Maximizing Cochlear Implant Outcomes with Short-Term Aural Rehabilitation

Abstract

Background Increasing numbers of adults are receiving cochlear implants (CIs) and many achieve high levels of speech perception and improved quality of life. However, a proportion of implant recipients still struggle due to limited speech recognition and/or greater communication demands in their daily lives. For these individuals a program of aural rehabilitation (AR) has the potential to improve outcomes. Purpose The study investigated the effects of a short-term AR intervention on speech recognition, functional communication, and psychosocial outcomes in post lingually deafened adult CI users. Research Design The experimental design was a multisite clinical study with participants randomized to either an AR treatment or active control group. Each group completed 6 weekly 90-minute individual treatment sessions. Assessments were completed pretreatment, 1 week and 2 months post-treatment. Study Sample Twenty-five post lingually deafened adult CI recipients participated. AR group: mean age 66.2 (48–80); nine females, four males; months postactivation 7.7 (3–16); mean years severe to profound deafness 18.4 (2–40). Active control group: mean age 62.8 (47–85); eight females, four males; months postactivation 7.0 (3–13); mean years severe to profound deafness 18.8 (1–55). Intervention The AR protocol consisted of auditory training (words, sentences, speech tracking), and psychosocial counseling (informational and communication strategies). Active control group participants engaged in cognitive stimulation activities (e.g., crosswords, sudoku, etc.). Data Collection and Analysis Repeated measures ANOVA or analysis of variance, MANOVA or multivariate analysis of variance, and planned contrasts were used to compare group performance on the following measures: CasperSent; Hearing Handicap Inventory; Nijmegen Cochlear Implant Questionnaire; Client Oriented Scale of Improvement; Glasgow Benefit Inventory. Results The AR group showed statistically significant improvements on speech recognition performance, psychosocial function, and communication goals with no significant improvement seen in the control group. The two groups were statistically equivalent on all outcome measures at preassessment. The robust improvements for the AR group were maintained at 2 months post-treatment. Conclusion Results of this clinical study provide evidence that a short-term AR intervention protocol can maximize outcomes for adult post lingually deafened CI users. The impact of this brief multidimensional AR intervention to extend CI benefit is compelling, and may serve as a template for best practices with adult CI users.

Teledelivery of Aural Rehabilitation to Improve Cochlear Implant Outcomes

“…Social HHI showed statistically significant improvement for the AR group at 1 week posttreatment [t(17) = 2.62, p = 0.018] with large effect size (1.18). This pattern of medium to large effect sizes for HHI results is consistent with those found in Bernstein, Brewer et al 27 COSI (Table III, Fig. 3)COSI means at pretest were not significantly different between groups (Cohen's d, Goal 1: 0.10, Goal 2: 0.10, Goal 3: 0.39).…”

“…Planned analyses of group differences were not significant at 1-week posttreatment or 2 months posttreatment, though small effect sizes were seen (0.28 and 0.36). The pattern of these results follows the trend seen in Bernstein, Brewer et al 27 which showed medium effect sizes for improvements in speech recognition.…”

Longitudinal Speech Recognition Changes After Cochlear Implant: Systematic Review and Meta‐analysis

“…Patients who demonstrate little improvement in speech recognition in the early post-operative period might require additional interventions such as speech-language pathologist-led auditory rehabilitation and computer-based auditory training activities, which have been demonstrated to improve speech recognition in the early post-implantation period. [56][57][58][59][60] Long-term evaluation of speech recognition is necessary for all patients as individual patient outcomes may demonstrate wide variation from group means. 61,62 Although speech recognition is considered to be the standard for measuring outcomes in CI users, word and sentence recognition measured in a controlled environment does not assess communication abilities in more complex environments and, therefore, does not reflect CI users' abilities in real-world listening situations.…”

“…For clinicians, these findings underscore the importance of regular use of the device and repeated evaluation in the early post‐operative period. Patients who demonstrate little improvement in speech recognition in the early post‐operative period might require additional interventions such as speech‐language pathologist‐led auditory rehabilitation and computer‐based auditory training activities, which have been demonstrated to improve speech recognition in the early post‐implantation period 56–60 . Long‐term evaluation of speech recognition is necessary for all patients as individual patient outcomes may demonstrate wide variation from group means 61,62 …”

Systematic Review of Auditory Training Outcomes in Adult Cochlear Implant Recipients and Meta-Analysis of Outcomes

“…The majority of studies (n = 13) were repeated measure studies, examining a single uncontrolled cohort [13,20,[28][29][30][31][32][33][34][35][36][37][38]. A total of seven studies were randomized controlled trials or crossover trials [39][40][41][42][43][44][45], and four studies were nonrandomized controlled trials or cohort studies [21,28,46,47].…”