Does Mode of Communication Affect Childrens Speech Perception Outcomes after Cochlear Implantation - Literature review Example

Introduction With the use of cochlear implants, many children who earlier depended primarily on sign language for communication are attainingcompetence in the spoken language. It has been found that children who receive an implant early in life, followed by appropriate rehabilitation, achieve good speech perception, production, and oral language skills. Many studies have evaluated the impact of communication modes, in particular, oral communication (OC) and total communication (TC) approaches. In general, an emphasis on oral-aural communication is associated with high performance outcomes when compared to any other educational factor. This is a critical review to examine whether the mode of communication affects children’s speech perception outcomes after cochlear implant. Review of literature Several studies have examined the effect of communication mode (signed/total communication or oral communication) on speech outcomes, and have found it to have a positive effect. Archbold et al., 2000, aimed to explore the relationship between approach to communication, speech perception and speech intelligibility after cochlear implantation of young children with profound early deafness. A prospective speech perception and speech intelligibility assessment were measured before cochlear implantation and annually thereafter (46 children at the three-year, 26 at the four-year and 20 at the five-year intervals). The childrens communication mode included those using an oral approach and those using a signing approach. The results revealed that at all intervals, those children who used oral communication significantly exceeded those using signed communication on measures of speech perception and intelligibility. No significant difference in the results was seen when those children who had changed from signed to oral communication were compared at the three-year interval with those who used oral communication throughout. Osberger et al., 1994, studied 18 children with prelingual deafness and aimed to explore the relationship between communication mode and speech intelligibility in children who used oral or total communication. The inclusion criteria included children who were implanted at a young age, since it was assumed that they would have the greatest potential to improve their speech.  The speech intelligibility of these children was examined after using multichannel cochlear implants for an average of three years. Half of the children used an oral communication program and the other half used a total communication program.  The results of the study revealed that the mean score for children who used oral communication was 48% (SD=31) and the mean score for children who used total communication was 21% (SD=21).  From this, it can be inferred that the average speech intelligibility score of the children who used oral communication was 27% higher than that of the children who used total communication.  Connor et al., 2000, examined the effect of oral and total communication on children’s consonant-production accuracy and vocabulary development over a period of time. A superior consonant-production accuracy was achieved by children in OC programs when compared to children in TC programs. However, the TC group children achieved higher receptive spoken vocabulary and superior scores and rates of growth on the expressive vocabulary measure (spoken and/or signed) scores than children in the OC group, if they received the implant at an earlier age. The authors also point out that children may benefit from using cochlear implants irrespective of the communication strategy/teaching approach employed by their school. Tobey et al., 2003, investigated speech production outcomes and the factors influencing the outcomes in 181 children with a multichannel cochlear implant received before 5 years of age. The production variables, which were examined included speech intelligibility, accuracy of consonant and vowel production, percentage of plosives and fricatives produced, duration of sentences, percentage of time involved in communication breakdowns during a communication sample, and responses to a speech usage questionnaire. Independent variables included the amount and type of educational intervention, and intervening variables were child, family and implant characteristics. Multiple regression analyses provided a measure of the amount of variance associated with speech production skills accounted for by the intervening and independent variables. An emphasis on oral-aural communication and classrooms that emphasized on speech and listening were the primary rehabilitative factors contributing to high levels of oral communication. Factors like age of onset of deafness and age of implantation, which were previously thought to be major contributors to speech production performance, did not appear to play significant roles in predicting levels of speech production performance. Geers et al., 2003, investigated factors contributing to speech perception outcomes in children with prelingual deafness after 4 to 7 yr of multichannel cochlear implant use. In order to identify educational factors most conducive to maximum implant benefit, the analysis controlled for the effects of child, family and implant characteristics. The study involved 181 children who had received a cochlear implant by the age of 5 years. The independent variables included type and amount of educational intervention since implantation, while the intervening variables included characteristics of the child, the family, and the implant itself. Among the other findings, the results revealed that communication mode used in the classroom affects speech perception outcome. The children whose educational program emphasized dependence on speech and audition for communication were able to use the information provided by the implant to understand speech in a better way. In a similar study by Sarant et al., 2001, it was found that children who normally use oral communication scored significantly higher in the speech perception scores than children normally using sign or simultaneous oral and sign communication. Somers, 1991, also found significant differences in performance on some of the speech perception measures in children educated in oral programs compared to those educated in total communication settings. Geers, 2002, examined the effects of communication mode, class placement, and therapy on five outcome variables (speech perception, speech production, spoken language, total language, and reading) after controlling for the effects of intervening variables associated with the child, the family, and the implant device. The results showed that the characteristics of the child and the family (primarily nonverbal IQ) accounted for approximately 20% of the variance in post-implant outcome. Implant characteristics accounted for 24% and educational variables, particularly oral communication mode accounted for 12% of the variance in post-implant outcome. According to Lachs, Pisoni, Kirk, 2001, an early sensory experience contributes to perceptual development, specifically, language acquisition and the use of phonological processing skills. On an examination of the effects of communication mode of children enrolled in oral Communication (OC) and total Communication (TC), the authors found that OC children tended to score higher on measures of audiovisual gain, spoken word recognition, and speech intelligibility. A study by Cullington et al., 2000, found that children using a oral mode of communication demonstrated significantly less spoken language delay than did subjects using total communication, based on speech perception scores only. Meyer et al., 1998, examined the perception performance in fifty-eight children with prelingual profound hearing loss using multichannel cochlear implants.  The study aimed to estimate the amount of improvement in speech perception scores based on the degree of hearing loss and communication program and to compare the observed changes over time in speech perception by children using cochlear implants to the improvements predicted for children with profound hearing loss who use hearing aids. The results showed that the average scores for the children in oral communication programs were slightly higher. Not all studies support the fact that the mode of communication has an affect on the speech perception after cochlear implants. Deggouj, Phillips, Gersdorff, 1998, are of the opinion that an exclusive oral communication is associated with an insufficient knowledge of the oral language. Total communication is a defective communication mode with a bad representation of the morpho-syntactic and the phonologic aspects of the oral language. The authors feel that the best choice is the simultaneously use of a spoken language and a manual coding of their phonological structures. Cassandro et al., 2003, carried out a study on a preverbal deaf child who had undergone cochlear implant at 7 years of age and has always used both languages. The study aimed to establish whether knowledge of sign language affects speech production negatively and to evaluate which mode of communication, oral or gestural, is preferred. The verbal skills were evaluated in the precochlear implant stage, and 6 and 12 months later. An evaluation was also done on the changes in the use of sign language and in the relationship between the two modes. Results revealed no temporal or qualitative differences in post-cochlear implant evolution of speech skills, compared to that observed in those with an exclusively aural-oral approach. Vieu, 1998, examined the speech production in 12 prelingually deafened French children who received a Nucleus multichannel cochlear implant. They focused on word intelligibility, sentences syntax, and sentence pattern stages, by incorporating direct comparisons between speech production skills and communication modes in the same children. Speech production intelligibility, syntax, and sentence pattern stages were assessed at 1, 2 and 3 years post-implant. Speech production skills were related to the communication mode of the children (auditory-oral, four children; cued-speech, four children; sign-language, four children). The results showed that the cued-speech group had the highest scores (average score of 66.8% at 36 months post-implant) and even at 3 years post-implant, when compared to auditory-oral or sign-language modes of communication. Critical review Archbold et al., 2000, showed that children who used oral communication significantly exceeded those using signed communication on measures of speech perception and intelligibility. However, it remains to be examined whether the children used oral communication after cochlear implantation because they are doing well, or whether they do well because they are using oral communication. Sarant et al., 2001, found that children who normally use oral communication scored significantly higher in the speech perception scores than children normally using sign or simultaneous oral and sign communication. However, the reasons for significant differences between children using different communication modes were not identified. Except for Osberger et al., 1994, the pre-implant status of the children is not mentioned. The inclusion criteria are also not mentioned in most studies except Osberger et al., 1994, where the inclusion criteria included children who were implanted at a young age, assuming that they would have the greatest potential to improve their speech. Most studies do not follow-up after the cochlear implant to know if the gains achieved with the mode of communication is sustained. Only Osberger et al., 1994 and Vieu, 1998 followed up the children post-implant. In general, most studies have a small sample size and this may not give enough validity to the conclusions. Deggouj, Phillips, Gersdorff, 1998, are of the opinion that the best choice is the simultaneously use of a spoken language and a manual coding of their phonological structures, but it should be noted that not all profoundly deaf children are able to integrate a manually coded language. In summary, most studies showed that the mode of communication, especially the oral mode of communication, has a positive affect on speech perception outcomes after cochlear implantation. Dependence on speech and audition for communication is not only critical for achieving maximum auditory benefit, but the constant use of auditory input to monitor speech production and to comprehend spoken language gives the required practice for optimum benefit from a cochlear implant (Geers, 2002). The intense, direct training that children receive in the oral mode of communication in developing their auditory and speech skills, could lead to better post-implant outcomes. Conclusion Despite some methodological flaws, the majority of studies show that an oral mode of communication has a positive effect on speech perception outcomes after cochlear implantation. These results, which favor oral communication, have important implications for accelerating speech perception development and maximizing rehabilitation effects in children with cochlear implants. There are only a few studies, which do not support the fact that the mode of communication has any positive effect on speech perception outcomes. In the future, studies should aim to overcome methodological flaws like small sample size, and clearly mention pre-implant status and inclusion criteria to give more validity to the results. References Archbold, SM, Nikolopoulos, TP, Nait, M., ODonoghue, GM., Lutman, ME, Gregory, S (2000). Approach to communication, speech perception and intelligibility after paediatric cochlear implantation. British Journal of Audiology, 34(4), 257-264. Cassandro, E, Nicastri, M, Chiarella, G, Genovese, E, Gallo, LV, Catalano, M (2003). Development of communication and speech skills after cochlear implant in a sign language child. Acta Otorhinolaryngol Ital, 23(2), 88-93. Connor, CM, Hieber, S, Arts, HA, Zwolan, TA (2000). Speech, vocabulary, and the education of children using cochlear implants: Oral or total communication? Journal of Speech, Language, and Hearing Research, 43(5), 1185-1204. Cullington, H, Hodges, A.V, Butts, S.L, Dolan-Ash, S, Balkany, TJ (2000). Comparison of language ability in children with cochlear implants placed in oral and total communication educational settings. Ann Otol Rhinol Laryngol Suppl. 85:121-3. Deggouj, N, Phillips, C, Gersdorff, M (1998). Role of speech therapy and sign language prior to cochlear implantation. Acta Otorhinolaryngol Belg, 52(4), 275-9. Geers, A, Brenner, C, Davidson, L (2003). Factors associated with development of speech perception skills in children implanted by age five. Ear Hear, 24(1 Suppl), 24S-35S. Geers, AE (2002). Cochlear Implants and Education of the Deaf Child. Geers, A.E (2002). Factors Affecting the Development of Speech, Language, and Literacy in Children With Early Cochlear Implantation. Language, Speech and Hearing Services in Schools. 33:172–183. Lachs, L, Pisoni, DB, Kirk, KI (2001). Use of audiovisual information in speech perception by prelingually deaf children with cochlear implants: a first report. Ear Hear, 22(3), 236-51. Osberger, MJ, Robbins, A., Todd, S, Riley, A (1994). Speech intelligibility of children with cochlear implants. The Volta Review, 96, 169-180. Sarant, JZ, Blamey, PJ, Dowell, RC, Clark, GM, Gibson, WPR (2001). Variation In Speech Perception Scores Among Children with Cochlear Implants. Ear & Hearing, 22(1), 18-28. Tobey, EA, Geers, AE, Brenner, C, Altuna, D, Gabbert, G (2003). Factors associated with development of speech production skills in children implanted by age five. Ear Hear, 24(1 Suppl), 36S-45S. Vieu, A, Mondain, M, Blanchard, K, Sillon, M, Reuillard-Artieres, F, Tobey, E, Uziel, A, Piron JP (1998). Influence of communication mode on speech intelligibility and syntactic structure of sentences in profoundly hearing impaired French children implanted between 5 and 9 years of age. Int J Pediatr Otorhinolaryngol, 4(1), 15-22. Read More