Graeme Clark Collection
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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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ItemSpeech perception for children with different levels of residual hearing using the cochlear 22-channel cochlear prosthesis [Abstract[( 1996)Over the past 10 years, since the implantation of the first children with the Nucleus 22-channel cochlear prosthesis in Melbourne, the number of profoundly deaf children using this implant system has rapidly expanded. Longer-term experience with implanted children has led to improvements in paediatric assessment and management. Speech processing strategies have also been improved, resulting in a series of increases in speech perception benefits. Results of comparative studies of Speak and Multipeak speech processing strategies have shown that open-set word and sentence scores for a group of thirteen children evaluated over a two year period showed an advantage with the Speak speech processing strategy. The increases were noted particularly in speech perception in poor signal-to-noise conditions. Analysis has shown that consonant perception was significantly increased, due to an improved place perception. Given current speech perception scores for implanted children, it has been suggested that severely-to-profoundly deaf children currently using hearing aids could in fact benefit more from a cochlear implant. Preliminary investigation of results for children in the Melbourne and Sydney cochlear implant programs has shown that children with higher levels of preoperative residual hearing as a group do score significantly on open-set word and sentence perception tests using the implant alone. In children with lower levels of residual hearing, results were variable across the group.
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ItemThe progress of children using the multichannel cochlear implant in Melbourne( 1995)Multi-channel cochlear implantation in children began in Australia in 1985 and there are now close to 4000 profoundly deaf children and adolescents using the Australian implant system around the world. The aim of the implant procedure is to provide adequate hearing for speech and language development through auditory input. This contrasts with the situation for adults with acquired deafness where the cochlear implant aims to restore hearing for someone with well-developed auditory processing and language skills. As with adults, results vary over a wide range for children using the Multi-channel implant. Many factors have been suggested that may contribute to differences in speech perception for implanted children. In an attempt to better understand these factors, the speech perception results for children implanted in Melbourne were reviewed and subjected to statistical analysis. This has indicated that the amount of experience with the implant and the length of sensory deprivation are strongly correlated with perceptual results. This means that younger children are likely to perform better with an implant and that a number of years of experience are required for children to reach their full potential. The results have also indicated that educational placement and management play a crucial role in children reaching their potential. Overall, 60% of the children and adolescents in the study have reached a level of open-set speech understanding using the cochlear implant without lipreading.
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ItemHabilitation issues in the management of children using the cochlear multiple-channel cochlear prosthesis(Wien, 1994)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-impairments, a wide-range of 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 of 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 of 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 setting will have a bearing on the integration of listening and device use into the classroom environment.
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ItemPreliminary speech perception results for children with the 22-electrode Melbourne/ cochlear hearing prosthesis( 1993)The 22-electroce cochlear prosthesis developed by the University of Melbourne and Cochlear Pty. Ltd. has been shown to provide significant speech perception benefits to profoundly deafened adults. More recently, use of an improved Multipeak encoding strategy has significantly improved speech perception performance both in quiet and in noise. Benefits to speech perception in children have not as yet been fully documented, in part due to the shorter history of implant use in children and the smaller overall number of children implanted as compared with adults. The first implantation of the 22-electrode cochlear prosthesis in a child was carried out in Melbourne in January of 1985. In Melbourne, a 5-year-old child was operated on in April 1986, and a first congenitally deaf child in April 1987. The age of implantation has been progressively reduced, with the first 2-year-old child implanted in Melbourne in 1990. As at January 1992, approximately 1,200 children (under 18 years of age inclusive) have been implanted worldwide with the 22-electrode cochlear prosthesis. Of this number, approximately 50% are under the age of 6 years. The age of the child, aetiology of the hearing loss, age at onset and duration of the hearing loss, education program attended both prior to and subsequent to implantation, and parental motivation to assist in habilitation are all factors which may affect an individual child's development and progress with the device. Evaluation of performance in children is complicated by a number of issues, including the effects of delayed speech and language development, and the ability of individual children to perform auditory tests. The measure of performance chosen for any evaluation will also reflect the interests of the particular clinician. For example, effects of device use on speech production may be of interest to the speech therapist, whereas educational progress will be of primary importance to the teacher of an implanted child. However, in choosing an appropriate evaluation test to measure progress woth the cochlear prosthesis, it is vital to realize that all measures such as effects of device use on speech production, educational progress, development of language, and effects on social and communication skills depend on the child being able to accurately perceive speech information through her/his device.
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ItemMulti-channel cochlear implants for children: the Melbourne Program( 1991)Although there have been 300 years of deaf education, profoundly-totally deaf children today on average are not able to reach the same level of achievement as their normally hearing peers (Geers & Moog, 1989). This failure of deaf children to develop their true potential is largely due to the difficulty they have in communicating with normally hearing people. During the last 300 years there have been basically two different methods of education used (The New Encyclopaedia Britannica, 1983). Firstly, one which maximises auditory and lip reading cues (auditory/oral), advocated by Juan Pablo Bonet (1620), and one which uses a series of signs to convey meaning (signing), developed by Charles-Michel (1712-89). In addition, there is a method which endeavours to combine both auditory/oral and signing approaches called total communication. In practice, however, children taught by total communication tend to receive speech more predominantly by one or other of these methods.
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ItemSpeech perception results for children changing from multipeak to SPEAK speech processing strategy [Abstract]( 1996)In mid-1994, a new speech processing strategy termed SPEAK was introduced for the Nucleus Spectra-22 cochlear prostheses. To compare benefits in implanted children changing to the SPEAK strategy, speech perception in a group of twelve children from Melbourne and Sydney was evaluated. The children were assessed in quiet and in background noise.
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ItemFactors affecting speech perception in children cochlear 22-channel cochlear prosthesis [Abstract]( 1996)Since the implantation of the first children with the Nucleus 22-channel cochlear prosthesis in Melbourne in 1985, there have been rapid expansion world-wide in the number of children using this implant system. Longer-term experience with implanted children has led to improvements in paediatric assessment and management. Speech processing strategies have also been improved, resulting in a series of increases in speech perception benefits.
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ItemSpeech perception results for implanted children with different levels of preoperative residual hearing [Abstract]( 1996)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 suggestions that severely or severely-to-profoundly deaf children might benefit more from a cochlear implant than conventional amplification.
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ItemSpeech perception benefits for implanted children with preoperative residual hearing [Abstract]( 1995)Since the implantation of the first children with the Nucleus 22-channel cochlear prosthesis in Melbourne in 1985, there has been rapid expansion in the number of implanted children world-wide. Improved surgical technique and experience in paediatric assessment and management have contributed to a trend to implant very young children. At the same time there has also been continuing development of improved speech processing strategies resulting in greater speech perception benefits.