A child with hearing loss whether a hearing aid user or a cochlear implantee should be trained for effective communication.
There is a great variability in the speech recognition
performance of cochlear implant patients. Auditory performance is
defined as the ability to discriminate, detect, identify or recognize
speech.
Some of the factors that have been found to affect
auditory performance are listed below:
Duration of deafness: Early presentation & intervention is the keyThe duration of deafness prior to implantation has been found to have a strong negative effect on auditory performance. Individuals with shorter duration of auditory deprivation tend to achieve better auditory performance than individuals with longer duration of auditory deprivation.
Age of onset of deafnessThe age of onset of deafness has a major impact on the success of cochlear implants depending on whether the deafness was acquired before (prelingual) or after (postlingual) learning speech and language. It is now well established that children or adults with postlingual deafness perform better than children or adults with prelingual or congenital deafness.
Age at implantation
Prelingually deafened persons who were implanted in adolescence have been found to obtain different levels of auditory performance than those implanted in adulthood. People implanted at an early age seem to perform better than people implanted in adulthood.
Duration of cochlear implant use
Duration of experience with the implant has been found to have a strong positive effect on auditory performance for both adults and children. The speech perception and speech production skills of children continue to improve over a four year period following implantation.
Other factors
There are also factors, such as patient's level of intelligence and communicativeness, which are unrelated to deafness but may also affect auditory performance. Aural rehabilitation, commitment from the cochlear implant patient in terms of time and effort, and support from family, friends and workplace also play an important role.
As we are becoming very strict with cochlear implant candidacy or selection,the other factors listed above play a vital role in speech development.It is therefore important to get the child's psychological evaluation & have a highly motivated mother.
As I am getting to know implanted children better with time,I have realised that my job is even harder once the child learns to listen & speaks few words.
Let me explain this by an example.We have a parent presented with this 8 year old post lingual who lost hearing at 6 years of age to meningitis.Eventually she lost speech & when she reached us she had a non intelligible speech.She was offered cochlear implant & underwent one sided implantation.
Post implantation AVT(Auditory Verbal Therapy )commenced & she started showing good improvement in speech.She started school & mother was given home lessons for continuing therapy.When the child recently visited us, we asked her to narrate a story or tell us about her routine in school.She could not accomplish this task!!
We realised this child needs to bring her communication skills to a 9 year old.However the mother had no complaints!!She was happy that her child who could not speak like other normal children is now doing so.It took lot of effort to make her realise that this was not enough & the aim is to get communication skills age appropriate.
The improvement in speech & communication in an implantee goes on for upto 4 years post implantation.It does not stop at able to express basic needs & learning to listen.These children with hearing impairment can be effective communicators using listening and spoken language.
Children are taught a number of listening & communication skills with therapist,followed by application and practice at home with their parents in everday situations.
"Conversational competence involves an effective response to language.It does not involve parroting or merely repeating memorised phrases" - HOPE (Re)Habilitation Resources
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