Graeme Clark Collection
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ItemThe effect of language ability and residual hearing on speech perception outcomes for older children using multichannel cochlear implants [Abstract]( 2002)Early-deafened teenagers or young adults have shown somewhat disappointing performance with cochlear implants in the past, however, in recent years a proportion of older children have demonstrated excellent speech perception performance. There is a great deal of variability in speech perception performance within this group. It is important to investigate the factors influencing performance so that adolescents and their families can make informed decisions regarding cochlear implant surgery. This study considered a number of possible predictive factors in a group of 25 children implanted in Melbourne between the ages of 8 and 18 years. Subjects completed open set speech perception testing using BKB sentences both pre-and postoperatively, and pre-operative language testing using the Peabody Picture Vocabulary Test. Data were collected regarding the type of hearing loss, age at implant, age at hearing aid fitting, audiometric details, and the pre-and post-operative communication mode. Multivariate analysis suggested that three factors were associated with postoperative speech perception performance. Results were improved for subjects with better pre-operative speech perception, better pre-operative language ability, and when the duration of profound hearing loss was shorter. These three factors accounted for 66% of the variance in this group. The results of this study suggest that children who have useful pre-implant speech perception, and higher age-equivalent scores on language measures, would be expected to do well with a cochlear implant. A shorter duration of profound hearing loss is also advantageous. Mean speech perception scores for the older group were not significantly different from younger children.
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ItemThe effects of post-implant habilitation on long-term outcomes for children using multichannel cochlear implants [Abstract]( 2002)Those working in the cochlear implant field advocate a regular habilitation program for young children receiving implants. Developing auditory skills and the incorporating these into general language development are considered to be key areas for such programs. Investigations of speech perception and language outcomes have demonstrated that the emphasis of spoken language development appears to enhance the results for implanted children. It remains difficult, however, to demonstrate the effect of habilitation as a separate factor and to determine how much individual attention is desirable for each child. This preliminary study considered the long term speech perception and language outcomes for two groups of children who received Nucleus cochlear implants in Melbourne. The first group (n = 17) was identified as receiving regular habilitation from the Melbourne Cochlear Implant Clinic over a four year post-operative period. A second group (n = 11) was identified as receiving very little regular habilitation over the post-operative period. Language and speech perception results for these two groups showed significant differences in performance on a wide range of measures. The group who received regular, formal habilitation demonstrated better performance on all measures. These groups included only congenitally, profoundly hearing- impaired children and did not differ significantly on mean age at implant or experience at the time of assessment. A more comprehensive study is needed to clarify these results on a larger group of children, and to control for additional confounding variables. Nonetheless, these results provide support for the incorporation of regular long-term habilitation into cochlear implant programs for children.
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ItemSpeech perception outcomes for older patients using the nucleus cochlear implant [Abstract]( 2002)With improved medical technology and increased life expectancy, more patients are receiving cochlear implants at a later age. It is important to examine speech perception outcomes for older patients, in order to be able to provide appropriate pre-operative counselling regarding post-operative expectations. Speech perception scores for patients at the Melbourne Cochlear Implant Clinic implanted at age 65 or more were examined, and compared to the adult population implanted under the age of 65. (All of these patients were users of SPEAK or later strategies.) The aims were to see if speech perception scores were significantly different between the two groups as a whole, and to see if a correlation existed between increasing age of implantation above 65 and speech perception scores. Preliminary results suggest that there is a small but significant effect of age on speech perception outcomes. The findings from this study will be used to help clinicians provide more accurate advice and counselling for older patients, regarding the potential outcomes from a cochlear implant.
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ItemValidation of a technique for establishing maximum comfortable levels for children using cochlear implants [Abstract]( 2002)The aim of fitting a cochlear implant is to establish electrical stimulation parameters that will provide the wearer with comfortable and useful auditory sensations. One parameter that is fundamental to achieving this aim is the Maximum Comfortable Level (C-level). A C-level is the amount of electrical current that produces a loud, but comfortable sound. C-levels need to be established for all channels that a person will use in their speech processor Map. Determining C-levels can be complicated as the person is required to make a judgment about the loudness of a sound. While most adults and older children have the ability to make such a judgment and provide feedback to the clinician, this is rarely the case for young children. Generally, the only way a clinician will be aware a sound could be too loud for a young child is when they observe the child giving an aversive reaction or an involuntary blink. A current level that produces such a reaction is called the Loudness Discomfort Level (LOL). This study examines the relationship between LDLs and C-levels. Testing was performed with a group of adults, using stimulation rates and stimulation modes that are commonly used by children. The LDL/C-level relationship established in this study provides a procedure for selling C-Levels for young children when only loudness discomfort responses can be obtained.
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ItemFactors affecting speech perception outcomes for older children using multichannel cochlear implants( 2002)Experience with cochlear implantation in early-deafened teenagers or young adults has been somewhat disappointing, however, in recent years a proportion of older children have demonstrated excellent speech perception performance. There appears to be a wide gap between the good and poor performers within this group. It is important to investigate the possible factors influencing performance so that adolescents and their families are able to make informed decisions regarding cochlear implant surgery. This study considered a number of factors in a group of 25 children implanted in Melbourne between the ages of 8 and 18 years. Each subject completed open set speech perception testing using BKB sentences before and after implantation and pre-operative language testing using the Peabody Picture Vocabulary Test. Data were collected regarding the type of hearing loss, age at implant, age at hearing aid fitting, audiometric details, and the pre-and postoperative communication mode. Multivariate analysis suggested that three factors have a significant predictive value for post-implant speech perception: pre-operative open-set sentence score, duration of profound hearing loss and equivalent language age. These three factors accounted for 66% of the variance in this group. The results of this study suggest that children who have useful pre-implant speech perception, and higher age-equivalent scores on language measures, would be expected to do well with a cochlear implant. A shorter duration of profound hearing loss is also advantageous. Mean speech perception scores for the older group were not significantly different from younger children.
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ItemPost-implant habilitation for children using cochlear implants: effects on long-term outcome( 2002)Most clinicians working in the cochlear implant field advocate a regular habilitation program for young children receiving implants. The development of auditory skills and the incorporation of these skills into language development are thought to be key areas for such programs. Studies of speech perception and language outcomes demonstrate that an educational approach that emphasises spoken language development appears to enhance the results for implanted children. It remains difficult, however, to demonstrate clearly the effect of habilitation objectively and to determine how much individual attention is desirable for each child. This pilot study considered the long term speech perception and language outcomes for two groups of children who received Nucleus cochlear implants in Melbourne. One group (n=17) was identified as receiving regular habilitation from the Melbourne Cochlear Implant Clinic over a four year post-operative period. Another group (n=l1) was identified as receiving very little regular habilitation over the post-operative period. The language and speech perception results for these two groups showed a significant difference in performance on a wide range of measures with the group receiving regular formal habilitation demonstrating better performance on all measures. These groups included only congenitally, profoundly hearing-impaired children and did not differ significantly on mean age at implant or experience at the time of assessment. Further studies are needed to clarify these results on a larger group of children, and to control for additional confounding variables. Nonetheless, these preliminary results provide support for the incorporation of regular long-term habilitation into cochlear implant programs for children.
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ItemWhat factors contribute to successful outcomes for children using cochlear implants( 2000)Long term speech perception data has been collected for 100 children using the Nucleus multichannel cochlear prosthesis in Melbourne. Scores on a number of different assessments are available at approximately six month intervals following implantation for these children. The group represents an unselected sample of cochlear implant users, as all children were included if they had sufficient developmental skills to perform formal speech perception tests. Information was also collected on each child regarding type of hearing loss, age of onset of profound hearing loss, duration of profound hearing loss, age at implantation, pre and post-implant communication mode, developmental delay, speech processing strategy and length of experience with implant use.
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ItemLatest results for adults & children using cochlear implants & future implications( 2000)The overall success of a cochlear implant procedure is most often quantified by assessing how well implantees can understand speech. This is because a primary aim of the application of cochlear implants is to improve communication, and it is relatively straightforward to obtain accurate measures of speech recognition. The quality of cochlear implant hearing is not well described by measuring an audiogram, as the detection of sound is similar across all implantees if the device is functioning correctly. A commonly used measure of speech understanding is the CID everyday sentence test where the number of correctly identified words within sentences is assessed. In the early days of cochlear implants, subjects could only recognize a few words without lipreading but the most recent results show average scores of 80% without lipreading for this sentence test, after 6 months of experience with the device.
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ItemHearing levels and speech perception prior to cochlear implantation - are they predictive of outcomes for adult implant users?( 2000)As the speech perception results obtained for adults using multichannel cochlear implants have improved, people with a wider range of hearing losses are now considering implantation. In the mid-1980s, most adults undergoing cochlear implantation had little or no residual hearing. This made selection and counselling relatively straightforward as any level of hearing obtained through use of the cochlear implant could be considered as a benefit in such cases. Most patients evaluated for implantation today have some degree of useful residual hearing, and may be reliant on this hearing to varying degrees in their everyday life. In essence, they have something to lose if their postoperative performance is poor. In counselling these patients, it would be most helpful to have reliable predictors of postoperative performance. A number of factors such as duration of profound hearing loss, congenital profound hearing loss, and certain aetiologies (eg, head injury) have shown significant links with outcomes in previous studies.