Cochlear Implants. What is a Cochlear Implant (CI)? Audiological Rehabilitation SPA 4321

Transcription

1 Cochlear Implants Audiological Rehabilitation SPA 4321 What is a Cochlear Implant (CI)? A device that turns signals into signals, which directly stimulate the auditory. 1

2 Basic Workings of the Cochlear Implant Basic Parts of the CI Internal Components Receiving antenna Array Ground electrode 2

3 Basic Parts of the CI External Components Microphone Connecting Cables Transmitting How a Cochlear Implant Works Sound comes in through the. The speech processor analyzes and codes sounds into a series of. These pulses are sent to the coil and are transmitted across the skin, via radio wave, to the. The implant sends the pulses to the electrodes in the, which stimulate the nerve. 3

4 Signal: Microphone to Coil 4

5 Implant to Cochlea Electrodes Stimulating Nerve 5

6 Hearing Aids vs. Cochlear Implants Hearing Aids Amplify sound so that the remaining can be used. Can be used for persons with mild to profound hearing loss. Cochlear Implants Bypass the hair cells and stimulate the nerve directly. Indicated for persons with to hearing loss. Who is a candidate for a cochlear implant? Cochlear implant candidacy has been expanded over the years to include not only the very young, but also the. Currently we are implanting children less than old and adults well into their! 6

7 Who is a candidate for a cochlear implant? FDA Guidelines months or older Bilateral profound Little to no benefit from No medical contraindications Family Support Candidacy Continued FDA Guidelines (cont ) Educational program that emphasizes development of auditory skills Either Communication or Auditory-Verbal in conjunction with educational placement Appropriate Expectations 7

8 Cochlear Implant Team Surgeon Audiologist Patient Parents/Family SLP/ Teacher of the HI Psychologist and social worker Pre- vs. Post-Implant Pre-Implant Audiological evaluation Medical evaluation evaluation Educational Evaluation Post-Implant week healing time Initial stimulation Follow-up programming Auditory skill development 8

9 Surgical Considerations Anatomical Features Nerve Monitoring Type Possible Complications Incision Newer 9

10 Electrode Insertion 10

11 Psychological Considerations functioning functioning Parenting Predictors of use of CI Information Obtained in CI Evaluation Parent information Psychological function Stress and Relational functioning functioning for implant Child information Behavioral functioning Cognitive functioning Motivation for implant 11

12 Audiological Considerations Motivation for the implant data Length/consistency of use Educational Placement Appropriate expectations Audiometric Considerations Children Plateau of speech/language development Aided thresholds poorer than ~ db Appropriate and Consistent use of HAs Adults Scores on sentence material presented at 50dB % or less in the worse ear % or less in the better ear 12

13 Appropriate Expectations CI is not a bionic ear or a miracle cure Requires a tremendous commitment in terms of money, time and benefit will be realized if there is not a commitment to auditory and speech development Appropriate Expectations Speech/Language therapy does not end when a child gets a CI it Hook-up is Day 1 hearing may take a for the child to say their first word. 13

14 Factors that affect outcomes Structure of the Presence of disabilities Presence of a formal system Expectations of the parent and child Amount and quality of Educational environment Factors that affect outcomes Availability and quality of support services Wear-time of the device of implant use Presence of a second in the home Proper functioning of the device Appropriate of the device 14

15 Educational Considerations Increasing numbers of CI children in the school system in 10 deaf children are implanted Closer communication between Cochlear Implant Centers and the schools Educators for the Hearing Impaired need: in CIs To raise their expectations More emphasis on auditory training Post-Implant Procedures 4-6 week healing time Initial Orientation Follow-up Auditory Skills Development 15

16 Initial Stimulation Setting minimal levels based on behavioral or conditioned responses Setting maximum levels based on Working on conditioning activities when -appropriate Orientation Proper use and care of the processor Changing Precautions regarding electricity Physical activities MRI precautions 16

17 Follow-Up Programming MAP is continually refined and Comfort levels are adjusted as the patient adapts to the implant Most drastic mapping changes are made within the first weeks Processing strategy may be changed based on performance Auditory Skill Development Detection Pattern identification Auditory comprehension 17

18 Cochlear Implant Companies Currently 3 companies world-wide Advanced Bionics Cochlear Corporation More than users worldwide Advanced Bionics 18

19 Cochlear Corporation Med-El Med-El 19

20 True or False Cochlear implants are only appropriate for people who have no hearing at all. Cochlear implants should be recommended only for people who show NO benefit from hearing aids. Most insurance companies will cover cochlear implants. A cochlear implant is a type of hearing aid. True or False Patients with pure tone averages of 70 db have too much hearing for cochlear implants. Prelingually deafened adults with no auditory experience made great cochlear implant candidates. People with cochlear implants hear noises rather than speech, which they must learn to interpret. 20

21 True or False Cochlear implants are capable of eliminating background noise. Children with cochlear implants achieve approximately the same level of use whether they are in Total Communication or oral programs. The primary benefit of cochlear implants for children is environmental sound awareness. True or False The average speech recognition of postlingually deafened adults on sentence material is less than 20%. Music appreciation for people with cochlear implants is generally more difficult than speech recognition. Most people with cochlear implants still rely heavily on speechreading. Adolescents are the best candidates for CI. A child with a profound loss should immediately be implanted rather than wasting precious time with HAs. 21

22 True or False Children who wear cochlear implants should not take PE or play sports. The most important factor in the success of implantation in children is: a) Surgical Skill b) Programming device c) Both a & b d) neither Deaf Culture Feel that implanted children may become culturally, belonging to neither the Deaf nor the hearing communities. (1989) Deaf culture activists maintain that those children (who use CIs) are sure to be failures deprived of the dignity of their deafness and yet never accepted as full members of the world. They say that choosing to implant children is 22

23 Deaf Culture (cont d) irresponsible, done for the convenience of hearing parents. At the very least, they argue, deaf children should be allowed to wait to make the choice themselves. They recommended that deaf children be raised by the Deaf community, using ASL, in one of residential schools scattered across the country. Trying to fix a deaf child, they say, is like trying to fix someone because he/she speaks Japanese. 23