Orientador: Ana Cláudia Moreira Almeida-Verdu / Resumo: A deficiência auditiva sensorioneural pré-lingual pode comprometer o desenvolvimento da linguagem oral. O implante coclear (IC) é um dispositivo auditivo que permite a essa população a detecção de sons na frequência da fala humana. A detecção de sons pode não ser suficiente para o desenvolvimento da linguagem e requer procedimentos de ensino para que se promova a aprendizagem do uso do dispositivo e o desenvolvimento das habilidades auditivas e expressivas. Pesquisas em interface entre Fonoaudiologia e Análise do Comportamento mostraram que o ensino baseado em equivalência (Equivalence-Based Instruction, EBI) envolvendo a rede de leitura pode aumentar a precisão da fala de crianças com deficiência auditiva pré-lingual que usam IC, de palavras às sentenças. Ainda, a produtividade verbal tem sido demostrada nos estudos prévios por meio da combinação do EBI que inclui o constructed response matching to sample (CRMTS) e ensino por matrizes, o que pode aumentar o controle por unidades menores e o potencial recombinativo. Nessa direção, o presente estudo avaliou os efeitos de dois procedimentos de ensino, baseado em seleção (MTS) e em construção de respostas (CRMTS), sobre a aprendizagem ou fortalecimento das relações condicionais entre sentenças ditadas e impressas, em crianças com IC; ainda, visou verificar se relações derivadas e consistentes com as relações de equivalência são observadas, e avaliar se esse EBI poderia promover o aumento da precisão da fala em tarefas de nomeaçã... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Pre-lingual sensorineural hearing loss can compromise the development of oral language. The cochlear implant (CI) is an auditory device that allows this population to detect sounds in the frequency of human speech. Sound detection may not be sufficient for language development and require teaching procedures to promote learning how to use the device and develop auditory and expressive skills. Research on the interface between Speech-Language Pathology and behavior analysis has shown that Equivalence-Based Instruction (EBI) involving the reading network can increase the speech accuracy of children with pre-lingual hearing loss who use CI, from words to sentences. Still, verbal productivity has been demonstrated in previous studies through the combination of EBI that includes constructed response matching to sample (CMRTS) and training by matrices, which can increase control by smaller units and the recombinative potential. In this sense, the present study evaluated the effects of two teaching procedures, based on selection (MTS) and the constructed response (CRMTS), on learning or strengthining the conditional relations between dictated and printed sentences, in children with CI, still, it aimed to verify if derived and consistent relations with the equivalence relations are observed, and to evaluate if this EBI could promote the increase of speech accuracy in tasks of naming action figures and recombinative performances. Two children participated, with sensorineural hearing l... (Complete abstract click electronic access below) / Mestre

De nombreux modèles numériques ont été proposés pour mieux comprendre comment le courant électrique est répartit lors d’une stimulation électrique par implant cochléaire. Ceci permet à terme d’optimiser la géométrie des électrodes et les stratégies de stimulation. Les modèles précédemment proposés modélisent les modèles d'interface électrochimique de façon très basique, et ne prennent généralement compte que de l'intensité du courant sur les électrodes. Par conséquent, il leur est difficile de simuler la dynamique temporelle de la stimulation ou de modéliser la répartition du courant en fonction de différents modes de stimulation contrôlés en tension, tels que le mode de de retour commun (Common Ground), ou de retour multiple (Multi-Mode Grounding). Dans cette thèse, nous avons développé un nouveau modèle surfacique de la cochlée. Le modèle géométrique dépend d'un ensemble de paramètres permettant d'ajuster la forme de la cochlée, en utilisant par exemple des données histologiques, des scans CT, ou encore des maillages de surface. Un modèle paramétrique nous a permis de comparer les courants générés par les modèles d'électrodes actuellement disponibles et par un nouveau type d'électrode - faisceau transmodiolaire. Le modèle peut prendre en compte des courants ou des tensions en entrée à chaque électrode, ce qui permet de simuler le mode de retour commun ou multiple. Afin de valider les résultats de simulation et calibrer les paramètres du modèle, nous avons créé un système permettant d'acquérir des mesures in-situ et in-vitro. Les données enregistrées ont permis de valider le modèle combinant le modèle d'interface électrochimique et le modèle tridimensionnel de cochlée. / Computational models have been widely used to improve the knowledge of the current distribution behavior in cochlear implant stimulations, optimizing electrode designs and stimulation strategies. The existing models employed no or simple electrochemical interface models and took current intensity on the electrodes as input. Therefore they have difficulties in making time domain simulations and simulating the stimulation modes that have voltage constraints, such as the Common Ground and the Multi-Mode Grounding modes. In this PhD work, a new parametric surface mesh model of the cochlea has been developed. The shape of the model is controlled by a set of input parameters which can be tuned to fit the cochlear shape acquired from histological images, CT scans or existing cochlear mesh models. The symmetric boundary element method, which was implemented in OpenMEEG, has been applied on the model to simulate the current distribution of the cochlear implant stimulation. Using the parametric model, comparisons on the current field has been made between the existing electrode layouts and a new transmodiolar electrodes. The new model can take either current or voltage as input for each electrode to simulate the common ground and multi-mode grounding modes. By coupling the surface model with lumped capacitor and constant phase element models, time domain simulation of the stimulation waveform has also been achieved. To validate the simulation results and calibrate the parameters of the model, in-situ and in-vitro measurements have been carried out with self-made devices. The recorded data proved the effectiveness of combining lumped components with the surface model.

Background and Aim: „CI-Wizard“ is a new, three-dimensional software planning tool for cochlear implant surgery with manual and semi-automatic algorithms to visualize anatomical risk structures of the lateral skull base preoperatively. Primary endpoints of the study represented the evaluation of the CI Wizards usability, accuracy, subjectively perceived and objectively measured time in clinical practice. Materials and Methods: In a period from January 2014 to March 2015, n=36 participants were included in this study. These members were divided into three groups of equal number (n=12), but different level of experience. Senior doctors and consultants (group 1), residents (group 2) and medical students (group 3) segmented twelve different CT-scan data sets of the CI Wizard (four per participant). In total, n=144 data sets were collected. The usability of the CI Wizard was measured by the given questionnaire with an interval rating scale. The Jaccard coefficient (JT) was used to evaluate the accuracy of the anatomical structures segmented. The subjectively-perceived time was measured with an interval rating scale in the questionnaire and was compared with the objectively mean measured time (time interact). Results: Across all three groups, the usability of the CI Wizard has been assessed between 1 ('very good') and 2 ('with small defects'). Subjectively, the time was stated as 'appropriate' by questionnaire. Objective measurements of the required duration revealed averages of n=9.8 minutes for creating a target view. Concerning the accuracy, semi automatic anatomical structures such as the external acoustic canal (JT=0.90), the tympanic cavity (JT=0.87), the ossicles (JT=0.63), the cochlea (JT=0.66) and the semicircular canals (JT=0.61) reached high Jaccard values, which describes a great match of the segmented structures between the partcipants and the gold standard. Facial nerve (JT=0.39) and round window (JT=0.37) reached lower Jaccard values. Very little overlap tendency was found for the chorda tympani (JT=0.11). Conclusion: This software program represents a further important step in the development of pre-operative planning tools in cochlear implant surgery. The study revealed a high level of satisfaction in the usability. The subjectively required time was considered as „appropriate“ and the objectively mean measured time was n=9.8 minutes short enough, so that a clinical application seems realistic. Particularly for semi-automatically segmented structures, it represented a good accuracy. For purely manual segmented structures, further improvements are desirable. Finally, this program also provides a good learning tool for medical students and residents to become familiar with the anatomy of the lateral skull base.:1 Einführung 1 1.1 Cochlea Implantate (CI) 1 1.2 Bildverarbeitungsprogamme zur präoperativen Planung eines Cochlea Implantates 2 1.2.1 Segmentierung in der Medizin 2 1.2.2 CI-Wizard 4 1.3 Fragebogen 6 1.4 Zielsetzung 6 1.5 Zusammenfassung der Ergebnisse 7 2 Publikation 8 3 Zusammenfassung 19 4 Literaturverzeichnis 23 Anlagen 26 Beitrag der Promovendin bei geteilter Erstautorenschaft 34 Erklärung über die eigenständige Abfassung der Arbeit 35 Lebenslauf 36 Danksagung 37

This thesis deals with theory of mind in preschool cochlear implant users. The theoretical part introduces topics: hearing impairment in childhood, cochlear implantation, theory of mind in preschool children and development of preschool children. All these topics are processed with regard to the issue of children using cochlear implant (or implants). In addition to general information, the thesis focuses mainly on the results of current foreign researches concentrating on children using cochlear implants. The empirical part summarizes the research of theory of mind in Czech preschool cochlear implant users. Thirty-one children in total participated in this research, eleven cochlear implant users, and twenty intact children in the control group. Theory of mind has been tested by similar desires task, dissimilar desires task, Smarties task, and Sally-Ann task. In addition, a short questionnaire was distributed to the parents of cochlear implant users. In order to assess competences in the Czech language, the cochlear implant users were given Vocabulary test from test battery of Seidlová-Málková and Smolík (2014). On the basis of the results of this research, it can be concluded that theory of mind is delayed in Czech preschool cochlear implant users in contrast to their hearing peers. These results...

The early diagnosis of hearing loss can be a life-changing event for families. Parents are required to make several prompt decisions where they might be overwhelmed with all the information being shared with them. Patient education materials (PEMs) are often provided by clinical health professionals – yet these materials are often written above the average reading level of adults in the United States, thus presenting an additional challenge to many parents. The purpose of this study was to examine the ease of reading cochlear implant (CI) brochures that are provided to parents who are making informed decisions about the management of their child's hearing loss. The CI brochures analyzed include those from three Food and Drug Administration (FDA)-approved CI manufacturers: Advanced Bionics, Cochlear Americas, and MED-EL. Reading grade levels were analyzed using a commercially-available computer software program, applying six readability formulas commonly used to examine PEMs. Analyses revealed that the readability of the three CI brochures exceed the fifth- to sixth-grade reading levels recommended by health literacy experts. Audiology-focused PEMs continue to be created without full consideration of their reading grade level despite health literacy initiatives. Researchers should consider the health literacy skills of the reader when creating or revising PEMs such as CI brochures.

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L’implant cochléaire devient une ressource importante pour contrer la surdité alors qu’il a été démontré qu’une privation auditive précoce ou tardive affecte le développement des systèmes auditif et visuel. Le but des études présentées dans cette thèse est d’évaluer l’impact développemental d’une privation auditive sur les systèmes auditif et visuel. En premier lieu, l’étude du développement chez une population entendante a montré que les systèmes auditif et visuel se développent à des rythmes distincts et qu’ils atteignent leur maturité respective à des âges différents. Ces conclusions suggèrent que les mécanismes qui sous-tendent ces deux systèmes sont différents et que leur développement respectif est indépendant. Aussi, tel qu’observé par une mesure comportementale et électrophysiologique, la discrimination fréquentielle auditive chez les personnes porteuses d’un implant cochléaire est altérée et corrélée aux performances de perception de la parole. Ces deux études suggèrent que suite à une privation auditive, le traitement auditif diffère d’une personne malentendante à une autre, et que ces différences touchent les processus de bas-niveaux, tel que suggéré par la disparité présente dans les performances de discrimination fréquentielle. La dernière étude observe qu’une privation auditive affecte aussi le développement de la modalité visuelle, tel qu’indiqué par une diminution des capacités de discrimination visuelle observée chez des malentendants. Cette indication appuie l’hypothèse qu’un développement normal de chacun des sens est requis pour un développement optimal des autres sens. Globalement, les résultats présentés dans cette thèse suggèrent que les systèmes auditif et visuel se développent de façon distincte, mais demeurent toutefois interreliés. En effet, une privation auditive affecte non seulement le développement des habiletés auditives, mais aussi celui des habiletés visuelles, suggérant une interdépendance entre les deux systèmes. / The cochlear implant is an important resource for deaf people, as it is known that an auditory deprivation alters the auditory and the visual systems. We aimed to study the impact of deafness on the development of the auditory and visual systems. First, the study of these systems in a hearing population has shown that both systems develop at different rates and reach adult-like levels at different ages. These conclusions suggest that the mechanisms underlying these treatments are different and that their developments are independent. Moreover, as shown with the behavioral and the electrophysiological study, auditory frequency discrimination in cochlear implant users is altered and correlated with the speech perception performance. These two studies suggest that following deafness, the auditory discrimination is different from one individual to another, and also that these differences affect lower processing, as shown by differences found in auditory discrimination. Finally, a hearing deprivation also modifies the visual system, as shown by a reduction in the visual frequency discrimination. This last study suggests that normal development in one modality is required for the efficient development of the other modalities. Globally, the results shown in this thesis suggest that the auditory and visual systems have a distinct development, but are however linked and suggest the interdependence of the two systems.

My thesis focuses on the problem on person with hearing impaiment in physical training and sport. My research is based on own experience as I am a hearing impaired pesrosn myself. After having collected the all the necesery data, the theorectical part was dividend into six charter. The first chapter focuses on hearing itself hearing impairment and hearing dysfunctions. The second chapter focuses on the issue of hearing aids. The third chapter is devoted to education and communication of people with hearing impairment. In the fourth and fifth chapter, sports opportunites and limitations of aurally weakened persons are analyzed. Last chapter is devoted to motor skills. The balance between healty persons and those with hearing impariment is described in the practical part of the thesis. A hypothesis is suggqsted and research results will either support or oppose it. The essential part odt the part the thesis consists in the results of a questionnaire and physical test applied and also graph processing. The thesis work includes additional affachments which are essential for further understanding. Keywords weakened persons, hearing impared, communication, locomotive abilities, coordination and balance skills, sport, hearing aids, cochlear implant

My diploma thesis deals with pupils who are struggling to hear and a cochlear implant may be their hearing aid. The goal of my thesis was to look into the specific work with hearing impairment pupils in lessons of Physical education in elementary school. In theoretical part knowledge of mentioned problem from professional literature was collected. My attention was dedicated to the problem of the first grade hearing impairment pupils' integration to the education system. This thesis presents the cochlear implant as one of the essential opportunity for better quality life of hearing impairment people. Moreover I make the readers familiar with functioning and indication of a cochlear implant, and organisations which support people like these. Besides that I also write about PE education and support of hearing impairment pupils in PE lessons. In empirical part I used a qualitative research design. The collection of information was realized with the methods of watching and deep half-structured talks. The gained information was analysed by using the method of opened coding. The research questions were focused on the most important aspects in PE lessons - in communication, activity, and safety. For answering to research questions led particular categories gained from the opened coding analysis. The...

L’ambition de la thèse est de contribuer à une meilleure compréhension des difficultés cognitives rencontrées par les enfants sourds munis d’un implant cochléaire (IC). Elle présente une recension de travaux et une étude originale concernant la mémoire à court-terme/mémoire de travail.Est évalué l’apport recommandé de la lecture labiale et des clés de la LPC (Langue Parlée Complétée) sur le rappel.Une série d’épreuves originales de rappel immédiat a été conçue sur support informatique. Elle comprend des tâches contrastées du point de vue de la nature de l’information à mémoriser (spatiale vs verbale) et des modalités de présentation de l’information. Les épreuves ont été validées auprès d’une population d’enfants normo-entendants (NE)(âgés de 6 à 8 ans, N=42). Les réponses d’enfants IC(N=14) ont été comparées à celles d’enfants NE, sur la base de la constitution de deux groupes appareillés selon les critères d’âge, de sexe et d’aptitude intellectuelle.Pour les deux groupes, le rappel immédiat est meilleur pour les informations visuo-spatiales. Les informations verbales sont moins bien retenues par les enfants IC. Contrairement aux attentes, l’apport de la LPC, spécifiquement dans la modalité verbale, ne conduit pas à une augmentation des performances des enfants sourds. L’analyse de l’ordre de rappel des items ne fait pas apparaître de difficultés spécifiques. En revanche, la longueur des listes est préjudiciable en verbal. L’analyse des erreurs atteste de leurs difficultés au plan des connaissances langagières. Une analyse fine des performances individuelles montre des profils différenciés attestant de la singularité des modes d’adaptation des enfants sourds IC. / The aim of the thesis is to contribute to a better understanding of cognitive difficulties in deaf children with a cochlear implant (CI). Firstly, this thesis presents a comparative analysis of previous research work. Secondly, it presents an original study addressing short-term memory (STM)/working memory (WM) issues, in which the contribution of cued speech (CS) is assessed on memorization performances. To do so, a novel STM/WM task series was developed and used to investigate whether the use of verbal stimuli versus spatial stimuli differentially affects immediate memory processes and to examine whether the presentation of items in an enriched context has a benefit on the immediate memory capacity. The developed tasks were validated on normal-hearing (NH) children (6- and 8-year-old, N=42) and the capacities of CI deaf children(N=14) were compared to those of their NH peers matched for age, sex and reasoning ability. For both groups, the immediate recall proves to be better for visuo-spatial information. Also, CI deaf children appear as memorizing less verbal information. Surprisingly, CS, appears to be ineffective to improve the CI deaf children performances, especially in the verbal modality case; if the analysis of the order of recall of items does not reveal any specific difficulty, the length of the items lists is harmful in the verbal modality. The analysis of the recall errors confirms difficulties in linguistic knowledge. Individual performances of CI deaf children show diverse patterns.