Country Presentation: the Netherlands

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Country Presentationthe Netherlands
Anneke Vermeulen University Hospital St
Radboud Nijmegen the Netherlands
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Contents

• CI in the Netherlands
• Reading skills after Cochlear Implantation
• Changing educational needs of deaf children

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Cochlear Implant centres in the Netherlands

• 8 university medical centres
• Amsterdam (vu and umc)
• Groningen
• Leiden
• Maastricht
• Nijmegen
• Rotterdam
• Utrecht
• Implant Centres are engaged in a formal
  cooperation
• Cochleaire Implant Overleg Nederland CI-ON
• The CI-ON at a regular basis consults all
  involved client and patient groups.

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Cochlear Implant centres in the Netherlands

• Cooperations of University Medical Centres
• with 7 family guidance departments
• Amsterdam
• Haren (Effatha Guyot Groep)
• Middle East NL
• South East NL (Nijmegen, Hoensbroek, Eindhoven)
• St Michielsgestel (Viataal)
• Rotterdam (Aurisgroep)
• Zoetermeer

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Numbers of CI recipients in NL

• 1984 2007 total 2000 recipients
• 700 children (ca 300 in UMC Nijmegen)
• 1300 adults
• In 2006 total 351
• 115 children
• 30 children bilateral (20 in UMC Nijmegen)
• 236 adults

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Reading Skills after Cochlear Implantation

• Vermeulen, Van Bon, Schreuder, Knoors, Snik
• Radboud University Nijmegen, NL
• Evaluate the reading comprehension in profoundly
  deaf childeren with CIs
• Assess the role of the two components in
• the Simple View of Reading Model
• Determine the link in the causal chain between
• post implant auditory speech perception
• and reading comprehension

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Reading skills

• The use of a cochlear implant enables auditory
  access to spoken language
• Post implant development of vocabulary has been
  frequently reported in
• literature (Robbins, Svirsky, Connor)
• Development of morpho-syntactic competence has
  been found to be
• speech perception based
• More recently reading skills of deaf children
  with cochlear implants have
• been investigated (Geers, Connor and Zwolan,
  Spencer et al.)

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Simple View of Reading Model (Hoover Gough,
1990)

• How is print transferred to meaning ?
• Reading Decoding x Linguistic Comprehension
• Reading Comprehension is the product of
• the ability to decode words in the text
• and the ability to understand (spoken) language

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Reading Comprehension levelsof deaf children
without CIs

• 3 th grade (8 yr), 8 to 18 yrs old students
  (Allen,1986)
• 4 th grade (9 yr) 17 yrs of age (Holt,1993)
• 4 th grade (9 yr) 17 and 18 yrs (Holt, Traxler,
  Allen,1996)
• 3 th grade (8 yr) 7 to 20 yrs (Wauters, van Bon,
  Tellings, 2006)
• Reading levels in deaf children without cochlear
  implants are
• substantially lower than those in hearing children

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Reading Comprehension levelsof children with CIs

• Within 8 months range, n 40 (Spencer, Tomblin,
  Gantz, 1997)
• 63 within 1 sd range, n16 (Spencer, Barker
  Tomblin, 2003 )
• 50 within 1 sd range, n181(Geers, 2003)
• gt 1 sd below mean, mean standard score 69.8
  (Connor Zwolan, 2004)
• median and mean within 1 sd range, n27 (Spencer,
  Gantz Knutson, 2004)
• Reading levels in deaf children with cochlear
  implants are
• superior to those in childeren without implants

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Reference data500 deaf children with hearing
aids(Wauters, Van Bon Tellings, 2006)

• Unaided PTA best ear gt80 dB
• Comparable factors in the samples
• Age range
• Educational setting / schools
• Pre or postlingual onset of deafness
• No learing disorders

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Study group 50 profoundly deaf children with CIs

• Chronological age at reading assessment 7- 22
  years
• 20 meningitis,18 congenital, 12 unknown
• Unaided PTA best ear gt115 dB
• 25 boys, 25 girls
• Parents with normal hearing
• Duration of CI use 3 to 11 years
• mean range
• Age at onset of deafness 13 0 80
• Duration of deafness 58 5 140

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Assessments

• Reading comprehension
• Multiple choice questions about short texts
  (Aarnoutse 1996)
• Decoding
• Lexical decision tasks (Wauters 2002)
• Receptive vocabulary (Language age in months)
• Reynell scales (Reynell 1977)
• Language Tests for Children (Van Bon 1982)
• Auditory speech perception (Equivalent Hearing
  Loss in dB)
• Gestel-Nijmegen Speech Perception Test (Snik
  1997)

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Reading Comprehension
Anneke Vermeulen, Wim van Bon, Rob Schreuder, Ad
Snik, Harry Knoors
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Reading Comprehension Z-scores
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Reading skills of children with CIs

• The reading comprehension of the children with
  CIs was superior
• to that of the children with conventional hearing
  aids,
• In all grades studied.
• Though the scores were still lagging behind those
  of hearing peers.

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Decoding Z-scores
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Decoding skills of children with CIs

• The decoding skills of the children with CIs were
  better than
• those of the children with conventional hearing
  aids,
• at secondary education level.
• The scores were in the same range as those of
  hearing peers.

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The Relation between Reading Comprehension and
Decoding

• Strong relation between RC and Decoding
• Spearman rank correlation rs.73, plt.01
• Regression analysis
• 13 of the variance in reading comprehension
• after the variance due to instructional age was
  removed
• (Beta.49, t3.85, p.000).
• Decoding did not explain the superior RC in the
  children with CIs compared to that in hearing aid
  users
• Ancova
• Eliminating the effect of decoding, significant
  effects
• of group (F(1,513)26.63, plt.001)
• and grade-level (F(3,513)4.67, plt.005) on
  reading comprehension.

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The relation between reading comprehension and
language comprehension

• The receptive vocabulary of the children with CIs
  developed at a
• faster rate than that in profoundly deaf children
  with hearing aids.
• (in HA children the ratio 0.5, e.g. Svirsky,
  Robbins)
• Receptive vocabulary at 36 months post implant
  explains 29
• of the variance in reading comprehension scores
• (Age Receptive vocabulary R2 .51)
• Strong relation between receptive vocabulary age
  equivalent
• and reading comprehension

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Language Comprehension/Receptive vocabulary
(Reijnell/TvK)
1 Hearing norm
lt 0,5 ratio of deaf children with CHA
N 16, prelingually deaf children were able to
perform test prior to implantation
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Association between speech perception and
receptive vocabulary
96,00
84,00
72,00
60,00
48,00
Receptive vocabulary delay 36
36,00
24,00
12,00
0,00
-12,00
70,00
80,00
90,00
100,00
110,00
Equivalent Hearing Loss 24
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The effect of improved auditory speech
perceptionon reading comprehension

• No relation between auditory speech perception
• and decoding
• No direct relation beteween auditory speech
  perception and
• reading comprehension
• Strong relation between auditory speech
  perception
• and receptive vocabulary
• Auditory speech perception at 24 months explains
  12 of the
• Variance in Receptive vocabulary scores at 36
  months
• (Age Auditory speech perception R2 .45)

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Structural Equation Modeling the intervening
role of vocabulary in post implant text
comprehension
Fit indices NC2.1, ?23063.994 (p.000),
GFI.826, AGFI.618, NFI.879
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The effect of CI on reading comprehension

• Structural equation modelling
• did not falsify the hypothesis that
• post implant auditory speech perception
• positively affects reading comprehension
• via receptive vocabulary

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Educational placement in the Netherlands

• Changes in placement in educational setting
• Factors involved in choices
• Capacities of young children with implants
• Changing Needs

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Dutch data on changes in educational settings,
n370 Vermeulen, Langereis, Van den Broek, 2005
pre implant gt 2jaar post implant
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Educational settingsVermeulen (2007)
pre implant n50 at reading test, in 2002
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Educational Setting, first grade primary
educationchildren with age _at_ implant ? 30
monthsVermeulen, Mylanus, Snik, 2007
gt 5 jaar post implant
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Language comprehension
CI m 77 age at onset 9.5 months age at CI 77
months, n16
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Zo hoort het Jet Isarin, 2006

• Interview and observations
• Free cooperation, Contents loneliness, Solo
  equipment,
• Speech language
• Listening / looking-listening / listening types
• What does the individual child need?
• Does the teacher in mainstream education know
  what to look at?
• If you didnt know she was deaf you wouldnt
  notice.

Sue Implants work to well
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School related factors

• Mainstream education
• Demanding or tolerant
• Learning via explicit instruction-communication
• Teacher dependent (VO!)
• Acoustical environment
• Deaf peer group???
• Focusses on childs abilities

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School related factors

• Education for the Deaf
• Fast development after CI
• Varying abilities between children
• protective
• Less focus on spoken language
• Focuses on what the child misses
• Contact with hearing peers???
• School flexible or dogmatic

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Child related factors

• Cognitive level
• Communicative abilities
• Language level
• Speech and intelligibility
• Social emotional development
• Motivation
• Auditory speech perception skills

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Abilities of children with implants

• Large variabillity
• Large part of children within hearing range
• Other group still 1 a 2 SD below norm
• Much better than deaf children without CI
• Children still miss a lot of information in
  mainstream classroom situations
• Do they know (compensate?)
• Does the child have access to the interactive
  process of teaching and
• learning? (Thoutenhoofd)
• Responsibility for teachers to provide support
  and monitor functioning
• (Archbold)

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Needs of children with implants

• The capacities of children with CI demand a
  different approach than hearing aid users do.
• With better devices optimal use becomes even more
  important
• Technical support and training
• Educational / speech and language support and
  training
• Evaluations
• Identification of areas of concern
• Development of therapeutic interventions

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