Speech Therapy intervention


A systematic Speech Therapy intervention following the cochlear implantation is considered essential. Its starting point is set on the activation of the speech processor and it includes the systematic practise of hearing and speech and the creation of models for the content and the structure of speech therapy after the cochlear implantation, so as for the patient to develop a good acoustic perception and comprehension of oral language and moreover a good communication via the oral path.
The objective of speech therapy is that the patient uses and exploits with the best way the advantages that the cochlear implant offers. He should be better directed in space and communicate better in situations such as on the telephone, in places with noise, rush etc. These objectives can be achieved if the patients can:
a) Differentiate and analyze with precision acoustic stimuli.
b) Gain better acoustic perception and comprehension of speech without the help of lipsreading, for postlingual patients, or in combination with lipsreading, acquire oral language with the least possible effort and later on the acoustic discrimination of speech without help of lipsreading, for the prelingual patients and preschool aged children.
c) Restore articulation, voice and prosody.
d) Develop structures of spoken language.
Speech therapy consists of the preparation period and the sectors of perception of speech and environmental sounds, comprehension of speech, of articulation, of phonation, of dialogue and of the transmission of information to the listener. A big phase of preparation is necessary in prelingual patients for the new acoustic experience via his cochlear implant and postoperative treatment.
An objective is the awareness and intensifying of visual and tactile perception thus these sectors in the duration of treatment are helpers of the acoustic perception.
Patients take exercises for the stability of acoustic perception and in equivalences of comprehension the relation between picture and reason. Also they process forms for judging different perceptual qualities and quantities so that the patients can categorize better their senses. Via these exercises begin the extension of concept repertory or differently of their vocabulary. Proportionally with what abilities they have develop up to that moment there can begin a further systematic growth of speech and language for the description of tactile, visual but later on hearing stimuli. Individual sectors of the preparation phase can continue through the duration of the treatment.
In postlingual patients this phase is not required thus they do not present disturbances in structure of speech and their hearing ability has developed completely. For them the treatment begins with the phase of acoustic discrimination of noises and sounds after speech processor’s activation. Basic point of the treatment with postlingual patients is the sector of acoustic discrimination of speech, which begins with the discrimination of sounds and it continues with main acoustic discrimination of speech.
For the check of the development of the treatment, protocols for acoustic discrimination of speech are used. With repeated examinations is checked if comprehension of phoneme has improved or needs new mapping of the speech processor. Parallel with this analytic work they are offered exercises with automatic sequences, proposals and texts.
Two to six speech therapy sessions are in the most cases enough for processing sounds and noises with postlingual adult patients.

The general objective of the treatment which is the total integration of the cochlear implant in everyday routine requires a confrontation of the patient with psychosocial changes in the new reality. This is a piece that also needs to be supported and it constitutes a small or big part of the treatment with supporting discussions. Patient’s self-esteem should be vitalized, prospects must be opened to him, and he should be helped to distinguish them and should be given ways to deal with their problems. Thus a discussion for the maintenance of encouragement and for mapping out right expectations and attitude of life is an important, interdisciplinary piece of the treatment.