate in our clinic is minimal. My introduction to LACE was a lecture by Dr. Robert Sweetow a few years ago. What finally got me started was a number of patients coming to us with articles or other information about LACE. I decided to try it out on patients with a variety of hearing losses to see how much of a difference it would make to them. To maximize my chances of initial success, I deliberately picked bright, active people who I thought would be diligent about doing LACE at home, and was happy that all six patients I offered LACE to jumped at it. The woman with the greatest hearing loss is a candidate for a cochlear implant; I was very impressed that LACE works for her. She likes the helpful hints the most, and even quotes them to me! She has done all 20 sessions and felt like she got some important information and coping skills.

The patient doesn't have to be a computer whiz to do LACE, as it's very user friendly. I've gotten a few phone calls from these early users about not doing so well and getting a bit discouraged. I've told them to persevere with the sessions and be consistent about doing it at a particular time every day when they're not feeling tired. One patient with an enjoyable sense of humor said she was delighted to be doing something besides waiting for the hearing aids to kick in.

How do I benefit personally from LACE? Well, it makes me feel that I'm providing more than just hearing aids and working more together with my patients to optimize their communication abilities. Two things become clear to the patient: they have to take responsibility for their auditory training, and they have to have realistic expectations about what they are going to accomplish. I've done three LACE sessions myself so far, and I have to say they're hard! It's not just a walk in the park. I believe every practitioner who is going to dispense LACE should go through the training themselves. It can make us a little more compassionate about our patient's everyday challenges and gain a better understanding of what it's like to have a hearing loss.

Doing LACE myself has also helped set my own expectations about LACE. These first three sessions were enough for me to reach the 'aha!' moment and experience what LACE is actually doing to the brain, and I'm excited about finishing the rest of the 20 sessions. And like my most challenged patient, I especially like the helpful hints and communication strategies. From a practical standpoint, having LACE present all this information means that they get reinforcement of the counseling I do on the day of delivery.

So, after just six weeks and positive results from all my initial LACE users, I'm convinced that LACE needs to be an integral part of our hearing aid dispensing protocol. I feel very comfortable asking most of my patients to do the program when they get their new aids.

return to top ^

---

Developing a Breakthrough Strategy in LACE Compliance

By: Trisha Ostermeier, A.u.D., Clinical Audiologist
Evergreen Speech & Hearing Clinic, Redmond, Washington

Evergreen Speech and Hearing Clinic is a private practice with three locations in Redmond, Kirkland and Bellevue, Washington. The audiology department consists of five Doctors of Audiology who regularly collaborate on program development to keep improving patient outcomes. Over two years ago, this collaboration resulted in the creation of a new program to better meet the needs of our hearing patients. During the development of this new program, the product LACE was introduced to the team, and we integrated it into our program.

How did we apply LACE?
For over a year, LACE was introduced to each patient during the consultation appointment, after his or her hearing evaluation. This delivery format simply placed the opportunity in their hands, like a gym membership, and told them to go "work out" to "exercise" their hearing. We emphasized the importance of this computer-based therapy program in maximizing their ability to communicate. However, as with many gym memberships, we found that few used the product consistently.

Analysis of results
A few months ago, we compiled data from the LACE website on program utilization. The statistics showed a gap in patient motivation. Patients were intrigued, but didn't know how to maximize the value of the entire program. We decided to look deeper. Our audiologist team, together with each member of the office staff, committed to doing LACE over a six-week period in order to gain a user's understanding of the program and its full range of benefits. We kept track of the effects of the program, and I took on the role of LACE coordinator.

What did we learn?
The result of this effort is that we all now know from personal experience how well LACE works, and we are all now true believers. This has resulted in a fundamental attitude change in our company regarding LACE. We are all now re-energized and have become active participants with our patients in driving LACE compliance. Through firsthand experience with the program we have identified four components that greatly affected motivation to complete the program. In addition, we have a better understanding of the areas where difficulties can emerge during the 20-session process.

The greatest motivation resulted from four components:
1. Education on benefits of the program
2. Individualized coaching
3. E-mail encouragement and reminders (Free automated service of NeurotonePro.com)
4. Feedback on results

Application of our personal experience
Since the completion of our in-house case study we have taken these lessons directly to the patient, and are using multiple forms of communication to motivate each individual to work through the program. Since we implemented these changes we have seen a shift in patient attitude and compliance.

I encourage each of you to take time out of your day to walk in your patient's shoes, and try the LACE program. Not only will you have a new outlook on your patient's experience, you might just improve your own communication skills.

return to top ^

---

LACE - a Tool Worth its Weight in Gold!

By: Ross Osborne, B.C.H.I.S.
Miracle-Ear Franchisee, Columbia TN

I have been improving my patients' quality of life for over 16 years, and have been using LACE with my patients for almost a year now. I have seen a lot of new ideas hyped, only to find that they were just gimmicks without any real benefits or proven results. I have always been looking for that extra edge to help my patients in difficult listening situations, and until now, I have had very limited success finding that solution.

When the industry finally made the jump from analog to digital, it solved a lot of issues my patients were encountering on a daily basis. True speech processing, and multiple frequency targeting on hearing aids became reality vs. analog systems just making sounds louder. Later the improvements in directional microphones were a huge help in boosting speech signals in noisy environments. However directional microphones are limited, depending on individual patient speech discrimination abilities. So what was the missing link for helping my patients get the results they wanted after I had exhausted all the technological options hearing aids had to offer? It was the patient's ability to focus and listen!

Countless times I've heard my patient's say, "I can hear one-on-one but I can't hear when three or more people are talking" or "My grandkids talk too fast and they sound like they are mumbling". My answer to all of those concerns was, "You have to work at those difficult listening situations and over time you should do better!" But I had no measurable way for them to learn how, much less monitor their abilities in real time.

Now, with LACE I have a tool that has proven to be worth its weight in gold!

Patients, new and existing, are finding LACE to be an invaluable exercise for their listening skills. When I sit down with patients, I have the confidence that I can help them find a hearing solution to fit their loss and a tool to help them take full advantage of their individual listening skills. Even patients with low discrimination scores can benefit from LACE. One patient with particularly low speech abilities said he found that he was more aware of his hearing abilities now, and had a better understanding of his hearing situation and what it took for him to understand. Almost all my patients who have completed LACE recognize an improvement in their listening ability, and now understand that there is a difference between hearing better and listening better!

LACE is quickly becoming a staple in my practice. With the coming advancements it will easily be incorporated as just part of the normal fitting and adjustment process for every patient striving for better hearing.

Neurotone, thanks for your help and keep up the good work!

return to top ^

---

Getting Your Patients To Use LACE

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.

Hello Melody,
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 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.
Oshkosh, WI

Response from Melody Martin:

Dear Juliette,

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!

Sincerely,
Melody Martin, Ph.D., Au.D

return to top ^

---

You Don't Need to Have a Hearing Loss to Benefit from LACE

By Frank Butts, Ph.D.
Co-owner of Hearing Clinics of Virginia, an eleven-year old practice in Richmond, Virginia

I am a bit out of the ordinary in the world of Audiology and dispensing of hearing aids, having earned my Audiology Ph.D. with a specialization in temporal masking, a form of central auditory processing, focusing on the aging auditory system. We have three offices in the Richmond area with seven audiologists. Our group dispenses hearing aids to about 80 patients per month. We deal with lots of geriatric patients older than 70.

I was attracted to LACE for several reasons:

1. The critical issue for the next generation of hearing aid users will be adapting new hearing aid technologies to their specific environment. LACE demonstrates the critical dimensions of speech perception, and proves to users that improvement is possible.
2. In the future, there will be many places where patients can get high-tech hearing instruments, but few places that will support that technology with outcome-based procedures that ensure the patient will realize real improvement in communication. Those who commit to LACE will be committing to the essential role of therapist, who accepts the need for a long-term relationship with the patient and provides real value for their investment.
3. The process of LACE helps the patient move from the perspective of getting a "fix" for hearing loss with a device, to the perspective of successfully managing a chronic problem - a condition that can be controlled if patient and audiologist commit to a treatment plan. Moreover, LACE is a brief enough treatment course to give patients a sense of accomplishment in a short time while allowing them to continue to practice with the material when they need a booster shot.

Our industry must face the fact that audiologists are historically not therapists. Despite this, we now need to accept the therapy role. The problem is that changing the behavior of professional people is one of the hardest things in the world to do.

Here is perhaps the most interesting and valuable aspect of LACE that we have identified: virtually everyone over the age of 50 has some speech processing difficulties; we just don't multitask that well after 50. Actually, when I did my research at the University of Virginia we found that most people over thirty have some word-processing degradation. There are temporal resolution changes that are unavoidable, especially by age 50. Hence, even with no hearing loss, LACE with its rapid speech and other exercises can benefit practically everyone. Consequently, from a business standpoint we see LACE as a way to introduce people to the idea of exercising their brains. Some significant percentage of these people will ultimately need some form of amplification to go with their LACE auditory training.

We know that incorporating LACE into our practice will take commitment, and that patients and audiologists alike will experience frustration with the learning of new ways to deal with this difficult problem. However, the opportunity exists to change the world's perception of hearing aids from something that costs a lot and doesn't work to instruments that, when properly fitted and used in concert with a rehabilitation treatment plan, will yield a real improvement in the quality of life.

return to top ^

---

LACE has improved my return rate while taking a ton of work off my plate

by Crystal L. Chalmers, Au.D
Clinical Audiologist and owner of North State Audiological Services, Chico, CA

My patients and I love the LACE aural rehabilitation program. Nearly 100% of my patients are provided with LACE when they are fitted with new hearing aids, regardless of whether they are first-time or experienced hearing aid wearers. I love it because it is such a great tool for successful aural rehabilitation, and aural rehabilitation is the very foundation of clinical Audiology. The patients love it because they can see first-hand the progress and improvements that they make after every session.

For patients who don't have home computers, I have LACE CE set up in my neuroscience lab. I am fortunate in that about 75% of my patients have home computers, so there is no logjam of patients waiting to use LACE CE in the lab. I currently have three patients who come into the lab every weekday to do LACE and have been doing so for the last two weeks. With the success of LACE CE, I've started hearing support groups at three local retirement communities and am setting up LACE CE for the residents to use.

I am such a believer in the LACE program that I've put together my own LACE display, which sits on the counter in the front office (see photo). The new, bright green LACE packaging works extremely well; people gravitate to it. I don't have any other promotional material in the clinic - only the LACE point-of-sale display.

Before I put up this display, LACE wasn't always at the top of my mind. Now, the display is a reminder for me and encourages the patients to inquire about it with about 90% of them asking, "Is this for me?" I am convinced the display is a big reason LACE usage has reached nearly 100% in the last six months.

While aural rehabilitation has been a big contributor to my historically very low return rates, LACE has improved this rate even more while taking a ton of work off my plate.

return to top ^

---