PRE SURGERY REHABILITATION FOR

DEAF CHILDREN

SANDRO BURDO MD — ,

VARESE PIACENZA MILANO — , ,

http://www.audiovestibologia.it

Sandro Burdo 2016

NOT VERBAL COMMUNICATION Sign Language

NOT FULLY FLUENT LISTENING ++ Lip Reading + Hearing

FLUENT LISTENING ++ Hearing + Lip Reading

- AQUIRED LISTENER To be activated

- NATIVE LISTENER Always Active

LISTENING CLASSIFICATION ATTEMPT

PAST

TODAY

Sandro Burdo 2016

++ +

++ +

- ,

- ,

Sandro Burdo 2016

TODAY REHABILITATION TARGET OF

PRELINGUAL DEAF CHILD

NORMAL COMMUNICATION

and FULL MAINSTREAM —

RE-ESTABLISHING A NORMAL

HEARING AND NOT ONLY NORMAL

LISTENING SKILLS ,

THREE COMPONENTS —

•

– TECHNOLOGY

– ORAL REHABILITATION

– FAMILY ACTIVE INVOLVEMENT –

–

– Sandro Burdo 2016

PROGNOSIS —

• PATIENT — ц

HEARING MEMORY —

CNS PLASTICITY —

NO A.P.D. -

• MOTHER — М

ACTIVELY INVOLVED — • IMPLANT — И ц я BILATERAL vs UNILATERAL — -

ELECTRODE model —

STRATEGIES — MAPS —

• SURGERY - я • Residual hearing — • Lateral or perimodiolar —

• REHABILITATION — ц я • PRE SURGERY — • POST SURGERY —

Sandro Burdo 2016

KEY WORD: :

IDENTIFICATION

DIAGNOSIS

HEARING AID FITTING

SURGERY

MAISTREAMING

EARLY

А

Sandro Burdo 2016

WE NEED TIME —

Clinician — To confirm diagnosis —

Parents —

To understand the problem —

Child — To be prepared for the procedure -

but not too long ! я !

Sandro Burdo 2016

TODAY FOUR CONCEPTS

ARE WELL KNOWN

EARLY INTERVENTION IS REQUIRED IN ORDER TO TAKE

ADVANTAGE OF THE PHYSIOLOGIC PLASTICITY TO LEARN

ORAL LANGUAGE AND ACHIEVE COGNITIVE SKILLS

THE EFFECTS OF DEPRIVATION ARE WORSENED IN

CONGENITALLY DEAF CHILDREN BECAUSE OF THE LACK OF

FETAL HEARING

AN ORALISTIC APPROACH AND COCHLEAR IMPLANTATION

REPRESENT THE GOLD STANDARD IN THE TREATMENT OF

HEARING IMPAIRMENTS AND RELATED COGNITIVE ISSUES.

BUT SURGERY CANNOT PERFORMED AT BIRTH, SINCE IT IS

ONLY POSSIBLE AT 8/15 MONTHS OF AGE

Sandro Burdo 2016

,

,

-

,

, 8-15

Sandro Burdo 2016

WHAT TO DO BEFORE SURGERY

TWO STRATEGIES —

A) SURGERY ORIENTED —

B) REHABILITATION ORIENTED —

Sandro Burdo 2016

REHABILITATION STEPS

SHORT OR NOT STRUCTURED ONLY TO CONFIRM DIAGNOSIS

VARIABLE….ALSO TO GET THE CHILD READY FOR COMMUNICATION

C.I. ALSO TO ACTIVATE THE BASIC HEARING SKILLS

C.I. TO ALLOW A NORMAL EDUCATION

PRE-SURGERY POST-SURGERY

SURGERY

ORIENTED

REHAB

ORIENTED

Sandro Burdo 2016

, ,

,

,

,

.

.

Sandro Burdo 2016

PRESURGERY ACTIVITY

REHABILITATION ORIENTED —

Sandro Burdo 2016

TODAY REHABILITATION TARGET OF

PRELINGUAL DEAF CHILD

NORMAL COMMUNICATION

and FULL MAINSTREAM —

RE-ESTABLISHING A NORMAL

HEARING AND NOT ONLY NORMAL

LISTENING SKILLS ,

THREE COMPONENTS —

•

– TECHNOLOGY

– ORAL REHABILITATION

– FAMILY ACTIVE INVOLVEMENT –

–

– Sandro Burdo 2016

WE HAVE TO FILL THE LEARNING GAP BETWEEN DIAGNOSIS AND

SURGERY WITH REHAB ACTIVITIES ORIENTED TO ORAL

COMMUNICATION AND COGNITIVE MATURATION

,

Sandro Burdo 2016

PRESURGERY REHABILITATION

BRAIN IS THE TARGET OF REHAB, NOT THE

ъцR… OUR ьOцL IS TO TURN THъ LISTENING BRAIN ON

я я я б г б

Sandro Burdo 2016

HEARING PERCEPTION

MODEL

Ira Hirsch

1966

Norman Erber

1982 Dianne Meeklenburg

Richard Dowell

Virgine Denison

1991

Doreen Pollack

1970-85-97

1994 1995 1997

Sandro Burdo 2016

BABY AUDITORY PROCESSING

MODEL

Awareness -

Communicative attention —

Detection -

Discrimination -

Prosodic Phonetic —

Identification Recognition —

Comprehension —

pro

cessing

cascade

Sandro Burdo 2016

FINAL AUDITORY PROCESSING MODEL

Awareness — Communicative attention - Detection — Discrimination — Prosodic — Phonetic — Identification —

Recognition —

Comprehension —

pro

cessing

cascade

PREREQUISITES

SENSORIAL

PHASE

PRESEMANTIC

PHASE

SEMANTIC PHASE

Sandro Burdo 2016

TECHNOLOGY FOR PRESURGERY

REHABILITATION

VIBRATOR ON THE STERNUM

HEARING AIDS

Sandro Burdo 2016

STERNAL VIBRATOR: A TOOL TO BECOME PART OF THE

COMMUNICATIVE ENVIRONMENT :

IT HELPS ACTIVATING THE PRE-

HEARING SKILLS —

AWARENESS -

VISUAL ATTENTION —

IT HELPS ACHIEVING SOUND

DETECTION, TOGETHER WITH

HEARING AID — ,

IT GIVES THE CHILD SOME

PROSODIC CUES —

IN PROFOUND

DEAFNESS

HA ARE NOT

ENOUGH А я

( )

HORENTEK VIBRATOR

…ПШЫ ЫОЧЭ !!

Sandro Burdo 2016

STERNAL VIBRATOR IS ESSENTIAL

WHEN THE HA IS NOT ENOUGH —

, FREE FIELD —

no Hearing Aid

без СА

with Vibrator

к ы .

with Hearing Aid

СА

Sandro Burdo 2016

EXTERNAL HEARING AIDS

• ANALOGIC - А NOT ACOUSTICALLY UPDATED —

• PROGRAMMABLE — REALLY PUSH PULL / WIDE BAND -

• DIGITAL — EXPENSIVE HIGH LEVEL: SOPHISTICATED, BUT NOT REALLY PUSH PULL AND WIDE BAND — : ,

CHEAPER MEDIUM LEVEL: WITHOUT SOME SOPHISTICATED PROCESSING BUT PUSH PULL AND WIDE BAND — :

, ,

THEY CAN BE RENTED !!

А я !! Sandro Burdo 2016

WHY A PARTICULAR PUSH PULL

HEARING AID

WE ASK THE HEARING AID TO ENSURE

SOUND DETECTION

PERCEPTION OF THE PROSODIC CUES

A STRONG AMPLIFICATION

AT LOW FREQUENCIES IS NEEDED

Sandro Burdo 2016

STERNAL VIBRATOR AND LOW

FREQUENCIES AMPLIFICATION MEAN:

Total control of the environment: the child calm down

Prosodic mother-to-child communication can start, relying on low frequencies, as

it is in hearing babies during the first months of life

Listening attention is activated and formal training can be started, to reinforce

information transfer

:

, ,

….to acclimatize with surgical and mapping team

Sandro Burdo 2016

SETTING

TARGETS:

To switch on attention, ensuring a direct face-to-face

communication

On this way the lip reading can be effectively used

TOOLS:

Baby chair

High chair :

,

:

EVERY MORNING CHECK THE INSTRUMENTS FUNCTIONALITY

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BE CAREFUL — ! DON’T CONFUSE THE SETTING АITH THE CONTENTS BECAUSE THE CHILD

SHOULD PLAY WITH THE CONTENTS AND NOT WITH THE SETTING

. ,

NO

YES

Sandro Burdo 2016

SPEECH CODE AND

ENVIRONMENT

PROSODIC EMPHASIZED

COMMUNICATION (because the

babies understand through

feelings)

SOUND TOYS (to train some

gross discrimination)

( )

( )

Sandro Burdo 2016

WHAT TO COMMUNICATE

DESCRIBE YOUR ADMIRATION FOR THE CHILD WITH

HAPPINESS — ,

EXPLAIN ALL THE DAILY ACTIVITIES —

INTRODUCE FORMAL EXERCISES: -

Listening training -

Cognitive training -

Sandro Burdo 2016

HOW TO CHECK COMPREHENSION

,

THE CHILD ATTENTION AND

HIS FEELINGS ARE THE

KEY —

Sandro Burdo 2016

IMPORTANCE OF DIALOGUE —

BABBLING TAKING TURNS IN CONVERSATION —

, Sandro Burdo 2016

HOW TO EVALUATE:

TAIT VIDEO ANALYSIS :

• eye contact

• turn taking

• vocal autonomy

• gestural autonomy

• auditory awareness

Г

ящ

Г я я

Ж я я

Sandro Burdo 2016

HEARING PROCESSING AND PRESURGERY REHABILITATION FOR SEVERE TO

PROFOUND HEARING LOSS

Awareness — Communicative attention - Detection — Discrimination — Prosodic — Phonetic — Identification —

Recognition —

Comprehension —

pro

cessing

cascade

PREREQUISITES

SENSORIAL

PHASE

PRESEMANTIC

PHASE

SEMANTIC PHASE

Sandro Burdo 2016

2ND REHABILITATION STEP 2

When the child has achieved listening and cognitive basic

skills and when surgery risks are low, he is ready for

cochlear implantation

,

now the target is the hearing because the listening

brain is already achieved ,

Sandro Burdo 2016

SP

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AR

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аа

Sandro Burdo 2016

SP

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LIS

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Са

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IMP

LA

NT

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Sandro Burdo 2016

REHABILITATION WITH COCHLEAR IMPLANT

Awareness — Communicative attention - Detection — Discrimination — Prosodic — Phonetic — Identification —

Recognition —

Comprehension —

PREREQUISITES

SENSORIAL

PHASE

PRESEMANTIC

PHASE

SEMANTIC PHASE

Sandro Burdo 2016

PROGNOSIS —

• PATIENT — ц

HEARING MEMORY —

CNS PLASTICITY —

NO A.P.D. -

• MOTHER — М

ACTIVELY INVOLVED — • IMPLANT — И ц я BILATERAL vs UNILATERAL — -

ELECTRODE model —

STRATEGIES — MAPS —

• SURGERY - я • Residual hearing — • Lateral or perimodiolar —

• REHABILITATION — ц я • PRE SURGERY — • POST SURGERY —

Sandro Burdo 2016

WHAT TO DO BEFORE SURGERY

TWO STRATEGIES —

A) SURGERY ORIENTED —

B) REHABILITATION ORIENTED —

Sandro Burdo 2016

, ,

,

,

,

Sandro Burdo 2016