Graeme Clark Collection
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ItemContributing factors to improved speech perception in children using the nucleus 22-channel cochlear prosthesis( 1997)It has been established that use of multiple-channel intracochlear implants can significantly improve speech perception for postlinguistically deafened adults. In the development of the Nucleus 22-channel cochlear implant, there have been significant developments in speech processing strategies, providing additional benefits to speech perception for users. This has recently culminated in the release of the Speak speech processing strategy, developed from research at the University of Melbourne. The Speak strategy employs 20 programmable bandpass filters which are scanned at an adaptive rate, with the largest outputs of these filters presented to up to ten stimulation channels along the electrode array. Comparative studies of the Speak processing strategy (in the Nucleus Spectra-22 speech processor), with the previously-used Multipeak (Multipeak) speech processing strategy (in the Minisystem-22 speech processor), with profoundly deaf adult cochlear implant users have shown that the Speak processing strategy provides a significant benefit to adult users both in quiet situations and particularly in the presence of background noise. Since the first implantation of the Nucleus device in a profoundly hearing-impaired child in Melbourne in 1985, there has been a rapid growth in the number of children using this device. Studies of cochlear implant benefits for children using the Nucleus 22-channel cochlear implant have also shown that children can obtain significant benefits to speech perception, speech production and language, including open-set understanding of words and sentences using the cochlear implant alone. In evaluating contributing factors to speech perception benefits available for children, four specific factors are important to investigate: (1) earlier implantation -resulting from earlier detection of deafness; (2) improved hardware and surgical techniques -allowing implantation in infants; (3) improved speech processing, and (4) improved habilitation techniques. Results reported previously have been recorded primarily for children using the Multipeak strategy implemented in the MSP speech processor. While it is important to evaluate the factors which might contribute to improvements in speech perception benefits, an important question is the effect of improved speech processing strategy, since this will determine what is perceived through the device. Given that adult patients changing to the Spectra speech processor had also shown improved perception in noisy situations, and the fact that children are in general in noisy environments in the classroom setting for a large proportion of their day, it was of obvious interest to evaluate the potential for benefit in poor signal-to-noise ratios from use of the Speak processing strategy and from specific training in the ability to perceive in background noise. The study was aimed at evaluating whether children who were experienced in use of the Multipeak speech processing strategy would be able to changeover to the new Speak processing strategy, which provides a subjectively different output. Secondly, the study aimed to evaluate the benefits which might accrue to children from use of controlled habilitation in background noise.
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ItemThe effect of language knowledge on speech perception: what are we really assessing?( 1997)Objective: The authors examined whether open-set speech perception scores are limited by knowledge of vocabulary and syntax and further considered whether remediation of vocabulary and syntax will increase open-set speech perception scores. Study Design: This was a repeated-measures study design in the setting of a primary (elementary) school for the hearing impaired. Patients: The study population was composed of three hearing-impaired children using Nucleus 22-channel cochlear implant. Intervention: Intervention used was language remediation sessions. Main Outcome Measures: The main outcome measures were assessment of auditory-alone speech perception benefit using open-set words and sentences and assessment of syntactic knowledge using the Test of Syntactic Ability. Outcome measures were applied before and after remediation. Results: Child 1 and child 2 showed a significant postremediation improvement in their overall scores on the Test of Syntactic Ability and in their ability to perceive words learned during remediation. Child I and child 2 also showed a significant improvement in their scores on a modified Bamford-Kowal-Bench open-set sentence test, which specifically targeted grammatical constructs trained in remediation sessions. Conclusions: Remediation of language knowledge deficits significantly improved open-set speech perception for two children, suggesting a need to include language remediation in cochlear implant habilitation programs.
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ItemSpeech perception results for children with implants with different levels of preoperative residual hearing( 1997)Objective: Many reports have established that hearing-impaired children using the Nucleus 22 channel cochlear implant may show both significant benefits to lipreading and significant scores on open-set words and sentences using electrical stimulation only. These findings have raised questions about whether severely or severely-to-profoundly deaf children should be candidates for cochlear implants. To study this question, postoperative results for implanted children with different levels of preoperative residual hearing were evaluated in terms of speech perception benefits. Study Design/Setting: A retrospective study of the first 117 children, sequentially, to undergo implantation in the Melbourne and Sydney Cochlear Implant Clinics was undertaken. All children had been assessed by and received their implants in a tertiary referral centre. Main Outcome Measures: To assess aided residual hearing, the children were grouped into four categories of hearing on the basis of their aided residual hearing thresholds measured preoperatively. To assess benefits, the scores of children on standard speech perception tests were reviewed. As different tests were used for children with different ages and language skills, children were grouped into categories according to the level of postoperative speech perception benefit. Results: The results showed that children in the higher categories of aided preoperative residual hearing showed significant scores on open-set word and sentence perception tests using the implant alone. For children in lower categories of aided residual hearing, results were variable within the groups. More than 90% of children with implants with aided residual hearing thresholds in the speech range above I kHz achieved open-set understanding of words and sentences. Conclusion: While the results of this preliminary study confirm previous findings of differential outcomes for children with different levels of preoperative residual hearing, they suggest that children with severe to profound hearing impairments should be considered for cochlear implantation.
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ItemThe Melbourne Cochlear Implant Clinic program(Singular Publishing, 1997)The Melbourne Cochlear Implant Clinic program involves a multidisciplinary clinical team, collaborating with those engaged in more fundamental research, and with the biomedical company Cochlear Limited. This chapter reflects the contributions of many professionals to managing children with cochlear implants.
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ItemIntroduction(Singular Publishing, 1997)From the time single-channel cochlear implants were first implanted in children in the early 1980s in Los Angeles (Laxford et al 1987) closely followed in 1985 by the multiple-channel cochlear implant in Melbourne (Clark et al 1987a, 1987b) there has been a considerable expansion in the work to apply the multiple-channel cochlear implant to infants and young children.
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ItemEthical issues(Singular Publishing, 1997)The ethics of cochlear implantation in infants and children is an important issue which has received a lot of attention, in particular from the signing deaf community and their advocates. Many of the issues raised by the signing deaf community are in regard to human experimentation and are therefore ethical in nature. Others are concerned with whether it is natural to have a hearing loss, and this goes beyond the realm of ethics. This chapter examines cochlear implantation in children in light of generally accepted ethical principles.
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ItemSpeech perception in implanted children: influence of preoperative residual hearing on outcomes [Abstract]( 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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ItemA modification of play audiometry to assess speech discrimination ability in severe-profoundly deaf 2- to 4-year-old children( 1998)Objective: The aim was to develop an assessment procedure that was independent of language and speech production ability, to test speech feature discrimination severe-profoundly deaf children 2 to 4 yr of age. Design: The procedure being trialled was adapted from existing procedures. The child was required to respond with a game-like motor response to a “change” in a speech stimulus that was being presented repeatedly through a speaker. The change occurred at randomly determined times, and false alarm responses were measured during the waiting periods (while the child waited for the change). Two- to four-yr-old normally hearing children and hearing-impaired children using hearing aids and a group of 4-yr-old hearing-impaired children using cochlear implants were assessed on the task. Results: More than 82% of the 3- and 4-yr-old normally hearing and hearing-impaired children were able to complete the testing for the eight speech sound contrasts within three 20 minute sessions. Fifty percent of the 2-yr-old normally hearing and hearing-impaired children were able to condition and complete the task. All of the normally hearing children who completed the task successfully discriminated all speech sound contrasts. The performance of the hearing-impaired children using hearing aids was influenced by the degree of hearing loss and the type of speech contrast being tested. Similarly, the average performance of the children using cochlear implants was better for easier contrasts such as /ba/bi/ with contrasting vowel formant cues. Conclusions: This procedure has potential for use as a reliable clinical and research tool for assessing the development of auditory discrimination ability in 2- to 4-yr-old severe-profoundly deaf children.
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ItemWithin-subject comparison of speech perception benefits for congenitally deaf adolescents with an electrotactile speech processor and a cochlear implant( 1996)This study assessed speech perception benefits for three congenitally deaf adolescents who used an electrotactile speech processor (Tickle Talker™) and subsequently went on to use a Nucleus Minisystem 22 cochlear implant. Both devices provided significant and comparable benefits for all children in the device plus lipreading condition. All children benefited from the additional information provided by either the Tickle Talker™ or the cochlear implant, and were able to perceive speech information with these devices that was not available through either aided residual hearing or lipreading. None of the three children were able to understand open-set words or sentences using either hearing aids alone or Tickle Talker™ alone, without the aid of lipreading. Two of the children showed significant open-set speech perception benefits while using their cochlear implant alone.
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ItemMultichannel auditory brainstem implants: an Australian case study [Abstract]( 1996)The multichannel Auditory Brainstem Implant (ABI) is an implantable device designed to restore a level of auditory perception in patients with bilateral acoustic neuromas, where the removal of the tumours is expected to result in a total loss of hearing. As with the cochlear implant, the ABI utilises an externally worn speech processor and headset, together with a surgically-placed receiver-stimulator and electrode array. The electrode array, developed through the collaboration of the House Ear Institute in the United States and Cochlear Corporation, consists of eight electrodes on a carrier, which is placed on the surface of the brainstem in the area of the cochlear nucleus.