fitting and reha of ci children at cic friedberg yvonne havers
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Cochlear Implant Centrum Rhein - Main
Friedberg, Germany
Fitting and rehabilitation of chidren with CI in the CIC Rhein-Main, Germany
Yvonne Havers
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kRehabilitationcenters (>60)Rehabilitationcenters (>60)
Germany:
80 Million
deaf children
600-800/ year
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therapists
audiologists
housekeeping
administration
Neural development of normal hearing children
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SCSRehabilitation in CICimplantationa hospital
diagnosisa screening
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0-3 years 3-6 years > 6 years
Early education Kindergarten School
CI-Rehabilitation
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percepience
discriminate
identificate
Speech Understanding
Speech Understandin in noise
To phone
music
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} Dialougue is the aim (Bruner, Goswami, Horsch, Papousek and Papousek, Szagun, Zollinger, …)◦ Eye-contact◦ Turn-Taking◦ Joint attention◦ Imitation◦ Motherese◦ Intuitive Parenting◦ …
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} Morag Clark◦ Language through living◦ Importance of everyday-life
} Problem: Lack of quantitative and objective diagnostics
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} Aims:
◦ Identification of critical areas
◦ Designing therapeutic and promotional measures
◦ Systematic support and guidance for parents} Evaluation of therapeutic measures} Documentation of the learning processes
} Relationship between the child‘s actual age and its“hearing“ and “speaking“ age
} Prevention and intervention
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} Regular diagnostic check-ups (every 6 or 12
months)
} Observation of the overall development
} Main focus in a check-up: hearing and speaking
} Identification of critical areas of development
} Introducing measures of intervention
} Evaluating these measures
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} Following the guidelines of natural language acquisition
and the specified order for the acquisition of linguistic
competences
} Integration of tests, conversations with parents and
observation by therapists
} Test procedure in comfortable atmosphere for parents
and children
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} Interdisciplinary conversations with educational/
therapeutic institutions
} Conversation with parents as conclusion of the
diagnostic evaluation
◦ State of development
◦ Positive developments
◦ Critical areas
◦ Possible measures of intervention => therapeutic/at home
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0,000,501,001,502,002,503,003,50
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Fitting, therapy and counceling during the first 2-3 years after implantation
}inpatient 1: 2 - 5 daysevery 6 - 10 weeksfor 2 - 3 years
}inpatient 2: like inpatient treatment but without overnight stay
}ambulant: minimum once a week
}New aspect: Rehab by using live-online rooms!
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Audiology Fitting CI-Counceling
Therapy Parent groupsDiagnostics
Music Motor functionRhythm
CI-Rehabilitation with children
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1. Measurement of impedances(telemetry) and if necessary NRT
2. Loudness Scale� Determination CL-values (Comfortable Level)� Identification of the most comfortable level for each
electrode
3. Determination of Threshold-values ◦ like audiometrie◦ not often◦ problem: hide own movements !!!
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} 4. Loudness adjustment of THR- and CL-values between neighboured electrodes (sweep)
◦ Playing the first tone of one electrode and then directly the neighboured electrode
◦ Child has to decide whether the loudness of the two heard tones are equal or not
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} checking of map:} LING sounds e.g.
◦ Test of sounds of main speech field
0
10
20
30 F0 t40 o b
m d n j g
sp
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50w l r f sch
60 aF1
u ei
F4
ch
70F2 F3
80
125 250 500 750 1000 1500 2000 3000 4000 6000 8000
Hz
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} Discrimination between frequencies ( low and high) and loudness (loud, quiet)
} Sensibility concerning of high frequencies, butthe high frequencies are very importent for speechdiscrimination
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5. decreasing/ increasing the valuese.g.◦ If the child can‘t hear the LING sounds◦ If it‘s to loud/silent◦ …
6. Checking additional map parameters, e.g.:◦ Microphone sensitivity◦ Loudness growth function◦ Input dynamic range (40dB – 80dB) ◦ AGC
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7. Determination of the parameters, which can be adjusted by the patient him- or herself◦ Loudness, if the recipient is in a loud or silent situation◦ Microphone sensitivity, if the backroundnoise is to loud
8. creation of additional maps e.g.:◦ „everyday“, „focus“, „noise“, „music“ (Cochlear)
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} I. Results depend on the examiner…◦ Sympathetic understanding◦ Patience and calmness◦ Good knowledge of the control panel◦ The better you know the child, the better you
are able to interpret the child‘s reactions◦ Consideration of individual preferences◦ Skills to preserve the child‘s motivation◦ experience◦ Knowledge of age: Age of life is different from
the age of development!
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} II. Results depend on the child…◦ Power of concentration ◦ Understanding of the task ◦ Understanding of speech ◦ Cognitive skills ◦ Perceptive faculties◦ Willingness for co-operation ◦ The more the child is used to the rooms, tasks
and examiner, the better it is able to work
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} III. Results depend on…◦ Good links to ohter professionals ◦ Communication amongst the team◦ Evaluation of match concerning audiology and
observation of parents
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