This study aimed to answer whether current research addressing executive function abilities in cochlear implant users was accurately depicting their impairments. Secondly, this study aimed to identify differences in identification of executive function impairments when measured using parent report versus behavioral measures of executive function. Results suggest that children do have executive function impairments in areas of measure nonverbal planning, problem-solving, monitoring, and self-regulation abilities as well as attention to a visually presented array of pictures which has been documented in previous research. However, it is likely that these abilities are modulated by children with cochlear implants' poorer language ability as demonstrated on the PPVT, which seems not to be related to their age of implantation. The behavioral measures and parent report measures identified impairments in the subsets which required a greater language demand and subsequently subsets that were significantly more difficult for CI children.

Doctor of Philosophy (PhD) / An in-depth, longitudinal study of the speech and oral language development of eight infants with a profound hearing loss who receive early interventions focused on developing their auditory, speech and oral language capacity is presented in this thesis. Infants were tracked for two years, during the period when they are changed from a hearing aid to a cochlear implant. All infants in this study had their hearing loss identified early and were fitted with hearing aids between 1 and 7 months of age and received their cochlear implant between 8 and 16 months of age. They attended a number of different auditory-verbal early intervention programs (depending on where they lived) all of which focused on developing speech and language skills through listening. Attendance at their particular early intervention program at least once a week was in addition to weekly attendance the Sydney Cochlear Implant Centre for therapy and audiological services. A broad range of measures has been used to track the infants’ acquisition of oral language skills, including measures of communicative intention, pre-speech and speech development, and oral language development. Despite a wide range of individual differences across the group of infants, the results suggest some general trends. In the area of communicative intent most infants followed typical development patterns in terms of both the types (e.g. requesting, answering etc) and forms (gestural, vocal, verbal) used, but they showed delays in their frequency of usage of these types and forms. For speech development the infants demonstrated typical speech skills by 18-months post-cochlear implantation in the areas of consonant inventories, severity of phonological involvement (speech intelligibility) and phonological process development, but they showed delays in vowel and consonant acquisition. Finally, for language development the infants were delayed relative to typical development at 18 months post-implantation. The findings support and extend previous studies which have demonstrated the benefits of early intervention for communication development in infants with hearing loss (Calderon & Naidu, 2000; Mayne, Yoshinaga-Itano & Sedey, 2000; Moeller, 2000; Yoshinaga-Itano & Apuzzo, 1998). However, the delays in the oral communication skills of the infants in the current study suggest that more intensive long-term intervention is required if the infants are to attain typical oral speech and language development. The findings capture the complexity of early oral language development, which has been lacking in previous studies of infants with significant hearing loss, receiving a cochlear implant (Dettman, Briggs, & Dowell, 2005; Houston, Ying, Pisoni, & Iler Kirk, 2003; Schauwers, Gillis, Daemers, De Beukelaer, & Govaerts, 2004). The present data also provide some limited support for earlier implantation, that is, before 12 months of age, as the infants made little progress in oral language development while using hearing aids. The reduced amount of auditory signal available to them prior to implantation may be the determining factor in their inability to follow typical rates and patterns of development. However, rates of development with the implant were not straightforward and further research on this population is needed. Universal neonatal screening programs for hearing loss will potentially provide a larger population of early identified infant for future research. This will create the opportunity for large scale, prospective, longitudinal, studies examining the acquisition of speech and oral language development. Limitations of this study, tracking the early stages of speech and language development over a two year period are identified. Future studies are needed to follow the infants for a longer time to determine if their rate of development is sufficient for them to catch up in areas of delay and maintain their performance in areas where they match their typically developing peers.

The current study sought to examine predictors of language acquisition for deaf children who received cochlear implants in a large, multi-center trial. General maternal sensitivity as well as two specific types of maternal sensitivity, cognitive and linguistic stimulation, were all evaluated in relation to speech production. Characteristics of the family and child (e.g. maternal education, family income, age at implantation, etc.) were also evaluated. The hypotheses tested were: 1) child age at implantation and gender, maternal education, and family income were expected to predict speech production across 6 and 12 months post-implantation, 2) both Cognitive and Linguistic Stimulation were expected to predict the growth of speech production at 6 and 12 months post-implantation, and 3) Cognitive and Linguistic Stimulation were expected to predict speech production above and beyond that predicted by general Maternal Sensitivity. Results indicated that, of the demographic variables, only child age at implantation was a significant predictor of speech production. Cognitive and linguistic stimulation were significantly associated with the development of speech production in the first year following activation of the implant. Furthermore, these important maternal behaviors accounted for gains in speech production beyond that accounted for by general maternal sensitivity. These findings have several clinical implications, including the development of formalized training for parents of children who receive cochlear implants.

Cochlear implants (CIs) provide coarse representations of pitch, which are adequate for speech but not for music. Despite increasing interest in music processing by CI users, the available information is fragmentary. The present experiment attempted to fill this void by conducting a comprehensive assessment of music processing in adult CI users. CI users (n =6) and normally hearing (NH) controls (n = 12) were tested on several tasks involving melody and rhythm perception, recognition of familiar music, and emotion of recognition in speech and music. CI performance was substantially poorer than NH performance and at chance levels on pitch processing tasks. Performance was highly variable, however, with one individual achieving NH performance levels on some tasks, probably because of low-frequency residual hearing in his unimplanted ear. Future research with a larger sample of CI users can shed light on factors associated with good and poor music processing in this population.

Cochlear implants (CIs) provide coarse representations of pitch, which are adequate for speech but not for music. Despite increasing interest in music processing by CI users, the available information is fragmentary. The present experiment attempted to fill this void by conducting a comprehensive assessment of music processing in adult CI users. CI users (n =6) and normally hearing (NH) controls (n = 12) were tested on several tasks involving melody and rhythm perception, recognition of familiar music, and emotion of recognition in speech and music. CI performance was substantially poorer than NH performance and at chance levels on pitch processing tasks. Performance was highly variable, however, with one individual achieving NH performance levels on some tasks, probably because of low-frequency residual hearing in his unimplanted ear. Future research with a larger sample of CI users can shed light on factors associated with good and poor music processing in this population.

<p>It is well established that cochlear implants (CIs) are able to provide many users with excellent speech recognition ability in quiet conditions; however, the ability to correctly identify speech in noisy conditions or appreciate music is generally poor for implant users with respect to normal-hearing listeners. This discrepancy has been hypothesized to be in part a function of the relative decrease in spectral information available to implant users (Rubinstein and Turner, 2003; Wilson et al., 2004). One method that has been proposed for increasing the amount of spectral information available to CI users is to include time-varying stimulation rate in addition to changes in the place of stimulation. However, previous implementations of multi-rate strategies have failed to result in an improvement in speech recognition over the clinically available, fixed-rate strategies (Fearn, 2001; Nobbe, 2004). It has been hypothesized that this lack of success was due to a failure to consider the underlying perceptual responses to multi-rate stimulation. </p><p>In this work, psychophysical experiments were implemented with the goal of achieving a better understanding of the interaction of place and rate of stimulation and the effects of duration and context on CI listeners' ability to detect changes in stimulation rate. Results from those experiments were utilized in the implementation of a tuned multi-rate sound processing strategy for implant users in order to potentially ``tune" multi-rate strategies and improve speech recognition performance. </p><p>In an acute study with quiet conditions, speech recognition performance with a tuned multi-rate implementation was better than performance with a clinically available, fixed-rate strategy, although the difference was not statistically significant. These results suggest that utilizing time-varying pulse rates in a subject-specific implementation of a multi-rate algorithm may offer improvements in speech recognition over clinically available strategies. A longitudinal study was also performed to investigate the potential benefit from training to speech recognition. General improvements in speech recognition ability were observed as a function of time; however, final scores with the tuned multi-rate algorithm never surpassed performance with the fixed-rate algorithm for noisy conditions. </p><p>The ability to improve upon speech recognition scores for quiet conditions with respect to the fixed-rate algorithm suggests that using time-varying stimulation rates potentially provides additional, usable information to listeners. However, performance with the fixed-rate algorithm proved to be more robust to noise, even after three weeks of training. This lack of robustness to noise may be in part a result of the frequency estimation technique used in the multi-rate strategy, and thus more sophisticated techniques for real-time frequency estimation should be explored in the future.</p> / Dissertation

The purpose of this thesis is to provide a review and discussion of the current literature on auditory processing, speech discrimination, word recognition, and early lexical representations in children with normal hearing and those with hearing impairment in addition to identifying areas in which current research is lacking. This information is needed to consider potential interactions between various factors affecting the development of spoken word recognition. This will also provide a starting point for identifying further research needs. Since children with hearing loss do not receive the same amount of exposure to speech and language as typically developing children, it can be expected that the development of speech and word recognition in this population may progress differently. If we can identify differences in auditory processing and phonological development in children with hearing impairment, we can modify speech and language therapy to focus on more specific and effective targets. The subsequent chapters will provide a critical review of the current literature on the aforementioned topics. In Chapters 2 and 3, studies assessing differences in processing, attention to sound, intersensory perception, and sound discrimination abilities in children with normal hearing and hearing impairment will be discussed. Chapters 4 and 5 focus on word recognition skills, and early lexical representations. Chapter 6 will synthesize results of available studies and suggest areas in which more research is needed. Together, these chapters will help us gain a better understanding of the complex interactions between auditory processing, executive functioning, phonological development and later word recognition outcomes. By identifying which avenues have the greatest effect on outcomes in cochlear implant users, we can modify speech and language therapy in order to address the unique needs of this special population. / text

Background: To date, there is a lack of research that has focused on the needs of late cochlear implanted adults with prelingual deafness. The specific study aims were: (1) to explore the met and unmet long-term needs of late cochlear implanted adults with prelingual deafness from their own perspectives and those of the employees at SCIP; and 2) to identify a consensus of the most important met and unmet long-term needs of late cochlear implanted adults with prelingual deafness. Method: This study used a modified Delphi technique with two rounds. In the first round, nine adults who were considered experts on this topic participated in semi-structured in-depth interviews. The participants were five late cochlear implanted recipients with prelingual deafness who were involved in the Southern Cochlear Implant Programme in New Zealand, and four clinicians from the programme. The interview transcripts were analysed using qualitative content analysis. The results from the first round were used to inform the development of the survey for the second round. The second round of the study involved surveying the same participants who participated in the first round. These surveys were quantitatively analysed so as to discover which needs were considered important and met, and important and unmet for the cochlear implant recipients, from the perspectives of the two categories of participants. Results: The first round of the study revealed 42 met needs and 39 unmet needs that fell into 15 categories. Of these needs, 26 met needs and 18 unmet needs were identified as being important by a majority of the participants in the second round. Conclusion: The results from the study may impact potential CI recipients’ and their families’ expectations of what the device can provide, as well as the development of future services and governmental policies in the area.

published_or_final_version / abstract / toc / Surgery / Master / Master of Philosophy

Everyday speech perception frequently occurs in degraded listening conditions, against a background of noise, interruptions and intermingling voices. Despite these challenges, speech perception is remarkably successful, due in part to perceptual learning. Previous research has demonstrated more rapid perceptual learning of acoustically-degraded speech when listeners are given the opportunity to map the linguistic content of utterances, presented in clear auditory form, onto the degraded auditory utterance. Here, I investigate whether learning is further enhanced by the provision of naturalistic facial gestural information, presented concurrently with either the clear auditory sentence (Experiment I), or with the degraded utterance (Experiment II). Recorded materials were noise-vocoded (4 frequency channels; 50- 8000 Hz). Noise-vocoding (NV) is a popular simulation of speech transduced through a cochlear implant, and 4-channel NV speech is difficult for naïve listeners to understand, but can be learned over several sentences of practice. In Experiment I, each trial began with an auditory-alone presentation of a degraded stimulus for report (D). In two conditions, this was followed by passive listening to either the clear spoken form and then the degraded form again (condition DCD), or the reverse (DDC); the former format of presentation (DCD) results in more efficient learning (Davis et al, 2005). Condition DCvD was similar to DCD, except that the clear spoken form was accompanied by facial gestural information (a talking face). The results indicate that presenting clear audiovisual feedback (DCvD) does not confer any advantage over clear auditory feedback (DCD). In Experiment II, two groups received a degraded sentence presentation with corresponding facial movements (Dv); the second group also received a second degraded (auditory-alone) presentation (DvD). Two control conditions and a baseline DCvD condition were also tested. Although they never received clear speech feedback, performance in the DvD group was significantly greater than in all others, indicating that perceptual learning mechanisms can capitalize on visual concomitants of speech. The DvD group outperformed the Dv group, suggesting that the second degraded presentation in the DvD condition further facilitates generalization of learning. These findings have important implications for improving comprehension of speech in an unfamiliar accent or following cochlear implantation. / Thesis (Master, Psychology) -- Queen's University, 2011-09-01 16:50:58.923