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Children with cochlear implants integrated into the hearing world-eng 2006-04-08

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Children with cochlear implants integrated into the hearing world-eng 2006-04-08

  1. 1. Children with Cochlear Implants:The Freedom Cochlear Implant: fully integrated into the world ofAnother Innovation from Cochlear hearing – how and when? Monika Lehnhardt PhD Varese, April 8th, 2006
  2. 2. Vis ionIn 20 years, an implant willbe the treatment of choicefor anyone with a hearingloss greater than 50 dBDr Jay RubensteinMarch 2004
  3. 3. "90% of children with a CI will besuccessfully integrated into mainstreamkindergarden and schools, provided they donot have an additional handicap and theyget adequate rehabilitation with familysupport".
  4. 4. Step 1: Is there a hearing loss? Neonatal Hearing Screening Programmes
  5. 5. Accurate diagnosis
  6. 6. Neonate’s response to sound DeCasper & Fifer (1980) Spring and Dale 1977 Eimas et al (1971, 1979)
  7. 7. Infant vocalisations Stoel- Gammon & Otomo, 1986 Kent, et al 1987
  8. 8. The Window of Opportunity
  9. 9. Sharma et al, 2002Ear and Hearing, December 2002
  10. 10. Sharma et al, 2004 450 400 350 13 month old recipientP1 latency, ms 300 250 200  At CI activation 150 100 1 week post CI 50 Normal limits 1 month post CI 0 0 5 10 15 20 25 30  3 months post CI Age  12 months post CI 350 300 P1 latency, ms 250 20014 month old recipient 150 100 50 Normal limits 0 0 12 24 36 Age Archives of Otolaryngology – Head & Neck Surgery, May 2004
  11. 11. Categories of Auditory Performanceref: P Govaerts, C De Beukelaer et al., Neurotology and Audiology 2002(Antwerp) Children with normal hearing use of telephone discrimination of speech sounds response to speech sounds
  12. 12. Govaerts, et al. 2002 Age at Mainstream Integration 100 Percentage of children 80 Age at implantation 60 Under 2 yrs 40 2 to 4 yrs 20 0 0 3 5 7 Age (in years)Otology & Neurology, vol 23; 2002
  13. 13. Maree Doble: PhD thesis in progress (University of Sydney)8 Children, Age of Implantation 8-16 months, enrolled in an AVT program.Language SpeechFirst words ⇒ All vowels and consonants2- 5 months post activation developing along “normal” expectations ⇒ 18 monthsGrammatical development post activation.⇒ within normal range @ 2 Again, ahead of theiryrs post activation “Hearing Age” but delayedStandard assessments compared to their⇒language scores ahead Chronological Ageof their “Hearing Age” butdelayed compared to theirChronological Age
  14. 14. Geers (2004)* Geers, et al (2003)***Archives of Otolaryngology- Head and Neck Surgery, May 2004*Ear and Hearing, February 2003
  15. 15. PPVT 7 Manuel"Peabody" age (years) 6 5 4 Manrique, et 3 2 al (2004) 1 0 0 1 2 3 4 5 6 7 Chronolgical age (years) Reynell 7 "Reynell" age (years) 6 >2 yrs 5 4 3 2 to 6 yrs 2 1 0 0 1 2 3 4 5 6 7 Chronological age (years) Laryngoscope, August 2004
  16. 16. Svirsky, et al (2004) Average Language Development 84 Expressive Language Age 72 60 (months) 12-24 months 48 25-36 months 36 37-48 months 24 12 0 0 12 24 36 48 60 70 84 AGE (months)Audiology and Neuro-Otology, vol. 9, 2004
  17. 17. children Language development The deafened child is “at risk” for listening & spoken language skill developmentM. Svirsky et al Am. Psy.J. 2000
  18. 18. Speech Intelligibility, Svirsky et al."The inability to speak intelligibly is a major impediment tointegration in mainstream society for many deaf children".Normal hearing children have 25% intelligible speech at the age of18 months and 75 -100% at the age of 36 months.Is there a sensitive period for CI communicative outcomes?Earlier CI results in earlier development of speech intelligibilityshows adevelopmental trajectory Analysis: the curve moves into the rightdirection, i.e. "younger do better".For the children < 2 y.o. there is a 20% slope improvement, i.e. in5 years their speech will be totally intelligible.For older children there is only 9% of slope improvement.The sensitive period starts at 24 months. "
  19. 19. Int J Audiol. 2005 Jul; 44(7): 400 -7.Paediatric cochlear implantation: the views ofparentsInterviews with 216 families of childrenwho were implanted at the NottinghamPaediatric Cochlear Implant Programmebetween 1989 and 2002."the biggest area of contention is inrespect of their childs education".
  20. 20. Laryngoscope.2004 Sep; 114(9): 1576-81.Outcomes and achievements of students who grew upwith access to cochlear implants.27 prelinguallydeaf young adults who received a CI atthe University of Iowa between the ages of 2 and 12yearsparticipated.•Speech perception and production scores werehighly correlated. Achievement test results indicatedthat scoreswere within 1 SD from normative data based onhearing individuals.•Over 50% of the college-age eligible studentsenrolled in college.•The cohort that uses the CI full-time comparesfavourably with their hearing peers on academicachievement measures.
  21. 21. Pediatr Clin North Am. 2003 Apr;50(2): 341 - 61.viii.Cochlear implantation updateFrancis HW, Niparko JK"Early identification of hearing loss, early hearing aiduse and language intervention, and cochlearimplantationby 2 years of age are positive predictors for languageacquisition that can approach the levels of normal-hearingchildren.These are early indications that increased access tomainstream education and gains in quality of life arelong-term benefits that render cochlear implantation acost-effective intervention.
  22. 22. Ear Hear. 2003 Jun;24 (3): 236 - 47.Exploring the language and literacy outcomes of pediatriccochlear implant users. Spencer LJ, Barker BA, Tomblin JB"In this study in Iowa 16 peadiatric CI users languageand literacy skills were evaluated and then comparedwith a reference group of 16 age-matched,normal-hearing children.•The results show, that children with CI performedwithin 1 SD of the normal-hearing, age-matchedchildrenon measures of language comprehension, readingcomprehension and writing accuracy.However, the children with CI performed significantlypoorer than the children with normal hearing on theexpressive "Sentence Formulation" subtest, they alsoproduced fewer words on the written narrative task."
  23. 23. Br J Audiol. 1998 Oct; 32(5): 295-300.Educational placement of deaf children following cochlearimplantation. Archbold S, Nikolopoulos TP, ODonoghue GM,Lutman ME.This study from Nottingham examined the educationalplacements before cochlear implantation of 121children,and the educational placements two years afterimplantation, of the 48 children who had reached thatstage.•It compared the educational placements of thosegiven implants prior to schooling,and those givenimplantswhen already in an educational setting.•53% of children who were in pre-school at the time ofimplantation were in mainstream schools two yearsafterimplantation, whereas only 6% of those who were
  24. 24. The Canadian Model•Trends toward mainstreaming vary from province to province and aredependent on numerous factors.•Over the last two years there has been a growing trend towardsmainstreaming the CI children.• This tends to occur in provinces where mandatory new born hearingscreening and early intervention are both encouraged and practised.• In this environment, many children are no longer accepted as a candidatefor a CI unless they provide evidence that they are enrolled and activelyinvolved in an ongoing aural rehabilitation program prior to and followingsurgery.•There tends to be a natural progression toward mainstreaming for thesechildren.•Estimate of mainstreamed children would be as high as 75-80%.•The trend to encourage oral communication / auditory verbal approaches torehabilitation across Canada, is largely due to the teachings of manyprominent professionals in the AV world, among them, Warren Estabrooks,
  25. 25. 92% mainstreamed at the Hear and SayCentre, AustraliaThis case control study with longitudinal design and repeatedmeasures investigated the rate of speech and languagedevelopment of 29 children with hearing loss (aged 2-6 years,mean pure tone average loss = 74dB HL in the better ear)educated using an Auditory-Verbal approach. Results on abattery of standardised speech and language tests administeredat the start of the study and then 9 months later were comparedto those of a control group of hearing children matched forlanguage age, gender, intellectual ability and socio-economiclevel. There were no significant differences in rate of progressbetween the children with hearing loss educated using theAuditory-Verbal approach and the hearing children on allstandardised assessments (p = <0.001). This research will nowbe extended longitudinally.Outcomes of an Auditory-Verbal Program for Children with Hearing Loss:A Comparative Study with a Matched Group of Hearing ChildrenDimity DornanSchool of Health and Rehabilitation Sciences, University of Queensland, AustraliaHear and Say Centre, Brisbane, Australia
  26. 26. Schüler im gemeinsamen Unterricht 1994 – 2004 Land Schulen Integration 1994 Integration 2004 Veränderung1 Baden-Württemberg 132 Bayern 10 9,18% 25,22% 16,04%3 Berlin 3 42,40% 43,21% 0,81%4 Brandenburg 1 21,72% 34,86% 13,14%5 Bremen 1 9,75% 46,61% 36,86%6 Hamburg 1 kAm 20,50% kAm7 Hessen 4 14,73% 35,22% 20,49%8 Meckl. - 1 (+1) 33,25% 48,41% 15,16% Vorpommern9 Niedersachsen 5 kAm 35,30% kAm10 Rheinland-Pfalz 3 4,95% 30,27% 25,32%11 Saarland 1 20,85% 41,29% 20,44%12 Sachsen 3 21,64% 40,00% 18,36%13 Sachsen-Anhalt 2 kAm 40,60% kAm14 Schleswig-Holstein 1 kAm 14,63% kAm15 Thüringen 1 27,40% 69,67% 42,27%16 Durchschnittswert3 49 kAm 38,38% kAm
  27. 27. Kinder mit CI ohne Zusatzbehinderung und fremde Mutterspracheund ihr Anteil in den verschiedenen Schulformen (n= 251)   30 30 30 25 23 23 22 20 18 Ges am t 15 0 bis 2:12 14 14 10 8 5 4 2 3 1 1 3 3 0 0 0 ule hu le Hg S p as s e ig a iga ig a ru n g ch sc fü r f ür l e lk rK e rk de e ls ufs le ul e o rk eg ve nd fö r eg r hu h V R a ti So R Be S c Sc eg r rü h In t F
  28. 28. Institutionelle Förderung (n=372) 11% 3% 4% Regelschule 2% 1% Schule für Hg 1% 22% Schule für Spb Sonstige Schulen Regelkiga Sonderkiga Integrativer Kiga39% 17% Vorklasse Frühförderung
  29. 29. Institutionelle FörderungImplantationsalter: 0-1 (n=12) 70% 10% 10% 10% Frühförderstelle Regelkiga Sonderkiga Integr. Kiga Regelschule Schule für Hg. Sonst. Sonderschule
  30. 30. Institutionelle FörderungImplantationsalter: 1-2 (n=47) 48% 17% 4% 6% 13% 6% 6% Frühförderstelle Regelkiga Sonderkiga Integr. Kiga Regelschule Schule für Hg. Sonst. Sonderschule
  31. 31. Institutionelle FörderungImplantationsalter: 2-3 (n=56) 26% 29% 14% 15% 5% 11% Frühförderstelle Regelkiga Sonderkiga Integr. Kiga Regelschule Schule für Hg. Sonst. Sonderschule
  32. 32. Institutionelle FörderungImplantationsalter: 3-6 (n=107) 59% 12% 6% 4% 10% 6% 3% Frühförderstelle Regelkiga Sonderkiga Integr. Kiga Regelschule Schule für Hg. Sonst. Sonderschule
  33. 33. Institutionelle FörderungImplantationsalter: 6-8 (n=46) 59% 12% 3% 6% 4% 10% 6% Frühförderstelle Regelkiga Sonderkiga Integr. Kiga Regelschule Schule für Hg. Sonst. Sonderschule
  34. 34. Institutionelle FörderungImplantationsalter: > (n= 8 47) 4% 30% 66% Frühförderstelle Regelkiga Sonderkiga Integr. Kiga Regelschule Schule für Hg. Sonst. Sonderschule
  35. 35. The Wonderful World of Hearing Thank You For Your Attention

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