320 likes | 694 Views
Session Goals. Status of research on children with multiple disabilities and cochlear implantsChallenges of working with multiple partnersCharacteristics of children with deaf-blindness who have cochlear implantsImpact of CI on communication. Trends in Cochlear Implantation. FDA continues to low
E N D
1. 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
2. Session Goals Status of research on children with multiple disabilities and cochlear implants
Challenges of working with multiple partners
Characteristics of children with deaf-blindness who have cochlear implants
Impact of CI on communication
3. 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.)
4. 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.
5. 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
6. 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
7. 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
8. 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.
9. 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)
10. 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
11. 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
12. 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
13. 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%)
14.
47% were premature
15. Participants’ Vision Status
16. 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
17. 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
18. Time in Sound (months)
19. Duration with Implant“Time in Sound”
20. Additional disabilities
21. Percentage with additional impairments
22. 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
23. Data Trends: MacArthur-Bates(initial assessments)
24. First Communicative Gestures(initial assessment)
25. 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)
26. Bilateral Cochlear Implants Six participants have bilateral cochlear implants
Tend to be younger
Introducing Grace
27. 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
28. 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
29. 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)
30. 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
31. 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
32. 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
33. Contact Info Susan M. Bashinski (sbashins@ku.edu)
Ella Taylor (taylore@wou.edu)
Project Website
http://www.wou.edu/cidb