Graeme Clark Collection
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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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ItemThe importance of different frequency bands to the speech perception of cochlear implantees [Abstract]( 1996)It is well known that cochlear implantees exhibit a wide range of speech perception ability. Understanding the reason for this variability may lead to improved speech processors. This study investigates whether implantees rely on different areas of the speech spectrum for speech cues, compared to normally hearing listeners, and whether poor performers rely on different spectral areas than better performers. Six subjects with the Mini System 22 implant and using the SPEAK strategy participated in this experiment. Scores for monosyllabic words were obtained using the full speech spectrum and with selected frequency bands removed from the subjects’ speech processor maps. The Articulation Index (AI) is a measure of the proportion of speech information available to a listener, and the relative contribution to AI from different frequency bands is termed the Importance Function. The five frequency bands studied in this experiment were determined to be of equal importance to normally hearing listeners for the speech material used. The scores for each implantee were transformed into AI values, and hence the relative importance of the bands was determined. This relative importance was compared between the implantee group and normally hearing listeners to determine the way in which speech perception by electrical stimulation varies from that by acoustical stimulation. Comparisons were also made between individual implantees to determine whether correlations exist between their speech perception ability and their use of cues in different parts of the spectrum. Further research will determine whether the differences among implantees are correlated with their ability to perceive changes in stimulation place or temporal characteristics.
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ItemPreoperative residual hearing as a predictor of postoperative speech scores for adult cochlear implant users [Abstract]( 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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ItemThe evolution continues: the clinical trials of the SPEAK strategy in Nucleus 22 channel cochlear implant users [Abstract]( 1994)Research in the field of cochlear implants continues in centres around the world. The aim of all centres is to improve the speech perception abilities of those children and adults fitted with a cochlear implant. Most recently the work of Hugh McDermott and Colette McKay (Melbourne University, Department of Otolaryngology) in developing and researching the SMSP (Spectral Maxima Sound Processor) has greatly enhanced the speech understanding abilities of a number of subjects implanted with the Nucleus 22 Channel Cochlear Implant.
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ItemThe Tickle Talker: a speech perception aid for profoundly hearing impaired children [Abstract]( 1990)Fifteen prelingually profoundly hearing-impaired children participated in speech perception training and evaluation, to assess potential benefits from use of the Tickle Talker. This device, a multichannel electrotactile speech processor, developed by Cochlear Pty. Ltd. and the University of Melbourne, presents speech as a pattern of electrical sensations felt on the fingers. The eight small electrodes are located over the digital nerve bundles, on both sides of the four fingers of the non-dominant hand. Speech processing hardware is similar to that used in the 22-channel cochlear implant. In the encoding strategy, second formant frequency (F2) is presented as electrode position, speech waveform amplitude as stimulus strength, and fundamental frequency (FO) as rate of stimulation. Each child participated in an ongoing training program involving clinicians, teachers and parents. The evaluation program included measures of sound and speech detection thresholds, and discrimination of speech features, words and open-set sentences. Both individual and mean scores for all the children demonstrate significant improvements in speech perception scores when input from the Tickle Talker is combined with either aided-residual hearing, or aided residual hearing and lipreading. These results are consistent with those previously reported for profoundly hearing-impaired adults using the Tickle Talker, and indicate that children are able to integrate speech information provided through the tactual modality with information from vision or residual hearing.
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ItemSpeech feature recognition by profoundly deaf children using the University of Melbourne multichannel electrotactile aid [Abstract]( 1989)Abstract not available due to copyright.
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ItemSpeech perception with cochlear implants and tactile aids [Abstract]( 1988)Abstract not available due to copyright.
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ItemA clinical protocol for multiple electrode cochlear implants in children [Abstract]( 1986)A clinical protocol for an experimental study to evaluate the speech perception and production, and communication skills using the multiple electrode cochlear implant in pre-adolescent children has been developed. A single-subject time-series design has been adopted to regularly assess these abilities. During the pre-operative stage the subject's current hearing aids or tactile device are used, and for the post-operative stage the Nucleus multiple electrode intracochlear implant. Training is provided in both stages of the study. Also included in the pre-operative stage are the audiological and medical evaluations to determine whether the subject meets the selection criteria. Speech perception and production, and communication skills are assessed from a large selection of language and developmental-age appropriate materials. Psychophysical studies are also undertaken to measure the subject's abilities to discriminate simple stimuli differing in electrical parameter values.
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ItemThe perception of vowels by hearing impaired children [Abstract]( 1982)This paper reports the results of a series of closed-set vowel identification experiments with four congenitally hearing impaired children (age 13 years) with moderate to profound bilateral sensorineural losses. Material was presented under three test conditions: hearing alone, through currently worn hearing aids; lipreading alone; and hearing plus lipreading. Analysis of the results using multidimensional scaling and hierarchical clustering revealed a strong relationship between the perceptual organisation of the responses and the physical attributes of the method of signal presentation. In the case of acoustic signals, the results indicated a perceptual organisation describable in terms of the duration of the vowel and the relative frequencies of the first and second formant. For visual signals, the perceptual organisation correlated with characteristics of lip-shaping during production. These results indicated that the subjects attempted to use similar perceptual cues as the normally hearing population. The relationship between the perceptual organisation of the acoustic stimuli and the aided audiogram is also discussed.
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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.