TABLE 1.

Summary of main modifications compared to the original ACE program.

Type of modification		Motivation
Length of program and frequency of sessions	Two modules were added to the original 5, giving a total of 7. Sessions were fortnightly.	The program was aimed at the older adults with CI: an introductory module was added to give information on the correct management and functioning of CI (module 1). A further module was added after the 4th to give more time for participants to practice assertive skills and communication strategies. The fortnightly frequency was decided to allow participants to have more opportunities to practice the strategies and to meet participant organizational needs.
Content of sessions	Modification of the content of modules 5 (listening to other signals) and 7 (usability of advance CI technology)	The general objectives of the two modules were maintained but adapted to the technology in use (i.e., bimodal mode), with specific information concerning Assistive Listening Devices (MODULE: “usability of advance CI technology”). Clinical specialists for all CI brands worn by the participants were involved in these sessions.
Linguistic modification	Partial modification of handout 26: speechreading (section linguistic factor) and lipreading exercise (spin test)	Only phonetic, syntactic and morphological changes were made to make exercises suitable for Italian-speaking participants. The adaptation was undertaken by the audiologist and speech therapist who participated in the study.