PRE SURGERY REHABILITATION FOR DEAF CHILDREN ɉɊȿȾɈɉȿɊȺɐɂɈɇɇȺə ɊȿȺȻɂɅɂɌȺɐɂə ɋɅȺȻɈɋɅɕɒȺɓɂɏ ȾȿɌȿɃ SANDRO BURDO MD — ɋɚɧɞɪɨ Ȼɭɪɞɨ, ɞɨɤɬɨɪ ɦɟɞɢɰɢɧɫɤɢɯ ɧɚɭɤ VARESE PIACENZA MILANO — ȼɚɪɟɡɟ, ɉɶɹɱɟɧɰɚ, Ɇɢɥɚɧ http://www.audiovestibologia.it Sandro Burdo 2016
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
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
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
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
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
Sandro Burdo 2016
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 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
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