Swimming with both CI's on...

It's not easy to get them right, but when they finally sit... they sit...
After not wanting any CI under the swimming cap (pre-summer) she agreed (after we forced her) that hearing what the trainers said was kind of handy. So.. 1 CI was accepted. Then she came up with the idea of 2 CI's.. Who are we to disagree with that...

Anyway... We found out that when we first localise where the spool needs to go above the cap, then put the spool there - under the cap, and then push the processors under the cap (on the ear is really awkward..) it works well..

So.. Bilateral Swimming....

  

   

 

Priceless - Bubbles

Lotte doesn't discover many new sounds, or at least she's hardly surprised when she hears a new sound..


Today she discovered a new one that did surprise her. The sound of bubbles coming from her coke!!

At first she said "what's that.?" when she poured her coke.
Then we let her listen with her ear on top of the glass with coke.
As she listened, a big grin came on her face..

Priceless.!!

 

Update:
And of course Lotte wants it om the blog....

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..)

I want to hear the snow...

Lotte asked if she could go outside...
"Why?" we asked...


"Because I want to hear the snow under my feet..." was the answer...

Did you hear that?

OK...
just have to put this down for the record...

Early morning.. Lotte just out bed, (but been awake for a while) and is sitting on the toilet.. doing a (powerful) #1. No CI on the ears / shoulders... so completely deaf....
Lotte's mother is there as well, hearing how she is working... Suddenly a big "splash..!!".
Lotte triumphantly looks up to her mom and says... "Did you hear that..!" :-)


(Update: more a "plong" than a "splash"..)








What's going on inside that lovely girl's head.. ??? LOL
(Probably this..)

Speaking & hearing & understanding for all..

Trying FM wasn't a big success. (See other posts..) The school had some meeting with the councel and got themself informed about the possibilities for making Lottes learningenvironment better.

One of the conclusions was that having a sound-system in the classroom would be of great benefit to Lotte, and the rest of the class.

So, last week, th school has installed a sound-system in Lotte's classroom. Speakers on the wall, a microphone for the teacher to have around her/his neck, and microphones for all the children.. (well, 1 for every 2 children) so that from now on everyone should be abe to hear and understand everyone else.

We haven't heard yet about how it's working. We understood that on the first day it was available, the teacher used the microphone, but not the kids. But all the kids liked it, and I'm sure they are all looking forward to using the microphone.

It's not just for Lotte, even though she's the reason it's installed. The other children will benefit from better sound, AND they will be trained in speaking in turns. 

Will keep you all informed....

Have a look here... (Norwegian)

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....

Yes... I can hear that. :-)

Saterday morning... I walk down the stairs into the living room... The girls, Lotte and Sanne are watching TV, around the corner.. they can't see me coming down..

Then, a little voice say's... "Good morning daddy.. :-) "

Lotte gives me a big smile when I turn the corner...

"I could hear it was you.. :-)  "

How's that for CI technology... Hearing someone coming down the stairs, and even hearing who it is..

So, next time you hear a simulation of "how a CI sounds".... don't believe it..

Because - there's one thing those programs can't simulate...

The brain...

FM equipment..

We're going to experiment with Lotte's FM equipment.
We have had it for a while, but since she didn't have problems in the classroom, we decided to wait a bit... That's.. until now. Time to experiment.

On my search for some explanations about the equipment I came across this webside..

Nice site to give an idea about using FM in a classroom with noise.
Have a try... . Adjust the parameters. For example - distance to the teacher... and the noise. Then turn on the FM-equipment.... 

Impressive demo... Not sure how real the situation is... perhaps readers that have CI and use FM may confirm that it's a good demonstration....

p.s.
Some linke (Thanks Dan..)
Acoustics: http://www.lenardaudio.com/education/04_acoustics.html
Info: http://www.babyhearing.org/HearingAmplification/AidChoices/FMSystem.asp
Question: http://forums.about.com/n/pfx/forum.aspx?tsn=1&nav=messages&webtag=ab-deafness&tid=4918
Acoustics in classroom: http://asa.aip.org/classroom/booklet.html

Cables or headphones....

With the Freedom package there are the complimentary (for us at least) cables to connect to a audio-socket on a CD-player or other appliances..
It works.. but it takes time to put it on... Plus, the BTE needs to go outof the pouch (in Lotte's case) and hang on her ear. Not the favorite location in Lottes world.. And.. it will be connected to only 1 BTE. OK... with a splitter, you can get it to both, but you can forget about any stereo-effect..

So, we bought wireless headphones.... They will cover the BTE's when on the ear... Stereo sound... Yes..!!
Still, we have to get the BTE's on the ears, but then... Lotte loves it..
Next station.... make her listen to storybooks on CD's instead of watching TV....

But... back on the shoulders when she's done.....
'

Hearing and speaking....

Wonderful "happening" this morning..
Woke up late, and were listening to Lotte playing with Lego outside our bedroom. Lotte would have been up since 7:30, and she comes to us to have the batteries (rechargeable) put in her processors and have the pouches pinned on her clothes.
So... listening we were wondering if she had a friend with her, since she was engaged in role-play. There was definitely an alternate voice, and it sounded like one of her friends from down the road was with her.. So, Lotte's mum got up, dressed and had a look, only to find Lotte engaged in a wonderful play.. just by herself.

Many times, people will talk about how CI would sound completely different compared to normal hearing... and fine, who can argue with that, except that here's a girl that is doing two different characters, in two different voices, communicating in a make-believe conversation...
Pretty amazing, and far, far away from the simulations you can find on the net.
The mind is an amazing tool, and apparently is able to discriminate sounds very well... even with "only" 22 or 24 electrodes..

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.

Calling grandma

Using the telephone is no longer a problem.
We need to help putting the CI from the shoulder to her ear, but otherwise she is using it like every one else
It's great to see her waiting for her turn, and when she finally has it, she will wander through the house, (have a look here..) pointing at things as if her grandma can see her... Very typical..

She has no problems understanding the other end. When I talk to her, I know I have to get her to focus on listning, instead of just talking...
.. but that could be a female thing.. nothing to do with the ability to hear.. ;-)

A peek in Lotte's world...

Imaging this....
Early in the morning... Kids got up and the discussion is about being able to sleep, or about waking up.. Not sure..

But suddenly Lotte says "I can't sleep because I can hear Jelle speak when I try to sleep, he wakes me up..."
So we smile and say "You cannot hear when you are in bed because you have no CI on. You cannot hear."
Long silence, and then a big smile. She realized that she needs the CI in order to hear.

This morning a similar incident.
When she wakes up, she needs to come to us in order to have the batteries inserted (rechargeable) and the BTE pinned to her shirt.
She knocks... and waits.. (for nothing.. she's deaf) and then comes in.. We pretended to be asleep... She goes out, knocks again (harder) and comes in again...
Then she tells us: "I knocked, and then you should say "come in" !.."

She is tuned in for hearing.. With or without CI...

Bi-lateral CI... any doubts?

.. well, go to this post in the blog of Ethan..

Hard-of-hearing or Language-deprived ?

A thought that crossed my mind - actually, it didn't cross, it got caught, is that the way we look at children with CI might be wrong. Wrong in the sense of what kind of support we give compared to the support they need.

Historically, CI's were the next step from HA's. And with that, CI's are many times still regarded as such. A hearing aid. Working in a different way, but still, an aid to hear.
People with CI are therefore still regarded as Hard-of-hearing since "obviously" they use an aid to hear.

This might very well be true in many cases, but a new generation CI-users is emerging. Children that are implanted (often on two sides) before the age of three that do not conciously grow up deaf. CI is giving them sound that enables them to speak and understand language.
The "problem" these children have is not lack of hearing. They hear very soft sounds, they understand and reply with whisper. In that sence they are not hearing impaired. (Keep in mind... I have Lotte in mind. I know results can be different.)

They ARE however behind in language and therefore cognitive thinking. The older the child, (1, 2, 3 years old) the more this is true. This is where the supportsystem should focus! On gaining on the lost language. Because language defines us.

Obviously, the situation depends from child to child. 1 CI will make undrestanding in noisy environment much more difficult, and with that, there is a hearing impairement. But think of children that do well with bi-lateral CI. These children need language, speech and above all, comprehension.

Example,
Lotte is now in an all-hearing kindergarten, and with the language she has, she is behind compared to other 4-year olds. (We are not worried about that. She only has two years of sound, so obviously she's behind - and catching up nicely...) She is not able to master communication with children that otherwise would be her "equal" because the others do not understand her. The result is that she will look for other children that either ar younger but at her speech level, or children that are more fysical that communicative. (e.g. boys, playing outside... where screaming and actions goes a long way.)
Focus should be on making sure Lotte is understand. (And this is being done in her kindergarden..)

It seems that for the children, focus is actually on communication and speech.
But what about the parents...
In Norway, the parents are offered sign-laguage classes free of charge. BUT, the focus is only on that. Sign. WE, Lotte's parents, do not have a need for that. Lotte does not use it any more. We need information in speech and language development. How does it work. What are the milestones... What to look for, how to play, what to do, what NOT to do.
BUT since children with CI are still looked at through "DEAF" glasses instead of "Language deprived" glasses, that support is not available. Only "DEAF" therefore "Sign" support...

How is that elsewhere..??
Is the support sysem different.
Like, AV-therapy. It's not available here in Norway, but I have a feeling that there the focus is on educating the parent.... Correction, it's not available where we live..
Anyway... have to do some more research on it.

Visiting the preschool. Communication.

One of Lotte's best friends, Tone, visited her at her kindergarten. Tone was Lotte's speech therapist for 2 years in the "deaf" preschool/kindergarten and they really bonded. Then she started working elsewhere, and Lotte went to the new kindergarten.
We still have good contact since we all became good friends. Also, she now works close to the university, where Marieke now studies.

In her new job, Tone is still connected to Lotte, but in another setting.
This allows her to get involved, and this happened last week.

Lotte was allready informed and she was very excited to see Tone.
Tone lead a "gathering" where all the children are together and everyone is involved.
She explained sign, the colours, and as allways, the children loved it. (I still have to meet a child that is not entrigued by sign) She used sign throughout the whole gathering.
And this showed the gap between Lotte and the rest of the children.
Lotte was 100% focused and got everything. This is not the case when only spech is used. She still has to get more exposure so in a normal gathering she loses focus quickly due to the lack of understanding. Not when sign is used together with speech.

In a know situation she will be fine. When it's lunchtime, she knows the routine and has more control over what's happening. Outside these standard situations she will be less secure because she will have more problems understanding what's going on.
The "problem" is likely to be due to a lack of understanding speech, but a large part is comprehension. She does not have the capacity to think like a 4-5 year old child.

But it will come. With speech the comprehension will follow.

Pressing the little button and Yes .... Sound !!

Over the last two years, since the activation of Lotte's CI, Lotte has gradually realised that her working ears are on her shoulder... or at least, they need to be attatched above her ear.
This realisation has slowly grown.
In the beginning she would be happy to run around with her coils loose on her back . A BTE that stopped functioning (e.g. low batteries) would not be a problem. A soundless environment has never bothered her, and it still doesn't.
Later on, especially the last half year, the lack of sound, or perhaps better said, communication with her surroundings, does bother her, and we never see her with 2 loose coils. Sometimes one falls off and she won't notice, but normally she puts them on herself quickly.

IN the last month, in the morning (Lotte being awake before us... ), she will pluck them from the medicine-cabinet (which is steel, so the CI's stick on it due to the magnets in the coils) and comes to us to have them put on.
The way to do this was to switch them on, check the program, then the "volume" and then pin them on her shoulders (don't worry, by that time she wears some sort of clothing. :-) and finally attach the coil on her head. Only then sound would come in.

This weekend I changed that routine, and actually showed her for the first time that her CI gave her sound.
I first attatched the coil, and she realised that that did not help.... no sound.
Then I showed her how I pushed the button to turn the BTE on... and her face lit up..

YES !!! sound !

Only then I put the BTE in the bag on her shoulder, after checking the program and volume.

The other BTE, I had her turn it on herself, and again it was great to see her face light up with excitement. The realisation that it was her, by pushing that little button, that gave her sound...

In a way this is a new era, where Lotte realises that sound is something that comes through a thing that needs to be turned on.

Lotte's own will.....

Having a bright young lady in the family (2 actually) that knows what she wants and is not afraid to demand it is wonderful.... It is helping her tremendously now and she will have great benefit of it later in life....

But obviously it has it's downsides.
She has a very good idea about what she wants to wear. And most of the times it is something not chosen by her mother. (allmost by default ?)
We allready made the concession that when clean clothes are to be chosen, she can pick from two sets. This will give her enough feeling that it is her choice that she will agree.
However, yesterday she was told to wear the same clothes today (poor child... ). However, she managed to dive into the closet and find a clean pair of pants. Since this would be the first hurdle of the day - we chose to look the other way. And as expected, the second hurdle was no problem. This is "how to wear her hair".

When hurdle one (cloths) has finally been taken (this can take some time, unlike today) hurdle two grows proportionally.

Today... it went smoothly. (see picture above)

Her stubburness can have something to do with her intelligence. Even though she hears a lot, there must still be a lot of moments that she realises that she doesn't understand what's going on. She knows she's missing something.
Her way to handle this is to have very fixed ways of behaving and any deviation from this can cause a demand in returning to HER way of things.

An example was today in the pre-school. Marieke brought her and instead of leaving the normal way, she left via another door. (She had to go to the admin to talk with the leader of the school) For Lotte, this was totally "out of the normal" and she reacted strongly to that. Refusing to let her mother go.
After calming her down, leaving through the "correct" door, Marieke entered the school through another door.

But it indicates Lottes strong sense to have everything in order.

Obviously, there could be another reason than a "feeling of missing something". But if this is the case, what if she had been deaf without CI.
She would have had even more the feeling of missing something. She would be able to communicate fine with us - her parents - and her siblings. Also with the other children in the kindergarten that know sign.
But she would have missed out in communication with her grandparents, with our friends, and with her siblings when the three of them watch television or a DVD.
With more activities than now from which she would have the feeling she's missing out, would she have reacted in the same way. Would she have been earlier with these kind of responses? We will never know.

What we do know is that we have a deaf girl that has no problem explaining to strangers what happened today, what she ate, the drawings she made ect. (For the strangers, understanding might have been a challenge..)
This happened yesterday as well, on the school where her siblings go. There was a celebration and Lotte chatted with everyone willing to listen.. She enjoyed herself the whole evening..
Below, she's helping her brother and sister with making a collage. She just jumped in with all these other - elder - children and started working. Chatting away..
(AllDeaf)