Phoneme accuracy as a function of mode of communication in pediatric cochlear implantation

The Limits of "Communication Mode" as a Construct

Questions about communication mode (a.k.a. "communication options" or "communication opportunities") remain among the most controversial issues in the many fields that are concerned with the development and well-being of children (and adults) who are d/Deaf or hard of hearing. In this manuscript, we argue that a large part of the reason that this debate persists is due to limitations of the construct itself. We focus on what we term "the crucial question": namely, what kind of experience with linguistic input during infancy and toddlerhood is most likely to result in mastery of at least one language (spoken or signed) by school entry. We argue that the construct of communication mode-as currently construed-actively prevents the discovery of compelling answers to that question. To substantiate our argument, we present a review of a relevant subset of the recent empirical literature and document the prevalence of our concerns. We conclude by articulating the desiderata of an alternative construct that, if appropriately measured, would have the potential to yield answers to what we identify as "the crucial question."

Effectiveness of Rehabilitation Approaches Proposed to Children With Severe-to-Profound Prelinguistic Deafness on the Development of Auditory, Speech, and Language Skills: A Systematic Review

Purpose The purpose of this systematic review is to identify and evaluate the available scientific evidence on the effectiveness of rehabilitation approaches proposed to children with severe-to-profound prelinguistic deafness on the hearing, speech, and language skills development. Method Databases (PubMed, CINHAL, PsycInfo, Cochrane, ERIC, and EMBASE) were searched with relevant key words (children, deafness, rehabilitation approach, auditory, speech, and language). Studies published between 2000 and 2017 were included. The methodological quality of the studies was evaluated with the Quality Assessment Tool for Quantitative Studies, and the level of evidence was evaluated with the Oxford Centre for Evidence-Based Medicine Levels of Evidence. Every step of the selection and analysis was made by 2 independent judges. Results Of 1,739 articles listed in different databases, 38 met the inclusion criteria and were selected for analysis. The majority of included articles present a relatively low level of evidence. Rehabilitation approaches that do not include signs appear more frequently associated with a better auditory, speech, and language development, except for receptive language, than approaches that included any form of signs. Conclusion More robust studies are needed to decide on the approach to prioritize with severe-to-profound deaf children.

Assessing consonant production in children with cochlear implants

OBJECTIVE

The objective of this study was to investigate the development of consonant inventory and accuracy in pediatric cochlear implant (CI) recipients and compare their performance to typical hearing (TH) children.

METHODS

One hundred and twenty nine children with CIs, implanted between 6-38 months of age, and 30 age-matched children with TH participated in this study. Spontaneous speech samples were collected at 3.5 and 4.5 years chronological age and the first 100 different words spoken by each participant were transcribed. Two consonant production measures were subsequently calculated to assess consonant acquisition and mastery. The percentage of Consonants Correct (CC) was used for measuring accuracy and Consonant Diversity (CD), an inventory measure, was used to identify the number of different consonants spoken by each participant. Repeated measures analyses of variance were conducted to examine the differences in consonant production scores based on presence of CI (participants with CI versus typical hearing (TH) participants), and chronological age at data collection (3.5 years versus 4.5 years).

RESULTS

CI recipients displayed lower consonant production scores compared to TH children. Children with the most device experience (32-38 months at 3.5 years) performed on par with their TH peers.

CONCLUSIONS

The two measures used in this study together appear capable of comprehensively describing the changes in consonant production skills of children. Results from this study indicate that while most CI participants display lower scores compared to TH children, many of the CI users are able to produce speech sounds on par with TH children.

Relationships between spoken word and sign processing in children with cochlear implants

The effect of using signed communication on the spoken language development of deaf children with a cochlear implant (CI) is much debated. We report on two studies that investigated relationships between spoken word and sign processing in children with a CI who are exposed to signs in addition to spoken language. Study 1 assessed rapid word and sign learning in 13 children with a CI and found that performance in both language modalities correlated positively. Study 2 tested the effects of using sign-supported speech on spoken word processing in eight children with a CI, showing that simultaneously perceiving signs and spoken words does not negatively impact their spoken word recognition or learning. Together, these two studies suggest that sign exposure does not necessarily have a negative effect on speech processing in some children with a CI.

Listen up: children with early identified hearing loss achieve age-appropriate speech/language outcomes by 3 years-of-age

OBJECTIVES

Age-appropriate speech/language outcomes for children with early identified hearing loss are a possibility but not a certainty. Identification of children most likely to achieve optimal outcomes is complicated by the heterogeneity of the children involved in outcome research, who present with a range of malleable (e.g. age of identification and cochlear implantation, type of intervention, communication mode) and non-malleable (e.g. degree of hearing loss) factors. This study considered whether a homogenous cohort of early identified children (≤ 12 months), with all severities of hearing loss and no other concomitant diagnoses could not only significantly outperform a similarly homogenous cohort of children who were later identified (>12 months to <5 years), but also achieve and maintain age-appropriate speech/language outcomes by 3, 4 and 5 years of age.

METHODS

A mixed prospective/retrospective comparative study of a homogenous cohort of 45 early identified (≤ 12 months) and 49 late identified (> 12 months to < 5 years) children with hearing loss was conducted. The children all attended the same oral auditory-verbal early intervention programme. Speech/language assessments standardized on typically developing hearing children were conducted at 3, 4 and 5 years of age.

RESULTS

The early identified children significantly outperformed the late identified at all ages and for all severities of HL. By 3 years of age, 93% of all early identified participants scored within normal limits (WNL) for speech; 90% were WNL for understanding vocabulary; and 95% were WNL for receptive and expressive language. Progress was maintained and improved so that by 5 years of age, 96% were WNL for speech, with 100% WNL for language.

CONCLUSIONS

This study found that most children with all severities of hearing loss and no other concomitant diagnosed condition, who were early diagnosed; received amplification by 3 months; enrolled into AV intervention by 6 months and received a cochlear implant by 18 months if required, were able to "keep up with" rather than "catch up to" their typically hearing peers by 3 years of age on measures of speech and language, including children with profound hearing loss. By 5 years, all children achieved typical language development and 96% typical speech.

Production of contrast between sibilant fricatives by children with cochlear implants

Speech production by children with cochlear implants (CIs) is generally less intelligible and less accurate on a phonemic level than that of normally hearing children. Research has reported that children with CIs produce less acoustic contrast between phonemes than normally hearing children, but these studies have included correct and incorrect productions. The present study compared the extent of contrast between correct productions of /s/ and /∫/ by children with CIs and two comparison groups: (1) normally hearing children of the same chronological age as the children with CIs and (2) normally hearing children with the same duration of auditory experience. Spectral peaks and means were calculated from the frication noise of productions of /s/ and /∫/. Results showed that the children with CIs produced less contrast between /s/ and /∫/ than normally hearing children of the same chronological age and normally hearing children with the same duration of auditory experience due to production of /s/ with spectral peaks and means at lower frequencies. The results indicate that there may be differences between the speech sounds produced by children with CIs and their normally hearing peers even for sounds that adults judge as correct.

Consonant and sign phoneme acquisition in signing children following cochlear implantation

Deaf children from signing programs provide new opportunities to investigate changes in sign and speech acquisition following cochlear implantation. We describe the acquisition of sign phonemes (location, movement, and handshapes) and speech phonemes (consonants) in 22 implanted children with diverse demographic backgrounds. New consonants and new sign phonemes emerged in developmentally expected sequences and with statistically significant correlation coefficients between cumulative number of new consonants and new sign phonemes over time. Regression slopes from plotted z scores revealed a burst in consonant and sign growth in early months post-implant, with continuous but plateauing growth over time. These results and documentation of developmental levels of sign and speech phoneme trajectories should be helpful to other researchers and to clinicians working with signing children who have cochlear implants.