In noise, two tests were used: One using a signal-to-noise ratio of +10 dB and one using the standard adaptive HINT procedure. The Hearing In Noise Test (HINT) was used for evaluating speech understanding of sentences and words in sentences in quiet and in noise. Three workshops including supervision with AVT therapists were conducted before and during the intervention to maximise the use of AVT-inspired activities and Auditory Verbal strategies and techniques.ĭantale I was used for evaluating speech understanding of phonemes in monosyllabic words in quiet and in noise with a signal-to-noise ratio of 0 dB. The AVST intervention was performed by three speech, language and hearing pathologists with a master’s degree in speech, language and hearing therapy (hereafter hearing pathologist). The intervention consisted of ten sessions at the CI Centre and included both analytic and synthetic training. The auditory verbal techniques and strategies used were highlighting, auditory closure, auditory sandwich, auditory before visual and waiting. Home training was agreed upon from session to session. The activities were practiced in the clinic with the CI users and their relatives, hereby supporting “carry-over” to the home setting. The activities were designed to match the CI user’s interests and auditory performance to enhance motivation. The short-term goals focused on the activities that developed the auditory and communicative skills needed to reach a specific long-term goal. The long-term goals typically focused on participation in specific activities (e.g., being able to talk with the grandchildren seated in the back seat of the car while driving, or being able to follow the meditation instructor’s guidance with soft music playing in the background). Long- and short-term goals for each CI user were defined. The intervention consisted of goal-based and individualised activities, involvement of relatives and the use of auditory verbal strategies and techniques. The AVST rehabilitation programme for adults was developed at the East Danish CI-Centre. Description of the applied intervention and tests At the CI Centre, the intervention group followed the AVST rehabilitation programme and the control group followed the standard follow-up sessions. Ten patients were placed in the intervention group and seven in the control group. The patients were allocated to either the intervention group or the control group in accordance with their wish to participate in AVST intervention with a relative. The 17 patients were informed about the study and gave informed consent. Fifty-two patients were seen in the clinic during the inclusion period 35 were excluded and 17 were included. The exclusion criteria were patients getting their second CI sequentially after their first CI (n = 10), timing issues due to project timelines (n = 14), patients receiving a CI because of single-sided deafness (n = 2) or other reasons such as the patient not wanting the treatment or not being suitable for CI treatment after candidacy evaluation (n = 9). The inclusion criteria were that the participants should be first-time CI users capable of completing the test battery without help from others. The CI users were recruited at the East Danish CI Centre from March to July 2017. METHODS Study design and inclusion of participantsĪ prospective comparative study design was used including 17 adult CI users. Additional specific objectives were to apply and explore the effects of the AVST intervention, and to investigate the patients’ need for technical follow-up and CI fine-tuning. The overall objective was to investigate the CI outcome for first-time adult CI users. This approach is recommended by both the Danish Health Authority and Danish Social Services. We chose to adapt the approach from the broad clinical experience of paediatric habilitation the auditory verbal therapy (AVT). In this study, an auditory verbal skills training (AVST) rehabilitation programme for adults was developed at the East Danish CI Centre. No national or best practice guidelines exist for cochlear implant (CI) rehabilitation activities or auditory training in Denmark. The outcome after cochlear implantation in adults varies and research shows that several factors affect the outcome, including age at onset of the hearing impairment (HI), duration and degree of auditory deprivation, cortical reorganisation, preoperative speech understanding, preoperative residual hearing, aetiology of the HI, duration of the HI, age at implantation and auditory rehabilitation or training.
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