Cochlear Implant Programming for Infants and Toddlers

1. Cochlear Implant Programming for Infants and Toddlers Roxanne J. Aaron, MA, CCC-A, FAAA Board Certified in Audiology with a Specialty in Cochlear Implants February 2006 The Moog Center for Deaf Education St. Louis, Missouri

2. 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.

3. Goals for CI Programming • Audibility • Average speech inputs • Soft speech inputs • Comfort for all sounds • Facilitate acquisition of spoken language

4. Set-Up for Success • Audiologist must prepare in advance • Mentally • Physically

5. 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

6. Set-Up for Success • Physically • Assistant for programming • Seating • High chair • Parent’s lap • Table

7. Set-Up for Success • Physically • VRA equipment • Age-appropriate toys for different purposes • Waiting times • VRA distracters • CPA manipulatives

8. 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.

9. 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

10. 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.)

11. 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

12. 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

13. 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

14. 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

15. Verification • Speech Understanding • Speech Perception Testing • Ling thresholds • ESP • GASP • MLNT • LNT • Etc.

16. Verification • Progress in therapy • Regular contact with EI teacher/therapist • Team Tracking form

17. 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

18. 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

19. Questions?