Graeme Clark Collection
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ItemResearch in auditory training(Academy of Rehabilitative Audiology, 1994)Speech perception and communication can improve as a result of experience, and auditory training is one way of providing experiences that may be beneficial. One of the most important factors influencing the effectiveness of auditory training is the amount of experience the client already has. Other factors include the severity of the hearing loss, the sensory device used, the environment, personal qualities of the client and clinician, the type of training, and the type of evaluation used. Despite a long history of clinical practice, the effects of these factors have been investigated in few controlled studies. Even in special cases where training has an obvious role, such as adults using cochlear implants, there has been little objective comparison of alternative training methods. One reason for this is the difficulty of carrying out definitive experiments that measure changes in performance over time in the presence of many confounding variables. These variables may also help to explain the apparently contradictory results that can be found in the literature on auditory training and in the diverse points of view expressed by practicing clinicians. Issues and methods appropriate for research in auditory training among adult clients are discussed with reference to the needs of modem clinical practice.
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ItemSignal processing for multichannel cochlear implants: past, present and future [Abstract]( 1994)Since the late 1970's, many groups have worked on developing effective signal processing for multichannel cochlear implants. The main aim of such schemes has been to provide the best possible speech perception for those using the device. Secondary aims of providing awareness and discrimination of environmental sounds and appreciation of music have also been considered. Early designs included some that attempted to simulate the normal cochlea. The application of such complex processing schemes was limited by the technology of the times. In some cases, researchers reverted to the use of single channel systems which could be controlled reliably with the existing technology. In other cases, as with the Australian implant, a simple multichannel processing scheme was devised that allowed a reliable implementation with available electronics. Over the next 15 years, largely due to the improvements in integrated circuit technology, the signal processors have slowly become more complex. Further psychophysical research has shown how additional information can be transferred effectively to implant users via electrical stimulation of the cochlea. This has lead to rapid improvement in the speech perception abilities of adults using cochlear implants. Some of the main developments in signal processing over the last 15 years will be discussed along with the latest speech perception results obtained with the new SPEAK processing scheme for the Australian 22-channel cochlear implant. Initial results for SPEAK show mean scores of 70% (equivalent to 85-90% phoneme scores) for open set monosyllabic word testing for experienced adult users. Although there remains a large range of performance for all users of cochlear implants, average speech perception scores for all implanted adults have also improved significantly with the developments in signal processing. It appears likely that multichannel cochlear implants will be a viable alternative for the treatment of severe hearing loss in the future.
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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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ItemCochlear implants in children: unlimited potential? [Abstract]( 1994)Multichannel cochlear implants have been in use for adolescents for 8 years and for children for 6 years. Due to the substantial benefits obtained by postlinguistically deafened adults using multichannel implants, there was a degree of optimism about the potential benefits for profoundly hearing impaired children using these devices. It was speculated that children may adapt more quickly and learn to use information from implants more effectively than adults. On the other hand, there were cautionary predictions that there may be a "critical age", particularly for congenitally or early deafened children, that, once passed, would preclude effective use of auditory information from implants. This age was variously predicted to be anywhere from 2 to 12 years, based on neurophysiological, developmental or psychological arguments. With some years of experience with implanted children, it can now be said that neither the optimistic nor the more cautionary "critical age" predictions have been supported. As with many areas of clinical science, the situation appears to be far more complex than first thought. This paper will discuss the results obtained for 100 children using the multichannel cochlear implant in Sydney and Melbourne in terms of predictive factors, and the potential for the future application of multichannel cochlear implants in children. The results suggest that experience with implant, the number of years of auditory deprivation, the amount of preoperative residual hearing, and the postoperative educational environment may have a significant effect on speech perceptual abilities in implanted children. In addition, approximately 60% of all implanted children show significant open-set speech perception ability with auditory input alone. It is now possible for multichannel cochlear implants to provide auditory skills sufficient for young children to develop functionally normal speech and language through audition, provided consistent, long term habilitation is available.
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ItemPsychophysics of electrical stimulation of the auditory nerve: implications for coding of sound and speech processing for cochlear implants [Keynote address]( 1994)Psychophysical studies on electrical stimulation of the auditory nerve have contributed to our understanding of the coding of sound and speech signals. Those studies have also helped establish speech processing strategies for multiple-electrode cochlear implant patients. The first studies were on temporal coding of frequency and pitch perception to help determine whether a single or multiple electrode implant would be preferable for the coding of speech frequencies. Temporal frequency coding was initially studied in the experimental animal by measuring difference limens for frequency of stimulus rate. The results showed that rate coding occurs for low frequencies up to 200 or even 600 pulses per second. It was concluded that higher speech frequencies cannot be conveyed by variations in stimulus rate but require multiple-electrode stimulation. These studies in experimental animals were essentially confirmed in the human.
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ItemCochlear pathology following chronic electrical stimulation of the auditory nerve: II Deafened kittens( 1994)The present study examines the effects of long-term electrical stimulation of the auditory nerve on cochlear histopathology and spiral ganglion cell survival in young sensorineural deafened cats. Eight kittens were deafened using kanamycin and ethacrynic acid, and implanted with bipolar or monopolar scala tympani electrodes. Following recovery from surgery the animals were unilaterally stimulated using charge balanced biphasic current pulses for 450-1730 hours over implant periods of up to four months. Charge densities varied from 0.6-0.9 µC.cm ^-2 geom. per phase for monopolar electrodes to 12-26 µC.cm ^-2 geom. per phase for the bipolar electrodes. Electrically-evoked auditory brainstem responses (EABRs) were periodically monitored during stimulation to confirm that the stimulus levels were above threshold, and to monitor any change in the response of the auditory nerve. Following completion of the stimulation program cochleae were prepared for histological examination. EABRs exhibited relatively stable thresholds for both stimulated and implanted, unstimulated control cochleae for the stimulus duration. While the growth in response amplitude as a function of stimulus current remained stable for the bipolar control and monopolar stimulated cochleae, the five cochleae chronically stimulated using bipolar electrodes exhibited a moderate to large increase in response amplitude. These increases were associated with a more widespread fibrous tissue response which may have altered the current distribution within these cochleae. Implanted control cochleae exhibited significantly less tissue response within the scala tympani. Importantly, we observed no statistically significant difference in the spiral ganglion cell density associated with chronic electrical stimulation when compared with unstimulated control cochleae. While the present study supports the safe application of cochlear implants in young profoundly deafened children, it does not corroborate previous studies that have reported electrical stimulation providing a trophic effect on degenerating auditory nerve fibres.
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ItemSpeech perception for adults using cochlear implants(Whurr, 1994)A mere 16 years ago, the title of this chapter would have created considerable consternation in audiological circles. A high proportion of otologists and audiologists would have wondered, with good reason, about the potential content of such a chapter. In 1977, there were certainly cochlear implants in use with reported benefits, but reliable documentation of any useful speech perception under controlled conditions was difficult to find. The rapid development of cochlear prostheses since that time has led to thousands of profoundly hearing-impaired adults obtaining benefits for speech perception, and there is now no doubt regarding the efficacy of such devices. This chapter will provide a brief overview of this rapid improvement in the speech perception of adult cochlear implant users, consider some of the reasons for this improvement, and discuss some of the factors that may influence speech perception performance for the individual user. (From Introduction)
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ItemThe perception of electrodes by cochlear implant patients who became deaf early in life [Abstract]( 1994)Two separate studies measuring the perception of differences in site of electrode stimulation were conducted with cochlear implant patients who became deaf early in life. The multiple-electrode prosthesis manufactured by Cochlear Pty. Limited was used. Two of the possible mechanisms for the discrimination of different electrodes are pitch and loudness. The first study measured the discrimination of different electrodes using two procedures which minimised the influences of loudness cues on performance. In the first procedure, the stimulation patterns were symmetric sweeps across electrodes. The reference stimuli were apical-basal trajectories and the comparison stimuli were basal-apical trajectories. The electric stimulation levels were the same in the reference and comparison stimuli because the same electrodes were used in the trajectories. In the second procedure, the stimulation patterns used randomised variations in electric stimulation levels on the different electrodes. By randomly varying the loudness of the stimuli in a discrimination task, the patient is required to listen for more salient cues such as pitch. Both procedures gave comparable results. The second study was concerned with the estimation of order in percepts for stimulation on the different electrodes along the array which was related to the tonotopic order of the cochlea. Approximately half of the early-deafened patients tested revealed a tonotopic order in percepts which was comparable to that obtained from postlinguistically deafened adults.
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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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ItemCochlear implants for congenitally deaf adolescents: is open-set speech perception a realistic expectation?( 1994)The prognosis for benefit from use of cochlear implants in congenitally deaf adolescents, who have a long duration of profound deafness prior to implantation, has typically been low. Speech perception results for two congenitally deaf patients implanted as adolescents at the University of Melbourne/Royal Victorian Eye and Ear Hospital Clinic show that, after 12 months of experience, both patients had significant open-set speech discrimination scores without lipreading. These results suggest that although benefits may in general be low for congenitally deaf adolescents, individuals may attain significant benefits to speech perception after a short period of experience. Prospective patients from this group should therefore be considered on an individual basis with regard to prognosis for benefit from cochlear implantation.