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!