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The Freedom Cochlear Implant: Another Innovation from Cochlear
Children with Cochlear Implants on their Way to
Inclusion Дети с кохлеарными имплантатами на пути к
инклюзии
Dr. Dr. h.c. Monika LehnhardtKiev, October 7th, 2011
"90% of children with a CI will be successfully included in mainstream education provided they do not have an additional handicap and they get adequate rehabilitation with family support".
Step 1: Is there a hearing loss?
Neonatal Hearing Screening Programmes
Accurate diagnosis
Neonate’s response to sound
DeCasper & Fifer (1980)
Spring and Dale 1977
Eimas et al (1971, 1979)
Infant vocalizations
Stoel-Gammon & Otomo,
1986
Kent, et al 1987
The Window of Opportunity
Sharma et al, 2002
Ear and Hearing, December 2002
Sharma et al, 2004
Archives of Otolaryngology – Head & Neck Surgery, May 2004
0
50
100
150
200
250
300
350
400
450
0 5 10 15 20 25 30
Age
P1
late
ncy
, m
s
Normal limits
14 month old recipient
0
50
100
150
200
250
300
350
0 12 24 36
Age
P1
late
ncy
, m
s
Normal limits
13 month old recipient
At CI activation
1 week post CI
1 month post CI
3 months post CI
12 months post CI
Categories of Auditory Performanceref: P Govaerts, C De Beukelaer et al., Neurotology and Audiology 2002 (Antwerp)
response to speech sounds
discrimination of speech sounds
use of telephone
Children with normal hearing
Govaerts, et al. 2002
Otology & Neurology, vol 23; 2002
Age at Mainstream Integration
0
20
40
60
80
100
0 3 5 7
Age (in years)
Per
cen
tag
e o
f ch
ild
ren
Under 2 yrs
2 to 4 yrs
Age at implantation
Manuel Manrique, et al (2004)
Laryngoscope, August 2004
Reynell
0
1
2
3
4
5
6
7
0 1 2 3 4 5 6 7
Chronological age (years)
"Rey
nel
l" a
ge
(yea
rs)
PPVT
0
1
2
3
4
5
6
7
0 1 2 3 4 5 6 7
Chronolgical age (years)
"Pea
bo
dy"
ag
e (y
ears
)
>2 yrs
2 to 6 yrs
Average Language Development
0
12
24
36
48
60
72
84
0 12 24 36 48 60 70 84
AGE (months)
Ex
pre
ss
ive
La
ng
ua
ge
Ag
e
(mo
nth
s)
12-24 months
25-36 months
37-48 months
Svirsky, et al (2004)
Audiology and Neuro-Otology, vol. 9, 2004
Factors
Key Factors supporting the dramatic changes in indication- Continuous advances in technology (diagnostic equipment, hearing aids, implants, FM, assistive listening devices)- Improved imaging and surgical techniques- User friendly software for fitting and trouble shooting of cochlear implants- Proven rehabilitation methodologies (e.g. oral education, auditory verbal approach)
Indication
Broadening of indication
- Age (6 months - > 80 years)
- Severity of hearing loss (“totally deaf” – “severely hearing impaired” – “partially deaf”)
- Bilateral deafness – unilateral deafness
- Unilateral CI – bilateral CI – bimodal (HA + CI)
- Children whose mother tongue is not the language of the country they are living in
- Multiple handicapped children / autistic children
- Deaf children with deaf parents
"90% of children with a CI will be successfully included in mainstream education provided they do not have an additional handicap and they get adequate rehabilitation with family support".
Чудесный мир звуков
Спасибо за внимание!
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