Graeme Clark Collection

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    Speech perception in implanted children: influence of preoperative residual hearing on outcomes [Abstract]
    Cowan, R. S. C. ; Barker, E. J. ; Pegg, P. ; Dettman, S. ; Rennie, M. ; Galvin, K. ; Meskin, T. ; Rance, G. ; Cody, K. ; Sarant, J. ; Larratt, M. ; Latus, K. ; HOLLOW, RODNEY ; Rehn, C. ; Dowell, R. C. ; Pyman, B. ; Gibson, W. P. R. ; Clark, Graeme M. ( 1998)
    Since the first child was implanted with the Nucleus 22-channel prosthesis in Melbourne in 1985, several thousand children world-wide have now benefitted from this technology. More effective paediatric assessment and management procedures have now been developed, allowing cochlear implants to be offered to children under the age of 2 years. Improvements in speech processing strategy have also been implemented in the Nucleus implant system, resulting in increased mean speech perception benefits for implanted adults. Although a range of performance on formal measures of hearing, speech or language has been reported for children using implants, results from the first decade of implant experience consistently show that significant benefits are available to children receiving their implant at an early age. Reported speech perception results for implanted children show that a considerable proportion (60%) of paediatric patients in the Melbourne and Sydney clinics are able to understand some open-set speech using electrical stimulation alone. These results, and the upward trend of mean speech perception benefits shown for postlinguistically deafened adults have raised questions as to whether severely, or severely-to-profoundly deaf children currently using hearing aids would in fact benefit more from a cochlear implant. To investigate the potential influence of the degree of preoperative residual hearing on postoperative speech perception, results for all implanted children in the Melbourne and Sydney cochlear implant programs were analysed. Results showed that as a group, children with higher levels of preoperative residual hearing were consistently more likely to achieve open-set speech perception benefits. Potential factors in this finding could be higher levels of ganglion cell survival or greater patterning of the auditory pathways using conventional hearing aids prior to implantation. Conversely, children with the least preoperative residual hearing were less predictable, with some children achieving open-set perception, and others showing more limited closed-set benefits to perception. For these children, it is likely that preoperative residual hearing is of less significance than other factors in outcomes.
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    The development of the Melbourne/Cochlear multiple-channel cochlear implant for profoundly deaf children
    Clark, Graeme M. ; Busby, Peter A. ; Dowell, Richard C. ; Dawson, Pamella W. ; Pyman, Brian C. ; Webb, Robert L. ; Staller, Steven J. ; Beiter, Anne L. ; Brimacombe, Judith A. ( 1992)
    In 1978-79, a speech processing strategy which extracted the voicing (FO) and second formant (F2) frequencies and presented these as rate and place of stimulation respectively to residual auditory nerve fibres was developed for the University of Melbourne's prototype multiple-channel receiver-stimulator (Clark et aI1977, Clark et a11978, Tong et aI1980). This speech processing strategy was shown to provide post linguistically deaf adults with some open-set speech comprehension using electrical stimulation alone, and considerable help when used in combination with lipreading (Clark et al 1981).
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    Preliminary speech perception results for children with the 22-electrode Melbourne / cochlear hearing prosthesis
    Sarant, J. Z. ; Clark, Graeme M. ; Cowan, Robert S. C. ; Dowell, R. C. ; Pyman, B. C. ; Dettman, S. J. ; Dawson, P. W. ; Rance, G. ( 1992)
    The Cochlear 22-electrode cochlear prosthesis was first implanted in a child at the Cochlear Implant Clinic at the University of. Melbourne and Royal Victorian Eye & Ear Hospital in 1985. Since that time 42 children have received the device in Melbourne. Analysis of patient details shows that the majority of these children have a congenital as opposed to on acquired aetiology of hearing loss. In all but 3 cases, the children use 15 or more electrodes. In order to assist with evaluation of, benefits to speech perception across the very heterogeneous group of children, a six level hierarchical classification scheme for speech perception performance levels was created. All of the children achieved a minimum of Category 2 (discrimination of suprasegmental information). In total, 59 % of the children achieved Category 5 or 6 (open set recognition for unfamiliar materials). Analysis showed that the majority of these children had more than one year of experience. In contrast, the majority of children in Category 2 are those with less than one year of experience with the device.
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    Improvements in speech processing for the nucleus cochlear implant [Abstract]
    Cowan, Robert S. C. ; Dowell, R. C. ; McDermott, H. D. ; McKay, C. ; Clark, Graeme M. ( 1992)
    The Nucleus Cochlear implant allows ~ variety of multiple channel speech processing strategies to be developed and trialled. The initial strategy first developed by the University of Melbourne presented the second formant frequency as place and voicing as rate of stimulation. The strategy was subsequently improved by presenting the first format on a place basis as well. Since that time the addition of more spectral information coded as place of stimulation and temporal information presented as variations in amplitude have resulted in better open-set CNC word and sentence scores for electrical stimulation alone. One of the improved strategies selects four pairs of electrodes from the 22 electrode array each glottal pulse to present the first and second formants as well as the output from two high Frequency band pass filters. The other strategy stimulates six of the 22 electrodes representing the six maximal outputs from 16 bandpass filters. The clinical results have shown that both the above strategies results in better open-set speech perception for electrical stimulation in quiet and in noise. 80 % scores have been obtained for open-sets of CNC words and 90 % for open-sets of words in sentences for some of the patients using the latter strategy.