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67 Cards in this Set
- Front
- Back
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first wearable cochlear implant device in |
1972 |
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What is a cochlear implant? |
-implanted device that electrically stimulates the auditory nerve -auditory signal encoded by a speech processor and the electrical signal is delivered to the implant |
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internal components of cochlear implant |
-surgically implanted electrode array -surgically implanted receiver stimulator |
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external components of cochlear implant |
-transmitter coil -speech processor -microphone -battery source |
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how a cochlear implant works |
1. microphone picks up sound, sound processor converts to digital information 2. this is transferred to implant 3. implant sends electrical signals down electrode into cochlea 4. hearing nerve fibers in cochlea pick up the signals and send them to the brain |
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tonotopic mapping |
mapping of cochlea- low frequency at apex, rising to base as it's coiled; cochlear implants mimic this |
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cochlear implant candidacy |
-desire to be part of hearing world -will have therapy/education for auditory skills -no medical contraindications -highly motivated -appropriate expectations |
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not a CI candidate |
-hearing loss of neural or central origin -absense of cochlea or 8th nerve development -active middle ear infection or disease -tympanic membrane perforation -unrealistic expectations -adolescents with parental pressure |
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manufacturers of CIs |
Cochlear Americas Advanced Bionics MedEl |
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hybrid CI |
also acts as a hearing aid; helps with high frequencies without the feedback of a hearing aid |
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CI process |
-preoperative assessment -medical assessment -surgery -recovery -activation/programming -follow-up -auditory training and speech-language intervention |
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CI assessment for adults |
-case history, audiogram, etc. -minimum speech battery -3-6 month hearing aid trial with limited benefit -medical evaluation by otolaryngologist |
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CI assessment for children |
-case history, audiogram, etc. -OAE -ABR -medical evaluation -speech/language evaluation -minimal benefit from hearing aids -failure to hit basic auditory milestones |
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how to decide which ear to implant |
-CT scan to find better anatomy -ear with more recent hearing loss onset -patient preference -maybe better ear because less atrophy or maybe worse ear because better ear can be helped by hearing aids |
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things that affect outcome |
-etiology -age of onset -age at implantation -duration of deafness -residual hearing -anatomy (ex. cochlea doesn't complete full 2.5 turns) |
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Neural Response Telemetry (NRT) |
telemetry- sending info to implant and getting info back -impedance- is electrode functioning? -voltage compliance- can we deliver amount of current needed given impedance? -neural response- is nerve functioning in response to stimulation? (looking for wave I of ABR) -electrical stimulation delivered to electrode, nearby electrodes record response, information recorded on computer -used to determine functioning of electrodes during surgery and estimate comfort levels post-operatively |
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NRT- impedence testing |
test function of electrodes using computer program etc. |
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CI recovery time |
3-6 weeks before external headset and processor can be hooked up; must be fully healed |
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CI programming and activation |
mapping takes 15-30 minutes, measure voltages and impedances, calculate threshold and comfort levels, done on PC, microphone activated, also counsel patient |
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cochlear implant mapping |
-select speech coding strategy -measure appropriate stimulation levels -adjust other parameters for listening preferences -do this regularly with patients |
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principles for CI speech perception |
-vowels have lower frequency, higher intensity -consonants have higher frequency, lower intensity -important to stimulate electrodes corresponding to frequency range of speech -greater number of electrodes/channels needed to listening in noise than in quiet |
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speech coding strategies |
-set of rules to convert acoustic stimulation into electrical stimulation -depends on software and hardware |
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spectral resolution |
higher number of channels |
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temporal resolution |
-amplitude of pattern of stimulation -fixed number of channels with a high rate of stimulation |
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Continuous Interleaved Sampling (CIS) |
-current delivered proportional to amount of energy delivered in each filter |
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SPEAK |
-spectral/pitch cues -moderate-slow rate of stimulation -filters sound into 22 bands covering different frequencies, selects 6-10 that have greatest amount of energy -stimulus rate is equal to the period of the lowest frequency of speech (Fo) |
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Advanced Combination Encoder (ACE) |
-combination of SPEAK and CIS, emphasizes spectral and temporal cues, flexible number of channe;s |
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HiRes |
high resolution, 16 or 120 channels |
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spectrally based coding strategies |
-SPEAK -ACE -HiRes |
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temporally based coding strategy |
CIS |
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CI features |
-sensitivity control (how far away picking up sound from) -volume control -programs -multiple speech processing strategies -telecoil -rechargeable batteries |
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CI follow-up |
more frequent at first, then once a year -reprogramming MAP -functional testing with CI -testing and questionnaires |
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CI technical and safety issues |
-can't get MRI -meningitis concerns |
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bimodal system |
one hearing aid and one CI, better for localization or with noise |
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cons for bilateral implantation |
-bimodal may be better -save ear for future technology -impact of second device not as great as first; expectations -difficulty with programming, especially if one implant is newer |
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1-3-6 plan |
1- infants screened for hearing loss before 1 month old 3- infants who don't pass will have a diagnostic audiologic evaluation before 3 months 6- infants with hearing loss will have intervention before 6 months |
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babies begin to hear |
at around 20 weeks |
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the role of SLP in hearing loss |
initial evaluation, review of communication options, collaborate with audiologists to monitor progress, interval evaluations |
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5 communication options |
-bilingual-bicultural- ASL and Deaf culture -total communication- speaking and signing -cued speech -oral communication- listening and lipreading -auditory-verbal- spoken language via audition alone |
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how to choose method of communication |
-age -duration/degree of hearing loss -family -long term goals |
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auditory-verbal approach- desired outcome |
-to develop the child's auditory pathways/centers in the brain for listening and spoken language -for children who are deaf/hard of hearing to grow up in a typical learning and living environment (mainstreamed) |
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10 principles of auditory-verbal approach |
1. early diagnosis 2. immediate assessment and use of best technology to get maximum benefits of auditory stimulation 3. guide/coach parents to help child use hearing as primary sensory modality in developing spoken language (w/out sign language or lipreading) 4. guide/coach parents to become primary facilitators of child's listening and spoken language development through participation in therapy 5. guide/coach parents to create supportive environments 6. guide/coach parents to help child integrate listening and spoken language into all aspects of life 7. guide/coach parents to use natural developmental patterns of audition, speech, language, cognition, and communication 8. guide/coach parents to help their child self-monitor spoken language through listening 9. use diagnostic assessments to develop individualized objectives, monitor progress, and evaluate effectiveness 10. promote education in regular schools with peers |
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good listening environment for AV |
reduce background noise, reduce reverberation, move closer to child's ear |
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in AV, do what with visuals |
try not to use |
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school accommodations for students with hearing loss |
FM radio, preferential seating, pre-teaching, closed captioning of AV materials, noise dampening, adequate lighting, etc. |
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auditory-verbal vs. auditory-based |
auditory-verbal follows all the principles, parent is always present, early intervention with focus on habilitation, early mainstreaming; for auditory-based parents are not always present, may be rehabilitation, may wait longer to mainstream |
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normal listening development- 3 months |
startled by sounds, searches for sounds with eye movements; cooing |
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normal listening development- 3-6 months |
searches for sounds, can ignore a sound that isn't meaningful, recognizes mother's voice, voice vs. noise; laughs, babbles, vocalizes emotions |
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normal listening development- 6-9 months |
responds when called, listens when spoken to, responds to common phrases; 2-syllable babble, shouts for attention, intonation |
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normal listening development- 9-12 months |
attends to new words, identifies two body parts, follows simple commands, gives objects; says mama or dada meaningfully, imitates names of familiar objects |
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expectant look/pause time |
create the need for them to talk- allow for processing time; give look |
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AV birth to 3 years |
lengthen auditory memory, power words, natural sounding speech, common phrases, vocal turn taking |
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power words |
words that will get a response if used (ex. "Mommy", "no") |
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AV strategies in preschool |
add background noise for some tasks, move further from ear, decrease acoustic highlighting/repetitions |
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auditory sandwich |
auditory only -> auditory + visual/tactile -> auditory only |
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growing up with hearing loss- difficulties |
-self-concept -emotional development/understanding emotions -family concerns -social competence -adolescence |
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psychosocial aspects of acquired hearing loss |
-self-concept -psychoemotional reactions -family concerns -social concerns -grief cycle -conversational exclusion |
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average time from noticing problem to seeking assistance |
7 years |
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% of population who would benefit from hearing aids that actually uses them |
20% |
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ASL is/has |
-a unique natural language -made up of cheremes -prosodic features -regional dialects -roots in French Sign Language |
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Deaf people feel strongly about using |
manual communication rather than developing any kind of oral communication |
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Deaf people are typically |
bilingual- communicate using ASL and English (oral or written) |
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first American school for the deaf |
1817, Conneticut Asylum for the Education & Instruction of Deaf and Dumb Persons -later renamed the American School for the Deaf |
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Gallaudet and Clerc founded more schools and used these approaches |
-bilingual; sign language, fingerspelling, written English; manualism philosophy |
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Alexander Graham Bell was a proponent of |
oralism; advocated separation of deaf people |
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Babbidge Report |
1965, recommended procedures for early identification and evaluation of hearing impairment |
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Gallaudet University protests |
1998- Deaf President Now 2006- didn't like Fernandes |
