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
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.
Goals for CI Programming

Audibility




Average speech inputs
Soft speech inputs
Comfort for all sounds
Facilitate acquisition of spoken
language
Set-Up for Success

Audiologist must
prepare in
advance

Mentally

Physically
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
Set-Up for Success

Physically


Assistant for programming
Seating
 High chair
 Parent’s lap
 Table
Set-Up for Success

Physically


VRA equipment
Age-appropriate toys for different
purposes
 Waiting times
 VRA distracters
 CPA manipulatives
Set-Up for Success

Physically



Food/Stickers
 Motivator
 Reward
Materials for counted T’s and loudness scaling
activities
Chart, worksheets
 Careful notes during programming about what
techniques worked or did not work, how child
responded to stimulation, etc.
Programming

Psychophysical/Behavioral Measures
(Gold Standard)

Thresholds for stimulation through CI
(T’s = minimum stimulus level patient perceives as
very soft)
BOA
 VRA
 CPA
 Counted

Programming

Psychophysical/Behavioral
Measures

Loudness Measures

Scaling is the goal



BOA for loud vs. too loud


M’s = comfortably loud, not too loud
C’s = loud, but OK
Astute observation
Scaling readiness activities (big vs. little,
good sound vs. bad sound, etc.)
Programming

Electrophysiologic


tNRT/tNRI
 Use levels for training a conditioned response
 Use cautiously to create MAP’s
 Use to assess responsiveness of child’s system
to each electrode and monitor for changes
over time
ESRT
 Estimates C or M levels
 Below UCL
 Requires normal ME status and cooperation
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

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
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
Verification

Speech
Understanding

Speech Perception
Testing
 Ling thresholds
 ESP
 GASP
 MLNT
 LNT
 Etc.
Verification

Progress in
therapy


Regular contact
with EI
teacher/therapist
Team Tracking
form
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

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
Questions?