This research describes the development of communicative intention of young children with cochlear implants in order to study the relationship between the early communicative intention of these children and their later verbal communication. Five children under the age of three years with cochlear implants were selected from the records of the University of Stellenbosch, Tygerberg Academic Hospital’s Cochlear Implant Unit, Cape Town as subjects. Video recordings of each of the five subjects in unstructured free play interaction with their caregivers, before cochlear implantation and each six months after cochlear implantation over a period of two years were used to identify the development of their communicative intention. The Communicative Intention Inventory (Coggins&Carpenter, 1981) was used to classify the communicative behaviour of the subjects according to the types of communication functions that were used, as well as the way in which they expressed the functions of communication. Results of the study show that the development course of the functions of communication that the subjects used over a two-year period, were consistent with the development patterns found in younger children with normal hearing. There was however marked individual differences between the subjects during the transition from nonverbal to dominantly verbal ways of communication as far as the rate of development of verbal communication was concerned. A strong relationship was found among the five subjects regarding the use of the nonverbal communication functions, request for object or action and protest before cochlear implantation and their total verbal communication two years after cochlear implantation, which could account for these individual differences in the rate of verbal communication development after cochlear implantation. Indications for clinical application and future research were identified on the basis of these conclusions. The data collected during the research is seen as meaningful in clinical decision-making regarding the suitability of young children under the age of three years with a profound hearing loss for cochlear implantation and their therapeutic management. / Dissertation (M (Communication Pathology))--University of Pretoria, 2006. / Speech-Language Pathology and Audiology / Unrestricted

Cochlear implantation is a proven and accepted option for young children with profound hearing loss. Cochlear implantation requires a professional team which should inform, guide, support and collaborate with parents constantly throughout the process. Existing programs for children with hearing loss and their families are generally designed on the basis of what experts believe they should contain, rather than on what parents actually wish to receive, which may often lead to a mismatch between the professionals view and the parents’ views of parental needs. In order to ensure that parental needs are appropriately addressed it is imperative that professionals investigate and understand the individual needs and desires of the parents with whom they collaborate. This can be managed by carefully tailoring information to their individual needs and presenting information in an accessible format at the time it is most appropriate and digestible. The aim of this research study was to develop a pre-implantation tool to rate the individual support and information needs of parents of young cochlear implant candidates. Within the context of applied research, a qualitative descriptive intervention research design was used in the study. Ten parents of children with cochlear implants participated in a semi-structured interview to investigate their need for information and support during the pre-implantation phase of cochlear implantation. Their responses were analysed and compared to relevant literature in order to develop the pre-implantation rating tool for parents of cochlear implant candidates. The rating tool consists of ten areas for information and support. These areas are as follows: general, technical, surgery, social support, financial, communication options, education, outcomes, rehabilitation and parental role. Parents are able to rate which areas of information and support is important to them and what they would like to discuss with the professional involved. Parents are also encouraged to identify any area of information and support that is not included in the rating tool that they would want information on from the cochlear implant team. This rating tool was evaluated by eight speech-language pathologist/audiologist working in six cochlear implant programmes in South Africa to determine the value of the rating tool. Positive responses were given about the adaptability of the tool to identify individual needs for support and information and the tool would be useful to guide speech-language pathologist/audiologists to identify needs of parents that should initially be addressed. Respondents agreed that the rating tool provides an opportunity to express parent’s individual needs for information and support; that the tool correlates with a family centered approach and would be useful to include in cochlear implant programs. The majority of participants felt the rating tool possibly will be effective in identifying information and support needs of parents before cochlear implantation and respondents would be willing to implement the rating tool in their cochlear implant programme. The positive response from professionals working in the field of cochlear implantation validates the effectiveness of the rating tool. AFRIKAANS : Kogleêre inplantering is ‘n beproefde en aanvaarde opsie vir jong kinders met ‘n uitermatige gehoorverlies. Kogleêre inplanting vereis dat ‘n professionele span ouers deur die proses inlig, lei en ondersteun. Huidige programme vir kinders met gehoorverlies en hulle gesinne, is oor die algemeen gebaseer op grond van inligting wat volgens kundiges belangrik is om in te sluit. Hierdie programme is nie noodwendig gebaseer op inligting ouers graag wil ontvang nie. Dit kan lei tot ‘n verskil tussen die perspektief van professionele persone teenoor die van die ouer oor ouer- behoeftes aan inligting. Om te verseker dat ouers se behoeftes effektief aangespreek word, is dit noodsaaklik om dit te ondersoek en die individuele behoeftes van ouers te verstaan. Dit kan gedoen word deur inligting aan te pas volgens die individuele behoeftes van ouers en die inligting te verskaf in ‘n toeganklike wyse op ‘n gepaste tyd wanneer dit geskik is en die ouer die inligting kan prosesseer. Die doel van hierdie navorsing studie was om ‘n pre-inplantering instrument te ontwikkel om die individuele behoeftes aan inligting en ondersteuning van ouers van jong kogleêre inplantings kandidate te bepaal. Binne die konteks van toegepaste navorsing is ‘n kwalitatiewe beskrywings intervensie navorsingsontwerp gebruik. Tien ouers van kinders met kogleêre inplantings het deelgeneem aan ‘n semi-gestruktureerde onderhoud. Die onderhoud het ouers se behoefte aan inligting en ondersteuning tydens die pre-inplanterings fase van kogleêre inplantasie ondersoek. Die resultate is geanaliseer en vergelyk met relevante literatuur om sodoende die pre-inplantering bepaling instrument vir ouers van kogleêre kandidate te ontwerp. Die instrument bestaan uit tien areas van inligting en ondersteuning. Hierdie areas is as volg: algemeen, tegnies, chirurgie, sosiale ondersteuning, finansieel, kommunikasie opsies, onderrig, rehabilitasie en ouer rol. Ouers kan bepaal watter areas van inligting en ondersteuning vir hulle belangrik is en wat hulle graag wil bespreek met die professionele persone betrokke by die kogleêre inplanting proses. Ouers word ook aangemoedig om enige area van inligting en ondersteuning te identifiseer wat moontlik nie ingesluit is in die instrument nie, maar wat hulle graag met die kogleêre span wil bespreek. Agt spraak-taal patoloë/oudioloë van ses kogleêre inplantings programme in Suid-Afrika het die instrument geëvalueer om die waarde daarvan te bepaal. Positiewe insette is gegee oor die aanpasbaarheid van die instrument om die individuele behoeftes vir inligting en ondersteuning te bepaal; dat die instrument betekenisvol is om die spraak-taal patoloog/oudioloog te lei om die behoeftes van ouers te identifiseer en aan te spreek; dat die instrument ooreenstem met ‘n familie- gesentreede benadering en dat die instrument effektief ingesluit kan word in kogleêre inplantings programme. Die meeste deelnemers het aangedui dat die instrument effektief sal wees in die identifisering van inligting en ondersteunings behoeftes van ouers voor ‘n kogleêre inplanting. Deelnemers het aangedui dat hulle bereid sal wees om die instrument te implementeer in hulle kogleêre inplantingsprogram. Die positiewe respons van spraak-taal patoloë en oudioloë dui op die geldigheid en effektiwiteit van die instrument. / Dissertation (MCommunication Pathology)--University of Pretoria, 2010. / Speech-Language Pathology and Audiology / unrestricted

Electrophysiological measures such as impedance telemetry and Neural Response Telemetry (NRT™) were developed by Cochlear™ in 1992 as clinical tools allowing the objective setting of stimulus levels for cochlear implant users. Extensive research proved the usefulness of NRT™’s as an aid in the programming process of audible and comfortable stimulus levels for children younger than six years. The Nucleus® Freedom™, launched in 2005, introduced new developments in cochlear implantation. Approval from the FDA for this system was obtained in March 2005 and for the first time included children from age 12 months with profound hearing loss. The Joint Committee on Infant Hearing suggested that children be diagnosed and that treatment commenced by the age of six months. The new features of the Nucleus Freedom™ give clinicians the necessary tools to treat this challenging population. An urgent need exists to ascertain the stability and accuracy of the new features introduced by this system, especially the Auto-NRT™ software, to validate its use within the paediatric population. A longitudinal descriptive design was utilized implementing quantitative research methods to critically describe the behaviour of impedance telemetry and NRT™’s in a group of young cochlear implant users. The quantitative method included the application of the Custom Sound™ software and the Auto-NRT™ feature for this group at implantation, device activation, and then at determined follow-up visits. Nine young children between nine months and five years and eleven months were used as participants during the twelve months of research. Impedance telemetry was described in terms of the mean Common Ground (CG) and Monopolar 1+2 (MP1+2) values calculated from measurement data collected on the basal, medial, and apical electrodes of the electrode array. The electrodes identified for statistical procedures for both measurement types were E3, E6, E8, E11, E13, E16, E19 and E21. Friedman’s ANOVA was used as a statistical measure to determine the level of significance in changes among the measurement modes and conditions. The Wilcoxon signed-rank test was indicated in the presence of significant changes identified by Friedman’s ANOVA to calculate the level of significance in a pair-wise comparison. Results indicate that impedance telemetry remained consistent over the electrode array and over time in both measurement modes. A slight increase in mean values was observed during the first three months, followed by a gradual decrease at the six months interval. These changes were statistically nonsignificant. No specific trends were evident in impedance telemetry over time. NRT™-measurements remained consistent across the electrode array over time. Significant changes were present between the intra-operative to device activation measurement intervals. This trend is also described in studies of adult cochlear implant users. NRT™-measurements were stable during the first year postimplantation within the paediatric population. A comparison between the mean impedance telemetry and NRT™’s disclosed an inverse trend during the first six months post-implantation. Most changes were non-significant, indicating that these measures can be used effectively in the new semi-automated fitting software. The implementation of these measurements can lead to streamlined and accountable service delivery to young cochlear implant users. AFRIKAANS : In 1992 is elektrofisiologiese metings soos impedanstelemetrie en Neurale Respons Telemetrie (NRT™) deur Cochlear™ ontwikkel as kliniese hulpmiddels om objektiewe instelling van stimulasievlakke vir kogleêre gebruikers moontlik te maak. Navorsing het bewys dat NRT™’s ‘n effektiewe hulpmiddel is tydens programmering van hoorbare en gemaklike stimulasievlakke by kinders jonger as ses jaar. Die Nucleus® Freedom™ met nuwe ontwikkelings ten opsigte van kogleêre inplantings is in 2005 bekendgestel. Die FDA het in Maart 2005 hierdie sisteem goedgekeur vir gebruik by kinders selfs so jonk as 12 maande met uitermatige gehoorverlies. Die Joint Committee on Infant Hearing het voorgestel dat diagnose en aanvang van rehabilitasie teen ses maande ouderdom moet plaasvind. Die nuwe funksies van die Nucleus® Freedom™ stel oudioloë in staat om hierdie uitdagende bevolking te hanteer. ‘n Dringende behoefte bestaan om te bepaal of hierdie sagteware, veral Auto-NRT™ wat saam met hierdie sisteem bekendgestel is, oor voldoende akkuraatheid en stabiliteit beskik om in die hantering van die pediatriese bevolking te gebruik. ‘n Longitudinale, beskrywende ontwerp, wat kwantitatiewe metodes implementeer, is aangewend om die beweging van impedanstelemetrie en NRT™’s by ‘n groep jong gebruikers van kogleêre inplantings krities te beskryf. Dit het die gebruik van die Custom Sound™ sagteware en die ingeslote Auto- NRT™ funksie behels. Dit is tydens inplantering, by aktivering van die toestel, en bepaalde opvolgsessies uitgevoer. Nege jong kinders tussen die ouderdomme van nege maande en vyf jaar en 11 maande is tydens die 12 maande navorsingsperiode as proefpersone benut. Die impedansmetings is beskryf in terme van die Common Ground (CG) en Monopolar 1+2 (MP1+2) stimulasiemodaliteite. Data is verkry vanaf geselekteerde elektrodes op die basale, mediale en apikale gedeeltes van die elektrode. Vir statistiese ontledings van impedans en NRT™ is hierdie elektrodes geselekteer: E3, E6, E8, E11, E13 E16, E19 en E21. As statistiese ontledingsmetode, is Friedman se ANOVA toegepas om die vlakke van beduidenheid van beweging tussen die verskillende toetsmodaliteite en -omstandighede te bepaal. Die Wilcoxon signed-rank toets is aangedui in die teenwoordigheid van statisties beduidende veranderinge. Die doel van hierdie toets was om die vlak van beduidenheid paarsgewys te verifieer. Resultate dui op konstante impedansmetings oor die elektrode asook oor tyd in beide toetsmodaliteite. ‘n Geringe, statisties nie-beduidende, verhoging in gemiddelde waardes is waargeneem tydens die eerste drie maande na inplantering, waarna die waardes weer geleidelik afgeneem het tot en met die ses maande opvolginterval. Geen spesifieke neiging kon vir impedanstelemetrie bepaal word nie. NRT™-metings het konstant gebly oor die elektrode en met tyd. Statisties beduidende veranderinge is gemeet tussen die intra-operatiewe en aktiveringsintervalle. Hierdie neiging is ook beskryf in studies van volwasse gebruikers van kogleêre inplantings. NRT™-metings, binne die pediatriese populasie, het dus stabiel gebly oor die 12 maande periode post-inplantering. ‘n Vergelyking tussen die gemiddelde impedans- en NRT™-metings het ‘n inverse neiging geïdentifiseer gedurende die eerste ses maande na inplantering. Veranderinge was oor die algemeen statisties nie-beduidend, wat daarop dui dat hierdie metings effektief gebruik kan word. Die implementering van hierdie metings kan meer doeltreffende dienslewering aan die jong gebruikers van kogleêre inplantings tot gevolg hê. / Dissertation (MCommunication Pathology)--University of Pretoria, 2010. / Speech-Language Pathology and Audiology / unrestricted

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