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 in children using the advanced Speak speech-processing strategy( 1995)The Speak speech-processing strategy, developed by the University of Melbourne and commercialized by Cochlear Pty Limited for use in the new Spectra 22 speech processor, has been shown to provide improved speech perception for adults in both quiet and noisy situations. The present study evaluated the ability of children experienced in the use of the Multipeak (Mpeak) speech-processing strategy (implemented in the Nucleus Minisystem-22 cochlear implant) to adapt to and benefit from the advanced Speak speech-processing strategy (implemented in the Nucleus Spectra 22 speech processor). Twelve children were assessed using Mpeak and Speak over a period of 8 months. All of the children had over 1 year's previous experience with Mpeak, and all were able to score significantly on open-set word and sentence tests using the cochlear implant alone. Children were assessed with both live-voice and recorded speech materials, including Consonant-Nucleus-Consonant monosyllabic words and Speech Intelligibility Test sentences. Assessments were made in both quiet and in noise. Assessments were made at 3-week intervals to investigate the ability of the children to adapt to the new speech-processing strategy. For most of the children, a significant advantage was evident when using the Speak strategy as compared with Mpeak. For 4 of the children, there was no decrement in speech perception scores immediately following fitting with Speak. Eight of the children showed a small (10% to 20%) decrement in speech perception scores for between 3 and 6 weeks following the changeover to Speak. After 24 weeks' experience with Speak, 11 of the children had shown a steady increase in speech perception scores, with final Speak scores higher than for Mpeak. Only 1 child showed a significant decrement in speech perception with Speak, which did not recover to original Mpeak levels.
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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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ItemThe development of the Melbourne/Cochlear multiple-channel cochlear implant for profoundly deaf children( 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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ItemEvaluation of a two-formant speech-processing strategy for a multichannel cochlear prosthesis( 1987)Initial results with the two-formant speech-processing strategy (F0FIF2) confirm the advantage of a multichannel cochlear prosthesis capable of stimulating at different sites within the cochlea. The successful presentation of two spectral components by varying the place of stimulation leads to the possibility of presenting further spectral information in this manner. Because virtually all multichannel implant patients demonstrate good "place" (electrode site) discrimination, these more refined coding strategies should lead to benefits for the majority of implantees. Already, with the F0FIF2 strategy, we have a system that appears to provide some effective auditory-alone communication ability for the average patient.
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ItemSpeech perception in implanted children: effects of speech processing strategy and residual hearing(Mendoza Editor, 1997)The ability of implanted children to adapt to different speech processing strategies has been demonstrated for the Nucleus implant system. Children previously experienced with the Multipeak speech processing strategy. were able to gain significant improvements in consonant, word and sentence perception using the Speak speech processing strategy. suggesting some degree of neural plasticity in neural-auditory coding. Of 192 implanted children with different degrees of preoperative residual hearing, 65% were found to obtain significant scores on open-set speech materials using electrical stimulation alone. Those children with more residual hearing had a greater probability of achieving open-set understanding and at a minimum level, perceived high frequency consonant information which would not have been available through conventional hearing aids.
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ItemSpeech perception in implanted children: effects of preoperative residual hearing and speech processing strategy [Abstract]( 1997)Since the first child was implanted with the Nucleus 22-channel cochlear prosthesis in Melbourne in 1985, the number of implanted children world-wide has rapidly expanded. Over this period, more effective paediatric assessment and management procedures have developed, allowing cochlear implants to be offered to children under the age of 2 years. In addition, a succession of improved speech processing strategies have been implemented in the Nucleus implant system, resulting in increased mean speech perception benefits for implanted adults. Research in the Melbourne and Sydney Cochlear Implant Clinics has also demonstrated that young children can adapt to and benefit from improved speech processing strategies such as the Speak strategy. 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 speech perception benefits to improve over time with advances in speech processing. 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 effect of the level 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 8 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 benefits for children using an advanced cochlear implant speech processing strategy in quiet and in noise [Abstract]( 1994)A new speech processing strategy (SPEAK) has been developed by the University of Melbourne and Cochlear Pty Ltd for use with the Nucleus 22-channel electrode array. In this strategy, 20 programmable filters are repetitively scanned at an average rate of 250Hz and the largest spectral components or maxima are selected from the incoming speech signal. This new speech processing strategy has been shown to provide significantly improved benefits in adult implant patients, particularly in the presence of background noise. This report presents data of a preliminary paediatric clinical trial of the new SPEAK speech processing strategy.
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ItemPreliminary speech perception results for children with the 22-electrode Melbourne / cochlear hearing prosthesis( 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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ItemImprovements in speech processing for the nucleus cochlear implant [Abstract]( 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.