Cochlear Implants and Early Communication Planning

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Cochlear Implants and Early Communication Planning
Debra Nussbaum, MA CCC-A Coordinator
Susanne Scott, MS CCC-A Outreach Specialist
Cochlear Implant Education Center Laurent Clerc
National Deaf Education Center Gallaudet
University
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What we will discuss today

• The complex issues for consideration in
  communication planning
• The varied profiles and outcomes of children
  with cochlear implants
• A philosophical framework to support diverse
  communication, language, educational,
  and psycho-social planning for children with
  cochlear implants

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Complex Issues

• The impact of deafness on language, communication
  psychosocial development

• Early language acquisition regardless of
  modality, is critical to timely development in
  all areas
• Language delay is difficult to overcome

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Complex Issues

• Viewing the implant within the context of the
  whole child
• Having sufficient information to develop
  realistic expectations
• Understanding the road to success with a
  cochlear implant
• Understanding that the implant is only a
  technology
• Understanding that a child with an implant is
  still deaf

Keeping the Cochlear Implant In Perspective
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Complex Issues

• Referral to educational professionals as well as
  medical professionals
• Collaboration between hospital implant centers
  and educational programs
• Collaboration between multiple educational
  programs and/or support service providers

Uniting medical and educational professionals
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Varied Profiles and Outcomes
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Diverse ChildrenDiverse Outcomes

• Student characteristics
• Age
• Family support
• Type of early intervention
• Developmental history
• Home language use
• Pre-implant language level (spoken/sign)

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Diverse ChildrenDiverse Outcomes

• Hearing History
• Age of onset
• Age of identification
• Age of intervention
• Degree of hearing loss
• Cause of hearing loss
• Amplification history
• Auditory experiences
• Age at implantation
• Consistency of use
• Mapping
• Habilitation

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Diverse ChildrenDiverse Outcomes

• Realities
• Desire of family
• Outside pressures
• Additional learning issues (may be uknown)
• Third language use

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Diverse ChildrenDiverse Outcomes

• 
  Childrens Hospital Oakland
  Research Study

• 80 children implanted between ages 2-5
• Pre-lingually deaf, profound hearing loss,
  minimal
• benefit from hearing aids
• Progress documented for three years

AuSpLan (Auditory Speech and Language),
McClatchie and Therres, 2003
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Diverse ChildrenDiverse Outcomes

• Predicted 25 would become primarily Auditory
  communicators
• Outcome 3yrs post CI
• 87 Auditory Only
• 13 needed some visual support
• Predicted 46 Both- Auditory communicators
  with some visual support
• Outcome 3yrs Post CI
• 85 Both
• 5 Auditory
• 15 Primarily visual
• Predicted 29 Combination- Mostly Visual with
  some auditory support
• Outcome 3 yrs. Post CI
• 70 Combination
• 15 Became low Both
• 15 became poor users/non-users

Childrens Hospital Oakland- summary of findings
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Diverse ChildrenDiverse Outcomes
Auditory-Verbal/Oral Communicators
Combined Auditory Visual Communicators
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Building a case for diverse planning
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Building A Case for Diverse
Planning
Fully Visual Communicator
Mostly Auditory Communicator
Mostly Visual Communicator
Fully Auditory Communicator
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Building A Case for Diverse
Planning

• Support for signing with hearing babies
• Signing is an easier motor skill to develop
• than speaking
  
• Signing babies tend to talk earlier
• Symbolic gestures support spoken
• vocabulary development
• Parents noted decreased frustration,
• increased communication, and enriched
• parent-infant bonding
• More sophisticated play occurred in signing
• babies and an increased interest in
  books.

Importance of Early Visual Support
Sign With Your Baby http//www.sign2me.com/defaul
t6.htm
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Building A Case for Diverse
Planning

• Question Does signing with hearing babies delay
  their speech development?  
•                      
• Answer
• Research indicates that babies who sign tend
  to have a stronger command of verbal language and
  also begin speaking at an earlier age than babies
  who don't sign.
•                      

Sign With Your Baby
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Building A Case for Diverse
Planning

• The Question Remains
• If sign language is a positive support for
  early language development for hearing babiesWhy
  not deaf babies????

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Building A Case for Diverse
Planning

• What is some research suggesting?
• Early sign language use, coupled with
  implantation at an early age, appears to promote
  stronger vocabulary development and thinking
  skills which in turn appears to be positively
  related to increased spoken language
  communication potential and to improved reading
  comprehension.
• 
  

• The Effect of Age at Implantation and
  Communication Method on the Vocabulary and
  Reading Comprehension Skills of children Who Use
  Cochlear Implants, McDonald Connor, C. and
  Zwolan, T. University of Michigan, Draft
  presented, Nov. 2002)

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Building A Case for Diverse
Planning

• Foundational User-Bridge to oral development (for
  early identified infant)
• Transitional User-Sign has been part of childs
  life, yet goal is to transition to oral
  environment
• Strategic User-Child continues to rely on the
  combination of spoken and signed language
• Dominant Sign User-ASL user who receives implant
  at a later age. Will develop useful listening
  skills, yet progress may be slow

• Sign language use may play a range of roles and
  may change over time

Moeller, Boys Town National Medical Center, 2002
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Diverse Programming
Visual
Auditory
A finely choreographed dance
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In Summary

• Children with cochlear implants are diverse
• It should therefore follow that communication
  and educational approaches be flexible and
  individualized to meet the diverse needs of these
  children and families.

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So keep in mind

• If youve met one child with a cochlear implant
  and their family
• Then youve met ONE child with a cochlear implant
  and their family

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For Further Information
Visit our website at

• http//clerccenter.gallaudet.edu/CIEC/index.html

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For Further information
http//clerccenter2.gallaudet.edu/KidsWorldDeafNet
/e-docs/CI/index.html
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For Further Information
http//clerccenter.gallaudet.edu/Products/Sharing-
Ideas/CI/index.html
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For further information

• Contact
• Debra.Nussbaum_at_gallaudet.edu
• or
• Susanne.Scott_at_gallaudet.edu