Hörseln är en viktig förutsättning för utveckling av talat språk och kan därigenom påverka den psykiska hälsan. Vid medfödd eller tidigt förvärvad dövhet eller grav hörselnedsättning kan ett cochleaimplantat (CI) opereras in för att underlätta ljud- och taluppfattning. Syftet med pilotstudien var att undersöka psykisk hälsa hos unga vuxna (18–26 år) med fokus på hörselns betydelse, genom att jämföra personer med och utan CI. Studien utgjordes av en experimentgrupp (n = 5) samt en kontrollgrupp (n = 20). Deltagarna i experimentgruppen hade en medfödd eller tidigt förvärvad dövhet och hade fått sitt första CI före 30 månaders ålder. Deltagarna i kontrollgruppen hade typisk hörsel. Samtliga deltagare fick besvara en enkät med olika formulär (SDQ+18, Covid-19-frågor, bakgrundsinformation). Psykisk hälsa undersöktes med formuläret Strenghts and Difficulties Questionnaire (SDQ) i en ny tillbakaöversatt svensk version (SDQ+18). Resultatet av studien visade inte att unga vuxna med CI har en sämre psykisk hälsa än unga vuxna i samma åldrar med typisk hörsel. Inget samband mellan ålder vid första CI-operation och psykisk hälsa kunde påvisas. Utifrån studiens resultat finns indikationer att Covid-19-pandemin kan ha påverkat resultaten av SDQ+18, då det framkom att majoriteten av deltagarna upplevt en förändring gällande deras psykiska hälsa till följd av pandemin. Mer forskning behövs i en större kohort för att undersöka om unga vuxna med CI har sämre psykisk hälsa än typiskt hörande. / Hearing is an important prerequisite for the development of spoken language and can therefore affect mental health. With congenital or prelingual deafness or severe hearing impairment, a cochlear implant (CI) can be implanted to perceive sounds and speech. The aim of the pilot study was to investigate mental health in young adults (18–26 years of age) with focus on the importance of hearing by comparing individuals with and without CI. The study consisted of an experimental group (n = 5) and a control group (n = 20). The participants in the experimental group had a congenital or early acquired deafness and had received CI before the age of 30 months. The participants in the control group had typical hearing. The participants were asked to answer a survey with different questionnaires (SDQ + 18, Covid-19- questions, background information). The Strenghts and Difficulties Questionnaire (SDQ), was used in a new back-translated Swedish version (SDQ+18) to examine mental health. The results of the study showed that the young adults with CI do not experience poorer mental health than their age matched peers with typical hearing. No correlation was found between age at first CI surgery and mental health. The results of the study indicate that the Covid-19 pandemic may have affected the outcomes of the SDQ+18, since it was shown that the majority of the participants had experienced a change in their mental health due to the Covid-19-pandemic. Further research is needed to explore whether young adults with CI have poorer mental health than young adult with typical hearing.

Spatial hearing is crucial in real life but deteriorates in participants with severe sensorineural hearing loss or single-sided deafness. This ability can potentially be improved with a unilateral cochlear implant (CI). The present study investigated measures of sound localization in participants with single-sided deafness provided with a CI. Sound localization was measured separately at eight loudspeaker positions (4°, 30°, 60°, and 90°) on the CI side and on the normal-hearing side. Low- and high-frequency noise bursts were used in the tests to investigate possible differences in the processing of interaural time and level differences. Data were compared to normal-hearing adults aged between 20 and 83. In addition, the benefit of the CI in speech understanding in noise was compared to the localization ability. Fifteen out of 18 participants were able to localize signals on the CI side and on the normal-hearing side, although performance was highly variable across participants. Three participants always pointed to the normal-hearing side, irrespective of the location of the signal. The comparison with control data showed that participants had particular difficulties localizing sounds at frontal locations and on the CI side. In contrast to most previous results, participants were able to localize low-frequency signals, although they localized high-frequency signals more accurately. Speech understanding in noise was better with the CI compared to testing without CI, but only at a position where the CI also improved sound localization. Our data suggest that a CI can, to a large extent, restore localization in participants with single-sided deafness. Difficulties may remain at frontal locations and on the CI side. However, speech understanding in noise improves when wearing the CI. The treatment with a CI in these participants might provide real-world benefits, such as improved orientation in traffic and speech understanding in difficult listening situations.

Det är viktigt att ha god språkförmåga och ett brett ordförråd för kunskapsinhämtning och kommunikation. Idag ställs det höga krav på språkförståelse, därtill förståelse av metaforer. Metaforer är en typ av figurativt språk vars tolkning inte är bokstavlig. Därtill behövs det mer kunskap om figurativt språk hos gruppen ungdomar med cochleaimplantat (CI). Syftet med examensarbetet var att undersöka metaforkunskap hos svensktalande ungdomar med CI i relation till ålder när deltagarna fick sitt första cochleaimplantat (CI1), expressivt ordförråd och pragmatisk förmåga. I studien ingick 17 svensktalande ungdomar med CI i åldern 12 – 20 år. Deltagarna rekryterades via mottagningen för hörselimplantat vid Karolinska universitetssjukhuset. Sexton deltagare hade bilaterala CI och en hade bimodal hörsel (ett CI och en hörapparat). Genomsnittlig ålder för CI1 var 15 månader. Metaforkunskap bedömdes med hjälp av en norsk metaforuppgift översatt till svenska, expressivt ordförråd med Boston namning test (BNT) och pragmatisk förmåga med ett föräldraformulär (CCC-2). Deltagarnas svarsmotiveringar av metaforuppgiften transkriberades och analyserades med en kvalitativ svarsanalys. Resultaten visade att ungdomar med CI uppvisar metaforförståelse. Dock varierar den inom gruppen avseende antalet korrekt valda svarsalternativ. Ytterligare fynd indikerar att det finns ett måttligt negativt statistiskt signifikant samband mellan ålder vid CI1 och resultatet på metaforuppgiften. Ju yngre ålder vid CI1, desto bättre resultat på metaforuppgiften. En slutsats är att det finns en stor variation gällande metaforkunskap inom gruppen ungdomar med CI. Den kvalitativa analysen visar på en hög grad av diskrepans mellan val av rätt svarsalternativ, och otillräcklig eller felaktig motivering av det aktuella svarsalternativet. Tidig ålder vid CI tycks ha en gynnsam effekt på högre språkliga förmågor som metaforkunskap. Dock behövs det fler liknande studier, i större kohorter och med hörande kontrollgrupp. / It is important to have good language skills and a broad vocabulary for knowledge acquisition and communication. Today, there are high demands on language comprehension, which includes the understanding of metaphors. Metaphors are one type of figurative language whose interpretation is not literal. Therefore, more knowledge about figurative language in the group of teenagers and young adults with cochlear implant (CI) is needed. The aim of the study was to investigate metaphor knowledge in Swedish - speaking teenagers and young adults with CI in relation to implantation age of the first CI (CI1), expressive vocabulary and pragmatic ability. The study included 17 participants with CI between the ages of 12 and 20 years. They were recruited by the Hearing Implant Clinic, Karolinska University Hospital. Sixteen participants had bilateral CI and one had bimodal hearing (one CI and one hearing aid). The average age at CI1 was 15 months. Participants' metaphor knowledge was assessed using a Norwegian metaphor task translated to Swedish, expressive vocabulary with the Boston Naming Test (BNT), and pragmatic ability with a parent questionnaire (CCC-2). The participants' motivations in the metaphor task were transcribed and analyzed using a qualitative response analysis. The results showed that young people with CI exhibits metaphor understanding. However, it varies within the group regarding the number of correctly selected responses. Further findings indicate that there is a moderate negative statistically significant relationship between age at CI1 and the results of the metaphor task. One conclusion is that there is a large variation regarding metaphor knowledge within the group of teenagers and young adults with CI. The qualitative analysis shows a high degree of discrepancy between the choice of correct answer option and insufficient or incorrect justification of the given answer. Early age at CI1 appears to have a beneficial effect on higher language abilities such as metaphor knowledge. However, further studies are needed, preferable in larger cohorts and with a hearing control group.

In unserer lautsprachlichen Welt ist Kommunikation stark auf das Hören angewiesen. Normalhörende Kinder sammeln in ihren ersten Lebensjahren Hörerfahrungen, die ihre sprachliche Entwicklung unterstützen. Früh ertaubten oder von Geburt an gehörlosen Kindern fehlt diese Möglichkeit bis zur Cochlea-Implantation. Ein Cochlea-Implantat (CI) ist eine Innenohrprothese, die geschädigte sensorische Haarzellen ersetzt und das Hören ermöglicht, wenn der Hörnerv intakt ist. Nach der Implantation beginnen CI-tragende Kinder ohne relevante Hörerfahrung mit der lautsprachlichen Entwicklung und müssen zu gleichaltrigen normalhörenden Kindern aufschließen. Die CI-Funktionen werden in mehreren Sitzungen an die Wahrnehmung der Person angepasst, doch das CI überträgt die Tonwelt nicht so exakt wie ein intaktes Gehör, was die auditive Umgebungswahrnehmung von CI-tragenden Kindern erschwert. Erwachsene CI-Nutzer können bei der Anpassung verbal kommunizieren, Kleinkinder oder Säuglinge jedoch nicht, weshalb ihre Hörwelt weitgehend unbekannt bleibt. Sprache und Musik teilen einige Wahrnehmungseigenschaften: Prosodie (Sprachmelodie) basiert auf Frequenz und Intonation, Emotionen werden durch Rhythmus und Intensität ausgedrückt, und Klangfarbe ermöglicht die Unterscheidung von Sprechstimmen und Instrumenten. Die Studie untersucht die musikalische Hörverarbeitung bei normalhörenden Säuglingen und CI-tragenden Kleinkindern mit vergleichbarem Höralter. Mithilfe der Mismatch Negativity (MMN) im EEG, die unabhängig von der Aufmerksamkeit des Probanden ausgelöst wird, wurde die Hörwahrnehmung objektiv beurteilt. Verschiedene musikalische Qualitäten wurden mit einem Multi-feature-MMN-Paradigma untersucht. Die Stimuli bestanden aus einem Tonlauf von vier Achtelnoten (Alberti-Bass) und wurden in allen Dur- und Moll-Tonarten in randomisierter Reihenfolge dargeboten, wobei der dritte Ton in Tonhöhe (pitch), Klangfarbe (timbre), Intensität (intensity), Rhythmus (rhythm), Glissando (slide) und einem zweiten Standard (standard2) variierte. Die Probanden wurden während der Stimulus-Präsentation geräuschlos abgelenkt. Es wurden Daten von 17 prälingual ertaubten CI-tragenden Kleinkindern (durchschnittlich 1 Jahr und 7 Monate alt) und 21 normalhörenden Säuglingen (6 Monate alt), beide mit 6 Monaten Hörerfahrung, ausgewertet. Für jede Bedingung wurde der Grand Average in beiden Gruppen und deren Untergruppen gebildet, und die MMN in frühen und späten Zeitfenstern analysiert. Die Ergebnisse zeigen, dass CI-tragende Kinder bei allen Devianten eine signifikante MMN zeigten. Die Untergruppe „mit Hörerfahrung“ wies bei timbre, intensity, rhythm und standard2 signifikante Ergebnisse auf, während die Untergruppe „ohne Hörerfahrung“ bei allen Devianten Signifikanzen zeigte. Dies wird jedoch aufgrund der kleinen Stichprobengröße nicht als robust betrachtet. Normalhörende Kinder zeigten bei allen Devianten außer standard2 eine signifikante MMN. CI-tragende Kinder reagierten unerwartet stark auf intensity und schwach auf rhythm, während normalhörende Kinder standard2 nicht wahrnehmen konnten. Erstmals wurde die Hörwahrnehmung von früh implantierten, bilateral CI-tragenden Kindern in ihrem frühen Höralter von sechs Monaten untersucht. CI-tragende Kinder konnten alle untersuchten Abweichungen wahrnehmen, wobei timbre und intensity besser und rhythm schwächer als erwartet wahrgenommen wurden. Normalhörende Kinder konnten standard2 aufgrund ihres Entwicklungsstandes nicht wahrnehmen, während ältere CI-tragende Kleinkinder dies kognitiv leisten konnten. Die CI-tragenden Kinder zeigten eine vergleichbare Fähigkeit zur Wahrnehmung akustischer Reize wie normalhörende Kinder, trotz fehlender oder unterbrochener Hörerfahrung.:Inhaltsverzeichnis Relevanz der Dissertation für den Forschungsbereich 1. Einleitung 1.1. Das auditive System 1.1.1. Anatomie des Ohres 1.1.2. Physiologie der akustischen Wahrnehmung 1.1.3. Embryologische Entwicklung des Innenohres: Der Beginn des Hörens 1.1.4. Kindliche Hörstörungen 1.2. Das Cochlea-Implantat (CI) 1.2.1. Definition und Entwicklung 1.2.2. Aufbau und Funktion 1.2.3. CI-Versorgung bei Kleinkindern 1.3. EEG und evozierte Potentiale 1.3.1. EEG 1.3.2. Ereignis-korrelierte Potentiale 1.3.3. CI-Artefakte 1.4. Bedeutung von Musik für die Entwicklung 1.4.1. Musik als Kulturgut 1.4.2. Psychosoziale Aspekte 1.4.3. Hörwahrnehmungen bis zum Kleinkindalter 1.4.4. Musikwahrnehmung mit CI 2. Experiment 2.1. Motivation 2.2. Stand der Wissenschaft 2.3. Fragestellung und Hypothesen 2.4. Methoden 2.4.1. Probanden 2.4.2. Versuchsdesign 2.4.3. Versuchsablauf 2.4.4. Elektrophysiologische Ableitung 2.4.5. Datenanalyse 2.5. Ergebnisse 2.5.1. Patientengruppe (CI-tragende Kinder) 2.5.2. Kontrollgruppe (normalhörende Kinder) 2.5.3. Übersicht über die CI- und die NH-Gruppe 2.5.4. Die Auswirkung des CI-Artefakts auf die MMN 3. Diskussion 3.1. Hörwahrnehmung CI-tragender Kinder 3.1.1. Pitch 3.1.2. Timbre 3.1.3. Intensity 3.1.4. Rhythm 3.1.5. Slide 3.1.6. Standard2 3.1.7. Globaler Vergleich der diskutierten Studien 3.2. Hörwahrnehmung normalhörender 6 Monate alter Säuglinge 3.3. Untergruppen „mit“ und „ohne Hörerfahrung“ 3.4. Latenzen 3.5. Fazit 3.6. Limitationen 3.7. Ausblick 4. Zusammenfassung 4.1. Deutsch 4.2. English Abbildungsverzeichnis Tabellenverzeichnis Literaturverzeichnis Anlage 1: Erklärung zur Eröffnung des Promotionsverfahrens Anlage 2: Erklärung zur Einhaltung aktueller gesetzlicher Vorgaben

Bilateral cochlear implantation is accepted medical practice since 2008 in clinically suitable adults and children to enhance bilateral processing benefits. Bilateral implantation may lead to the restoration of some bilateral hearing advantages, such as improved speech recognition in noise, localisation, head shadow effect, summation, and squelch. The majority of the advantages stated in literature, though, are characteristic of the simultaneously implanted cochlear implant population. Simultaneous implantation is not yet a reality in South Africa due to funding constraints, therefore determining the bilateral processing abilities in sequentially implanted adults is essential. Determining bilateral processing benefits achievable with sequential implantation could result in evidence-based recommendations in terms of candidacy considerations, surgery protocols, motivations for medical aid funding for simultaneous cochlear implantation, and relevant measures to determine the bilateral processing benefit attainable. Furthermore, it might enhance audiologists‟ insight regarding post-implantation performance of sequentially implanted patients and enable them to counsel prospective candidates realistically. The aaim of this study was to determine the bilateral benefit attained by sequentially implanted adults. A quantitative, cross-sectional research approach was followed in a one group post-test-only exploratory research design. A purposive convenient sampling method with specified selection criteria was used to select 11 adult clients of an established cochlear implant programme in Pretoria. Tests of sound localisation in the horizontal plane and speech perception in noise were performed. During the test of sound localisation, performance with only the first or only the second implant was found to be very similar. For the majority of participants the second cochlear implant (CI 2) was the superior performing implant during xviii speech perception in noise testing, in spatially separated speech and noise conditions where noise was directed to the first implant, as well as in spatially coincident speech and noise. A statistical significant bilateral benefit (p < 0.05) was attained by sequentially implanted adults for sound localisation. A bilateral benefit for speech perception in noise was observed when noise was directed to the first implant and in the diotic listening condition with average benefits of 1.69 dB and 0.78 dB, respectively. It was not statistically significant (p > 0.05), however, and was smaller than bilateral benefit values achieved by simultaneously implanted adults in previous studies. The head shadow effect at 180° was found to be the strongest and most robust bilateral spatial benefit. Squelch and summation benefit values ranged from negative values to 2 dB and 6 dB, respectively. This corresponded with values found in previous studies. The improvement in speech perception in spatially distinct speech and noise from adding the ear with a better SNR (signal to noise ratio) indicated that the contribution of CI 2 seems to be greater than that of CI 1 for bilateral spatial benefit. It can be concluded that adults with sequential implants may achieve some extent of bilateral benefit even with many years of unilateral implant use, when speech processors differ, when the second implant is done ≥ 10 years after the first implant, and in cases of prelingual deafness. A key benefit of sequential implantation appears to be related to the advantage of having hearing on both sides so that the ear with the more favourable environmental signalto-noise ratio is always available. AFRIKAANS : Bilaterale kogleêre inplanting is sedert 2008 aanvaarde mediese praktyk vir klinies geskikte volwassenes en kinders, ten einde bilaterale prosesseringsvoordeel te verhoog. Bilaterale inplanting kan lei tot die herstel van sommige van die voordele van bilaterale gehoor, soos verbeterde spraakherkenning in lawaai, klanklokalisering, die kopskadueffek, sommering en selektiewe onderdrukking (“squelch”). Die meeste van die voordele wat in die literatuur bespreek word, is egter kenmerkend van dié persone by wie twee kogleêre inplantings gelyktydig gedoen is. Gelyktydige inplanting is as gevolg van beperkte befondsing nog nie in Suid-Afrika 'n werklikheid nie, daarom is dit noodsaaklik om te bepaal watter bilaterale prosesseringsvoordele by opeenvolgend-geïnplanteerde volwassenes voorkom. Die bepaling van watter bilaterale prosesseringsvoordele met opeenvolgende inplanting bereik kan word, sou kon lei tot getuienis-gebaseerde aanbevelings met betrekking tot besluite oor die geskiktheid van kandidate, protokol vir sjirurgie, motiverings vir die befondsing van gelyktydige kogleêre inplantings deur mediese voorsorgfondse, en toepaslike maatstawwe om te bepaal watter mate van bilaterale prosesseringsvoordeel haalbaar sou wees. Dit sou verder oudioloë se insig kon verbreed met betrekking tot die na-operatiewe prestasie van opeenvolgend-geïnplanteerde persone en hulle sodoende in staat stel om voornemende kandidate van realistiese raad te bedien. Die doel van hierdie studie was om te bepaal wat die bilaterale prosesseringsvoordele is wat deur opeenvolgend-geïnplanteerde volwassenes verkry kan word. 'n Kwantitatiewe navorsingsbenadering met 'n dwarsprofiel van „n enkelgroep is gevolg, met 'n post-toets verkennende navorsingsontwerp. 'n Doelgerigte gerieflikheidssteekproef met 'n gespesifiseerde seleksiekriteria is gebruik om 11 volwasse kliënte van 'n gevestigde kogleêre inplantprogram in Pretoria te selekteer. Klanklokalisering in die horisontale vlak en die waarneming van spraak in lawaai is getoets. Tydens die toets vir klanklokalisering is gevind dat prestasie met slegs die eerste of slegs die tweede inplanting soortgelyk was. Vir die meeste deelnemers aan die studie het die tweede kogleêre inplanting (KI 2) die beste prestasie gelewer tydens spraakwaarneming in lawaai, in omstandighede waar spraak en lawaai ruimtelik geskei is en die lawaai op die eerste inplanting gerig is, asook in omstandighede waar spraak en lawaai ruimtelik saamvoorkomend aangebied is. 'n Statisties beduidende bilaterale voordeel (p < 0.05) is deur opeenvolgend-geïnplanteerde volwassenes vir klanklokalisering behaal. 'n Bilaterale voordeel vir spraakwaarneming in lawaai is waargeneem waar lawaai op die eerste inplanting gerig is en ook in diotiese luistertoestande, met 'n gemiddelde voordeel van 1.69 dB en 0.78 dB, onderskeidelik. Dit was egter nie statisties beduidend nie en was ook kleiner as die bilaterale voordeelwaardes wat in vorige studies deur gelyktydig-geïnplanteerde volwassenes behaal is. Die kopskadu-effek by 180° was die sterkste en mees robuuste bilaterale ruimtelike voordeel. Voordeelwaardes vir selektiewe onderdrukking en sommering het gewissel van negatiewe waardes tot 2 dB en 6 dB onderskeidelik. Dit stem ooreen met waardes wat in vorige studies gevind is. Die verbetering in spraakwaarneming in ruimtelik geskeide spraak en lawaai wat verkry is deur die oor met 'n beter STR (sein-tot-ruis ratio) by te voeg, het daarop gedui dat die bydrae van KI 2 tot bilaterale ruimtelike voordeel waarskynlik groter as die bydrae van KI 1 is. Die gevolgtrekking kan gemaak word dat volwassenes met opeenvolgende inplantings 'n mate van bilaterale voordeel verkry selfs na vele jare van unilaterale inplantingsgebruik, wanneer die spraakprosesseerders in die twee inplantings van mekaar verskil, wanneer die tweede inplanting ≥ 10 jaar na die eerste plaasvind, en in gevalle van prelinguale doofheid. 'n Sleutelvoordeel van opeenvolgende inplanting hou klaarblyklik verband met die voordeel van gehoor aan albei kante te hê sodat die oor met die gunstigste sein-tot-lawaai ratio altyd beskikbaar is. / Dissertation (MCommunication Pathology)--University of Pretoria, 2011. / Speech-Language Pathology and Audiology / Unrestricted

The impact of the diagnosis and the reality of being hearing impaired could trigger uncomfortable feelings at different times in the client's life. With the cochlear implant, these feelings will still be a reality, as the implant does not heal the hearing impairment. Psychological interventions could assist the client during this healing process. The process of cochlear implants could also bring other challenges into the client's life. Expectations of quick healing play a major role and should be addressed throughout the process of implantation and rehabilitation. This is another opportunity for the psychologist to intervene. This research shows that the role of the psychologist could be expanded not only to evaluate but also to bring about change. The treatment model gives a logical and workable explanation of how and where the psychologist may intervene in the process of cochlear implantation. This model was tested and adapted by the cochlear implant team at the University of Pretoria over a period of ten years. The model may be used as a template for new teams. Intervening as described in the model presents the opportunity to address various different needs as they occur. The qualitative research design proved to be a fitting method to explore the experiences of the participants from their own viewpoints. The qualitative research is also congruent with a systemic perspective and emphasises social context, multiple perspectives, complexity, recursion and holism. This study aims to develop a complementary psychological treatment programme and create awareness within professionals working with hearing impairment of the complexity of systems. The study shows that one can only understand the behaviour of any given system by tracking changes that occur within that system and its subsystems and by tracking changes between that system and the larger whole. In this study three different therapeutic interventions are used on three different case studies, two children from different age groups and an adult, to accommodate the multiple realities of the different systems. The aim of the study with cochlear implantees and their families is to stimulate new leads and avenues of enquiry that may be used as a basis for further research. / Psychology / Thesis (D.Litt. et Phil. (Psychology))

This dissertation based on a case study explores the acquisition and the guidance of Swedish Sign Language and spoken Swedish over a span of seven years. Interactions between a pair of fraternal twins, one deaf and one hearing, and their Deaf[1] family were video-observed within the home setting. The thesis consists of a frame which provides an overview of the relationship between four studies. These describe and analyze mainly storytime sessions over time. The first article addresses attentional expressions between the participants; the second article studies the mediation of the deaf twin’s first language acquisition; the third article analyses the hearing twins acquisition of parallel bimodal bilingualism; the fourth article concerns second language acquisition, sequential bimodal bilingualism following a cochlear implant (CI). In the frame, theoretical underpinnings such as mediation and language acquisition were compiled, within a sociocultural frame. This synthesis of results provides important information; in the 12- and 13-month sessions simultaneous-tactile-looking was noted in interchanges between the twins and their mother; mediation of bilingualism was scaffolded by the caregivers with the hearing twin by inserting single vocal words or signs into the language base used at that time, a finding that differs from other reported studies; a third finding is the simultaneousness in which the deaf child’s Swedish Sign Language skill worked as a cultural tool, to build a second and spoken language. The findings over time revealed actions that included all the family members. Irrespective of the number of modes and varied types of communication with more than one child, mediation included following-in the child’s initiation, intersubjective meaningfulness and encouragement. In accordance with previous research, these factors seem to promote the acquisition of languages. In conclusion, these findings should also prove useful in the more general educational field. [1] Deaf with a capital ‘D’ is commonly used for cultural affiliation whereas lower case ‘d’, as in deaf, refers to audiological status (Monaghan, Schmaling, Nakamura &amp; Turner, 2003). / <p>Disputationen tolkas till svensk teckenspråk, hörselslinga finns.</p><p>At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 2: Submitted. Paper 3: Accepted. Paper 4: Submitted.</p>

Objectives: To assess the subjective and objective performance of the new fine structure processing strategy (FSP) compared to the previous generation coding strategies CIS+ and HDCIS. Methods: Forty-six adults with a minimum of 6 months of cochlear implant experience were included. CIS+, HDCIS and FSP were compared in speech perception tests in noise, pitch scaling and questionnaires. The randomized tests were performed acutely (interval 1) and again after 3 months of FSP experience (interval 3). The subjective evaluation included questionnaire 1 at intervals 1 and 3, and questionnaire 2 at interval 2, 1 month after interval 1. Results: Comparison between FSP and CIS+ showed that FSP performed at least as well as CIS+ in all speech perception tests, and outperformed CIS+ in vowel and monosyllabic word discrimination. Comparison between FSP and HDCIS showed that both performed equally well in all speech perception tests. Pitch scaling showed that FSP performed at least as well as HDCIS. With FSP, sound quality was at least as good and often better than with HDCIS. Conclusions: Results indicate that FSP performs better than CIS+ in vowel and monosyllabic word understanding. Subjective evaluation demonstrates strong user preferences for FSP when listening to speech and music. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

The aims of this study were to examine a) whether the family-centered intervention method Auditory Verbal Therapy (AVT) has had an effect on the levels of empowerment of caregivers of children with CI; and b) whether the parents feeling most empowered have a continual habit of reading frequently with their child and have children who achieve higher scores on lexical-semantic tasks; c) whether the empowerment questionnaire “Att vara förälder” (“Being a parent”) is an appropriate assessment tool to evaluate intervention intending to empower the caregivers of children with hearing impairment. Vocabulary was used as a way to gauge the effectiveness of the method. Perceived empowerment of 23 parents was assessed with “Att vara förälder” (“Being a parent”) along with an informal conversation about the questionnaire. In addition, lexical-semantic ability of 11 children (age 5;1-11;8) was assessed with the BNT and the Semantic Feature Test for evaluation if the level of empowerment would affect vocabulary level. Overall the caregivers reported high levels of empowerment. Duration of intervention (range 6 months – 2 years or more) and levels of empowerment corresponded significantly positive. Further, a more active parent scored higher on empowerment than did the parent less active in intervention, as indicated by the self-reports. Qualitative data from the conversation revealed that many of the parents felt that the AVT intervention had helped them to feel more empowered. The results for lexical-semantic ability showed a large variability in the group, not significantly correlated to parents’ level of empowerment. The children older than eight years performed at stanine 5 and over on the BNT. The younger children did not score above stanine 4. In conclusion, the present study represents a first step towards applying empowerment as an instrument for the evaluation of family-centered intervention. Based on our results we argue that all children receiving a CI and their families would benefit from being provided with the possibility for prolonged intervention periods. / Syftet med denna studie var att undersöka a) om den familjebaserade interventionsmetoden Auditory Verbal Therapy (AVT) har haft effekt på känslan av empowerment hos föräldrar till barn med CI; och b) om de föräldrar med högst känsla av empowerment har som vana att ofta läsa för sina barn och har barn som presterar högt på testning av ordförråd; c) om enkäten ”Att vara förälder” är ett användbart verktyg för att utvärdera intervention som har som mål att öka känslan av empowerment hos vårdnadshavare till barn med hörselnedsättning. Bedömning av ordförråd användes som ett sätt att undersöka metodens effektivitet. 23 föräldrar fyllde i en empowerment-enkät ”Att vara förälder” och deltog sedan i ett informellt samtal med författarna till studien. Vidare bedömdes lexikal-semantisk förmåga hos 11 barn (ålder 5;1-11;8) med BNT och Särdragstestet med syfte att undersöka om nivån av empowerment påverkar ordförråd. Överlag hade vårdgivarna en hög känsla av empowerment. Interventions-längd (mellan 6 månader – 2 år eller mer) korrelerade signifikant positivt med empowerment. Därutöver framkom att den i interventionen mer aktiva föräldern erhöll ett högre resultat avseende empowerment, jämfört med den föräldern som varit mindre aktiv, enligt självskattningsdata. Kvalitativa data från det informella samtalet tydliggjorde att föräldrarna upplever att interventionen med AVT har förstärkt deras känsla av empowerment. Resultaten varierade stort vad gällde lexikal-semantisk förmåga, vilket inte korrelerade statistiskt med föräldrarnas nivå av empowerment. Barnen äldre än åtta år presterade stanine 5 eller över. De yngre barnen presterade inte över stanine 4. Sammanfattningsvis representerar denna studie ett första steg i ledet att implementera empowerment som ett utvärderingsinstrument i familjebaserad intervention. Baserat på resultaten i vår studie dras slutsatsen att alla barn som får CI skulle, tillsammans med sina familjer, gagnas av att få möjligheten till en långvarig familjebaserad interventionsinsats.

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