Graeme Clark Collection

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    The effect of language knowledge on speech perception: what are we really assessing?
    Sarant, Julia Z. ; Blamey, Peter J. ; Cowan, Robert S. ; Clark, Graeme M. ( 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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    The effect of loudness imbalance between electrodes in cochlear implant users
    Dawson, P. W. ; Skok, M. ; Clark, Graeme M. ( 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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    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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    The progress of children using the multichannel cochlear implant in Melbourne
    Cowan, R. S. C. ; Dowell, R. C. ; Hollow, R. ; Dettman, S. J. ; Rance, G. ; Barker, E. J. ; Sarant, J. Z. ; Galvin, K. L. ; Webb, R. C. ; Pyman, B. C. ; Cousins, V. C. ; Clark, Graeme M. ( 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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    Comparison of the SPEAK (Spectral Maxima) and multipeak speech processing strategies and improved speech perception in background noise
    Clark, Graeme M. ; Whitford, L. ; Van Hoesel, R. ; McKay, C. M. ; McDermott, H. D. ; Seligman, P. ; Vandali, A. ; Pyman, B. C. ; Cowan, R. C. ( 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.
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    Initial investigation of the efficacy and biosafety of sodium hyaluronate (healon) as an aid to electrode array insertion
    Donnelly, M. J. ; Cohen, L. T. ; Clark, Graeme M. ( 1995)
    Stimulation of residual neural elements by electrodes inserted into the cochlea to produce the perception of speech and environmental sounds in profoundly deaf people is a fundamental aim of cochlear implantation. The multiple-channel cochlear implant utilizes the tonotopic arrangement of the organ of Corti to also achieve place pitch perception by stimulating different electrode bands. It may be possible to improve the range of pitches perceived by present cochlear implant patients by inserting the electrode array more deeply. To help achieve this, investigators have used sodium hyaluronate as a lubricant for electrode insertions. 1 It was felt deeper insertions were produced with sodium hyaluronate. Before introducing this substance as part of the surgical protocol for the Melbourne Cochlear Implant Clinic, it was decided to investigate its efficacy in aiding deeper insertions of the electrode. In addition, it was also necessary to determine if sodium hyaluronate, in conjunction with cochlear implantation, had adverse effects on the inner ear. This study was undertaken to address these issues.
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    Vowel imitation task: results over time for 28 cochlear implant children under the age of eight years
    Dettman, S. J. ; Barker, E. J. ; Dowell, R. C. ; Dawson, P. W. ; Blamey, P. J. ; Clark, Graeme M. ( 1995)
    With increasing numbers of implanted children under the age of 4 years, numerous researchers have reminded us of the need for valid, sensitive, and reliable tests of developing speech perception.1,2 In addition to studies of the efficacy of implanted prostheses, there is a need to investigate the many variables that influence children's communicative performance, such as changes in speech-coding strategy, updated speech-processing systems, the effects of various training regimens, and the selection of educational and communication modes.
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    Within-subject comparison of speech perception benefits with a multiple-channel cochlear implant and tactile device
    Sarant, J. Z. ; Cowan, R. S. C. ; Blamey, P. J. ; Galvin, K. L. ; Clark, Graeme M. ( 1995)
    In order to adequately advise prospective cochlear implant patients and their families, a clinician must have a good knowledge of the potential for particular individuals to benefit from cochlear implants and other alternatives.
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    Speech perception in children using the advanced Speak speech-processing strategy
    Cowan, R. S. C. ; Brown, C. ; Whitford, L. A. ; Galvin, K. L. ; Sarant, J. Z. ; Barker, E. J. ; Shaw, S. ; King, A. ; Skok, M. ; Seligman, P. M. ; Dowell, R. C. ; Everingham, C. ; Gibson, W. P. R. ; Clark, Graeme M. ( 1995)
    The Speak speech-processing strategy, developed by the University of Melbourne and commercialized by Cochlear Pty Limited for use in the new Spectra 22 speech processor, has been shown to provide improved speech perception for adults in both quiet and noisy situations. The present study evaluated the ability of children experienced in the use of the Multipeak (Mpeak) speech-processing strategy (implemented in the Nucleus Minisystem-22 cochlear implant) to adapt to and benefit from the advanced Speak speech-processing strategy (implemented in the Nucleus Spectra 22 speech processor). Twelve children were assessed using Mpeak and Speak over a period of 8 months. All of the children had over 1 year's previous experience with Mpeak, and all were able to score significantly on open-set word and sentence tests using the cochlear implant alone. Children were assessed with both live-voice and recorded speech materials, including Consonant-Nucleus-Consonant monosyllabic words and Speech Intelligibility Test sentences. Assessments were made in both quiet and in noise. Assessments were made at 3-week intervals to investigate the ability of the children to adapt to the new speech-processing strategy. For most of the children, a significant advantage was evident when using the Speak strategy as compared with Mpeak. For 4 of the children, there was no decrement in speech perception scores immediately following fitting with Speak. Eight of the children showed a small (10% to 20%) decrement in speech perception scores for between 3 and 6 weeks following the changeover to Speak. After 24 weeks' experience with Speak, 11 of the children had shown a steady increase in speech perception scores, with final Speak scores higher than for Mpeak. Only 1 child showed a significant decrement in speech perception with Speak, which did not recover to original Mpeak levels.
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    Cochlear implantation: osteoneogenesis, electrode-tissue impedance, and residual hearing
    Clark, Graeme M. ; Shute, S. A. ; Shepherd, R. K. ; Carter, T. D. ( 1995)
    This study was undertaken to find out how new bone is produced in the implanted cochlea, and the effects of fibrous tissue and new bone growth on electrode-tissue impedance. This knowledge is essential, as bone and fibrous tissue in the cochlea could account for variations in patients' speech perception performance. The study was also carried out to examine the effects of implantation on residual hearing. This information is also important, as cochlear implant speech perception results in profoundly deaf people are now better on average than severely or profoundly deaf people obtain with a hearing aid. Consequently, more people will need to be considered for cochlear implantation in ears with some residual hearing. In this case we need to know to what extent residual hearing is affected by implantation. (From Introduction)