Fitting and Reha Of CI Children At CIC Friedberg Yvonne Havers

k 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

k Rehabilitationcenters (>60) Germany: 80 Million deaf children 600-800/ year 1st Monsana Conference

k audiologists therapists administration housekeeping 1st Monsana Conference

k Neural development of normal hearing children 1st Monsana Conference

k diagnosis implantation a screening a hospital Rehabilitation in CIC SCS 1st Monsana Conference

k 0-3 years 3-6 years > 6 years Early education Kindergarten School + CI-Rehabilitation 1st Monsana Conference

k music To phone Speech Understandin in noise Speech Understanding identificate discriminate percepience 1st Monsana Conference

k } Dialougue is the aim (Bruner, Goswami, Horsch, Papousek and Papousek, Szagun, Zollinger, ) Eye-contact Turn-Taking Joint attention Imitation Motherese Intuitive Parenting 1st Monsana Conference

k 1st Monsana Conference

k } Morag Clark Language through living Importance of everyday-life } Problem: Lack of quantitative and objective diagnostics 1st Monsana Conference

k } 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 1st Monsana Conference

k } 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 1st Monsana Conference

k } 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 1st Monsana Conference

k } 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 1st Monsana Conference

k 3,50 3,00 2,50 2,00 1,50 1,00 0,50 0,00 1st Monsana Conference

k 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! 1st Monsana Conference

CI-Rehabilitation with children Audiology Fitting CI-Counceling Diagnostics Therapy Parent groups Rhythm Music Motor function 1st Monsana Conference

k 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 !!! 1st Monsana Conference

k } 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 1st Monsana Conference

k } 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

k } Discrimination between frequencies ( low and high) and loudness (loud, quiet) } Sensibility concerning of high frequencies, but the high frequencies are very importent for speechdiscrimination 1st Monsana Conference

k 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 1st Monsana Conference

k 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) 1st Monsana Conference

k } 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! 1st Monsana Conference

k } 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 1st Monsana Conference

k } III. Results depend on Good links to ohter professionals Communication amongst the team Evaluation of match concerning audiology and observation of parents 1st Monsana Conference

Fitting and Reha Of CI Children At CIC Friedberg Yvonne Havers

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