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S1 Development of rehabilitation concepts
Auditory sentence processing in adult cochlear implant users
Hoffmann V. , Willmes K. , Coninx F.
MED-EL Germany GmbH, Starnberg, Germany, 2University Hospital of the RWTH, Section Neuropsychology, Department of Neurology,
Aachen, Germany, 3Early Intervention Center, Solingen, Germany
With increasing confidence in effectiveness and reliability in recent years, the cochlear implant (CI) has been
proven an indication for severe and profound hearing loss and has brought considerable gains to many implant
recipients. But hearing with a CI cannot be equated with typical hearing, and those differences affect sustained
auditory language comprehension (Hahne et al., 2012). Furthermore, current research supports the claim that
auditory sentence comprehension in adult CI recipients is determined by processing semantic before syntactic
information (Hahne et al., 2012; Hahne & Friederici, 2001; Friederici, Hahne & Saddy, 2002). The present study
therefore examines, whether postlingually deaf or hearing-impaired patients focus more on semantic information
when interpreting linguistic utterances by incorporating contextual information, or whether they apply alternative
strategies. For this purpose listening training has been developed, which requires both the identification of
semantic and syntactic features in the set, and to match sonically fragmentary gap sentences. Furthermore, the
empirical study was carried out to contribute to the question of whether to strengthen compensatory strategies or
to focus on deficits to overcome hearing limitations. In a cross-over design, n=42 postlingually deafened CI users
participated in all three training programs for two weeks each with patients from 14 homogeneous triplets being
assigned at random to their first treatment, with a subsequent split into two groups of 7 participants each
receiving one sequence of the other two training procedures. The patients were between 20 and 76 years old
and had been fitted with cochlear implants unilaterally or bilaterally for at least 2 to a maximum of 9 months
before inclusion in the training study. To avoid influences on the results by potential confounding variables,
several parameters were considered as covariates with intrinsic and phasic attention as well as vocabulary
performance finally serving as control variables. Changes in linguistic performance in audiometric tests were
assessed within each group before and after each training regimen and to a control group, which received no
specific training in addition to their standard treatment. Results showed that problems with sentence
comprehension mainly concerned extracting of morpho-syntactic information. Patients mostly profited from
auditory sentence training, which also supports application of top-down driven comprehension and inference
processes. In summary, all patients benefited from the sequence of auditory training procedures, but particularly
positive changes in performance were found for the semantically oriented training for auditory speech
understanding in quiet and in noise.