LongTerm Benefits of Cochlear Implantation in Preschool

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Long-Term Benefits of Cochlear Implantation in
Preschool

• Ann Geers and Emily Tobey
• University of Texas at Dallas
• Jean Moog and Chris Brenner
• Moog Center for Deaf Education
• Funded by NIH-NIDCD

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Primary School Sample

• N 181
• Recruited between 1996 and 2000
• Research Conducted at Central Institute for the
  Deaf

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181 Subjects
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Sample Selection

• 1. Between 8 and 9 years of age
• 2. Onset of deafness by age 3
• 3. 4-6 years of implant use
• 4. Implanted before 5 years of age
• 5. No additional disabilities
• 6. Monolingual English home environment
• 7. No open set speech perception

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Age at Onset
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Year Implanted
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Subject Age at Implant
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Educational Reporting Periods

• 1. Pre-Implant
• 2. First Year Post-Implant
• 3. Second Year Post-Implant
• 4. Third Year Post-Implant
• 5. Current Year

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Classroom Placement (n181)
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Methodology Rating Scale

• Mostly Sign

• Speech Sign

• Speech Emphasis

• Cued Speech

• Auditory Oral

• Auditory Verbal

(Total Communication)
(Oral Communication)
Increased Auditory Emphasis
Increased Speech Emphasis
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Communication Mode (n181)
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Data Collection

• Summer Research Camps
• 15 Children per Camp
• All expenses paid
• 3 Mornings of Testing
• Afternoon Recreational Activities

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Outcome Variables
Speech Perception Speech Production Language Re
ading
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Intervening Variables
Family Characteristics Implant
Characteristics Child Characteristics
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Independent Variables
Methodology Individual Therapy Educational
Setting
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Data Analysis

• Purpose To identify sources of variability in
  speech, language and reading outcomes

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Multivariate Analysis
INDEPENDENT VARIABLES
Method Classroom Therapy
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Multivariate Analysis
OUTCOME VARIABLES
INDEPENDENT VARIABLES
Speech Perception Speech Production Language Readi
ng
Method Classroom Therapy
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Multivariate Analysis
OUTCOME VARIABLES
INDEPENDENT VARIABLES
Speech Perception Speech Production Language Readi
ng
Method Classroom Therapy
INTERVENING VARIABLES
Child Family Implant
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Results

• Variance associated with
• Child and Family Characteristics
• Implant Characteristics
• Educational Characteristics

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Child Family Characteristics
plt.05, plt.01, plt.001
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Implant Characteristics
plt.05, plt.01, plt.001
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Rehabilitation Characteristics
plt.05, plt.01, plt.001
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Overall Outcome (n181)
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Factors Influencing Outcomes in Primary Grades

• What the child brings to the learning environment
• What is provided by the cochlear implant
• What is provided by the rehabilitation program

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Characteristics of High School Sample (N 85)
39 boys / 46 girls) Age at Implant 111
54 Recruited 2004-2007 Targeted N 120
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Two Test Sessions
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Implant Processor Worn
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Map of Home States
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Early Communication Mode
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Classroom Placement
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Grade Placement at Follow-up
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Grade and Age
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Outcome Measures
Speech Perception Language Reading
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LNT Word Perception
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LNT Word Perception
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BKB Sentence Perception
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BKB Sentence Perception
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WISC Similarities
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WISC Similarities
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PIAT Total Reading Scores
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PIAT Total Reading Scores
Note 88 is the mean at the younger age, 83 is
the mean at age 16-17
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Age-Appropriate Scores
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Reading Grade and Age
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Reading Grade Improvement
27 achieved 10th grade reading level 21
achieved 6th grade reading level 52 achieved
less than 6th grade reading level
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Predictors of Outcome(n85)
Speech Perception Factor Score Language Factor
Score Reading Factor Score
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Child Family Characteristics
plt.05, plt.01, plt.001
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Implant Characteristics
plt.05, plt.01, plt.001
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Rehabilitation Characteristics
plt.05, plt.01, plt.001
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Speech Perception Results

• Auditory development continued into adolescence
• Better CI threshold aided speech recognition
• Early oral education had long-term auditory
  benefits

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Language Results

• Verbal development was faster than expected
  normal growth.
• Normal hearing at birth promoted later language
  growth
• Early oral education had long-term language
  benefits

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Reading Results

• Reading development was slightly below normal
  rate.
• Over 40 achieved age-appropriate reading levels
  in high school.
• Few predictors of reading achievement were
  identified.

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Future Research

• Long-term effects of younger implant age on
  language and reading development
• Skills underlying reading development (e.g.,
  memory, phonological processing)
• Self-esteem and cultural identification in
  teenagers with long duration of CI use.

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Language Samples
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Balloon Picture Sequence