Fitting and Reha Of CI Children At CIC Friedberg Yvonne Havers

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

Cochlear Implant Centrum Rhein - Main
Friedberg, Germany
1st Monsana Conference

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Rehabilitationcenters (>60)

Germany:
80 Million

deaf
children
600-800/
year


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audiologists

therapists administration

housekeeping

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Neural development of normal hearing children


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diagnosis implantation
a screening a hospital
Rehabilitation in CIC SCS


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0-3 years 3-6 years > 6 years

Early education Kindergarten School

+
CI-Rehabilitation


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music

To phone

Speech Understandin in noise

Speech Understanding

identificate

discriminate

percepience


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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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3,50
3,00
2,50
2,00
1,50
1,00
0,50
0,00


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Fitting, therapy and counceling during the first 2-3 years after
implantation

}inpatient 1: 2 - 5 days
every 6 - 10 weeks
for 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!


CI-Rehabilitation with children
Audiology Fitting CI-Counceling

Diagnostics Therapy Parent groups

Rhythm Music Motor function


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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

Hz
125 250 500 750 1000 1500 2000 3000 4000 6000 8000

0

10

20

30
F0 t
m s k
40
o b d n j g p
w l r f sch
50
i ch
60
a u e F4
F1
F2 F3
70

80

1st Monsana Conference 27

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} Discrimination between frequencies ( low and
high) and loudness (loud, quiet)
} Sensibility concerning of high frequencies, but
the high frequencies are very importent for
speechdiscrimination


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5. decreasing/ increasing the values
e.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
W illingness 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


Fitting and Reha Of CI Children At CIC Friedberg Yvonne Havers

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Fitting and Reha Of CI Children At CIC Friedberg Yvonne Havers