PORA July 2016

1. PRE SURGERY REHABILITATION FOR
DEAF CHILDREN
SANDRO BURDO MD — ,
VARESE PIACENZA MILANO — , ,
http://www.audiovestibologia.it
Sandro Burdo 2016

2. 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

3. 


 ++ +





 ++ +
- ,

- ,

Sandro Burdo 2016

4. 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

5. 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

6. KEY WORD:
:
 IDENTIFICATION
 DIAGNOSIS
 HEARING AID FITTING
 SURGERY
 MAISTREAMING





EARLY
А
Sandro Burdo 2016

7. 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

8. 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

9.  ,
,

-
 ,
 ,
8-15
Sandro Burdo 2016

10. WHAT TO DO BEFORE SURGERY
 TWO STRATEGIES —
 A) SURGERY ORIENTED
 —
 B) REHABILITATION ORIENTED —


Sandro Burdo 2016

11. 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

12.  ,
,
 ,
 ,
 ,
.
.
Sandro Burdo 2016

13. PRESURGERY ACTIVITY
REHABILITATION ORIENTED —
Sandro Burdo 2016

14. 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

15. WE HAVE TO FILL THE LEARNING GAP BETWEEN DIAGNOSIS AND
SURGERY WITH REHAB ACTIVITIES ORIENTED TO ORAL
COMMUNICATION AND COGNITIVE MATURATION
,
Sandro Burdo 2016

16. 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

17. 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

18. BABY AUDITORY PROCESSING
MODEL
Awareness -
Communicative attention —
Detection -
Discrimination -
Prosodic Phonetic —
Identification Recognition —
Comprehension —
processingcascade
Sandro Burdo 2016

19. FINAL AUDITORY PROCESSING MODEL
Awareness —Communicative attention -
Detection —Discrimination —Prosodic —Phonetic —Identification —
Recognition —
Comprehension —
processingcascade
PREREQUISITES
SENSORIAL
PHASE
PRESEMANTIC
PHASE
SEMANTIC PHASE
Sandro Burdo 2016

20. TECHNOLOGY FOR PRESURGERY
REHABILITATION
 VIBRATOR ON THE STERNUM
 HEARING AIDS



Sandro Burdo 2016

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. SPEECH CODE AND
ENVIRONMENT
 PROSODIC EMPHASIZED
COMMUNICATION (because the
babies understand through
feelings)
 SOUND TOYS (to train some
gross discrimination)

(
)
 (
)
Sandro Burdo 2016

29. 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

30. HOW TO CHECK COMPREHENSION
,
 THE CHILD ATTENTION AND
HIS FEELINGS ARE THE
KEY —
Sandro Burdo 2016

31. IMPORTANCE OF DIALOGUE —
BABBLING TAKING TURNS IN CONVERSATION —
,
Sandro Burdo 2016

32. 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

33. HEARING PROCESSING AND PRESURGERY REHABILITATION FOR SEVERE TO
PROFOUND HEARING LOSS
Awareness —Communicative attention -
Detection —Discrimination —Prosodic —Phonetic —Identification —
Recognition —
Comprehension —
processingcascade
PREREQUISITES
SENSORIAL
PHASE
PRESEMANTIC
PHASE
SEMANTIC PHASE
Sandro Burdo 2016

34. 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

35. SPEAKER
Гвя
LISTENER
Саеь
NOISE
Ш
HEARINGAID
Схвааа
Sandro Burdo 2016

36. SPEAKER
Гвя
LISTENER
Саеь
NOISE
Ш
IMPLANT
И
Sandro Burdo 2016

37. REHABILITATION WITH COCHLEAR IMPLANT
Awareness —Communicative attention -
Detection —Discrimination —Prosodic —Phonetic —Identification —
Recognition —
Comprehension —
PREREQUISITES
SENSORIAL
PHASE
PRESEMANTIC
PHASE
SEMANTIC PHASE
Sandro Burdo 2016

39. 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

40. WHAT TO DO BEFORE SURGERY
 TWO STRATEGIES —
 A) SURGERY ORIENTED
 —
 B) REHABILITATION ORIENTED —


Sandro Burdo 2016

41.  ,
,
 ,
 ,
 ,
Sandro Burdo 2016