1. Cochlear Implant Programming for Infants and Toddlers Roxanne J. Aaron, MA, CCC-A, FAAA Board Certified in Audiology with a Specialty in Cochlear Implants February 2006 The Moog Center for Deaf Education St. Louis, Missouri

2. Faculty Disclosure Information In the past 12 months, I have not had a significant financial interest or other relationship with the manufacturers of the products or providers of the services that will be discussed in my presentation. This presentation will not include discussions of pharmaceuticals or devices that have not been approved by the FDA.

3. Goals for CI Programming Audibility Average speech inputs Soft speech inputs Comfort for all sounds Facilitate acquisition of spoken language

4. Set-Up for Success Audiologist must prepare in advance Mentally Physically

5. Set-Up for Success Mentally Decide how frequently to schedule programming Find out what works best for each child Review previous sessions Involve EI Service Providers Create a plan of action for each session

6. Set-Up for Success Physically Assistant for programming Seating High chair Parents lap Table

7. Set-Up for Success Physically VRA equipment Age-appropriate toys for different purposes Waiting times VRA distracters CPA manipulatives

8. Set-Up for Success Physically Food/Stickers Motivator Reward Materials for counted Ts and loudness scaling activities Chart, worksheets Careful notes during programming about what techniques worked or did not work, how child responded to stimulation, etc.

9. Programming Psychophysical/Behavioral Measures (Gold Standard) Thresholds for stimulation through CI (Ts = minimum stimulus level patient perceives as very soft) BOA VRA CPA Counted

10. Programming Psychophysical/Behavioral Measures Loudness Measures Scaling is the goal Ms = comfortably loud, not too loud Cs = loud, but OK BOA for loud vs. too loud Astute observation Scaling readiness activities (big vs. little, good sound vs. bad sound, etc.)

11. Programming Electrophysiologic tNRT/tNRI Use levels for training a conditioned response Use cautiously to create MAPs Use to assess responsiveness of childs system to each electrode and monitor for changes over time ESRT Estimates C or M levels Below UCL Requires normal ME status and cooperation

12. Programming Record Keeping Write it all down! Assess different sets of electrodes at each session so that all electrodes are eventually assessed (includes behavioral and electrophysiological measures) Continue to rotate electrode assessment until all electrodes can be tested in each session Use records to track changes over time

13. Verification Audibility with new program/MAP Informal assessment using Ling sounds, words, and phrases at a distance Aided detection of soft sounds in booth for each new MAP Target 20 to 30 dB HL detection of warbled tones

14. Verification Comfort Sweeps at C or M levels BOA Loudness judgements (Big/Loud vs. Stop/Too Loud) With live MAP test with variety of loud sounds/noisemakers and carefully observe reactions Make corrections as needed

15. Verification Speech Understanding Speech Perception Testing Ling thresholds ESP GASP MLNT LNT Etc.

16. Verification Progress in therapy Regular contact with EI teacher/therapist Team Tracking form

17. Need a MAP Check? Child may need additional programming if changes noted in the following: Hearing skills No longer detects sounds Less attentive to sounds Confuses sounds already learned Requests repetition or clarification

18. Need a MAP Check? Speech skills Decreased vocalizations Changes in pitch or loudness of voice Increased nasality Loss of intonation Changes in speech articulation General behavior Slower response times Change in demeanor Trying to manipulate CI controls Withdrawn/less interactive

19. Questions?