Adult Rehabilitation Post Cochlear Implantation: Why is it important?
People sometimes ask about the need for adult auditory rehabilitation after cochlear implantation. How can one teach hearing? Are there special speech and language therapists who work with adult CI users? Is adult rehab really necessary?
Such questions, together with a belief that modern cochlear implant technology is sufficiently robust to allow the auditory learning process to happen on its own, sometimes discourages adult CI recipients from seeking appropriate auditory rehabilitation after implantation.
There are people who acclimate to the sound provided by a cochlear implant relatively easily and some even note that their auditory learning proceeds rapidly and smoothly. Often they are individuals who had normal hearing for most of their lives and experienced relatively short periods of bilateral deafness. Such individuals may be well served with periodic mapping sessions and being able to direct questions to their audiologist with no additional rehab support.
Other people find that they need guidance in learning to understand the auditory signal provided by their newly activated cochlear implant. Some feel that their speech understanding is restricted to certain situations (e.g., people who speak clearly and at a slower pace, quiet one-on-one environments). Some people may understand speech, with time, in specific communication situations and using strategies, such as prior knowledge of a topic, content cues or context. However, when they are exposed to new words (for example, names of people) or to terms not used frequently, these strategies may not work for them and they may have difficulty perceiving speech sounds. Another group of CI recipients who may derive benefit from auditory rehabilitation are those who experience the new auditory signal as an almost meaningless blend of sounds. Some people even find that the new sounds disrupt their prior speechreading ability.
The support of an expert in the adult hearing rehabilitation process can help address all of these issues. We can also describe this process as guidance in finding meaningful footholds in the presence of an abundance of auditory data.
It is well accepted that people can improve their physical fitness with the help of an expert who takes into account one’s physical abilities and lifestyle and then customizes an exercise program appropriate for one’s age, fitness and agility. Similarly, an auditory therapist can suggest training activities appropriate for your hearing history, communication skills, and lifestyle. A therapist can help you with a hierarchical auditory training program that includes exercises that consider: (1) type of auditory task (e.g. detection, discrimination, understanding and auditory memory); (2)linguistic content (e.g., monosyllables, short/long words, sentences, every day spoken language versus more formal written language); and (3) presentation method of the auditory stimuli (with or without speech reading, rate of speech, recorded or live speech, telephone).
Adaptation to a cochlear implant is a dynamic process. While adapting to new hearing aids can take a few weeks or even months, hearing access after cochlear implantation changes dramatically immediately and during the first few months and continues to improve during the first few years after cochlear implantation. Therefore, the rehabilitation goals vary according to the individual’s hearing history and where (s)he is in the process. The rate of progress and rehabilitation goals differ between CI users due to various parameters including previous use of hearing aids, amount of residual hearing, non-implanted ear functional hearing, spoken language skills, daily use of spoken language, age, physical condition, additional disabilities, cognitive state, family support, and motivation.
Short term rehabilitation goals:
One of the first short term rehabilitation goals for CI user "A" might be establishing the ability to detect speech sounds while for CI user "B" a first rehabilitation goal might be discrimination between speech sounds. At a later stage of rehabilitation, one of the rehabilitation goals for CI user "A" might be recognition of two-syllable words (presented in a closed set of 3 to 4 words) and for CI user "B" the goal might be to understand short everyday sentences on a given topic (presented in a relatively slow speaking rate with repetition as needed).
At a more advanced stage, the goals for user "A" might include enlarging the sets of two-syllable words presented in recognition tasks, moving towards the ability to identify and understand words from a given category and recognition of short everyday sentences (presented in a closed set of 3-4 sentences). For user "B" the goals at a more advanced stage can include understanding short everyday sentences and expanding auditory memory skills (3-5 words presented in a closed set of 10 words). As you can see from these examples of two adult CI users, a customized rehabilitation based on an assessment of individual needs is essential.|
CI recipients can benefit significantly from an expert's help in adapting short-term rehabilitation goals to their current auditory abilities as well as in determining long-term rehabilitation goals. Working constructively towards appropriate goals will enable an adult recipient to identify and celebrate the steps of his or her progress. It will help the recipient to focus on their achievements rather than being frustrated by the hearing skills that they have not yet acquired.
There is also much to say about the emotional experience that is an integral part of almost every adult CI recipient's rehabilitation process and we will discuss this element in a separate posting. Your rehabilitation therapist can be a significant source of support for you and for your family. Ongoing communication with the speech and language therapist provides CI users with a reliable source of information about a range of topics.
From personal experience, I can say that I encountered many CI candidates who were not certain they would be able to attend weekly or bi-weekly rehabilitation sessions, mainly due to workplace commitments. After implantation they all made time in their busy schedules to attend the rehabilitation sessions, depending on their progress and needs. Weekly or bi-weekly sessions provide the speech language therapist with the ability to track process and offer a reliable basis for collaborative work with the audiologist. CI users who are more aware of their CI usage patterns and rehabilitation programs can promote their own needs in effective ways. Involving a professional in the long-term rehabilitation support following cochlear implantation will positively contribute to the process by making it easier and more enjoyable for the recipient and his or her family and by potentially resulting in better long term outcomes.
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