Meeting the challenge of simultaneous talk for cochlear implant users

Although people do not usually talk at the same time, simultaneous speech by two or more speakers is surprisingly frequent. In the typical conversations recorded for our recent AHRC -funded project it occupies 16% of total talking time, 41% of speaker turns being overlapped by another speaker. Simultaneous or overlapping talk is known to be a particular problem for individuals who have a hearing loss, even when using a conventional hearing aid or cochlear implant. Until recently, even in one-to-one settings many users would need optimum conditions in order to hold a satisfactory conversation, e.g. a quiet environment and the communication awareness of both participants that they should avoid talking at the same time. Professionals have steered clear of advising cochlear implant users about how to deal with situations of overlapping talk, on the basis that such a situation would be just too hard to handle. However, recent improvements in the signal processing strategies used in cochlear implants mean that it is now more realistic for users to attempt to engage in conversations where overlapping talk occurs. The aim of this follow-on project is to engage with a group of adult users of cochlear implants in order to develop useful training materials for handling overlapping talk in conversation. These materials will draw mainly on the outputs from our earlier project on overlapping talk, where we have developed a unique corpus and some key findings about overlapping talk in normal conversation. To the best of our knowledge, these will be the first materials that specifically address the problems raised by overlapping talk.

The main objectives of this project are:

1. To identify the specific issues that overlapping talk raises for cochlear implant users
This will be accomplished by direct questioning, via focus group and questionnaire survey; observation of recorded naturalistic conversations; and by exploring linguistic and cultural differences.

2. To develop ways of improving the experience of cochlear implant users
This will involve devising training software and activities for cochlear implant users, in close collaboration with a group of cochlear implant users. The idea is that the implant user will be able to work with the materials on their own, and with their family members, at home. The software will make use of real examples from our collection of recorded conversations, where people are quite often talking in overlap. The software will focus on both listening and speaking. On the listening side, for example, it will allow users to simultaneously hear and visualise the flow of a conversation over time, by presenting speaker activity on a graphical timeline. On the speaking side, it will provide learning tasks that allow users to practise producing cues in their own speech.

3. To promote and disseminate the training software through a special event, a dedicated website and through existing channels for cochlear implant users and professionals.

This project will engage with a small number of cochlear implant users initially, in order to develop software materials that can assist cochlear implant users when dealing with overlapping talk. The project is embedded in the local NHS cochlear implant service, in which two project team members are employed. Initially the outputs of the project will benefit users of that service. They will be disseminated more widely in the UK through the final dissemination event, and through participation in established national meetings for professionals and for cochlear implant users. Other team members will disseminate results at national and international conferences, which will raise awareness of the work within relevant academic communities. The project website will provide global access to the software materials: the project therefore has the potential to enhance the social participation of more than a quarter of a million cochlear implant users worldwide.

This project is embedded in a local NHS service for cochlear implant users. Its more immediate benefits will be for the users of that service, and also for the professionals who work with them.
The Sheffield Cochlear implant service provides lifelong support to over 60 adult implant users. As technology improves, expectations of performance with implants are higher and in addition users wish to participate at a higher level in everyday communication. As part of the service's ongoing audit of performance of implants, more complex aspects of communication skills have been identified, which could benefit from further rehabilitation, improving quality of life, and occupational skills. In addition new technology is opening up options for access to rehabilitation tools at home and allowing more tailored remote access to rehabilitation. However, there is little time or funding, within the remit of an NHS service, to address these issues. This collaboration between the service and the University of Sheffield will provide further methods of supporting patients that can also be facilitated by patients themselves.

This Follow-on project for impact and engagement will initially engage with a small number of CI users in Sheffield , in order to develop software materials for CI users who, like other hearing aid users, experience problems when trying to deal with simultaneous or overlapping talk. Until recently, even in one to one settings most users would need optimum conditions in order to have a satisfactory conversation, e.g. a quiet environment and communication awareness of both participants not to overlap in conversation. However, because of recent technical improvements in CIs, many users are now able to participate in more complex communication settings. Thus the envisaged proposal is now highly relevant to improving everyday performance with implants. This will enhance the social participation of CI users.The Cochlear Implant team will facilitate access to users, provide expertise regarding implant technology and ensure any work is patient focused in both its ease of use and delivery, by involving users in this process at all stages.

The Sheffield CI service is partnered with 'Yorkshire Cochlear Implant Service' centred in Bradford and has close relationships with other CI services nationally,therefore training materials can be disseminated to a large group of users via these clinical links. Outputs will be disseminated more widely in the UK through the end-of project engagement event, and through the participation of team members in national and international meetings. The project website will provide global access to the software materials: worldwide there are at least a quarter of million people using CIs.

It is envisaged that the direct benefit to users of the software will be increased social participation, as a result of greater access to conversations.There may also be a benefit to service providers, in terms of improved service delivery:where a user can train him or herself on conversational skills at home using a computer, this potentially reduces the pressure on staff time.