fitting and reha of ci children at cic friedberg yvonne havers

Cochlear Implant Centrum Rhein - Main

Friedberg, Germany

Fitting and rehabilitation of chidren with CI in the CIC Rhein-Main, Germany

Yvonne Havers

1st Monsana Conference

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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

+1st Monsana Conference

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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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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

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30 F0 t40 o b

m d n j g

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50w l r f sch

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u ei

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70F2 F3

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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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fitting and reha of ci children at cic friedberg yvonne havers

Health & Medicine