Julie Brinton

Orthographic influences, vocabulary development, and phonological awareness in deaf children who use cochlear implants

In the current study, we explore the influence of orthographic knowledge on phonological awareness in children with cochlear implants and compare developmental associations to those found for hearing children matched for word reading level or chronological age. We show an influence of orthographic knowledge on syllable and phoneme awareness in deaf and hearing children, but no orthographic effect on rhyme awareness. Nonorthographic rhyme awareness was a significant predictor of reading outcomes for all groups. However, whereas receptive vocabulary knowledge was the most important predictor of word reading variance in the cochlear implant group, rhyme awareness was the only important predictor of word reading variance in the reading level matched hearing group. Both vocabulary and rhyme awareness were equally important in predicting reading in the chronological age-matched hearing group. The data suggest that both deaf and hearing children are influenced by orthography when making phonological judgments, and that phonological awareness and vocabulary are both important for reading development.

Measuring language development in deaf children with cochlear implants

For the past ten years profoundly deaf children in the UK have been able to receive cochlear implants as an alternative to conventional hearing aids. The South of England Cochlear Implant Centre (SOECIC) has implanted 78 profoundly deaf children. As cochlear implantation is still a relatively new procedure it is important to record progress comprehensively. One of the main aims of implantation is to give the recipient access to sound so that, in the case of a child, they can acquire speech and language. There is a need for a test that assesses a wide range of language abilities and which is also sensitive to change. The Preschool Language Scales-3 (UK) (PLS-3)(Zimmerman et al. 1997) has been standardised on a British population and was chosen to be part of a test battery at SOECIC. The test assesses skills from birth to seven years of age and has been administered at regular intervals to the clinic population. The outcome results show that average scores improve with use following implantation.

Localization performance of unilateral cochlear implant users for speech, tones and noise

Abstract Bilateral cochlear implants aim to improve sound localization compared to monaural implants, among other potential benefits. Monaural cochlear implants should not support localization in the horizontal plane as there are no interaural level and time difference cues available, although some previous studies have suggested limited capability. As background to other studies of bilateral implantation, the localization abilities of 18 monaural cochlear implantees were investigated experimentally in an anechoic chamber, using various sound stimuli with different amounts of temporal information. The effects of head movement and reverberation were also investigated. Localization performance was found to be close to chance for all stimuli. It is confirmed that monaural cochlear implants are unable to support useful auditory sound localization, even when head movements are allowed.

Speech intelligibility rating of cochlear implanted children: inter-rater reliability

Abstract The Speech Intelligibility Rating (SIR) scale was designed to classify childrens global speech production according to one of five hierarchical categories. Individuals rating the scale need to judge which category is appropriate, giving the possibility that different raters could use different scores in their assessments. The aim of this study was to determine the inter-rater reliability of the scale, i.e. whether judges agree as to the category membership for the assessed behaviour. Inexperienced (‘naive’) judges rated videotape excerpts of implanted children in communication with a known adult according to the scale. Each judge rated four children sequentially from one of four videos: there were two videos of different sets of children, each recorded with two different orders. Both subsets of subjects ranked children in the same order of intelligibility (Kendalls W = 0.86 and W = 0.98 respectively, both p < 0.01). There was agreement on the category membership for each child (Kappas K = 0.45 and K = 0.68 respectively, both p < 0.001). The intra-class correlation coefficient showed that agreement between raters was high (ICC2,1 values = 0.80 and 0.81, both p < 0.001), and that ratings were consistent (ICC3,1 values = 0.82 and 0.97, both p < 0.001). This study indicated that the scale demonstrates good inter-rater reliability. It can be used confidently by cochlear implant teams to monitor the progress of implanted childrens speech intelligibility.

United Kingdom national paediatric bilateral audit.

Abstract Prior to 2009, UK public funding was mainly only available for children to receive unilateral cochlear implants. In 2009, the National Institute for Health and Clinical Excellence (NICE) published guidance for cochlear implantation following their review. According to these guidelines, all suitable children are eligible to have simultaneous bilateral cochlear implants or a sequential bilateral cochlear implant if they had received the first before the guidelines were published. NICE stated that they would review this decision in 2011. In preparation for this review, 13 UK cochlear implant centres formed a consortium, and the decision was made to carry out a multi-centre audit. The audit involves collecting data from simultaneously and sequentially implanted children at three intervals: before bilateral cochlear implants or before the sequential implant, 1 year after bilateral implants, and 2 years after bilateral implants. The measures include localization, speech recognition in quiet and background noise, speech production, listening, vocabulary, parental perception, quality of life, and surgical data including complications. The audit has now passed the 1-year point, and data have been received on more than 400 children. Preliminary results will be available a year later.

United Kingdom national paediatric bilateral project: Demographics and results of localization and speech perception testing

Objectives: To assess longitudinal outcomes in a large and varied population of children receiving bilateral cochlear implants both simultaneously and sequentially. Methods: This observational non-randomized service evaluation collected localization and speech recognition in noise data from simultaneously and sequentially implanted children at four time points: before bilateral cochlear implants or before the sequential implant, 1 year, 2 years, and 3 years after bilateral implants. No inclusion criteria were applied, so children with additional difficulties, cochleovestibular anomalies, varying educational placements, 23 different home languages, a full range of outcomes and varying device use were included. Results: 1001 children were included: 465 implanted simultaneously and 536 sequentially, representing just over 50% of children receiving bilateral implants in the UK in this period. In simultaneously implanted children the median age at implant was 2.1 years; 7% were implanted at less than 1 year of age. In sequentially implanted children the interval between implants ranged from 0.1 to 14.5 years. Children with simultaneous bilateral implants localized better than those with one implant. On average children receiving a second (sequential) cochlear implant showed improvement in localization and listening in background noise after 1 year of bilateral listening. The interval between sequential implants had no effect on localization improvement although a smaller interval gave more improvement in speech recognition in noise. Children with sequential implants on average were able to use their second device to obtain spatial release from masking after 2 years of bilateral listening. Although ranges were large, bilateral cochlear implants on average offered an improvement in localization and speech perception in noise over unilateral implants. Conclusion: These data represent the diverse population of children with bilateral cochlear implants in the UK from 2010 to 2012. Predictions of outcomes for individual patients are not possible from these data. However, there are no indications to preclude children with long inter-implant interval having the chance of a second cochlear implant.

United Kingdom National Paediatric Bilateral Cochlear Implant Audit: Preliminary results

Abstract Prior to 2009, United Kingdom (UK) public funding was mainly only available for children to receive unilateral cochlear implants. In 2009, the National Institute for Health and Care Excellence published guidance for cochlear implantation following their review. According to these guidelines, all suitable children are eligible to have simultaneous bilateral cochlear implants or a sequential bilateral cochlear implant if they had received the first before the guidelines were published. Fifteen UK cochlear implant centres formed a consortium to carry out a multi-centre audit. The audit involves collecting data from simultaneously and sequentially implanted children at four intervals: before bilateral cochlear implants or before the sequential implant, 1, 2, and 3 years after bilateral implants. The measures include localization, speech recognition in quiet and background noise, speech production, listening, vocabulary, parental perception, quality of life, and surgical data including complications. The audit has now passed the 2-year point, and data have been received on 850 children. This article provides a first view of some data received up until March 2012.

United Kingdom national paediatric bilateral project: Results of professional rating scales and parent questionnaires.

Objectives: This fourteen-centre project used professional rating scales and parent questionnaires to assess longitudinal outcomes in a large non-selected population of children receiving simultaneous and sequential bilateral cochlear implants. Methods: This was an observational non-randomized service evaluation. Data were collected at four time points: before bilateral cochlear implants or before the sequential implant, one year, two years, and three years after. The measures reported are Categories of Auditory Performance II (CAPII), Speech Intelligibility Rating (SIR), Bilateral Listening Skills Profile (BLSP) and Parent Outcome Profile (POP). Results: Thousand and one children aged from 8 months to almost 18 years were involved, although there were many missing data. In children receiving simultaneous implants after one, two, and three years respectively, median CAP scores were 4, 5, and 6; median SIR were 1, 2, and 3. Three years after receiving simultaneous bilateral cochlear implants, 61% of children were reported to understand conversation without lip-reading and 66% had intelligible speech if the listener concentrated hard. Auditory performance and speech intelligibility were significantly better in female children than males. Parents of children using sequential implants were generally positive about their childs well-being and behaviour since receiving the second device; those who were less positive about well-being changes also generally reported their children less willing to wear the second device. Conclusion: Data from 78% of paediatric cochlear implant centres in the United Kingdom provide a real-world picture of outcomes of children with bilateral implants in the UK. This large reference data set can be used to identify children in the lower quartile for targeted intervention.

Is the Software Package Embedding Dynamic Causal Modeling Robust

In recent years, Dynamic CausalModeling (DCM) has become a very popular method in the field of effective connectivity measurement of the brain and it is being used widely for different purposes. The only software available that has embedded this algorithm is Statistical Parametric Mapping (SPM) which is a MATLAB-based toolbox. In this paper, we compare the results obtained from data analyses using different versions of the software. The dispersion of results suggest that researchers should approach the SPMtoolbox with caution as the results of the analysis of the same set of data and the same defined model may vary depending on the version of SPM or MATLAB or even the operating system used.

Reliability of Dynamic Causal Modeling using the Statistical Parametric Mapping Toolbox

Dynamic causal modeling (DCM) is a recently developed approach for effective connectivity measurement in the brain. It has attracted considerable attention in recent years and quite widespread used to investigate brain connectivity in response to different tasks as well as auditory, visual, and somatosensory stimulation. This method uses complex algorithms, and currently the only implementation available is the Statistical Parametric Mapping (SPM8) toolbox with functionality for use on EEG and fMRI. The objective of the current work is to test the robustness of the toolbox when applied to EEG, by comparing results obtained from various versions of the software and operating systems when using identical datasets. Contrary to expectations, it was found that estimated connectivities were not consistent between different operating systems, the version of SPM8, or the version of MATLAB being used. The exact cause of this problem is not clear, but may relate to the high number of parameters in the model. Caution is thus recommended when interpreting the results of DCM estimated with the SPM8 software.