ASHA 2007 Boston, Massachusetts Brenda Seal, Ph.D. Kate Belzner, Ph.D/Au.D Student Lincoln Gray, Ph.D. Debra Nussbaum, M.S. Susanne Scott, M.S. Bettie Waddy-Smith, M.A.
Welcome: w ε lk ɚ m English Consonants American Signs Welcome: θβ R Β L )(
Movement Handshape Location Consonant Voice/less Consonant Manner Consonant Place Upward A-hand Neutral Voiced /w/ Glide /w/ Bilabial /w/ Downward 5-hand Upper face Up and Down C-hand Lower face Side to side G-hand Face side Movement away E-hand To and from Pronating rotation Opening action Closing action 3-hand O-hand At 13 months old, 1 month post-implant 11 different sign movements 7 different handshapes 4 different locations 1 consonant Wiggling action of fingers Convergent action, touching
Movement Handshape Location Consonant Voice/less Consonant Manner Consonant Place Movement toward K hand Supine wrist Voiced /b/ Plosive /b/ Bilabial /b/ Twisting movement Voiced /m/ Nasal /m/ Bilabial /m/ Voiced /n/ Nasal /n/ Alveolar /n/ 17 months old, 4 months post implant 2 new sign movements (sum = 13) 1 new handshape (sum = 8) 1 new location (sum = 5) 3 new consonants (sum = 4) At 21 months old, 8 months post implant 3 new consonants (sum = 7) voiceless bilabial plosive voiceless velar plosive voiceless labiodental fricative /p/ /k/ /f/
Movement Handshape Location Consonant Voice/less Consonant Manner Consonant Place Rightward L-hand Head Voiced /d/ Plosive /d/ Alveolar /d/ Leftward V-hand Trunk V-less /t/ Plosive /t/ Alveolar /t/ Supinating rotation Circular action Convergent action, approaching W-hand Voiced /l/ Liquid /l/ Alveolar /l/ At 24 months old, 11 months post implant 5 new sign movements (sum = 18) 3 new handshapes (sum = 11) 2 new locations (sum = 7) 3 new consonants (sum = 10)
Subject # Gender Race Age at Non-Verbal Motor/Cogni Activation Intelligence tive Issues Funding 1 F Caucasian 0:12 Low Spina Bifida Insurance 2 F Caucasian 5:5 WNL None Insurance 3 F African Amer 2:9 Low None Medicaid 4 F African Amer 1:6 WNL None Medicaid 5 M Hispanic 3:1 Low None Medicaid 6 M Ethiopian 3:0 Low None Medicaid 7 M African Amer 2:3 WNL None Medicaid 8 F Caucasian 3:9 Low None Military 9 M African Amer 6:2 Low None Medicaid 10 M African Amer 7:0 Low None Medicaid 11 M Caucasian 3:5 N/A PDD Medicaid 12 F Caucasian 6:11 N/A ADHD Medicaid 13 M Caucasian 4:2 N/A Autism Medicaid 14 F Caucasian 0:12 N/A None Insurance 15 F Caucasian 2:2 N/A None Insurance 16 M Russian 2:8 N/A None Insurance 17 M Caucasian 3:7 N/A CP; Seizures Insurance 18 F Caucasian 4:5 N/A None Medicaid 19 F Caucasian 4:7 WNL None Insurance 20 F Caucasian 2:7 WNL None Insurance 21 F Hispanic 1:6 WNL None Medicaid 22 F Russian 2:8 WNL None Insurance
Consonant Acquisition No Additional Disabilities With Secondary Disabilities Sign Movement Acquisition Sign Handshape Acquisition Sign Location Acquisition r = 0.58 R 2 = 0.34, p<0.001 r = 0.57 R 2 = 0.33, p<0.001 r = 0.56 R 2 = 0.32, p<0.001 r = 0.70 R 2 = 0.49, p<0.001 r = 0.78 R 2 = 0.61, p<0.001 r = 0.76 R 2 = 0.58, p<0.001
What changes occur in children s sign and spoken language acquisition post implantation? Are the changes predictable? Across ages? Across children with secondary disabilities? How can these findings be used for programming?
There is not one unified deaf community perspective on cochlear implants Attitudes towards cochlear implants are changing Culturally deaf families are beginning to consider implantation for their young children
Cochlear Implants and Sign Language: Putting It All Together April 2002
KidsWorld Deaf Net What is a Cochlear Implant? Cochlear Implant Candidacy Factors Influencing Performance The Decision-Making Process Considerations in the Implantation Process What About Insurance? Surgical Considerations Educational Settings The Deaf Community Perspective Communication Methodology Sign Language Use Fitting the Speech Processor Training the Ear to Listen Resources Available in Spanish
Cochlear Implants and Children: Considerations for Implantation and Educational Planning
National Training Workshops Spoken Language and Sign: Optimizing Learning for Children with Cochlear Implants
Spoken Language and Sign It does not have to be a competition!
For spoken language to develop: Opportunities must be available to develop listening and speaking skills There must be times when sign is not utilized Spoken language must be valued and utilized in the child s daily environment
We want children to be the most effective language users and communicators possible. In any way possible! As early as possible!
The path of learning to listen may vary for each child and And each child with an implant will vary in their ability to listen to learn
Receptive Communication Continuum Fully Visual Communicator Mostly Visual Communicator Mostly Auditory Communicator Fully Auditory Communicator V VA Av A
V Accesses communication visually via ASL/Signs or visual clarifiers VA Accesses most information visually via ASL/Signs or visual clarifiers; obtains some benefit from auditory information VA Equally accesses information via ASL/Signs or Spoken English Av Accesses most information through spoken English, sometimes needs support via signs or visual clarifiers A Accesses all information through Spoken English
Expressive Communication Continuum Fully Sign Communicator Mostly Sign Communicator Mostly Oral Communicator Fully Oral Communicator S SO Os O Continuum concept: Bettie Waddy-Smith
S Uses Signs/ASL Only So Primarily uses Signs/ASL; uses some oral communication SO Equally able to use sign and oral communication Os Primarily uses oral communication; uses signs for clarification O Uses oral communication only
To guide: Language use Placement Child and Family Supports
As a transition to oral language As an ongoing clarifier of spoken English. Bilingual development of ASL and Spoken English
Age 4:11 years Adopted at 2:5 years Received CI at age: 2:9 years Consistent use of both ASL and Spoken English in the home (mom is interpreter) Consistent user of CI Developing equal use of both ASL and English
Fully Visual Communicator Receptive Continuum Mostly Visual Communica tor Mostly Auditory Communicat or Fully Auditory Communicat or V VA Av A LW Expressive Continuum Fully Sign Communicator Mostly Sign Communicator Mostly Oral Communicator Fully Oral Communicator S SO Os O
Cochlear implant activation at: 3.1 years; not all electrodes could be inserted Problems with getting a good map and keeping coil in place Spanish used in the home Family very interested in having Jason become an auditory communicator Consistently aware of Ling 6 sounds Demonstrates awareness of single words and familiar sentences in a closed set; does not generalize spoken language skills outside of therapy sessions Additional learning disabilities Language development has been slow in both ASL and Spoken English Difficulty in spontaneous and imitative production of new words and phrases
Receptive Continuum JC Fully Visual Communicator Mostly Visual Communica tor Mostly Auditory Communicat or Fully Auditory Communicat or V VA Av A Expressive Continuum Fully Sign Communicator Mostly Sign Communicator Mostly Oral Communicator Fully Oral Communicator S SO Os O
M eeting each child at their auditory functioning level M odifying the challenge factors M onitoring use of sign language M aking links between sign and spoken language M odeling spoken language
The demographics of children with cochlear implants varies widely Spoken language and sign language outcomes vary for each child with a cochlear implant Early use of sign language can support the acquisition of spoken language development Continued research is important to support and validate the use of sign language with implanted children
Thank you to: James Madison University and Gallaudet University s Cochlear Implant Education Center for funding the graduate students who worked on this project: English King, Kelly Clingempeel Skubicz, Christi Hess, and Kate Belzner The University of Virginia Cochlear Implant Center (Lori Bobsin) for referrals The families and children involved in our project.
For more information contact: Debra.Nussbaum@gallaudet.edu