Post-operational therapy in children with ci – Learning to hear

Take care of the sense and the sounds will take care of themselves!

Lewis Caroll, Alice's Adventures in Wonderland

In the post-operative stage, children¹⁶ with ci require an intensive rehabilitation program. First priority within the rehabilitation is to help them ’utilize the auditory signal and to naturally integrate the various components of communication including listening, speech, language, reading and thinking’ (Sorkin and Caleffe-Schenck 2008, 1).

As congenital¹⁷ and pre-lingually deafened children with ci have not heard any sounds before,¹⁸ they have to learn first to interpret the sounds, as they have not built-up an acoustic scheme of sounds in their brain yet that would link a sound to a meaning (Diller and Grasser 2005). The intensity of the rehabilitation has implications for the speed at which children with ci will acquire language and the way they will communicate (Dolnick 1993, Stedt and Rosenberg 1987). This could also be shown by the study of Schauwers et al. (2005) which attested, that despite some initial delays in language development, some children with ci have similar and in some cases faster spoken language development, when compared to children with normal hearing of the same age (Schauwers et el. 2005). However, there are various factors that affect the

16 Ci-adults also receive an intensive rehabilitation, but have different needs than pre-lingually deafened ci-children.

17 With congenital deaf we refer to children, who have been born deaf (Müller and Wagenfeld 2003).

18 Pre-lingually deafened children might have heard sounds before becoming entirely deaf, but as most of them become deaf before the age of 2, the experienced sounds are not enough to build up an acoustic memory.

outcome a child with ci will have and individual results are highly variable (Geers et al. 2007).

Some of characteristics of hearing with a ci, which accompany the rehabilitation process of these children are:

• The perception of sounds might differ according to the coding strategy of the particular implant or implants used by the child. Some children might have a cochlear implant in one ear and a hearing aid in the other. This bimodal way of hearing, then, might bring with it difficulties in hearing. The sound processor’s adjustment and how the child responds to the particular adjustment must therefore be constantly monitored (Tavartkiladze 2005, Lehnhardt 2005).

• The identification of speech differs according to word frequency, lexical density and word length. For example, lexically easy words, which appear in a high frequency and have few phonetic neighbours, are better identified than more difficult words, which appear in higher frequencies and have more phonetic neighbours. The recognition of words also tends to be better for polysyllabic than for monosyllabic stimuli (Quellet and Cohen 1999).

• As a ci is not able to filter simultaneously incoming sounds, like a physiological auditory system is able to, the children tend to have great problems in understanding with background noise or when there is a greater distance to the sound source, or when there is reverberation (Diller 2005).

• Children with ci gain their understanding of spoken language based on a combination of lip-reading, hearing and visually received information (Diller et al.

2005).

• Children with ci show increased eye contact, e.g. for being able to lip-read and turn taking, which is frequently indicated more verbally (Diller and Grasser 2005).

• Due to the limited auditory access that a ci provides the child, children with ci have difficulties in self-monitoring their speech and their language production (Pakulski 2011).

Professionals who are involved with/in the rehabilitation of children with ci are well informed and aware of the listed challenges and incorporate their knowledge into the rehabilitation, with the aim of providing the best help. One of the basic steps in rehabilitation, which usually is either provided by the implanting clinic or in special rehabilitation centres, is the so-called auditory-verbal therapy. With this type of therapy, the discrimination between specific sounds and the detection of individual words is practised (Sorkin and Caleffe-Schenck 2008). In auditory-verbal therapy, repetition of words or whole sentences and redundancy are used to train the auditory memory of the children. The basic aim of auditory-verbal therapy is a ‘speech and language development that nearly matches that of normal-hearing people’ (Diller 2005). In general this therapy adopts a holistic view, as it tries to involve all the senses (e.g. the vision) for making it possible to hear. The focus though lies on the auditory education and the child’s individual personality and linguistic performance with the goal to provoke a reflective and natural linguistic behaviour.¹⁹

Once the children have acquired the skills to perceive and interpret sounds, the focus moves on to understanding speech and applying the acquired linguistic skills in daily communication. This is of particular interest, especially when the children start to go to school. Here, the children have different needs, which are to be found in improving their grammar and pronunciation. Children with ci are reported to acquire inflectional morphology and vocabulary more slowly, when compared to their hearing peers (Szagun 2002), for example. They are also shown to have a lower working memory when they have to process unknown speech and language input (Diller and Grasser 2009). In general they have difficulties with grammatical markings, especially when the perceptual salience of these markers is low (Szagun 2002).

The various ci manufacturers, as well as organizations concerned with cochlear implants, offer a variety of clear guidelines and instructions on how to work with a

19 It should be noted, that different countries also have developed different programs (and policies) for hearing impaired intervention. For further reading see: (Diller et al. 2005).

child with ci, which varies depending on whether the rehabilitation is for toddlers or for school children.²⁰ Finally, the children’s parents play also an important part in the rehabilitation of their child, as they are responsible for the language and sound input the child gets at home. The better the cross information and intervention between doctors, therapists, teachers and parents is, the more beneficial the results for the child will be.

The next subsection will present an institution, which is dedicated to meet the particular needs, as described above, of children with cochlear implants. It will present the school where the data for this study was collected, but also how professionals in this institution work with children with ci. Hence, we will be able to get a complete picture of how educational stuff working with children with ci put their professional skills into practice.