differences in the sensitive phase of the maturation of the auditory and visual pathways-eng 2008-06
TRANSCRIPT
Differences in the sensitive phase of the maturation of the
auditory and visual pathwaysDr. Dr. hc. Monika Lehnhardt
Cernobbio, June 2008
„Direct stimulation of the auditory nerves with resultant speech perception is not feasible
M. Lawrence, 1964
“It is a crime to provide deaf children with a cochlear implant”
German physiologist R. Klinke, 1988
From: “Strabismus und Motilität” Zur Entstehung der Amblyopie. Experimentelle Untersuchungen, G.K. v. Noorden Ber. Dtsch. Ophthalmol. Ges. 77, 815 – 828 (1980), P. 821, Abb. 4a
Vision for a technology that would enable the deaf to hear
Research supported by public donation, commenced 1967
First cochlear implant, 1978, Melbourne Hospital
“In spite of the problems and criticisms, I just had to go on. A cochlear implant was their only hope of ever hearing.” Professor Graeme Clark
History of the Cochlear Implant
Archives of Otolaryngology – Head & Neck Surgery, May 2004
050
100150200250300350400450
0 5 10 15 20 25 30
Age
P1
late
ncy,
ms
Normal limits
14 month old recipient
0
50
100
150
200
250
300
350
0 12 24 36
Age
P1
late
ncy,
ms
Normal limits
13 month old recipient
At CI activation
1 week post CI
1 month post CI
3 months post CI
12 months post CI
Sharma et al, 2004
response to speech sounds
discrimination of speech sounds
use of telephone
Children with normal hearing
Categories of Auditory Performanceref: P Govaerts, C De Beukelaer et al., Neurotology and Audiology 2002 (Antwerp)
Govaerts, et al. 2002
Otology & Neurology, vol 23; 2002
Age at Mainstream Integration
0
20
40
60
80
100
0 3 5 7
Age (in years)
Per
cent
age
of c
hild
ren
Under 2 yrs2 to 4 yrs
Age at implantation
Manuel Manrique, et al (2004)
Laryngoscope, August 2004
Reynell
01234567
0 1 2 3 4 5 6 7
Chronological age (years)
"Rey
nell"
age
(yea
rs)
< 2 yrs
2 to 6 yrs
Average Language Development
0
12
24
36
48
60
72
84
0 12 24 36 48 60 70 84
AGE (months)
Expr
essi
ve L
angu
age
Age
(m
onth
s) 12-24 months25-36 months37-48 months
Svirsky, et al (2004)
Audiology and Neuro-Otology, vol. 9, 2004
Lone Percy-SmithE. Danish CI centre, Gentofte Hospital University of
Copenhagen. October 2007
Factors associated with Speech/Language Outcomes and Social Well-being
for Children with Cochlear Implant in Denmark
N=168. 91 girls. 77 boys.Age 1-18yrs. Mean age if CI = 4 years50 spoken language 85 support sign 30 sign
Lone Percy-Smith continued
Summary – Speech and Language Datatests scored for HA, not CA.• Strong statistical effect of communication mode
at home• Clear improvement of sp./lang. dev. for children
exposed to spoken Danish only• Parent assessments and test responses are highly
positively associated. (auditory capacity and speech intelligibility)
Lone Percy-Smith conclusions
• 64% of CI children had high level of social wellbeing• 36% of CI children with low level - 57% operation age >36 mon - 68% in schools or kindergarten for deaf - 85% use sign support or sign language
Level of social well being significantly associated with communication mode.
Early implantation
Waltzman S & Roland T. 2005 Pediatrics‘Cochlear Implantation in Children Younger than 12 Months’ James A. & Papsin J. 2004 The Laryngoscope‘Cochlear Implant Surgery at 12 Months of Age or Younger’. Colletti V. et al. 2005 The Laryngoscope‘Cochlear Implantation at under 12 Months: Report on 10 Patients.’
Vision
In 20 years, an implant will be the treatment of choice for
anyone with a hearing lossgreater than 50 dB
Dr Jay Rubenstein , March 2004