Cued Speech to the Rescue for Cochlear Implant Kids

Transcription

1 Cued Speech to the Rescue for Cochlear Implant Kids Barbara LeBlanc, ED Sp, M.A. CCC-SLP Jane Smith, M.A., LSLS Cert. AVEd ASHA Convention November 20, 2009 New Orleans, LA

2 Agenda: Welcome and remarks Cochlear implants how they work and how they have evolved How cochlear implants are changing the education of the deaf How Cued Speech can help What is Cued Speech Research on cochlear implants and Cued Speech Student profiles and video Wrap up and discussion

3 Cochlear implant

4 Cochlear Implant Device Internal/External Components

5 Hearing aid Cochlear implant Acoustic signal Electronic signal Amplifies sound that travels through the middle ear to the cochlea Bypasses the middle ear Electrodes transmit signals to the auditory nerve

6 Internal and external CI devices

7 There are increasing numbers of deaf children with quality access to sound Approximately 15,000 children in the US under the age of 18 have cochlear implants (all manufacturers) 52% are 0-5 years 37% are 6-13 years 11% are years (from Cochlear Corporation, June 2005)

8 Increasing numbers of children have cochlear implants Since 2005 about twice as many children have CIs Children are being implanted earlier and earlier Most children are implanted under 5 years of age At many hospitals, the majority of children implanted are under the age of two FDA allows implantation at 12 months, many are implanted younger Predictions are that at least half of all deaf children will have a CI soon

9 Trends and Facts--CIs 20-25% annual increase in cochlear implants Bilateral implantation is a trend Common and beneficial to use hearing aid on opposite ear There is a trend to reduce or eliminate visual information when teaching deaf children.(not necessarily the way to go!)

10 Cochlear implants have changed the way deaf children receive information Improved access to sound Ability to learn through listening More incidental and less didactic teaching More high frequency listening information available (order of speech teaching changes as a result)

11 Cochlear implants have not solved: Noise, distance and reverberation Speed, depth and complexity of language Hardware problems A CI will malfunction Deafness a child is deaf when the CI is off The diversity of our deaf population

12 Factors Effecting Outcomes Outcomes for children with CIs vary for unknown reasons Children with secondary disabilities constitute about 40% of D/HH children 41% of the population of D/HH children are from minority or culturally diverse families At least 16% of D/HH children under 18 are living in poverty (U.S.Dept. of Ed. 2004)

13 Therefore.. Outcomes for spoken language, listening development and literacy skills for children with cochlear implants depend on much more than the device alone Cued Speech can be a solution.

14 Recent research 2002, Belgium: Information delivered visually through Cued Speech may help to refine the speech perception received through the cochlear implant (Leybaert, 2002)

15 Recent research (cont d) 2003: Cued Speech users use the same parts of their brain the auditory cortex to process phonological information as hearing peers ( LaSasso, Crain, Lansdale, Cappell, Zeffiro, Eden, 2003)

16 Recent research (cont d) 2003: CI children who used Cued Speech showed rhyme sensitivity equivalent to age-matched peers. Exposure to Cued Speech reinforces the cross-modal interaction between auditory and visual cortex. (LaSasso, Crain, Leybaert, 2003)

17 Recent research (cont d) 2005: Speech, for hearing people, is a bimodal percept when we see and hear the voice and lip movements of the speaker. The brain combines what it sees and hears to make the best guess of what is said. Children who get cochlear implants before 30 months are able to fuse the auditory and visual aspects of speech. (Schorr, Fox, van Wassenhove, Knudsen 2005)

18 Video From Insight Into Cued Speech 4 minute segment: What is Cued Speech? ( Insight into Cued Speech 2008 National Cued Speech Association.)

19 Why was Cued Speech invented in the Mid to Late 1960 s? In 1966 Dr. Orin R. Cornett, a physicist, worked in the U.S. Department of Education. concerned about what he saw as the distressingly low literacy rates of deaf children.studied the theories of how information is communicated and decided that there was a way to make spoken language clear through vision alone, using a finite system! Realized that one must be about to distinguish phonemes in order to be able to read and write a language proficiently

20 Dr. Orin R. Cornet invented a user friendly visual system so... the speaker could cue the spoken words exactly the way they pronounced the word using the phonemes for that particular spoken language. The cuer would cue in vowel-consonant units. The mouth and hand are of equal importance. In combination, each consonant and vowel will be visually distinct.

21 What is Cued Speech? Phonemic system Based on sounds that make up words in a given spoken language Forty individual phonemes in Cued American English 25 Consonants with 8 handshapes 11 Vowels and 4 diphthongs with hand placements around the face Handshapes/placements plus mouth shapes

22 What is Cued Speech? (cont) Sounds with similar mouth shapes have different hand shapes Combining shape of mouth with shape and position of hand efficiently shows all sounds of English Deaf child learns to distinguish phonemes visually, the same way a hearing child does auditorily THUS, Cued Speech provides clear and unambiguous access to language necessary for comprehension, fluency and literacy

23 Shape of Hand from: 1= d, p, zh 2= th, v, k, z 3= h, s, r 4= b, n, wh 5= m, f, t 6= w, l, sh 7= j, th, g 8= y, ng, ch

24 Vowel Placements Mouth:ee,er Chin: oo, aw, e Throat: i, a, u Side: uh, oe, ah

25 Diphthongs Chin to throat= a (flat to flat mouth), oy (open to flat mouth) Side to throat= I (open to flat mouth), ow (open to round mouth)

26 Basic Cueing Principles Handshape goes to the vowel ( me ) Handshape 5 /m/ goes to the mouth /i/ Flat hand, straight wrist Touch placement windshield movement Keep lips and cues synchronized Cue the word based on sound, not spelling The cue reader sees what the listener hears verbatim (phonologically)

27 Cued Speech Clarifies cats vs dogs s vs z in plurals kicked vs bagged vs planted t vs d vs Id in ed past Blends str-, bl-, tr-, --st, -ts, -nd, -kle, etc. in words and between words

28 CS Clarifies Pronunciation Wash- wahsh, wawsh, wawrsh Defend deefend, difind, duhfind, etc. Car cahr, cawr Them them, thim Power pahwer, power

29

30 Let s Cue some! Handshape 5 [m,f,t,] my taffy and Mouth [ee,ur] leisure 1. CV syllable: The handshape will go to the vowel position in the syllable: handshape 5 to the mouth for me, fee, tee/tea, fur, etc. and the mouth will form the CV syllable 2. Solitary Consonants meet team 3. Solitary Vowels eat E-e-e-e-e-e 4. CVC - firm feet (includes rules#1 and 2)

31 Basic Principles Continued 5. Syllables repeated at the same vowel placement a. with the same vowel MiMi FeeFee firmer b. with different vowels but the same placement Meter femur

32 Practice Words and Sentences Words Meet Feet Me Meter Fur Femur Fee murmur Sentences Meet me for tea? (Briton) Me eat firm meat. (Tarzan would say)

33 Review American Cued English has How many handshapes? eight To denote the? consonants How many placements around the face? four To denote the &? vowels & diphthongs The 3rd major component of CS is the. Ears? Face? Mouth? Eyes? mouth Smallest unit of speech that can be cued is? Word? Syllable? Sentence? syllable

34 Review.. CS facilitates lipreading with % accuracy. The speaker can cue the spoken words the way they pronounce the words using the phonemes for that particular spoken language. (somewhat or exactly?) exactly CS is a visual mode which can be used to communicate effectively. (naturally or formally?) naturally CS users use the same parts of the brain, the auditory cortex to process information, as hearing peers do! phonological

35 Where does Cued Speech fit in? Educators and parents must safeguard language development of deaf children Because deaf children are diverse and because cochlear implants don t conquer every obstacle, a visual representation of spoken language may be necessary Technology doesn t necessarily bring understanding to the brain

36 Cued Speech.. Conquers distance, noise, and reverberation Gives the child access to language when the CI is off or not working properly Gives something extra for deaf kids with additional learning/processing problems Assures equal opportunity for all CI children Gives visual clarity and specificity for what is being talked about

37 Video Two ten year old girls having a conversation using Cued Speech

38 What it is/is not Called Cued Speech, but not simply an articulation tool (Often referred to as Cued American English ) IS a tool for learning vocabulary, syntax, semantics and literacy Not language specific and can be adapted for any spoken language Can be used naturally with natural inflection Not the same purpose as Visual Phonics

39 Cued Speech is an oral system Cued Speech is not a language It is a phonemic system, that can show any spoken language Cued Speech can complement rather than hinder use of residual hearing

40 Visual component in oral programs Even oral and A/V programs use vision to clarify what is heard Auditory Verbal mentions auditory sandwich Auditory Oral programs use Mouth Time, Visible Speech.. Oral and TC programs use Visual Phonics Some oral and auditory verbal programs use Rhythmic Phonetics.

41 Visual Phonics/Cued Speech Visual Phonics Uses 46 hand cues Minimal unit is a phoneme Graphic symbols correspond w/phonemes Meant to be used at the word level Lack of research for reading Used with school aged children Cued Speech Uses 8 handshapes and 4 placements Minimal unit is a syllable Does not have to be associated with graphemes Meant to be used for conversation Strong research that CS helps reading Used with babies through school-aged children

42 Sign language and cochlear implants ASL is not English cannot speak and use ASL ASL does not support literacy Schools for the deaf are having difficulty on how to instruct deaf children sign supported speech? Sim/com? SEE or Signed English? Part of the day, all day? Changing guidelines

43 Video Insight Into Cued Speech Who Uses Cued Speech? Insight into Cued Speech 2008 National Cued Speech Association. (From: Insight into Cued Speech 2008 National Cued Speech Association.)

44 Personal observations--cis after 3 years After language Cued Speech children have an internalized phonological grid Hear what they have internalized visually Listening progress is quick Children interpret the sound they are hearing through electrical stimulation that they are seeing through Cued Speech

45 Personal observations--cis before 3 years Develops internal phonological model of speech that sets a foundation for literacy Child can see morphological structures that are difficult to hear plurals, possessives, tenses, little words It is a great system for children with auditory neuropathy Safeguards language development and literacy

46 Personal observations--school age CI children Additional problems often show up when children start school (apraxia, auditory processing, learning disabilities) Problems of distance, noise and reverberation can be solved only somewhat with FM The speed and amount of information and new vocabulary in mainstream classes is helped

47 Auditory-oral or A/V first? Why wait? If you wait to use Cued Speech, the child s progress may lag Cued speech supports perception/ production loop Use Cued Speech as early as possible so that children with cochlear implants can compete with hearing peers

48 Sign language first? Why wait to use Cued Speech? Most parents of deaf children are hearing Use Cued Speech as early as possible for literacy development Use both, but keep them separate

49 Video----twins and Max Max at one year Twins at three years 4 years

50 Literacy, CIs and Cued Speech Reading is understanding spoken language in written form Children must make a connection between written and spoken language A typical hearing child s phonemic repertoire of language is complete by seven (Fry, 1966) As a child s vocabulary develops, he/she compares similar sounding words and keeps the words in his brain as a mental lexicon. (Goswami, 2002) Thus, we remember vocabulary and become flexible with words by storing them based on their parts

51 More on literacy Children with normal hearing understand about 14,000 words by the time they are six (Goswami, 2002) You need to know a language in order to hear it properly. Meaning determines the grammatical structure of sentences (Smith, F. 2004) The onion was planted by the tree/the onion was planted by the farmer.multiple meaning of check bring your card to the library.get carded Cued Speech along with cochlear implants supports literacy

52 Video Elisabeth and story

53 Student Profiles

54 Bob Seven years old Arrived from Uganda this year Sudden drop in hearing. Hope to get an implant Bantu is the language of the home Is learning English through C.S. and retaining Bantu

55 Darren Ten years old Implanted at two years Did not seem to process Cued Speech multiple issues Went to oral program Came back to Cues Speech Helps with reading Helps with auditory memory, processing, apraxia, pronunciation

56 George Six years old Only partial insertion at 2 years BOR syndrome Malformed cochlea Oral/motor issues Processing issues CS helps with reading, rhyming, manipulating language

57 Lola and Ella Four years old Implanted at 1 1/2 Parents are native Cuers Love to listen. Excellent use of CI. Cue fluently, speech is excellent Above age level in all areas

58 Mary Eight years old CI at 2 years Excellent speech and use of hearing Fully mainstreamed Cued Speech clarifies language (Hears vegetable / festival ; icebird /ice berg ; movie / smoothie ; Sea cow/ see saw )

59 Jack Six Implanted at two Deaf family, uses ASL at home. Truly bilingual Above grade level Excellent reader C.S. Clarifies pronunciation ( science, Hermione, Philadelphia, honest. ) Cues at school. Prefers Cued Speech for academics

60 Video 22 year old senior in college student who grew up using Cued Speech

61 Summary Cochlear implants are changing deaf education Cued Speech... - verifies what is heard - creates phonological awareness necessary for literacy - builds a kinesthetic feedback loop for speech, and - ensures progress and safeguards language development for all deaf children Cued Speech can rescue language, literacy, and speech for children with cochlear implants