Cochlear implant rehabilitation

A range of skills

Consider the range of skills needed to use the telephone. Many cochlear implant users find that they can use the phone for some purposes. It is unusual to be able to use the phone for all of these levels:

1. Listening to a dial tone / engaged tone / ringing tone.
2. Listening to an answer phone and leaving a message (recognising the end of recorded speech and the signal tone).
3. Listening to a pre-recorded announcement e.g. speaking clock, 1471.
4. Making an emergency call.
5. Calling a familiar voice [friends / family].
6. Taking a call from a familiar voice.
7. Calling a stranger.
8. Taking a call from a stranger.
9. Dealing with automated voice menus.

Practice does help to gain confidence to move from one level of listening to another.

Remember it takes TIME to learn to use the phone with an implant.

Technical tips

Caller display

Some phones display the caller’s number. This can help you anticipate the caller’s identity.

Streaming

All processors have the ability to stream directly to your implant using Bluetooth technology. Streaming provides the clearest sound on the phone. Your rehabilitationist can support you with setting this up.

T switch

If you do not have a Bluetooth enabled phone, you could check if your phone has an inductive loop or T setting. If so, this could be used in conjunction with some types of implant processors. (Not all processors are set up to receive sound with a T setting. Ask your audiologist for information.) Some CI users find that the sound is clearer through a T setting; others report little additional benefit.

Positioning

Positioning the handset to your head (if using the phone receiver to your ear). Ask advice from your clinician if needed. The microphone on the processor should be positioned to the earpiece of the phone. For processors with a microphone sitting above the ear, this means holding the phone a little higher than your ear. A cushion can support your elbow to maintain this position as needed.

Hands-free speaker

Some CI users use a hands-free phone and listen through the loudspeaker function. This means no holding the phone but the sound may not be as clear.

Strategies

Prediction

The key idea is that when we can predict what the other person will say, it helps us to hear and understand their response.

You can increase prediction by:

• Phrasing the question for a specific answer:

E.g. Shall I meet you at 6.30 or 7.30? [instead of "what time shall we meet?"]

• Ask yes / no questions

E.g. Did you say 6.30? [ instead of "what time did you say?"]

Control the topic

Steer the conversation. The cochlear implant user making a call can often ask the questions. At the outset maybe explain that you are doing this to help you hear better.

State your topic clearly.

Ask the speaker to state their topic clearly. They may need to tell you when they change the topic.

Repairing misunderstandings

Spelling words: When you don’t hear an unfamiliar word, use a spelling code to help you decode the word. E.g. A for alpha, b for bravo [see practice ideas]

Numbers: When you don’t hear a number e.g. 740: For each digit in turn, ask the speaker to count from one to nine and stop at the target number. You can confirm the digit by asking for a yes / no response.

Words: "Please describe that in different words" / "Please give me other clues" / "I heard up to the word…..I think you said…."

Set the pace

If you, the cochlear implant user, talk steadily and not too fast, the other speaker may well imitate you.

You can also make a direct request such as

"Please talk (more) clearly"

"Please talk slowly"

"Please talk normally"

"Please do not shout"

Encourage the speaker to speak well

If you want them to modify their speaking behaviour, they need to know why and they need to know what you need:

"I am still deaf, but I can hear sound on the phone with my cochlear implant"

"The CI helps me best when you talk slowly and clearly"

"If you shout the CI does not send clear sound"

"It is easier for me when you have one main idea per sentence"

"Please keep your sentences short and on the topic"

"Please tell me when you change the topic. Being deaf, I may not catch any sudden changes of topic"

Praising others

They may also respond well to praise (to reinforce this new behaviour):

"It was very helpful when you slowed down just then"

"I could hear you well today, and I didn’t have to ask you to repeat. Thank you for making it easier for me"

"I really liked it when you changed the sentence round. You found words that were easier to hear. Thank you"

"When you talk like that, it is really clear. That’s great. Can you do that next time too please?"

1. Start with music you know very well. Your memory for the music will help your listening.
2. Choose music carefully. Some pieces have instruments which are very clear and separate. Other pieces have a blend / mix of instruments which is harder for you as a listener. It can be hard to pick out the different instrument sounds. Go for music with a few instruments only and ones which are quite different. Slower music is likely to be easier at first.
3. Use the words of the songs written out (most can be found via an internet search engine). Follow the lyrics as you listen. Get someone else to listen with you and show you where you are in the song.
4. Use visual information where possible, e.g watch the music video (use YouTube.com), or attend live music events.
5. Listen to male and female singers. Which is easiest?
6. Try plugging in directly to the sound (rather than playing through speakers). E.g. Use wireless streaming or the plug in cable to access music stored on your phone / tablet / computer. Only you hear the music, not anyone else.
7. Keep listening to the same piece more than once. You may find it gets better.
8. Experiment with different types of music. You may find your tastes change.