Cochlear Implant Programming for Infants and Toddlers

Roxanne J. Aaron, MA, CCC-A, FAAABoard Certified in Audiology with a Specialty in Cochlear Implants

February 2006The Moog Center for Deaf Education

St. Louis, Missouri

Faculty Disclosure Information

In the past 12 months, I have not had a significant financial interest or other relationship with the manufacturers of the products or providers of the services that will be discussed in my presentation.

This presentation will not include discussions of pharmaceuticals or devices that have not been approved by the FDA.

Goals for CI Programming

Audibility Average speech inputs Soft speech inputs

Comfort for all sounds

Facilitate acquisition of spoken language

Set-Up for Success

Audiologist must prepare in advance

Mentally

Physically

Set-Up for Success

Mentally Decide how frequently to schedule

programming

Find out what works best for each child Review previous sessions Involve EI Service Providers

Create a plan of action for each session

Set-Up for Success

Physically

Assistant for programming

SeatingHigh chairParent’s lapTable

Set-Up for Success

Physically

VRA equipment

Age-appropriate toys for different purposes

Waiting times VRA distracters CPA manipulatives

Set-Up for Success

Physically Food/Stickers

Motivator Reward

Materials for counted T’s and loudness scaling activities

Chart, worksheets Careful notes during programming about what

techniques worked or did not work, how child responded to stimulation, etc.

Programming

Psychophysical/Behavioral Measures (Gold Standard) Thresholds for stimulation through CI

(T’s = minimum stimulus level patient perceives as very soft)

BOA VRA CPA Counted

Programming

Psychophysical/Behavioral Measures

Loudness Measures Scaling is the goal

M’s = comfortably loud, not too loud C’s = loud, but OK

BOA for loud vs. too loud Astute observation

Scaling readiness activities (big vs. little, good sound vs. bad sound, etc.)

Programming

Electrophysiologic tNRT/tNRI

Use levels for training a conditioned response Use cautiously to create MAP’s Use to assess responsiveness of child’s

system to each electrode and monitor for changes over time

ESRT Estimates C or M levels Below UCL Requires normal ME status and cooperation

Programming

Record Keeping Write it all down!

Assess different sets of electrodes at each session so that all electrodes are eventually assessed (includes behavioral and electrophysiological measures)

Continue to rotate electrode assessment until all electrodes can be tested in each session

Use records to track changes over time

Verification

Audibility with new program/MAP Informal assessment using Ling sounds,

words, and phrases at a distance Aided detection of soft sounds in booth

for each new MAP Target 20 to 30 dB HL detection of

warbled tones

Verification

Comfort Sweeps at C or M levels

BOA Loudness judgements (Big/Loud vs.

Stop/Too Loud) With live MAP test with variety of loud

sounds/noisemakers and carefully observe reactions

Make corrections as needed

Verification

Speech Understanding Speech Perception

Testing Ling thresholds ESP GASP MLNT LNT Etc.

Verification

Progress in therapy

Regular contact with EI teacher/therapist

Team Tracking form

Need a MAP Check?

Child may need additional programming if changes noted in the following: Hearing skills

No longer detects sounds Less attentive to sounds Confuses sounds already learned Requests repetition or clarification

Need a MAP Check?

Speech skills Decreased vocalizations Changes in pitch or loudness of voice Increased nasality Loss of intonation Changes in speech articulation

General behavior Slower response times Change in demeanor Trying to manipulate CI controls Withdrawn/less interactive

Questions?