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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ItemThe effect of language knowledge on speech perception: what are we really assessing?( 1997)Objective: The authors examined whether open-set speech perception scores are limited by knowledge of vocabulary and syntax and further considered whether remediation of vocabulary and syntax will increase open-set speech perception scores. Study Design: This was a repeated-measures study design in the setting of a primary (elementary) school for the hearing impaired. Patients: The study population was composed of three hearing-impaired children using Nucleus 22-channel cochlear implant. Intervention: Intervention used was language remediation sessions. Main Outcome Measures: The main outcome measures were assessment of auditory-alone speech perception benefit using open-set words and sentences and assessment of syntactic knowledge using the Test of Syntactic Ability. Outcome measures were applied before and after remediation. Results: Child 1 and child 2 showed a significant postremediation improvement in their overall scores on the Test of Syntactic Ability and in their ability to perceive words learned during remediation. Child I and child 2 also showed a significant improvement in their scores on a modified Bamford-Kowal-Bench open-set sentence test, which specifically targeted grammatical constructs trained in remediation sessions. Conclusions: Remediation of language knowledge deficits significantly improved open-set speech perception for two children, suggesting a need to include language remediation in cochlear implant habilitation programs.
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ItemTraining place pitch perception in cochlear implant users [Abstract]( 1997)The study has aimed at determining whether the ability to use place coded vowel formant information could be enhanced with analytical vowel training in a group of -congenitally deafened patients, who showed limited speech perception skills after cochlear implant experience ranging from 1y8m to 6y11m. It has investigated whether improvements in vowel perception after training can carry over to word recognition. A further objective was to see whether poorer vowel perception was associated with poorer electrode position difference limens. Three children, one adolescent and one young adult were assessed with synthesized versions of the words /hid, head, had, hud, hod, hood/ and a natural version of these words as well as with a closed-set monosyllabic word task. The change in performance after 10 training sessions was compared to the change in performance during a non-training period. Four of the five patients showed a significant gain in synthetic vowel perception post-training on at least one assessment, but only two patients showed gains across a number of tests post-training. For one of these 2 children improvements in vowel perception generalized to word perception. Patients’ electrode limens ranged from 1 to 3 electrodes except for 1 adolescent whose minimal progress post-training could be partly explained by poorer apical electrode discrimination. The findings are discussed with reference to a number of factors, including the notion of a "critical period" for neural plasticity.
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ItemThe effect of loudness imbalance between electrodes in cochlear implant users( 1997)Objective: The aim was to determine the effect of loudness imbalance between electrodes in patients using the 22-electrode cochlear implant (Cochlear Pty Ltd). It was hypothesized that speech perception scores would be greater when the loudness of electrodes was balanced at the comfort (C) levels than when the C levels were unbalanced. Design: Ten adult patients received a monosyllabic word test (CNC words) in quiet and a sentence test (CUNY sentences) in noise under two conditions: with C levels balanced for equal loudness and with unbalanced C levels. Results: When the C levels across electrodes were pseudo-randomly unbalanced by 0 to ±20% of the electrodes' dynamic ranges (20% unbalancing), 6 of the 10 subjects showed a significant drop in sentence perception scores. Of these patients, none had a significant decrease in perception when the degree of unbalancing was halved. Of the four patients who showed no change with 20% unbalancing, three revealed a significant decline in sentence perception when the degree of unbalancing was doubled. There also were significant group effects for phonemes on the word test as well as for sentences in noise for the 20% unbalancing. Conclusions: The implications for clinical practice are that it is important to balance the C levels and that clinicians should be encouraged to refine methods for setting C levels in very young children, who may be using unbalanced MAPs. Nevertheless, although most patients revealed a statistically significant drop in sentence perception with 20% imbalance of the C levels, the changes in percentage scores often were only small.
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ItemChanges in synthetic and natural vowel perception after specific training for congenitally deafened patients using a multichannel cochlear implant( 1997)Objective: The aim was to determine whether the ability to use place-coded vowel formant information could be improved after training in a group of congenitally deafened patients, who showed limited speech perception ability after cochlear implant use ranging from 1 yr 8 mo to 6 yr 11 mo. A further aim was to investigate the relationship between electrode position difference limens and vowel recognition. Design: Three children, one adolescent, and one young adult were assessed with synthesized versions of the words /hid, head, had, hud, hod, hood/ containing three formants and with a natural version of these words as well as with a 12-alternative, closed-set task containing monosyllabic words. The change in performance during a nontraining period was compared to the change in performance after 10 training sessions. Results: After training, two children showed significant gains on a number of tests and improvements were consistent with their electrode discrimination ability. Difference limens ranged from one to three electrodes for these patients as well as for two other patients who showed minimal to no improvements. The minimal gains shown by the final patient could be partly explained by poorer apical electrode position difference limen. Conclusions: Significant gains in vowel perception occurred post-training on several assessments for two of the children. This suggests the need for children to continue to have aural rehabilitation for a substantial period after implantation. Minimal improvements, however, occurred for the remaining patients. With the exception of one patient, their poorer performance was not associated with poorer electrode discrimination.
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ItemSpeech perception results for children with implants with different levels of preoperative residual hearing( 1997)Objective: Many reports have established that hearing-impaired children using the Nucleus 22 channel cochlear implant may show both significant benefits to lipreading and significant scores on open-set words and sentences using electrical stimulation only. These findings have raised questions about whether severely or severely-to-profoundly deaf children should be candidates for cochlear implants. To study this question, postoperative results for implanted children with different levels of preoperative residual hearing were evaluated in terms of speech perception benefits. Study Design/Setting: A retrospective study of the first 117 children, sequentially, to undergo implantation in the Melbourne and Sydney Cochlear Implant Clinics was undertaken. All children had been assessed by and received their implants in a tertiary referral centre. Main Outcome Measures: To assess aided residual hearing, the children were grouped into four categories of hearing on the basis of their aided residual hearing thresholds measured preoperatively. To assess benefits, the scores of children on standard speech perception tests were reviewed. As different tests were used for children with different ages and language skills, children were grouped into categories according to the level of postoperative speech perception benefit. Results: The results showed that children in the higher categories of aided preoperative residual hearing showed significant scores on open-set word and sentence perception tests using the implant alone. For children in lower categories of aided residual hearing, results were variable within the groups. More than 90% of children with implants with aided residual hearing thresholds in the speech range above I kHz achieved open-set understanding of words and sentences. Conclusion: While the results of this preliminary study confirm previous findings of differential outcomes for children with different levels of preoperative residual hearing, they suggest that children with severe to profound hearing impairments should be considered for cochlear implantation.
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ItemThe importance of different frequency bands to the speech perception of cochlear implantees [Abstract]( 1996)It is well known that cochlear implantees exhibit a wide range of speech perception ability. Understanding the reason for this variability may lead to improved speech processors. This study investigates whether implantees rely on different areas of the speech spectrum for speech cues, compared to normally hearing listeners, and whether poor performers rely on different spectral areas than better performers. Six subjects with the Mini System 22 implant and using the SPEAK strategy participated in this experiment. Scores for monosyllabic words were obtained using the full speech spectrum and with selected frequency bands removed from the subjects’ speech processor maps. The Articulation Index (AI) is a measure of the proportion of speech information available to a listener, and the relative contribution to AI from different frequency bands is termed the Importance Function. The five frequency bands studied in this experiment were determined to be of equal importance to normally hearing listeners for the speech material used. The scores for each implantee were transformed into AI values, and hence the relative importance of the bands was determined. This relative importance was compared between the implantee group and normally hearing listeners to determine the way in which speech perception by electrical stimulation varies from that by acoustical stimulation. Comparisons were also made between individual implantees to determine whether correlations exist between their speech perception ability and their use of cues in different parts of the spectrum. Further research will determine whether the differences among implantees are correlated with their ability to perceive changes in stimulation place or temporal characteristics.
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ItemDesign fundamentals for electrotactile devices: the Tickle Talker case study(Whurr, 1995)Since the work of Gault in the 1920s, the literature has chronicled the development of numerous tactile devices for use by the hearing impaired in improving communication. Devices have been developed to target improvements in both speech perception and speech production. In each development, the inventors have attempted to encode speech information through stimulation of the intact kinaesthetic system of the individual, as a supplement or replacement for speech input available from the damaged auditory pathway.
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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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ItemComparison of the SPEAK (Spectral Maxima) and multipeak speech processing strategies and improved speech perception in background noise( 1995)As more is known about speech processing for Cochlear Implant patients, results should continue to improve. It now appears possible that Cochlear Implant patients may, in some instances, reach performance levels that are better than those obtained by most severely deaf people who use hearing aids.