Instruments to assess the oral language of children fitted with a cochlear implant: a systematic review

Assistive Hearing Technology for Deaf and Hard-of-Hearing Spoken Language Learners

Radical advancements in hearing technology in the last 30 years have offered some deaf and hard-of-hearing (DHH) children the adequate auditory access necessary to acquire spoken language with high-quality early intervention. However, meaningful achievement gaps in reading and spoken language persist despite the engineering marvel of modern hearing aids and cochlear implants. Moreover, there is enormous unexplained variability in spoken language and literacy outcomes. Aspects of signal processing in both hearing aids and cochlear implants are discussed as they relate to spoken language outcomes in preschool and school-age children. In suggesting areas for future research, a case is made for not only expanding the search for mechanisms of influence on outcomes outside of traditional device- and child-related factors, but also for framing the search within Biopsychosocial systems theories. This theoretical approach incorporates systems of risk factors across many levels, as well as the bidirectional and complex ways in which factors influence each other. The combination of sophisticated hearing technology and a fuller understanding of the complex environmental and biological factors that shape development will help maximize spoken language outcomes in DHH children and contribute to laying the groundwork for successful literacy and academic development.

Selección de pruebas del lenguaje y análisis crítico de su aplicación en población infantil con discapacidad auditiva

El objetivo de este estudio ha consistido en seleccionar aquellas pruebas que mejor permitieran estudiar desde un punto de vista formal, el lenguaje del niño/a con hipoacusia. Aunque no hay un consenso general, consideramos que es fundamental analizar todos los aspectos del lenguaje, para tener un conocimiento más completo del desarrollo lingüístico, porque no es paralelo en todos sus ámbitos. Las pruebas escogidas han sido: el test PEABODY; el registro fonológico de Laura Bosch; EDAF; EMLE-TALE 2000; PLON-R y BLOC-SR. Esta evaluación se complementa con un cuestionario dirigido a quienes aplican los test y con la opinión de expertos logopedas en el terreno práctico. En términos generales todas las pruebas han resultado adecuadas en función de su finalidad. Las que mejor se corrigen son EDAF, PEABODY y BLOC-SR y la que peor, el registro fonológico de Laura Bosch. Para nosotros, el procedimiento de aplicación de PEABODY y PLON-R es ideal para niños con hipoacusia, presentando mayores dificultades el EDAF y BLOC-SR y siendo muy difíciles de aplicar, el registro fonológico de Laura Bosch y el EMLE. Consideramos que la selección realizada para evaluar el desarrollo del lenguaje en el niño/a con discapacidad auditiva es adecuada, siempre y cuando tengamos en cuenta la edad de desarrollo y las modificaciones específicas que debemos adoptar en esta población.

Early Expressive Language Skills Predict Long-Term Neurocognitive Outcomes in Cochlear Implant Users: Evidence from the MacArthur-Bates Communicative Development Inventories

PURPOSE

The objective of the present article was to document the extent to which early expressive language skills (measured using the MacArthur-Bates Communicative Development Inventories [CDI; Fenson et al., 2006]) predict long-term neurocognitive outcomes in a sample of early-implanted prelingually deaf cochlear implant (CI) users.

METHOD

The CDI was used to index the early expressive language skills of 32 pediatric CI users after an average of 1.03 years (SD = 0.56, range = 0.39-2.17) of CI experience. Long-term neurocognitive outcomes were assessed after an average of 11.32 (SD = 2.54, range = 7.08-16.52) years of CI experience. Measures of long-term neurocognitive outcomes were derived from gold-standard performance-based and questionnaire-based assessments of language, executive functioning, and academic skills.

RESULT

Analyses revealed that early expressive language skills, collected on average 1.03 years post cochlear implantation, predicted long-term language, executive functioning, and academic skills up to 16 years later.

CONCLUSION

These findings suggest that early expressive language skills, as indexed by the CDI, are clinically relevant for identifying CI users who may be at high risk for long-term neurocognitive delays and disturbances.

Brazilian adaptation of the Functioning after Pediatric Cochlear Implantation (FAPCI): comparison between normal hearing and cochlear implanted children

OBJECTIVE

Enabling development of the ability to communicate effectively is the principal objective of cochlear implantation (CI) in children. However, objective and effective metrics of communication for cochlear-implanted Brazilian children are lacking. The Functioning after Pediatric Cochlear Implantation (FAPCI), a parent/caregiver reporting instrument developed in the United States, is the first communicative performance scale for evaluation of real-world verbal communicative performance of 2-5-year-old children with cochlear implants. The primary aim was to cross-culturally adapt and validate the Brazilian-Portuguese version of the FAPCI. The secondary aim was to conduct a trial of the adapted Brazilian-Portuguese FAPCI (FAPCI-BP) in normal hearing (NH) and CI children.

METHODS

The American-English FAPCI was translated by a rigorous forward-backward process. The FAPCI-BP was then applied to the parents of children with NH (n=131) and CI (n=13), 2-9 years of age. Test-retest reliability was verified.

RESULTS

The FAPCI-BP was confirmed to have excellent internal consistency (Cronbach's alpha > 0.90). The CI group had lower FAPCI scores (58.38 ± 22.6) than the NH group (100.38 ± 15.2; p<0.001, Wilcoxon test).

CONCLUSION

The present results indicate that the FAPCI-BP is a reliable instrument. It can be used to evaluate verbal communicative performance in children with and without CI. The FAPCI is currently the only psychometrically-validated instrument that allows such measures in cochlear-implanted children.

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.

Expressive vocabulary, morphology, syntax and narrative skills in profoundly deaf children after early cochlear implantation

Practical experience and research reveal generic spoken language benefits after cochlear implantation. However, systematic research on specific language domains and error analyses are required to probe sub-skills. Moreover, the effect of predictive factors on distinct language domains is unknown. In this study, outcomes of 70 school-aged children with cochlear implants were compared with hearing peers. Approximately half of the children with cochlear implants achieved age-adequate language levels. Results did not reveal systematic strong or weak language domains. Error analyses showed difficulties with morphological and syntactic rules and inefficient narrative skills. Children without additional disabilities who received early intervention were raised with one spoken language, and used a second cochlear implant or contralateral hearing aid were more likely to present good language skills.

A classification model for infant cries with hearing impairment and unilateral cleft lip and palate

OBJECTIVE

The aim of the study was to examine the acoustic features of infant cries in order to find differences between infants with normal development, hearing impairment (HI) and unilateral cleft lip and palate (UCLP). The study focused on two issues: (1) are differences in acoustic cry parameters specific of a certain pathological development, and (2) do these differences allow for a reliable classification of infant cries?

PATIENTS AND METHODS

In total, 128 spontaneous cries of infants up to 12 months of age were recorded. The mean values of acoustic cry parameters were statistically analyzed by one-way analysis of variance and Sheffé post hoc tests. A C5.0 decision tree was trained to classify infant cries by their acoustic parameters.

RESULTS

Significant differences in cry duration, fundamental frequency, formants 2 and 4, intensity, jitter, shimmer and harmonics-to-noise ratio were found between the groups. The C5.0 decision tree was able to predict an infant's membership to the healthy, UCLP or HI groups with a probability of 89.2%.

CONCLUSION

We conclude that C5.0 decision trees are suited to reliably classify healthy infants as well as infants with HI and UCLP by acoustic parameters.