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Implant cochléaire

Intensive functional rehabilitation

Mots clefs

"cochlear implant rehabilitation", IFR, "Intensive functional rehabilitation", "post-implant follow-up", rehabilitation

Description

Français


Duration :

  • IFR is 12 weeks long for children.

  • The child must be accompanied by at least one parent. Parental involvement is essential in helping the child transfer the skills he/she learned in therapy to activities of everyday life.  

  • For adults, the duration varies. The IFR can last up to a maximum of 10 weeks depending on the rate of the development of auditory skills and the achievement of rehabilitation goals.

 

Required IFR services identified by the Comité sur le cadre structurant (a committee established by the Ministry of Health and Social Services) : 


Minimum Service Intensity :
  • Audiology: 3 times/week.

  • Speech Therapy:  1 to 2 times/week (according to need).

  • Psychosocial Support is available (provided by a psychologist or social worker).

  • Users benefit from practice sessions, additional exercises or from support (provided by a Specialized Educator or Psycho-educator) in their natural living environments.

  • Auditory training with an audiologist must begin without delay after completion of initial programming.  Other required services must begin within a maximum of 2 weeks.  

Decentralization of the IFR

Here are the rehabilitation centers that offer IFR services :


Schooling during RFI

  • For children undergoing the IFR process in Quebec City, the Premières Seigneuries School Board is responsible for ensuring that school-age children can continue their education. 

  • Tutoring requirements of users undergoing the IFR process in their region are determined in accordance with their intervention plan. 


IFR at IRDPQ, Saint-Louis site

  • Therapy takes place over a 3 to 4-day period and lasts 1 to 3 hours a day.

  • Follow-up is conducted by a multidisciplinary team (Audiologist, Speech Therapist, Psychologist, Specialized Educator and Occupational Therapist). 

 

Services for children include :   
  • Individual therapy 3 times a week in Audiology. 

  • Individual therapy 2 times a week in Speech Therapy.

  • Meetings for parents.

  • Follow-up in psychology (as needed).

  • Individual courses in sign language (as needed).


The child must be accompanied by at least one parent. Parental involvement is essential in helping the child transfer the skills he/she learned in therapy to activities of everyday life.  

 

Services for adults include :
  • Individual therapy 3 times a week in Audiology,  

  • Individual therapy in Speech Therapy (as needed). 

  • ​Follow-up in psychology (as needed).

  • ​Individual  therapy 1 to 2 times a week in specialized education to generalize the objectives seen in Audiology and/or Speech Therapy. 
  • ​Group meetings.

 

Stay in Quebec City - Accomodation/Transport :


Plan your visit at IRDPQ, Saint-Louis site
 

  • For those undergoing the IFR process in Quebec City, it is preferable to stay near the CIUSSS de la Capitale-Nationale, IRDPQ Saint-Louis site. The Association des Implantés Cochléaires du Quebec – AICQ (The Quebec Association of Persons with a Cochlear Implant) can provide you with assistance in searching for a place to stay (418-623-7417; aicq@bellnet.ca/www.aicq-implant.org). This organization keeps an up-to-date list of various lodging options including short-term leases, board, lodging and private rooms.

  • You must arrage your own transportation between your accomodation and the IRDPQ, Saint-Louis site. If you do not have a vehicle, you can take public transit or taxi. Check the route times in advance. If you are a member of the paratransit service in your area, you can submit a "Visitor STAC" request.

  • You will need to check whether you are eligible for financial assistance and confirm which costs are covered.  

  • If you need help planning your stay in Quebec City, you can refer to your social worker in your region.

 

Schooling (service provided by the Premières Seigneuries School Board) :
  • Individual tutoring is provided 6 hours a week for elementary level students and 8 hours a week for secondary level students. The tutoring period falls within the child’s schedule.

  • School Board documents are sent by mail to the parents’ main residence. These must be filled out and returned as soon as possible to ensure that the services corresponding to the child’s needs are implemented.


Post-IFR follow-up

Post-IFR Rehabilitation Follow-up :
  • Children, as well as some adults, will need a post-IRF follow-up in rehabilitation. Clinicians of the rehabilitation centre where the IFR took place will meet with the user and his/her family at an appropriate time.

  • For users who underwent the IFR process in Quebec City, the CIUSSS de la Capitale-National, IRDPQ will forward all relevant information to clinicians responsible for their follow-up in their specific region.

  • ​Periodic follow-up is required to monitor the person’s progress and make any necessary adjustments to the cochlear implant. Measurements must be taken at the end of the IFR and 1 year post-IFR. The results are sent to the Centre québécois d’expertise en implant cochléaire.

 

Post-IFR Complementary Assessments :
  • As part of the decentralization process, the MSSS ruled that people doing their IFR at their regional rehabilitation centre must return to the CIUSSS de la Capitale-Nationale - IRDPQ, Saint-Louis site for additional assessments (at the end of their IFR and 1 year post-IFR). You will be informed during the initial programming period if this applies to you.

 

Programming Follow-up :

The MSSS has mandated 3 centres to monitor the implant’s programming :

  • the CHU de Québec-UL, L’Hôtel-Dieu de Québec for users from the Eastern Region of Quebec.

  • the CIUSSS du Centre-Sud-de-l’Île-de-Montréal, CRDP Raymond-Dewar for French-speaking users from the Western Region of Quebec.

  • the CIUSSS du Centre-Ouest-de-l’Île-de-Montréal, MAB-Mackay Rehabilitation Centre for English-speaking users from the Western Region of Quebec.

 

​Institutions that offer troubleshooting/emergency services and technical support :


CHU de Québec-UL, Hôtel-Dieu de Québec for people in eastern Québec. 

  • Cochlear implant program office : 418-691-5407 for all emergencies. 

  • Technical support : supporttechniqueimplantcochleaire@chudequebec.ca or 418-525-4444, ext. 16826, in case of a processor malfunction, to repair or replace a part, or to order certain accessories. 

 

​CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Institut Raymond-Dewar for French-speaking people in western Québec.

  • Leave a voice message with your contact information and an audiologist will call you back. 

  • Troubleshooting/emergency service: 514-284-2214, ext. 3330. 

  • Technical support: 514-284-2214, ext. 3148. 

 

CIUSSS du Centre-Ouest-de-l’Île-de-Montréal, MAB-Mackay Rehabilitation Centre for English-speaking people in western Québec.

  • Leave a voice message with your contact information and an audiologist will call you back.

  • Technical support, troubleshooting/emergency: 514-488-5552, ext. 4016.



Use and maintenance of a cochlear implant


 Parts and accessories (cochlear implant)

Questions et réponses

Will a cochlear implant enable me to regain normal hearing ?

A person wearing a cochlear implant continues to have restricted hearing. The cochlear implant may improve the perception of speech and sounds, but some very soft sounds remain inaudible. The cochlear implant makes it possible to hear soft sounds, but analysis of these is not the same as with normal hearing. Therefore, a person wearing a cochlear implant has more difficulty understanding speech than a person with normal hearing. In fact, understanding speech in a noisy environment remains difficult even with the cochlear implant and the perception of music is altered.

Does a cochlear implant allow me to hear as with a hearing aid ?

The perception of sounds with a cochlear implant differs from a hearing aid (more acute, echo, muffed, metallic).
The hearing aid amplifies sounds while the cochlear implant codes them (like a computer) and transmits electrical impulses to the auditory nerve. This is why the brain needs time and auditory training to interpret this new auditory information.

 

Will I be able to hear with my cochlear implant the day after the surgery ?

As soon as the cochlear implant is activated the day after the surgery, the person can hear sounds. However, speech may remain unclear without lipreading. Speech comprehension will improve with the adjustments made during the intensive initial programming period, auditory training and time.

With a cochlear implant, will I be able to have a conversation over the phone ?

Most adults with a cochlear implant are able to follow a conversation over the phone with a person they are familiar with; but the ease with which they hear may vary. Some may understand a conversation with a stranger while for others, telephone conversations may be very limited, if not impossible. Telephone skills are directly related to the ability to understand speech through hearing only.

With a cochlear implant, will I finally understand people in a noisy environment (eg. restaurant, family meetings) ?

Certain limitations to one’s hearing remain, especially when it comes to understanding speech in a noisy environment. People report that they have more difficulty following a conversation in noisy situations than in silence. They must then use more visual cues (lipreading, natural gestures) and communication strategies to understand. The programming may be adjusted to facilitate hearing in a noisy situation; nonetheless, communication remains difficult.

With a cochlear implant, will I be able to watch my TV shows without the need for subtitles ?

Most cochlear implant users continue to rely on subtitles to complete auditory information. You must bear in mind that background noise or music broadcast during a show, as well as a lack of any possibility of lipreading, can interfere with the understanding of what is said. A sound transmission system may make listening to television easier.

With a cochlear implant, can I go to the movies ?

As with television, it may be difficult to understand what is said. Some movie theatres provide transmission systems than can be hooked up to the cochlear implant. 

With a cochlear implant, will I be able to speak more clearly ?

Even though the cochlear implant provides better hearing, adult speech patterns developed over the years remain hard to change.

If my cochlear implant does not work to my satisfaction, can I go back to wearing my hearing aid ?

The insertion of electrodes in the cochlea usually destroys any residual hearing. It is therefore usually no longer possible to use a hearing aid in the ear with a cochlear implant.

Does a cochlear implant make it possible to listen to music ?

Variances in cochlear implant performance were noted in this regard.  Some cochlear implant users enjoy listening to music, while for others the music appears as set of noises. On the other hand, some may identify musical instruments or keep pace, but are unable to recognize the lyrics of a song. Others may recognize words and/or complete sentences of a known and sometimes even unknown song.

With a cochlear implant, will I be able to go back to the theater ?

In this regard, one must take into account that these are typically difficult listening conditions : the presence of background noise, several actors who sometimes speak all at once, variable lighting and varying access to lipreading.

With a cochlear implant, will I be able to more actively participate in meetings at work ?

Even though the cochlear implant improves comprehension of speech, the environment in which meetings are held may become a hindrance to communication : people speaking all at once or jumping frequently from subject to another, lack of opportunities for lipreading, etc. Therefore, it is important to use appropriate communication strategies and foster good group management.

 

At family dinners, will I be able to follow all the table talk ?

The ease with which you will understand table talk may vary according to the number of diners, the lighting, the presence of background noise, the opportunities for lipreading and the flow of conversation (people not talking all at once). It is important for the cochlear implant user and his/her parties to adopt appropriate communication strategies.

With a cochlear implant, will it be necessary to use sign language with my child ?

It depends on the child’s overall development, the level of his/her hearing abilities and the progress of language acquisition. This aspect will be discussed with parents during speech therapy follow-up.

Do children who have received a cochlear implant go to regular school ?

Many factors come into play : the age when the cochlear implant was received, individual potential, the level of hearing and language abilities, and the educational environment. Children with a cochlear implant may have different needs with regard to their schooling (e.g. interpreter, academic advisor, etc.). Most will use an FM system in class.

Will children who receive their cochlear implant at a very young age (before 2 years old) develop their language at the same rate as their normal hearing peers ?

Very young children with a cochlear implant have a very good chance of developping speech abilities.  They will however normally demonstrate a delay in language acquisition with varying degrees of severity.

What benefits can people with profound congenital deafness (since birth) and who have a functional oral language expect to gain ?

It is more difficult to predict the benefits of a cochlear implant for these users.  The results are likely to be more limited, notably because of the long duration of their deafness.  The lack of stimulation of the auditory nerve and brain is among the hypotheses that may explain the weaker implant performance observed in these individuals. 

In general, these adults have more difficulty understanding speech without lipreading.  After several weeks of rehabilitation, they can normally understand simple sentences if spoken slowly.  The use of the telephone may remain difficult or even impossible, and be limited to short conversations with a familiar person.  In exceptional cases, a person belonging to this category may experience hearing performance comparable to the ones experienced by adults who became deaf.

With regard to communication, it is important to point out that the use of a cochlear implant brings about little change to one’s level of speech and language.  Although the person benefits from improved access to speech sounds, articulation habits developed over several years are difficult and perhaps impossible to change.  Despite the motivation and determination observed among many adults, it is unfortunately rare to observe improvements in speech production.  For most people, the cochlear implant will facilitate conversation with the support of lipreading. 

Because accomodating to the new auditory information is often more difficult for this group of individuals, they often require more rehabilitation time.

With a cochlear implant, will I be able to understand speech in all situations without lipreading ?

Following IFR, most adults are able to understand words and/or sentences with their hearing only (without seeing the lips of the people they are speaking with) in a calm environment. However, the percentage of words and/or sentences recognized, as well as the degree of ease with which they can do so varies from one person to another.  It is difficult to predict the maximal level that can be attained, as several factors must be considered (duration of deafness, pre-implant hearing abilities, etc.). 

It should be noted, however, that cochlear implant performance is influenced by the sound environment.  Indeed, when people find themselves in a noisy environment or in a group (ex: restaurant, family dinner ...), they often have more difficulty understanding speech.  

Will the cochlear implant help me understand a person who is talking to me and whose lips I can see ?

Most people who receive a cochlear implant experience a significant improvement in their ability to follow conversations with the support of lipreading.  Daily exchanges are also greatly facilitated as they require much less effort. 

Can one hear sounds from his/her environment with a cochlear implant ?

With a cochlear implant, people are able to hear (sometimes at the beginning without knowing what it is) low intensity sounds (ex. ticking of a clock, birds, refrigerator humming).  However, a few weeks may be necessary before being able to recognize sounds emanating from the environment (identify what was heard).  

What do sounds “sound” like with a cochlear implant ? Will I hear the same way as I do with my hearing aids ?

According to several adults, sound with a cochlear implant is different than that heard with a hearing aid or with a normal ear.  For some people, sounds may seem metallic, muffled or sharp, and for others, it comes close to the actual sound.  The appreciation of sounds will evolve over time.  At the beginning of the programming, some people may find sound to be unpleasant, but will get used to it afterwards. Children with a significant degree of deafness since birth have nothing to compare the sounds they are hearing with, as they only experienced limited benefits provided by hearing aids.  It will be for them their way of hearing.

 

Does the cochlear implant make it easier to watch television ?

Some people may understand words and/or sentences without lipreading or subtitles. However, as soon as there is background noise or music in a television program, speech becomes much more difficult to understand.  Moreover, it is very arduous to understand translated television programs because one cannot use lipreading.  Consequently, most people resort to assistive listening devices (system that sends television sounds directly to the implant) and/or close captioning (subtitling) to watch television. 

When will I benefit from my cochlear implant ?

Adjusting to the new auditory information provided by the cochlear implant requires work and perseverance.  However, the benefits gained vary greatly from one person to another and depend on certain characteristics (duration and degree of deafness, use of hearing aids, language level, etc.).  Generally, the more the profound deafness is of short duration, the more the results obtained with the cochlear implant are interesting and appear rapidly.  As such, a person with short duration deafness can refer more easily to his or her auditory memory to make sense of the new sounds heard with the cochlear implant.  

Dernière révision du contenu : le 28 novembre 2019

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