ABSTRACT
Purpose: This study evaluated whether younger cochlear implantation, longer cochlear implant use, and greater pre-implant aided hearing was associated with better language outcomesat 3.5 and 4.5 years of age.Method: Language samples were obtained at ages 3.5 and 4.5 years from 76 children who received an implant by their 3rd birthday. Hierarchical linear modeling was used to identify characteristics associated with spoken language outcomes at the 2 test ages. The Preschool Language Scale was used to compare the participants’ skills with those of hearing age-mates at age 4.5 years.
Results: Expected language scores increased with younger age at implant and lower pre-implant thresholds, even when compared at the same duration of implant use. Expected Preschool Language Scale scores of the children who received the implant at the youngest ages reached those of hearing age-mates by 4.5 years, but those children implanted after 24 months of age did not catch up with hearing peers.
Conclusion: Children who received a cochlear implant before a substantial delay in spoken language developed (i.e., between 12 and 16 months) were more likely to achieve age-appropriate spoken language. These results favor cochlear implantation before 24 months of age, especially for children with aided pure-tone average thresholds greater than 65 dB prior to surgery.
10 comments:
After reading through this article, I feel that this particular study was very well done. I am finding it very difficult to point out any specific flaws in the way that it was conducted. I think the conclusions are strongly supported by the data they collected, and I also feel that the ramifications for professionals working with potentially implanted children are very great. This study is important to remember when encouraging families to implant a child with a cochlear implant early in age. I would also like to say that although statistics may argue that some children implanted later may never catch up with their peers, I think we should be careful not to develop an "it's too late" attitude towards them and still hold high expectations for them.
I thought that this article was very interesting and seemed well done. I think it emphasizes the need for early identification of children with hearing loss, along with providing evidence of a critical period for cochlear implantation--this article supports many others that I have read that come to a similar conclusion. This article provides strong evidence that if identified early, implanted early, and have the proper support structure for therapy and services--these kids can catch up with their peers(by kindergarten). I would like to see further studies (like mentioned in the article) of whether these children stay on par with their peers into elementary school and beyond.
Nicholas and Geers address an important topic and have correctly identified some of the issues that have made it difficult to interpret past research about the effects of cochlear implantation on the development of spoken language (e.g. confounding effects of age of surgery and duration of use, amount of residual hearing, and changing CI technology). Their strategy of using hierarchical linear modeling to try to unravel these variables is sensible, but the fact that there are only 12 hearing children in the 3.5 year age group and 12 more in the 4.5 year age group, is a significant weakness. It is impressive that they have 76 children with CIs. It is unfortunate that we don't know much about the quality, duration, or intensity of the early educational experiences these children had. Also, even though it makes sense to have limited the children to those without any other issues besides hearing loss, it makes the results less generalizable, since a significant number of CI recipients do have other issues. This is an excellent beginning, but replication with larger samples and inclusion of other variables is needed.
Nicholas and Geers have produced a very good research study. They have helped to confirm the relationship between age of implantation and later language success. However, they didn't measure parental participation, attitudes, expectations or comfort in reinforcing important language-learning techniques in the home. Previous research has shown that the degree of parental involvement is also a predictor of later language growth. And finally, more information on the quality of early intervention and preschool services/placements would have provided more insight into the children's overall performance. We all know that not all auditory learning/oral programs are the same.
This article did a good job at looking at age of implantation compared to length of use of the CI. It appears there is a definate critical period for implantation, before 18 months, if you want your child to progress at age-related levels. I think this is important information that needs to be shared with parents when they are determining whether or not to implant thier child. I think parents need to be presented with all the options and realistically need to know the possible outcome of each decision. The important thing is to get children language as soon as possible.
My comment applies only to the Introduction. On p 1049, the authors mention two studies that reported neurophysiological measurements of neural plasticity following intracochlear electrical stimulation (Sharma et al and Ryugo et al). No details were provided, but some students may be interested in that work. If so, I would be happy to answer questions about it.
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The immaculate detail in which this study was recounted gave it credibility; nothing to hide. I did wonder, however, why they used teachers of the deaf to assess the children in the study group when this was not the case in the control group.
I was very impressed with this article. I felt that it was well constructed and very thorough about descriptions of the people in the study they were dealing with. I was a little disappointed that they didn't factor in home environment/attitudes after implantation and through the auditory/oral therapy. The article was well constructed to my knowledge, but, of course, it would also be important to see some other good, supporting evidence for clinical implications.
Николи не могла подумать, что такое может со мной случиться, что меня могут бросить, отвергнуть... Он перестал меня воспринимать целиком и полностью. Он начал оскорблять меня, вытирал относительный меня ноги всяческими способами. И раз мы поругались с ним. Он просто пропал без объяснения причин. Я не знаю, как пережить это расставание. Я ложусь спать, думаю о нем, плачу, просыпаюсь с теми же мыслями, погода начинается тоже со слез. Век без него петеряла смысл. Ничто не хочется, безвыездно все мысли о нем. Прозябать тоже не хочется... [url=http://profvesti.ru/o-monolitnom-stroitelstve/96-opalubka-dlya-monolitnogo-stroitelstva.html]ремонт трехкомнатной квартиры[/url]
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