Cochlear Implants

Frequently Asked Questions

FAQ answers prepared by: Ellen Rajtar, Oral School Coordinator

Atlanta Speech School
404-233-5332
e-mail: erajtar@atlspsch.org
or visit www.atlantaspeechschool.org
or
www.oraldeafed.org/schools/atlanta

Q:Which cochlear implant is best?

A:
All cochlear implants are designed to create sound. The selection of which implant is appropriate for any particular individual depends on a number of factors including the age of the individual, the condition of the individual's cochlea, the approval status given by the Food and Drug Administration (FDA), and a particular surgeon's choice. Some people prefer one manufacturer over another based on aesthetic or cosmetic reasons. All implants currently approved by the FDA for use in children have shown great success.

For more information about each cochlear implant, call the manufacturers for information or visit their websitesat www.cochlear.com (Cochlear Corporation) www.cochlearimplant.com (Clarion)

Q:What therapy or methodology is most effective for children to make the maximum use of their implants?

A:
All communication interactions should emphasize listening. The emphasis on listening grows as the child's auditory skills grow. Auditory training goals should be intertwined with speech, language, and academic goals. In other words, the child listens for sounds in words that are speech targets, words and sentence structures that are language goals, and academic vocabulary and concept discussion. Some "pull out" time for individual or small-group listening drill should be combined with stimulation of listening skills outside the therapy session. A general rule of thumb is that short "pull out" times spread throughout the week are more effective than a longer period of time devoted to listening once a week.

It is crucial that any therapy be integrated into the child's every day program. Current research shows that children enrolled in programs with emphasis on listening and spoken language development achieve higher levels of success.

Q:Where should I start in therapy with a newly implanted student?

A:
Start with detection activities. This is the ability to perceive the presence or absence of a sound (Do I hear it? Yes or no) This is not the ability to tell the difference between or among sounds. Teach the child the conditioned play response. When the child hears a sound he/she makes a response. A crucial part of this concept is that the child learns not to make the response if there is no stimulus. Children often produce a number of false positive reactions. This must be discouraged. During this process you must find out what part of the speech signal the child can hear. Focus on these sounds when teaching detection.

Encourage the development of a spontaneous alerting to sound. This is a more spontaneous behavior that indicates that the child has heard a sound without being directed to listen. Spontaneous responses can include searching for sound, turning eyes or head toward sound, stopping activity, quieting or vocalizing, startling. If spontaneous alerting doesn't happen naturally, set up situations where child needs to search for a sound. The ultimate goal of auditory training is that the child develops spontaneous use of listening throughout the day. The child must demonstrate some spontaneous response to sound before moving on to other levels of listening.

Once the child demonstrates ability to detect sounds move to higher level auditory perception activities. The hierarchy is as follows: Discrimination, Identification/Recognition, and Comprehension.

Numerous auditory training curricula are available to help guide you through these skill levels. Information on these curricula can be obtained through the cochlear implant manufacturers.

Q:What can be the expected amount of progress in one year?

A:
There are a number of factors that influence an individual child's progress.
These factors include:

• Age at which the hearing loss occurred - Does the child have some memory for sound?
• Age at Diagnosis
• Etiology
• Length of Deafness
• Degree of Loss - How much residual hearing did the child have before receiving the implant?
• Consistency of Implant Use/Amplification
• Audiological Management
• Health
• Intelligence
• Emotional State
• Personality-Learning Style
• Additional Challenges
• Family Participation
• Skills of Professionals (SLP, Audiologist, Educator)
• Skill of Parents

Given no other additional challenges impacting progress, a child's auditory skills should match his/her receptive language skills within a year. His/her ability to comprehend language listening alone should match what he/she understands when listening and watching (lipreading or signing).Research studies have determined that twelve months language growth should be expected in the first year after the implant.

Q:How long does a child need therapy?

A:
How much therapy is required is also influenced by the factors listed above. Learning to listen is a process and children progress at different rates based on many factors, some of which we cannot predict.

It is often inappropriate to place a child in a mainstream classroom immediately after receiving an implant. Unless a child has developed appropriate speech and language skills necessary to function competitively in a mainstream setting, he/she should be served in a self-contained, language intensive environment.One researcher reported that after two years of intensive rehabilitative therapy there was a significant trend toward mainstream placement and after four years, 75 percent of the children in the study were in mainstream classes full-time, with a minimum of special education support.

The child with a cochlear implant will continue to need work in auditory stimulation and vocabulary development even after speech and language is deemed to be at age-appropriate levels.

Q:Who should provide services?

A:
All professionals who work with a child should stimulate appropriate listening skills throughout the child's day. The "pull-out" therapy can be done by an appropriately trained audiologist, speech-language pathologist, teacher of children who are deaf or hard of hearing, or learning specialist. All staff members with primary responsibility for auditory therapy must have knowledge and skills in the areas of speech acoustics, language development, speech acquisition and auditory training.

Q:What do I do when the implant stops working in class?

A:
It is important to monitor the function of the implant throughout the school day. This can be achieved by incorporating listening checks as well as a visual inspection of the device including cords and processor at scheduled times of the day.

Keep a spare set of batteries and cords for each child. It is most often a dead battery that causes an implant to stop working. The next most common culprit is a short in the cords or wires connecting various parts of the device.If possible, it is also helpful to have a spare headset to swap out if this part of the device is malfunctioning.

If you have any questions about whether an implant is working or not, refer to the troubleshooting guide which accompanies the implant. If you do not have one, contact the manufacturer or the implant audiologist. They will send you one.

Most manufacturers have a teachers' guide which has a great deal of helpful information specific to the implant that your child(ren) might have. Contact the manufacturer to get a copy of the teachers' guide.

Q:Who can work with me to develop the child's auditory skills?

A:
All efforts of any importance require teamwork. Your child(ren)'s team could include:

• Teacher of the Deaf and Hard of Hearing
• Educational Audiologist
• Implant Audiologist
• Speech Language Pathologist
• Classroom Teacher
• Learning Support Personnel
• Implant Physician
• Physical Therapist
• Occupational Therapist
• School Psychologist
• Parents
• The Child.

Please make every effort to communicate with the implant surgeon's audiologist. This person is a crucial link in the chain and can be forgotten because he/she is not physically located where the therapy is taking place. The implant audiologist can answer any questions about the specific nature of your child(ren)'s implant and help you when things are not progressing as you would expect.

Q:The following are questions best asked of your child(ren)'s cochear implant audiologist:

A:
What does a cochlear implant sound like?
Who is a candidate for a cochlear implant?
What is the surgery like?
How much does it cost? Does insurance pay?
What is the effect of electro-static discharge (static electricity) on the implant?
Which are better, rechargeable or disposable batteries?
How often does the child need to return to the implant audiologist to get the device reprogrammed?
What are the troubleshooting procedures for a specific cochlear implant device?

Seek out professional contacts with others who are working on similar goals with their children. Ask questions. Attend workshops.

Q:How do I or my child(ren) meet people with cochlear implants?

A:
Contact:

The implant audiologist
Georgia Peach Cochlear Implant Club
Georgia Chapter of the Alexander Graham Bell Association for the Deaf and Hard of Hearing

If you have additional questions, submit them here.