Graeme Clark Collection
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ItemVowel imitation task: results over time for 28 cochlear implant children under the age of eight years( 1995)With increasing numbers of implanted children under the age of 4 years, numerous researchers have reminded us of the need for valid, sensitive, and reliable tests of developing speech perception.1,2 In addition to studies of the efficacy of implanted prostheses, there is a need to investigate the many variables that influence children's communicative performance, such as changes in speech-coding strategy, updated speech-processing systems, the effects of various training regimens, and the selection of educational and communication modes.
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ItemSpeech processing for cochlear implants(JAI Press Ltd, 1992)The cochlear implant is a hearing prosthesis designed to replace the function of the ear. The operation of the prosthesis can be described as a sequence of four functions: the processing of the acoustic signal received by a microphone; the transfer of the processed signal through the skin; the creation of neural activity in the auditory nerve; and the integration of the experience of this neural activity into the perceptual and cognitive processing of the implantee.
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ItemCochlear implants in children, adolescents, and prelinguistically deafened adults: speech perception( 1992)A group of 10 children, adolescents, and prelinguistically deafened adults were implanted with the 22-electrode cochlear implant (Cochlear Pty Ltd) at the University of Melbourne Cochlear Implant Clinic and have used the prosthesis for periods from 12 to 65 months. Postoperative performance on the majority of closed-set speech perception tests was significantly greater than chance, and significantly better than preoperative performance for all of the patients. Five of the children have achieved substantial scores on open-set speech tests using hearing without lipreading. Phoneme scores in monosyllabic words ranged from 30% to 72%; word scores in sentences ranged from 26% to 74%. Four of these 5 children were implanted during preadolescence (aged 5:5 to 10:2 years) and the fifth, who had a progressive loss, was implanted during adolescence (aged 14:8 years). The duration of profound deafness before implantation varied from 2 to 8 years. Improvements were also noted over postoperative data collection times for the younger children. The remaining 5 patients who did not demonstrate open-set recognition were implanted after a longer duration of profound deafness (aged 13:11 to 20:1 years). The results are discussed with reference to variables that may affect implant performance, such as age at onset of loss, duration of profound loss, age at implantation, and duration of implantation. They are compared with results for similar groups of children using hearing aids and cochlear implants.
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ItemCochlear implants in children, adolescents, and prelinguistically deafened adults: speech perception( 1992)A group of 10 children, adolescents, and prelinguistically deafened adults were implanted with the 22-electrode cochlear implant (Cochlear Ply Ltd) at the University of Melbourne Cochlear Implant Clinic and have used the prosthesis for periods from 12 to 65 months. Postoperative performance on the majority of closed-set speech perception tests was significantly greater than chance, and significantly better than preoperative performance for all of the patients. Five of the children have achieved substantial scores on open-set speech tests using hearing without lipreading. Phoneme scores in monosyllabic words ranged from 30% to 72%; word scores in sentences ranged from 26% to 74%. Four of these 5 children were implanted during preadolescence (aged 5:5 to 10:2 years) and the fifth, who had a progressive loss, was implanted during adolescence (aged 14:8 years). The duration of profound deafness before implantation varied from 2 to 8 years. Improvements were also noted over postoperative data collection times for the younger children. The remaining 5 patients who did not demonstrate open-set recognition were implanted after a longer duration of profound deafness (aged 13:11to 20:1 years). The results are discussed with reference to variables that may affect implant performance, such as age at onset of loss, duration of profound loss, age at implantation, and duration of implantation. They are compared with results for similar groups of children using hearing aids and cochlear implants.
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ItemSpeech perception results in children using the 22-electrode cochlear implant [Abstract]( 1990)Twenty-one profoundly hearing impaired children ranging in age from 3 to 20 years have been implanted with the 22-electrode cochlear implant (Cochlear Pty ltd) at the University of Melbourne Cochlear Implant Clinic. Five children (aged 6.0 to 14.8 years) have achieved substantial scores on open set speech tests using hearing without lipreading. Phoneme scores in monosyllabic words ranged from 30% to 72%. Word scores in sentences ranged from 26% to 74%. Four of these five children were implanted during preadolescence and the fifth who had a progressive loss, was implanted during adolescence. Eight children (aged 3.0 to 11 years), have either been implanted recently or are too young for detailed assessments. However some have shown using closed set speech perception tests or vowel imitation tasks, that they are beginning to use the auditory input provided by the implant. The remaining children (aged 13.11 to 20.1 years) have not demonstrated open set recognition but are all full time users of the device. This group was implanted during adolescence after a long duration of profound deafness. The results will be discussed with reference to a number of variables which may contribute to successful implant use; such as age of onset of deafness, duration of deafness. age of implantation, educational program and type of training.
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ItemClinical comparison of open-set speech perception with MSP and WSPIII speech processors and preliminary results for the new SPEAK processor [Abstracts]( 1993)There are several studies which compare the WSP III (FOIF11F2) and MSP (Multipeak) speech processors for the Nucleus multiple-channel cochlear implant in small, controlled groups of patients. In the present study we were interested in the benefits of open set speech perception provided by the MSP over the prior WSP III speech processor in a large, unselected clinical population.
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ItemFuture directions in the clinical application of multichannel cochlear prostheses [Abstract]( 1992)Three main areas of work at the University of Melbourne relating to the clinical application of multichannel cochlear prostheses will be discussed. Speech perception results for 40 children and adolescents implanted with the Nucleus multichannel device will be presented with an analysis of potentially predictive clinical factors. Overall results have shown that 60% of the children have developed useful open-set speech recognition ability without visual cues. Due to the improved speech perception for postlinguistically deafened adult cochlear implant patients, the multichannel implant has become a viable alternative for patients with some useful residual hearing. A "bimodal" speech processor which provides acoustic output for the residual hearing ear and electrical output for the cochlear implant will also be discussed. This device provides a flexible, programmable acoustic processor which can make use of feature coding aspects of the implant processing. The "bimodal" device has also addressed problems of incompatibility of the implant signal with the acoustic signal from conventional hearing aids. Results for the new "Spectral Maxima Speech Processor" (SMSP) will also be presented. The SMSP has shown improved speech perception performance in quiet and in noise when compared with the MSP (MULTIPEAK) system, currently in use with the Nucleus device. Results for four subjects with the SMSP showed mean scores of 57.4% for open-set monosyllabic words in quiet, and 78.7% for open-set sentences in a 10 dB signal-to-noise ratio
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ItemHabilitation issues in the management of children using the cochlear multiple-channel cochlear prosthesis( 1993)Since 1985, a significant proportion of patients seen In the Melbourne cochlear Implant clinic have been children. The children represent a diverse population, with both congenital and acquired hearing-impairment, a wide-range or hearing levels pre-Implant, and an age range from 2 years to 18 years. The habilitation programme developed for the overall group must be flexible enough to be tailored to the Individual needs of each child, and to adapt to the changing needs or children as they progress. Long-term data shows that children are continuing to show Improvements after 5-7 years of device use, particularly In their perception of open-set words and sentences. Habilitation programs must therefore be geared to the long-term needs of children and their families. Both speech perception and speech production need to be addressed In the specific content of the habilitation program for any Individual child. In addition, for young children, the benefits or Improved speech perception should have an Impact on development of speech and language, and the focus of the programme for this age child will reflect this difference In emphasis. Specific materials and approaches will vary for very young children, school-age and teenage children. In addition, educational selling will have a bearing on the Integration of listening and device use Into the classroom environment.
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ItemFuture developments in speech processing for multichannel cochlear implants in children [Abstract]( 1992)The average speech perception score for adult implant patients is now about 60% on an open-set sentence test without lipreading. This is higher than the scores obtained by many profound and severe-to-profoundly impaired hearing aid users. This suggests that some hearing aid users, particularly those who use a hearing aid in one ear only, could benefit from a cochlear implant. As neither the implant nor the hearing aid will provide perfect speech recognition it is to be expected that this group should obtain maximum benefit by using the hearing aid in one ear together with the implant in the other ear. However, experience with this group of patients has shown that many people find the use of two independent devices unacceptable. Furthermore, perceptual interaction of the acoustic and electrical signals makes it desirable to be able to control the two outputs in a more co-ordinated way than is possible with two independent devices. Consequently, a "bimodal" speech processor has been developed with both acoustic and electrical outputs controlled from the same speech processing unit. Feature coding aspects of the implant processing have been applied to the acoustic signal in such a way as to enhance speech perception with the hearing aid and improve compatibility with the implant. Initial testing with the bimodal aid shows promise to help severely-to-profoundly impaired individuals. The device has also been useful as a research tool to investigate the complex interactions of simultaneous acoustic and electrical stimulation. The Spectral Maxima Sound Processor (SMSP) has also been developed at the University of Melbourne for use with the Nucleus cochlear implant. Studies with adult subjects have shown improved perception of vowels, consonants, words and sentences in quiet and sentences in background noise with the SMSP as compared with the MSP(MULTIPEAK) which is currently supplied for use with this implant. Results for four subjects showed mean scores for open set sentences at a 10 dB signal-to-noise ratio of 78.7% for the SMSP and 50.0% for the MSP. Mean scores for the same group on open set monosyllabic words in quiet were 57.4% for SMSP and 39.9% for MSP. These results suggest that future improvements in speech perception will be possible for children using the Nucleus cochlear implant.
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ItemFactors affecting speech perceptual performance for children using the 22-electrode cochlear prosthesis [Abstract]( 1992)Speech perception results for all 40 children and adolescents implanted with the. Nucleus 22 electrode cochlear prosthesis in Melbourne (as of February 1, 1992) were used to categorize performance for each child into one of six hierarchical groups: 1: detection of speech including high frequencies 2: discrimination of suprasegmental features of speech in addition to 1,3: discrimination and recognition of .vowel sounds in addition to 1 and 2,.4: discrimination arid recognition of consonant sounds in addition to 1, 2 and 3,5: open set speech. recognition with scores less than 20% for unfamiliar material in addition to 1 to 4,6: open set speech recognition with scores greater than 20% for unfamiliar material in addition to 1 to 5, above.All children demonstrated discrimination of suprasegmentals (level 2) and 58% demonstrated some openset speech recognition (levels 5 and 6). The pattern of results suggested that children who can discriminate segmental features of speech tend to achieve open set speech perception after adequate experience with the prosthesis. The performance level, described above, was used as the dependent variable in a multiple regression analysis to assess the effect of various factors on speech perception performance. The duration of profound hearing impairment and the amount of experience with the prosthesis were shown to contribute significantly to the variance, in performance level. A weaker trend was evident (or recently implanted children which may suggest that those' in oral/aural educational settings progress more rapidly, in terms of speech perception, than those in total communication settings. Age at implantation, cause of deafness, hearing levels prior to implantation, and number of electrodes in use, did not contribute significantly. to the variance in speech perception performance for these children. The results showed that all children with less than seven years of profound hearing impairment and with over one year of experience with the prosthesis have achieved some open-set speech recognition. This is an encouraging result as the trend in clinical application of cochlear prostheses has been towards implanting younger children in recent years. If this sample of hearing-impaired children in Melbourne is representative of the general population, we may expect that most implanted young children will ,develop reasonable speech perception skills after adequate experience and training.