Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern...

45
Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas

Transcript of Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern...

Page 1: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

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

Page 2: 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

Page 3: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

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

Page 4: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

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)

Page 5: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

Intervening Variables

Family Characteristics

Implant Characteristics

Child Characteristics

Page 6: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

Family Characteristics

Family Size

Parent’s Education

Family Income

Page 7: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

Implant CharacteristicsImplant Characteristics

Duration of Implant Use

Duration of SPEAK Use

Number of Active Electrodes

Dynamic Range

Highest Frequency Coded

Loudness Growth

Page 8: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

Child CharacteristicsChild Characteristics

Age at Onset

Age First Hearing Aid

Age at Implant

Cause of Deafness

Intelligence

Page 9: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

Independent VariablesIndependent Variables

Methodology

Individual Therapy

Educational Setting

Page 10: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

Rating PeriodsRating Periods

1. Pre-Implant

2. First Year Post-Implant

3. Second Year Post-Implant

4. Third Year Post-Implant

5. Current Year

Page 11: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

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

Page 12: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

Subject Communication Mode

0

1

2

3

4

5

6

Subject (n=181)

Mod

e A

vera

geTC Oral

n=89 n=92

Page 13: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

Outcome Variables

Speech Perception

Speech Production

Language

Reading

Page 14: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

Multivariate AnalysisMultivariate Analysis

Method

Classroom

Therapy

INDEPENDENTVARIABLES

Page 15: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

Multivariate AnalysisMultivariate Analysis

Method

Classroom

Therapy

Speech Perception

Speech Production

Language

Reading

INDEPENDENTVARIABLES

OUTCOME VARIABLES

Page 16: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

Multivariate AnalysisMultivariate Analysis

Method

Classroom

TherapyChild

Family

Implant

Speech Perception

Speech Production

Language

Reading

INDEPENDENTVARIABLES

INTERVENINGVARIABLES

OUTCOME VARIABLES

Page 17: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

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

Page 18: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

Speech IntelligibilitySpeech Intelligibility

0

20

40

60

80

100

Subject (n=181)

% K

eyw

ords

Cle

ar

TC

Oral

zero scores: 4 TC

Page 19: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

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

Page 20: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

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

Page 21: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

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

Page 22: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

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

Page 23: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

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

Page 24: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

Overall Outcome (n=181)Overall Outcome (n=181)Predictor Variables

Child & Family 25%

Implant 18%

Rehabilitation 10%

Total Explained Variance 53%

Page 25: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

Perception OutcomePerception Outcome

0

20

40

60

80

100S

peech P

erc

eption:

BK

B

2 3 4

Age at Cochlear Implant

Page 26: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

Speech Production OutcomeSpeech Production Outcome

0

20

40

60

80

100S

peech Inte

llig

ibility:

McG

arr

2 3 4

Age at Cochlear Implant

Page 27: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

Language OutcomeLanguage Outcome

0

20

40

60

80

100Language:

Best

IPS

yn

2 3 4

Age at Cochlear Implant

Page 28: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

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

Page 29: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

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?

Page 30: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

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

Page 31: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

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

Page 32: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

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

Page 33: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

ProcedureProcedure

3.5 years of age: 30 minute language sample

4.5 years of age: 30 minute language sample Preschool Language Scale

Page 34: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

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

Page 35: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

Parent-Child Play SessionsParent-Child Play Sessions

Page 36: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

Language Sample VariablesLanguage Sample Variables

Total Number of WordsNumber of Different Root WordsMLU in WordsNumber of bound morphemes per wordNumber of different bound morphemes

Page 37: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

Hierarchical Linear ModelingHierarchical Linear Modeling

At any given duration of implant use,

what factors significantly impact:

Language level

Rate of language growth

Page 38: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

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

Page 39: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

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)

Page 40: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

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

Page 41: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

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

Page 42: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

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)

Page 43: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

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

Page 44: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

ConclusionsConclusions

AOI <2 yrs: Language closer to normal for each month younger age at implant

AOI >2 yrs: Less payoff for younger cochlear implantation

Page 45: Speech, Language & Communication Outcomes in Children with Cochlear Implants Ann Geers Southwestern Medical Center University of Texas at Dallas.

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.