Language Outcomes After Cochlear Implantation
Section snippets
Language acquisition in children with CIs
The primary goal of implantation in children is to facilitate communication in the modality that is native to the families of the vast majority of deaf children: spoken language. Language is defined as a vehicle for shaping and relating abstractions for communication3 in which meaning is independent of the immediate situation. Practical use of speech is based on the assignment of a single name to various appearances and situations under varying conditions. Spoken language involves a conversion
Literacy skills in children with CIs
The nature of a child’s language development, whether manual or oral, will depend on the quantity and quality of exposure to a complete language system. Early and appropriate language stimulation appears to be an important factor in the acquisition of visual language as manifest in comprehension (reading) and expression (writing), as well as in acquisition of spoken language. For example, reading comprehension ability among deaf 15-year-old students who use American Sign Language as their
Auditory rehabilitation after cochlear implantation
The uniqueness of the listening experience enabled by a CI is underscored by qualitative differences in how sound perception is elicited in comparison with other strategies of auditory rehabilitation. For example, a hearing aid filters, amplifies, and compresses the acoustic signal, thereby delivering a processed signal to the cochlea for transduction. By contrast, a CI receives, processes, and transmits acoustic information by generating electrical fields. Electrical stimulation bypasses
Premise 1. The Child Must Learn to Attach Meaning to What is Heard Through the CI
To learn a spoken language via a CI, two conditions must be met. First, the listener must have sufficient (not necessarily perfect) auditory access to the language code—the vowels, consonants, and suprasegmental patterns that make up that language. In other words, one must be able to hear a language to learn it. Auditory access is essential, but not sufficient, for language acquisition. A second, critical condition must also be met: The sounds must gradually be attached to meaning. Attaching
Premise 3. Skills Learned in a Therapy Setting Must be Transferred Out of the Therapy Room and into the Classroom, Home, and Other Aspects of the Child’s Everyday World
Clinicians must develop and practice skills within the therapy room but always with the greater goal that those skills will generalize out of the therapy room, into the child’s classroom, home setting, and other everyday environments.
Studies and clinical experience support the notion that the parents are primary agents in their child’s communicative competence and overall development.48, 49 Clinicians should view their role largely as one of helping parents facilitate their child’s
Premise 6. Almost All Children with CIs Require a Combination of Didactic Instruction and Incidental Learning to Acquire Spoken Language
Auditory development in children with profound deafness has been traditionally viewed as requiring rote training. This viewpoint implied that the child required didactic instruction to achieve each of the listening skills along a hierarchy of auditory development, and virtually hundreds of such skills were required to achieve mastery. The assumption was that the child learned only what was directly taught.
This approach was not unreasonable, given limitations in conveying the highly nuanced
Premise 11. Auditory Milestones that have been Established May be Used to “Red Flag” Children who are Progressing at a Slower than Expected Rate
Research and clinical findings have documented the auditory milestones achieved by the average child with a CI during the first year of device use.11, 30, 55, 56 Three different groups of CI children reflect different preimplant characteristics and show different patterns of skill achievement. When a child is identified as progressing at a slower rate than expected, red flags are raised and specific steps taken, allowing clinicians to intervene as early as possible and identify the source of
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