Audiology and Speech Pathology - Theses
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ItemStudent engagement of children who are deaf or hard of hearing attending mainstream schools( 2021)Student engagement in classroom learning is recognized as being important for a child’s school success. It is a major focus in the education literature, with a range of intervention programs being designed to increase engagement levels in the classroom as a way of increasing school completion rates, and improving school outcomes for the student. Students who are deaf or hard of hearing (DHH) and attend mainstream schools may experience additional difficulties engaging in their learning compared to their peers with typical hearing. Despite this, research investigating the student engagement of children who are DHH remains sparse. To address this gap, the overarching aim of this thesis was to explore the student engagement of DHH students attending mainstream schools. This thesis consisted of two studies. The first study compared the observed and the self-reported engagement of 16 DHH students (aged 9 – 12 years) who attended mainstream schools to that of matched controls with typical hearing. Observed engagement was measured through observations in the classroom setting using the Mainstream Version of the Code for Instructional Structure and Student Academic Reponses (study 1a), and self-reports of engagement were obtained using the Classroom Participation Questionnaire (study 1b). The main finding of this study was that there were no significant differences for either observed or self-reported engagement for the group of DHH students compared to that for the group of matched controls. When looking at individual results, three individual DHH participants had lower levels of observed engagement compared to their matched control. Adverse noise levels for one student, and low vocabulary scores for another student are possible causes for these poor results. The second study was a qualitative study that used individual interviews to explore the self-perceived barriers and facilitators to engagement for DHH students attending mainstream schools. Interviews consisted of a series of question and a card-sorting activity. The same 16 DHH students who participated in study 1, participated in study 2. Thematic analysis of the interview transcripts resulted in the generation of four themes. These were: challenges to engagement, student strategies, supports to students, and teacher actions. These themes demonstrate the complex range of factors that contribute to or impede engagement of students who are DHH in mainstream classrooms.T he work undertaken for this research demonstrated that, for the participating students, there were no differences between the groups on either observed or self-reported engagement. One notable characteristic which is likely to have contributed to this positive finding was that all but one of the participants attended a mainstream school with a deaf facility. As such, it is possible that factors related to this school setting, such as having high levels of support available and having a DHH peer group within the school, may have contributed to the positive finding. Although there were no differences in engagement levels between groups, three individual DHH participants had lower levels of observed engagement compared to their matched controls. As such, some DHH students may benefit from receiving support with a specific focus on engagement. The factors identified in the second study may be used to inform professionals about the engagement of students who are DHH attending mainstream schools, and provide strategies towards reducing the barriers and increasing the facilitators to engagement for these students.
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ItemA study of electrical stimulation levels over 10 years for adults using Nucleus cochlear implants( 2017)Cochlear implants have improved sound perception for thousands of people with severe and profound sensorineural hearing loss. To ensure a good quality sound signal, the implant must be individually programmed throughout the user’s lifetime. Programming determines the electrical stimulation level requirements for each electrode of the implant. The frequency with which programming occurs has so far been based primarily on clinical experience and resources available to the clinic for programming purposes. To develop an evidence-based schedule for the frequency of programming, a comprehensive investigation of the change in electrical stimulation level requirements over time for a large group of adults is necessary. The overall purpose of this retrospective study was therefore to investigate the change in electrical stimulation levels up to 10 years postimplantation for a large group of adults using Nucleus cochlear implants. In addition, this study also aimed to investigate whether demographic characteristics and electrode array segments were predictive of the change in electrical stimulation levels. The Cochlear Implant Clinic of the Royal Victorian Eye and Ear Hospital, Victoria, Australia, has been providing programming services for cochlear implant users for over 25 years. The electrical stimulation data obtained at the programming sessions were extracted for 680 participants who used a Nucleus® cochlear implant over the course of 10 years. For each implant user, programming data for the following time points were extracted from Cochlear Limited’s TM Custom Sound 3.2® fitting software: 2, 3, 6, 9 months postimplantation and biennial time points from 1 year up to 10 years postimplantation. For each time point, the mean T level, C level, and dynamic range (DR) were calculated separately for four electrode array segments: apical (mean of electrodes 22, 20, 18), medial (16, 14, and 10) upper-basal (7, 6), and lower-basal (4, 3). The degree of change (DC) in levels between consecutive time points was also calculated. Long-term changes in electrical stimulation levels were also investigated for 128 participants from the same group who had adequate programming data up to 10 years postimplantation. The trends and amount of change in programming levels were investigated separately for the four electrode array segments using regression analyses. The effects of several demographic characteristics (e.g., aetiology and onset of hearing loss) were also investigated. For the 680 participants, the average T levels and C levels were consistent from 3 months and 6 months postimplantation, respectively. In terms of the degree of change between time points, the majority of participants showed an average of ≤ 20% change in levels as a function of DR after the 3- to 6-month time point comparison postimplantation. Long-term patterns of change for 128 individual participants showed that, for 42% of these participants, the electrical stimulation levels remained relatively stable without any significant trends for either the T levels or C levels, from 6 months up to 10 years postimplantation. Some significant changes in levels were evident up to 10 years postimplantation; however, changes were small, equating to less than 6% per year as a function of DR for 75% of the participants and a maximum of 10% change in levels for the remaining 25% of participants. Additional noteworthy findings include the following: 1. For the participants who showed more change in levels in the first 3 to 6 months postimplantation, approximately 70% of these participants showed a non-significant long-term trend in levels up to 10 years postimplantation, 2. The mean T levels and C levels were found to differ significantly for the four electrode array segments in the first 2 years postimplantation, but were relatively consistent in the long-term, and 3. The mean degree of change in levels as a function of DR was significantly greater for the Otosclerosis pathological group (n = 72) compared to all other groups, and for the prelingual onset of deafness group compared to the postlingual group. This thesis provided strong evidence that electrical stimulation levels change in the first 6 months but expected to remain relatively stable up to 10 years postimplantation for the majority of adults using Nucleus cochlear implants. Based on this evidence, a programming protocol for 10 years postimplantation has been proposed. The proposed protocol recommends more frequent programming sessions in the first 6 months compared to the number of sessions thereafter. The reduced number of sessions over an implant user’s lifetime will assist in managing the increasing caseload with the amount of resources currently available for programming. Given that the levels differed across the segments in the first 2 years postimplantation, but not in the long-term, the proposed protocol recommends measuring levels separately for the four segments in the early postimplantation period. This can then be limited to one or two segments beyond 2 years postimplantation. The protocol also suggests that more programming sessions may be required in the first two years for implant users with Otosclerosis and those with a prelingual onset of hearing loss.