Cochlear Implants in Education

A cochlear implant is a complex electronic device that is surgically implanted in a deaf or severely hard-of-hearing person to help provide a sense of sound. It has four parts: a microphone, a speech processor, a transmitter, and electrodes. All these parts work together to stimulate auditory nerves inside the cochlea and send sounds to the brain to be "heard" by the deaf person; much like the functions of a normal, working, inner ear. This implant is an option for children as well as adults; depending on severity of hearing loss and predicted outcome and benefit of being "implanted". Because of the expense and the permanence of this procedure, it is important that a candidate be evaluated meticulously before a decision should be made on whether to implant or not.
In order to determine if a child is a candidate for implant surgery, many things must be taken into consideration. Most children's hospitals I researched held the following qualifications to determine candidacy: first, the child must have severe to profound sensorineural hearing loss (of 90 decibels or greater) in both ears. Secondly, it is realized that hearing aids provide limited benefit in the case. They must also have strong family commitment. Lastly, there must be a strong educational plan that will emphasize development of auditory skills. Other things can be taken into consideration (health concerns, parental motivation, etc.) but these were main criteria that I found to be consistent among many hospitals and clinics.
In any case of determination of candidacy, though, many meetings are held with parents, clinicians, audiologists, otolaryngologists, social workers and speech language pathologists. The team of professionals ("cochlear implant team") will decide ultimately if the child is a good candidate for implantation. Sometimes a decision is made to delay implantation, or in some cases it is decided that a cochlear implant is not the best solution for the child at hand.
If indeed an implant has been chosen as the right direction to go in, many moves must be made to ensure the best benefit. In the time immediately after implantation, the auditory therapy experiences begin. Because these children are young and inexperienced in the world, the speech development and communication techniques are really starting from scratch. Auditory experiences are provided, structured programs are constructed in auditory skill development, and activities are carried out to practice speech and communication. Auditory training helps children to learn, recognize, and discriminate between environmental and speech sounds. Auditory performance in areas of lesson-type activities and play must be charted and analyzed carefully. Through this process, the auditory-verbal therapist, audiologist, school educator, and parents can assess whether the child receives sufficient auditory information with amplified hearing for the development of the spoken language or if an alternative intervention strategy should be used. Audiological monitoring is also an important part of follow-up with an implant surgery; it allows for the audiologist to reprogram and troubleshoot any problems with the implant.
Speech development and communication skills are critical in a child who has received a cochlear implant. They must learn to recognize, process, and respond to sounds that the implant allows them to hear. It has been found that the earlier the child is implanted, the better the results of speech development and communication. Researchers from the Washington University School of Medicine and University of Texas reported that "with increased implant time, children's vocabulary was richer, their sentences longer and more complex and their use of irregular words more frequent". So of course parents should investigate this procedure as soon as possible, to get the best benefit for the deaf child. Results will differ from child to child, of course, but informed parents, teachers, and audiologists can really help a child progress in speech development after implantation.
Research findings are showing that children who have implants develop speech perception and production abilities that exceed children who just wear hearing aids. Researchers found that substantial numbers of implanted children who were retested over seven years made significant improvements in some auditory, speech, spoken language and reading skills.
Teaching a new language (or sometimes introducing a first language) to a cochlear implant child is challenging. For most deaf children to acquire language, it must be visible to them; whether it be on the lips, faces, or via the hands. This is true for deaf children who have been implanted, too. They cannot depend on the implant to work magically immediately after receiving it. There must be other ways to support language development. English is a tricky language for children who come from ASL or another method of communication. Many parents choose to use cued speech or signed English to accompany verbal therapy, because it reiterates the rules of the spoken English language.
There is no doubt that parent-child interaction is a strength in language development for these children. The competencies and strategies children learn with their parents are anticipators for language development and help set the stage for exploration, learning, and further social interactions. Children who have been implanted must learn to "hear" like hearing children; they must hear what is being said and at the same time visually explore relevant objects or observe appropriate events. This is something that comes naturally to hearing children, but must be learned by implanted deaf children. Vocabulary development is also key in learning how to read and comprehend better. This must be a vital part in verbal therapy as well. All in all, children who have been implanted must build on their perception and production abilities to further develop the pragmatic, semantic, syntactic, and morphological skills (the higher-level grammatical and discourse skills) that are necessary for full participation in a conversation.
Many professionals argue over which mode of communication to use with a cochlear implant child. Some stress the auditory-oral mode where lip-reading and talking are promoted and sign language is discouraged. Most of the time, children who are "oral" are mainstreamed in a regular classroom without interpreting services and are expected to succeed academically and socially in a hearing environment.
Auditory-verbal is another mode that is promoted for implanted children. This is similar to being "oral", except that speech reading is not supported so that listening skills can be optimized. Again, this is a method that pushes children to become self-sufficient in a hearing society.
Cued speech is becoming a more increasingly popular mode of communication for implanted children. It is used as a supplement to speech reading and promotes phonics and lip-reading to understand words and speak them more clearly.
American sign language is not as widely used among children with implants. It is often the language used before implantation, but fades quickly as the child can hear the difference in the English language (word order, endings, etc.) through the implant.
Signed English is sometimes used to accompany oral techniques after a child has been implanted. This is still a signed system but follows English order and grammatical rules, and corresponds with what is being processed through the implant. This is what is commonly used in schools to promote writing and grammar skills to take the child further into the educational and career world.
Lastly, there is the total communication method. This is a mixture of communication methods that is combined to ensure maximum benefit for a deaf implanted child. Some people disagree with total communication because it does not stress one method specifically, so a child cannot learn to perfect or lean on one particular method. It is argued that the child can be confused and not completely "tuned in" to perfecting one method of communication, therefore not getting the best benefit from the implant.
I have many opinions about these methods of communication. Being in an elementary school and seeing children being implanted from very young ages, I have drawn my own conclusions and seen what has worked and not worked for these children. When they are very young and just beginning school (usually age three), most have very little or no communication skills at all. They are implanted very early because parents are too lazy to learn sign language or just eager for them to start talking and becoming "normal". So in that case, I believe that it is beneficial to begin auditory-verbal therapy and speech development right away so they can start recognizing and repeating sounds. They usually do not pick up or depend on sign language, so throwing a sign in occasionally or completely banning sign language is not a big deal to me. I have seen teachers work both ways. Most of the time the auditory-verbal method is successful for these young children as they do not feel confused or obligated to choose between methods.
On the other hand, there are children who have signed since they were very young, or those who have been implanted later (age 5-10 instead of 3-4) and have found other ways to communicate before that. These children are being forced to get used to, learn to comprehend, and respond to sounds that they are receiving now and were not before. This is hard for them because they are used to signing at home with family and on the playground with friends, and all of a sudden they have to stress and drill oral methods they are not used to. This is why I believe in the total communication method for this case. I have found that no matter how hard verbal and oral skills are drilled into these kids, they still sign to their friends on the playground and gain great benefit from sign language interpreters to reiterate heard information. This also allows for parents to have a "backup" method in case implants fail (processors go out, batteries die, pieces lost…) and for when the child is just not understanding what is being said in a classroom or other noisy environment. Why take that comfortable first language away? Why deprive a child of what he knows and trusts to enforce the implementation of a new system? Children are young and fragile, and are easily frustrated.
As a teacher, I believe that learning should happen through any means necessary. If a student did not understand a word or concept, why not be able to look at a sign language interpreter for clarification? That, to me, ensures that the concept or spoken word has come across as successfully as for the hearing children. I understand that signing is often used as a "crutch", but this can be detected and intervention can take place depending on the student as soon as this is discovered. Kids are smart! They can take advantage of having several modes, so teachers and parents need to stay up on ways to outsmart these kids and not let them get spoiled by too much supplementation, because they will not receive that in the real world as they get older.
I also believe that total communication allows for the cochlear implant child to still be a part of his important deaf culture. Most older deaf kids have defined themselves as being part of this strong circle and do not wish to be rejected because he has been implanted and can talk now. Why not allow that child to experience the best of both worlds? These are the people that will grow up to be advocates for both cultures and will be educated in both areas because of their experiences.
All of the opinions I have expressed are results of personal experience. I can read and research forever, but my experience with kids of different backgrounds, home lives, educational experiences, and implantation results has proven the most realistic point of view for this argument. This will forever be a tender topic as long as there are deaf advocacy groups and people who want all deaf to become "normal hearing citizens", but as long as there are success stories, we should recognize and praise those techniques that have proven themselves through practice. Deaf children are human beings and deserve the best that the world has to offer just as their hearing brothers and sisters do.