Using SNAP Dragons to monitor narrative abilities in young deaf children following cochlear implantation

Story Generation and Narrative Retells in Children Who Are Hard of Hearing and Hearing Children

PURPOSE

The primary goal for this study was to compare story generation and narrative retell performance in children who are hard of hearing (CHH) and hearing children. A secondary goal was to determine factors that influence narrative performance. Research on this topic is important because narrative language competency is an essential communication function.

METHOD

Participants included 86 CHH and 53 seven-year-old hearing children who had completed a test battery composed of vocabulary, grammar, phonological processing, story generation, and narrative retell tasks. Coders who were blind to hearing status used a scoring rubric to judge the quality of narrative macrostructure in story generation and narrative retells. Data were analyzed using analysis of variance to determine group differences and correlational models to examine individual differences.

RESULTS

At 7 years of age, CHH demonstrated significant deficits in narrative macrostructure compared to hearing children, with larger delays in narrative retell than story generation. Vocabulary, grammar, and phonological memory acted as mediators in the relationship between hearing status and story generation; grammar acted as a mediator between hearing status and narrative retell. Auditory access variables accounted for a significant proportion of shared variance in story generation skills for CHH.

CONCLUSIONS

School-age CHH are at risk for delays in narrative production, particularly with retelling stories. The results of this study highlight a narrative coding approach and task procedures that are sensitive to differences in language levels and may be clinically useful for professionals working with early school-age children.

The effects of narrative-based language intervention (NBLI) on spoken narrative structures in Persian-speaking cochlear implanted children: A prospective randomized control trial

BACKGROUND

Previous research has shown that narrative-based language intervention (NBLI) is a feasible approach increasing the narrative skills of hearing-impaired children.

OBJECTIVE

In the present study, the efficacy of NBLI on the macrostructure and microstructure components of the spoken narrative of children with cochlear implants (CI) was evaluated in an experimental study.

MATERIALS AND METHODS

Thirty-six CI children between the ages of 5.5 and 7 years were randomly divided in three groups of equal size. Group 1 attended 24 1-h sessions of NBLI group therapy. Group 2 participants each attended 24 1-h private sessions of NBLI instruction. Group 3 attended 24 1-h conventional speech therapy (CST) sessions. The subjects' storytelling skills were prompted using pictures from the Persian version of the Language Sample Analysis test. The results were assessed before treatment (T0), after treatment (T1) and two months after treatment (T2) as follow-up.

RESULTS

Groups 1 and 2 showed significantly better results over Group 3 on all microstructure components of spoken narrative at the T1 (p ≤ 0.04) and T2 (p ≤ 0.04) levels in comparison with T0, but no differences were observed between the NBLI approaches (p > 0.05). All three intervention programs significantly improved the macrostructure of the spoken narrative in CI children.

CONCLUSION

Improvements in spoken narrative structures were observed in CI children that support the efficacy of NBLI over CST for the hearing-impaired population.

Narrative spoken language skills in severely hearing impaired school-aged children with cochlear implants

Cochlear implants have a significant positive effect on spoken language development in severely hearing impaired children. Previous work in this population has focused mostly on the emergence of early-developing language skills, such as vocabulary. The current study aims at comparing narratives, which are more complex and later-developing spoken language skills, of a contemporary group of profoundly deaf school-aged children using cochlear implants (n=66, median age=8 years 3 months) with matched normal hearing peers. Results show that children with cochlear implants demonstrate good results on quantity and coherence of the utterances, but problematic outcomes on quality, content and efficiency of retold stories. However, for a subgroup (n=20, median age=8 years 1 month) of deaf children without additional disabilities who receive cochlear implantation before the age of 2 years, use two implants, and are raised with one spoken language, age-adequate spoken narrative skills at school-age are feasible. This is the first study to set the goals regarding spoken narrative skills for deaf children using cochlear implants.

Narrative competence among hearing-impaired and normal-hearing children: analytical cross-sectional study

CONTEXT AND OBJECTIVE

oral narrative is a means of language development assessment. However, standardized data for deaf patients are scarce. The aim here was to compare the use of narrative competence between hearing-impaired and normal-hearing children.

DESIGN AND SETTING

analytical cross-sectional study at the Department of Speech-Language and Hearing Sciences, Universidade Federal de São Paulo.

METHODS

twenty-one moderately to profoundly bilaterally hearing-impaired children (cases) and 21 normal-hearing children without language abnormalities (controls), matched according to sex, age, schooling level and school type, were studied. A board showing pictures in a temporally logical sequence was presented to each child, to elicit a narrative, and the child's performance relating to narrative structure and cohesion was measured. The frequencies of variables, their associations (Mann-Whitney test) and their 95% confidence intervals was analyzed.

RESULTS

the deaf subjects showed poorer performance regarding narrative structure, use of connectives, cohesion measurements and general punctuation (P < 0.05). There were no differences in the number of propositions elaborated or in referent specification between the two groups. The deaf children produced a higher proportion of orientation-related propositions (P = 0.001) and lower proportions of propositions relating to complicating actions (P = 0.015) and character reactions (P = 0.005).

CONCLUSION

hearing-impaired children have abnormalities in different aspects of language, involving form, content and use, in relation to their normal-hearing peers. Narrative competence was also associated with the children's ages and the school type.

Development of speech intelligibility and narrative abilities and their interrelationship three and five years after paediatric cochlear implantation

This study sought to determine the level of speech intelligibility, narrative abilities, and their interrelationship in 18 Finnish children implanted at the average age of three years, four months. Additionally, background factors associated with speech intelligibility and storytelling ability were examined. Speech intelligibility was examined by means of an item identification task with five listeners per child. Three and five years after activation of the implant, the children reached average intelligibility scores of 53% and 81%, respectively. The story generation abilities of the implanted children exceeded their hearing age by one year, on average. This was found after comparing their results with those of normally-hearing two- to six-year-olds (N = 49). According to multiple regression analysis, comorbidity (number of additional needs), chronological age, and/or age at activation usually explained from 46% to 70% of the variation in speech intelligibility and narrative abilities. After controlling for age, communication mode, and number of additional needs, speech intelligibility and ability to narrate were statistically significantly associated with each other three years after activation, but not anymore five years after activation.

Bilateral cochlear implants in children: localization acuity measured with minimum audible angle

OBJECTIVE

To evaluate sound localization acuity in a group of children who received bilateral (BI) cochlear implants in sequential procedures and to determine the extent to which BI auditory experience affects sound localization acuity. In addition, to investigate the extent to which a hearing aid in the nonimplanted ear can also provide benefits on this task.

DESIGN

Two groups of children participated, 13 with BI cochlear implants (cochlear implant + cochlear implant), ranging in age from 3 to 16 yrs, and six with a hearing aid in the nonimplanted ear (cochlear implant + hearing aid), ages 4 to 14 yrs. Testing was conducted in large sound-treated booths with loudspeakers positioned on a horizontal arc with a radius of 1.5 m. Stimuli were spondaic words recorded with a male voice. Stimulus levels typically averaged 60 dB SPL and were randomly roved between 56 and 64 dB SPL (+/-4 dB rove); in a few instances, levels were held fixed (60 dB SPL). Testing was conducted by using a "listening game" platform via computerized interactive software, and the ability of each child to discriminate sounds presented to the right or left was measured for loudspeakers subtending various angular separations. Minimum audible angle thresholds were measured in the BI (cochlear implant + cochlear implant or cochlear implant + hearing aid) listening mode and under monaural conditions.

RESULTS

Approximately 70% (9/13) of children in the cochlear implant + cochlear implant group discriminated left/right for source separations of <or=20 degrees , and, of those, 77% (7/9) performed better when listening bilaterally than with either cochlear implant alone. Several children were also able to perform the task when using a single cochlear implant, under some conditions. Minimum audible angle thresholds were better in the first cochlear implant than the second cochlear implant listening mode for nearly all (8/9) subjects. Repeated testing of a few individual subjects over a 2-yr period suggests that robust improvements in performance occurred with increased auditory experience. Children who wore hearing aids in the nonimplanted ear were at times also able to perform the task. Average group performance was worse than that of the children with BI cochlear implants when both ears were activated (cochlear implant + hearing aid versus cochlear implant + cochlear implant) but not significantly different when listening with a single cochlear implant.

CONCLUSIONS

Children with sequential BI cochlear implants represent a unique population of individuals who have undergone variable amounts of auditory deprivation in each ear. Our findings suggest that many but not all of these children perform better on measures of localization acuity with two cochlear implants compared with one and are better at the task than children using the cochlear implant + hearing aid. These results must be interpreted with caution, because benefits on other tasks as well as the long-term benefits of BI cochlear implants are yet to be fully understood. The factors that might contribute to such benefits must be carefully evaluated in large populations of children using a variety of measures.

Long-Term Functional Outcomes and Academic-Occupational Status in Implanted Children After 10 to 14 Years of Cochlear Implant Use

OBJECTIVES

To assess a group of consecutively implanted children over 10 years after implantation with regard to implant device use and function, speech perception, and speech intelligibility outcomes; and to document current academic or occupational status.

STUDY DESIGN

A prospective longitudinal study assessing device function, device use, speech perception, speech intelligibility, and academic/occupational status of implanted deaf children.

SETTING

Pediatric tertiary referral center for cochlear implantation.

METHODS

The auditory performance and speech intelligibility development of 30 profoundly deaf children were rated before cochlear implantation and at 5 and 10 years after implantation using the Categories of Auditory Performance and the Speech Intelligibility Rating. The academic and/or occupational status of the participants after 10 years of implant experience was documented. All children received a Nucleus multichannel cochlear implant between the ages of 2.5 and 11 years (mean age at implantation, 5.2 yr). Implant experience ranged from 10 to 14 years of use.

RESULTS

After 10 years of implant experience, 26 subjects (87%) reported that they always wore their device; 2 subjects (7%), frequently; and 1 subject (3%), occasionally. Only one child had discontinued use of his device. After 10 years of implant use, 26 (87%) of the children understood a conversation without lip reading and 18 (60%) used the telephone with a familiar speaker. Ten years after implantation, 23 (77%) of the subjects used speech intelligible to an average listener or a listener with little experience of a deaf person's speech. One-third to one-half of the implanted children continued to demonstrate improvements at 5 to 10 years of implant use. Of the 30 implanted children, 8 (26.7%) experienced nine device failures. The length of time from identification of the first faulty electrode to reimplant surgery ranged from 2 weeks to 5.5 years, as several failures were gradual or intermittent. However, all children were successfully reimplanted. At the end of the study (10-14 yr after implantation), 19 subjects were in secondary school for children aged 11 to 16 years: 6 were in mainstream schools, 7 were in specialist hearing-impaired units attached to a mainstream secondary school, and 6 were in schools for the deaf. Of the remaining 11 subjects, 4 were in college studying vocational subjects, 2 were in a university studying for a bachelor's degree, 3 were working full-time, 1 was working and going to a university part-time, and 1 was a full-time mother of two young children.

CONCLUSION

All but 1 of the 30 implanted children continue using their devices 10 to 14 years after implantation, showing significant progress in speech perception and production. Device failure was frequent, but successful reimplantation occurred in all cases. One-third to one-half of the implanted children in this study continued to demonstrate improvements at 5 to 10 years of implant use. All children are studying or working and are actively involved in their local communities. The results suggest that cochlear implantation provides long-term communication benefit to profoundly deaf children that does not plateau for some subjects even after reimplantation. This study further indicates that cochlear implant centers need the structure and funding to provide long-term support, counseling, audiologic follow-up, rehabilitation, and device monitoring to implanted children.

Young deaf children with hearing aids or cochlear implants: early assessment package for monitoring progress

BACKGROUND

Very few assessment measures exist for evaluating progress in young deaf children with hearing aids and cochlear implants.

OBJECTIVE

To introduce and describe an early assessment package that covers auditory perception, communication/language development, and speech production in very young deaf children.

MAIN OUTCOME MEASURES

Seven of the assessment measures (Listening Progress Profile, Categories of Auditory Performance, Tait Video Analysis, Stories-Narratives Assessment Procedure, Profile of Actual Linguistic Skills, Speech Intelligibility Rating, and the Profile of Actual Speech Skills) have been specifically developed at the Nottingham Cochlear Implant Programme, and a further one (Meaningful Auditory Integration Scale) was modified for use within the package. Moreover, two commercially available tests (Pragmatics Profile of Everyday Communication Skills and Preschool Language Scale) are included to complete the package.

METHODS

The present paper describes each measure, how to use it, and its time frame. In addition, two case studies demonstrate the usefulness of the package as a whole.

RESULTS AND CONCLUSIONS

The Nottingham Early Assessment Package (NEAP) offers a framework with which to assess in young deaf children the use of audition and language and communication in real-life situations. Being simple, reliable, and time effective can be used in everyday clinical practice. NEAP is innovative in design and offers a structured approach to monitor very young deaf children, both in short and long term. In addition, it allows the identification of additional problems and areas of difficulty as well as specific abilities and skills. This enables the clinician to determine appropriate intervention strategies.