RU2743847C1 - Method for generating responses to vibrotactyl stimuli in children with pronounced hearing loss and deafness to hearing care - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to surdology and otorhinolaryngology, and can be used to generate a response to vibrotactile stimuli in children with pronounced hearing loss prior to hearing care. First, an orientation and conditioned-reflex motor reactions are formed on vibrotactile stimuli in water. Vibrotactile stimuli used are hydro vibration pulses supplied through acoustic amplifier to two underwater speakers. Child is immersed into water, excluding his head, between two speakers at distance of 1 meter from each. First, low-frequency non-musical signals and musical, and then speech signals are sent, and an orientation and conditioned-reflex motor reaction to frequency-modulated tones are formed. Course is 7, or 9, or 10, or 12 sessions.EFFECT: method provides accelerated generation of auditory attention in a deaf child, interest in surrounding sounds, voice of a person, voice, ability to identify sounds surrounding it daily; shorter duration and higher quality of hearing aid or cochlear implant.1 cl, 2 ex

Description

The invention relates to medicine, namely to audiology-otorhinolaryngology and can be used to form indicative and conditioned reflex motor responses to vibrotactile stimuli prior to hearing aids (including acoustic hearing correction and cochlear / brainstem implantation) in children with severe hearing loss and deafness.

Several methods are used to form responses to vibrotactile stimuli in children with severe hearing loss and deafness prior to hearing aids.

The verbotonic method developed by P. Guberina is known and has been used in deaf education since the second half of the 20th century. One of the components of this method is teaching a child to detect, perceive and imitate speech transmitted through a vibrator mounted in a tabletop (the so-called vibrating table), or through a portable vibrator brought to various parts of the child's skin. In the verbotonic method, vibrational signals "replace" a dysfunctional auditory analyzer. Currently, “audio-verbal” and auditory methods are widely used, in which the formation of speech in a deaf child is based primarily on auditory perception, compensated by a hearing aid or a cochlear / brainstem implant. The advantage of the verbotonal method is the ability to form orientational (spontaneous) responses to sounds in the range available to him in a deaf child, to induce vocalizations and control his own voice based on vibrotactile stimuli [Guberina. R. Verbo-Tonal method and its application to the rehabilitation of the deaf. In Report of the Proceedings of the International Congress on Education of the Deaf. Washington, DC: U.S. Government Printing Office. 1964]. The disadvantage of the method is the rapid depletion of the child's attention due to the same type of stimuli and the material used, which reduces the possibility of the formation of a conditioned reflex motor reaction to sound and limits the effectiveness of subsequent exercises.

A known method of converting sounds into vibration and its transmission to various areas of the skin (usually palm, forearm) by means of vibrotactile "hearing aids" of stationary and portable types. The method was used in deaf and deaf-blind patients before the advent of high-quality ultra-powerful hearing aids and cochlear implants. Vibrotactile "hearing aids" made it possible to achieve only a reaction to the appearance of sounds and the initial skills of distinguishing them, but not speech intelligibility. The advantage of the method is the portability of a part of the devices, which makes it possible to receive the child's reactions to sounds converted into vibrational stimuli throughout the day in everyday conditions. [Carney A.E .; Osberger M.J .: A comparison of speech discrimination with cochlear implants and tactile aids. The Journal of the Acustica Society of America 94,2036; 1993].

The disadvantages of this method are the high cost of vibrotactile devices, as well as their stimulation of a small area of the body surface, which limits the differentiation of sensations to vibrotactile stimuli, as well as low noise immunity when they are perceived.

As a prototype for the closest technical essence, we have chosen a method of forming the reactions of a child with severe hearing loss and deafness before hearing aids to vibrotactile stimuli accessible to his perception in the absence of reactions to very loud acoustic stimuli. The method consists in tapping on the chair on which the child is sitting, on the floor on which he is standing, or in irritating the back of the head or ear of the child with a stream of air. The child's orientation responses to the above-mentioned vibrotactile stimuli are evaluated. [Koroleva I.V. Developing activities for children with hearing impairment at an early age. Study guide. SPb .: KARO. 2017].

The disadvantages of the method we have chosen as a prototype include:

orientational responses to vibrotactile stimuli received before hearing aids do not affect the formation of an orientational and conditioned motor response to sound after hearing aids, which leads to the duration of tuning the hearing aid / processor of the cochlear (brainstem) implant, which, according to our own data, is 5-6 tuning sessions and insufficient quality of tuning, which is manifested in the fact that in some cases tuning by behavioral reactions fails and is based on objective methods;

monotony of stimuli and a sharply limited possibility of changing the dynamic range, which leads to a rapid attenuation of the child's motor reaction and does not allow the formation of a stable conditioned reflex motor response to vibrotactile stimuli;

rapid depletion of the child's attention and loss of interest in the lesson, which limits its effectiveness;

stimulation of a limited area of the body surface, which weakens the child's sensations and does not allow obtaining a conditioned reflex motor reaction to weak vibrotactile signals;

the duration of the formation of orientational reactions in a deaf child, constituting, according to his own data, 4 lessons for new sounds, auditory attention, interest in surrounding sounds, a person's voice, his own voice, the ability to identify sounds surrounding him in everyday situations at the first stage after hearing aids / cochlear replacement (brain stem) implantation.

The objective of the invention is:

• accelerating the formation of auditory attention in a deaf child, interest in surrounding sounds, a person's voice, his own voice, the ability to identify sounds surrounding him in everyday situations;

• shortening the duration and improving the quality of the fitting of the hearing aid / processor of the cochlear (brainstem) implant.

The technical result of the invention is:

• formation of orientational and conditioned reflex motor reactions to sound after hearing aid;

• formation of an indicative and stable conditioned-reflex motor reactions to hydrovibration signals;

• the ability to keep the child's long-term attention to stimuli;

• the ability to achieve a conditioned reflex motor reaction even to low-amplitude, near-threshold stimuli.

The technical result of the invention is achieved by the fact that the method of forming reactions to vibrotactile stimuli in children with severe hearing loss and deafness before hearing aids consists in the fact that they form an indicative and conditioned reflex motor reactions to vibrotactile stimuli in water with the child immersed in the pool, excluding his head. Hydro-vibrational signals are used as vibrotactile stimuli, which, using a personal computer, are fed through an acoustic amplifier to two Dolphin underwater speakers immersed in an aquatic environment and creating vibroacoustic shocks, and the child is immersed in water between the above two speakers at a distance of 1 meter from each. Initially, the formation of indicative and conditioned reflex motor reactions to hydrovibration signals is carried out on low-frequency non-musical signals, namely, the beep of a locomotive, the sound of a dull beat, and musical, namely, the sound of a drum roll, sounds of a march. Then they move on to the formation of reactions to speech hydrovibrational signals, namely, live speech through a microphone or syllables in audio recordings containing low-frequency phonemes. After that, orientational and conditioned reflex motor responses to frequency-modulated tones with frequencies of 100, 200, 300, 400, 500 and 600 Hz are formed. The amplitude of the stimulus is selected individually, depending on the child's response to hydrovibration signals. The course is 7-12 lessons.

The method is implemented as follows:

Contraindications for performing the method include inflammatory diseases of the respiratory tract in the acute period, skin, infectious, parasitic, mycotic diseases.

Immediately after the diagnosis of bilateral chronic sensorineural hearing loss of III, IV degree or deafness, children aged 3 months to 7 years old, at the stage of preparation for hearing aids / cochlear / brainstem implantation, are given classes on the formation of responses to vibrotactile signals. The method consists in creating vibroacoustic shocks in an aquatic environment using two underwater speakers "Dolphin" (manufactured by JSC "Concern" Oceanpribor ", Russia). [Product" Dolphin ". Passport. LYUKI.464221.001 PS. Pages 6].

The stimuli are delivered using a personal computer through an acoustic amplifier to two speakers immersed in a pool or bath. During the lesson, the child is in the water with an instructor. The entire body of the child, excluding his head, is submerged in water between two speakers at a distance of 1 meter from each speaker. At the command of the instructor, the assistant turns on and off the hydro-vibration signal, and the instructor observes the child's reactions. Initially, the formation of indicative and conditioned reflex motor reactions to hydrovibration signals is carried out on low-frequency non-musical signals, namely, the beep of a locomotive, the sound of a dull beat, and musical, namely, the sound of a drum roll, sounds of a march. Then they move on to the formation of reactions to speech hydrovibrational signals, namely, live speech through a microphone or syllables in audio recordings containing low-frequency phonemes. After that, orientational and conditioned reflex motor reactions are formed to frequency-modulated tones with frequencies of 100, 200, 300, 400, 500 and 600 Hz. The amplitude of the stimulus is selected individually, depending on the child's response to hydrovibration signals. The duration of the lesson is 20-40 minutes, depending on the age of the child. A course of 7-12 lessons is conducted. The course ends just before the first hearing aid fit / connecting a cochlear or brainstem implant processor. The goals of the course, depending on the age of the child and the presence of concomitant diseases, include the formation of an indicative and / or stable conditioned-reflex motor reactions to the inclusion / shutdown of the hydrovibration signal, its duration, intensity and rhythm. Lessons in the pool, the unusualness and variety of hydrovibration signals, rhythmic stimulation evoke positive emotions in the child throughout the course, which increases the effectiveness of the classes. Formed orientational and conditioned reflex motor reactions to hydrovibration signals allow the child to show similar reactions to sound signals given when setting up the device / implant processor. Based on the behavioral responses, the device / implant processor is fine-tuned.

Essential distinguishing features and a causal relationship between them and the achieved technical result:

• Form orientational and conditioned reflex motor responses to vibrotactile stimuli in the form of hydrovibration signals in water with the child's immersion in the pool, excluding his head.

Submerging the child in the pool, excluding the head, allows the use of hydro-vibration signals that are felt throughout the child's body.

• Hydro-vibration signals are used as vibrotactile stimuli, which, using a personal computer, are fed through an acoustic amplifier to two Dolphin underwater loudspeakers immersed in an aquatic environment and creating vibroacoustic shocks, and the child is immersed in water between the two above-mentioned loudspeakers at a distance of 1 meter from each ... The distance of 1 m between the child submerged in the water and each of the two Dolphin underwater speakers was selected during the study. A shorter distance creates the risk of a child's foot or hand touching the underwater speaker, while a greater distance will diminish the hydro-vibration signal.

Underwater speakers "Dolphin" (manufactured by JSC "Concern" Okeanpribor ", Russia). [Product" Dolphin ". Passport. LYUKI.464221.001 PS. Pages 6] are intended for direct perception of sound by a person under water without using additional receiving equipment and for teaching swimming in children's sports schools, including for children with hearing impairments.

The applied hydrovibration signals have advantages when propagating in an aquatic environment, compared with the propagation of vibration in solids: higher speed, less energy loss with increasing distance.

• The formation of orientational and conditioned reflex motor responses to hydrovibration signals is initially carried out to low-frequency non-musical signals, namely, the beep of a steam locomotive, the sound of a thud, and musical, namely, the sound of a drum roll, sounds of a march, then to speech hydrovibration signals, and namely - live speech through a microphone or syllables in audio recordings containing low-frequency phonemes. The sequence of formation of orientational and conditioned-reflex motor reactions to hydrovibration signals, that is, initially they are carried out to low-frequency non-musical signals, and then to musical ones, and then to speech ones, is due to an increase in the complexity of perception of the types of supplied hydrovibration signals, that is, the easiest for primary detection and the response of a child who has no auditory experience is high-amplitude non-musical signals, after recognizing and memorizing these stimuli, the child begins to detect rhythmic musical stimuli and only after adaptation to them begins to react to speech stimuli given in the form of hydrovibration signals. Detecting and responding to frequency modulated tones is a more difficult task for a child, so they are used after developing responses to the above stimuli.

• Then - to frequency-modulated tones with frequencies of 100, 200, 300, 400, 500 and 600 Hz; the amplitude of the stimulus is selected individually, depending on the child's reaction to the hydrovibration signals, while the course is 7-12 lessons. Hydro-vibration signals have a common frequency domain with acoustic stimuli in the low-frequency range, which ensures that the child quickly manifests similar orientational and conditioned motor responses to sound signals after hearing aids.

In the proposed method, various types of stimuli are used, varying in amplitude and frequency.

The set of essential distinctive features is new and allows:

• to form an indicative and conditioned reflex motor reactions to sound after hearing aids;

• to form an indicative and conditioned reflex motor reactions to hydrovibration signals;

• keep the child's long-term attention to stimuli;

• to achieve a conditioned reflex motor reaction even to low-amplitude, near-threshold stimuli,

which, in turn, provides:

• accelerating the formation of auditory attention in a deaf child, interest in surrounding sounds, a person's voice, his own voice, the ability to identify sounds surrounding him in everyday situations;

• shortening the duration and improving the quality of the fitting of the hearing aid / processor of the cochlear (brainstem) implant.

Here are some clinical examples:

Example 1. Boy E., 3 years 4 months, first diagnosed with bilateral chronic sensorineural hearing loss of 4 degrees. Immediately after the diagnosis was made, before hearing aids, a course was started on the formation of a conditioned reflex motor response to hydrovibration signals. The amplitude of the hydrovibration signals is individually selected, which ensures the emergence of behavioral reactions. 10 sessions were conducted, during which a stable conditioned-reflex motor reaction (throwing objects into a container) to hydrovibration signals (non-musical, musical, speech sounds and frequency-modulated tones) was obtained. After the initial tuning of super-powerful hearing aids to both ears on the day of tuning, an unstable conditioned-reflex motor reaction to sounds of threshold intensity in hearing aids (tones in the range of 500-4000 Hz) was obtained, and on the second day - a stable conditioned-reflex motor reaction to sounds of a threshold intensity in hearing aids.

Example 2 (according to the prototype method)

Boy C, 3 years 6 months, was first diagnosed with grade 4 bilateral chronic sensorineural hearing loss. At the stage of preparation for hearing aids, classes were held to form the child's reactions to vibrotactile stimuli available to his perception in the absence of reactions to very loud acoustic stimuli. In the course of the lesson, an orientation response was obtained to the first few stimuli, which was then depleted due to the scattering of the child's attention and his adaptation to stimuli. After the initial tuning of the super-powerful hearing aids to both ears on the day of tuning, the conditioned-reflex motor response to sounds of threshold and suprathreshold intensity in hearing aids was not obtained, an indicative reaction to sound stimuli of suprathreshold intensity was observed. A stable conditioned reflex motor reaction to sounds of threshold intensity in hearing aids was formed after 4 sessions with a deaf teacher.

The method was used in 15 children aged 4 months to 3 years. In 4 children, it took 7 lessons to form orientational and conditioned-reflex motor reactions to hydrovibration signals, in 2 children - 9 lessons, in 5 children - 10 lessons, in 4 children - 12 lessons.

The formation in a deaf child of auditory attention, interest in surrounding sounds, a person's voice, his own voice, the ability to identify sounds surrounding him in everyday situations, was achieved by the claimed method in an average of 2 lessons with a deaf teacher, while using a prototype, according to his own data, - for 4 lessons, which indicates the acceleration of the formation of these skills after hearing aids.

The optimal adjustment of the hearing aid / processor of the cochlear (brainstem) implant in children, based on behavioral responses, was achieved by the claimed method in an average of 3 tuning sessions, while using the prototype, according to our own data, in 5-6 tuning sessions, At the same time, in a number of cases, adjustment by behavioral reactions was not possible at all and was based on objective methods, which proves a reduction in the duration and an improvement in the quality of adjustment of the hearing aid / processor of the cochlear (brainstem) implant, in comparison with the prototype.

Thus, the claimed method for the formation of reactions to vibrotactile stimuli in children with severe hearing loss and deafness before hearing aid allows:

• to form an indicative and conditioned reflex motor reactions to sound after hearing aids;

• to form an indicative and conditioned reflex motor reactions to hydrovibration signals;

• keep the child's long-term attention to stimuli;

• to achieve a conditioned reflex motor reaction even to low-amplitude, near-threshold stimuli,

which, in turn, provides:

• acceleration of the formation of auditory attention in a deaf child, interest in surrounding sounds, a person's voice, his own voice, the ability to identify sounds surrounding him in everyday situations.

• shortening the duration and improving the quality of the fitting of the hearing aid / processor of the cochlear (brainstem) implant.

The method has been successfully tested on the basis of the St. Petersburg State Government Healthcare Institution "Children's City Surdological Center".

Claims (1)

A method of forming reactions to vibrotactile stimuli in children with severe hearing loss and deafness before hearing aids, characterized in that they form orientational and conditioned reflex motor responses to vibrotactile stimuli in water with the child's immersion in the pool, excluding his head, and hydrovibrational stimuli are used as vibrotactile stimuli. signals that, using a personal computer, are fed through an acoustic amplifier to two underwater speakers immersed in the water environment and creating vibroacoustic shocks, and the child is immersed in water between the two above-mentioned speakers at a distance of 1 meter from each, and the formation of orientational and conditioned reflex motor reactions the hydrovibration signals are initially triggered by low-frequency non-musical signals, namely, the whistle of a steam locomotive, the sound of a thud, and musical, namely, the sound of a drum roll, the sounds of a march, then - to speech hydrovibration signals, namely, live speech through a microphone or syllables in audio recordings containing low-frequency phonemes; then - to frequency-modulated tones with frequencies of 100, 200, 300, 400, 500 and 600 Hz; the course is 7, or 9, or 10, or 12 lessons.