COCHLEAR IMPLANT AWARENESS, EDUCATION, INFORMATION AND SUPPORT FOR ADULTS

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CI REHAB TOOLKIT


You’ve read all the stories about how life-changing cochlear implants can be for adults and now you’ve had your cochlear implant switched on, you’re waiting to hear all those sounds again and engage in conversation without missing a beat.

But hold the phone before you go dialing your nearest and dearest on a video call. A bit of practice is needed to train your brain to understand and interpret all these sounds you may not have heard for a while. While your new cochlear implant provides access to sound, understanding takes more than just hearing.

This is why rehabilitation is so important: your brain has to attach meaning to the sound signals it is now receiving. How your brain first interprets these when you are switched on is different for everyone and is dependent on your hearing history and physiology. Some people say the sounds seem robotic when they were initially switched on, but it quickly changed as their brains adapted.

How you progress during rehab isn’t apples for apples so it’s unfair to compare your hearing journey and experience with someone else. This is uniquely you with practice and patience becoming your newest virtues. The rehab team at the cochlear implant programme will work closely with you to develop a plan tailored to your hearing needs.

Be open and honest with them as in addition to tailoring listening exercises to suit you, they can suggest assistive listening devices to promote better hearing at home, work, and in the community, including devices that connect the CI to sound sources such as a computer or tablet, TV, sound system in theaters or other venues, or the telephone.

As you progress, your mapping sessions will be adjusted to provide you with louder clearer sounds.

As well as your rehab plan, there are listening exercises and activities that you can do in everyday situations to help and we have compiled some ideas for you. Remember to pace yourself too, as all the listening effort may make you fatigued.

 

What is a cochlear implant?

During those first few weeks at home after your switch on, it is the perfect opportunity get used to wearing your CI and to start listening and identifying the sounds around your home and outdoors.

Keep an ear out for the differing noises your appliances make: the humming of the fridge; the spin of the washing machine; the kettle boiling; microwave pinging, the doorbell ringing.

Some other common noises you can try identifying at home and outdoors are:

 

INDOORS:

  • Emptying the dishwasher and the different sounds of plates, pans and cutlery.
  • Making a cup of tea, pouring the water, clinking of the spoon against the cup.
  • Vacuuming the house and the different sounds of the floor coverings.
  • Typing on the computer and the noise of the keystrokes.
  • Doors opening and closing.
  • Footsteps through the house.
  • The shower running (making sure you take your processor off before you get in).
 

OUTDOORS:

  • Leaves rustling in the trees.
  • Birds singing and tweeting.
  • A dog barking or cat meowing.
  • Waves crashing onto the beach.
  • Cars driving down the road.
  • Beeping of pedestrian crossing lights.

Were some of these easier or harder than others? What challenges did you face?

It can be helpful to keep a listening diary to make a note of the sounds you found easy to pick up, and the more challenging ones. Note the times of day too- are you finding it harder to hear and understand when you are tired? Does it get easier after you’ve had a rest?

All this information is good to help you track your progress, especially on the days when you find the going tough. It can remind you how far you have come and to be easy on yourself.

 

There are a number of things that you can do at home to help your speech recognition.

First up, is talking to yourself. Might sound a bit silly, but it is a good way to get used to your own voice after switch on, which may of sounded a bit strange at first.

Take every opportunity to read aloud to yourself, from reading the news on your device or that new book you’ve been waiting for from the library. This will help you recognize the sound of the words you speak as well as your own voice.

The new CI processors also have Bluetooth technology, enabling you to stream audio from your TV, Smartphone, Computer and some radios, straight to your CI. This helps tremendously with clarity of sound and speech when watching your favourite show or listening to a podcast. If you have any trouble connecting your CI processor to your devices via Bluetooth, ask your rehab team, hearing therapist or techno savvy family member or friend to help you.

The best way to train your brain with watching and listening to shows is to start with the cheat sheet (a show you know or has captions). The good thing these days if you are a subscriber to a global streaming service such as Netflix, Prime, Disney+ or AppleTV, all their shows are captioned (they have to be by law).

Streaming the audio straight to your processor, sit back, guilt free, on a relaxing Sunday morning for a binge fest of your favourite Netflix show, all in the name of rehab. To start, have the captions on to help you identify and understand the dialogue, but as you grow more confident in your hearing ability, switch them off.

After you’ve mastered watching your show without the help of captions, why not challenge yourself to listening to an audiobook? To help, you can follow along by having the book text in front of you.

Next up, try listening to a podcast or a radio interview; 9 to Noon with Kathryn Ryan, Afternoons with Jesse Mulligan or Saturday Morning with Kim Hill all feature good interesting topics and are worth a listen. Whose voice are you most used to?
 

Try video calling them and see how you get on. Having the visual cues as well as a familiar voice makes video calling a tad easier then a voice call.

A few more helpful hints when video calling are:

  • Make sure the caller’s back is not facing the sun, as this can cast a shadow over their face making their lips hard to see.
  • Ensure both of you are someplace quiet to limit background noise.
  • If a caller wears a headset, their voice will also be clearer.

When you feel confident with video calling, try a voice call. Use simple sentences to start with, progressing onto more in depth conversations as you can.

 

You’ve been invited to your first social get together since you had your implant, and you’re feeling a tad nervous about not being able to follow the conversation in a potentially noisy environment. This is only natural given your previous experiences. But there are a few things you can do to make it easier.

When chatting to someone new, a friendly heads up to them that you are a cochlear implant user. You can advise them that it’s helpful for you to see their faces and if in a group, to speak one at a time, not all at once. Also position yourself where there is good lighting and easiest for your processor to pick up sound. If you are in a noisy room, try and have your back to a wall or away from the sound source.

Settings on your processor and accessories help too, such as forward focus on Cochlear Ltd processors and use of their mini-mic, which can be placed in the center of a table or worn on a speaker’s top (similar to a TV presenters lapel mic).

Sometimes, these strategies don’ t work and you have to ask someone to communicate in a way that makes things easier for you. There is a way of doing this so others don’t feel they are doing something wrong.

A few ideas are:

“My cochlear implant helps me a lot, but in noisy environments, it is still a struggle. Can we move someplace a bit quieter please?”

For the person who keeps touching their face, try:

“Sorry Nick, can I ask you to lower your hands, thank you. This makes it easier for me to lipread and follow what you are saying.”

For the person who thinks they need to shout, try:

“Thank you for trying to help. My implant is programmed to make speech loud enough for me to understand, what’s important is clarity. Just speaking as you normally would is the best thing.”

If you’re not sure what was said, ask:

“I’m not sure I picked that up correctly, did you say…?”

 
 

Communication is at it’s best when people understand each others needs, so be open and honest about your hearing with colleagues.

If you’ve just recently had your implant, let them know you are still adjusting and learning new sounds every week, so as colleagues to be patient if you misunderstand something in those early days. Here are some tips and advice on how they can help you:

  • Talking normally and clearly while facing you.
  • Speaking one at a time in-group meetings.
  • Conducting meetings in quiet rooms.
  • Requesting agendas/reports ahead of meetings.
  • Having a note taker at meetings so you can read up post meeting incase you missed something.

There are assistive devices that can also help at work, such as:

  • Mini-mic or phone clips can be placed in the middle of a conference table or attached to the presenter in meetings to stream the audio direct to your processor.
  • If your processor has streaming capabilities through Bluetooth, you can place your smartphone in the middle of the conference table to record the meeting. Later, you will be able to stream the audio to check you didn’t miss anything.
  • iPhones have a Live Listen option, acting like a mini-mic, whereby placing your iphone in the middle of the group, the audio will be streamed directly to your processor, helping with speech clarity.
  • Download live captioning apps to your SmartPhone to use in meetings to help follow the conversation.
  • Video conferencing platforms, such as ZOOM, come with live captioning options, which can be turned on. Note to the wise- with varying accents, the words that pop up on screen may not be the words spoken. Be rest assured the presenter did not say rude words!

Listening effort can be tough and make you fatigued. It is best to talk to your manager and have a plan for taking regular short breaks to recharge if needed.

The above tips and advice are very office centric, and may not apply to your work environment.

There are things that can be done to help in none-office situations, such as:

  • Ask your CI specialists or rehab team to set your processor onto the ForwardFocus or SmartSound IQ SCAN settings, which can help in challenging listening situations.
  • Use the mini-mic to help in noisy environments such as hair salons, kitchens or factories to stream audio direct to your processor.
 

It’s exciting to be going on a trip, and now you have your new CI, you don’t want to go off air and miss out on anything. So here are some tips and advice for travelling with your cochlear implant.

  • Take a note of the closest cochlear implant center to where you are visiting and takedown their contact details.
  • Ask your CI team for a copy of your most recent MAP settings.
  • Insurance – make sure your processor is covered for loss, damage or theft.
  • Bring your patient ID cards (handy for security screenings at airports and info about MRI’s).

Important things to brings with you include:

  • Back up sound processor with spare coil and cables.
  • Wireless devices and accessory cables.
  • International plug adapters
  • Care and maintenance accessories
  • Waterproof accessories; such as thee Aqua+ processor cover.
 

If you are flying, here is another few pointers to make the trip hassle free.

  • Check with the airline about packing your batteries in your luggage.
  • At airport screening, show your Patient ID card to let personnel know you have a hearing loss and are a CI user.
  • Scanners do not affect your implant so you can wear them, although you may hear a buzzing sound when you pass through the scanner.
  • If you do get asked to remove your implants, do not pass them through the conveyer as these can interfere with the MAP settings on your processor.
  • If you have a mini-mic, connect its cable into the inflight entertainment audio socket to stream sound direct to your processor.
 

Music has a tremendous influence on our lives, from childhood lullaby’s, teenage dance crazes, traditional and cultural songs and celebrations. It forms an integral part of who we are. Hearing loss can rob us of much of that enjoyment, with many hoping that a cochlear implant will restore their ability to hear music again.

Cochlear implants are primarily designed for speech clarity, with music containing complex compositions of tones, tempos, pitch and lyrics, which is challenging for a CI processor to match in ability, that of our natural hearing.

There are things that can be done to help improve and optimize your experience with music over time. First up…

SOME MUSIC PERCEPTION FUNDAMENTALS

Cochlear implant recipients have a range of pitch discrimination outcomes but in general, it is limited. This impacts our perception of music. However, many CI users can perceive melodic contour correctly and have near normal rhythm perception, but their timbre perception is often poor. Understanding lyrics is usually challenging, but music memory for songs and their lyrics can prove helpful in listening enjoyment. Some tips for helping with your music perception:

CHOOSE SONGS WITH CARE

  • Keep it simple to start with- such as songs you know well played on one or two instruments.
  • Familiar songs or music selections that you know from before your hearing declined will be easier to follow.
  • Music with a strong beat (e.g., rock, rap, hip hop, country) may be easier to perceive.
  • Selections that are not overly “complicated” or noisy may sound better. Fewer instruments may help.
  • Create playlists with your favourite music to listen to.
  • Start with simple melodies with fewer instruments, building to more complex compositions as your music perception improves.

MAKE THE SOUND AS CLEAR AS POSSIBLE

  • Listen in a quiet environment with limited reverberation.
  • Avoid competing background sounds or noise.
  • tream the audio direct to your processor via Bluetooth if possible.
  • Avoid listening to music through in-built laptop speakers, as they tend to distort the music.
  • CKeep the volume down at a moderate level to begin with.

OBTAIN THE LYRICS

  • Most of us have difficulty understanding lyrics in unfamiliar music.
  • Download the lyrics and try following along by reading the words.
  • Watch a music video so you have the visual clues such as the singer’s face.
  • Listening repeatedly to songs may make the words more accessible.

TRY DIFFERENT SETTINGS ON YOUR PROCESSOR

  • Try the setting designed for noise.
  • Compare the noise setting to your usual setting (if different).
  • If using a hearing aid on the contralateral ear, wearing it while listening to music may help with melody.

PRACTICE

Like other auditory training, repetition helps “train your brain.”

  • Start out with short 10 minute sessions, building up to longer
  • Start by watching music videos with captions
  • Watch live music performances
  • As your confidence builds, listen to songs without video
  • Listen to new music
  • Pick up an instrument again and start playing.

The University of Southampton have developed an online music rehabilitation toolkit for cochlear implant users called More From Music. To check it out visit:

https://morefrommusic.org/

Remember to maintain realistic expectations as the 22 electrodes of your cochlear implant can’t quite convey the range of tone and pitch that 30,000 hair cells can within your cochlea. Music will sound different but through listening practice, most CI users can enjoy music again.