Amy McConkey Robbins

Language Development in Profoundly Deaf Children with Cochlear Implants

Although cochlear implants improve the ability of profoundly deaf children to understand speech, critics claim that the published literature does not document even a single case of a child who has developed a linguistic system based on input from an implant. Thus, it is of clinical and scientific importance to determine whether cochlear implants facilitate the development of English language skills. The English language skills of prelingually deaf children with cochlear implants were measured before and after implantation. We found that the rate of language development after implantation exceeded that expected from unimplanted deaf children (p < .001) and was similar to that of children with normal hearing. Despite a large amount of individual variability, the best performers in the implanted group seem to be developing an oral linguistic system based largely on auditory input obtained from a cochlear implant.

Enhancement of expressive language in prelingually deaf children with cochlear implants.

Expressive language skills were assessed in two groups of prelingually-deafened children using the Reynell Developmental Language Scales (RDLS). Results from a group of 89 unimplanted subjects provided cross-sectional data which suggested that profoundly deaf children without implants, on average, could only be expected to make 5 months of expressive language growth in one year. Twenty-three children who received cochlear implants made up the second group of subjects and were administered the RDLS at three intervals: preimplant, 6-, and 12-months postimplant. The scores obtained at the post-implant intervals were then compared to scores that would be predicted on the basis of maturation alone, without the implant (these predictions were formulated based on the data obtained from the unimplanted subjects). At the 12-month postimplant interval, the observed mean language score was significantly higher than the predicted score. Although the mean group data were extremely encouraging, wide inter- subject variability was observed. Although the implant subjects, as a group, were substantially delayed compared with their normal hearing peers, their rate of language growth was found to match that of hearing peers, following implantation. Thus, the gap between chronological age and language age, which normally widens over time in deaf children, remained constant. Preliminary analyses over the first 2.5 years post-implant are consistent with this trend. These results suggest that early implantation (before age 3) might be beneficial to profoundly deaf children because the language delays at the time of implantation would be much smaller.

Variables affecting implant performance in children

This study examined the variables that contribute to the large individual differences in the speech perception skills of children with the Nucleus multichannel cochlear implant. Sixty‐one children were tested on four measures of speech perception: two tests of closed‐set word recognition, one test of open‐set recognition of phrases, and one open‐set monosyllabic word test, scored on the basis of the percentage of phonemes as well as words identified correctly. The results of a series of multiple regression analyses revealed that the variables of processor type, duration of deafness, communication mode, age at onset of deafness, length of implant use, and age implanted accounted for roughly 35% of the variance on two tests of closed‐set word recognition, and 40% of the variance on measures that assessed recognition of words or phomenes in an open set. Length of implant use accounted for the most variance on all of the speech perception measures.

Children with implants can speak, but can they communicate? ☆ ☆☆ ★

English-language skills were evaluated in two groups of profoundly hearing-impaired children with the Reynell Developmental Language Scales, Revised. The first group consisted of 89 deaf children who had not received cochlear implants. The second group consisted of 23 children wearing Nucleus multichannel cochlear implants. The subjects without implants provided cross-sectional language data used to estimate the amount of language gains expected on the basis of maturation. The Reynell data from the group without implants were subjected to a regression by age. On the basis of this analysis, deaf children were predicted to make half or less of the language gains of their peers with normal hearing. Predicted language scores were then generated for the subjects with implants by using the childrens preimplant Reynell Developmental Language Scale scores. The predicted scores were then compared with actual scores achieved by the subjects with implants 6 and 12 months after implantation. Twelve months after implantation, the subjects demonstrated gains in receptive and expressive language skills that exceeded by 7 months the predictions made on the basis of maturation alone. Moreover, the average language-development rate of the subjects with implants in the first year of device use was equivalent to that of children with normal hearing. These effects were observed for children with implants using both the oral and total-communication methods.

Assessing Cochlear Implant Benefit in Very Young Children

3. Tyler RS, Fryauf-Bertschy H, Kelsay DMR, Gantz BJ, Woodworth GP, Parkinson A. Speech perception by prelingually deaf children using cochlear implants. Otolaryngol Head Neck Surg 1997;117:1807. 4. Balkany T, Hodges AV, Luntz M. Update on cochlear implantation. Otolaryngol Clinic North Am 1996;29:277-89. 5. Miyamoto R, Osberger M, Todd S, et al. Variables affecting implant performance in children. Laryngoscope 1994;104:1120-4. 6. Harrison R, Nedzelski J, Picton N, et al. The Paediatric Cochlear Implant Program at the Hospital for Sick Children, Toronto. J Otolaryngol 1997;26:180-7. 7. De Jong A, Nedzelski J, Papsin B. Surgical outcome measures of pédiatrie cochlear implantation. J Otolaryngol 1998;27:26-30. 8. Dawson PW, Blarney PJ, Rowland LC, et al. Cochlear implants in children, adolescents, and prelinguistically deafened adults: speech perception. J Speech Hear Res 1992;35:401-17.

Effect of Age at Onset of Deafness on Children's Speech Perception Abilities with a Cochlear Implant

The speech perception abilities of 37 children with cochlear implants (single-channel or multichannel) were examined as a function of age at onset of deafness. There was no significant difference in the speech perception abilities of implanted children who were born deaf and those of implanted children who lost their hearing during the first 3 years of life. In contrast, the performance of children whose age at onset of deafness was 5 years or later was significantly better than that of the children with congenital or early-acquired deafness on tests of stress pattern categorization, closed-set word identification, open-set identification of common phrases, and lipreading enhancement.

Language Outcomes After Cochlear Implantation

This article presents a focused review of language, speech, and comprehension outcomes in children with cochlear implants. Language acquisition with early-age implants and later-age implants are discussed, along with literacy and comprehension skills. A wide range of language outcomes is possible for children with cochlear implants, but many can achieve listening and spoken language skills at the same rate as their hearing peers. Appropriate auditory rehabilitation and parental guidance is vital for the development of listening and spoken language skills.

Comparison of speech perception abilities in deaf children with hearing aids or cochlear implants

The speech perception abilities of deaf children with a single- or multi-channel cochlear implant are compared with those of deaf children who derive substantial benefit from conventional hearing aids. The children with hearing aids have unaided pure-tone thresholds ranging from 90- to 110-dB HL through at least 2000 Hz, and aided thresholds of 30- to 60-dB HL. The group data show that the speech perception scores of the subjects with hearing aids were significantly higher than those of the subjects with implants on a range of speech perception measures. Although a few subjects with implants achieved scores as high as those who used hearing aids, the majority did not. Even though the children with implants receive substantial benefit from their devices, they continue to have limited auditory perception abilities relative to their peers who derive benefit from conventional hearing aids. The data highlight the importance of establishing hearing aid benefit in potential candidates for implant.

The Effect of Adventitious Deafness on the Perception and Production of Voice Onset Time in Thai: A Case Study

The perception and production of voice onset time (VOT) was investigated in a Thai patient with an adventitious, profound sensorineural heating loss. Thai exhibits a three-category voicing distinction for bilabial (/b, p, ph/) and alveolar (/d, t, th/) stops, and a two-category distinction for velar (/k, kh/) stops. VOT perception was measured in labeling responses to synthetic speech continua differing in VOT; VOT production was measured in word-initial stops of words produced in isolation. These measurements were compared with previously published VOT data for normal-hearing Thai speakers. The results of acoustic analyses of this subjects productions suggested only minor articulatory perturbations, and the target phonemes were generally identified accurately by normal listeners.

Jumpstarting auditory learning in children with cochlear implants through music experiences.

Abstract Musical experiences are a valuable part of the lives of children with cochlear implants (CIs). In addition to the pleasure, relationships and emotional outlet provided by music, it serves to enhance or ‘jumpstart’ other auditory and cognitive skills that are critical for development and learning throughout the lifespan. Musicians have been shown to be ‘better listeners’ than non-musicians with regard to how they perceive and process sound. A heuristic model of music therapy is reviewed, including six modulating factors that may account for the auditory advantages demonstrated by those who participate in music therapy. The integral approach to music therapy is described along with the hybrid approach to pediatric language intervention. These approaches share the characteristics of placing high value on ecologically valid therapy experiences, i.e., engaging in ‘real’ music and ‘real’ communication. Music and language intervention techniques used by the authors are presented. It has been documented that children with CIs consistently have lower music perception scores than do their peers with normal hearing (NH). On the one hand, this finding matters a great deal because it provides parameters for setting reasonable expectations and highlights the work still required to improve signal processing with the devices so that they more accurately transmit music to CI listeners. On the other hand, the finding might not matter much if we assume that music, even in its less-than-optimal state, functions for CI children, as for NH children, as a developmental jumpstarter, a language-learning tool, a cognitive enricher, a motivator, and an attention enhancer.