title: Conversion from the SPEAK to the ACE strategy in children using the nucleus 24 cochlear implant system: speech perception and speech production outcomes.
abstract: OBJECTIVE
  The main objective of this study was to assess whether speech perception and speech production in children using the Nucleus 24 cochlear implant system improved with a change in speech processing strategy from the SPEAK to the Advanced Combination Encoder (ACE) strategy. The major difference between the two strategies is that ACE uses a higher stimulation rate (in this study the stimulation rate was 900 Hz per channel) compared with the SPEAK strategy, where the stimulation rate is 250 Hz per channel. Information also was obtained regarding the adjustment period after conversion to the ACE strategy.
  
  
  METHODS
  An ABA experimental design was used where scores were initially obtained using the SPEAK strategy' (in the initial A time interval), and subsequently performance was assessed using the ACE strategy (B time interval) and then again with the SPEAK strategy (second A time interval). The duration of the B interval was 10 wk, and the duration for the second A interval was 4 wk. Seven children aged between 9 and 16 yr who had at least 6 mo experience with the SPEAK strategy participated. Open-set monosyllabic CNC word perception in quiet and Speech Intelligibility Test sentence perception in noise was evaluated at the end of each of the time intervals. Word perception was also monitored at fortnightly intervals during the B time interval. Speech production was assessed at the end of the initial A time interval and at the end of the B time interval.
  
  
  RESULTS
  Mean word and phoneme scores for open-set words in quiet for the group of seven children were significantly higher with the ACE strategy as compared with the SPEAK strategy scores obtained in both of the A time intervals. For sentences in noise, mean scores using the ACE strategy as well as the SPEAK strategy at the second A evaluation point were significantly higher than the scores using the SPEAK strategy measured at the first A time interval. This suggests that learning effects may have influenced outcomes. For some subjects, an initial decrease in scores was found during the initial 2-wk period after fitting the ACE strategy; however, scores subsequently were found to be similar to or higher than those when using the initial SPEAK strategy. Analysis of speech production assessments showed an improvement in the medial consonant scores after using the ACE strategy.
  
  
  CONCLUSIONS
  This study demonstrated that some children were able to benefit from the additional information provided by the ACE strategy as compared with the SPEAK strategy. However, the differences in overall performance between the two strategies appear to be relatively small.
authors.affiliation: CRC for Cochlear Implant and Hearing Aid Innovation, Melbourne, Australia.
authors.forename: C E
authors.initials: CE
authors.lastname: Psarros
authors.forename: K L
authors.initials: KL
authors.lastname: Plant
authors.forename: K
authors.initials: K
authors.lastname: Lee
authors.forename: J A
authors.initials: JA
authors.lastname: Decker
authors.forename: L A
authors.initials: LA
authors.lastname: Whitford
authors.forename: R S C
authors.initials: RS
authors.lastname: Cowan
mesh_terms: D000161:Acoustic Stimulation / Q000295:instrumentation*; D000293:Adolescent; D002648:Child; D019929:Cochlear Implantation; D003638:Deafness / Q000534:rehabilitation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D013067:Speech Perception / Q000502:physiology*; D013068:Speech Production Measurement