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Postlingually deafened cochlear implant (CI) adults have large variability in speech perception abilities. While CIs are one of the most successful neural prosthetic devices, they are not able to adequately provide fine structure cues which results in a degraded signal for the listener to interpret. While behavioral measures remain the gold standard for determining speech perception abilities, an objective measure is needed for patients who are unable to provide reliable behavioral responses. Behavioral, cognitive, and neural measures were collected in this study to identify potential neural biomarkers that correlate with speech perception performance. Behavioral experiments evaluated participants' abilities to identify, discriminate, and recognize words as well as sentences in quiet and in noise. Cognitive measures were assessed to determine the roles of attention, impulse control, memory, and cognitive flexibility on speech recognition. Auditory event-related potentials (ERP) were obtained with a double oddball paradigm to produce the mismatch negativity (MMN) response, which has been shown to have associations with phonetic categorical perception at the group level. The results indicated that executive function is highly predictive of speech performance and that the MMN is associated with categorical perception at the individual level. These findings are clinically relevant to determining appropriate follow-up care post-implantation.

Thesis (M.Eng.(Bio-Engineering))--University of Pretoria, 2008. / Summaries in Afrikaans and English. Includes bibliographical references.

Thesis (MEdPsych (Educational Psychology))--Stellenbosch University, 2008. / Cochlear implants are electronic devices implanted in the ear, which can give children with severe to profound hearing loss, access to sound and the opportunity to aquire spoken language. Such implants are achieved via a delicate surgical procedure, followed by an intensive rehabilitation program. Parents are intimately involved in this entire process and play a pivotal role in terms of decision-making, the surgery and the child’s language development. Research has shown that this procedure causes increased stress levels in parents, as well as an initial experience of mixed emotions. They also have to consider that some cochlear implants are not successful and thus do not provide all children with access to sound and the possibility of learning spoken language. Parents’ first contact with professional services/persons is generally doctors, ear, nose and throat specialists, audiologists, speech therapists and social workers. Further research shows that the relationship between such professionals and parents is not always satisfactory. As mothers often work closest with professionals, the following research questions arose: How do mothers experience the emotional support they receive during the diagnosis, implantation procedure and rehabilitation, and what are their emotional needs during this time? Because of a lack of literature concerning the role of educational psychologists in this process, a third question arose: What role can the educational psychologist play during the diagnosis of deafness and the cochlear implant process? The purpose of this generic qualitative study, therefore, was to analyze, describe and explain the experience of eight mothers of children with cochlear implants, with regard to support and support needs. The study was conducted within the interpretive paradigm, which guided the qualitative research design. Data was collected by means of semi-structured interviews. The interview data were transcribed and analyzed. The data analysis was done by using aspects of grounded theory. The findings show that mothers’ experiences of the process were unique, as the situation of each family differed. The eight mothers’ needs for emotional support also differed because of their unique experiences. Furthermore, a lack of support to parents after the rehabilitation process, just before children start primary school, was identified, and it was established that the educational psychologist can play a role in this phase and transition phases. Recommendations were made to improve the support mothers receive from professional services or people.

Thesis (MAud)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Cochlear implantation is an expensive but cost-effective intervention which must be used for life. It can provide individuals with severe-to-profound hearing loss improved sound perception in comparison to that obtained using hearing aids. In South Africa implants are not state subsidised, and related costs need to be covered by implant recipients. Cochlear implant teams thus need to ensure that individuals, who are selected, will benefit from the device and will be able to use it for their lifetime. Implantees should know the immediate and potential future costs involved, to be able to decide on its affordability. The primary aim of this study was to determine the immediate and long-term costs of cochlear implantation. One hundred and fifty four implant recipients from the Tygerberg Hospital- University of Stellenbosch Cochlear Implant Unit in Cape Town, South Africa were surveyed. Costs were categorized according to the time period post implantation and were converted to Constant Rands (June 2010) using the Consumer Price Index to allow for comparison in real terms over time. In the first 10 years of implantation the average estimated costs incurred by adult implantees totalled R379 626, and children R455 225. The findings showed that the initial purchase of the implant system was the most substantial cost involved (currently R221 000). Upgrading the speech processor, which on the average took place every 7 years, was the second highest cost subjects encountered (currently R85 000). The cost of spares (on average R276 per year) and repairs (R3000 per repair) increased with duration of use. Battery costs ranged between R1200 and R3372 per year and insurance costs averaged R4040 per year. Most appointments took place in the first two years following implantation. Average travel costs during the first two years were R1024 for those within 50km of the implant unit and R8645 for those living more than 1000km away. Accommodation costs for non-local recipients, peaked during this period (on average R3390). Additional rehabilitation services for paediatric implantees cost an estimated R37 159 in the first five years after implantation. Subjects advised potential implantees to save, budget and plan for the high costs involved in implantation, as well as to join a medical aid which could assist with the costs involved. The findings of the study hold great relevance for both implantees and cochlear implant professionals. Careful consideration of the financial implications of cochlear implantation is critically important in the South African context to ensure that recipients are successful longterm cochlear implant users. Although the actual costs in the study were related to the one implant system used at Tygerberg Hospital-University of Stellenbosch Cochlear Implant Unit, it is believed that the types and amounts of costs involved hold relevance for all individuals implanted in South Africa. / AFRIKAANSE OPSOMMING: Kogleêre inplantering is ‘n duur maar koste-effektiewe prosedure wat lewenslank gebruik moet word. Dit verskaf aan individue met erge-tot-uitermatige gehoorverlies verbeterde klankpersepsie in vergelyking met dié wat gehoorapparate gebruik. In Suid Afrika word kogleêre inplantings nie deur die staat gesubsidieer nie en koste moet deur die inplantgebruiker verhaal word. Kogleêre inplantingspanne moet gevolglik verseker dat individue wat geselekteer word daarby baat sal vind en lewenslank sal kan gebruik. Inplantgebruikers moet bewus wees van die onmiddelike, sowel as langtermyn onkoste. Die primêre doel van hierdie studie was om die onmiddelike en langtermyn onkoste van implanterings te bepaal. Een honderd vier en vyftig inplantgebruikers van die Tygerberg Hospitaal-Universiteit Stellenbosch Kogleêre Inplantingseenheid in Kaapstad, Suid Afrika is gebruik vir die studie. Onkoste was gekatogoriseer ten opsigte van die periode van tyd postinplantering en dit is omgeskakel na konstante Randwaarde (Junie 2010) deur die Gebruikers Prys Indeks te gebruik sodat vergelykings gemaak kon word in reële terme oor tyd. Gedurende die eerste 10 jaar na inplantering was die geskatte onkoste by volwasse inplantgebruikers R379 626 en by die pediatriese groep was dit R455 225. Bevindings het aangedui dat die aanvanklike aankoop van die inplantsisteem die grootste onkoste behels het (huidig R221 000). Opgradering van die prosesseerder, gemiddeld elke 7 jaar, was die tweede hoogste onkoste, naamlik R85 000. Die gemiddelde koste van spaaronderdele was R276 per jaar. Herstelkoste het R3000 per herstelling beloop. Koste van spaaronderdele en herstelkoste het met duur van gebruik vermeerder. Batteryonkoste het gewissel tussen R1200 en R3372 per jaar. Onkoste van jaarlikse versekering was gemiddeld R4040. Meeste afsprake het gedurende die eerste twee jaar plaasgevind. Vervoeronkoste gedurende hierdie periode was R1024 vir die wat binne 50km woon en R8645 vir dié meer as ‘n 1000km ver. Akkommodasie koste het ‘n piek gedurende hierdie periode bereik (gemiddeld R3390). Addisionele rehabilitasie dienste vir pediatriese inplantgebruikers was gemiddeld R37159 gedurende die eerste vyf jaar. Die proefpersone het aanbeveel dat potensiële inplantgebruikers moet spaar, begroot en beplan vir die hoë onkoste en is aanbeveel om aan te sluit by ‘n mediese fonds. Die bevindinge van die studie is van belang vir beide ontvangers sowel as inplantingspanne. Bewusmaking van die finansiële implikasies van kogleêre inplantering is van kritiese belang om suksesvolle langtermyn gebruik te verseker. Alhoewel die werklike onkoste in die studie van toepassing is op een inplanting sisteem wat by Tygerberg Hospitaal-Universiteit Stellenbosch Kogleêre Inplantingseenheid gebruik word, kan dit aangeneem word dat die tipes en hoeveelheid onkoste van toepassing is op alle individue in Suid Afrika wat kogleêre inplantings ontvang.

published_or_final_version / Speech and Hearing Sciences / Master / Master of Science in Audiology

This thesis examines technological framings for communication and identity issues, with a particular focus on Swedish mainstream schools where children with cochlear implants are pupils. Based on a sociocultural perspective on learning, the thesis focuses on how pupils and teachers interact with (and thus learn from) each other in classroom settings. The study comprises a) a sociohistorical analysis of three Swedish non-governmental organizations’ periodicals from 1891 to 2010, and b) an ethnographic study including micro-analyses of interaction in two mainstream classrooms where there are children with cochlear implants. The sociohistorical analysis illustrates how different technologies, in a range of ways, have shaped (i) how people with hearing loss communicate and interact with others and (ii) their identity positions. The analysis also demonstrates the presence of language ideologies in settings where children with hearing loss are taught. Here the main preference is for spoken communication, even though different types of visual communication emerge during the 1980s and 1990s. In addition, the issue of integration has been a matter of debate since the 1970s and provides a backdrop for the current situation, where an increasing number of children with cochlear implants receive their schooling in mainstream public rather than segregated regional deaf schools. Against this background, micro-analyses have been carried out of classroom interaction and recurring patterns and activities have been identified. The results illustrate that audiologically-oriented and communicative-link technologies play major roles in the classrooms and these both facilitate and limit the pupils’ participation. Based on postcolonial theory, the results can be understood in terms of participation and non-participation of the pupil with cochlear implants, who acquire peripheral identity positions in these classroom settings. The analysis also illuminates unequal power relations regarding technologies in use, and expressions of language ideologies in the classrooms, where spoken communication is preferred. Overall, the everyday life of children with cochlear implants in mainstream schools appears to be complex, and it is technologies in use that frame the conditions for their participation in interaction and communication.

Children with cochlear implants (CI) have difficulty perceiving pitch differences, which contributes to poor melodic perception. Aims/Methods. This study investigated how children with bilateral CIs (n = 23, M = 6,9 years) and children with normal hearing (NH) (n = 27, M = 7,2 years) were able to discriminate pitch intervals with a semitone as the smallest difference, and recognize melodies presented without lyrics in two conditions: as a melody and as a melody combined with pictures. An interview related to music was also conducted. Results. Children with bilateral CIs achieved very high scores on the pitch discrimination task. Children with NH surpassed the children with bilateral CIs at identifying songs without pictures (children with CIs 11%, NH 52%) and together with pictures (CIs 30%, NH 83%).  Measurement of effect size showed moderate to strong differences between children with CIs/NH. The interview findings showed positive attitudes towards music, with 77% of the children with CIs (versus 100% of children with NH) saying they enjoyed listening to music, had favourite artists and favourite songs. Conclusion. Children with CIs demonstrated a very good ability to discriminate pitch differences, but scored low on melody recognition tasks. The results confirm that melody recognition is demanding for children with CIs. In spite of the difficulty CIs have transmitting musical information, these children with CIs as a group have developed positive attitudes towards music. This finding suggests the potential capacity of CIs in relationship to music, but even more the potential capacity of growing children’s brains.     Barn med cochleaimplantat (CI) har svårighet att uppfatta skillnader i tonhöjd, vilket påverkar förmågan att identifiera melodier. Syfte/metod. Syftet var att studera hur barn med bilaterala CI (n = 23, M = 6,9 år) kunde diskriminera mellan tonhöjdsintervall med en semiton som minsta enhet och identifiera fem barnsångsmelodier jämfört med barn med normal hörsel (NH), (n = 27, M = 7,2 år). Melodierna presenterades i två betingelser: utan stöd av bilder (UB) samt med stöd av bilder (MB). Dessutom genomfördes en intervju om musik. Resultat. Förmågan att diskriminera tonhöjdsskillnader var mycket god. Melodier (UB): barn med CI klarade 11 %, barn med NH 52 %. Melodier (MB): barn med CI klarade 30 %, barn med NH 83 %. Analys av effektstyrka mätt i Cohens d visade moderata till stora skillnader mellan barn med CI/NH. Deskriptiv analys av intervjuerna visade positiva attityder till musik och att 77 % av barn med CI (100 % av barn med NH) tyckte om att lyssna på musik, och att flera barn hade favoritartister och favoritlåtar. Slutsats. Barn med CI hade mycket god förmåga att uppfatta tonhöjdsskillnader, men hade svårt att identifiera melodier. Resultatet bekräftar att melodiigenkänning är krävande för barn med CI. Trots de begränsningar som CI har beträffande musikåtergivning har barnen som grupp positiva attityder till musik. Det torde säga en del om den potential CI har i relation till musik, men ännu mer om den stora kapacitet som uppväxande barns hjärnor har.