Graeme Clark Collection
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ItemIssues in long-term management of children with cochlear implants and tactile devices [Abstract]( 1994)For many children with severe and profound hearing losses, conventional hearing aids are unable to provide sufficient amplification to ensure good oral communication and/or in the case of very young children, development of speech and language. Traditionally a number of these children have opted for the use of sign language alone or in Total Communication approaches as a primary means of communication. The advent of multiple channel cochlear implants for children and the continuing development of multiple channel speech processing tactile devices provide auditory approaches to resolving communication difficulties for these children. The successful use of such devices depends on a number of factors including the information provided through the aid; the ease of use, convenience and reliability of the aid; the individual communication needs of the child; and the habilitation and management program used with the device. Long-term data has shown that children continue to show increased speech perception benefits from improvements in speech processing and from further experience with these devices. Habilitation and management programs must therefore be geared to meet the changing needs of children as they progress and of families as children mature and face new challenges. Habilitation must address specific individual needs in speech perception and in speech production. For very young children, benefits of improved speech perception should have an impact on the development of speech and language, and habilitation and management must emphasise the need for language growth.
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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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ItemPerformance benefits and costs for children using cochlear implants and hearing aids [Abstract]( 1998)The value of cochlear implants as an established clinical option for profoundly hearing impaired adults and children has been supported by significant research results over a number of years which has clearly established the benefits available (U.S. National Institutes of Health Consensus Statement 1995). Benefit has traditionally been considered as the direct impact of the cochlear implant procedure on speech perception, or in the case of children, on the use of that auditory information to develop understandable speech and to acquire a knowledge of language. As a consequence of continuing research to improve hardware and speech processing strategies, mean scores on open-set tests of monosyllables or sentence materials for implanted adults using the cochlear implant alone without lipreading have continued to show an upwards trend. In response to the increased mean scores in quiet, perception tests in background noise are now being used as a more accurate direct measure of the potential benefits of cochlear implants to severely-to-profoundly hearing-impaired candidates. Consideration should also be given to indirect benefits, such as reduction in the stress of listening and lipreading, improved performance at work, enhanced opportunity to maintain speech, or in children to develop speech which is understandable to the general community, and the social effects of reducing the isolating effects of profound deafness. Measurement of indirect benefit can be combined with an analysis of the costs of the procedure, enabling evaluation of the implant procedure from a cost-utility standpoint, and a comparison of outcomes using other technologies such as hearing aids. This study will present data on direct and indirect benefits for hearing-impaired children using Nucleus cochlear implant systems, and compare this data with benefits shown for similarly hearing impaired children using hearing aids. The significance of these results to cost-effective delivery of services will be discussed.