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

...
k
             Rehabilitationcenters (>60)


Germany:
80 Million


deaf
children
600-800/
year




                       ...
k




                                                   audiologists




therapists       administration

               ...
k

Neural development of normal hearing children




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


  0-3 years          3-6 years                     > 6 years




Early education    Kindergarten                    Sc...
k


               music

             To phone

    Speech Understandin in noise

       Speech Understanding

          ...
k



}   Dialougue is the aim (Bruner, Goswami, Horsch,
    Papousek and Papousek, Szagun, Zollinger, )
     Eye-contact
 ...
k




    1st Monsana Conference
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    1st Monsana Conference
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    1st Monsana Conference
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    1st Monsana Conference
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    1st Monsana Conference
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    1st Monsana Conference
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}   Morag Clark
     Language through living
     Importance of everyday-life


}   Problem: Lack of quantitative and ...
k


}   Aims:
        Identification of critical areas
        Designing therapeutic and promotional measures
        Syst...
k


}   Regular diagnostic check-ups (every 6 or 12
    months)
}   Observation of the overall development
}   Main focus ...
k

}   Following the guidelines of natural language acquisition
    and the specified order for the acquisition of linguis...
k

}   Interdisciplinary conversations with educational/
    therapeutic institutions
}   Conversation with parents as con...
k


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




           1st Monsana Conference
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Fitting, therapy and counceling during the first 2-3 years after
implantation

}inpatient 1:             2 - 5 days
  ...
CI-Rehabilitation with children
 Audiology                 Fitting                      CI-Counceling




Diagnostics     ...
k




    1st Monsana Conference
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1. Measurement of impedances(telemetry) and if
   necessary NRT

2. Loudness Scale
   – Determination CL-values (Comfo...
k




    1st Monsana Conference
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}   4. Loudness adjustment of THR- and CL-values
       between neighboured electrodes (sweep)
     Playing the first ...
k
}   checking of map:
}   LING sounds e.g.
     Test of sounds of main speech field


                                   ...
k



}   Discrimination between frequencies ( low and
    high) and loudness (loud, quiet)
}   Sensibility concerning of h...
k


5. decreasing/ increasing the values
 e.g.
   If the child can t hear the LING sounds
   If it s to loud/silent



6. ...
k


7. Determination of the parameters, which can be
  adjusted by the patient him- or herself
   Loudness, if the recipie...
k

}   I. Results depend on the examiner
      Sympathetic understanding
      Patience and calmness
      Good knowledge ...
k

}   II. Results depend on the child
      Power of concentration
      Understanding of the task
      Understanding of...
k

}   III. Results depend on
      Good links to ohter professionals
      Communication amongst the team
      Evaluatio...
k




    1st Monsana Conference
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    1st Monsana Conference
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    1st Monsana Conference
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    1st Monsana Conference
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    1st Monsana Conference
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    1st Monsana Conference
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    1st Monsana Conference
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    1st Monsana Conference
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    1st Monsana Conference
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    1st Monsana Conference
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    1st Monsana Conference
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    1st Monsana Conference
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Fitting and Reha Of CI Children At CIC Friedberg Yvonne Havers

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Language: English: Yvonne Havers from the Cochlear Implant Rehabilitation Center in Friedberg, Germany explains how this very experienced center performs fitting and rehabilitation of Children with a Cochlear Implant. Different Methods and Setups are described and the Center and the whole team are presented (photos). This presentation was given at the first Monsana Conference in St. Petersburg, Russia in May 2009. See also www.monsana.net/firstconference

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Fitting and Reha Of CI Children At CIC Friedberg Yvonne Havers

  1. 1. 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
  2. 2. k Rehabilitationcenters (>60) Germany: 80 Million deaf children 600-800/ year 1st Monsana Conference
  3. 3. k audiologists therapists administration housekeeping 1st Monsana Conference
  4. 4. k Neural development of normal hearing children 1st Monsana Conference
  5. 5. k diagnosis implantation a screening a hospital Rehabilitation in CIC SCS 1st Monsana Conference
  6. 6. k 0-3 years 3-6 years > 6 years Early education Kindergarten School + CI-Rehabilitation 1st Monsana Conference
  7. 7. k music To phone Speech Understandin in noise Speech Understanding identificate discriminate percepience 1st Monsana Conference
  8. 8. 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
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  11. 11. k 1st Monsana Conference
  12. 12. k 1st Monsana Conference
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  14. 14. k 1st Monsana Conference
  15. 15. k } Morag Clark Language through living Importance of everyday-life } Problem: Lack of quantitative and objective diagnostics 1st Monsana Conference
  16. 16. 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
  17. 17. 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
  18. 18. 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
  19. 19. 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
  20. 20. k 3,50 3,00 2,50 2,00 1,50 1,00 0,50 0,00 1st Monsana Conference
  21. 21. 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
  22. 22. CI-Rehabilitation with children Audiology Fitting CI-Counceling Diagnostics Therapy Parent groups Rhythm Music Motor function 1st Monsana Conference
  23. 23. k 1st Monsana Conference
  24. 24. 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
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  26. 26. 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
  27. 27. 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
  28. 28. 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
  29. 29. 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
  30. 30. 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
  31. 31. 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
  32. 32. 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
  33. 33. 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
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