{"id":31518,"date":"2019-04-16T18:52:13","date_gmt":"2019-04-16T16:52:13","guid":{"rendered":"http:\/\/www.invarena.cz\/?p=31518"},"modified":"2019-06-04T14:20:06","modified_gmt":"2019-06-04T12:20:06","slug":"budou-mit-moje-hluche-dcery-lepsi-zivot-s-kochlearnim-implantatem","status":"publish","type":"post","link":"https:\/\/www.invarena.cz\/?p=31518","title":{"rendered":"Je pro n\u011b kochle\u00e1rn\u00ed implant\u00e1t vhodn\u00fd?"},"content":{"rendered":"<p><strong>DOTAZ: M\u00e1m v p\u00e9\u010di 5letou a 10letou hol\u010di\u010dku \u2013 u obou byla diagnostikov\u00e1na tot\u00e1ln\u00ed hluchota. Ob\u011b znakuj\u00ed, je pro n\u011b kochle\u00e1rn\u00ed implant\u00e1t vhodn\u00fd? Co to p\u0159esn\u011b obn\u00e1\u0161\u00ed?<\/strong><!--more--><\/p>\n<p>ilustra\u010dn\u00ed sn\u00edmek<\/p>\n<p>Doporu\u010duji si sjednat <strong>konzultaci<\/strong> s odborn\u00edkem nap\u0159\u00edklad Kliniky otorinolaryngologie a chirurgie hlavy a krku I. LF UK a FN v Motole, kter\u00e1 je statut\u00e1rn\u00edm <strong>centrem pro kochle\u00e1rn\u00ed implantace<\/strong>. Dal\u0161\u00ed centra jsou ale i v jin\u00fdch &#8222;krajsk\u00fdch&#8220; nemocnic\u00edch, nap\u0159. v Hradci Kr\u00e1lov\u00e9, v Brn\u011b, v Ostrav\u011b.<\/p>\n<p>V rozhodov\u00e1n\u00ed m\u016f\u017ee pomoci i zapojen\u00ed se do komunity rodi\u010d\u016f d\u011bt\u00ed s voperovan\u00fdmi kochle\u00e1rn\u00edmi implant\u00e1ty, kte\u0159\u00ed jsou v <strong>Sdru\u017een\u00ed u\u017eivatel\u016f kochle\u00e1rn\u00edho implant\u00e1tu<\/strong> http:\/\/www.suki.cz<\/p>\n<p>P\u0159i posuzov\u00e1n\u00ed vhodnosti zaveden\u00ed kochle\u00e1rn\u00edho implant\u00e1tu (KI) je v prvn\u00ed \u0159ad\u011b t\u0159eba vylou\u010dit <strong>kontraindikace<\/strong>. K nim pat\u0159\u00ed nap\u0159\u00edklad t\u011b\u017ek\u00e9 po\u0161kozen\u00ed nebo chyb\u011bn\u00ed sluchov\u00e9ho nervu,\u00a0 po\u0161kozen\u00ed centr\u00e1ln\u00edch sluchov\u00fdch drah, chronick\u00e1 infekce st\u0159edou\u0161\u00ed nebo nevyvinut\u00fd hlem\u00fd\u017e\u010f.<\/p>\n<p>V\u00fdsledky implantace zhor\u0161uj\u00ed i dal\u0161\u00ed p\u0159idru\u017een\u00e9 vady, nap\u0159\u00edklad psychiatrick\u00e1 onemocn\u011bn\u00ed, r\u016fzn\u00e9 mozkov\u00e9 dysfunkce, d\u011btsk\u00e1 mozkov\u00e1 obrna, nedostate\u010dn\u00e1 podpora rodi\u010d\u016f apod.<\/p>\n<p><strong>Optim\u00e1ln\u00ed v\u011bk pro KI<\/strong> je jeden a\u017e dva roky. KI lze ale doporu\u010dit pro d\u011bti a\u017e do 6 let v\u011bku s t\u00edm, \u017ee ov\u0161em plat\u00ed, \u017ee \u010d\u00edm d\u0159\u00edve se s KI za\u010dne, t\u00edm jsou lep\u0161\u00ed v\u00fdsledky. Pro <strong>6letou d\u00edvku<\/strong> je tedy nejvy\u0161\u0161\u00ed \u010das, aby se p\u0159\u00edpadn\u011b do programu zapojila. U<strong> desetilet\u00e9 d\u00edvky<\/strong> je to u\u017e pom\u011brn\u011b pozd\u011b, ale ani tam nemus\u00ed b\u00fdt v\u0161e ztraceno, z\u00e1le\u017e\u00ed na posouzen\u00ed v\u0161ech okolnost\u00ed odborn\u00edky, kte\u0159\u00ed provedou pot\u0159ebn\u00e1 kompletn\u00ed vy\u0161et\u0159en\u00ed, na z\u00e1klad\u011b kter\u00fdch KI doporu\u010d\u00ed \u010di nikoli. Nicm\u00e9n\u011b u dosp\u011bl\u00fdch, kte\u0159\u00ed jsou vrozen\u011b nesly\u0161\u00edc\u00ed, plat\u00ed, \u017ee se KI obvykle neprov\u00e1d\u00ed, proto\u017ee ji\u017e vytvo\u0159en\u00e9 synapse v mozku neumo\u017en\u00ed o\u017eivit centr\u00e1ln\u00ed sluchov\u00e9 dr\u00e1hy.<\/p>\n<p>\u017d\u00e1dn\u00fd kochle\u00e1rn\u00ed implant\u00e1t ov\u0161em <strong>pln\u011b nenahrad\u00ed lidsk\u00e9 ucho<\/strong> a dlouho tomu je\u0161t\u011b tak nebude. Av\u0161ak od doby v\u00fdvoje prvn\u00edho implant\u00e1tu u\u017e tytu neuroprot\u00e9zy prod\u011blaly obrovsk\u00fd technick\u00fd pokrok a je st\u00e1le v\u011bt\u0161\u00ed procento u\u017eivatel\u016f, kte\u0159\u00ed jsou schopni telefonovat, nau\u010dit se ciz\u00ed \u0159e\u010d, vystudovat vysokou \u0161kolu apod. <strong>Schopnost porozum\u011bt lidsk\u00e9 \u0159e\u010di<\/strong> v\u0161ak nebude u nikoho stoprocentn\u00ed z toho d\u016fvodu, \u017ee tento apar\u00e1t m\u00e1 do dokonalosti lidsk\u00e9ho ucha st\u00e1le daleko. Nap\u0159\u00edklad proto, \u017ee po\u010det elektrod KI je mnohem ni\u017e\u0161\u00ed ne\u017e po\u010det smyslov\u00fdch bun\u011bk, kter\u00e9 zprost\u0159edkov\u00e1vaj\u00ed sluchov\u00e9 vjemy. Pou\u017eiji-li velice jednoduch\u00fd p\u0159\u00edm\u011br, je to jako kdyby v klav\u00edru \u0159ada kl\u00e1ves chyb\u011bla. Rozli\u0161ovac\u00ed charakteristiky u \u0159e\u010dov\u00e9ho procesoru implant\u00e1tu jsou ni\u017e\u0161\u00ed ne\u017e u lidsk\u00e9ho ucha. Lid\u00e9, kte\u0159\u00ed sly\u0161eli a pot\u00e9 ohluchli, zpravidla ud\u00e1vaj\u00ed, \u017ee s pomoc\u00ed KI sly\u0161\u00ed zvuky jinak a \u017ee se mus\u00ed s t\u00edmto zkreslen\u00edm znovu u\u010dit naslouchat a rozum\u011bt lidsk\u00e9 \u0159e\u010di.<\/p>\n<p>Ka\u017ed\u00fd rodi\u010d by m\u011bl po\u010d\u00edtat s t\u00edm, \u017ee <strong>poopera\u010dn\u00ed rehabilitace<\/strong> <strong>bude velmi n\u00e1ro\u010dn\u00e1<\/strong> a dlouhodob\u00e1. B\u011bhem t\u00e9 doby d\u00edt\u011b absolvuje mnoho sezen\u00ed s nastavov\u00e1n\u00edm \u0159e\u010dov\u00e9ho procesoru. M\u016f\u017ee trvat a\u017e dva roky, ne\u017e se d\u00edt\u011b nau\u010d\u00ed obstojn\u011b rozum\u011bt lidsk\u00e9 \u0159e\u010di a komunikovat. Z toho d\u016fvodu se nedoporu\u010duje d\u00edt\u011b za\u0159azovat p\u0159\u00edli\u0161 brzy do b\u011b\u017en\u00e9 \u0161koly.<\/p>\n<div>Program rehabilitace by m\u011bl obsahovat <strong>pl\u00e1n<\/strong>, jak motivovat d\u00edt\u011b k no\u0161en\u00ed \u0159e\u010dov\u00e9ho procesoru a pl\u00e1n pro u\u010ditele, rehabilita\u010dn\u00ed pracovn\u00edky a rodinu, kter\u00fd je zam\u011b\u0159en\u00fd na rozvoj sluchov\u00e9ho vn\u00edm\u00e1n\u00ed a mluven\u00e9 \u0159e\u010di.<\/p>\n<p>Proces poopera\u010dn\u00ed rehabilitace d\u011bt\u00ed s KI zahrnuje v\u00fdchovu sluchovou, \u0159e\u010dovou a cvi\u010den\u00ed odez\u00edr\u00e1n\u00ed. Pat\u0159\u00ed sem r\u016fzn\u00e9 sluchov\u00e9 hry, kter\u00e9 d\u00edt\u011b hraje s rodi\u010di. Tak\u00e9 se vyu\u017e\u00edvaj\u00ed hudebn\u011b pohybov\u00e9 a rytmick\u00e9 hry, \u0159\u00edkadla, hry spojen\u00e9 se slovn\u00edm koment\u00e1\u0159em, hry s ma\u0148\u00e1sky, vypr\u00e1v\u011bn\u00ed, rozhovor. P\u0159i t\u011bchto \u010dinnostech d\u00edt\u011b zpo\u010d\u00e1tku odez\u00edr\u00e1, ale postupn\u011b se mu odez\u00edr\u00e1n\u00ed zt\u011b\u017euje. U t\u011bchto metod je podstatn\u00e1 aktivita rodi\u010d\u016f i d\u00edt\u011bte, jejich vz\u00e1jemn\u00e1 spolupr\u00e1ce.<\/p>\n<p>P\u0159edn\u011b je t\u0159eba \u0159\u00edci, \u017ee i nesly\u0161\u00edc\u00ed lid\u00e9 mohou v r\u00e1mci sv\u00e9 komunity pro\u017e\u00edt spokojen\u00fd \u017eivot. \u0158\u00edk\u00e1 se, \u017ee u sluchov\u011b posti\u017een\u00fdch existuj\u00ed dv\u011b komunity, kter\u00e9 se mezi sebou navz\u00e1jem p\u0159\u00edli\u0161 nest\u00fdkaj\u00ed. Nedosl\u00fdchav\u00ed, jejich\u017e sluchov\u00e1 ztr\u00e1ta je kompenzov\u00e1na sluchadly, se moc &#8222;nebav\u00ed&#8220; s nesly\u0161\u00edc\u00edmi a naopak. Nesly\u0161\u00edc\u00ed se obecn\u011b pova\u017euj\u00ed za <strong>entitu s vlastn\u00edmi kulturn\u00edmi zvl\u00e1\u0161tnostmi<\/strong> a vlastn\u00edm jazykem, nebo\u0165 znakovka nen\u00ed toto\u017en\u00e1 s \u010de\u0161tinou.<\/div>\n<p>Je t\u0159eba po\u010d\u00edtat s t\u00edm, \u017ee pokud nesly\u0161\u00edc\u00ed za\u010dne sly\u0161et a komunikovat b\u011b\u017en\u00fdm zp\u016fsobem, za\u010dne se ze <strong>soci\u00e1ln\u00edho<\/strong> hlediska p\u0159esouvat do komunity nedosl\u00fdchav\u00fdch. Zintenz\u00edvn\u00ed i soci\u00e1ln\u00ed kontakty s norm\u00e1ln\u011b sly\u0161\u00edc\u00edmi lidmi. Lze o\u010dek\u00e1vat i to, \u017ee se zlep\u0161\u00ed v\u00fdchoz\u00ed pozice p\u0159i hled\u00e1n\u00ed vhodn\u00e9ho zam\u011bstn\u00e1n\u00ed. To m\u016f\u017ee m\u00edt ze soci\u00e1ln\u00edho hlediska dopady v tom, \u017ee si u\u017eivatel implant\u00e1tu sice d\u00edky sv\u00e9 znalosti znakovky n\u011bkter\u00e9 sv\u00e9 p\u0159\u00e1tele z nesly\u0161\u00edc\u00ed komunity udr\u017e\u00ed, jin\u00e9 ale z r\u016fzn\u00fdch d\u016fvod\u016f ztrat\u00ed.<\/p>\n<p>P\u0159\u00ednos KI\u00a0 je v rozvoji mluven\u00e9 \u0159e\u010di, osvojen\u00ed si spr\u00e1vn\u00e9 gramatiky a i v lep\u0161\u00edch studijn\u00edch mo\u017enostech, ve zlep\u0161en\u00ed kognitivn\u00edch funkc\u00ed a v \u017eivot\u011b obohacen\u00e9m o sv\u011bt zvuk\u016f.<\/p>\n<p>N\u011bkter\u00e9 studie ud\u00e1vaj\u00ed, \u017ee dosp\u011bl\u00ed s KI rozum\u00ed v\u011bt\u00e1m a\u017e sedmkr\u00e1t l\u00e9pe, ne\u017e p\u0159ed ohluchnut\u00edm sly\u0161eli se sluchadly. V pr\u016fzkumu, kter\u00fd byl proveden v USA mezi 900 u\u017eivateli kochle\u00e1rn\u00edch implant\u00e1t\u016f, v\u011bt\u0161ina respondent\u016f \u0159ekla, \u017ee dok\u00e1\u017ee bez probl\u00e9mu komunikovat p\u0159es telefon a u\u017e\u00edv\u00e1 si poslechu hudby.<\/p>\n<p>MUDr. Jan \u010cin\u010dura<\/p>\n","protected":false},"excerpt":{"rendered":"<div class=\"mh-excerpt\"><p>DOTAZ: M\u00e1m v p\u00e9\u010di 5letou a 10letou hol\u010di\u010dku \u2013 u obou byla diagnostikov\u00e1na tot\u00e1ln\u00ed hluchota. Ob\u011b znakuj\u00ed, je pro n\u011b kochle\u00e1rn\u00ed implant\u00e1t vhodn\u00fd? Co to <a class=\"mh-excerpt-more\" href=\"https:\/\/www.invarena.cz\/?p=31518\" title=\"Je pro n\u011b kochle\u00e1rn\u00ed implant\u00e1t vhodn\u00fd?\">[&#8230;]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":8720,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[18],"tags":[],"class_list":["post-31518","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-poradna"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/31518","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=31518"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/31518\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/8720"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=31518"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=31518"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=31518"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}