Examining the Language Environment ofExamining the Language Environment of Children Who Are Deaf-Blind With

Cochlear ImplantsCochlear Implants

Kathleen Stremel ThomasThe Teaching Research Institute

(stremelk@wou.edu)&&

Susan Wiley, M.D.Cincinnati Children’s Hospital Medical CenterCincinnati Children s Hospital Medical Center

www.kidsdbci.org/

A Federal Project: Influencing Outcomes for ChildrenA Federal Project: Influencing Outcomes for Children Who Are Deaf-Blind With Cochlear Implants

St d A F O t & P di ti F tStudy A – Focus on Outcomes & Predictive FactorsAcross Time

Study B – Focus on Communication & Language Environments

Steppingstones of Technology InnovationOffi f Ed i POffice of Special Education Programs (#H327A0800045)

Project Partners

The Teaching Research Institute (Western Oregon T e Teac g esea c st t te (Weste egoUniversity)

Cincinnati Children’s Hospital Medical Center

East Carolina University

In collaboration – University of Kansas – LSIParsonsParsons

Study A

Multi-center studyEnrolled deaf blind children 12 months to <8Enrolled deaf-blind children, 12 months to <8 years who have or will receive a cochlear implantimplantEvaluated language trajectoriesAssessed language development auditory skillsAssessed language, development, auditory skills

Communication and Symbolic Behavior Scales MacArthur-Bates Communication ScaleRynell-Zinkin (developmental assessment for DB)ITMAIS-MAIS

Examine Individualization & Variability of the Child ’ PChildren’s Progress

Age at ImplantAge at ImplantDegree of Vision ImpairmentAdditional DisabilitiesAdditional DisabilitiesDuration of “time in sound”Type frequency and intensity of interventionType, frequency and intensity of interventionParent communication, language and speech interactions in the natural environmentinteractions in the natural environment

Characteristic/Demographics PercentageN=84

Gender = boys 59%

Gender = girls 41%

EthnicityCaucasian

L ti72%9%Latino

African AmericanAsian

9%5%1%

Other 13%

Other issuesPhysical challenges 65 1%Physical challenges

Cognitive challengesBehavior challenges

65.1%39.5%16.3%

Complex health care needs 54.7%

Participant Demographics n=84Etiology Percentage Etiology Percentage

Complications of 25.9% Klippel-Feil sequence 1.2%pPrematurity

pp q

CHARGE 25.9% Leber congenital amaurosis

1.2%

CMV (Cytomeglovirus)

10.6% Usher I syndrome 1.2%

Other 9.4% Usher II syndrome 1.2%y

Unknown 12.9% Congenital Rubella 1.25

Meningitis 2.4% Asphyxia 1.2%

Refsum syndrome (MSP I-S)

2.4% Encephalitis 1.2%

Microcephaly 1 2%Microcephaly 1.2%

Participant Demographics: Vision

Vision Impairment ParticipantsVision Impairment Participants

Low Vision (<20/200) 22%

Legally Blind 20%Legally Blind 20%

Light perception only 5%

Blind 7%

CVI 23%

Diagnosed progressive loss 1%

Other 22%Other 22%

Participants age at implant

50

30

40

Percentage

20

30gof participants

0

10

<12 19 24 25 35 36 48 > 48<12mos

19-24mos

25-35mos

36-48mos

> 48mos

A t i l tAge at implant

Range of implant ages: 7 months to 5 years, 2 months

Participants Duration with Implant(as of 2/15/10)

50

30

40

Percentage

20

30Percentage of participants

0

10

< 12 13-24 25-36 37-48 > 48< 12mos

13-24mos

25-36mos

37-48mos

> 48mos

Duration with Implantu at o t p a t

Range of duration is 1 month to 7 years, 2 months

Individual Differences & Variability

Example Data Analyses: Variability

Reynell-Zinkin: Response to Sound

36

27

0-36

)

9

18

Scor

e (

0

9

0

Example Data Analyses

Reynell-Zinkin: Response to Sound

3540

202530

51015

08 11 12 12 13 15 17 17 18 19 20 21 21 22 23 23 24 24 25 27 28 28 34 37 40 46 54 59

Age at Implant (in months)g p ( )

Example Data Analyses

Reynell-Zinkin: Response to Sound by Time in Sound

3540

202530

51015

01 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3

Years in SoundYears in Sound

Example Data Analyses

Reynell-Zinkin: Vocalization and Expressive Language

18

12

18

(0-2

2)

6

12

Sco

re (

0

Example Data Analyses

Reynell-Zinkin: Vocalization and Expressive Language

15

20

10

15

5

08 11 12 12 13 15 17 17 18 19 20 21 21 22 23 23 24 24 25 27 28 28 34 37 40 46 54 59

Age at Implant (in months)g p ( )

Example Data Analyses

Reynell-Zinkin: Vocalization and Expressive Language

18

12

6

01 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3

Years in SoundYears in Sound

Study B: Examining Communication & Language Environments

Many of the children with multiple disabilities are dropped from “therapy” if they do not make sufficient progressParents and teachers often do not “talk” to their child any more or any differently “after” the child receives the implant y y pthan beforeMany children with multiple disabilities do not demonstrate intentional prelinguistic communication and object useintentional prelinguistic communication and object useParents and teachers are often not taught effective strategies to use with their children in natural routines and activitiesPart C service providers often teach isolated skills without working as a team to assist the parents to facilitate (1) receptive and expressive communication forms and functions (2) receptive and expressive language forms and functions

Meaningful Differences Pre and Post Implant

A battery of assessments are given pre-implant and post-implant (CSBS, MacArthur-Bates, (Rynell-Zinkin, ITMAIS-MAIS) to determine developmental skills/needs

Children and caregivers are video-taped in motivating routines and activitiesmotivating routines and activities

Language Environmental Analysis (LENA) data d t i th f & t fare used to examine the frequency & type of

caregiver/teacher “talk” across a day (8-12 hours)hours)

Language Environmental Analysis Data

Auditory EnvironmentMeaningful TalkDistant TalkTVNoiseSilSilence

Adult WordsChild VocalizationsConversational TurnsEstimated Mean Length of UtteranceEstimated Developmental Age (in months)Estimated Developmental Age (in months)Standard ScorePercentile

Use of LENA data to individualize a child’s intervention in natural environmental routines andintervention in natural environmental routines and activities

Patterns of child vocalizations pre-implantExamining “meaningful” speech in a preschoolExamining meaningful speech in a preschool environmentExamining type and frequency of “talk” inExamining type and frequency of talk in specific routines in a home environment

Examples of LENA Graphs will be presented but not included here due to size of the visual display & colorincluded here due to size of the visual display & color

Child AChild A

Child BChild B

Child C