Graeme Clark Collection
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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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ItemPreoperative residual hearing as a predictor of postoperative speech scores for adult cochlear implant users [Abstract]( 1994)The development of multiple channel cochlear implants has been a significant advance in the rehabilitation of profound hearing loss. Speech perception benefits have been particularly evident for postlinguistically deafened adults, who as a group have shown not only supplementation of lipreading scores but also significant comprehension of words and sentences using an implant alone, without the aid of lipreading. In many cases, patients are able to use their implant for telephone conversation. Speech perception benefits for adult users have increased with advances in speech processing and improved means of habilitation. These improvements in open-set speech benefits for adult users have resulted in a steady increase in group mean scores and a reevaluation of selection criteria for cochlear implantation. In the initial development of cochlear implants, only those with little or no residual hearing were considered as candidates. Current selection criteria now include those with substantial residual hearing, who may score up to 40% in the best-aided condition on word and sentence speech perception tests. In order to provide realistic expectations for prospective cochlear implant patients, it is important to establish the relationship of many preimplant factors to postimplant speech perception benefits. For severely hearing impaired adults, the relationship between preoperative residual hearing, as measured by aided word and sentence speech perception test scores, and postoperative speech perception benefits is of significant interest. Analysis of data collected over a 15 year period for adult patients is presented. The rationale for conducting full speech perception assessments for all potential cochlear implant patients is stressed.
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ItemThe evolution continues: the clinical trials of the SPEAK strategy in Nucleus 22 channel cochlear implant users [Abstract]( 1994)Research in the field of cochlear implants continues in centres around the world. The aim of all centres is to improve the speech perception abilities of those children and adults fitted with a cochlear implant. Most recently the work of Hugh McDermott and Colette McKay (Melbourne University, Department of Otolaryngology) in developing and researching the SMSP (Spectral Maxima Sound Processor) has greatly enhanced the speech understanding abilities of a number of subjects implanted with the Nucleus 22 Channel Cochlear Implant.
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ItemPsychophysical and speech perception studies: a case report on a binaural cochlear implant subject( 1993)Abstract not available due to copyright.
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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. In the Melbourne program, over 60% of children obtain significant scores on open-set word and sentence tests using their cochlear implant alone without the aid of lipreading. As parents and professionals have become aware of these improved benefits to speech perception benefits in profoundly deaf children, there have been requests to consider implanting severely-to-profoundly deaf children. In these children with higher levels of residual hearing, only those children with poorer-than-expected performance on speech perception tests using hearing aids have been considered for surgery. A number of such cases have now been implanted in the Melbourne program. The speech perception benefits for this group are reported and are being compared with benefits for the profoundly deaf group of children.
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ItemResults of multichannel cochlear implantation in very young children [Abstract]( 1995)Most researchers and clinicians working in the cochlear implant field have assumed that profoundly deaf children will have a better prognosis in terms of speech perception, speech production and language development. if implanted at as young an age as possible. However, it has been difficult to gather direct evidence for this hypothesis due to the problems in assessing children under the age of five years with formal tests. Recent results with older children have supported the view that early implantation may provide the optimal outcome in most cases. The implantation of very young children raises two areas of concern that do not apply in adults and older children: accurate assessment of degree of hearing loss and auditory potential; and postoperative assessment of outcomes. This paper will describe research results from the University of Melbourne which address these issues and present results for children implanted as young as eighteen months of age.
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ItemThe development of auditory comprehension in children after receiving a cochlear multiple-channel implant( 1992)Since late 1989, half the cochlear implant patients at the Royal Victorian Eye and Ear Hospital have been young children. There is a gradual improvement of auditory comprehension in most cases using the criteria of environmental sound detection, as well as, prosody, high frequency phoneme and word discrimination. The rate of improvement and final result depend on the duration of deafness, presence of residual hearing, and quality of auditory-oral habilitation. Younger children usually progress more quickly than older children. Some adolescents who use Total Communication and who have no residual hearing, achieve assistance with lipreading. Children with Usher's Syndrome should be actively encouraged to participate in auditory-oral habilitation should they become totally deaf or blind.
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ItemClinical comparison of open-set speech perception with MSP and WSPIII speech processors and preliminary results for the new SPEAK processor [Abstracts]( 1993)There are several studies which compare the WSP III (FOIF11F2) and MSP (Multipeak) speech processors for the Nucleus multiple-channel cochlear implant in small, controlled groups of patients. In the present study we were interested in the benefits of open set speech perception provided by the MSP over the prior WSP III speech processor in a large, unselected clinical population.
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ItemHabilitation issues in the management of children using the cochlear multiple-channel cochlear prosthesis( 1993)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-impairment, a wide-range or 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 or 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 or 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 selling will have a bearing on the Integration of listening and device use Into the classroom environment.