Post on 30-Dec-2015
Speech, Language & Communication Outcomes in Children with
Cochlear Implants
Speech, Language & Communication Outcomes in Children with
Cochlear Implants
Ann Geers
Southwestern Medical Center
University of Texas at Dallas
Cochlear Implants
& Education
of the Deaf Child
Cochlear Implants
& Education
of the Deaf Child
Funded by the NIDCD
Sample CharacteristicsSample Characteristics
1. Between 8 and 9 years of age
2. 4-6 years of implant use
3. Implanted at 2,3 or 4 years of age
4. Normal intelligence
5. Monolingual home environment
Home States: 181 ChildrenHome States: 181 Children
ON
AB
NS
QCBC
Canada1997-2000
6 (1)3 (1)1 (3)0 (7)
VT
MA
TN
FL
GAAL
NC
VA
PA
NY
OHINIL
MO
IA
MN
NE
NM
CA
TX
AK
HI
NH
CT
MD
NY
WA
NJ
ME
MIWI
KY
SC
MS
LA
OKAR
ND
SD
MT
WYID
OR
NVUT
AZ
COKS
United States1997-2000
4 or more (18)3 (4)2 (5)1 (7)0 (17)
Intervening Variables
Family Characteristics
Implant Characteristics
Child Characteristics
Family Characteristics
Family Size
Parent’s Education
Family Income
Implant CharacteristicsImplant Characteristics
Duration of Implant Use
Duration of SPEAK Use
Number of Active Electrodes
Dynamic Range
Highest Frequency Coded
Loudness Growth
Child CharacteristicsChild Characteristics
Age at Onset
Age First Hearing Aid
Age at Implant
Cause of Deafness
Intelligence
Independent VariablesIndependent Variables
Methodology
Individual Therapy
Educational Setting
Rating PeriodsRating Periods
1. Pre-Implant
2. First Year Post-Implant
3. Second Year Post-Implant
4. Third Year Post-Implant
5. Current Year
Increased Auditory EmphasisIncreased Auditory Emphasis
Methodology Rating ScaleMethodology Rating Scale
(Total Communication) (Oral Communication)
Mostly Sign
Speech & Sign
Speech
Emphasis
Cued
Speech
Auditory
Oral
Auditory Verbal
Increased Speech EmphasisIncreased Speech Emphasis
Subject Communication Mode
0
1
2
3
4
5
6
Subject (n=181)
Mod
e A
vera
geTC Oral
n=89 n=92
Outcome Variables
Speech Perception
Speech Production
Language
Reading
Multivariate AnalysisMultivariate Analysis
Method
Classroom
Therapy
INDEPENDENTVARIABLES
Multivariate AnalysisMultivariate Analysis
Method
Classroom
Therapy
Speech Perception
Speech Production
Language
Reading
INDEPENDENTVARIABLES
OUTCOME VARIABLES
Multivariate AnalysisMultivariate Analysis
Method
Classroom
TherapyChild
Family
Implant
Speech Perception
Speech Production
Language
Reading
INDEPENDENTVARIABLES
INTERVENINGVARIABLES
OUTCOME VARIABLES
Open-Set: Lexical Neighborhood Test
0
20
40
60
80
100
Subject (n=181)
Per
cent
Cor
rect
TC
Oral
zero scores:15 TC, 2 Oral
Speech IntelligibilitySpeech Intelligibility
0
20
40
60
80
100
Subject (n=181)
% K
eyw
ords
Cle
ar
TC
Oral
zero scores: 4 TC
Spontaneous Language Samples
Spontaneous Language Samples
Every child had two 25-minute Interviews:
• Speech interview:
Partner used spoken English onlyOnly speech transcribed
• Speech & Sign interview
Partner used speech and sign
Both speech & sign transcribed
IPSyn Total ScoreIPSyn Total Score
72 7357 610
20
40
60
80
100
SpeechInterview
Speech & SignInterview
IPS
yn T
ota
l S
core
Oral Kids
TC Kids
Oral exceeds TC in both interviews
Child & Family CharacteristicsChild & Family CharacteristicsSpeech
PerceptionSpeech
ProductionSpoken
LanguageSpoken&Signed
LanguageReading
Age **Age at Onset ** **
Age at Implant
Performance IQ *** *** ** *** ***Family Size ** * *** ***Family SES * *** *** **
Gender * *** ** *Explained Variance 22% 22% 23% 27% 25%
*p<.05, **p<.01, ***p<.001
Implant CharacteristicsImplant CharacteristicsSpeech
PerceptionSpeech
ProductionSpoken
LanguageSpoken&Signed
LanguageReading
Duration SPECTRA
*** *** ** *** **
# Active Electrodes
*** * ** *
Dynamic Range *** *** ** ** ***Loudness
Growth* ** * *
Added Variance 22% 20% 15% 14% 12%
*p<.05, **p<.01, ***p<.001
Rehabilitation CharacteristicsRehabilitation CharacteristicsSpeech
PerceptionSpeech
ProductionSpoken
LanguageSpoken&Signed
LanguageReading
Hours of Therapy
Therapist Experience
Parent Participation
Private/Public Schl
Mainstrm/Spec Ed. * ***Oral/TC Mode *** *** *** *
Added Variance 12% 11% 9% 3% 6%
*p<.05, **p<.01, ***p<.001
Overall Outcome (n=181)Overall Outcome (n=181)Predictor Variables
Child & Family 25%
Implant 18%
Rehabilitation 10%
Total Explained Variance 53%
Perception OutcomePerception Outcome
0
20
40
60
80
100S
peech P
erc
eption:
BK
B
2 3 4
Age at Cochlear Implant
Speech Production OutcomeSpeech Production Outcome
0
20
40
60
80
100S
peech Inte
llig
ibility:
McG
arr
2 3 4
Age at Cochlear Implant
Language OutcomeLanguage Outcome
0
20
40
60
80
100Language:
Best
IPS
yn
2 3 4
Age at Cochlear Implant
Younger is NOT BetterYounger is NOT Better
Age 2 isn’t young enough
Early advantage no longer apparent at age 8-9
Implant coding is not sufficient for normal speech & language development
Is Younger Better?Is Younger Better?
Is there an advantage to implanting before 2 years of age?
Are the outcomes of younger implantation apparent earlier?
Are the effects of younger implantation apparent for newer technology users?
Effect of Very Early Cochlear Implantation on Language
Effect of Very Early Cochlear Implantation on Language
Johanna Nicholas, Ph.D.Washington University
Ann Geers, Ph.D.U. of Texas -- Dallas
Research Sponsored by NIDCD
Study DesignStudy Design
Test Groups
Age at Test/Observation
Cochlear Implant NormalHearing
3.5 years of age N = 76 N = 12
4.5 years of age Same children, 1 yr later
N=12
Selection criteriaSelection criteria Received a CI by 38 months of age Presumed deaf since birth No other significant disabilities Normal nonverbal intelligence Enrolled in oral education English the primary language at home No loss of implant use > 30 days Full insertion of the electrode array
ProcedureProcedure
3.5 years of age: 30 minute language sample
4.5 years of age: 30 minute language sample Preschool Language Scale
Age CI and CI use at each testAge CI and CI use at each test
0
5
10
15
20
25
30
35
40
45
50
0 10 20 30 40
Parent-Child Play SessionsParent-Child Play Sessions
Language Sample VariablesLanguage Sample Variables
Total Number of WordsNumber of Different Root WordsMLU in WordsNumber of bound morphemes per wordNumber of different bound morphemes
Hierarchical Linear ModelingHierarchical Linear Modeling
At any given duration of implant use,
what factors significantly impact:
Language level
Rate of language growth
Hierarchical Linear ModelingStandardized Coefficients-Level 1 InterceptHierarchical Linear ModelingStandardized Coefficients-Level 1 Intercept
Pre-CIAided Age at Implant
Total Words -7.82*** -11.93**# Root Words -1.80*** - 2.07***MLU -0.02*** - 0.04***# Bnd Morphs -0.98*** - 1.58***Diff Bnd Morphs -0.11***- 0.19***__________** p <.01; ***p<.001, df=72
Hierarchical Linear ModelingStandardized Coefficients-Level 2 Slope
Hierarchical Linear ModelingStandardized Coefficients-Level 2 Slope
Pre-CIAided Age at Implant
Total Words -0.08 0.22# Root Words 0.00 0.02MLU -0.01* 0.00# Bnd Morphs -0.06*** 0.02+*Diff Bnd Morphs -0.01 0.00**__________** p <.01; ***p<.001 (+ quadratic)
Number of Different Root WordsNumber of Different Root Words
0
25
50
75
100
125
150
175
200
225
7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43
Duration of CI Use (Months)
Nu
mb
er
of
Dif
fere
nt
Ro
ot
Wo
rds Age at Surgery: 12 Months
Age at Surgery: 18 Months
Age at Surgery: 24 Months
Age at Surgery: 30 Months
Age at Surgery: 36 Months
Mean Length of Utterance (MLU)Mean Length of Utterance (MLU)
0.00
0.25
0.50
0.75
1.00
1.25
1.50
1.75
2.00
2.25
2.50
2.75
3.00
3.25
3.50
7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43
Duration of CI Use (Months)
ML
U
Age at Surgery: 12 Months
Age at Surgery: 18 Months
Age at Surgery: 24 Months
Age at Surgery: 30 Months
Age at Surgery: 36 Months
ConclusionsConclusions
Language scores increased with better pre-implant aided threshold
Language scores increased with longer implant experience
Language scores increased with decreasing age at implant
At the same duration of implant use, language scores increased as age at implant decreased (AOI <2 years)
PLS – Expressive QuotientPLS – Expressive Quotient
0
10
20
30
40
50
60
70
80
90
100
110
120
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38
Age at Surgery
Expre
ssiv
e S
tandard
Score
(Duration of Implant Use in Months)
42 41 40 39 38 37 36 35 34 33 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 16
ConclusionsConclusions
AOI <2 yrs: Language closer to normal for each month younger age at implant
AOI >2 yrs: Less payoff for younger cochlear implantation
ConclusionsConclusions
It is appropriate for expectations of spoken language competence to be raised for children receiving cochlear implants before 2 years of age
Children who receive the implant before 2 years of age will likely be able to make a successful transition to the mainstream educational system in time for kindergarten.