Graeme Clark Collection
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ItemContributing factors to improved speech perception in children using the nucleus 22-channel cochlear prosthesis( 1997)It has been established that use of multiple-channel intracochlear implants can significantly improve speech perception for postlinguistically deafened adults. In the development of the Nucleus 22-channel cochlear implant, there have been significant developments in speech processing strategies, providing additional benefits to speech perception for users. This has recently culminated in the release of the Speak speech processing strategy, developed from research at the University of Melbourne. The Speak strategy employs 20 programmable bandpass filters which are scanned at an adaptive rate, with the largest outputs of these filters presented to up to ten stimulation channels along the electrode array. Comparative studies of the Speak processing strategy (in the Nucleus Spectra-22 speech processor), with the previously-used Multipeak (Multipeak) speech processing strategy (in the Minisystem-22 speech processor), with profoundly deaf adult cochlear implant users have shown that the Speak processing strategy provides a significant benefit to adult users both in quiet situations and particularly in the presence of background noise. Since the first implantation of the Nucleus device in a profoundly hearing-impaired child in Melbourne in 1985, there has been a rapid growth in the number of children using this device. Studies of cochlear implant benefits for children using the Nucleus 22-channel cochlear implant have also shown that children can obtain significant benefits to speech perception, speech production and language, including open-set understanding of words and sentences using the cochlear implant alone. In evaluating contributing factors to speech perception benefits available for children, four specific factors are important to investigate: (1) earlier implantation -resulting from earlier detection of deafness; (2) improved hardware and surgical techniques -allowing implantation in infants; (3) improved speech processing, and (4) improved habilitation techniques. Results reported previously have been recorded primarily for children using the Multipeak strategy implemented in the MSP speech processor. While it is important to evaluate the factors which might contribute to improvements in speech perception benefits, an important question is the effect of improved speech processing strategy, since this will determine what is perceived through the device. Given that adult patients changing to the Spectra speech processor had also shown improved perception in noisy situations, and the fact that children are in general in noisy environments in the classroom setting for a large proportion of their day, it was of obvious interest to evaluate the potential for benefit in poor signal-to-noise ratios from use of the Speak processing strategy and from specific training in the ability to perceive in background noise. The study was aimed at evaluating whether children who were experienced in use of the Multipeak speech processing strategy would be able to changeover to the new Speak processing strategy, which provides a subjectively different output. Secondly, the study aimed to evaluate the benefits which might accrue to children from use of controlled habilitation in background noise.
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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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ItemAdults with a severe-to-profound hearing impairment: investigating the effects of linguistic context on speech perception( 1998)Linguistic context is known to influence speech perception abilities in adults with normal hearing. Recent reports question the importance of context for adults with a severe-to-profound hearing impairment. The severe reduction and distortion in acoustic input may result in the listener perceiving insufficient acoustic-phonetic cues to allow access to higher level linguistic processing. To investigate this further, a detailed study of the speech recognition of adults with a severe-to-profound hearing impairment (N=34) was undertaken. A series of aided speech recognition tasks, sequentially examined the different levels of processing in the speech perception chain. The investigation concluded that the effects of severe-to-profound hearing impairment did not reduce the listener's ability to take advantage of contextual cues. There was, however, wide variability between participants in the utilisation of contextual processing. This indicates that to estimate "real-life" speech perception skills, an evaluation of contextual processing ability is required.
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ItemAn analysis of high rate speech processing strategies using the Nucleus 24 cochlear implant [Abstract]( 1998)The effects of varying the stimulation rate on speech perception was evaluated in five postlinguistically deaf adult users of the Nucleus 24 Cochlear Implant System. Three different rates of electrical stimulation, 250, 807, and 1615 pulses per second per channel were employed. For the high stimulus rate the analysis frequency was the same as for the medium rate condition. The study investigated the effect of varying rate of stimulation when using the electrode selection technique of the SPEAK strategy. The study used a repeated ABC experimental design, in order to account for learning effects and to minimize ordering effects. Speech perception was evaluated using both monosyllabic words (open-sets of CNC words in quiet) and sentence materials (open-sets of CUNY sentences at signal-to-noise ratios from +20 to 0dB). In addition, the subjects' perception of closed-sets of 19 vowels and 24 consonants, presented in the H/VID and A/C/A context, were also investigated. The recognition and perception of distinctive features were assessed across strategies and patients. Preliminary speech perception results have shown no statistically significant difference in performance between the low and medium stimulation rates. However, significantly poorer results were observed for the high rate condition for some tests with some individuals. Individual differences may be explained by the effects of rate of stimulation on speech features.
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ItemAn analysis of high rate speech processing strategies using the Nucleus 24 cochlear implant [Abstract]( 1998)Speech comprehension for a group of five users of the Nucleus 24 Cochlear Implant system was explored at three rates of electrical stimulation, 250, 807, and 1615 pulses per second per channel. For the high stimulus rate the analysis frequency was the same as for the medium rate condition. The study investigated the effect of varying rate of stimulation when using the electrode selection technique of the SPEAK strategy. This has been undertaken using a repeated ABC experimental design to account for learning and minimize ordering effects. Speech perception was assessed using open-sets of CNC words in quiet and open-sets of CLTNY sentences at signal-to-noise ratios from +20 to 0dB. Closed-sets of 19 vowels and 24 consonants were also presented, in the H/V/D and A/C/A context. The recognition and perception of distinctive features were assessed across strategies and patients. Preliminary speech perception results have shown no statistically significant difference in performance between the low and medium stimulation rates. However, significantly poorer results were observed for the high rate condition for some tests. Individual differences may be explained by the effects of rate of stimulation on speech features.
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ItemElectrical stimulation of the auditory nerve: chronic monopolar stimulation using very high stimulus rates [Abstract]( 1998)Speech processing strategies based on high rate electrical stimulation have been associated with recent improvements of speech perception among cochlear implant users. In the present study we investigated the effects of chronic monopolar stimulation using very high rates (14493 pulses\s). Under general anaesthesia (ketamine (20 mg/kg) and xylazine (3.8 mg/kg) i.p.) six normal hearing cats were implanted bilaterally with a three channel platinum (Pt) scala tympani electrode array, while a return Pt-electrode was placed outside the bulla. Chronic electrical stimulation using charge-balanced biphasic current pulses was delivered unilaterally via a transcutaneous leadwire connected to a backpack-stimulator for up to 2000 h. The animals hearing status was periodically monitored using acoustically evoked compound action potentials (CAP's) and brainstem responses (ABR's). In addition the electrically evoked ABR (EABR) was also recorded to ensure that the chronic stimulus was above threshold. Stimulus current and electrode voltage waveforms were monitored twice daily and access resistance (Ra) and electrode impedance (Zc) calculated. ABR and CAP thresholds were elevated immediately following implantation, but generally showed evidence of partial recovery (0-40 dB). Further deterioration of thresholds on the stimulated side (10-30 dB) was subsequently observed, while control-thresholds remained more stable. Ra (1.3-1.8 kΩ) and Zc (2.2-3.8Ω) typically increased in the first few weeks of electrical stimulation up to Ra:5.6 kΩ and Zc:8.1 kΩ, before decreasing slightly to a constant plateau. These initial results indicate changes in the electrode-tissue interface and tissue growth within the cochlea. They also indicate that chronic stimulation at these high rates may decrease residual hearing.
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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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ItemAdvances in cochlear implant speech processing(Monduzzi Editore, 1997)A cochlear implant is a device which restores some hearing in severely-to-profoundly deaf people when the organ of Corti has not developed or is destroyed by disease or injury to such an extent no comparable hearing can be obtained with a hearing aid. When the organ of Corti is severely malfunctioning or absent, sound vibrations cannot be transduced into temporo-spatial patterns of action potentials along the auditory nerve for the coding of frequency and intensity. As a result, a hearing aid which amplifies sound is of little or no use. Our early research (Clark, 1969) emphasized that with electrical stimulation there was an electro-neural "bottle-neck" restricting the amount of speech and other acoustic information that could be presented to the nervous system. It also showed the need to use multiple-channel stimulation presented non-simultaneously, to minimize channel interaction (Clark, 1987).