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Biomedical subjects

S Archbold

Publications and source records attributed to S Archbold.

12 recordsLinked to original sources
PubMed2001

Pediatric cochlear implantation: the parents' perspective.

OBJECTIVE: To analyze parental views on cochlear implantation, before and in the years following implantation, to determine whether the results from the intervention met their expectations. DESIGN: Prospective longitudinal study to assess parental perspectives of an unselected group of children with cochlear implantation. SETTING: Tertiary referral pediatric cochlear implant center in the United Kingdom. SUBJECTS: Forty-three parents of children with cochlear implantation. INTERVENTION: A specifically designed questionnaire was administered to assess preimplant expectations and observed changes and concerns at 1, 2, and 3 years following implantation. Three key domains were evaluated: (1) communication with others, (2) listening to speech without lipreading, and (3) the development of speech and language. RESULTS: Preoperative expectations were met or surpassed at each of the follow-up intervals. In the area of communication, 35 (81%) parents expected a definite improvement preoperatively, and 3 years following implantation, 42 (98%) actually saw such an improvement. The respective numbers in the area of listening to speech were 15 (35%) and 38 (88%), and for speech development, 37 (86%) and 37 (86%). Speech development was the major area of concern at all intervals. CONCLUSION: This study demonstrates the ability of cochlear implantation to meet or surpass parental expectations in 3 important outcome domains: communication, listening to speech, and the development of speech and language.

Child↗
PubMed2001

Functionally equivalent ages and hearing levels of children with cochlear implants measured with pre-recorded stimuli.

Three groups of children undertook an interactive computer-based closed-set test of the ability to identify pre-recorded spoken words presented acoustically. The test was completed by 31/39 children with profound hearing loss who had used the Nucleus Spectra-22 cochlear-implant system for at least one year (Group A); by 30 children with normal hearing (Group B); and by 22 children with severe-profound hearing loss who used acoustic hearing aids (Group C). Among the implanted children, those who were younger when implanted and who had used their devices for longer produced higher scores (multiple-r = 0.68). Logistic regression functions were fitted to the data from Group B to describe the relationship between performance and age, and to the data from Group C to describe the relationships between performance and average hearing level (AHL) and aided threshold. By use of the regression equations, the performance of each implanted child was converted into a functionally equivalent (FE) age, an FE AHL and an FE aided threshold. Despite high variability leading to wide confidence intervals, these transformations showed that: (1) mean FE age (3.4 years) lagged mean chronological age (7.4 years), but some implanted children performed within the range expected for children with normal hearing of the same age; (2) mean FE AHL was 94 dB compared with a mean pre-implant AHL of 117 dB; (3) mean FE aided threshold was 45 dB(A) compared with a mean pre-implant aided threshold of 99 dB(A). These results confirm that implantation of appropriate candidates leads to functionally better hearing than would be expected with acoustic hearing aids. The results also demonstrate that many implanted children can participate in interactive tests with pre-recorded speech, thus providing robust data for comparison with future performance.

Adult↗
PubMed2001

Use of the telephone in prelingually deaf children with a multichannel cochlear implant.

OBJECTIVE: To assess progress in the use of the telephone in a group of prelingually deaf children after cochlear implantation. SETTING: Tertiary referral pediatric cochlear implant center in the U. K. STUDY DESIGN: A prospective study was undertaken on a consecutive group of 150 congenital and prelingually deaf children up to 5 years after implantation. The study group was confined to prelingually deaf children aged less than 7 years at the time of implantation. No child was lost to follow-up, and there were no exclusions from the study. At the time of the study, 129 children had reached the 1-year stage, and 91, 68, 40, and 23 had reached the 2-, 3-, 4-, and 5-year intervals, respectively. METHODS: A specifically designed profile was used to assess the telephone use of the implanted children. Regression analysis was used to assess the correlation between the results of the telephone profile with the outcomes of the Iowa sentence test and connected discourse tracking. RESULTS: After implantation, prelingually deaf children showed significant progress in telephone use over time, not reaching a plateau at the 5-year interval (median score 27 with maximum score available 34). The results of the telephone profile showed significant correlations with the other tests of speech perception (correlation coefficients from 0.47 to 0.79, all statistically significant p < 0.0001). CONCLUSION: The telephone profile provided a useful method of monitoring children's telephone use. The profile was easily administered, and it was sensitive in assessing the progress of prelingually deaf children with cochlear implants. Outcomes from the profile were highly correlated with results from other widely used closed- and open-set tests.

Child↗
PubMed1999

Age at implantation: its importance in pediatric cochlear implantation.

OBJECTIVE: To assess the influence of age at implantation on speech perception and speech intelligibility following pediatric cochlear implantation. STUDY DESIGN: A prospective study was undertaken on a consecutive group of 126 congenital and prelingually deaf children up to 4 years after implantation. The study group was confined to prelingually deaf children less than 7 years of age at the time of implantation. All had implantation with the same multichannel cochlear implant system. No child was lost to follow-up, and there were no exclusions from the study. METHODS: The Iowa Matrix Closed Set Sentence test, connected discourse tracking, categories of auditory performance, and speech intelligibility rating were used to assess the speech perception (closed and open set) and speech intelligibility of the children with implants. Regression analysis and Spearman rank correlation coefficients were used to assess the correlation between the outcome measures with age at implantation. The setting was a tertiary referral pediatric cochlear implant center in the United Kingdom. RESULTS: Age at implantation positively correlated with preimplantation assessment performance and with most of the outcome measures up to 24 months following implantation. However, at the 3-and 4-year intervals following implantation, age at implantation was found to be a strong negative predictor of all the outcomes studied (correlation coefficients ranging from -0.44 to -0.58, all statistically significant [P<.05]). CONCLUSIONS: The results of the present study provide strong evidence that prelingually deaf children should receive implants as early as possible to facilitate the later development of speech perception skills and speech intelligibility and thus maximize the health gain from the intervention. However, because of the wide variation in individual outcomes, age alone should not be used as a criterion to decide implant candidacy.

Age Factors↗
PubMed1998

Categories of auditory performance: inter-user reliability.

Categories of Auditory Performance (CAP) describes a scale used to rate outcomes from paediatric cochlear implantation in everyday life. It differs from more technical measures by being readily applied and easily understood by non-specialist professionals and by parents. Being based on subjective assessments, there is a need to establish whether ratings by different persons are comparable. Therefore, an analysis of inter-user reliability was undertaken using ratings from 23 children followed up at various intervals after implantation. Analysis relating scores by local teachers of the deaf and the teachers of the deaf at the implant centre revealed very high inter-user reliability (correlation coefficient 0.97). This result establishes the reliability of CAP as an outcome measure for use in cochlear implant programmes.

Child, Preschool↗
PubMed1998

Educational placement of deaf children following cochlear implantation.

This study examined the educational placements, before cochlear implantation, of 121 deaf children, and the educational placements, two years after implantation, of the 48 children who had reached that stage, looking at the influence of age at implantation and duration of deafness on the placement of these children. In addition, it compared the educational placements of those given implants prior to schooling, and those given implants when already in an educational setting. Categories used were pre-school, school for the deaf, unit or resource base within a mainstream school and full-time mainstream provision. Age at implantation and duration of deafness were found to be significant predictors of placement two years after implantation. The duration of deafness of children in schools for the deaf or units was twice that of children in mainstream education. Fifty-three per cent of children who were in pre-school at the time of implantation were in mainstream schools two years after implantation, whereas only 6% of those who were already in educational placements at the time of implantation were in mainstream education. This difference was statistically significant. The results indicate that children who are given implants early, before an educational decision has been made, are more likely to go to mainstream schools than those given implants when already in an educational setting.

Adolescent↗
PubMed1998

Cochlear implants in children: an analysis of use over a three-year period.

OBJECTIVE: This study aimed to determine whether children continue to wear their cochlear implant systems 1 and 3 years after implantation. STUDY DESIGN: The design was a prospective study based on the analysis of forced-choice questionnaires on implant use completed independently by parents and teachers. SETTING: The study was performed at a dedicated pediatric cochlear implant program in a tertiary referral center in the United Kingdom. PATIENTS: All 85 consecutively implanted children who had reached the 1-year interval after implantation and 37 children who had reached the 3-year assessment interval after implantation participated. The patients represented all socioeconomic status groups, the entire range of educational settings, and often lived at a considerable distance from the implant center. MAIN OUTCOME MEASURES: Parents and local teachers were asked to describe implant use in the following categories: 1) all of the time; 2) most of the time; 3) some of the time; and 4) none of the time. RESULTS: One year after implantation, parents and teachers, respectively, rated 79 (93%) and 82 (96%) children as full-time users (category 1). Parents rated six children (7%) as users most of the time (category 2), and teachers rated three children (4%) as users most of the time. No child was rated as an occasional or nonuser (category 3 or 4). At 3 years after implantation, 33 (89%) and 34 (95%) children were rated as full-time users (category 1) by parents and teachers, respectively. Parents judged four children (11%) and teachers rated two children (5%) to be users most of the time (category 2). Again, no child was rated in category 3 or 4 as an occasional or nonuser. CONCLUSIONS: The majority of implanted children use their implant systems all of the time over a 3-year period after implantation when selected appropriately and given appropriate follow-up.

Child↗
PubMed1997

A European perspective on pediatric cochlear implantation, rehabilitation services, and their educational implications.

OBJECTIVE: To assess the educational implications of pediatric cochlear implantation from the perspective of the implant team. METHODS: Coordinators of pediatric cochlear implant teams throughout Europe took part in a survey using forced-choice questions. Fifty-four centers were originally sent the questionnaire; 41 centers replied. RESULTS: Of 504 children planned to receive cochlear implants in Europe during 1996, 54% (273/504) were aged 2-5 years and 12% (60/504) aged 0-2 years, indicating a trend toward pediatric implantation in younger children. There is a strong commitment to rehabilitation in the teams; 66% (27/41) employ a teacher of the deaf, the ratio of medical/audiological to rehabilitation personnel is 1:2, and 76% (31/41) of the implant teams visit local educators. Of all the children receiving implants to the date of this report, 23% were considered to be in unfavorable educational environments; these were environments where children were taught with an emphasis on sign language and little expectation from audition, and mainstream provision without support from experienced teachers of the deaf. CONCLUSION: There is a high staff input to children with cochlear implants from implant rehabilitation personnel over and above the input received in the educational environment. Hence, it is important for the school and the implant team to mutually agree on their shared responsibilities. Moreover, as the provision of service is variable and inconsistent, the development of guidelines for practice in each country should ensure consistency of rehabilitative and educational support to children with cochlear implants.

Adolescent↗
PubMed1997

Electrode and device problems: manifestation and management.

A total of 119 children were implanted with the Nucleus 22 implant on the Nottingham program by March 1996. Twenty-five (i.e. 21%) of these had an electrophysiologically confirmed fault on at least 1 channel and 6 (i.e. 5%) had experienced total device failure. How these problems were first manifested and what the subsequent effects were on the child and family were determined by means of questionnaires and detailed examination of clinical notes. Our findings indicated that 76% of all internal device faults were initially detected in tuning or electrophysiological measurement. All parents expressed deep anxiety about the threat of device failure; cases of total failure occurring over a long period of time resulted in the greatest distress and effect on the family. Recommendations are made for companies to assist clinics in minimizing such effects.

Anxiety↗
PubMed1997

Cost-effectiveness considerations in pediatric cochlear implantation.

OBJECTIVE: To summarizes the results of cost-utility analyses of pediatric cochlear implantation (CI) in the United Kingdom. METHOD: Analysis is based on the direct costs of medical and rehabilitative management and also on emerging evidence that implantation leads to a shift in educational placements in favor of mainstreaming with support. RESULT: The resulting cost-utility ratio falls on the margin of the range considered acceptable within the British health-care system. The analysis also suggests that pediatric CI could be acceptably cost-effective. CONCLUSION: The next step should be to measure the costs of alternative educational settings directly.

Adult↗
PubMed1995

Categories of Auditory Performance.

Categories of Auditory Performance (CAP) is an index consisting of eight performance categories arranged in order of increasing difficulty. It has been used to categorize 53 children who had been deafened below the age of 3. The children were assessed by means of the CAP before implantation, and over the following 3 years. Before implantation, only 2 of the children showed awareness of environmental sounds; immediately after initial tuning, all children showed awareness of environmental sounds, and 50% showed awareness of speech sounds. Their auditory receptive abilities gradually developed over the 3-year period, and by the 3-year assessment interval, 80% were understanding phrases without lipreading, and 40% were understanding conversation. Using these data, we predict that 90% of such children will understand conversation without lipreading 5 years after initial tuning.

Auditory Perception↗