Communication before and after cochlear implants

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Information about Communication before and after cochlear implants
Health & Medicine

Published on February 17, 2014

Author: glawrencehearingcrc

Source: slideshare.net

Description

Questionnaires investigating communication choices were posted to parents of all 640 children who received the cochlear implant at the Royal Vic Eye & Ear Hospital, Melbourne, Australia. Specifically this questionnaire [replicating Watson's (2007) study in the UK] investigated the factors that influence parents to choose either a visual/manual based approach (sign, sign language, total communication) or an auditory/oral based approach (oral-aural, auditory verbal) with their children, and whether the child's preferred communication approach had shifted over time.

Communication before and after cochlear implants Shani Dettman1,2 and Rita Lonski1 1 The University of Melbourne, Department of Audiology & Speech Pathology, 2 The HEARing Cooperative Research Centre, 3 Royal Victorian Eye & Ear Hospital Background to this study In their study, Watson and colleagues sent questionnaires to U.K. families of all 288 children who had received a CI in the past 5 years. They received 142 replies (49%), of whom 119 (83.8%) indicated that the child and family had changed their communication approach following cochlear implantation. In 113 cases the change was toward spoken language and in 6 cases the change was toward signed communication (Watson et al., 2007). This shift toward the use of spoken language and parent’s reports of satisfaction after five years of device use were largely related to the achievements in speech and language made by their child. The current study Questionnaires investigating communication choices were posted to parents of all 640 children who received the cochlear implant at the Eye & Ear Hospital, Melbourne, Australia. Specifically this questionnaire [replicating Watson's (2007) study in the UK] investigated the factors that influence parents to choose either a visual/manual based approach (sign, sign language, total communication) or an auditory/oral based approach (oral-aural, auditory verbal) with their children, and whether the child's preferred communication approach had shifted over time. Methods & Materials A new form of the questionnaire was developed with 4 themes; 1. Child’s actual communication mode now and in the past After completing some basic demographic information such as who completed the questionnaire and level of education, Parents were asked to select which communication mode best described the child’s communication before and after implant, one, two, three, five and 10 years post implant, and currently. Codes 1-6 were derived from definitions provided by Geers and Brenner (2003). Table 1. Examples of statements • I want to use most effective way of communicating with my child • I want the easiest method (for me) of communicating with my child • I want to use the communication method in which I am most skilled • I want to use the communication method which is more likely to be useful to my child in the future • Using sign language appeared to be impeding my child’s speech development / Using sign language appeared to be impeding my child’s speech development. • My child preferred to use spoken language • I think my child can communicate very well now • I think my child is still delayed in his/her communication • Overall, I am satisfied with the decisions I made regarding my child’s communication Figure 1. Who completed the  questionnaire % 3 mother 12 grandparent father 85 Visual and Sign Emphasis 1 Auditory and Speech Emphasis 2 3 4 5 Figure 2. Education level completed % 6 did not complete high school 10 21 completed high school 18 completed TAFE/other 2. Statements regarding communication choices Parents were asked to indicate their level of agreement with 12 statements by circling a Likert-like scale (e.g. agree strongly -- agree somewhat -- neither agree/nor disagree -- disagree somewhat -- disagree strongly). These statements were derived from Watson’s study (see examples in Table 1). 3. Sources of Information about Communication Parents were asked to nominate who/what was the primary source of information used to make decisions about the child’s communication. 4. Open ended responses Parents were invited to write anything they felt the researchers should know about their communication choices. Statistical testing of the 168 returned vs. non-returned questionnaires indicated the groups were not significantly different for gender, and duration post-implant, but were significantly different for age at implant; the returned questionnaires being from current families with younger children. Over 83% of returned questionnaires were completed by the mother (Figure 1.) with 90% finishing high school or higher education (Figure 2.). Over 54% of the children had shifted towards a more auditory/oral mode of communication, 40% had stayed the same and 6% had shifted towards a more sign based approach post-implant and overtime (Figure 3.). The majority of parents (47%) reported that their child currently used a mode of communication that used audition and speech with no reliance on visual cues (Figure 4.). With regard to the statements, over 93% of parents chose the "most effective" mode of communicating with their child and 82% wanted it to be "useful to my child in the future". Over 81% of parents agreed that their child could "communicate very well now" and 97% were satisfied with their decisions. 30% of parents reported that they used a combination of persons to assist them with making a decision regarding communication mode for the child. 17% reported the teacher-of-the-deaf was the primary source of information, and 16% reported that it varied over time. 11% considered the direction provided by family to be most important and 11% reported that the audiologist they first met at the diagnosis of hearing loss was the key person assisting them to make a decision about communication. The speech pathologist, audiologist, or ENT surgeon at the cochlear implant clinic were each regarded as the key person used to make communication decisions by 5 % of families. When invited to make their own open-ended comments, some parents expressed strong views. These could be summarised into three main themes; 1). sign was important, and conversely 2). a preference for emphasis on spoken language, and 3). requests for clear communication from professionals (Table 2.). www.hearingcrc.org creating sound value completed university 29 completed post‐grad Figure 3. Shift in communication over time % shift toward oral / aural  communication 6 stayed the same 40 54 shift toward sign /  visual communication Figure 4. What communication is used currently % Results dettmans@unimelb.edu.au 22 0 1. Sign only = 0 7 2. Sign with some speech 22 47 3. Sign and Speech 0 25 4. Cued Speech = 0 5. Oral / Aural 6. Oral / Aural no visual cues Table 2. Parents comments “I believe using both Auslan and oral language has helped my daughter greatly. She can fit into both worlds, hearing and deaf, which has helped her greatly with friendships and education. I believe that doing sign language does not delay speech; if you give your child all the tools, they then can decide later in life which forms of communication they choose.” Mother A “not signing with my child (after the implant) was a good decision, I think, to make. It forced us to use hearing and speech which was to my son’s advantage” Mother B “every specialist had a different opinion and sometimes I felt (and sometimes I still do) like I was doing it wrong or that my views/ opinions/ideas were not seen as valid to some professionals. I am the most experienced person at dealing with my daughter but they seemed not to care about that and it can be disheartening to feel that way about what you have tried so hard to achieve” Mother C of 2 children with cochlear implants at 2.5 and 2.17 years Conclusions 47% of parents reported that their child used spoken language and listening, and did not require visual communication. For 25% an Oral Aural approach was used. For 29% of parents, the role of Sign communication was important. The results suggested a flexible approach, in fact, a more parent-centred approach to communication choices may be warranted, particularly when children have significant additional special needs. Although clinicians may wish to counsel using the latest research evidence, we also need to listen to parents needs and aspirations. Acknowledgements to the children, parents, speech pathologists, audiologists, surgeons & administrative staff at the Cochlear Implant Clinic, RVEEH, Melbourne, Australia.

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