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73 Cards in this Set

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What is this?: Biomedical prosthetic devices that convert sound into electrical current in order to directly stimulate auditory nerve fibers to produce hearing sensations.
cochlear implants
True or false: The orginal cochlea is removed when having surgery for CIs.
False
Who is eligible for CIs?
persons with severe to profound sensorineural hearing losses bilaterally whose sensory cells in cochlea are so damaged they cannot adequately transduce sound energy
About how many Americans are profoundly hearing impaired and may not be able to participate in normal conversation, hearing warning signals, or use the telephone?
about 2 million
Who (nearly 200 years ago) inserted metal rods attached to an active current into his ears?
Allessandro Volta
What type of medical device are CIs considered by the FDA?
Class III medical device (high risk)
Who developed the first wearable processor?
the House Institute
Who developed the Nucleus 22 and who was it approved for?
the Cochlear Corporation, and it was approved for adults and adolescents (pre and postlinguistically impaired)
What are the 3 companies that can sell CIs in the U.S.?
-Cochlear Corporation
-Advanced Bionics
-Med-El
What percent of CIs worldwide are produced by Cochlear Corporation?
about 70-80%
As of 2009, about how many people have CIs worldwide?
180,000
About how many adults AND how many children have CIs in the U.S.?
adults = 41,000
children = 25,000
Where is the only CI center in Nebraska?
Omaha
Do all CI centers implant children and adults?
No
What is a key question to ask for candidacy for a CI?
Is the use of a cochlear implant likely to improve the patient's auditory perceptual skills?
What 3 categories do prospective CI candidates fall into?
-adults with acquired HL
-adults with prelingual HL
-children
What age must a person be to be considered for CIs?
12 months (as long as cochlea is developed)
For CI candidacy, what score must an adult have on a speech test?
< 50-60% on the HINT (Hearing In Noise Test)
For CI candidacy, what score must a child have on a speech test?
show lack of progress on the MAIS (Meaningful Auditory Integration Scale) or the Lexical NT (Neighborhood Test) <30%
True or false: Federal Law restricts sale, distribution, and use by or on the order of a physician.
True
What is the cost range for CI?
$50,000-60,000
True or false: For adult patients, a psychological examination may be required as part of the assessment process.
True
Who are the best candidates for CIs? AND why?
those with post-lingual or late-onset hearing losses because they have been exposed to speech and language and have "auditory memory" for speech. Also, there may be less ganglion cell deterioration.
What type of correlation is there between length of deafness and speech perception outcomes?
significant negative correlation
What are CIs comprised of?
components that are worn externally and those that are implanted internally. true for all devices
What are the external components of CIs?
-microphone
-speech processor
-transmitter
True or false: Length of deafness is not a crude predictor of potential loss of central auditory function.
False
True or false: CI microphones operate differently than HA microphones.
False; operate the same
What does the speech processor of CIs do?
takes the electrical signal from the microphone. here the signal is shaped according to the speech processing or coding strategy of the system
How are the transmitter and receiver of CIs coupled?
magnetically. the transmitter can be placed on or taken off by the patient
What are the internal, surgically implanted components of CIs?
-receiver/stimulator
-electrodes
How are the receiver/transmitter coupled to the transmitter?
via strong rare earth magnet
How do CIs work with MRIs?
-The Nucleus and Med-El devices are MRI safe
-Advanced Bionics has a removeable magnet for MRI studies
Explain electrodes for CIs.
the coded signal from the receiver/stimulator is sent to a series of electrodes which are inserted on an array into the cochlea. the number of electrodes varies across the implant systems
How many electrodes does the Nucleus 22/24 have? The Clarion? and The Med-El?
-20 (22)
-16
-12
How are electrodes inserted for CIs?
the electrode array is looped across the middle ear and inserted through the Scala Typani, via the round window. this access is chosen because of the less sharp basal turn, it is distal to the vestibular system, and is more accessible
How long does the CI surgery take? AND how long must a patient wait for a healing period before the unit is programmed?
2+ hours; 4 to 6 weeks
For CIs, what is mapping?
the programming of the CI. this involves setting the stimulation levels for threshold and discomfort for each of the electrodes. this involves deciding on a coding strategy
What are the auditory hierarchy steps proposed by Erber for CI rehab programs?
-detection
-discrimination
-identification
-comprehension
What are the outcomes of CIs?
-substantial % of post-lingually impaired adults demonstrate some open-set speech recognition
-improved perception of environmental sounds
-speechreading is nearly always facilitated when using the implant
-confirmed improvement in speech production in some patients (can hear themselves)
-some may use telephone
-individuals with acquired HL benefit more from CIs
-rehab may maximize the use of implant
-greatest improvements in perception are likely to be seen within first 6 months
True or false: It is not necessary to use both sign language and spoken language for children in the early stages of CI rehab.
False; may be necessary
Performance with a CI is most sensitive to _________________ and ______________.
age at implementation; length of deafness
Who gains skills from the CI at a slower rate: prelingual children who are deaf or post lingual children?
prelingual children
How long of time period does speech production and perception scores continue to improve?
at least over a 5 year period
How long may it be before a child experiences some degree of open set speech recognition?
3-4 years
What are some problems related to children and hearing?
-reduced sensitivity
-sound distortion
-fluctuating hearing
What are some communication problems that may arise from a child who is HOH?
underdevelopment of:lexical, semantic, phonological, pragmatics
What are some academic difficulties a child who is HOH may face?
-poor performance
-language-based subjects
-class participation
-class tests
-communicating with peers and teachers
What 3 separate areas could pediatric rehab be viewed as?
-early intervention
-preschool
-school age
What does UNHS?
universal newborn hearing screening
How many states have implemented UNHS guidelines?
47 and D.C.
What is the average age of ID for children with permanent HL in Nebraska?
4 months of age
What percent of babies going home from newborn nurseries are being screened for HL?
nearly 95%
In 2009, what percent of newborns in Nebraska were screened for HL?
99%
Children who received early identification of HL and had intervention demonstrated better _________________ and _____________ skills.
speech-language; social-emotional
Why is it important to have early amplification for children who have HL?
-critical stage for speech-language development
-central systems are more "plastic"
-bird study: those who did not hear species' song pattern during critical period never developed those patterns
-early implant: develop better speech recognition skills
True or false: Children with HL follow typical word-learning-developmental patterns, however, in the early stages of development there may be delays.
True
Overhearing slide for early intervention????
my notes are cut off :)
By the time a child graduates from high school, how much money can be saved in special education services if a child is identified and placed in intervention early?
more than $400K
What are the main areas of concern for parents of children with hearing aids?
-care and maintenance (75%)
-appearance-hearing aid effect (60%)
-realistic benefits from hearing aids (65%)
What is typically the audiologist's main concern for children with hearing aids?
hearing aid electronic functions
What are the stages of grieving?
-shock/denial
-anger/guilt
-acceptance
For early intervention of children with HL, how has the focus changed over the years?
-child focused (first)
-family involved
-family focused
-family centered
Why is early intervetion for children with HL now family centered?
-broadened perspective of relationships
-recognition of impact of environmental factors on language learning
-research with families underscores the importance of support in reducing stress
What are characteristics of family centered practices for early intervention of children with HL?
-recognizes the role of relationships
-respects expertise and perspectives of families
-uses joint discovery process to problem solve
-focus on identifying family strengths and priorities
-grieving is viewed as a natural, healthy process
-focus on accessing support opportunities
-support can impact parent-child relationship in a positive way
-families often prefer informal sources of support
-we need to offer help in response to family identified needs
What are some characteristics of the professional as the expert model (parent-infant intervention for HL)?
-clinician makes most decisions
-demonstrates how to work with child
-assignments given
How do you build a partnership with the families of a child with HL?
-parents in driver seat
-objective feedback
-understand before explaining/teaching
-accept parents' interpretation, predictions, and advice
-active listening!
-search for joint perspectives
-negotiation
-joint discovery through experiments
What is the Homebound Parent-Infant model? (in Boys Town)
-weekly or twice weekly visits to home by parent-infant specialist
-work with family routines to coach family members in creating lanuage-rich environments
-assist family in working with devices, ASL, and other resources
What is the Parent-Infant Curriculum model? (in Utah)
-national dissemination effort
-training of trainers model
-deaf mentor project
-supports family choices
What percent of children born with significant hearing loss have normal hearing parents?
95%
What is the Parent-Infant Curriculum-Infant Hearing Resource model? (Oregon)
-parent-child communication
-for families: video and workbook series
-developmental guidelines
What are some ways to expand a child's language?
-reading
-signaling expectation
-describing: self-talk
-modeling: expansion
-parallel talk
-question stimulation
-time-talk
-labeling
What are some family sign resources?
-Gallaudet Unviversity Press
-Deaf Mentor Concept (Utah)
-ASL University
-Laurent Clerc National Deaf Education Center
-Hands and Voices