Post Activation Update - Day 6

Our Superstar
It has been six days since activation. In short, Ava has been constantly amazing us with her new ears! She is both recognizing and localizing sound! She tolerated the different program levels on her processors so well that we were at the highest program setting (P4) in 4 days. Here are a few examples of what she is doing:

Sounds she recognizes:

-microwave beeping

-shaking of box of cheerios

-mommy and daddy's voice

-door knocking

-of the Ling Six Sounds - "ahhhh"

-we have been working on farm animal sounds using plastic fisher price farm animals - we were on the floor playing with the chicken and I used the "bock" bock" sound - Ava played with the chicken for a bit and then threw it off to the side and it rolled about 3 feet away - she became engaged in something else - at that point I started to say "bock bock" again and Ava turned around to look at the chicken she threw to the side - IS THAT A COINCIDENCE OR DID SHE RECOGNIZE THE CHICKEN SOUND? I guess time will tell.

-she REALLY LOVES songs - If you're Happy and You know it, This Little Piggie went to Market, Row Row Row your Boat.

Examples of localization:

-turns to our voice while watching baby einstein dvd or while engaged in play

-turns to sound of rattle in the appropriate direction while engaged in play

-we hide a plastic farm animal under a blanket - then we make the animal sound and she will search for the animal

-turning her head when we call her name - although this is inconsistent and I don't believe at this point she recognizes her name yet but she does hear our voice and turns toward it.

We learned today it takes approximately 10 months of hearing before Ava will form words - that is just average so it could be sooner or later than that time before Ava will start to form words.

Today, Ava had her second MAPing. We received 4 more programs which have increased volume and sensitivity levels. She tolerated the new program very well. I found it a bit troubling that she doesn't react much to the new sound levels but I was reassured that she is doing very well and her auditory nerve is functioning beautifully. (Ava is part of a study of bilateral implantation, therefore, in addition to her regular MAPing sessions, she also spends some time in the hospital lab for additional testing).

Oh, and did I mention that this is SO EXCITING! I look forward to waking up each morning with such anticipation of Ava's progress. Some days, there will be very little change from one day to the next. Other days there will be huge leaps of real progress. Some of the other CI mom's advised me to remember that this journey is not a sprint, but a marathon. While this may be quite true, I came across this quote by Michael Johnson ..."Life is often compared to a marathon, but I think it is more like being a sprinter; long stretches of hard work punctuated by brief moments in which we are given the opportunity to perform at our best".

AVA CAN HEAR!!!

Activation

Ava's activation was a success! It was the coolest thing ever - like witnessing a live miracle. BUT it was nothing like I expected. There was no drama or a-ha moment for Ava. She was cool as a cucumber. There were no tears nor discomfort - Ava took it as it came. First, the audiologist did a "mapping" of the cochlear implants ("CI's"). I will briefly explain what "mapping" is later in this post. Then one ear was activated first, then other the ear and then both at the same time. In the video below, Ava is hearing through both implants. You will note the change in her eyes/expression when I first start talking to her - she pauses briefly to listen to the sound of my voice.


Mapping

Programming the cochlear implant - called "mapping", refers to the setting of the electrical stimulation limits necessary for Ava to perceive soft and comfortably loud sounds. During mapping, the threshold and comfort levels of each individual electrode (which is in the internal implant) are adjusted in order for Ava to hear a wide range of sounds. There are 22 electrodes. Threshold adjustments are what allows for access to environmental and soft speech sounds. Comfort level adjustment refer to the amount of electrical current needed to hear a comfortably loud beeping signal. These measurements are downloaded into Ava's processors. The initial settings on her CI's are very, very low right now. So, while she will hear environmental sounds like the phone ringing or door knocking and our speech, the settings are too low for her to discriminate the different speech sounds. The audiologist instructed us to increase the sensitivity on her CI's every other day so that there is a gradual introduction to sound, so as not to bombard with so much sound that it would be uncomfortable. Next week we return to the audiologist for another mapping session. Then, her mapping sessions will be on a monthly basis. Mapping sessions are required as over time the settings can become weak due to tissue growth surrounding the implant, thus needing more power or electrical stimulation. Also, when maps are new, they sound really loud to Ava. As she adapts to the volume levels, the volume will seem weaker to her over time and the signal will no longer be strong enough. Therefore her processors will be always be mapped time after time. When a map is performed efficiently, Ava's hearing should be in normal to near normal range!!!

So now that she can hear, what do we do?

Ava will continue with her weekly auditory verbal therapy. There is a hierarchy of learning oral language. First, Ava's receptive language will need to be developed before she can start to talk. She is at square one, like a newborn baby. She now has to learn to listen to all the different sounds in her world. She needs to detect sounds (called Auditory Awareness) - such as the door, phone, a dog barking. Then she has to learn to discriminate sounds such as a cat meowing vs a dog barking or recognize her name being called. There are several additional steps to learning receptive language but I will get into that as we follow her progress. We will be spending our first several weeks pointing out all the sounds for Ava. For example, when the phone rings, we will excitedly point to our ear, look at Ava and say "do you hear that?" and then point to the phone and say "phone". We will praise her everytime she vocalizes. She will learn that language is power.

Ava is already amazing us with her very obvious awareness of sound around her. She is constantly turning her head, although not consistently yet, to the sound of my voice, at close range. She is responding to a knocking sound and clapping sound. I put a baby Einstein video on for her and in the past, she would look at the video then stop to play with something or divert her attention to something else. Today, however, she stared intently at the video and did not move a muscle throughout the whole video! I positioned the speakers so that they were facing towards her. It was incredible to watch!

Stay tuned!!!