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A cochlear implant is a surgically implanted prosthesis that provides sound awareness to those who don’t benefit from traditional amplification. It provides auditory benefit such as awareness of environmental sounds and speech detection. A cochlear implant does not, however, provide normal hearing.
Importance of Aural (Re)Habilitation
When an individual or family elects to receive the cochlear implant, they are also electing to pursue auditory skill development as a goal for the CI recipient. It is for this reason that management of a patient with a cochlear implant is a long-term commitment in the success of the patient’s functioning. For instance, in order for an individual to benefit from the use of a cochlear implant, precise setting of the device through computerization is necessary. This procedure is called psychophysics and entails determination of appropriate levels of electrical stimulation of the device necessary to deliver speech sound at a level sufficient for the patient to use this auditory information to communicate.
In addition, an individual’s speech acquisition and its enhancement rely heavily on the consistent refinement of skills learned in speech and language therapy. Regular sessions with a speech pathologist are crucial to the monitoring of the cochlear implant system’s functionality. A speech pathologist is often the first to note when a patient’s map, or listening program, needs re-tuning. Likewise, language growth; vocabulary, semantics, linguistic constraints and reading skills continue to increase in complexity throughout one’s life. Speech and language therapy, during these formative years of acquisition, is essential to mastery of such skills and to the long-term communicative success of the patient. Such therapy will maximize a CI recipient’s communication potential carrying over to all aspects of his/her life. Without the development of language skills, the individual will be very limited in his ability to communicate with others, and, in turn, to learn about the world around him.
Importance of Classroom Accommodations
Like other children with hearing loss, cochlear implant recipients also require classroom accommodations in order to have optimal auditory access to the information being taught. Many of the accommodations are the same as are required for any child with hearing impairment; however, there are also some additional considerations that should be made for those using cochlear implants.
Specifically, a CI recipient’s education is sensitive to the features and physical facilities in which the program is housed. Developing strategies for managing the classroom will improve the child’s ability to function in a mainstreamed education environment. As it is difficult for hard of hearing persons to follow conversations that move around the room, the CI recipient will benefit most from an environment that facilitates listening and learning. The speaker’s voice should be audible to the student with minimal background noise. Group activities should be conducted in a semi-circle to maintain attention and ensure audibility. Modifications to the learning environments are also essential for the recipient to have total access to learning. Components of an optimal physical facility include rooms that have minimal ambient noise and rooms located in areas where there is minimal ambient noise. Acoustically treated rooms (with carpet, acoustic tiles, and/or curtains) are optimal. Finally, the CI recipient may also benefit from preferential seating in order to have both improved auditory access and visual access to the teacher providing the instruction.
Importance of FM System and Other Assistive Technology
The use of assistive technology will enhance a CI recipient’s access to the auditory signal. FM systems are designed to help the child with hearing loss easily understand speech by allowing the recipient to have direct access to the speaker’s voice in order to minimize the distortions caused by distance, room reverberation, and ambient noise. With FM, the child can put his/her energy into learning rather than struggling to comprehend speech.
FM systems are designed to transmit sounds as radio waves. The teacher wears a small microphone and transmitter that send the signal from the teacher’s microphone to the student’s FM receiver. Currently, there are two types of technologies available for use in the classroom: sound field FM systems and personal FM systems. A sound field system amplifies a teacher’s voice and projects it from a loudspeaker. This system generally consists of a microphone/transmitter worn by the teacher and a receiver/speaker system that may sit near to the implanted individual. This allows the sound to be amplified so that the speaker’s voice is louder and more distinctly picked up by the cochlear implant microphone.
A personal FM system works in the same manner; however, it connects to the speech processor and sends the acoustic signal directly to the cochlear implant and eliminates the need for the loudspeaker component. It is important to note, however, that the signal output of the combined cochlear implant and personal FM system cannot be acoustically monitored. The quality of the sound can only be determined by how the pediatric CI user responds when using the two systems together. This requires that the teachers and parents have the capacity to accurately interpret a child’s attention, listening behavior, and speech production to determine that the child’s responses and actions are not based on visual attention alone.
During the first several months of cochlear implant use, patients are seen numerous times for adjustments to the cochlear implant signal; each time needing to adjust to the new quality of sound. Even adults who have previous experience with hearing are found to need several months of experience with a cochlear implant before feeling comfortable with its signal. Given this, many very young children simply do not have the listening experience and/or the language to tell us what the cochlear implant sounds like. Establishing experience with the cochlear implant alone is essential before introducing any other assistive technology that links directly to it.
Once consistent CI use has been established, the use of an FM system with his cochlear implant has several advantages including:
- Improved speech understanding in the presence of background noise. The mobile microphone fades out background noise significantly increasing the audibility and intelligibility of individual voices.
- Improved speech understanding at distances. The hearing ability of the cochlear implant user is optimized as the wireless microphone picks up the speaker’s voice directly at the source and transmits it to the speaker as an FM signal. This feature allows the cochlear implant user to better adapt to the demands of difficult listening situations and improves speech understanding.
- Improved speech understanding in a large group or discussion setting. The multi-microphone technology allows the cochlear implant user to focus directly on the intended speaker’s voice without the interference of ambient noise.
Consideration of Electrostatic Discharge (ESD)
Electrostatic discharge is the sudden and momentary electric current that flows between two objects at different electrical potentials. One of the causes of ESD events is static electricity. Static electricity is often generated by the separation of electric charges that occurs when two materials are brought into contact and then separated (friction). Examples of this include walking on a rug, descending from a car, and contacting plastic equipment or some types of plastic packaging.
Conductors like your body, moisture, and metal provide a safe path for the static electricity to travel through to the ground. Non-conductors such as plastic, rubber, synthetic cloth, and dry air often allow static to collect and build up to significant levels. It is only when static builds up to high levels that it can affect electronic equipment, such as a cochlear implant. In these rare cases, a high discharge of static electricity could damage the electronic components of the cochlear implant and possibly corrupt the programs of the speech processor. The damage can occur even if the electronic equipment is turned off.
To avoid a build up of static electricity or potential problems with ESD, consider the following precautions:
- Remove all CI equipment when playing on plastic play equipment (including plastic slides, swings, balls, inflatable carnival equipment, etc.).
- Try to avoid situations where there is friction between non-conductive materials.
- If you live in an area where there is dry air or are exposed to low-humidity environments (e.g. forced-air heating or air conditioning), consider using a humidifier.
- Try using fabric softener or anti-static spray on clothing, carpet, or cloth car seats.
- Touch someone or a conductive object first – before touching the CI equipment.
- Use wrist-grounding straps to control static, if necessary.
If you do suspect a problem with electrostatic discharge, contact the IUMC Cochlear Implant Program so that arrangements can be made to reload patient maps onto the affected speech processor.
All individuals involved in the CI recipient’s care can play an integral role in providing feedback to the cochlear implant audiologist. This feedback enables the audiologist to maximize auditory input through optimal device programming. Open communication between the parents/caregivers, teachers, speech therapists, and audiologists can ensure that each child is receiving the most appropriate services and is better able to reach his/her maximum potential.
** Make sure that parents/legal guardians have signed the appropriate release of information forms before communicating with other service providers about a child’s care.
Often the parents/caregivers, teachers, and speech therapists are the first to note when a child’s performance is not progressing as it should or when it has changed. These observations provide useful information for device programming. The following information about a child’s auditory behavior can be very helpful to the CI audiologists:
- Confirm that amplification/CI has made sounds audible
- Child detects presence vs. absence of sound
- Child can detect all Ling sounds
- Child can imitate sounds or words
- Teach behavioral detection tasks
- Provide information about the parents’ educational concerns
- Indicate what motivates the child in therapy
- State the conditions under which the child works the best
- Share the warning behaviors that suggest when a child will shut down
- Teach basic concepts such as big vs. little (in relation to loudness) that can be used for CI programming sessions
- Provide vocabulary lists of words understood and/or used by the child
The CI Audiology Referral Form and School Input Form for CI Centers (developed by Advanced Bionics) are quick and useful tools to provide feedback to the audiologists. Feel free to print the forms to send with your child to his/her mapping appointment.