PP802 - Development and Implementation of Low Vision Loudness Scale for Cochlear Implant Patients

Abstract:
Mapping of a cochlear implant (CI) includes defining the electric dynamic range, with recipients ranking the perceived loudness of electric stimulation from threshold to maximum comfortable loudness. Adult CI patients typically use a visual aid called a loudness scale to complete this procedure. The conventional loudness scale is a laminated paper with words and symbols that have little contrast and are challenging to perceive for patients with low vision. Our multidisciplinary team developed a prototype that includes two different contrasting color combinations (red and black), a tactile element, and Braille labeling. Overall, initial patient and clinician responses have been positive.

Summary:

Introduction
Mapping of a cochlear implant (CI) includes defining the electric dynamic range, with recipients ranking the perceived loudness of electric stimulation from threshold to maximum comfortable loudness. Adult CI patients typically use a visual aid called a loudness scale to complete this procedure. The conventional loudness scale is a laminated paper with words and symbols that have little contrast and are challenging to perceive for patients with low vision. Our team decided to develop and implement an alternative loudness scale for cochlear implant patients with varying degrees of vision loss. This report reviews the development of the loudness scale and initial responses from adult CI patients with low vision.

Methods
The development team for the Low Vision Loudness Scale included professionals from audiology, speech-language pathology, and ophthalmology. Conventional loudness scales were used as guidance. The prototypes included two different contrasting color combinations (red and black), a tactile element, and Braille labeling. Adult CI patients were asked to provide feedback about the scale overall, their preferred color combination, their opinion on the inclusion of a tactile component, and any suggestions to improve the alternative loudness scale.

Results
Eight adult CI patients have used and provided feedback on the Low Vision Loudness Scale. Six preferred the black contrast color, and two patients preferred the red contrast color. One patient reported they would prefer the loudness scale to be matte as opposed to laminate due to their specific vision and light sensitivity. One patient recommended a star over “LOUD” as opposed to an arrow to more clearly indicate the target volume for the mapping procedure. Overall, CI patient responses have been positive, and patients have reportedly found the Low Vision Loudness Scale to be a helpful tool for the mapping procedure. Subjectively, from the clinician perspective, this tool has made it easier for CI patients who have low vision or are blind to understand the loudness scaling task and has promoted greater ease of mapping. Additionally, multiple patients have expressed appreciation that this tool was designed to meet their unique needs.

Conclusion
The conventional loudness scale is not accessible for CI patients who have low vision or are blind. We used a multidisciplinary collaboration to develop a loudness scale to support patients who have low vision or are blind to more actively and effectively participate in their mapping process. The Low Vision Loudness Scale features two color options that provide bold color contrast as opposed to the low color contrast of a conventional loudness scale. The scale includes two tactile elements, sandpaper with decreasing/coarser grit size to illustrate the perceived increase in volume, and Braille labeling to help guide patients through the mapping process. Overall, initial patient responses to the Low Vision Loudness Scale have been positive. Future directions for this project include adapting it for use with the pediatric CI population and expanding its use for other patient populations who experience difficulty using conventional loudness scales.