cis for slps training 2

K I M B E R L Y W A R D , A U . D . , C C C - A

U N I V E R S I T Y O F S O U T H E R N M I S S I S S I P P I

COCHLEAR IMPLANTS: TRAINING FOR

SPEECH-LANGUAGE PATHOLOGISTS

WHY THIS TRAINING?

• Understanding the proper functioning of a cochlear implant is key to knowing how to troubleshoot the cochlear implant when it is malfunctioning.

• To do so, the SLP must have the knowledge and skills to carry out this task.

• Also, the SLP is often asked to perform teacher in-services on various topics related to speech, language, and hearing.

• The purpose of this power point is to train and equip the SLP with the knowledge needed to be knowledgeable on cochlear implants and troubleshooting techniques. It also provides the SLP with a “ready-made” in-service training on troubleshooting cochlear implants. The SLP has permission to use this power point and make any changes necessary to assist them in giving in-services on cochlear implants.

SYMPTOMS OF HEARING LOSS IN CHILDREN (ASHA, 2011)

• The child is inconsistently responding to sound.• Language and speech development is delayed.• Speech is unclear.• Volume is turned up high on electronic equipment

(radio, TV, CD player, etc.).• Your child does not follow directions.• Your child often says, "Huh?”• Your child does not respond when called.

WHAT SLPS SHOULD KNOW ABOUT COCHLEAR IMPLANTS

• Different types/styles• Basic components• Tools needed for listening checks/troubleshooting

of cochlear implants• How to perform a listening check• How to troubleshoot cochlear implants

BASIC FACTS ABOUT COCHLEAR IMPLANTS

• A cochlear implant is a small implantable device that uses electrical stimulation to provide hearing sensations to those with sensorineural hearing loss • Cochlear implants are different than hearing aids• Cochlear implants require special programming

called “MAPping” by specialized audiologists • When the child does not wear his/her hearing aid,

he/she may hear some environmental or speech sounds. When a child does not wear his/her cochlear implant, he/she does not hear anything• Can be bilateral or unilateral

MYTHS ABOUT COCHLEAR IMPLANTS

• MYTH: Once a child is implanted, he/she will automatically start hearing normally • MYTH: Once a child is implanted, no additional

therapies or (re)habilitation is needed • MYTH: Cochlear implantation and (re)habilitation

is a quick and easy process for the affected individual • MYTH: Without the client wearing his/her cochlear

implant, it is okay to continue with therapy

PICTURE OF A COCHLEAR IMPLANT

COCHLEAR IMPLANT MANUFACTURERS

• Cochlear • Advanced Bionics • Med El

COCHLEAR PROCESSORS YOU MAY SEE

Nucleus 5 Processor

Freedom Processor

ADVANCED BIONICS PROCESSORS YOU MAY SEE

Neptune Processor Harmony Processor

Naida CIQ70

MED EL PROCESSORS YOU MAY SEE

Opus 2 Processor

Rondo Processor

HOW COCHLEAR IMPLANTS WORK

• http://youtu.be/puoFhKYm2EU

• Video courtesy of Cochlear Americas

COCHLEAR IMPLANT PARTS

1. Earhook 5. Coil and magnet 2. Processor 6. Internal implant3. Battery compartment 7. Electrode array 4. Cable

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COCHLEAR IMPLANT PARTS AND FUNCTIONS

• 1. Earhook: used for retention purposes only to hold the processor on the ear • An earmold is sometimes fit to the earhook for retention but no sound is

delivered through the earmold as it is a hearing aid

• 2. Processor: contains the patient’s information (MAPs)• 3. Battery compartment: holds and stores the batteries • Can be rechargeable or non-rechargeable

• 4. Cable: sends the information from the processor to the coil • 5. Coil: used for attachment to magnet which is implanted

internally and sends information to internal implant • 6. Internal implant: processes the information received from

the external processor• 7. Electrode array: takes the processed information and

electronically stimulates the cochlea to produce sound

CANDIDACY CRITERIA: 12-24 MONTHS

• Age 12 months to 24 months:• Profound SNHL, bilaterally• Lack of progress in development of auditory skills • No medical contraindications • High motivation and appropriate expectations from

the family • Limited to no benefit from hearing aids

CANDIDACY CRITERIA: 2-17 YEARS

• Age 2 years to 17 years, 11 months:• Severe to profound SNHL hearing loss, bilaterally • Speech perception sentence testing 30% or less in best

aided condition • Multi-Lexical Neighborhood Test (MLNT) scores of 30% or

less in the best aided condition • (25 months-4 years, 11 months)

• Lexical Neighborhood Test (LNT) scores of 30% or less in best aided condition• (5 years-17 years, 11 months)

• Word Identification by Picture Identification (WIPI)• Early Speech Perception (ESP)

• Lack of progress in development of auditory skills • No medical contraindications • High motivation and appropriate expectations of family

(and child when appropriate) • Limited to no benefit from hearing aids

CANDIDACY CRITERIA: ADULTS

• Adults, 18 years of age and older:• Moderate to profound SNHL, bilaterally • Preoperative speech perception sentence

testing scores of 50% or less in the ear to be implanted AND 60% or less in the opposite ear OR binaurally • AZBio • HINT

• Prelingual or postlingual onset of hearing loss

• No medical contraindications • A desire to be part of the hearing world• Limited to no benefit from the hearing

aids

ERADICATING THAT MYTH - CONCEPT OF AUDITORY AGE

• Auditory age/hearing age are terms used to put the language development of a child in perspective• The child’s hearing age begins once he has access to the sounds of his world•Normal infants do not speak the day they are born – normally they say their first words after ~ a year•We cannot expect the hard-of-hearing child to speak “right away”.

HOW TO KNOW WHEN A COCHLEAR IMPLANT IS MALFUNCTIONING

• Children may produce symptoms of hearing loss not previously seen in therapy

• The child does not respond to the LING sound check as he/she did previously

• The Listening Check of the cochlear implant microphone prior to therapy indicates a problem

SYMPTOMS WHEN CHILDREN WHO HAVE HA’S/CI NEED REPROGRAMMING

• Poor/unusual voice quality • Relies on vision for input • Poor speech perception • Inappropriate/unusual consonant development • Consistent omission or substitution of specific

phonemes • Speech production not improving • Speech perception poor in competing noise• The child does not respond as he had previously

to the LING sound check(Hewitt, Madell & Rotfleisch, 2011)

LING SOUNDS• The goal of amplification is to make ALL speech sounds audible

to the child

• The LING sound check is a listening test that is often used with children who wear hearing aids/CI.

• This test is comprised of 6 sounds that represent the entire speech spectrum from low pitch sounds to high pitch sounds

• If the CI is functioning properly, the child should be able to repeat these sounds

• Have client repeat LING sounds without visual input (stand behind them/use speech hoop)

• Do this with each ear individually and then together BEFORE THERAPY OR A SPEECH EVALUATION

THE LING SOUNDS

• The 6 LING SOUNDS:• AHHHH• OOOO• EEEEEE• SSSSSS• SSHHHHH• MMMM

IMPORTANCE OF USING LING SOUNDS TO IDENTIFY NEED FOR REPROGRAMMING

• Allows a quick and easy way to check that a person is able to detect and identify sounds within the speech range. • Provides information regarding an individual's

distance of hearing or earshot. • Results ensure that the cochlear implant is

functioning properly and individual is receiving maximum benefit from his/her device • Represents all frequencies across the speech

banana(Archer & Crosby-Quinatoa, 2009)

WHEN TO DO THE LING SOUND CHECK

• The teacher should do the LING sound check at the beginning of class each day to ensure the child has access to all the speech she will use in class.

• The SLP should do the LING sound check at the beginning of therapy each day or the beginning of an evaluation.

• If the child cannot accurately produce the LING sounds as well as he/she was able to before, a listening check and troubleshooting of the cochlear implant should occur.

• If the cochlear implant microphone sounds fine and the battery is good, then contact the audiologist to see if a referral is warranted.

TOOLS SLP’S SHOULD HAVE HANDYFOR CARE OF HEARING AIDS

• Battery tester• Extra batteries• Listening earphones• Dri-Aid kit• An audiologist can help you put a kit together• Most cochlear implant companies supply kits

BATTERY TESTER

SAMPLE PICTURE OF DRI-AID KIT

PERFORMING THE LISTENING CHECK

EASY TIPS IN ORDER TO PERFORM A LISTENING CHECK

• How do you do it?• Before you put the cochlear implant on the child, listen to

the microphone yourself.• Make sure cochlear implant is turned on• Plug in the listening earphones into the microphone port • Talk into hearing aid and listen to the aid

Use the Ling Sounds (ooo, aahh, eee, sss, shhh, mmm)• Talk normally into the microphone

• Important to note that you are only listening to the microphone in the listening check, you are not listening to the child’s MAPs or programs.

• Important to complete a listening check with the child once the cochlear implant is placed and turned on

LISTENING EARPHONES/MICROPHONE PORT

LISTENING CHECK

• What are you listening for?• Dead cochlear implant• Distortion• Crackling• Intermittence/cutting in or out• Weak• Clarity

TROUBLESHOOTING

• Troubleshooting requires a visual inspection of the cochlear implant. • Examine all parts while looking for cracks, breaks,

dirt, missing pieces, broken connectors, or any unusual connection. • The parts to examine include the processor, the

microphones, the cable, the coil and magnet, and the battery compartment • If wax or dirt is seen, one should gently brush

these parts of the cochlear implant using a small brush made for this purpose.

CRITICAL SKILLS FOR SLP’S

• Troubleshooting the cochlear implant processor and performing a listening check are critical skills for the SLP who works with clients who are hard-of-hearing.

• It is also important for the SLP to perform a battery check. Several battery testers are available.

• Batteries come in a variety of sizes. Cochlear implants have non-rechargeable or standard batteries as well as re-chargeable batteries.

• Cochlear implants use standard batteries in size 675 (blue)

• The rechargeable batteries are housed in the battery compartment and are not removable

PICTURES OF STANDARD BATTERIES

BATTERY LIFE

• The length of battery life that a given battery has depends on the MAP settings in each particular processor. • Each child’s battery life will be different and will

vary • The SLP should keep a battery tester with

him/her when working with clients with cochlear implants as a dead battery is a frequent culprit for a “dead” processor and the client not being able to respond to sound.

TIPS FOR AMPLIFICATION USAGE

Keep them on during ALL waking hours• It is critical that the cochlear implants are used during all

waking hours to ensure auditory access to speech and language and environmental sounds.

• During academic classes, an FM system is most often recommended. If the child does not use an FM system, contact the audiologist to see if it was recommended.

• If retention of a cochlear implant is an issue, there are retention supplies and strategies that may be helpful- ask your audiologist

REFERENCES

• Advanced Bionics www.advancedbionics.com

• American Speech-Language-Hearing Association. (2001b). Knowledge and skills required for the practice of audiologic/aural rehabilitation [Knowledge and Skills], fromwww.asha.org/policy.

• American Speech-Language-Hearing Association. (2007). Scope of practice in speech-language pathology [Scope of Practice]. Available from www.asha.org/policy. 

• American Speech Language Hearing Association. (2011). Self-test for hearing loss.http://www.asha.org/public/hearing/Self-Test-for-Hearing-Loss/

• Archer, J., & Crosby-Quinatoa, G. (2009). Cochlear implant program: Strategies for treating children with hearing impairments in the schools. http://www.asha.org/Events/convention/handouts/2009/1431_Archer_Jamy_Claire/

• Bentler, R.A. (1993). Amplification for the hearing impaired child. J.G. Alpiner & P.A. McCarthy (Eds.). In Rehabilitative audiology: Children and adults,2nd ed. (pp. 115 – 160). Baltimore: Williams and Wilkins.

• Hewitt, J., Madell, J., & Rotfleisch, S. (2011). Listening to kids: Optimizing Technology http://www.asha.org/Events/convention/handouts/2011/Hewitt-Madell-Rotfleisch/

• Cochlear Americas www.cochlear.com

• Med El www.medel.com

• Mueller H.G., Johnson E.E., & Carter A.S. (2007). Hearing aids and assistive devices. In R. Schow & M. Nerbonne (Eds.). Introduction to audiologic rehabilitation, 5th ed. (pp.31-76). Boston: Allyn and Bacon.

• Wayner, D.S. (2004). What every SLP needs to know about hearing: Fingertip Facts. Latham, NY: Hearing Again, Inc.

• Woodford, C.M. (1987). Speech-language pathologists’ knowledge and skillsRegarding hearing aids. Language, Speech, and Hearing Services in Schools, 18, 312-322.

PICTURE REFERENCES

• www.cochlear.com• Advanced bionics • Med el • www.cochlearimplanthelp.com• http://dryandstore.com/zephyr_imgs/zephyr.jpg