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