Graeme Clark Collection
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ItemA comparison of a new prototype Tickle Talker with a Tactaid 7( 2001)This study compared the speech perception enhancement provided by two multichannel tactile aids: a new version of the Tickle TalkerT™ and the Tactaid 7. The subjects' impression of benefit was also examined. In an AB pattern, six adults with hearing impairment used each device daily for approximately 18 weeks and attended 12 training sessions. When tactile information was provided, the group demonstrated a significant enhancement for the perception of words (mean 17.2%) and phonemes (mean 12.9%) in monosyllabic word lists, words in sentences (mean 14.2%) and speech tracking (mean 7.7 wpm). The Tactaid 7 provided a significantly greater enhancement for the perception of words (21 % versus 13.4%), phonemes (16.7% versus 9.1%) and some speech features in monosyllabic word lists. Subjective ratings were slightly higher for the Tactaid 7, and four subjects preferred this device. Either device may be suitable for those not able or willing to have a cochlear implant.
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ItemGeneralisation of tactile perceptual skills to new context following tactile-alone word recognition training with the Tickle Talker( 2000)Abstract not available due to copyright.
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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 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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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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ItemAcquisition of a tactile-alone vocabulary by normally hearing users of the Tickle Talker( 1999)Abstract not available due to copyright.
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ItemA comparison of Tactaid II+ and Tactaid 7 use by adults with a profound hearing impairment( 1999)Objective: To evaluate and compare use of the Tactaid II+ and the Tactaid 7, in terms of speech perception, by adults with a hearing impairment. Design: Eight adults used one device daily for approximately 10 wk and attended seven training sessions. Performance was measured with tests of phonetic contrast perception, closed-set vowel and consonant identification, word and phoneme recognition in monosyllabic word lists, word recognition in sentences and speechtracking rate. A questionnaire was also administered. The protocol was repeated with the alternative device. Results: With each device, the group discriminated most phonetic contrasts at better-than-chance levels and demonstrated somewhat enhanced visual or auditory-visual perception when measured in terms of vowel identification, monosyllabic word recognition and speechtracking rate. An increase in speechtracking rate was also demonstrated for some individuals. Subjects generally reported little subjective improvement in speech perception and production, but were satisfied with the physical attributes of each device. Five of six subjects preferred the Tactaid 7. Conclusions: The Tactaid II+ and the Tactaid 7 provided suprasegmental and segmental information, enabling the group to discriminate phonetic contrasts and improve their perception of some speech materials. No consistent advantage was found for either device, thought most subjects preferred the Tactaid 7. Alternatives likely to provide a greater benefit to communication should be considered before Tactaid fitting.
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ItemWithin-subject comparison of speech perception benefits for congenitally deaf adolescents with an electrotactile speech processor and a cochlear implant( 1996)This study assessed speech perception benefits for three congenitally deaf adolescents who used an electrotactile speech processor (Tickle Talker™) and subsequently went on to use a Nucleus Minisystem 22 cochlear implant. Both devices provided significant and comparable benefits for all children in the device plus lipreading condition. All children benefited from the additional information provided by either the Tickle Talker™ or the cochlear implant, and were able to perceive speech information with these devices that was not available through either aided residual hearing or lipreading. None of the three children were able to understand open-set words or sentences using either hearing aids alone or Tickle Talker™ alone, without the aid of lipreading. Two of the children showed significant open-set speech perception benefits while using their cochlear implant alone.
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ItemA training program for use with multichannel speech perception/production tactile devices [Abstract]( 1996)Over the past ten years, there have been remarkable improvements in both conventional hearing aid technology and in the use of multichannel cochlear prostheses. These developments have resulted in improved speech perception for severely and profoundly hearing impaired adults and children. However, a small number of adults and children remain unable to benefit from either of these prosthetic approaches. This may occur as a result of medical/surgical issues, which render implantation unfeasible, or from a decision by the patient or parents that the device is inappropriate for the individual person. In these cases, use of a supplemental speech perception device employing the intact tactile modality has been advocated. A number of single and multichannel devices have been developed, both commercially and in the laboratory. One of these, the Tickle Talker, a multichannel electrotactile speech processor, has been developed and thoroughly evaluated with both adults and children at the University of Melbourne. Benefits to speech perception have been noted on both closed-set phonemic discrimination tests, and on open-set word and sentence scores, where the device was used to supplement lipreading and/or aided residual hearing. Benefits to articulation have also been noted. Recently, improved speech processing and the design of a new electrode handset have been implemented. While these factors are important to device acceptance, the critical factor in improving speech perception and production appears to be the training program which is employed with the device. The program must be based on the information available through the device, but organised to emphasize the integration of tactually-encoded speech information into open-set understanding of words and sentences if communication is to be improved. The important elements of the program will be discussed. At present, no tactile device is able to provide sufficient information for open-set speech understanding using only the tactile input. While this may be an ultimate goal, significant periods of training may be required to achieve this outcome.
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ItemComponents of a rehabilitation programme for young children using the multichannel cochlear implant(Whurr, 1996)Rehabilitation with young hearing-impaired children may be defined as a teaching; learning process where the role of the clinician is to facilitate acquisition of listening, speech and language in a normal developmental order. This is often referred to as habilitation. It differs from rehabilitation for adults, which is the process by which lost communication skills are reacquired. It is worth discussing the role of the cochlear implant as a tool in this process. For the adult with acquired hearing loss, the cochlear implant might be expected, in part, to facilitate rehabilitation by restoring the auditory sense. The aim is to facilitate speech reception and provide the adult with a speech feedback loop. For a child receiving the cochlear implant, the aims are more complex. The device needs to provide speech perception abilities to facilitate the development of the entire linguistic system, to develop a range of speech sounds, to enable speech monitoring via auditory feedback and to access shared knowledge of the world. (From Introduction)