Graeme Clark Collection

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    Cognitive processing in children using cochlear implants: the relationship between visual memory, attention, and executive functions and developing language skills
    Surowiecki, Vanessa N. ; SARANT, JULIA ; MARUFF, PAUL ; Blamey, Peter J. ; Busby, Peter A. ; Clark, Graeme M. ( 2002)
    We performed this study to determine whether children using a cochlear implant performed differently from age- and gender-matched hearing aid users on 8 neuropsychological measures of visual memory, attention, and executive functioning. The study also examined whether differences in cognitive skills could account for some of the observed variance in speech perception, vocabulary, and language abilities of hearing-impaired children. In contrast to previous studies, our results revealed no significant cognitive differences between children who use a cochlear implant and children who use hearing aids. Partial correlation analysis indicated that the children’s visual memory skills, i.e., their recognition memory, delayed recall, and paired associative learning memory skills, correlated significantly with their language skills. When examined at a significance level of .01, attention and executive functioning skills did not relate to the children’s developing speech perception, vocabulary, or language skills. The results suggested that differences in visual memory skills may account for some of the variance seen in the language abilities of children using implants and children using hearing aids.
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    Speech perception outcomes in older children who use multichannel cochlear implants: Older is not always poorer
    Dowell, RC ; Dettman, SJ ; Hill, K ; Winton, E ; Barker, EJ ; Clark, GM (ANNALS PUBL CO, 2002-05)
    Speech perception outcomes for early-deafened children who undergo implantation as teenagers or young adults are generally reported to be poorer than results for young children. It is important to provide appropriate expectations when counseling adolescents and their families to help them make an informed choice regarding cochlear implant surgery. The considerable variation of results in this group makes this process more difficult. This study considered a number of factors in a group of 25 children who underwent implantation in Melbourne between the ages of 8 and 18 years. Each subject completed open-set speech perception testing with Bamford-Kowal-Bench sentences before and after implantation and preoperative language testing with the Peabody Picture Vocabulary Test. Data were collected regarding the type of hearing loss, age at implantation, age at hearing aid fitting, audiometric details, and preoperative and postoperative communication mode. Results were submitted to a stepwise multiple linear regression analysis with postoperative open-set sentence scores as the dependent variables. The analysis suggested that 3 factors have a significant predictive value for speech perception after implantation: preoperative open-set sentence score, duration of profound hearing loss, and equivalent language age. These 3 factors accounted for 66% of the variance in this group. The results of this study suggest that children who have useful speech perception before implantation, and higher age-equivalent scores on language measures, would be expected to do well with a cochlear implant. Consistent with other studies, a shorter duration of profound hearing loss is also advantageous. The mean sentence score for this group, 47%, was not significantly different from the mean result across all children in the Melbourne program.
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    Speech perception in children using cochlear implants: prediction of long-term outcomes.
    Dowell, RC ; Dettman, SJ ; Blamey, PJ ; Barker, EJ ; Clark, GM (Informa UK Limited, 2002-03)
    A group of 102 children using the Nucleus multichannel cochlear implant were assessed for open-set speech perception abilities at six-monthly intervals following implant surgery. The group included a wide range of ages, types of hearing loss, ages at onset of hearing loss, experience with implant use and communication modes. Multivariate analysis indicated that a shorter duration of profound hearing loss, later onset of profound hearing loss, exclusively oral/aural communication and greater experience with the implant were associated with better open-set speech perception. Developmental delay was associated with poorer speech perception and the SPEAK signal coding scheme was shown to provide better speech perception performance than previous signal processors. Results indicated that postoperative speech perception outcomes could be predicted with an accuracy that is clinically useful.
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    Variation in speech perception scores among children with cochlear implants
    Sarant, JZ ; Blamey, PJ ; Dowell, RC ; Clark, GM ; Gibson, WPR (LIPPINCOTT WILLIAMS & WILKINS, 2001-02)
    OBJECTIVE: The objective of this study was to identify common factors affecting speech perception scores in children with cochlear implants. DESIGN: Speech perception data for 167 implanted children were collected at two cochlear implant centres in Melbourne and Sydney. The data comprised audition-alone scores on open-set word and sentence tests. Children were selected on the basis that they had a Nucleus 22-electrode cochlear implant. The average age of the children was 5 yr. Information was also collected about 12 factors that may have influenced speech perception scores for each child. Analysis of covariance was used to identify factors that significantly affected speech perception scores. Pearson pairwise correlation coefficients were also calculated for all factors analyzed. RESULTS: The analyses in this study identified factors that accounted for 51%, 34%, and 45% of the variance in phoneme, word and sentence perception scores. Scores decreased by 1.4 to 2.4% per year of profound deafness prior to implantation. Children who normally use oral communication scored significantly higher than children normally using sign or simultaneous oral and sign communication. Children implanted in Sydney scored higher on average than children implanted in Melbourne. CONCLUSIONS: The results show that a significant part of the variation in speech perception scores is systematically related to audiological and environmental factors for each child. The reasons for significant differences between children using different communication modes or from different clinics were not identified.
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    Speech perception as a function of electrical stimulation rate: using the nucleus 24 cochlear implant system
    Vandali, Andrew E. ; Whitford, Lesley A. ; Plant, Kerrie L. ; Clark, Graeme M. ( 2000)
    Objective: To investigate the effect of varying electrical stimulation rate on speech comprehension by cochlear implant users, while keeping the number of stimulated channels constant. Design: Three average rates of electrical stimulation,250, 807, and 1615 pulses per second per channel (pps/ch), were compared using a speech processing strategy that employed an electrode selection technique similar to that used in the Spectral Maxima Sound Processor strategy (McDermott, McKay,& Vandali, 1992; McDermott & Vandali, Reference Note 1; McKay, McDermott, Vandali, & Clark, 1991)and the Spectral Peak strategy (Skinner et al., 1994;Whitford et al., 1995). Speech perception tests with five users of the Nucleus 24 cochlear implant system were conducted over a 21-wk period. Subjects were given take-home experience with each rate condition. A repeated ABC evaluation protocol with alternating order was employed so as to account for learning effects and to minimize order effects. Perception of open-set monosyllabic words in quiet and open-set sentences at signal to noise ratios ranging from +20 to 0 dB, depending on the subject’s ability, were tested. A comparative performance questionnaire was also administered. Results: No statistical differences in group performance between the 250 and 807 pps/ch rates were observed in any of the speech perception tests. However, significantly poorer group performance was observed for the 1615 pps/ch rate for some tests due predominantly to the results of one subject. Analysis of individual scores showed considerable variation across subjects. For some subjects, one or more of the three rate conditions evaluated provided benefits on some speech perception tasks. The results of the comparative performance questionnaire indicated a preference for the 250 and 807pps/ch rates over the 1615 pps/ch rate for most listening situations. Conclusions: For the speech processing strategy, implant system, and subjects evaluated in this study, the group results indicated that the use of electrical stimulation rates higher than 250 pps/ch (up to 1615 pps/ch) generally provided no significant improvement to speech comprehension. However, individual results indicated that perceptual.
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    Generalisation of tactile perceptual skills to new context following tactile-alone word recognition training with the Tickle Talker
    Galvin, Karyn L. ; Blamey, Peter J. ; Cowan, Robert S. C. ; Oerlemans, Michael ; Clark, Graeme M. ( 2000)
    Abstract not available due to copyright.
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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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    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.