Simply having a cochlear implant alone doesn’t guarantee good hearing. It takes a lot of effort in the year after the surgery to re-teach your brain to hear – a process known as rehabilitation.
Rehabilitation is crucial after a CI operation
“I don’t know. I don’t think it will work,” says Josef Vorauer gloomily when asked how he’s getting on with his practice at home. He is just back from a hearing test, accompanied by Lisa Niederwanger, a speech therapist in the ENT department at the Wels- Grieskirchen Clinic, Austria.
The 75-year-old received a cochlear implant (CI) in his left ear in February 2014. He needs rehabilitation in order to get used to the implant and to learn to hear well again, but he hasn’t been for quite a while now, after having initially attended auditory training in the ENT department every other week. After a longish pause, the speech therapist checks the results of his hearing test in order to set the most appropriate exercises for him.
Such moments of resignation are common with CI rehabilitation. Patients’ expectations are usually very high. Although doctors, speech therapists and technicians explain that it can take up to a year before you can understand speech in difficult situations such as on the telephone or in noisy environments, everyone secretly hopes it will happen sooner for them. “Don’t give up. You’ve already achieved so much,” the speech therapist says encouragingly before she starts with the auditory training. “You always give me hope,” answers Josef, with a sigh.
During the auditory training, the speech therapist reads words, sentences and numbers and lets Josef repeat them. Because he can still hear in his right ear, it is covered by a loud random noise through an earphone. This way, just the deaf ear is being trained. She makes it extra hard by holding a fan in front of her lips while reading so Josef can’t cheat by lip-reading. He can’t understand the first words, ‘teddy bear’, even without the fan in front of her lips. Only once the random noise is turned off, does he understand.
“There are many ways to make the exercises more complex,” says Dr Vanessa Hoffmann, Rehabilitation Manager at MED-EL in Germany, where she prepares documentation, CDs and other supportive material for rehabilitation. She explains that it makes a big difference whether a patient works in a ‘closed set‘ or an ‘open set’. In a closed set, the patient knows the topic; in an open set, the content of the topic isn’t narrowed down. “An open set is a lot more difficult,” says Vanessa Hoffmann.
Sense of achievement
During rehabilitation and even during single exercise sessions, both principles are used. For Josef, the open set is still too difficult, so Niederwanger switches to the closed set and tells him the word ‘teddy bear’ occurs in the following sentences. Quick as a shot, he repeats the first sentence: “Lisa gets a teddy bear.” The achievement motivates him so much that he gets all the next sentences right.
The speech therapist has given Josef a confidence boost and from now on, the rest of the session goes well, with only a few hiccups and concentration lapses. In the same way, in everyday life, having the support of others, especially family and friends, can speed up progress. With children who are born deaf, the help of their parents is crucial. Donna Sperandio, Head of Rehabilitation at MED-EL in Austria, gives an example: “To get the attention of their child, the parents used to touch them or wave their hands. After surgery, they must stop this and call out the child’s name first.”
“There’s a long list of factors that can influence success,” says Vanessa Hoffmann. This includes the type of deafness, when it started and how long the person has been deaf. “Most adults became deaf at some point,” says Donna Sperandio. “The longer the deaf phase, the more difficult the rehab process because the brain will have changed during this time.” But support from family, friends and other social contacts is at least as important as self-motivation. And if all these criteria are fulfilled? “Even then, going to auditory training once a week for 45 minutes is not enough,” says Vanessa Hoffmann.
Just like learning a language or playing a musical instrument, success comes with practice – in everyday life as well as with tutorial CDs and textbooks at home. It takes a lot of patience and every little progress should be celebrated. A milestone has been reached, not just when the speech therapist praises the patient, but when the patient starts to be proud of his achievement. Josef Vorauer seems like a different person after hearing 88 instead of 48 and seal instead of luck. He beams: “Practice makes perfect.”
For more information about rehabilitation, check out the 'Rehab At Home' section in MED-EL's blog