University of Edinburgh
 

Working with children with cochlear implants in sign bilingual settings

Presented on 17 January 2008

Update

Sue Archbold

The Ear Foundation

Began cochlear implants in the UK in 1989.

What does it do now?

Cochlear implants are carried out in medical settings but are used at school and home - how do we ensure that they are used properly?

Our goal

  • To provide a bridge between the clinic based services and the community where they are used.
  • The children spend most of their time at home or school.
  • More than half the profoudly deaf children starting school have a cochlear implant.

Providing a bridge between implant centre and school

ear foundation

Making the technology work in the community.

  • Parent courses for communication and language development.
  • Courses for children and young people - Teenzunited
  • Courses for a range of professionals
  • Information for mainstream teachers and support assistants.

Three areas:

  • Family support and information
  • Community and education resources
  • Research and development

Models of deafness (Gregory)

  • Medical / impairment model
  • Disability model
  • Linguistic / cultural model

Medical model

  • Deafness is seen as an illness, a disability or an impairment to correct.
  • Medical model is to correct - to put it right.
  • Loss of hearing
  • Loss of a 'normal' function
  • Seen for the perspective of a hearing person
  • Makes the assumption that it is 'better' to hear.

Disability model

  • Deaf people are disabled by society - they have unequal access.
  • If society provides access, then the disability is removed.
  • Deaf people can then be assimilated into society.

Linguistic / cultural model

  • A separate linguistic and cultural minority
  • own language and art forms
  • members of a community
  • a community language BSL

What about...

  • An educational model of deafness
  • and sign bilingualism?

For me

  • Issues for me about cochlear implants and sign bilingualism
  • for the chidren I work with
  • for their parents.

What about cochlear implants?

  • Brought together medical and disability models
  • Providing hearing will provide access - will 'correct' the difference
  • Let's think about implants and some facts.

The face of deaf education: a long history of controversy: Abée de L'Epée and Itard.

How should deaf children be educated? OR To sign or not to sign.

1880 Milan conference:

  • The Convention considering the incontestable superiority of speech over signs
  • (a) for restoring deaf mutes to social life and
  • (b) for giving them greater facility of language,
  • declares that the method of articulation should have preference over that of signs in instruction in education of the deaf and dumb
  • considering the simultaneous use of speech and signs has the disadvantage of injuring speech and lipreading and the precision of ideas, the Convention declares that the oral method ought to be preferred.

The dominance of oralism in deaf education

1880 -1980 Oralism
1980 Introduction of Total Communication
1990 Introduction of sign bilingual approaches - use of British Sign Language

Interestingly at the same time as cochlear implants were introduced.

Where should deaf pupils be educated?

  • 1880-1940 Deaf pupils educated in schools for the deaf
  • 1940s First classes in mainstream schools introduced
  • 1980s Move to integration into mainstream schools for deaf pupils
  • 1990s The inclusion agenda for all pupils with disabilities into mainstream schools.

What of cochlear implantation?

Into the history of deaf education came implantation and surgeons.

What has this to do with deaf education?

Growth in paediatric implantation worldwide: 1990 (>100) to 2006 (60,000).

Over half the profoundly deaf children starting school in the UK are wearing implants.

  • A huge change in a comparatively short time.
  • Do teachers of the deaf realise this?
  • More importantly do they know what the potential is for education?

Age at implant

The effect of newborn hearing screening in the UK.

The age at fitting hearing aids has changed dramatically which may give us some time. With thanks to Professor Adrian Davis

What are the advantages of this for these families?

What are the disadvantages?

To be a parent is to be scared (Luterman, 1999)

  • Earlier diagnosis leads to earlier thinking about implantation.
  • Parents may still be in early stages of adjustment to deafness.
  • Parents may still be in denial and see an implant as a quick 'fix'

Surgical quotations (real)

  • "now that we can cure deafness..."
  • "now we can give better than normal hearing..."
  • "Your child will have normal speech and language"

A cochlear implant programme

  • Assessment
  • Surgery
  • Tuning
  • Rehabilitation
  • Maintenance

Changing candidates

  • Younger children
  • Older children - teenagers
  • Those with more hearing - hearing aid in one ear and implant in the other
  • Children with more complex problems
  • More deaf children of deaf parents

Audiological assessment

  • What do we do with young children?
    Behavioural testing: play audiometry, VRA, performance testing.
  • What do we need to complete it?
    Objective testing: auditory brainstem testing - why?
  • Complexities - very young infants, borderline children

Before implantation evoked response audiometry (ERA) with and without hearing aid. Children are often sedated on the ENT ward.

Current surgical issues

Medical assessment

General medical problems

  • Asthma and other respiratory disease
  • cardiac disease
  • epilepsy and other neurological disease
  • immunoogical disorder
  • CMV and similar disorders
  • malignancy.

Radiological problems

But during all this:

  • Don't forget the child and family
  • and their local support.
  • The children spend most time at home and at school - not in the implant centre.

Not just in the clinic!

  • We visit school and home to find out what really goes on.
  • Educational support
  • Family support
  • Communication in the home and school.

The decision for the child - who makes it? Family + CI team + local team.

Surgery

Hospital stay

  • head shave?
  • scar?
  • complications?

Surgical outcomes (Nottingham Cochlear Implant Programme)

Out of 500 children:

  • 25 failed devices
  • 3 removed
  • 6 infections

Initial tuning

About 4 weeks after the operation the child returns to the hospital to receive the outer parts of the system?

  • The processor
  • Headset and microphone

outer parts

The process of beginning to use the new signal begins.

What is the aim of cochlear implantation?

  • To provide access to speech via hearing which was not possible for that child with hearing aids.
  • What are likely aided thresholds through the implant?

What are a child's needs following implantation?

  • System functioning optimally at all times
  • oral/aural input whatever the educational setting
  • good listening conditions
  • purposeful communication - means, reasons, and opportunities to develop spoken language
  • realistic expectations by family and professionals
  • is this different to the needs of a hearing aid user?

Differences with children with cochlear implants

  • Complexity of tuning the system
  • complexity of monitoring device functioning
  • surgical/medical implications
  • access to good mid- and high frequency information
  • The possibility of incidental learning
  • Robbins, 2000 - the biggest challenge to clinicians: particularly with young children.

What next?

What does the word rehabilitation mean to you?

Rehabilitation

  • Taken to mean the whole programme of support needed to ensure the optimum use of the implant system in the development of communication and language.
  • Tuning, technical support, communication, support, education...