Transcript Cochlear Implants for Students who are Deaf

Cochlear Implants & Multiple
Disabilities: What We’ve Learned
So Far
Ella L. Taylor
Western Oregon University
Susan M. Bashinski
University of Kansas
2008 Council for Exception Children Conference
Boston, MA
Session Goals
Status of research on children with
multiple disabilities and cochlear implants
 Challenges of working with multiple
partners
 Characteristics of children with deafblindness who have cochlear implants
 Impact of CI on communication

Trends in Cochlear
Implantation

FDA continues to lower the age of eligibility for
receiving a cochlear implant

Cochlear implant centers are reporting a
dramatic increase in the number of bilateral
implants

CI technology continues to advance (i.e., the
number of implant channels, amount of damage
done to ear physiology by implant, etc.)
Research on CI & Multiple
Impairments
Edwards (2007) reviews the small amount
of research focusing on CI and children
with multiple disabilities
 General findings from her examination:

◦ Cognitive functioning is one of the strongest
predictors of progress in developing speech
perception and speech production
◦ Parents report satisfaction with CI due to
increased eye contact, awareness of the
environment and response to requests.
Trends in Results of Cochlear
Implantation (HI only)

Earlier ages for implantation are associated
with more significant, and rapid, progress

Variability in outcomes continues to exist,
especially for children who receive implants at
older ages

Orally-focused post-implant habilitation is,
generally, associated with more positive
outcomes than is total communication
Importance of This Research Project
States across the country are reporting:

A significant increase in the number of
children with DB receiving implants

Increasing numbers of children with
multiple disabilities receiving implants
Importance of This Research
Project

Current extant literature base nearly
entirely reports data re: cochlear
implants with children who are deaf

Very limited data exist regarding
post-implant outcomes for children
with deaf-blindness

Outcomes with children who are
deaf are NOT transferable to children
with deaf-blindness
Purpose
The overall purpose of this project is
NEITHER to:
 encourage families of children who
have DB to seek out an implant
NOR
 to discourage families from doing so.
The purpose of the study is to
establish a database that families, in
the future, might consult to make
more informed decisions.
Research Partners

Deaf-Blind Services Projects in 22 states
(AZ, CA, CT, DE, FL, GA, IL, KS, KY, MA, MD, MN, MO,
NC, NE, NJ, NY, OH, OK, OR, PA, TX)

Cochlear Implant Centers:
 Midwest Ear Institute (Kansas City, MO)
 Cincinnati Children’s Hospital (Ohio)
 Boys’ Town National Research Hospital (Omaha,
NE)
Challenges

Numerous collaborative partners exacerbate
the challenge of compliance with IRB
requirements

Completion of subcontracts and / or
collaborative agreements has had a negative
impact on ID & consent with participants

Identification and assessment of pre-implant
participants has been difficult because of health
and scheduling variables
Assessment Package

CIDB Project Demographic Survey

MacArthur-Bates Communicative Development
Inventories
 Words & Gestures
 Words & Sentences

Communication & Symbolic Behavior Scales
Developmental Profile (CSBS-DP)

Reynell-Zinkin Developmental Scales for Young
Children with Visual Impairments

Speech Intelligibility Rubric

C-SIM
Assessment Schedule

Participants are divided into three groups,
for purposes of assessment:
 Pre-implant
 Post-implant
 Implant less than seven years
 Implant for seven years or longer

Assessment schedule varies according to
the amount of time the child has had a
cochlear implant
Participants
Demographics reported here are in regard
to 63 participants:
 Chronological age: 13 mos. to 12 yrs. 7 mos.
 Gender: 64% male, 36% female
 Ethnicity:
70% Caucasian
13% Latino
13% African-American
2% Native American
3% Other
 Prematurity : 1 out of every 2 born prematurely
 CI Status: Pre-implant (19%), Post-implant (81%)
Etiology
Percentage
Complications of prematurity
26%
Unknown
24%
CHARGE
20%
Meningitis
47% were
6%
Refsum Syndrome
4%
CMV (Cytomeglovirus)
4%
Asphyxia
2%
Klippel-Feil sequence
2%
Pierre-Robin syndrome
2%
Usher syndrome
2%
Congenital Rubella
2%
Hydrocephaly
2%
Maternal drug use
2%
Leber congenital amaurosis
2%
premature
Participants’ Vision Status
Vision Impairment
Participants
Low vision (<20/200)
11%
Legally blind
29%
Light perception only
6%
Totally blind
17%
CVI
23%
Diagnosed progressive loss
Further testing needed
4%
11%
Participants’ Hearing Status
ALL participants have severe or profound
hearing loss-MUST have to qualify for
cochlear implant
 76% born with hearing impairment
 6% of those tested diagnosed with central
auditory processing disorder (CAPD)
 27% of those tested diagnosed with
auditory neuropathy (AN)
 Six children have bilateral CI

Participants’ Age at Implant

Demographics reported below are in
regard to 51post-implant participants:
 Range: 6 months to 10 years, 7 months
≤12 months = 12%
13 – 24 months = 33%
25 – 36 months = 18%
37 – 48 months = 11%
49 – 60 months = 12%
> 5 years
= 14%
 Median implant age: 28 months
Time in Sound (months)
Duration with Implant
“Time in Sound”
Children with CHARGE Syndrome
160
147
Age in Months
140
120
133
113
100
96
Age at Implant
Current Age
80
60
40
60
46
58
47
43
33
52
41
31
54
54
40
20
12
12
0
Child Child Child Child Child Child Child Child Child
1
2
3
4
5
6
7
8
9
Additional disabilities
Percentage with additional
impairments
Communication (initial assessment)

Large percentage of participants
demonstrate little vocabulary
comprehension (> 75%)
◦ 92% pre have less than 5 words
◦ 75% post have less than 5 words

Large percentage have little vocabulary
production (>80%)
◦ 92% pre have less than 10 words
◦ 88% post have less than 10 words
Data Trends: MacArthur-Bates
(initial assessments)
Pre-implant
Post-implant
Min Max Mean Min Max
Mean
Vocab
comprehension
(407 items)
0
0
0
0
347
45.88
Vocab production
(407 items)
0
32
6.17
0
85
9.27
First communicative
gestures (12 items)
0
5
2.16
0
11
3.35
Pretending to be a
parent (13 items)
0
1
0.17
0
13
1.12
Imitating adult
actions
(15 items)
0
9
1.50
0
15
2.73
First Communicative Gestures
(initial assessment)
DATA TRENDS: MACARTHUR-BATES
Children who had
implants for longer
duration
demonstrated
increased output of
“first communicative
gestures” (n = 23, p <
.10)
(e.g., Extends arm to
give something,
Extends arms to be
picked-up)
Bilateral Cochlear Implants
Six participants have bilateral cochlear
implants
 Tend to be younger
 Introducing Grace

Preliminary Findings

Population of children with DB is extremely
diverse; receiving a cochlear implant is not
associated with any particular etiology

Majority of participants have two or more
additional disabilities (beyond DB)

Younger participants in study, as a group, received
their implants at earlier ages

Participants in study, who had more additional
disabilities, as a group received their implants at
older ages

Participants appear to be demonstrating
tremendous variability in their outcomes
Preliminary Findings

Implantation at an earlier age appears to be
associated with more rapid, significant progress

Participants with longer “time in sound” appear
to demonstrate increased output

Participants appear to be showing increased
vocalizations during play, after CI

Participants appear to begin to show small
increases in response to gestures and words
Concerns and Limitations

Incredible variety in participants’ cochlear
implant wearing patterns
Reportedly:
 some children wear their implants during all waking
hours
 many children wear their implants only at school
 a number of children wear their implants
inconsistently-home and school
 some participants’ families have discontinued use of
their child’s implant (as much as 10% reported in
some states)
Concerns and Limitations

Intensity, frequency, and types of available
intervention / habilitation vary widely across
children and families

Tremendous need exists for appropriate
intervention / habilitation techniques for
implementation with children who have
concurrent vision and hearing losses AND
additional disabilities
Concerns and Limitations

Severe shortage of personnel trained in
auditory-verbal (A-V) therapy techniques

Even therapists trained in AV techniques are
unsure of how to adapt these for
implementation with children with DB
Acknowledgements
USDE grant award H327A050079
 Co-Investigators:
Kat Stremel, NCDB
Lisa Cowdrey, Midwest Ear Institute
State Deaf-Blind Project directors
 Teachers and families who allowed us
to complete research in their
classrooms and homes

Contact Info

Susan M. Bashinski ([email protected])

Ella Taylor ([email protected])
Project Website
http://www.wou.edu/cidb