May 2017 Townsville Bulletin

Two-year-old Hamish Budden gave his mum a gift more precious than gold when he said “I love you” clearly for the first time. And while those three words ring sweet with all parents, it was made all the more special because Hamish was born deaf. Hamish is one of 19 children and 10 adults who have been surgically fitted with a cochlear implant at The Townsville Hospital since the service first started two years ago, an experience that his mum Lorna described as “wonderful”. “The day Hamish went in for surgery was scary; it was a big change,” she said. “When he had the surgery done 12 months ago all he could say was ‘ah’. Now he sings the ABC song and says ‘I love you’; his receptive language is above average and his expressive language is almost where it needs to be. “Our speech therapist has said by the time he’s in kindy there will be no signs at all that he is deaf.”

Lorna said she would always remember when her family first realised the device was making a difference. “We were playing in the backyard when a cockatoo squawked and flew overhead,” she said. “Hamish looked up from where he was playing to look for the bird. I just felt like cheering; he was discovering this whole new dimension to the world.”

Paediatric audiologist Sreedevi Aithal said the past two years of the service running had been extremely rewarding. “It’s very fulfilling being able to provide a service to people that makes such a profound impact on their lives, as well as their loved ones’ lives. The service is going extremely well; we have seen patients from all age groups and all of them are on target with their hearing development.”

Lorna said she was grateful for the help she had received from the unit after Hamish’s hearing issue was picked up during routine newborn hearing screening. “It was initially devastating finding out that Hamish was deaf because of the extra challenges we knew he’d have to face in life,” she said. “However, because it was picked up so early through the newborn screening he had hearing aids fitted at nine weeks old and we were able to ensure he had access to both verbal and visual language straight away.”

June 2017 9News, SBS, Sky News, Northern Star

Hundreds of cochlear implant patients are receiving new and improved devices thanks to a New South Wales government grant. Sydney artist Angie Goto received the upgraded device nine years after getting her outdated cochlear implant. “You guys take it for granted listening,” Ms Goto told 9NEWS. “Where with deaf people, we’re always concentrating, listening and lip reading.” The new implants also provide patients with Bluetooth and wireless connectivity making simple tasks like using the phone or watchingtelevision even easier.

The state government is funding $2.8 million to deliver 370 public patients of all ages across New South Wales with the technology - the most advanced in implants. Health Minister Brad Hazzard said the new device would be a “giant leap”. “It’s one small step for the individual – but it’s actually a giant leap for everyone around them because it connects them,” Mr Hazzard said. "Every single hearing-impaired adult patient in the NSW public health system will now be able to continue to enjoy the quality of life that this amazing Australian invention provides.”

When Ms Goto tried the device for the first time, she was surprised by its clarity. “Wow! It’s very clear. Wow, it’s a much better microphone,” she said. She even marvelled at being able to hear her husband’s voice as well as noisy construction work.

Audiologist Jane Brew said it was “special” to see the huge impact the new technology is having on people’s lives. “Just being able to see the impact that this technology can make for people is super special,” Ms Brew said. 

Jane BrewFunding will allow the Royal Institute for Deaf and Blind Children (RIBDC) to purchase and coordinate the replacement of up to 370 cochlear sound processors for NSW public patients before they become obsolete at the end of 2019.

The replacement of the sound processor will be done free of charge at a patient's routine audiology appointment and does not require extra surgery. RIBDC's Chief Executive Chris Rehn said the upgrades will be life-changing for recipients - it will greatly improve their social life and, for some, enable them to stay in the workforce.

"This significant funding boost means that hundreds of NSW Cochlear implant recipients will be able to remain connected and continue to enjoy a world of better hearing," Mr Rehn said.

May 2017 Derby Informer

Casey Combs graduated from the University of Kansas with her doctorate in audiology. Less than two percent of Americans have a doctorate degree. The gruelling extra years of classes, papers and work make many people shudder. Combs, however, is an exception. She reached the highest level of education, and she did it with a disability. Combs became deaf when she was four years old. “As a young child, I knew I had to work hard to be equal to my peers,” Combs said. Because of her perseverance and determination to not let her disability interfere with her dreams, Combs can now help other people with hearing loss.

She was not born deaf. At 2 years old, she lost all hearing out of her left ear and partial hearing out of her right ear due to a virus. Her mother realized something was wrong when Combs wasn’t speaking. She wore hearing aids until she was 4 years old until the virus came back and took the rest of her hearing. Her first language was sign language, and she took speech therapy every day from preschool until second grade. “When you have a deaf child, you don’t realise how much children learn from their environment,” said Combs’ mother Dianna Pyles-Tauer. “A deaf child has to be taught everything.”

She got her first cochlear implant when she was 4, and she was the first child in Kansas to receive one. “Cochlear implants are very different from hearing aids,” Combs said. “People think cochlear implants for hearing loss is like putting on glasses, which is not true.” Combs couldn’t distinguish the sounds she heard. She had to go through auditory therapy and train her brain to recognise and differentiate between sounds. “At first, everything sounded ‘ping-pongy’ like at an arcade,” she said. “Speech didn’t sound like speech because it is such a complex sound. It is harder to distinguish.” When she started to recognise it, all speech sounded high or what she refers to as “Mickey Mouse voices.”

While at Derby Hills Elementary School, she worked with speech language pathologist Jean Fisher and special education teacher Sandy Chichester. “Sandy and Jean are like my second moms,” Combs said. “They had tough love. If I made a mistake or mispronounced a word, they made me fix it and then do it 10 more times perfectly.” Fisher and Chichester both came to Combs’s graduation. They have worked with Combs since she was 3 years old. “It was absolutely the most  overwhelming, incredible experience of my professional life,” Chichester said. “I was just in awe.”

Casey CombsSpecial Education teacher Sandy Chichester left, speech pathologist Jean Fisher with longtime student Casey Coombs at her graduation.

Chichester remembers when Combs told her in sixth grade that she wanted to be an audiologist.

“I kept thinking all along how are you going to do that,” Chichester said. “That is going to be a difficult field for you.” Audiologists have to be able to listen well, converse and understand deaf people who don’t know sign language. Most of the sounds that Combs knows are not from hearing them, but from learning the sounds from her teachers and family. “She was always terrible at understanding men’s voices,” Chichester said.

Combs didn’t have a lot of men to talk to at the elementary school. All of her teachers were female. Her brother would sit down and help her, and current Superintendent Craig Wilford would come to the school and read out loud so Combs could practice hearing a man’s voice. “By the time I was in first grade, I could read at a fifth grade level,” Combs said.

At 17 years old, Combs had the chance to get a cochlear implant for her other ear. Her doctor told her she would never be able to hear out of the other ear even with the implant, but she decided to do it anyway. “I told her you never let other people tell you what you are going to become,” Chichester said. “She learned to persevere.” Fisher remembers when Combs participated in a speech contest in high school, and she won. “She has always been very driven,” Fisher said. “She works very hard for whatever it is she wants.” Throughout her senior year of high school, she shadowed Fisher and Chichester after going to school in the morning. “Had it not been for those two, we would not have had the outcome we have now,” Pyles-Tauer said.

To this day, most people who meet Combs wouldn’t know she was deaf after talking with her.

She graduated from Derby High School in 2009 and went to the University of Kansas for her undergraduate and doctorate degrees. Although she has attained a lot of success, Combs still struggles with different aspects of her hearing and the social stigma that goes with her disability.

She still has trouble determining where sound comes from or distinguishing sound in a noisy environment. Just a couple of years ago she heard the sound of water for the first time. “She is still discovering sounds that she wasn’t aware of,” Fisher said.

Combs will start her dream job as an audiologist in June at a private ear, nose and throat clinic in Tyler, Texas. In the future, she sees herself becoming a specialist in cochlear implants or doing research about hearing loss. “I am thankful that I can use my hearing loss to help other people,” Combs said.

May 2017 Medical News Today

Neuroprosthetics, also known as brain-computer interfaces, are devices that help people with motor or sensory disabilities to regain control of their senses and movements by creating a connection between the brain and a computer. In other words, this technology enables people to move, hear, see, and touch using the power of thought alone. How do neuroprosthetics work? We take a look at five major breakthroughs in this field to see how far we have come - and how much farther we can go - using just the power of our minds.

neuroprostheticsUsing electrodes, a computer, and the power of thought, neuroprosthetic devices can help patients with motor or sensory difficulties to move, feel, hear, and see.

Every year, hundreds of thousands of people worldwide lose control of their limbs as a result of an injury to their spinal cord. In the United States, up to 347,000 people are living with spinal cord injury (SCI), and almost half of these people cannot move from the neck down. For these people, neuroprosthetic devices can offer some much-needed hope.

Brain-computer interfaces (BCI) usually involve electrodes - placed on the human skull, on the brain's surface, or in the brain's tissue - that monitor and measure the brain activity that occurs when the brain "thinks" a thought. The pattern of this brain activity is then "translated" into a code, or algorithm, which is "fed" into a computer. The computer, in turn, transforms the code into commands that produce movement.

Neuroprosthetics are not just useful for people who cannot move their arms and legs; they also help those with sensory disabilities. The World Health Organization (WHO) estimate that approximately 360 million people across the globe have a disabling form of hearing loss, while another 39 million people are blind. For some of these people, neuroprosthetics such as cochlear implants and bionic eyes have given them back their senses and, in some cases, they have enabled them to hear or see for the very first time.

Here, we review five of the most significant developments in neuroprosthetic technology, looking at how they work, why they are helpful, and how some of them will develop in the future.

Ear implant

Probably the "oldest" neuroprosthetic device out there, cochlear implants (or ear implants) have been around for a few decades and are the epitome of successful neuroprosthetics.

The U.S. Food and Drug Administration (FDA) approved cochlear implants as early as 1980, and by 2012, almost 60,000 U.S. individuals had had the implant. Worldwide, more than 320,000 people have had the device implanted. Although imperfect, cochlear implants allow users to distinguish speech in person or over the phone, with the media abound with emotional accounts of people who were able to hear themselves for the first time using this sensory neuroprosthetic device.

Eye implant

The first artificial retina - called the Argus II - is made entirely from electrodes implanted in the eye and was approved by the FDA in February 2013. In much the same way as the cochlear implant, this neuroprosthetic bypasses the damaged part of the retina and transmits signals, captured by an attached camera, to the brain. This is done by transforming the images into light and dark pixels that get turned into electrical signals. The electrical signals are then sent to the electrodes, which, in turn, send the signal to the brain's optic nerve. While Argus II does not restore vision completely, it does enable patients with retinitis pigmentosa - a condition that damages the eye's photoreceptors - to distinguish contours and shapes, which, many patients report, makes a significant difference in their lives. Retinitis pigmentosa is a neurodegenerative disease that affects around 100,000 people in the U.S. Since its approval, more than 200 patients with retinitis pigmentosa have had the Argus II implant, and the company that designed it is currently working to make colour detection possible as well as improve the resolution of the device.

Neuroprosthetics for people with SCI

Almost 350,000 people in the U.S. are estimated to live with SCI, and 45 percent of those who had an SCI since 2010 are considered tetraplegic - that is, paralysed from the neck down. We recently reported on a groundbreaking one-patient experiment that enabled a man with quadriplegia to move his arms using the sheer power of his thoughts. Bill Kochevar had electrodes surgically fitted into his brain. After training the BCI to "learn" the brain activity that matched the movements he thought about, this activity was turned into electrical pulses that were then transmitted back to the electrodes in his brain. In much the same way that the cochlear and visual implants bypass the damaged area, so too does this BCI area avoid the "short circuit" between the brain and the patient's muscles created by SCI. With the help of this neuroprosthetic, the patient was able to successfully drink and feed himself. "It was amazing," Kochevar says, "because I thought about moving my arm and it did." Kochevar was the first patient in the world to test the neuroprosthetic device, which is currently only available for research purposes.

However, this is not where SCI neuroprosthetics stop. The Courtine Lab - which is led by neuroscientist Gregoire Courtine in Lausanne, Switzerland - is tirelessly working to help injured people to regain control of their legs. Their research efforts with rats have enabled paralysed rodents to walk, achieved by using electrical signals and making them stimulate nerves in the severed spinal cord. "We believe that this technology could one day significantly improve the quality of life of people confronted with neurological disorders," says Silvestro Micera, co-author of the experiment and neuroengineer at Courtine Labs. Recently, Prof. Courtine has also led an international team of researchers to successfully create voluntary leg movement in rhesus monkeys. This was the first time that a neuroprosthetic was used to enable walking in nonhuman primates. However, "it may take several years before all the components of this intervention can be tested in people," Prof. Courtine says.

An arm that feels has also led other projects on neuroprosthetics. In 2014, MNT reported on the first artificial hand that was enhanced with sensors. Researchers measured the tension in the tendons of the artificial hand that control grasping movements and turned it into electric current. In turn, using an algorithm, this was translated into impulses that were then sent to the nerves in the arm, producing a sense of touch. Since then, the prosthetic arm that "feels" has been improved even more. Researchers from the University of Pittsburgh and the University of Pittsburgh Medical Centre, both in Pennsylvania, tested the BCI on a single patient with quadriplegia: Nathan Copeland. The scientists implanted a sheath of microelectrodes below the surface of Copeland's brain - namely, in his primary somatosensory cortex - and connected them to a prosthetic arm that was fitted with sensors. This enabled the patient to feel sensations of touch, which felt, to him, as though they belonged to his own paralysed hand. While blindfolded, Copeland was able to identify which finger on his prosthetic arm was being touched. The sensations he perceived varied in intensity and were felt as differing in pressure.

Neuroprosthetics for neurons? 

We have seen that brain-controlled prosthetics can restore patients' sense of touch, hearing, sight, and movement, but could we build prosthetics for the brain itself? Researchers from the Australian National University (ANU) in Canberra managed to artificially grow brain cells and create functional brain circuits, paving the way for neuroprosthetics for the brain. By applying nanowire geometry to a semiconductor wafer, Dr. Vini Gautam, of ANU's Research School of Engineering, and colleagues came up with a scaffolding that allows brain cells to grow and connect synaptically.

Project group leader Dr. Vincent Daria, from the John Curtin School of Medical Research in Australia, explains the success of their research:

We were able to make predictive connections between the neurons and demonstrated them to be functional with neurons firing synchronously. This work could open up a new research model that builds up a stronger connection between materials nanotechnology with neuroscience."

Neuroprosthetics for the brain might one day help patients who have experienced a stroke or who live with neurodegenerative diseases to recover neurologically. Every year in the U.S., almost 800,000 people have had a stroke, and more than 130,000 people die from it. Neurodegenerative diseases are also widespread, with 5 million U.S. adults estimated to live with Alzheimer's disease, 1 million to have Parkinson's, and 400,000 to experience multiple sclerosis.