Adapting to changed hearing: the potential role of formal training.

Changed hearing occurs when sensorineural loss is acquired or increases, when hearing aids or cochlear implants are first acquired, when hearing aids are reprogrammed, and when cochlear implants are remapped. The changes affect speech perception-a process in which decisions about a talker's language output are made on the basis of sensory and contextual evidence, using knowledge and skill. The importance of spoken communication dictates speedy and optimal adaptation to changed hearing. Adaptation is a process in which the individual acquires new knowledge and modifies skill. Formal training provides the listener with the opportunity to enhance both knowledge and skill by spending time on speech perception tasks without the demands, constraints, uncertainties, and risks associated with everyday communication. Benefits of such training have been demonstrated in terms of improvement on trained tasks and talkers, generalization to untrained tasks and talkers, improvements in self-perceived competence, and reduction of self-perceived handicap. So far, however, we lack information on which aspects of training are responsible for benefit, which aspects of perception are changed, how individual differences interact with the foregoing, and whether these benefits translate into significantly increased participation and quality of life.