Takîng Control..

Guess I'm not done with this blog after all..

Time flies, and Lotte is almost going to the next phase of the Norwegian Schooling system. after 7 years "Barneskole" (primary school) she will graduate to "ungdomsskole" (lower secondary school) where for the next three years she will work towards a more specific education.

The last couple of weeks there is activity getting to know the new school, teachers and new pupils. 

Lotte was placed in a class without one of her her best friends but after meeting her new classmates, of which some she never met, she was happy and positive about the new classmates.

Yesterday it was the parents that met, and Lottes mum (M) spend a little time explaining to other parents about Lotte's CI. Just a couple of minutes. Enough to inform, not too long to set too much focus on it. 

One of the parents spoke to M about how she met Lotte on a previous activity a couple of days ago and how Lotte had told her that she needed to speak slower because Lotte couldn't understand.

WOW... Great to hear that Lotte is taking care of herself. Making sure she understands what is being said. Making sure she is not missing some essential message.. And this towards a person she had never met... Proud parents here...

It's not often we get this kind of feedback. Obviously from teachers at school we hear how she's doing, but from other parents, unknown parents, this is rare.. Guess that's the "problem" with a child happy at school and with friends... She's fully accepted so nothing is special...

Anyway.... 

So, as said above, I'm far from done with this blog. Mew milestones are pushing buttons that require updating the blog as required I guess..

Loud in the morning..??

This came up on a Facebook group..
 People with CI experiencing loud noise when turning on the CI in the morning, after a long period of inactivity.

Lotte never had this problem.. (See this post from 2007.. Jeezz.. has it been that long....)

But for those who have this experience.. Here is a possible explanation..
Not that I really understand... out of my league. 

-------------------------------------------------------------------

(From.. http://www.ncbi.nlm.nih.gov/pubmed/23533184)

J Biomed Mater Res A. 2013 Mar 27. doi: 10.1002/jbm.a.34719. [Epub ahead of print]

Dexamethasone released from cochlear implant coatings combined with a protein repellent hydrogel layer inhibits fibroblast proliferation.

Wrzeszcz A, Dittrich B, Haamann D, Aliuos P, Klee D, Nolte I, Lenarz T, Reuter G.

Source

Department of Otolaryngology, Hannover Medical School, 30625, Hannover, Germany.

Abstract

The insertion of cochlear implants into the inner ear often causes inflammation and fibrosis inside the scala tympani and thus growth of fibrous tissue on the implant surface. This deposition leads to the loss of function in both electrical and laser-based implants. The design of this study was to realize fibroblast growth inhibition by dexamethasone (Dex) released from the base material of the implant [polydimethylsiloxane (PDMS)]. To prevent cell and protein adhesion, the PDMS was coated with a hydrogel layer [star-shaped polyethylene glycol prepolymer (sPEG)]. Drug release rates were studied over 3 months, and surface characterization was performed. It was observed that the hydrogel slightly smoothened the surface roughened by the Dex crystals. The hydrogel coating reduced and prolonged the release of the drug over several months. Unmodified, sPEG-coated, Dex-loaded, and Dex/sPEG-equipped PDMS filaments were cocultivated in vitro with fluorescent fibroblasts, analyzed by fluorescent microscopy, and quantified by cell counting. Compared to the unmodified PDMS, cell growth on all modified filaments was averagely 95% ±standard deviation (SD) less, while cell growth on the bottom of the culture dishes containing Dex-loaded filaments was reduced by 70% ±SD. Both, Dex and sPEG prevented direct cell growth on the filament surfaces, while drug delivery was maintained for the duration of several months. © 2013 Wiley Periodicals, Inc. J Biomed Mater Res Part A, 2013.

Copyright © 2013 Wiley Periodicals, Inc.

Lotte.. Signing & speaking.. 2005. 12 months hearing.

Cleaning up my harddisks I found this one.

It's a long one, and she uses Norewegian signs.. (Some of them similar with ASL)

So.. Here it is...

04:12 "Er is geen speld tussen te krijgen." - "Zeg eens "Monoloog"

Swimming ?

Swimming with sound.. That has been a while (2008).

But... we got some watertight bags for the BTE and coil, made by Cochlear..

Will see how they work..
Have seen some pictures of grown-ups and it didn't look comfortable.

But I guess it depends on the motivation of Lotte. I'm quite sure that she is looking forward to try them out in the water..

Thanks Bobbi

====================================

Cochlear Aqua Accessory Review

  

To Sign or not to Sign

First I want to say that communication is the most important goal...

With sign language or speech, or pen & paper....

As long as you establish communication..

Now.. read on...

http://jdsde.oxfordjournals.org/content/early/2012/05/09/deafed.ens018.short?rss=1

Language Planning for the 21st Century: Revisiting Bilingual Language Policy for Deaf Children

1. Harry Knoors and 
2. Marc Marschark

Abstract

For over 25 years in some countries and more recently in others, bilingual education involving sign language and the written/spoken vernacular has been considered an essential educational intervention for deaf children. With the recent growth in universal newborn hearing screening and technological advances such as digital hearing aids and cochlear implants, however, more deaf children than ever before have the potential for acquiring spoken language. As a result, the question arises as to the role of sign language and bilingual education for deaf children, particularly those who are very young. On the basis of recent research and fully recognizing the historical sensitivity of this issue, we suggest that language planning and language policy should be revisited in an effort to ensure that they are appropriate for the increasingly diverse population of deaf children.

• 
  

"I am deaf when I am asleep"..

Each morning the children watch the "childrens news" from Holland.. (Jeugdjournaal)

Lotte's sister had sent in a picture regarding the weather, and it was shown in the broadcast in the evening..

So.. Lotte wants to send something to the Dutch television as well... OK.. Why don't you make a video.. Write down what you want to say, and we will tape it...

Good idea... 

Lotte starts writing, saying it out loud....... We’re listning to what she’s going to tell the Dutch viewers....

Hello.

My name is Lotte.

I am 9 years old.

I am deaf when I sleep.

I have CI so I can hear...

WOW... so that's how she sees it.. how she experiences it... 

We’ll leave it at this... no depth interview about how she feels etc.. we’ll just take this little pearl of wisdom and enjoy it..

(Video below (Dutch and Norwegian) Subtitles added.... direct link here)

Milestones, Mountain-ranges and views

Milestones....
They happen all the time, and like I have said on the blog.. sometimes they fly by, and sometimes they stand up in your face... (well, I said something to that effect..)

Last Thursday was the yearly checkup for Lotte. A great day out since we (actually, this was the first time I couldn't be there..) have to fly to Oslo, then take a train & tram to the hospital where the center for the check-up is located. One of Lotte's teachers joined Lotte and her mum.

This time, for the first time, it was Lotte who was in charge. She has grown so much lately, that my wife had no problem just sitting back and let Lotte do all the talking. And the specialists were excellent at directing everything to Lotte.
It must have been a wonderful day for Lotte because she was 100% focused the hole time. While adjusting the settings on the CI/BTE's, when finding the noises that she doesn't like (flushing the toilet) and trying to do something with that, she got it, and gave excellent feedback.. While doing speech tests in noisy environments and while doing comprehension tests. she did great. Her teacher was very impressed with Lotte..
But it's a great day out. She loves to go there and thrives on the attention, but this time, at the same time she realises the importance of the day.

In all, this day marks a beginning of Lotte taking over the "CI business" from us. She can accurately give feedback about how and what she hears. She understands the tests they are doing. She understands that there are different programs on her BTE she can use, because she was mentally there when they made them.
Of course life goes back to normal for her as soon as she was back at school, and she won't be playing with the different proframs, but she knows they are there.
Also, with one of her teachers being there, there is someone at school that will recognise difficult situations and can tell Lotte to switch to another program.. or, she might identify that Lotte forgot to switch back to the default setting.

Anyway.. It's a huge milestone. It didn't fly by. We didn't bump into it. It was like the mountain range in the distance that we finally reached.. We knew it was there, and were cruising along towards it. Now, having reached it, we can enjoy the view forward, and back...
It's a great view...

(btw.. Lotes mom promised to post an account of the day as well.... so stay tuned..)

Wake-up call

A few days ago, while sitting at the kitchen table after school, Lotte put up a grave face and began to tell, "Mummy, today at school we learned about [......]". We could'nt understand the last word. Asked her to repeat it. "We learned about [.......] in the park behind our house. You have to stay on the path. If the children do not stay on the path and go walking in the woods, they can get killed".

?

Bombs. The [...] word was 'bombs'. This is one of those moments where as a parent you have to think FAST. Luckily, having read the newspaper the day before, we remembered suddenly that there was going to be huge campaign in Norway for land mine victims in Cambodia a few days later. We were able to explain to Lotte that this was in a different country, that there was no need for her to be afraid. At first she didn't believe us, because this was told at school! The ultimate truth...... But after a bit of persuasiveness it seemed like the best option to believe us. We also took contact with the teacher and explained what had happened.

This is a perpect example of how Lotte gives meaning to the parts and pieces of spoken language which she is able to pick up. It is like this giant puzzle with holes in it, where she needs to fill in the gaps in order for her to give meaning to the story. Needless to say, this is not always on par with reality. Even though we know this, we let ourselves get fooled again and again, because Lotte is excellent at hiding that she has not understood. No matter how well Lotte is doing, stories like these are essential to make us understand that we have to stay aware of this, and pay attention.

Imagine what this idea about bombs in our neighborhood could have meant for Lotte, if it had been allowed to develop in her head over time. Ever so glad she is the gabby, talkative type and wears her heart on her sleeve!!

Another checkup whooooshed by

Last Tuesday we went to Oslo. On the following day, Wednesday, we had another checkup at the Oslo Medical Centre.. (Refusing to call it a hospital.. that's another wing of the building..)

Plane and Tram to the hotel for a good night rest.

The hotel is next to the hospital, so that's very convenient.

Her teacher was with us. Lotte got 3 new teachers this year, and we found that it's good for them to see the process at least 1 time. It's one way to talk about deafness, about CI, about how much Lotte hears.. it's another thing to be there and see it..
The hospital is huge... and very modern...

The day starts with the technical stuff. The CI processor was checked and adjusted.
Here, program 3 and 4 were removed. That means that when going through the programs, we now go 1-2-1-2-1-2 instead of 1-2-3-4-1-2-3-4... In itself a minor thing, since we only use P1 for Lotte. BUT with the "teleslynge" (Hearing Loop) in the classroom and school, we have programmed P2 to be weaker and have the "teleslynge only" on there. P1 will have the "teleslynge" with the microphone activated.
So... to summerise:
P1 = Normal program and Teleslynge with microphone activated (MT).
P2 = Reduced (for loud environments) and Teleslynge without microphone (T).
This was perfectly demonstrated when we tried P2 and the "T"... Lotte didn't hear anything any more.. since there was no teleslynge in that area.. and the microphone was "off".... LOL.. It works..

While all the technical programming was done the audiologist was talking to Lotte about how she was hearing. If everything was OK etc.
It was the first time she was interviewed in this way.. after all.. she's older now.
Still, a lot of questions were difficult for her to answer, and Lotte replied many times "affirmative" to questions she didn't understand... Experienced as she is, the audiologist understands that and will refrase the question, or repeat it...
Still a good conversation...

After that over to the echo-free (anechoic) room.
It's amazing how that room works on a person. The only thing absent in that room is... echo's.. Amazingly.. just walking in that room makes (for me) the hair rise on my skin and gives pressure on my head... All that .. just due to the absence of sound...
Lotte needed to repeat words. First single words which went without problems.
She did 100% until she couldn't understand the word "cat". Tried again... but without luck... Very strange, since there were words that are closer to other words that she understood / repeated without problems. Also .. after the "cat" it was 100% again.... Perhaps she's allergic..

Then, sentences in noise. Previously, it would be words or short sentences, but this time Lotte got "grown-up" sentences at grown-up speed. This because.. well... that's how it is in the real world...
After a slow start she did pretty OK...
One sequence was done with the CI on the shoulders. The following sequence was done with CI on the ears. She did a little better on the last one, indicating that some information might be lost with the CI on the shoulder. Next year, we'll start on the ears, then on the shoulders... if it's still an issue.
All this testing was very good info for Lotte's teacher. Seeing how Lotte struggles with some of the tests gives excellent information to her.

A language comprehension test was done after this. Prepositions etc. Lotte has problems with this.

Information with "not" in there for example. The information in the word "not" is just ignored... resulting in wrong answers.
Also she has problems with distinguishing "on top of" and below... She was very consequent in doing that wrong. Anyway.. lot's of work to to in that area.
Again, for Lotte's teacher, it was very valuable information. Seeing where the problems are will be very beneficial for her when she's teaching Lotte.

This test continued after a lunch break. In the end, Lotte got tired and her answers reflected that. (especially in combination with more difficult questions).

After interpreting the tests we talked about the results.
Lotte is doing very well, and basically the tests show where the attention should be regarding Lotte's development.
Basically... hearing is not a problem. Sure, in noisy environment her ability to hear is reduced.
But, it is much more about catching up the "understanding"-gap left by 2-3 years of deafness... Training the cognitive part of the brain...
Plenty of work to do. For Lotte, for us, the teachers and the rest of the support-group around Lotte..

Hers.... all hers...

November 2010... time flies and our kids grow without us noticing it.
Lotte is growing as wel. Physically and more important, mentally... More and more things become hers.

Homework is hers...

She will start doing it herself, doesn't want help until she needs it, and (fortunately) allows us to check it and make comments.... If she has done anything wrong... she's OK with having to correct it.

They get a list of what to do from school with them... One of the questions was "Can you make two sentenses with the practice-words"... Her answer was a simpel "Yes"... Wonderful..

Handbal is hers...

She started 3 weeks ago. Many girls (and some boys) are playing in a team and she wanted to join. We brought her to the training and she did great. No chance of hearing anything the trainer said to her, but looking at the other children will get you a long way. She has good coordination, throws the ball fine (her dad - former low-level baseball player / catcher practiced with her before the first training...) and is totally at ease...

So much at ease there, that we're no longer allowed to accompany her to the training.. Well... dropping her of  is OK, but not into the training hal...

Last sunday her first games. A tournament in another part of town and she did great... Got a medal for it.. YES..!!

Hearing is hers...
From the phase where hearing was never an issue, where she just put on the CI and went to school, it now becoms clear to her that she has problems to hear at times..
Last week, children had to read aloud from a book. Some of the girls in the classroom speak very softly... Children away from these girls have no possibility to hear them. Nor has Lotte.
The teacher is very committed to making sure Lotte understands everything... So, she asked Lotte.. "Can you hear what they say.?" Lotte couldn't, and "had to" admit that. Thoughtful as the question was... I think that Lotte felt that she was the only one that couldn't hear whas was read aloud..
The teacher explained to her that the girls were reading very softly.... and that she herself couldn't hear then, and the other children couldn't hear either..  But I think Lotte didnt get much of that explanation...
She came home and explained to us that she had trouble understanding others...
That was a first time for us to hear her talk about not being able to hear. (we didn't know the circumstances yet. We were updated later by the teached.. It's great to have such an engaged teacher working with Lotte..)
We comforted her and she forgot about it, and after we got the message from the teacher about what happened, we were able to get back to the incident and explain to Lotte that it was not just she that didn't hear, but many children in the claas, including the teacher.
In retrospect, when a child is speaking so low that other children can't understand what's being said, it would be best to ask any child but Lotte if he/she can hear what's being said... That way, Lotte will understand that other children have the same problem as she.. This time, she thought it was just her..
(Isn't hindsight wonderfull... as they say... "Hindsight is always twenty-twenty.")

This week the school started to use a soundsystem for the classroom...
More about this later

Homework...

Yesterday a great moment..
Lotte needed to finish some homework; writing down 30 (Norwegian) words that they have been using the last 3 weeks. We say them out loud, she needs to listen to them, and then write them down.
Lotte's mother is in Holland, visiting grandma...
Just before we started the homework, I thought to let Lotte talk to her mother via Google-Chat-Video....

This means OK image with bad sound from the Acer mini-laptop. (Aspire-One)
But Lotte seemed to have no problems with understanding the other side, and before we knew it, her mother was saying the words, and Lotte wrote them down on the computer in the chat-line......
This was so wonderful.... Some of the words are pretty close - sound-wise - but Lotte understood them well.. in fact.. she made only one mistake....

Imagine.... our deaf daughter here in Norway, listening to her mother who's in Holland saying the words she needs to write down, and then Lotte listning, then writing them on the computer in Norway... being displayed in Holland.
Who could have thought that 10 years ago....
All this technology helping Lotte to make the best of the possibilities life has to offer....

For the teachers out there... :-)

http://www.medicine.iu.edu/documents/Otolaryngology/Medel.pdf

Home.. alone

Well...
the posts don't come as often as before.. and I guess that's good sign... Milestones are further apart .. or perhaps less visible. Or perhaps we're just too busy..
Vacation is over. Today was the first day of school, and Lotte had no problem adjusting to it..
But... I'm here to share another milestone....

We left Lotte "home alone"...
Needed to do some groceries, and Lotte was not eager to join us. Nor did we feel an urge to tell her that she HAS to come with us..
So.. we left her with "her" mobile phone (don't tell her.. she assumes it's hers, but we have not officially given it to her), set her up with her mothers mobile number and after some ground rules we left.
One of the ground rules was "Not to allow anyone in the house".... Lotte was quick to correct us that her brother and sister surely would be allowed to enter... We humbly acknowledged our mistake...

200m from the house... Lotte calling....
"Can my friend come in" - (son of our neighbours"..??
We answered that that was OK..

500m from the house... Lotte calling...
"He already left." - (apparently the video Lotte was watching did not interest the boy..)

She was good. Some more calls were made, to get the most out of her new freedom. She enjoyed it.
And we enjoyed it as well. Lotte was so at ease with calling us.... just wonderful..

So, with this episode, another milestone passed with warp speed. We hardly saw it... Well, that's not entirely true... It's more like an exit on the highway... "Milestone 1000m ahead" and then passing it at warp speed....


------------

btw...
She nowadays just opens the pouches herself in order to remove the CI from there, and hangs it on her ear by herself.... Giving all the freedom to be the chatterbox on the phone - or mobile phone....
Putting it back... well, that still requires the assistance of someone else....

Failure - and succes

Well,
one of the CI's broke down.
Lotte came home and complained about the left CI. It made a "bzzzz" sound, and she was not happy about that.
We checked with the earplugs, and indeed, the CI was not working...
Fortunately... we can call our supplier (Medisan in Oslo) where they have all the stuff they need to send a new one... and the next day it was in the mail. Excellent service...

But...
Lot's of learning come from such an event..
1: Sooo good to still have 1 "ear" left... It has been a couple of years since this happened, but again.. having a second CI to use is just PERFECT..

2: Lotte is at a stage where she will tell us when something is not working. It has happened before that she would not be bothered about a CI not being on... This time, the CI obviously made an awkward sound, so she got annoid.

3: She hears A LOT less with only 1 CI. More "huh"'s more misunderstandings....

4: With 1 CI, going to school, she is tired at the end of the day due to the intensity / concentration she needs in order to understand what's being said.... Another thing that shows how bi-lateral CI is helping Lotte tremendously..

So.. everything back to normal... Lotte was happy to get her new processor, and life is back to normal...

Good basic info regarding Bi-lateral CI....

From a thesis by Carol A. Sammeth, Ph.D, CCC-A

Please be careful that the statements selected are representative of the paper's overall conclusions.  Also, the part posted is only a piece of a longer work. (Full pdf here..)
------------------------------------------------------
BRIEF REVIEW OF BENEFITS OF TWO-EARED INPUT


The Psychoacoustic Literature
There is a fairly voluminous literature in psychoacoustics (hearing science) illustrating the benefits in normal hearing persons of having two-eared rather than one-eared input. When hearing loss disrupts the ability of the brain to process binaural inputs, whether due to large differences in the degree of loss between the ears, or a failure to provide amplification or a cochlear implant to one impaired ear, these benefits can be severely degraded or lost. There are three primary effects ascribed to binaural listening: the head shadow effect, the binaural summation effect, and the binaural squelch effect (e.g. Durlach & Colburn, 1978), producing benefits that range from improved speech recognition in noise, to the ability to localize the direction of a sound, to more “natural” perception. The following briefly describes the key benefits of binaural functioning.

Head Shadow Effect
When speech and noise come from different directions (i.e. are spatially separated, as typically occurs in the real world), there is always a more favorable signal-to-noise ratio (SNR) at one ear than at the other because of the head shadow effect and different sound distances to the ears. The head shadow effect is primarily seen in frequencies higher than 1500 Hz (e.g. Shaw, 1974), with the amount of attenuation of sounds from the opposite side of the head dependent on frequency but ranging from about 7 dB in the speech range up to 20 dB or more at the highest frequencies. If both ears are participatory, the ear with the most favorable SNR is always available so that the patient can selectively attend to this ear. This is compared to the unfavorable situation where only the ear with the poorer SNR is functional. Persons with unilateral hearing loss can become very frustrated when people are talking on both sides of them because they must constantly turn their “good ear” to whomever they want to hear best at the time, and then they miss sounds on the deaf ear side.

As will be shown later in this paper, a primary benefit of bilateral cochlear implants appears to be related to the beneficial aspects of hearing from both sides, and always having the ear with the more favorable SNR available. This is generally tested with speech from a frontal speaker and noise from a side speaker - - when the second ear is added that is contralateral to (opposite side of) the noise source, performance benefit comes primarily from the head shadow effect. Note, however, that there is discrepancy across the published studies in how to quantify the head shadow effect, with some researchers merely examining differences in scores with sound ipsilateral versus contralateral to a unilateral ear under test, and others comparing the score for listening with bilateral inputs to that for unilateral listening with the noise presented ipsilateral to the ear under test.

Binaural Summation & Redundancy
Sounds that are presented to both ears rather than just one are perceived as louder due to binaural summation of the information received at each ear. In fact, the threshold of hearing is known to improve by about 3 dB for binaural versus monaural presentation to normal ears, resulting in a doubling of perceptual loudness and improved sensitivity to fine differences in the intensity and frequency domains. This latter effect is sometimes referred to as binaural redundancy, and it is believed that it may translate into improved speech perception scores. When listening to speech with only one ear in a difficult listening situation or with one ear with greater sensorineural hearing impairment than the other, there is a loss of the redundancy in cues across the ears that may reduce performance.

The benefit of the binaural redundancy aspect of bilateral inputs is typically tested by presenting speech alone or having speech and noise emanate from the same loudspeaker frontally - - when the second ear is added, benefit is possible through redundancies or overlaps in representation at the two ears. In a normal hearing ear, this effect produces about a 1 to 2 dB improvement in SNR (Bronkhorst & Plomp, 1988). At this time, there is only limited evidence for true binaural redundancy effects on speech perception results in the
bilateral cochlear implant literature reviewed herein. This effect is probably not stronger either because such subtle cues are not able to be utilized by ears that have severe to profound hearing loss, or simply because the signal processing available in today’s cochlear implants (with two implants processing independently) does not adequately maintain these interaural cues.

Binaural loudness summation has been shown to occur, however, and is a potential confounding factor in comparing across studies. While most researchers have adjusted the loudness of the implant processing for binaural presentation versus monaural presentation (and made sure loudness is reasonably balanced across the ears), some have not. In a clinical bilateral implant fitting, it would generally be presumed that loudness would be adjusted so that the patient’s overall loudness comfort level is reasonable, and thus any purely binaural summation effects would be reduced or negated for bilateral listening compared to a previous unilateral implant.

Binaural Squelch/Unmasking
A person with only one functioning ear can usually understand conversation well when listening in a quiet environment, as long as the sounds of speech are made loud enough. However, even a normal hearing person who is listening in high levels of background noise can find speech understanding to be difficult in an adverse listening situation (consider, for example, competing conversations with multiple persons seated at a long table in a very high noise level restaurant). This occurs partly because of direct masking and partly because of upward spread of masking on the basilar membrane of the cochlea (whereby low-frequency sounds have a greater impact on reducing perception of higher-frequency sounds than vice versa). Speech recognition in such noisy environments is even harder for a person with sensorineural hearing loss both because of the inherent distortion and loss of normal nonlinearities introduced by cochlear damage, and because these patients show even greater amounts of upward spread of masking effects than do normal ears.

Fortunately, the auditory nervous system is wired to help in noisy situations as long as there is functional input from both ears - - that is, the auditory system and brain can combine information from both ears so that there is a better central representation than would be had with only information from one ear (e.g. Zurek, 1993). This effect, commonly referred to as binaural squelch (but also sometimes called binaural unmasking), results from the brainstem nuclei processing timing, amplitude, and spectral differences between the ears to provide a clearer separation of the speech and noise signals. The squelch effect takes advantage of the spatial separation of the signal source and the noise source(s) and the differences in time and intensity that these create at each ear. This is generally tested with speech from a front speaker and noise from a side speaker - - when the second ear is added that is ipsilateral to (same side as) the noise source, any benefit comes from the binaural squelch effect. There is some limited evidence of improved speech understanding in noise in bilateral cochlear implant patients due to binaural squelch effects, although the effect is not seen across all bilateral implant users or studies, and is not as large as the head shadow effect.

Note that binaural summation and squelch are signs of the ability of the auditory nervous system to integrate, fuse, and use information from the two ears. In contrast, the head shadow effect merely results from the physical attenuation of sound across the head and does not require central nervous system integration - - This does not negate the fact, however, that the head shadow effect is a substantial factor in everyday performance for those listeners with unilateral versus bilateral devices.

Localization
Finally, perhaps the most well-known practical binaural benefit is the ability to localize (i.e. determine the direction that a sound is coming from). This function is dependent on auditory Bimodal Devices and Bilateral CIs, page 9 system perception of interaural (between ear) differences in time, intensity, and phase (e.g. Yost & Dye, 1997). Localization ability can be a safety consideration. For example, when crossing a busy street, it is important to know the direction that a car is coming from. Persons with significant unilateral hearing impairment can also attest to the frustration of hearing their name spoken but not knowing which direction to turn in order to find the person calling them.

Research to date has focused on localization of sound sources in the horizontal azimuth, but keep in mind that it is also possible for a listener to differentiate sound sources in the vertical plane (by elevation) and in terms of the distance from the listener. It is well known that interaural timing differences provide the information necessary to locate the direction of low frequency sounds - - specifically, those less than about 1500 Hz. For sounds that are higher in frequency, the main cue for horizontal plane localization is the interaural intensity difference that occurs because of the head shadow effect. In addition, head and pinna shadow effects,
pinna filtering effects, and torso absorption properties can all contribute to spectral differences that can be particularly helpful in determining elevation of a sound. For a listener with only one functional ear, there are very few cues to assist in sound localization although some rudimentary localization ability can still exist. The literature on bilateral cochlear implants provides significant and substantial evidence that localization abilities are enhanced with the use of both ears versus just one.

OK... it's not English.... .... :-)

.... it's Dutch... but it's not about you understanding what Lotte is saying, it's about Lotte understanding what she's hearing....  And she does....

Click here to watch

Good signs...

It's been a long time... again... I should improve on keeping the blog update more.
Because.. lot of stuff is happening... Lotte's days - and therefore her experiences - are mainly at school and the "SFO".. the organisation that takes care of the kids after school. (from about 13:30... )

Of course a lot is happening at home as well, but when you think of it, she starts fresh at school, and gets more and more tired during the day. When she comes home, she wants to play with friends, cycle do homework, talk to us... but she already had a long day...
But it's at school where she's doing the hard stuff. Interacting with other children. Paying attention in class. Mastering the subjects... Quite a challenge for a girl that was born deaf, and started hearing 2 years after she was born. There's a lot of catching up to do.
At times, we can see how well she's doing. Some times we can see how well she's doing despite her situation. Some times we can see how things are not in place.
For example, cognitively she is not at the level of a 7-year old. This became painfully clear last week when they had a performance on stage, organised by the "SFO". Lotte had mentioned that there was going to be a show. The show was late in the afternoon. Lotte's mother came to pick her up later so that Lotte could see the whole show.

Think of the surprise when she entered the school, to find Lotte on stage taking the second price.!!!

She and 3 boys had practised an act with hoola-hoops, but Lotte never mentioned that to us. She never told us to be there...

Another mother had seen Lotte perform and told what happened. What Lotte and the boys had done, so when Lotte came from the stage, full with pride, Lotte's mum could pretend that she had seen the show.

But it was such a painful moment. The first show - in front of public - of your deaf daughter that is working hard to keep up with her friends and you miss it.. (btw.. Someone made a video, so we will see her.. I'll post it here.. )

It just shows that as parents we have to make sure that the adults around Lotte know that not everything that is communicated to Lotte is understood. Lotte is great at pretending that she understands, but there's a lot that she doesn't get. This was one of those situations. It showed us that communication between SFO and us has to be done on paper. Actual, we know that, but the people at the SFO didn't realise it..

So, room for improvement..
(And... looking for a "hoola-hoop" picture... until then, the diabolo will have to do..)

TAg For En SE i

(For the non-Norwegians.... It should be "Takk for en CI"... "Thank you for a CI".)

Lotte made a drawing for the two persons she knows from the Oslo Hospital, that

do the technical- & speech- checking..

Her right processor was damaged (fell to the floor..), so Medisan (provider for the Freedom system), sent a new one.. For Lotte, anything regarding CI comes from Tove and Ole. The two of them will get the credits.. :-)

The drawing will be in the box being returned to Medisan..... Perhaps it will make it to the hospital, but I hope the people from Medisan will find a nice place for it....

Here it says

"Til Ole og Tove"

"TAg For E" & "n SE i"

Eg har lagtteteg teinn

og TAG for en Sei

Se på en lagentent teinn te teg

One on one...

Today, Lotte has been with a friend from school almost the entire day.. Away from our house..

It went well. She's been with friends before, but never this long. At the end of the day she was tired...

And that's no surprise.

Think of it.. In a situation with many children, it is easy for her to camouflage that she doesn't understand. She watches the other children and whatever she hasn't understood will be filled in by the action of other children.

Playing 1 on 1 - like today - changes that completely. Any communication from her friend is towards her. So, Lotte will have to be more alert. Will have to focus if she doesn't want to ask too often to have a question repeated.

Apparently, it went very well. They played for a very long time, and at the end of the day they were still friends.

Lotte' s mum called the girl's house, and got the girl on the phone.

On my wife's question as to how it was going, the girl said "It is going very well. But we did fight a bit just now, but that is over now.."

Lovely !!!

Lotte started dance-classes..

As shown earlier in the blog, Lotte loves to dance and sing. Together with her sister, they have given quite a few performances.. (See here for example.)

A friend of us teaches jazz and ballet at the local music-/culture- school... and when we asked if Lotte could have a look one day she was very happy to invite Lotte.
Our experience before with these kind of activities - before she went to school - was that she is very shy entering an unknown group and joining. Difficult for her to understand what's happening...

Bought the required clothes to make sure Lotte would feel like part of the group, and little ballet shoes. All very much to Lotte's taste.. After all, dressing up is one of her favorite activities.

So, with mixed feelings and not-too-high expectations Lotte and her mom went to the class.

And there the miracle started.....

No problem getting into the classroom. She felt totally at ease, as if she had been there before. No problem that there were 7 other 6-year old girls there that she didn't know. She chatted with the teacher (who - as mentioned she knows a bit ) telling her what happened at school. But she was there to dance, and that's what was going to happen.
She understood the instructions, and was very able to do it.. Looking at what the other children did helped as well.. Total commitment, whilst carrying a radiant smile on her face!!

The teacher, our friend, is English but speaking mainly Norwegian to the class... Suddenly there was counting in English... and Lotte understood that as well.. (Has had it at school..) and when some colors were mentioned Lotte got in the discussion with mentioning "Pink"... in English...
So... understanding the context and not afraid to put in a word herself.

The class went extremely well.. Lotte floating on a cloud due to dancing.. Totally in her element.. It is wonderful to see how she as grown. Getting confidence in herself and the outside world.
Without CI it would have been impossible to do this to the level she is doing it now.

The way she feels secure, and is totally open for new challenges. The way she claims part of the world.

She was still on cloud 5 when going to bed...