children with cochlear implants and diagnosed disabilitiespresentation overview ‣ personal...

A Research Review

Children with Cochlear Implantsand Diagnosed Disabilities

Helen Armstrong

Contact [email protected]

ACE-DHH PresentationFebruary 18, 2012Jacksonville, Florida

1

Saturday, February 18, 2012

mailto:[email protected]

mailto:[email protected]

Presentation Overview

‣ Personal Background

‣ Research Review

‣ Time for discussion

2


Research Review

‣ Introduction / Background

‣ CI Literature Review

‣ Rationale and Research Questions

‣ Methods

‣ Description of the 18 Studies

‣ Analysis by Domain and Disability

‣ Discussion and Conclusions

3


Introduction

‣ Incidence: 2 to 3 per 1,000 children diagnosed with hearing loss (NIH, 2008)

‣ Before the 1990’s - hearing aids (NIDCD, 2011)

Currently CIs preferred intervention - (Chute & Nevins, 2006)

‣ 28,500 children in the U.S. have CIs (NIDCD, 2011)

‣ Candidacy criteria is expanding (Edwards, 2007)

‣ Definition of benefit is evolving (Paludneviciene & Leigh, 2011- Cochlear Implants: Evolving Perspectives)

4


Gallaudet Research Institute (2010)n = 37,107

‣ 5,562 - 15% one CI‣ 943 - 17% second CI

‣ 4,733 - 86% use in school‣ 454 - 8% non-users

‣ 40% with at least one disability

5


1 Data Accountability Center (2010), IDEA Part B: Child Count

6


What are the gaps in the literature?

1. The following authors recommend more research about children with CI and additional needs:

Belzner and Seal (2007)Berrettini et al. (2008)Bond et al. (2009)Edwards (2007)Holt and Kirk (2005)Meinzen-Derr, Wiley, Grether and Choo (2010)Spencer and Marschark (2010)

7


Gaps cont’d.

2. FDA clinical trials by the three CI manufacturers prior to approval of the devices excluded children with disabilities. (J. Patrick, Chief Scientist Cochlear Ltd, personal communication, April 14, 2011;

Holt & Kirk, 2005)

3. Lack of consensus about implanting this group of children. (Berrettini et al., 2008; Wiley, Jahnke, Meinzen-Derr, & Choo, 2005)

4. Research from “typically” developing deaf children may be generalized to this population.

8


Research Review Questions

1. What domains are included in research about children with cochlear implants and diagnosed disabilities.

2. Based on the domains included in research about children with cochlear implants and diagnosed disabilities, what are the research findings?

3. Do outcomes of children with cochlear implants differ by disability category?

9


The 18 Studies2000-2011

10


The 18 Studiesn = 512 participants

1

45

8

Num

ber

of S

tudi

es

Sample Size

1-10 11-30 49-69 106

11


Participants

Age range: 2 years to 17 years

CI experience: at least 1 year

Education program: 7 of 18 reported

12


Educational Placement

Author n = Pre-CIPre-CI Post-CIPost-CI ChangeTC Oral TC Oral

Bruce 1 1 1 +Hawker 12 9 3 5 7 +Dettman 49 8 41 11 30Winter 10 1 9 7 3

El-Kashlan 2 1 1 no change

Pyman 75 32 43Waltzman 29 12 17 17 12

Totals 178 31 70 74 96 no clear trend

% 17 39 42 54

13


What Domains? N=18 Studies

1513

96

Speech Perception

Speech &Language

Quality of Life

CommunicationModeN=

N=N=

N=

14


Authors & DomainsN=18 Studies

Authors n Speech Perception

Speech/Language

Quality of Life

CommMode

Bruce (2011) 1

Meinzen-Derr (2010) 20

Berrettini (2008) 23

Liu (2008) 9

Hawker (2008) 12

Johnson (2008) 2

15


Authors & DomainsN=18 Studies


Speech/Language

Quality of Life

CommMode

Daneshi (2006) 60

Holt & Kirk (2005) 69

Wiley (2005) 16

Dettman (2004) 49

Donaldson (2004) 7

Filipo (2004) 18

16


Authors & Domains N=18 Studies


Speech/Language

Quality of Life

CommMode

Vlahovic (2004) 4

Winter (2004) 10

Richter (2002) 103

El-Kashlan (2001) 2

Pyman (2000) 75

Waltzman (2000) 29

17


Overall Results

Speech Perception

When speech perception skills were measurable

Children demonstrated improved awareness of environmental sounds, detection of

speech sounds, and auditory discrimination to the word level in closed-set tasks.

N=15

18


Speech/Language

Donaldson (2004); Richter (2002); Vlahovic (2004); and Winter (2004) stated that speech production might not be a realistic goal for many children with CI and disabilities (across disability categories).

There was a trend for children’s receptive-expressive language scores to lag behind typically developing children with CI. Scores often remained in the “severely-disordered” range, although gains were reported by researchers (Bruce, 2011; Meinzen-Derr, 2010).

N=9

19


Quality of Life

Those parents who were asked said they would implant again and would support the decision to implant for families facing similar decisions:

Donaldson (2004) 67%, n= 7Vlahovic (2004) 100%, n= 4Wiley (2005) 99%, n= 16

Benefits included improved communication, sound awareness, a sense of safety and a sense of connectedness.

N=6

20


Communication Mode

Missing data precluded an analysis of changes in communication mode from pre to post implant. No clear trend was evident from the available data.

12 of the 18 studies included children who sign. This group was a large proportion of the samples as seen in the slide showing Educational Placements.

Mode of communication was not associated with different outcomes in several studies. (Dettman, 2004; Holt & Kirk, 2005; Liu, 2008; Meinzen-Derr, 2010)

N=13

21


Communication Mode

Only 1 study included a sign language interpreter

No study included measures of ASL

A trend for children developing functional-auditory oral skills as the primary or exclusive communication mode post CI was not

evident.

N=13

22


Results by Disability N=18 Studies

11

7

7

CognitiveImpairment

Deafblindness

Autism

N=

N=

N=

23


Authors Cognitive Level

Deaf-Blindness Autism

Bruce (2011)

Meinzen-Derr (2010)

Berrettini (2008)

Liu (2008)

Hawker (2008)

Johnson (2008)

Authors & Disabilities N=18 Studies

24




Deaf-Blindness Autism

Daneshi & Hassanzadeh (2006)

Holt & Kirk (2005)

Wiley (2005)

Dettman (2004)

Donaldson (2004)

Filipo (2004)

25




Deaf-Blindness

Autism

Vlahovic & Sindija (2004)

Winter (2004)

Richter (2002)

El-Kashlan (2001)

Pyman (2000)

Waltzman (2000)

26


Cognitive Impairment n=120N=11

Speech Perception

As cognitive impairment increased, speech perception scores decreased

Daneshi (2006): Gains in listening skills. Wilcoxin-matched pairs signed-ranked test, pre CI, 1 year post CI: mild mental retardation (p<0.012), moderate mental retardation (p<0.043).

Dettman (2004): 7 point CAP scale. The greater the degree of cognitive delay the lower the scale score (H=11.13, df=2, p<0.01). Kruskal-Wallis Test.

Holt & Kirk (2005): Children with mild cognitive delays improve but had reduced scores relative to typical peers with CI. ANOVA

27


Cognitive Impairment

Speech and LanguageN=11

Holt & Kirk (2005): Children with mild cognitive impairment showed improvement on speech-language tests over time but significantly lower scores compared to typically developing children with CI. ANOVA.

Meinzen-Derr (2010): NVCQ accounted for 67% of the variance in language outcomes. Multiple linear regression (p=.0003). LQ - no significant change.

28


Deafblindness, n=19Speech Perception

N=7

Bruce, 2011, n=1: improvement to 99% in sentences

Liu, 2008, n=9: significant gains from CAP Level 0 to Levels 3-6

Daneshi, 2006, n=3, no significant gains p<0.102

Wiley, 2005, n=1, QOL improved, oral pre and post CI

Filipo, 2004, n=2, 50 to 70%, 30 to 70% on listening measures

El-Kashlan, 2001, n=2, n=1 reported CID 88% sentences

Waltzman, 2000, n=1, 80%-100% on listening measures

29


Deafblindness, n=19

Speech/Language Quality of Life

N=7

Speech/Language: Only Bruce (2011) reported on speech-language outcomes. No test data was given. Results were reported as positive although scores were 4 years below age level.

Quality of Life: Daneshi, (2006); Wiley (2005); and Filipo (2004) reported improved QOL.

30


Autism, n=20

Speech PerceptionSpeech/Language

Quality of Life

Berrettini (2008), n=2, minimal gains. Improved QOL.

Daneshi (2006), n=4, least gain pre to post p=0.068

Donaldson (2004), n=7, gains sound awareness, attending, music, eye contact. Improved QOL.

N=7

31


Autism, n=20

Speech PerceptionSpeech/Language

Quality of Life

Filipo (2004), n=1, satisfactory gains. Improved QOL.

Johnson (2008), n=2, improved language

Winter (2004), n=2, minimal gains, unable to stay in oral

Waltzman (2000), n= 2, minimal gains

N=7

32


Conclusions

1. Outcomes according to domains

Speech Perception: Improvement included environmental sound awareness, detection of speech, and detection or comprehension of words in closed set tasks.

Speech-Language: Gains were reported but most children’s oral language scores remained in the severely-disordered range. Speech was not viewed as a realistic goal for many children, particularly with diagnosis of autism. ASL language skills were not assessed even though 12 of the 18 studies included children who sign.

N=15

N=9

33


Conclusions

1. Outcomes according to domains

Quality of Life: Six studies document improved quality of life across disability categories. Most families would implant again.

Communication Mode: A change from a visual system to an oral system was not evident. A large numberof children continue to sign.

N=6

N=13

34


Conclusions

2. Differences by disability category

Children diagnosed with deafblindness demonstrated the greatest gains.

Children with a diagnosis of autism showed the least improvement.

As level of cognitive impairment increased, speech perception scores decreased.

35


3. Proficient speech & listening. Improved QOL

2. Primarily sign. Some speech &

listening. Improved QOL

1. Only sign or augmentative system. No

change in QOL

Continuum of 3 Outcome Trajectories for All Children with Cochlear Implants

Children with CI with some disabilities

Conclusion

No benefit from cochlear implant............................................Benefit from cochlear implant

36


Implications Research and Practice

1. Quality of Life measures should be included in future research on this topic.

2. Sign language interpretation should be provided when conducting research with children who sign.

3. Additional research focusing on outcomes based on disability category is needed given this low incidence population.

37


Implications Research and Practice

4. Research investigating the threshold of cognitive skill necessary to process and interpret spoken language may be beneficial.

5. Parents and professionals should be advised that research shows many families continue to use sign language with this population.

6. The presence of disabilities may have significant implications for expectations of benefit given research findings. Research should be shared with parents presenting the full-range of expected outcomes.

38


References

The 18 Studies

Berrettini, S., Forli, F., Genovese, E., Santarelli, R., Arslan, E., Chilosi, A.M. & Cipriani, P. (2008).Cochlear implantation in deaf children with associated disabilities: Challenges and outcomes. International Journal of Audiology, 47, 199-208. doi:10.1080/14992020701870197

Bruce, I.A., Broomfield, S.J., Henderson, L., Green, K.M. & Ramsden, R. (2011). Cochlear implantationin donnai-barrow syndrome. Cochlear Implants International, 12 (1), 60-63.doi:10.1179/146701010X486534

Daneshi, A. & Hassanzadeh, S. (2006). Cochlear implantation in prelingually deaf persons withadditional disabilities. The Journal of Laryngology & Otology, 121, 635-638. doi:10.1017/S0022215107005051

Dettman, S.J., Fiket, H., Dowell, R.C., Charlton, M., Williams S.S., Tomov, M. & Barker, E.J. (2004).Speech perception results for children using cochlear implants who have additional special needs.The Volta Review, 104 (4), 361-392.

Donaldson, A.I., Heavner, K.S. & Zwolan, T.A. (2004). Measuring progress in children with autismspectrum disorder who have cochlear implants. Archives of Otolaryngology Head and NeckSurgery, 130, 666-671. doi:10.1001/archotol.130.5.666

El-Kashlan, H.K., Boerst, A. & Telian, S.A. (2001). Multichannel cochlear implantation in visuallyimpaired patients. Otology & Neurotology, 22, 53-56. doi:10.1097/00129492200101000-00010

Filipo, R., Bosco, E., Mancini, P. & Ballantyne, D. (2004). Cochlear implants in special cases: Deafnessin the presence of disabilities and/or associated problems. Acta oto laryngologica Supplementum,552, 74-80.

Hawker, K., Ramirez-Inscoe, J., Bishop, D.V., Twomey, T., O’Donghue, G.M. & Moore, D.R. (2008).Disproportionate language impairment in children using cochlear implants. Ear and Hearing, 29(3), 467-471. doi:10.1097/AUD.0b013e318167b857

Holt, R.F. & Kirk, K.I. (2005). Speech and language development in cognitively delayed children withcochlear implants. Ear & Hearing, 26 (2), 132-148. doi:10.1097/00003446200504000-00003

Johnson, K. C., DesJardin, J.L., Barker, D.H., Quittner, A.L., & Winter, M.E. (2008). Assessing jointattention and symbolic play in children with cochlear implants and multiple disabilities: Two casestudies. Otology & Neurotology, 29, 246-250. doi:10.1097/mao.0b013e318162f1f3

39


http://dx.doi.org/10.1001%2Farchotol.130.5.666

http://dx.doi.org/10.1001%2Farchotol.130.5.666

http://dx.doi.org/10.1097%2F00129492-200101000-00010

http://dx.doi.org/10.1097%2F00129492-200101000-00010

http://dx.doi.org/10.1097%2FAUD.0b013e318167b857

http://dx.doi.org/10.1097%2FAUD.0b013e318167b857

http://dx.doi.org/10.1097%2F00003446-200504000-00003

http://dx.doi.org/10.1097%2F00003446-200504000-00003

References

Liu, X.Z., Angeli, S.I., Rajput, K., Yan, D., Hodges, A.V., Eshraghi, A.,…Balkany, T.J. (2008).Cochlear implantation in individuals with usher type 1 syndrome. International Journal ofPediatric Otorhinolaryngology, 72, 841-847. doi:10.1016/j.jporl.2008.02.013

Meinzen-Derr, J., Wiley, S., Grether, S. & Choo, D. I. (2010). Language performance in children withcochlear implants and additional disabilities. The Laryngoscope, 120, 405-413. doi:10.1002/lary.20728

Pyman, B., Blamey, P., Lacy, P., Clark, G. & Dowell, R. (2000). The development of speech perceptionin children using cochlear implants: Effects of etiologic factors and delayed milestones. TheAmerican Journal of Otology, 21 (1), 57-61. doi:10.1016/S01960709(00)80113-1

Richter, B., EiBele, S., Laszig, R., & Lohle, E. (2002). Receptive and expressive language skills of 106children with a minimum of 2 years experience in hearing with a cochlear implant. InternationalJournal of Pediatric Otorhinolaryngology, 64, 111-125.

Vlahovic, S. & Sindija, B. (2004). The influence of potentially limiting factors on paediatric outcomesfollowing cochlear implantation. International Journal of Pediatric Otorhinolaryngology, 68,1167-1174. doi: 10.1015/j.ijport.2004.03.016

Waltzman, S.B., Scalchunes, V. & Cohen, N.L. (2000). Performance of multiply handicapped childrenusing cochlear implants. The American Journal of Otology, 21, 329-335.doi:10.1016/S0196-0709(00)80040-X

Wiley, S., Jahnke, M., Meinzen-Derr, J. & Choo, D. (2005). Perceived qualitative benefits of cochlearimplants in children with multi-handicaps. International Journal of Pediatric Otorhinolaryngology, 69, 791-798. doi:10.1016/j.ijporl.2005.01.011

Winter, M., Johnson, K.C. & Vranesic, A. (2004). Performance of implanted children with developmentaldelays and/or behavioral disorders: Retrospective analysis. Cochlear Implants. InternationalCongress Series. Proceedings of the VIII International Cochlear Implant Conference, 1273, 277-280 . doi:10.1016/j.ics.2004.08.017

*Additional references available upon request

40


http://dx.doi.org/10.1016%2FS0196-0709%2800%2980113-1

http://dx.doi.org/10.1016%2FS0196-0709%2800%2980113-1

http://dx.doi.org/10.1016%2FS0196-0709%2800%2980040-X

http://dx.doi.org/10.1016%2FS0196-0709%2800%2980040-X

http://dx.doi.org/10.1016%2Fj.ics.2004.08.017

http://dx.doi.org/10.1016%2Fj.ics.2004.08.017

children with cochlear implants and diagnosed disabilitiespresentation overview ‣ personal...

Documents