Cognitive and communicative development in children with cochlear implants

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Cognitive and communicative development in
children with cochlear implants

• Björn Lyxell Birgitta Sahlén
• Malin Wass, Birgitta Larsby, Mathias Hällgren,
  Elina Mäki-Torkko, Tina Ibertsson, Arne Leijon,
  Björn Lidestam, Claes Möller, Marianne Ors
  Magnus Lindgren

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• Cognitive and communicative development in
  children with CI
• in relation to
• Neurophysiological development
• - Signal characteristics
• - Development of language skills
• - Speech production
• - Communicative development

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The population Children with CI in Sweden is a
small population, spread over a relatively large
geographical area, often tested in other contexts
and characterized by a high degree of
heterogeneity.
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• Heterogeneity
• Factors related to
• Deafness (e.g., cause of deafness, duration of
  deafness, pre- or post-lingual deafness)
• CI (e.g., uni- or bilateral, type of CI, hearing
  capability with CI)
• Communication
• Education

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Cognitive development Focus on - Working memory
capacity, phonological and lexical skills -
Building-blocks in more composite cognitive
activities
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Basic assumptions about the cognitive effects of
cochlear implants
CI
Phonological skills
Working Memory
Lexical access
Reading
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• Purpose
• To examine the course of development in each of
  the three cognitive components in a longitudinal
  perspective. Specifically, we will examine how
  different sub-components develop within each of
  the three components.
• To examine the relation between cognitive
  development and development of reading ability.

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Children 34 children with CI Age 6 - 10 22
children with bilateral CI Main mode of
communication Oral 16 children integrated in
hearing schools 18 children in special classes
for children with CI
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Tests on Working Memory

• Serial recall of nonwords, nonword repetition
• Assesses phonological working memory, repeat
  nonwords and series of nonwords
• Sentence Completion and Recall
• Assesses general working memory, processing and
  storage of phonological/semantic information,
  make judgements about sentences and remember the
  last word
• Matrix Patterns
• Assesses visuo-spatial working memory, replicate
  a pattern of filled cells in an empty matrix

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Tests on phonological skills

• Nonword discrimination
• Assesses the ability to discriminate between
  speech sounds
• Phoneme segmentation
• Assesses the ability to notice phonemes in real
  words
• Phoneme identification
• Assesses the ability to identify phonemes in
  nonwords
• Phonological representations
• Assesses the phonological representations of real
  words. Indicate whether an auditorily presented
  word is correctly pronounced

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Tests on lexical access

• Word comprehension
• Assesses the ability to combine an auditorily
  presented word with the corresponding picture
• Wordspotting
• Assesses the ability to identify a real word in a
  context of nonsense words
• Semantic decision making
• Assesses the ability to identify words of a
  predefined semantic category

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Tests on reading skills

• TOWRE
• Decoding of words and nonwords
• Woodcock
• Reading comprehension
• Ortographic learning
• Assesses the ortographic strategies for reading
  the ability to learn the spelling of a nonsense
  word after 3 presentations
• Ortographic choices
• Assesses the ortographic strategies for reading
  the ability to identify the correct spelling of a
  word, presented in pairs where both words are
  phonologically correct

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Test-battery

• Computer-based test battery
• Sound Information Processing System (SIPS)
• - auditory-, and picture-based presentation of
  information
• - measures of speed and accuracy

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Results Group comparisons Working
memory General capacity NH gt CI Visual WM NH
CI Phonological WM NH gt CI
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Results Phonological tasks Proportion correct
answers NH gt CI Response-time NH gt
CI Response-time for correct answers NH
CI Lexical tasks Proportion correct
answers NH gt CI Response-time NH gt
CI Response-time for correct answers NH CI
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Number of children with CI performing within 1 SD
of normal hearing children General WM
capacity 65 Phonological WM 20 Phonological
tasks 11 Lexical access tasks 45
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Results Reading ability Reading
comprehension NH CI TOWRE NH
CI Ortographic learning NH CI Ortographic
choices NH CI
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Corrrelations Quality of articulation is
significantly correlated with all phonological
and lexical task and the phonological part of
working memory. Quality of articulation is NOT
correlated with any measures of reading ability!
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• Conclusions
• Children with CI have lower performance level
  than NH children on most of the cognitive tests
• BUT . . .
• The magnitude of difference between the groups
  are smaller in tasks with lower requirements on
  phonological processing.
• Children with CI may develop some form of
  abstract phonological skill that promote
  development of reading ability.

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Children with cochlear implant in conversation
with hearing peers

• Tina Ibertsson,
• Birgitta Sahlén, Kristina Hansson och Elina
  Mäki-Torkko

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• The success persons with hearing impairment
  achieve in conversation depends to some degree on
  their ability to use requests for clarification
  as well as on how the conversational partner
  responds to the request for clarification.
  (Erber, 1996).

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Tasks and tests

• Conversational skills - Referential communication
  task
• Speech recognition
• Speech intelligibility
• Cognition/language Working memory, phonology
  lexicon (SIPS), reading and writing (Script Log)

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Referential conversation - analyses

• Number of words
• Number of turns
• Time to solve the task
• Number of questions
• Types of questions

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Types of questions

• Non-specific request for clarification What?
• Request for repetition Say that about the eyes
  again!
• Request for confirmation of new information
  (mainly yes/no questions) Has he got blue eyes?
• Request for confirmation of already given
  information Did you say (before) that he had blue
  eyes?
• Request for elaboration What colour did you say
  his eyes had?
• Forced choice question Do you mean - the person X
  or the person Y?
• Control question Do you know who I mean? Have
  you got him?

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Number of questions
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The same pattern emerges when looking at the
type of request for clarification used by
individual children (CI vs HC)
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Summary

• CI-CIP pairs used more turns, longer time and
  more questions than HC-HCP pairs but less words.
• In the CI-CIP pairs more requests of new
  information (yes/no questions) than in the
  HC-HCP pairs
• In the HC-HCP pairs more requests for already
  given information and more requests for
  elaborations than in the CI-CIP pairs.

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Conclusion The children with CI spend more time
to get their message through and use more
requests for clarification of a type that help
them to avoid communication breakdown (questions
leading to more predictable answers). In the
context studied they act as competent
conversational partners.
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Children with CI

• age 117-19 år (median145 )
• age at implant 24-119 (median 51)
• time as deaf 4 mths - 41 (median 8 mths)
• time with CI 41-135

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Speech recognition, working memory, language and
conversation -preliminary results

• Speech recognition significantly correlates with
  the number of requests for clarification used in
  conversation, with phonology, lexicon, grammar
  and speech intelligibility - not with working
  memory
• A significant positive correlation between
  general working memory and number of request for
  confirmation of new information. Has he got blue
  eyes?
• A significant negative correlation between
  general working memory and number of request for
  confirmation of already given information. Did
  you say that he had blue eyes?

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Participants (2 conv.pairs)

• 8 children with CI, 9-18 years old, in
  conversation with hearing peers (CI- CIP)
• 8 hearing children, individually matched to the
  child with CI, in conversation with heering peers
  (HC-HCP)
• Both partners act a receiver and describer

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Different perspectives

• Dialogic Differences between the pairs?
• Individual Differences between participants
  (mainly CI and HC)?