Graeme Clark Collection

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    Speech perception in implanted children: influence of preoperative residual hearing on outcomes [Abstract]
    Cowan, R. S. C. ; Barker, E. J. ; Pegg, P. ; Dettman, S. ; Rennie, M. ; Galvin, K. ; Meskin, T. ; Rance, G. ; Cody, K. ; Sarant, J. ; Larratt, M. ; Latus, K. ; HOLLOW, RODNEY ; Rehn, C. ; Dowell, R. C. ; Pyman, B. ; Gibson, W. P. R. ; Clark, Graeme M. ( 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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    Multichannel auditory brainstem implants: an Australian case study [Abstract]
    Hollow, Rod ; COWAN, ROBERT ; BRIGGS, ROBERT ; KAYE, ANDREW ; DOWELL, RICHARD ; Shaw, Stephanie ; Clarke, Graeme M. ( 1996)
    The multichannel Auditory Brainstem Implant (ABI) is an implantable device designed to restore a level of auditory perception in patients with bilateral acoustic neuromas, where the removal of the tumours is expected to result in a total loss of hearing. As with the cochlear implant, the ABI utilises an externally worn speech processor and headset, together with a surgically-placed receiver-stimulator and electrode array. The electrode array, developed through the collaboration of the House Ear Institute in the United States and Cochlear Corporation, consists of eight electrodes on a carrier, which is placed on the surface of the brainstem in the area of the cochlear nucleus.
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    A training program for use with multichannel speech perception/production tactile devices [Abstract]
    GALVIN, KARYN ; COWAN, ROBERT ; Mavrias, Gina ; Moore, Alessandra ; SARANT, JULIA ; Clark, Graeme M. ( 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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    Speech perception for children with different levels of residual hearing using the cochlear 22-channel cochlear prosthesis [Abstract[
    Cowan, R. S. C. ; Galvin, K. L. ; Barker, E. J. ; Del Dot, J. ; Sarant, J. Z. ; Dettman, S. ; Hollow, R. ; Herridge, S. ; Rance, G. ; Larratt, M. ; Skok, M. ; Dowell, R. C. ; Pyman, B. ; Gibson, W. P. R. ; Clark, Graeme M. ( 1996)
    Over the past 10 years, since the implantation of the first children with the Nucleus 22-channel cochlear prosthesis in Melbourne, the number of profoundly deaf children using this implant system has rapidly expanded. Longer-term experience with implanted children has led to improvements in paediatric assessment and management. Speech processing strategies have also been improved, resulting in a series of increases in speech perception benefits. Results of comparative studies of Speak and Multipeak speech processing strategies have shown that open-set word and sentence scores for a group of thirteen children evaluated over a two year period showed an advantage with the Speak speech processing strategy. The increases were noted particularly in speech perception in poor signal-to-noise conditions. Analysis has shown that consonant perception was significantly increased, due to an improved place perception. Given current speech perception scores for implanted children, it has been suggested that severely-to-profoundly deaf children currently using hearing aids could in fact benefit more from a cochlear implant. Preliminary investigation of results for children in the Melbourne and Sydney cochlear implant programs has shown that children with higher levels of preoperative residual hearing as a group do score significantly on open-set word and sentence perception tests using the implant alone. In children with lower levels of residual hearing, results were variable across the group.
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    Introduction: International Cochlear Implant, Speech and Hearing Symposium - Melbourne 1994
    Clark, Graeme M. ; Cowan, Robert S. C. ( 1995)
    The International Cochlear Implant Speech and Hearing Symposium - Melbourne 1994 covered a wide range of presentations in a number of disciplines. The scientific program included 287 oral presentations and 40 posters, presented to a total of 456 delegates from 38 countries. This was a considerable expansion in the number and range of presentations from the first international conference held in Melbourne in 1985 (Ann Otol Rhinal Laryngal 1987;96[suppl 128]). This growth highlights the importance of the discipline and the advances being made in this area.
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    Preoperative residual hearing as a predictor of postoperative speech scores for adult cochlear implant users [Abstract]
    COWAN, ROBERT ; HOLLOW, RODNEY ; DOWELL, RICHARD ; PYMAN, BRIAN ; Clark, Graeme M. ( 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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    A clinical report on vocabulary skills in cochlear implant users [Abstract]
    Dawson, P. ; Blamey, P. ; Dettman, S. ; Rowland, L. ; Barker, E. ; Cowan, R. ; Clark, Graeme M. ( 1994)
    Receptive vocabulary results are reported for 32 children, adolescents and prelinguistically deafened adults implanted with the 22-electrode cochlear implant at the Melbourne Cochlear Implant Clinic. Age at implantation ranged from 2 years, 6 months to 20 years and implant use ranged from 1 year to 7 years, 8 months. There were significant gains from pre- to postoperative assessments on the Peabody Picture Vocabulary Test (PPVT) for the majority of subjects. Rates of improvement found are compatible with previous reports on smaller numbers of implant users, but cannot be attributable unambiguously to use of the implant. The group postoperative performance was significantly higher than mean preoperative performance (n =25). The relationship of variables such as duration of implant use, duration of profound deafness and speech perception ability to improvement on the PPVT is discussed. Expressive vocabulary results on the Renfrew Word Finding Vocabulary Scale are reported for 11 of the subjects. Less substantial gains were made on this measure.
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    Issues in long-term management of children with cochlear implants and tactile devices [Abstract]
    COWAN, ROBERT ; DOWELL, RICHARD ; Barker, Elizabeth ; GALVIN, KARYN ; DETTMAN, SHANI ; SARANT, JULIA ; RANCE, GARY ; Hollow, Rod ; BLAMEY, PETER ; Clark, Graeme M. ( 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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    A clinical report on speech production of cochlear implant users [Abstract]
    Dawson, P. ; Blamey, P. ; Dettman, S. ; Rowland, L. ; Barker, E. ; Tobey, E. ; Busby, P. ; Cowan, R. ; Clark, Graeme M. ( 1994)
    Speech production results are reported for a group of 15 children, adolescents and prelinguistically deafened adults implanted with the 22-electrode cochlear implant. Age at implantation ranged from 5 years to 20 years and implant experience ranged from 1 year to 4 years, 7 months. On a speech intelligibility test using sentences seven implant users improved significantly over time. Mean group performance (n = 11) improved from 18% preoperatively to 43% postoperatively. Similarly on a test of articulation, eight implant users improved significantly over time and the group mean postoperative performance (n = 11) exceeded the preoperative performance (55% compared to 38%). This group effect was significant for consonants and blends but was nonsignificant for vowels. Improvements occurred for front, middle and back consonants, for stops, nasals, fricatives and glides and for voiceless and voiced consonants. Three implant users showed no significant gain on either test. The results suggest complex relationships between speech production performance and sensory information provided by a multichannel implant.
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    Design fundamentals for a tactile speech processor: i) encoding of speech information, and ii) biomedical safety considerations [Abstract]
    Cowan, Robert S. C. ; Blamey, Peter J. ; Sarant, Julia Z. ; Galvin, Karyn L. ; Clark, Graeme M. ( 1992)
    Approaches to providing speech information through the tactual modality have varied in: number and spatial location of transducers; method of interfacing with the skin's sensory apparatus; and content of speech information presented. Use of a multiple speech feature encoding approach to design of a tactile device was implemented in the wearable multichannel electrotactile speech processor or Tickle Talker developed at the University of Melbourne. Psychophysical studies established that subjects could discriminate salient electrical parameters in the tactual display, and that this information could be used to discriminate acoustic speech feature contrasts. Results with normally-hearing and hearing-impaired adults and children using an FOF2 encoding strategy showed improved discrimination scores for closed-set speech feature discrimination batteries, closed-set vowel and consonant identification tasks, as well as for open-set word and sentence comprehension. Based on analyses of tactual encoding of speech features, alternative speech processing strategies designed to increase the quality of speech information available were evaluated. Results for two hearing-impaired adults showed improved feature discrimination with the addition of a voicing signal to the FOF2 strategy. Biomedical safety investigations conducted concurrently have established that the electrical parameters of the stimulus waveform, electrode handset design, and electrical circuitry of the device are free from potential risks. Longer-term physiological assessments included measures of possible effects of electrical stimulation on tactual sensitivity, finger temperature, finger and hand blood flow, electrical thresholds and maximum comfortable levels, and on central nervous system, function as measured by EEG. Results of the kinesthetic, vascular and neurological assessments showed no significant contraindications which might limit application or long-term use of the device.