Academic Performance, Communication, and Psychosocial Development of Prelingual Deaf Children with Cochlear Implants in Mainstream Schools

Motor Processing in Children With Cochlear Implants as Assessed by Functional Near-Infrared Spectroscopy

Auditory-motor and visual-motor networks are often coupled in daily activities, such as when listening to music and dancing; but these networks are known to be highly malleable as a function of sensory input. Thus, congenital deafness may modify neural activities within the connections between the motor, auditory, and visual cortices. Here, we investigated whether the cortical responses of children with cochlear implants (CI) to a simple and repetitive motor task would differ from that of children with typical hearing (TH) and we sought to understand whether this response related to their language development. Participants were 75 school-aged children, including 50 with CI (with varying language abilities) and 25 controls with TH. We used functional near-infrared spectroscopy (fNIRS) to record cortical responses over the whole brain, as children squeezed the back triggers of a joystick that vibrated or not with the squeeze. Motor cortex activity was reflected by an increase in oxygenated hemoglobin concentration (HbO) and a decrease in deoxygenated hemoglobin concentration (HbR) in all children, irrespective of their hearing status. Unexpectedly, the visual cortex (supposedly an irrelevant region) was deactivated in this task, particularly for children with CI who had good language skills when compared to those with CI who had language delays. Presence or absence of vibrotactile feedback made no difference in cortical activation. These findings support the potential of fNIRS to examine cognitive functions related to language in children with CI.

Hearing Impairment and School Engagement Outcomes in US Children

Importance

Ensuring appropriate school engagement for deaf or hard of hearing (DHH) children in the US is important for improving their long-term outcomes as they grow into adults.

Objective

To examine the associations between hearing loss (HL), its sequelae (speech and/or language disorders, behavioral and/or conduct problems, and neuropsychiatric and/or learning disorders), and various school engagement measures among school-aged children in the US.

Design, Setting, and Participants

This cross-sectional study combined data from the nationally representative 2016-2021 National Survey of Children's Health. A total of 155 178 randomly selected children (weighted, approximately 49 340 700 children) aged 6 to 17 years with a parent or caregiver who responded to an address-based survey by mail or online were included. All analyses were weighted to account for the probability of selection and nonresponse and to reflect population-based estimates representative of all noninstitutionalized school-aged US children and adolescents residing in housing units.

Main Outcomes and Measures

Diverse school engagement measures, including extracurricular participation in sports, clubs, paid work, volunteer work, and organized lessons, as well as educational performance variables, including missed school days, not caring about doing well in school, not doing required homework, grade repetition, and parent or guardian contacted by school.

Results

Of the estimated 49 340 700 children aged 6 to 17 years (41.1% aged 6-10 years; 51.1% male; 54.7% without underrepresented minority status), an estimated 1.4% (95% CI, 1.2%-1.5%) were reported by their parent or guardian to have deafness or hearing problems. Having DHH status was associated with significantly worse outcomes on 8 of 10 school engagement measures (eg, participation in sports: adjusted odds ratio [AOR], 0.75 [95% CI, 0.60-0.93]; missed school days: AOR, 2.98 [95% CI, 2.21-4.00]), even after adjustment for age, sex, underrepresented minority status, highest educational level of parent or guardian, federal poverty level of the household, and primary language in the household. Moreover, although subgroup analyses of DHH children with and without HL sequelae revealed significant differences (speech and/or language disorder: AOR, 5.83 [95% CI, 4.31-7.89]; behavioral and/or conduct problem: AOR, 2.75 [95% CI, 2.10-3.60]; neuropsychiatric and/or learning disorder: AOR, 3.06 [95% CI, 2.39-3.91]), HL sequelae only partially mediated the associations between these disparities.

Conclusions and Relevance

In this cross-sectional study, DHH status itself may have been the primary factor directly associated with school engagement disparities. These findings suggest the need for greater emphasis on educational accommodations and support for hearing status itself, independent of the presence or absence of HL sequelae.

Developmental Auditory and Speech-Language Performance in Pediatric Cochlear Implantation Recipients with Stable White Matter Lesions

To analyze the association between stable asymptomatic white matter lesions (WMLs) and the cochlear implantation (CI) effect in congenitally deaf children, 43 CI children with stable asymptomatic WMLs determined via preoperative assessments and 86 peers with normal white matter were included. Outcome measurements included closed-set Mandarin Chinese (tone, disyllable, and sentence) recognition tests; categories of auditory performance (CAPs); and speech intelligibility rating (SIR) scales at 1, 12, and 24 months post-CI. Generalized estimating equation (GEE) models were used to analyze the association between WML and outcomes. In the WML group (control group), median CAP and SIR scores were 5 (5) and 4 (4) with mean rates of tone, disyllable, and sentence recognition of 84.8% (89.0%), 87.9% (89.7%), and 85.8% (88.0%) at 24 months post-CI, respectively. Auditory and speech performance improved significantly with implant use. Compared to their peers in the control group, for the participants with stable asymptomatic WMLs, auditory and speech abilities were not significantly different (p > 0.05). Stable asymptomatic WMLs might not be associated with poor auditory and speech intelligibility post-CI, which indicates that it is feasible to use comprehensive assessments to screen suitable candidates with WMLs who are likely to present with a good prognosis.

Patient-centered empirical research on ethically relevant psychosocial and cultural aspects of cochlear, glaucoma and cardiovascular implants - a scoping review

BACKGROUND

The significance of medical implants goes beyond technical functioning and reaches into everyday life, with consequences for individuals as well as society. Ethical aspects associated with the everyday use of implants are relevant for individuals' lifeworlds and need to be considered in implant care and in the course of technical developments.

METHODS

This scoping review aimed to provide a synthesis of the existing evidence regarding ethically relevant psychosocial and cultural aspects in cochlear, glaucoma and cardiovascular implants in patient-centered empirical research. Systematic literature searches were conducted in EBSCOhost, Philpapers, PsycNET, Pubmed, Web of Science and BELIT databases. Eligible studies were articles in German or English language published since 2000 dealing with ethically relevant aspects of cochlear, glaucoma and passive cardiovascular implants based on empirical findings from the perspective of (prospective) implant-wearers and their significant others. Following a descriptive-analytical approach, a data extraction form was developed and relevant data were extracted accordingly. We combined a basic numerical analysis of study characteristics with a thematically organized narrative synthesis of the data.

RESULTS

Sixty-nine studies were included in the present analysis. Fifty were in the field of cochlear implants, sixteen in the field of passive cardiovascular implants and three in the field of glaucoma implants. Implant-related aspects were mainly found in connection with autonomy, freedom, identity, participation and justice, whereas little to no data was found with regards to ethical principles of privacy, safety or sustainability.

CONCLUSIONS

Empirical research on ethical aspects of implant use in everyday life is highly relevant, but marked by ambiguity and unclarity in the operationalization of ethical terms and contextualization. A transparent orientation framework for the exploration and acknowledgment of ethical aspects in "lived experiences" may contribute to the improvement of individual care, healthcare programs and research quality in this area. Ethics-sensitive care requires creating awareness for cultural and identity-related issues, promoting health literacy to strengthen patient autonomy as well as adjusting healthcare programs accordingly. More consideration needs to be given to sustainability issues in implant development and care according to an approach of ethics-by-design.

Longitudinal outcomes for educational placement and quality of life in a prospectively recruited multinational cohort of children with cochlear implants

OBJECTIVES

The aim of this study was to report on the educational placement, quality of life and speech reception changes in a prospectively recruited group of children after they received a cochlear implant (CI).

METHOD

Data was collected on 1085 CI recipients of as part of a prospective, longitudinal, observational, international, multi-centre, paediatric registry, initiated by Cochlear Ltd (Sydney, NSW, Australia). Outcome data from children (≤10 years old) implanted in routine practice was voluntarily entered into a central, externally hosted, e-platform. Collection occurred prior to initial device activation (baseline) and at six monthly follow-up intervals up to 24 months and then at 3 years post activation. Clinician reported baseline and follow up questionnaires and Categories of Auditory Performance version II (CAP-II) outcomes were collated. Self-reported evaluation forms and patient information were provided by the parent/caregiver/patient via the implant recipient baseline and follow up, Children Using Hearing Implants Quality of Life (CuHIQoL) and Speech Spatial Qualities (SSQ-P) Parents Version questionnaires.

RESULTS

Children were mainly bilaterally profoundly deaf, unilaterally implanted and used a contralateral hearing aid. Prior to implant 60% used signing or total communication as their main mode of communication. Mean age at implant was 3.2 ± 2.2 years (range 0-10 years). At baseline 8.6% were in mainstream education with no additional support and 82% had not yet entered school. After three years of implant use, 52% had entered mainstream education with no additional support and 38% had not yet entered school. In the sub-group of 141 children who were implanted at or after three years of age and were thus old enough to be in mainstream school at the three-year follow up, an even higher proportion (73%) were in mainstream education with no support. Quality of life scores for the child improved statistically significantly post implant compared to baseline and continued to improve significantly at each interval up to 3 years (p < 0.001). Parental expectation scores reduced statistically significantly from baseline compared to all intervals (p < 0.028) and then increased significantly at 3 years compared to all post baseline follow-up intervals (p < 0.006). The impact on family life was reduced post implant compared to baseline and continued to reduce between annual intervals (p < 0.001). At three years post follow up median CAP II scores were 7 (IQR 6-7) and mean SSQ-P scores were 6.8 (SD1.9) 6.0 (SD1.9) and 7.4 (SD 2.3) for speech spatial and qualities scales respectively. SSQ-P and CAP II scores improved statistically and clinically significantly compared to baseline by one year post implantation. CAP II scores continued to improve at each test interval up to three years post implant. Speech and Qualities scores improved significantly between years 1 and 2 (p < 0.001), but only the Speech scores improved significantly between years 2 and 3 (p = 0.004).

CONCLUSIONS

Mainstream educational placement was achievable for most of the children, including those implanted at an older age. Quality of life for the child and the wider family improved. Future research could focus on the impact of mainstream school placement on children's academic progress, including measures of academic attainment and social functioning.

Language and academic outcomes of children with cochlear implants in an inclusive setting: Evidence from 18 years of data

OBJECTIVE

This study examined outcomes in core and pragmatic language, receptive vocabulary, and academic skills in children with cochlear implants (CIs) enrolled in an inclusive educational setting.

METHODS

Eighty-eight children with CIs were included in the analyses. Data was collected over an 18-year period, at six-month intervals for core language, vocabulary, and pragmatic skills and in kindergarten and second grade for academic skills. Kaplan-Meier analyses were used to estimate the median time to achieve age-appropriate scores.

RESULTS

Results indicated the median time to obtain age-appropriate skills for children with CIs enrolled in our program was less than three years for core language and pragmatic skills and less than two years for vocabulary. Over 90% of the sample had academic skills in the average range in both kindergarten and second grade.

DISCUSSION

This study shares outcomes of children with CIs who received consistent and intensive transdisciplinary intervention in an inclusive educational setting, revealing the trajectory required to obtain age-appropriate skills, when compared to normative data.

CONCLUSION

Results were favorable, indicating that children with CIs in an inclusive program, with intensive intervention and strong language and social models, can develop skills commensurate with typically developing peers across a variety of core skills.

Reading comprehension skill in English as a second language of Japanese middle school students with cochlear implants

OBJECTIVES

To assess the English reading comprehension skill of Japanese middle school students with cochlear implants (CIs).

MATERIALS AND METHODS

The subjects were pre- or perilingually deafened CI recipients between seventh and ninth grades (age 12-15 years). English reading comprehension skill was evaluated using the Norm Referenced Test developed for Japanese students. Furthermore, factors related to English reading comprehension were assessed, focusing on a total of 11 variables: age; sex; age at CI; length of CI use; aided pure-tone thresholds with CI; Japanese listening word recognition score; performance intelligence quotient (PIQ) score; verbal intelligence quotient (VIQ); grade; school type; and Japanese reading comprehension skill.

RESULTS

A total of 40 subjects completed the test. Their average word recognition score was good, at 80.2%,and the average age at CI was late, at 4.4 years. The chi-square goodness of fit test showed the English reading comprehension skill level deviated toward lower achievement in the students with CIs compared with children with normal-hearing. VIQ and Japanese reading comprehension skill were correlated with English reading skill. On the other hand, there was no relationship between English reading skill and the factors of hearing level and CI experience.

School adjustment of adolescents with sequential bilateral cochlear implants in mainstream school

OBJECTIVES

Little is known about the school adjustment of adolescents with sequential bilateral cochlear implants (CIs) in mainstream educational settings. This study aims to investigate the school adjustment of adolescents with sequential bilateral CIs, in comparison to those of age-matched adolescents with typical hearing (TH), to explore the relationships between individual variables and school adjustment in the bilateral CI group, and to assess the factors leading to strong school adjustment in the bilateral CI group.

METHODS

Twenty-five adolescents with sequential bilateral CIs and 30 adolescents with TH, aged 13-19 years, participated in this study. The adolescents completed the school adjustment scale (SAS).

RESULTS

The two groups were not significantly different on overall SAS scores. However, the TH group scored higher on the SAS than the sequential bilateral CI group with regard to communication skills and relationships with peers. In the bilateral CI group, SAS scores significantly correlated with open-set sentence and receptive vocabulary scores. Receptive vocabulary scores were a significant predictive factor for the level of school adjustment for the bilateral CI group.

CONCLUSION

Adolescents who received sequential bilateral CIs adapted well to mainstream schools. However, they did experience barriers to communication and to make friends in mainstream schools, and their level of school adjustment was affected by their receptive vocabulary skills.

Examination of Language, Behavioral, Academic, and Social Skills of Cochlear Implant Users in Early Primary Education

BACKGROUND

 Cochlear implants (CIs) improve spoken language skills as well as social and academic performance in children with severe and profound sensorineural hearing loss.

PURPOSE

 We compare the social skills, academic competence, and problem behaviors in children with CIs and their typical-hearing peers and investigate the relationship between language skills and social skills, academic competence, and problem behaviors in children with CIs.

RESEARCH DESIGN

 Thirty-two children with CIs were divided into two groups according to implantation age: early (n = 17) and late-implanted group (n = 15). The control group was formed by the inclusion of five same-sex classmates of each implanted child selected by the teachers of the children with CIs. Thus, 160 typical-hearing children were included in the control group.

STUDY SAMPLE

 Thirty-two children with CIs and 160 typical-hearing children participated in this study.

DATA COLLECTION AND ANALYSIS

 Primary school teachers rated the children's social skills, academic competence, and problem behaviors using the Social Skills Rating System (SSRS). The language skills of the children with CIs were assessed with the Turkish Expressive and Receptive Language Test (TIFALDI).

RESULTS

 A statistically significant difference was found between the SSRS scores of the study and control groups, which was mostly due to lower social skills, and academic competence, and higher problem behavior ratings in the late-implanted group. In the study group, there was a statistically significant correlation between TIFALDI and SSRS scores.

CONCLUSION

 Early cochlear implantation provides advantages in social skills and vocabulary for children with profound congenital hearing loss. Late-implanted children need special support in different developmental areas despite attending mainstream education.

Parenting Stress, Self-Efficacy, and Involvement: Effects on Spoken Language Ability Three Years After Cochlear Implantation

OBJECTIVE

This study evaluated associations among parenting stress, self-efficacy, and involvement in relation to spoken language outcomes in young children 3 years following cochlear implantation.

STUDY DESIGN

Cross-sectional.

SETTING

Six university tertiary medical centers.

PATIENTS

One hundred sixty-four young children with bilateral, severe-to-profound sensorineural hearing loss who had 3 years of experience with a CI; children with substantial cognitive impairments were excluded from the study.

MAIN OUTCOME MEASURESS

Family Stress Scale (FSS), Scale of Parental Involvement and Self-Efficacy (SPISE), Oral and Written Language Scales (OWLS).

RESULTS

Correlations were of moderate strength between FSS scores and SPISE scores (Parental Self-Efficacy, r = -0.45, p < 0.01, Parental Involvement r = -0.32, p < 0.01). As hypothesized, parents reporting higher levels of stress reported lower perceptions of self-efficacy and involvement. In addition, results showed that family stress had a direct, negative effect on spoken language (-4.43 [95% confidence interval: -6.97; -1.89]). After controlling for maternal education and activation age, parental self-efficacy mediated the negative effect between family stress and spoken language (indirect effect = -1.91 [3.45; -0.69]; proportion mediated = 0.43). No mediating effects were found for parental involvement.

CONCLUSIONS

These findings highlight the need for parenting interventions that focus on reducing stressors and increasing parents' perceptions of self-efficacy in families of children using cochlear implants. Integration of mental health screening and tailored parenting interventions in CI clinics may increase parental self-efficacy and involvement, with measurable benefits in the child's use of spoken language.

Spatial Hearing Difficulties in Reaching Space in Bilateral Cochlear Implant Children Improve With Head Movements

Supplemental Digital Content is available in the text.

The aim of this study was to assess three-dimensional (3D) spatial hearing abilities in reaching space of children and adolescents fitted with bilateral cochlear implants (BCI). The study also investigated the impact of spontaneous head movements on sound localization abilities.

Experiences With the University Admission Process and Educational Support Among Students With Cochlear Implants in South Korea

Objectives

The aim of this study was to investigate the current university admission rate and experiences of educational support among students with cochlear implants (CIs) in South Korea.

Methods

A prospective online survey was conducted to examine the university admission process and academic support for students with CIs. Thirty individuals who took the college entrance exams at least 3 years after CI surgery were invited to participate, although two did not respond. The survey consisted of three topics (demographics, university admission process, and academic support) and 25 items regarding laws and policies related to university admission and support for students with hearing disabilities in Korea.

Results

The university matriculation rate for students with CI was 85.7% (24/28), of whom 50% were admitted through the special admission process for students with disabilities. Most universities provided teaching and learning support and rental services for assistive devices for students with disabilities to help them better adapt to school life. However, only a small percentage of the students benefited from accommodation services, and 62.5% and 12.5% of the students received teaching and learning support and used assistive devices, respectively.

Conclusion

To the best of our knowledge, this is the first study to investigate the university admission process and university disability services for students with CIs in South Korea. The results of this study will be helpful for young CI recipients and their parents as they prepare for university entrance.