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104-464: He led the cochlear implant team at UCSF, which transferred its technology to Advanced Bionics, and their version is the Clarion cochlear implant. He collaborated with Bill Jenkins and Gregg Recanzone to demonstrate sensory maps are labile into adulthood in animals performing operant sensory tasks. He collaborated with Paula Tallal, Bill Jenkins, and Steve Miller to form the company Scientific Learning. This

208-400: A TED talk titled “Growing evidence of brain plasticity” which outlines the basic findings of his research. Merzenich has helped to identify two distinct periods of brain plasticity: The Critical Period and the period of Adult Plasticity. The Infant Critical Period is when a child’s brain establishes neural processes for the stimuli to which it is presented. The Adult Plasticity period is when

312-409: A cochlear implant. Prolonged duration of deafness is another factor that is thought to have a negative impact on overall speech understanding outcomes for CI users. However, a study found no statistical difference in the speech understanding abilities of CI patients over 65 who had been hearing impaired for 30 years or more prior to implantation. In general, outcomes for CI patients are dependent upon

416-549: A cross-species analysis of the cochlear nucleus in large game cats and pinnipeds, did the first auditory cortical microelectrode maps in the macaque with John Brugge, and the first somatosensory maps in the macaque with neurosurgeon Ron Paul. He earned his neurophysiology fellowship between 1968 and 1971. He left Wisconsin to join the faculty at UCSF as the only basic scientist in the clinical Otolaryngology department, head and neck surgery. Merzenich started with UCSF in 1971 as faculty member becoming full professor in 1980. Merzenich

520-416: A manner consistent with the research-base. Practitioners claim to be responsive to each individual's dominant open sensory channel, the "basic features of training" to not appear to be distinctively different across the channels. Studying RPM's efficacy is made difficult by policies that prevent videotaping of RPM sessions (even of one's own child) and instructional workshops. Jaswal et al. also continued

624-534: A part of their identity, a majority either do "not really think about" their hearing loss, or are "proud of it." Though advancements in cochlear implant technology have helped patients in their understanding of language, users are still unable to understand suprasegmental portions of language, which includes pitch. A study by Johns Hopkins University determined that for a three-year-old child who receives them, cochlear implants can save $ 30,000 to $ 50,000 in special-education costs for elementary and secondary schools as

728-754: A patent for the cochlear implant; Kissiah later sold the patent rights. The modern multi-channel cochlear implant was independently developed and commercialized by two separate teams—one led by Graeme Clark in Australia and another by Ingeborg Hochmair and her future husband, Erwin Hochmair in Austria, with the Hochmairs' device first implanted in a person in December 1977 and Clark's in August 1978. Cochlear implants bypass most of

832-452: A range of assistive listening devices (ALDs), which help people to hear better in challenging listening situations. These situations could include talking on the phone, watching TV or listening to a speaker or teacher. With an ALD, the sound from devices including mobile phones or from an external microphone is sent to the audio processor directly, rather than being picked up by the audio processor's microphone. This direct transmission improves

936-537: A reducing incidence. To avoid the risk of bacterial meningitis, the CDC recommends that adults and children undergoing CI receive age-appropriate vaccines that generate antibodies to Streptococcus pneumoniae. The rate of transient facial nerve palsy is estimated to be approximately 1%. Device failure requiring reimplantation is estimated to occur 2.5–6% of the time. Up to one-third of people experience disequilibrium, vertigo, or vestibular weakness lasting more than one week after

1040-743: A reduction in some of the behavioral issues associated with autism. As noted by Stuart Vyse , although RPM differs from facilitated communication in some ways, "it has the same potential for unconscious prompting because the letter board is always held in the air by the assistant. As long as the method of communication involves the active participation of another person, the potential for unconscious guidance remains." Critics warn that RPM's over-reliance on prompts (verbal and physical cuing by facilitators) may inhibit development of independent communication in its target population. As of April 2017, only one scientific study attempting to support Mukhopadhyay's claims of efficacy has been conducted, though reviewers found

1144-481: A return on investment of 1.46 dollars. This rises to a return on investment of 4.09 dollars in an upper-middle-income setting. A study in Colombia assessed the lifetime investments made in 68 children who received cochlear implants at an early age. Taking into account the cost of the device and any other medical costs, follow-up, speech therapy, batteries and travel, each child required an average investment of US$ 99 000 over

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1248-538: A single channel. William House also invented a cochlear implant in 1961. In 1964, Blair Simmons and Robert L. White implanted a single-channel electrode in a patient's cochlea at Stanford University. However, research indicated that these single-channel cochlear implants were of limited usefulness because they cannot stimulate different areas of the cochlea at different times to allow differentiation between low and mid to high frequencies as required for detecting speech. NASA engineer Adam Kissiah started working in

1352-461: A stand instead of it being held by the assistant or putting a blindfold on the assistant) were not utilized. Accordingly, to date, RPM proponents, by resisting participation in studies, have failed to produce methodologically sound, evidence-based studies demonstrating that RPM provides people with autism and other developmental disabilities a reliable and independent method for communicating. Critics of RPM are concerned that, sometimes even on

1456-489: A telecoil. Implantation of children and adults can be done safely with few surgical complications and most individuals will undergo outpatient surgery and go home the same day. Occasionally, the very young, the very old, or patients with a significant number of medical diseases at once may remain for overnight observation in the hospital. The procedure can be performed in an ambulatory surgery center in healthy individuals. The surgical procedure most often used to implant

1560-611: A valuable and cost effective health intervention, insurance coverage has expanded to include private insurance, Medicare , Tricare , the VA System, other federal health plans, and Medicaid . In September 2022 the Centers for Medicare & Medicaid Services expanded coverage of cochlear implants for appropriate candidates under Medicare. Candidates must demonstrate limited benefit with appropriately fit hearing aids but with criteria now defined by test scores of less than or equal to 60% correct in

1664-480: A wide range of variation across individual implant users. Factors such as age of implantation, parental involvement and education level, duration and cause of hearing loss, how the implant is situated in the cochlea, the overall health of the cochlear nerve, and individual capabilities of re-learning are considered to contribute to this variation. André Djourno and Charles Eyriès invented the original cochlear implant in 1957. Their design distributed stimulation using

1768-505: Is a pseudoscientific technique that attempts to aid people with autism or other disabilities to communicate through pointing, typing, or writing. Also known as Spelling to Communicate, it is closely related to the scientifically discredited technique facilitated communication (FC). Practitioners of RPM have failed to assess the issue of message agency using simple and direct scientific methodologies, saying that doing so would be stigmatizing and that allowing scientific criticisms of

1872-583: Is a surgically implanted neuroprosthesis that provides a person who has moderate-to-profound sensorineural hearing loss with sound perception. With the help of therapy, cochlear implants may allow for improved speech understanding in both quiet and noisy environments. A CI bypasses acoustic hearing by direct electrical stimulation of the auditory nerve. Through everyday listening and auditory training, cochlear implants allow both children and adults to learn to interpret those signals as speech and sound. The implant has two main components. The outside component

1976-677: Is also often covered in the popular press, including The New York Times , The Wall Street Journal , Time and Newsweek . He has appeared on Sixty Minutes II, CBS Evening News and Good Morning America . His work has been featured on four PBS specials and the ABC Australia documentary "Redesign My Brain" (which aired on Discovery Channel as "Hack My Brain" in the United States.) He holds nearly 100 US patents. Merzenich holds nearly 100 U.S. patents. Along with Peter B. Delahunt, Joseph L. Hardy, Henry W. Mahncke, and Donald Richards hold

2080-694: Is always important to question scientific outliers. In May 1999, Merzenich was honored by election into the National Academy of Sciences for his research on brain plasticity . He went on to be elected to the National Academy's Institute of Medicine in 2008, making him one of a very select few to have been elected to more than one of the National Academies. As of 2001, he received the Award for Distinguished Scientific Contributions. He has been awarded

2184-626: Is considered a clean procedure with an infection rate of less than 3%. Guidelines suggest that routine prophylactic antibiotics are not required. However, the potential cost of a postoperative infection is high (including the possibility of implant loss); therefore, a single preoperative intravenous injection of antibiotics is recommended. The rate of complications is about 12% for minor complications and 3% for major complications; major complications include infections, facial paralysis, and device failure. Although up to 20 new cases of post-CI bacterial meningitis occur annually worldwide, data demonstrates

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2288-434: Is consistent with medicalisation and the standardisation of the "normal" body in the 19th century when differences between normal and abnormal began to be debated. It is important to consider the sociocultural context, particularly in regards to the deaf community, which has its own unique language and culture. This accounts for the cochlear implant being seen as an affront to their culture, as many do not believe that deafness

2392-426: Is generally worn behind the ear, but could also be attached to clothing, for example, in young children. This component, the sound processor, contains microphones, electronics that include digital signal processor (DSP) chips, battery, and a coil that transmits a signal to the implant across the skin. The inside component, the actual implant, has a coil to receive signals, electronics, and an array of electrodes which

2496-512: Is given credit for co-authoring (with his mother using RPM), "two poetry books, a collection of short stories, and a book describing his sensory experience." Print sources discussing RPM and the Mukhopadhyays, include The New York Times and Scientific American , the latter of which criticized active proponents for not attempting a scientific study of the method. The August 2014 documentary film, A Mother's Courage: Talking Back to Autism ,

2600-474: Is largely credited to Soma Mukhopadhyay, who has a master's degree in chemistry and a bachelor's in education. By trial and error, Mukhopadhyay combined various behavioral and communication techniques to help her son, Tito, who has a diagnosis of autism and exhibits limited speaking abilities. Mukhopadhyay posits that autism is a manifestation in which a child's cognitive abilities are undermined by poor sensory integration abilities and that RPM serves to "activate

2704-434: Is no purposeful or systematic fading of prompts with RPM, though research-based techniques exist to support transference of prompt-reliant behaviors to "naturally occurring discriminitive stimuli". This reliance on prompts creates a dependency that, essentially, reduces independent communication and increases the chances that the facilitators are authoring the messages. In other words, "accurate responding may not occur unless

2808-408: Is placed into the cochlea , which stimulate the cochlear nerve . The surgical procedure is performed under general anesthesia . Surgical risks are minimal and most individuals will undergo outpatient surgery and go home the same day. However, some individuals will experience dizziness , and on rare occasions, tinnitus or facial nerve bruising. From the early days of implants in the 1970s and

2912-413: Is something that needs to be cured. However, it has also been argued that this does not necessarily have to be the case: the cochlear implant can act as a tool deaf people can use to access the "hearing world" without losing their deaf identity. Cochlear implants for congenitally deaf children are most effective when implanted at a young age. Children who have had confirmed severe hearing loss can receive

3016-561: Is that an untrained observer might not be able to readily recognize such subtle prompts and may mistakenly assume that prompted responses accurately reflect the true preferences, academic abilities, and emotions of the individual. Such an outcome would make RPM equally as dangerous and inhumane as facilitated communication (FC), a thoroughly debunked method that creates a powerful illusion that seems notably similar to RPM." Critics point out that there are no procedures in place to prevent students' over reliance on their facilitator. Likewise, there

3120-535: Is the electrical stimulation that explains the decrease in tinnitus symptoms for many patients, and not only the increased access to sound. A 2015 literature review on the use of CI for people with auditory neuropathy spectrum disorder found that, as of that date, description and diagnosis of the condition was too heterogeneous to make clear claims about whether CI is a safe and effective way to manage it. The data for cochlear implant outcomes in older adults differs. A 2016 research study found that age at implantation

3224-607: Is working on a broad range of behavioral therapies. Their lead product is a brain-training application called BrainHQ (TM). Merzenich is Chief Scientific Officer, and on the Board of Directors, at Posit Science. Born in Lebanon , Oregon in 1942, Merzenich grew up fascinated by science. He attended the University of Portland in Portland, Oregon earning his Bachelor of Science in 1964. Here, he

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3328-458: The Hebbian learning principles that drive neuroplasticity can be used to treat learning-language impaired children. Dr. James T. Todd, a professor of psychology, has criticized Michael Merzenich for using the term "miraculous" to describe evidence allegedly supporting the rapid prompting method , claiming that scientific outliers are hard to analyze in the laboratory and replicate. Todd says that it

3432-410: The deaf community , some of whom are pre-lingually deaf people whose first language is a sign language . Some in the deaf community call cochlear implants audist and an affront to their culture, which, as they view it, is a minority threatened by the hearing majority. This is an old problem for the deaf community, going back as far as the 18th century with the argument of manualism vs. oralism . This

3536-413: The peripheral auditory system which receives sound and converts that sound into movements of hair cells in the cochlea ; the deflection of stereocilia causes an influx of potassium ions into the hair cells, and the depolarisation in turn stimulates calcium influx, which increases release of the neurotransmitter glutamate . Excitation of the cochlear nerve by the neurotransmitter sends signals to

3640-443: The suprameatal triangle , are used. A systematic literature review published in 2016 found that studies comparing the two approaches were generally small, not randomized, and retrospective so were not useful for making generalizations; it is not known which approach is safer or more effective. With the increased utilization of endoscopic ear surgery as popularized by professor Tarabichi, there have been multiple published reports on

3744-685: The "sole study of RPM", "Harnessing repetitive behaviours to engage attention and learning in a novel therapy for autism: An exploratory analysis", published in the journal Frontiers in Psychology (2012), as proof of the method's efficacy. In 2001, Mukhopadhyay brought RPM to the United States, in conjunction with a fellowship from the Cure Autism Now Foundation, led by Portia Iversen and Jon Shestack. In 2004, Mukhopadhyay and Helping Autism through Learning and Outreach (HALO) collaborated to expand RPM's reach nationally. Mukhopadhyay owns

3848-482: The 1980s, speech perception via an implant has steadily increased. More than 200,000 people in the United States had received a CI through 2019. Many users of modern implants gain reasonable to good hearing and speech perception skills post-implantation, especially when combined with lipreading. One of the challenges that remain with these implants is that hearing and speech understanding skills after implantation show

3952-608: The Informative Pointing Method. She also wrote a book called Strange Son: Two Mothers, Two Sons, and the Quest to Unlock the Hidden World of Autism , which, as one reviewer stated, expresses her "absorbing and speculative views" on autism which are "at once compelling and controversial." Iversen spends much of the book discussing Tito's communications and documenting her own son, Dov's, introduction to RPM. Alphabet Therapy

4056-599: The International Ipsen Prize, In 2015, the National Academy of Engineering awarded Dr. Merzenich the Fritz J. and Dolores H. Russ Prize , the most prestigious award in bioengineering , for his work on cochlear implants. In 2016 he was awarded one of the world's top neuroscience prizes, the Kavli Prize , for his achievements in the field of brain plasticity. Merzenich has published more than 200 articles. His work

4160-510: The Ministry of Health or ACC (depending on the cause of deafness) in New Zealand . In Germany and Austria , the cost is covered by most health insurance organizations. 6.1% of the world population live with hearing loss, and it is predicted that by 2050, more than 900 million people around the globe will have a disabling hearing loss. According to a WHO report, unaddressed hearing loss costs

4264-538: The RPM goals of ensuring student success, may unknowingly, unintentionally, or unconsciously move the letter board to achieve the desired communication outcome. In order to point, type or write using RPM, people with disabilities rely on an aide or facilitator to give verbal or gestural prompts and/or hold a letter board during the sessions, which precludes independent communication. Prompts may include verbal reprimands, trial termination, physical redirection, slapping or shaking

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4368-553: The Rapid Prompting Method (RPM) which was used to facilitate communication for one teenage boy featured on the programme. IASLT wish to put on record our position in relation to this method - primarily our concern that there is no evidence to support its use. There is a lack of substantive research evidence demonstrating that FC and RPM are valid forms of augmentative or alternative communication ... Research studies show that facilitators consciously and/or unconsciously influence

4472-441: The United States through the end of 2019. Cochlear implantation includes the medical device as well as related services and procedures including pre-operative testing, the surgery, and aftercare that includes audiology and speech language pathology services. These are provided over time by a team of clinicians with specialized training. All of these services, as well as the cochlear implant device and related peripherals, are part of

4576-432: The aide knows the answers." Proponents assert that "prompt dependency is preferable to no response" from the subjects. With advanced computer technology capable of allowing people access to communication with eye movements, critics also question "the validity of any communication method that requires the physical help of someone else." Critics counter this assertion. Prompt dependency creates an active participation in

4680-574: The answers were "routinely inaccurate". Facilitators were (unconsciously) authoring the messages. Proponents of RPM deny similarities with FC because the aide or facilitator in RPM holds the letter board but "does not touch the person typing" and that the prompts are "nonspecific." However, critics of RPM point out that subtle cuing takes place during RPM that makes it "highly susceptible to facilitator influence." Other similarities between RPM and FC include: reluctance or refusal to test facilitator/client pairs in controlled settings (purportedly because

4784-818: The assumption being that people with autism "are likely to possess considerable hidden knowledge that they cannot express" and that prompting will address these individuals' hypothesized difficulties with motor planning and self-stimulatory behaviors. RPM is a "low-tech approach that requires only an instructor, student, paper, and pencil". As of April 2017, RPM is not recognized as a clinical profession nor does it have recognized standards for registering, licensing or certifying treatment providers. Practitioners appear to be self-taught or have participated in workshops and camps offered by Mukhopadhyay, Heather Clare (Informative Pointing), or Vanderbilt Kennedy Center Angelman Program (Alphabet Therapy). Professionals applying for RPM workshops are required to submit 10-min video samples of

4888-774: The authors found that 137 people with UHL had received a CI. While acknowledging the weakness of the data, the authors found that CI in people with UHL improves sound localization compared with other treatments in people who lost hearing after they learned to speak; in the one study that examined this, CI did improve sound localization in people with UHL who lost hearing before learning to speak. It appeared to improve speech perception and to reduce tinnitus . In terms of quality of life, several studies have shown that cochlear implants are beneficial in many aspects of quality of life, including communication improvements and positive effects on social, emotional, psychological and physical well-being. A 2017 narrative review also concluded that

4992-404: The authors were unable to show that RPM itself had a direct correlation to the behaviors exhibited by the participants or that joint attention increased as a result of its use. Correct answers were observed while students were not engaged with the activity, leading reviewers of the study to ask: "How does the client know how to answer, what the answer options are, or where the letters are located if

5096-590: The authorship question, we strongly discourage clinicians, educators, and parents of children with ASD from using RPM." RPM founder Mukhopadhyay purports to base RPM on psychological, developmental and behavioral theories put forth by Jean Piaget ( developmental psychology ) and Anna Jean Ayres ( sensory integration ), the goal of which is to "establish functional independent pointing-based communication in people who are otherwise nonverbal due to severe autism or other developmental disabilities." RPM users employ elements of Applied Behavior Analysis (ABA), but reject

5200-568: The benefit of cochlear implants in octogenarians. The effects of aging on central auditory processing abilities are thought to play an important role in impacting an individual's speech perception with a cochlear implant. The Lancet reported that untreated hearing loss in adults is the number one modifiable risk factor for dementia. In 2017, a study also reported that adults using a cochlear implant had significantly improved cognitive outcomes including working memory, reaction time, and cognitive flexibility compared to people who were waiting to receive

5304-868: The best-aided listening condition on recorded tests of open-set sentence recognition. Just as there is with any medical procedure, there are typically co-pays which vary depending upon the insurance plan. In the United Kingdom , the NHS covers cochlear implants in full, as does Medicare in Australia , and the Department of Health in Ireland , Seguridad Social in Spain , Sistema Sanitario Nazionale in Italy , Sécurité Sociale in France and Israel , and

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5408-502: The brain refines its neural processes as it masters a variety of tasks. Understanding how the brain can re-wire itself has allowed Merzenich, Tallal, and other colleagues to develop strategies intended to remediate individuals with any speech, language, and reading deficits. Through research in experience dependent learning with non-human primates, neurophysiologists including Merzenich have demonstrated that neuroplasticity remains through adulthood. Further studies with monkeys suggested that

5512-405: The brain, which creates the experience of sound. With an implant, instead, the devices pick up sound and digitize it, convert that digitized sound into electrical signals, and transmit those signals to electrodes embedded in the cochlea. The electrodes electrically stimulate the cochlear nerve, causing it to send signals to the brain. There are several systems available, but generally they have

5616-470: The child is more likely to be mainstreamed in school and thus use fewer support services than similarly deaf children. A 2019 study found that bilateral cochlear implantation was widely regarded as the most beneficial hearing intervention for acceptable candidates, although it is more likely to be performed and reimbursed in children than adults. The study also found that the efficacy of bilateral implantation could be improved by enhancing communication between

5720-525: The client is not looking at the facilitator or at the moving letter board?" The study authors postulated that "direct gaze [at the facilitator or letter board] may actually inhibit the ability to respond correctly," The authors did not investigate authorship of the communications produced during the RPM sessions. According to reviewers, RPM method does make use of concepts such as errorless learning , response interruption, and redirection. However, these behavioral intervention components are not implemented in

5824-420: The communication process. Therefore, the "potential for unconscious guidance remains". Facilitated communication, a technique in which a facilitator supports a person with disabilities at the arm, wrist or hand during the process of typing on a letter board, is closely related to RPM. Controlled studies in the 1990s determined that, when facilitators did not know the answers to questions being asked through FC,

5928-638: The course of their life (assuming a life span of 78 years for women and 72 years for men). The study concluded that for every dollar invested in rehabilitation of a child with a cochlear implant, there was a return on investment of US$ 2.07. As of 2021, four cochlear implant devices approved for use in the United States are manufactured by Cochlear Limited , the Advanced Bionics division of Sonova , MED-EL , and Oticon Medical . In Europe, Africa, Asia, South America, and Canada, an additional device manufactured by Neurelec (later acquired by Oticon Medical)

6032-881: The degree of improvement after cochlear implantation may vary, the majority of patients who receive cochlear implants demonstrate a significant improvement in speech recognition ability compared to their preoperative condition. Multiple meta-analyses of the literature from 2018 showed that CI users have large improvements in quality of life after cochlear implantation. This improvement occurs in many different facets of life that extends beyond communication including improved ability to engage in social activities; decreased mental effort from listening; and improved environmental sound awareness. Deaf adolescents with cochlear implants attending mainstream educational settings report high levels of scholastic self-esteem, friendship self-esteem, and global self-esteem. They also tend to hold mostly positive attitudes towards their cochlear implants, and as

6136-420: The device is called mastoidectomy with facial recess approach (MFRA). The procedure is usually done under general anesthesia. Complications of the procedure are rare, but include mastoiditis , otitis media (acute or with effusion), shifting of the implanted device requiring a second procedure, damage to the facial nerve , damage to the chorda tympani , and wound infections. Cochlear implantation surgery

6240-505: The documentation and evaluation procedures integral to ABA as being unnecessary and stigmatizing. Mukhopadhyay postulates that, by observing student's self-stimulatory behaviors (as in the case of autism, the "sensory preoccupations that drive and develop them"), she can identify each student's "dominant learning channel" (visual, tactile, or auditory) and individualize a program to match his or her needs. RPM facilitators "presume competence" in their (often nonspeaking) communication partners;

6344-420: The expected responses, inadequate or non-existent protocols to fade supported or facilitated prompts. RPM has been featured in several documentary and on several television news programs including: 60 Minutes II , CNN , PBS (How does the autistic brain work?), and National Geographic (Mind Tree Poems, 2005). Mukhopadhyay's son, Tito, featured prominently in a BBC Documentary, Tito's Story , and

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6448-405: The fact that the assistant voiced each word aloud after the final letter of each word was touched. Vyse also argued that the authors have not provided a compelling reason why simpler, and more direct, methods of assessing message agency (some form of message passing methodology) were not used in the study, and why simple controls that could bolster the authors' claims (e.g. placing the letterboard on

6552-501: The field of Augmentative and Alternative Communication (AAC). It is the position of the American Speech-Language-Hearing Association (ASHA) that use of the Rapid Prompting Method (RPM) is not recommended because of prompt dependency and the lack of scientific validity. Furthermore, information obtained through the use of RPM should not be assumed to be the communication of the person with a disability. While

6656-458: The first attempt at using the method, people with profound communication and/or developmental disabilities achieve levels of communication or understanding of subject matter beyond what their expected age or exposure to formal education would predict. In some cases, students, with prompting, produce results in a language other than the one he or she has been exposed, indicating facilitator, rather than student authorship. Facilitators, sympathetic to

6760-447: The following components: External: Internal: A totally implantable cochlear implant (TICI) is currently in development. This new type of cochlear implant incorporates all the current external components of an audio processor into the internal implant. The lack of external components makes the implant invisible from the outside and also means it is less likely to be damaged or broken. Most modern cochlear implants can be used with

6864-718: The hospital. Reported rates of revision cochlear implant surgery vary in adults and children from 3.8% to 8% with the most common indications being device failure, infection, and migration of the implant or electrode. Disequilibrium and vertigo after CI surgery can occur but the symptoms tend to be mild and short-lived. CI rarely results in significant or persistent adverse effects on the vestibular system when hearing conservation surgical techniques are practiced. Moreover, gait and postural stability may actually improve post-implantation. Cochlear implant outcomes can be measured using speech recognition ability and functional improvements measured using patient reported outcome measures. While

6968-663: The implant as young as 9 months old. Evidence shows that deaf children of deaf parents (or with fluent signers as daily caregivers) learn signed language as effectively as hearing peers. Some deaf-community advocates recommend that all deaf children should learn sign language from birth, but more than 90% of deaf children are born to hearing parents. Since it takes years to become fluent in sign language, deaf children who grow up without amplification such as hearing aids or cochlear implants will not have daily access to fluent language models in households without fluent signers. Rapid prompting method The rapid prompting method ( RPM )

7072-411: The individual's level of motivation, expectations, exposure to speech stimuli and consistent participation in aural rehabilitation programs. A 2016 systematic review of CI for people with unilateral hearing loss (UHL) found that of the studies conducted and published, none were randomized, only one evaluated a control group, and no study was blinded. After eliminating multiple uses of the same subjects,

7176-521: The lack of evidence from previously conducted studies does not necessarily indicate that RPM is not effective at developing communication skills and reducing stereotypic behaviors in learners with autism, use of this intervention should not be used or recommended by practitioners until the claims made can be substantiated by peer reviewed research studies. Since the broadcast of the RTE documentary ‘Autism and Me’ on March 13th 2017 there has been much discussion about

7280-481: The last several decades to less than 1%, most of which demonstrated complete return of function within six months. The rate of permanent paralysis is approximately 1 per 1,000 surgeries and likely less than that in experienced CI centers. The majority of complications following CI surgery are minor requiring only conservative medical management or prolongation of hospital stay. Less than 5% of all complications are major resulting in surgical intervention or readmission to

7384-580: The letter board against the subject's face or chest, and blocking escape by positioning the subject between the table and walls. Some of the verbal and gestural prompting procedures used in RPM are similar to the Pinchbeck Technique used by conjurers to "create the illusion of letter-by-letter communication." "It is possible that no actual academic skills are taught to participants in RPM. Instead, participants may only learn how to better follow subtle, rhythmic, and frequent prompts. The danger, of course,

7488-412: The medical intervention and are typically covered by health insurance in the United States and many areas of the world. These medical services and procedures include candidacy evaluation, hospital services inclusive of supplies and medications used during surgery, surgeon and other physicians such as anesthesiologists, the cochlear implant device and system kit, and programming and (re)habilitation following

7592-446: The message being communicated ... thereby exposing people with communication disorders to risk of harm by preventing genuine self-expression ... For these reasons, SAC members and associates should not use FC and RPM in clinical practice. RPM proponents point to one study to support their claims of efficacy: "Harnessing repetitive behaviours to engage attention and learning in a novel therapy for autism: An exploratory analysis, as proof of

7696-408: The method's efficacy". In this peer-reviewed, quantitative study using videotaped sessions of Mukhopadhyay working with clients, the study authors attempted to measure how RPM influenced participants' attention to their facilitator and the materials being presented (joint attention) and the effect of RPM on restrictive and stereotypic behaviors (RSB). Although RSBs reduced as joint attention increased,

7800-468: The mid-1970s on what would become the modern cochlear implant. Kissiah used his knowledge learned while working as an electronics instrumentation engineer for NASA. This work took place over three years, when Kissiah would spend his lunch breaks and evenings in Kennedy Space Center's technical library, studying the impact of engineering principles on the inner ear. In 1977, NASA helped Kissiah obtain

7904-467: The patent for visual emphasis for cognitive training exercises. This patent explores a computer system of visual learning. The participant observes a scene which shows at least one foreground object against a background. The background or foreground are modified to enhance the participants response to achieve a correct response in an iterative basis. Merzenich has contributed to over 232 publications. Cochlear implant A cochlear implant ( CI )

8008-495: The pattern of proponents studying the issue of agency in the use of RPM by using indirect, rather than direct (message passing) methodologies. The study found that the non-verbal (according to their reports) autistic individuals in their study (1) made anticipatory eye movements to the next letter in a word prior to touching the letter, (2) had longer pauses in their letter-touching within words than between words, and (3) were faster at touching common letter patterns in sequence than

8112-467: The procedure, got it. Further research found that the electrical stimulation of the CI is at least partly responsible for the general reduction in symptoms. A 2019 study found that although tinnitus suppression in patients with CIs is multifactorial, simply having the CI switched on without any audiological input (while standing alone in a soundproof booth) reduced the symptoms of tinnitus. This would suggest that it

8216-543: The procedure; in people under 70 these symptoms generally resolve over weeks to months, but in people over 70 the problems tend to persist. In the past, cochlear implants were only approved for people who were deaf in both ears; as of 2014 a cochlear implant had been used experimentally in some people who had acquired deafness in one ear after they had learned how to speak, and none who were deaf in one ear from birth; clinical studies as of 2014 had been too small to draw generalizations. Other approaches, such as going through

8320-472: The process breaks the trust between the pair), presumed competence, reliance on anecdotal accounts as proof of efficacy, maintenance of practices, techniques and claims that are inconsistent with the known body of work around the behavior and communication skills of individuals with developmental disabilities or proven remediation techniques, claims of extraordinary literacy or intellectual breakthroughs, unconscious verbal or physical cuing by facilitators to obtain

8424-442: The quality of evidence to be poor and the results variable: overall total tinnitus suppression rates for patients who had tinnitus prior to surgery varied from 8% to 45% of people who received CI; decrease of tinnitus was seen in 25% to 72%, of people; for 0% to 36% of the people there was no change; increase of tinnitus occurred in between 0% to 25% of patients; and, in between 0 and 10% of cases, people who did not have tinnitus before

8528-494: The quality of life scores of children using cochlear implants were comparable to those of children without hearing loss. Studies involving adults of all ages reported significant improvement in QoL after implantation when compared to adults with hearing aids . This was often independent of audiological performance. As of October 2010, approximately 188,000 individuals had been fitted with cochlear implants. As of December 2012,

8632-468: The reasoning part of the brain" and, therefore, distracts the student into learning. Proponents of RPM and related techniques claim to be able to help people with disabilities express untapped intellectual abilities and advance communication skills through a system of pointing, typing, or writing with verbal and physical prompts from a facilitator. This is, purportedly, "the most direct and unlimited path to learning and communicating." RPM proponents point to

8736-534: The same publication cited approximately 324,000 cochlear implant devices having been surgically implanted. In the U.S., roughly 58,000 devices were implanted in adults and 38,000 in children. As of 2016, the Ear Foundation in the United Kingdom, estimates the number of cochlear implant recipients in the world to be about 600,000. The American Cochlear Implant Alliance estimates that 217,000 people received CIs in

8840-546: The sound of paper tearing), verbal (i.e. spoken directives), and visual (i.e. gestures by the facilitator). Choices move from two, three, to four and so on, with increased difficulty. The student progresses from making choices, to spelling on a letter board held by the facilitator, to spelling on a letter board (flat on a table or held by the student) or voice-output device, independently. The rapid prompting method (also known as RPM, Rapid Prompting, Soma®RPM, Informative Pointing, Spelling To Communicate (STC) and Alphabet Therapy)

8944-418: The sound quality for the user, making it easier to talk on the phone or stream music. ALDs come in many forms, such as neckloops, pens, and specialist battery pack covers. Modern ALDs are usually able to receive sound from any Bluetooth device, including phones and computers, before transmitting it wirelessly to the audio processor. Most cochlear implants are also compatible with older ALD technology, such as

9048-439: The student with a concept (i.e., The chair is yellow), then immediately follows up with a question (i.e., "What color is the chair?"). The student is then given prompts (i.e., two pieces of paper, with choices written on each) to represent the answer. This procedure is repeated, using a combination of prompts provided by the facilitator to elicit a response. Prompts may include physical (i.e. words written on paper), auditory (i.e.

9152-504: The study had serious methodological flaws. Vyse has noted that rather than proponents of RPM subjecting the methodology to properly controlled validation research, they have responded to criticism by going on the offensive, claiming that scientific criticisms of the technique rob people with autism of their right to communicate, while the authors of a 2019 review concluded that "...until future trials have demonstrated safety and effectiveness, and perhaps more importantly, have first clarified

9256-444: The surgery. In many countries around the world, the cost of cochlear implantation and aftercare is covered by health insurance. However, financial factors impact the evaluation selection process. Children with public health insurance or no health insurance are less likely to receive the implant before 2 years old. In the US, as cochlear implants have become more commonplace and accepted as

9360-404: The technique robs people with autism of their right to communicate. The American Speech-Language-Hearing Association has issued a statement opposing the practice of RPM. Soma Mukhopadhyay is credited with creating RPM, though others have developed similar techniques, known as informative pointing or alphabet therapy. RPM users report unexpected literacy skills in their clients, as well as

9464-641: The trademark for RPM. In 2005, Mukhopadhyay moved from California to Austin, Texas, where she established the Halo-Soma Institute. There, she provides clinical services, offers workshops and promotes RPM internationally. Evaluation research is not conducted by the institute. Mukhopadhyay is the author of Rapid Prompting: an Instructional Guide, Understanding Autism through Rapid Prompting (2008) and Curriculum Guide for Autism Using Rapid Prompting Method: with Lesson Plan Suggestions (2011). After some initial collaboration with Mukhopadhyay, Iversen developed

9568-401: The two implants and by developing sound coding strategies specifically for bilateral users. Early research reviews found that the ability to communicate in spoken language was better the earlier the implantation was performed. The reviews also found that, overall, while cochlear implants provide open-set speech understanding for the majority of implanted profoundly hearing-impaired children, it

9672-547: The use of endoscopic technique in cochlear implant surgery. However, this has been motivated by marketing and there is clear indication of increased morbidity associated with this technique as reported by the pioneer of endoscopic ear surgery . As cochlear implant surgical techniques have advanced over the last four decades, the global complication rate for CI surgery in both children and adults has decreased from more than 35% in 1991 to less than 10% at present. The risk of postoperative facial nerve injury has also decreased over

9776-411: The use of rapid prompting, a resume, and a letter explaining the "reason for wanting to attend course". RPM literature indicates that, along with autism , the technique has been tried with people who have Fragile X syndrome , blindness , deafness , Angelman syndrome , Down syndrome , Williams syndrome , and Prader-Willi syndrome . Beginning with a "teach-ask" protocol, the facilitator presents

9880-427: The world 980 billion dollars annually. Particularly hard hit are the healthcare and educational sectors, as well as societal costs. 53% of these costs are attributable to low- and middle-income countries. The WHO reports that cochlear implants have been shown to be a cost-effective way to mitigate the challenges of hearing loss. In a low-to-middle-income setting, every dollar invested in unilateral cochlear implants has

9984-466: Was valedictorian , receiving only one non-A, a C in a philosophy course in which he argued with the instructor. In 1968 he earned his PhD in Physiology at Johns Hopkins Medical School in the lab of Vernon Mountcastle , studying neural coding of stimulus magnitude in the hairy skin. He left Johns Hopkins to conduct his postdoctoral studies at the University of Wisconsin under Jerzy Rose. There, he did

10088-712: Was Co-Director at the Coleman Memorial Laboratory where he conducted research on the cerebral cortex . He was also the Francis A. Sooy Chair of Otolaryngology , in the Keck Center for Integrative Neurosciences at UCSF. His research examines neurological illness, learning processes and the neurological processes of the cerebral cortex. He remains in the same department, now as a professor emeritus , retiring in 2007. Merzenich has collaborated in numerous studies researching brain plasticity. In February 2004, Merzenich gave

10192-643: Was adapted from a 2009 Icelandic film entitled Solskinsdrengurrin (The Sunshine Boy) by Margrét Dagmar Ericsdóttir and Friðrik Þór Friðriksson. The film follows Margret, an Icelandic woman, in her quest to find answers for her 11-year-old son who is severely impaired. Her search leads her to Austin, TX, Mukhopadhyay and RPM. RPM was featured in an Apple Inc. commercial, which led to criticism of Apple for promoting pseudoscience. Critics of this type of media attention point out that these programs portray autism as "mysterious in nature", offer anecdotal evidence (i.e., Tito's poetry) as proof that RPM works, and downplay

10296-438: Was available. A device made by Nurotron (China) was also available in some parts of the world. Each manufacturer has adapted some of the successful innovations of the other companies to its own devices. There is no consensus that any one of these implants is superior to the others. Users of all devices report a wide range of performance after implantation. Much of the strongest objection to cochlear implants has come from within

10400-613: Was based on Fast ForWord software they co-invented that produces improvements in children's language skills that has been related to the magnitude of their temporal processing impairments prior to training, though the program's effectiveness is disputed. Merzenich was director and Chief Scientific Officer of Scientific Learning between November 1996 and January 2003. Merzenich took two sabbaticals from UCSF, in 1997 and 2004. In 1997 he led research teams at Scientific Learning Corporation, and in 2004 at Posit Science Corporation . Currently, Merzenich's second company, Posit Science Corporation,

10504-488: Was developed and is promoted by Vanderbilt University and focuses specifically on people with Angelman Syndrome. The Board of Directors concludes that rather than helping people express their thoughts, desires, and choices, FC and RPM have the potential to effectively take away people's voices. This is due to the risk of facilitator influence/authorship as well as the potential to displace efforts to access scientifically valid communication modes, such as those associated with

10608-676: Was highly correlated with post-operative speech understanding performance for various test measures. In this study, people who were implanted at age 65 or older performed significantly worse on speech perception testing in quiet and in noisy conditions compared to younger CI users. Other studies have shown different outcomes, with some reporting that adults implanted at the age of 65 and older showed audiological and speech discrimination outcomes similar to younger adults. While cochlear implants demonstrate substantial benefit across all age groups, results will depend on cognitive factors that are ultimately highly age dependent. However, studies have documented

10712-798: Was not possible to accurately predict the specific outcome of the given implanted child. Research since then has reported long-term socio-economic benefits for children as well as audiological outcomes including improved sound localization and speech perception. A consensus statement from the European Bilateral Pediatric Cochlear Implant Forum also confirmed the importance of bilateral cochlear implantation in children. In adults, new research shows that bilateral implantation can improve quality of life and speech intelligibility in quiet and noise. A 2015 review examined whether CI implantation to treat people with bilateral hearing loss had any effect on tinnitus . This review found

10816-414: Was the case for less common letter patterns. Based upon these indirect indices of message agency, it was concluded that the autistic individuals, rather than the assistants who held the letter boards, were the agents of the messages. Vyse, however, argued that none of these findings provides clear evidence regarding message agency. For example, the longer pauses between words could simply have resulted from

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