Laurent Clerc National Deaf Education Center,
Cochlear implant technology provides deaf children with "access" to sound. Observation and research indicates there is no "single profile" of deaf children with cochlear implants and that spoken language outcomes are extremely varied. Children obtaining cochlear implants have a range of pre-implant characteristics and post-implant expectations.
While some cochlear implant users/students become proficient spoken language communicators, there are others for whom this is not the case. While cochlear implants may provide significant quantitative and qualitative benefits, it may not necessarily provide full access to spoken language for all children.
As more people receive cochlear implants with various medical and audiologic origins of their hearing loss, as well as tremendously variable socio-economic backgrounds, educational programs and support services need to be designed to respect, understand and fulfill the needs of the increasingly varied post-implant population. In other words, as people with cochlear implants vary more and more, the support services provided need to be flexible and efficient, to better meet the needs of this new and diverse population of cochlear implant users.
During the initial era of cochlear implantation in children during the late 1980s and early 1990s, the number of students with cochlear implants was relatively small, and children with implants comprised a fairly homogenous group. Planning for that population was perhaps easier and more well defined. It was assumed that a decision to obtain a cochlear implant involved participation of an educational setting that exclusively utilized an auditory means of communication. The expectation was that all students with cochlear implants would have full access to spoken language.
As we have had the opportunity to take a closer look at the characteristics of students with cochlear implants for almost two decades now, it is become increasingly apparent that there must be more than one definition of an effective program for children with cochlear implants. As we plan and implement educational strategies for the new generation for students with cochlear implants entering our educational systems, we face new realities and new opportunities.
In the fall of 2000, the Laurent Clerc National Deaf Education Center at Gallaudet University in Washington, D.C., established a Cochlear Implant Education Center (CIEC) to gather, evaluate, and share information related to designing educational and habilitation services for children with cochlear implants from birth through high school. The programs focused on looking at the role of sign language for students with implants. The CIEC provides on-site supports to students with cochlear implants in two demonstration schools, Kendall Demonstration Elementary School (KDES) and the Model Secondary School for the Deaf (MSSD), as well as a range of national activities including workshops, resource development, and research.
At the time the CIEC was established, sign language for students with cochlear implants was rarely promoted, as sign language was viewed by many medical, audiology, speech-language pathology and education professionals as deterrent to spoken language development. While that opinion continues to be held by some, feedback from families and professionals across the country, and some early research, suggests that there is increasing support for use of sign language for a segment of implanted children. Those continuing to advise against the use of manual communication for children with cochlear implants warn that the use of sign language reduces the amount and consistency of spoken language stimulation for a child, promoting dependency on visual communication, and causing further delay in spoken language acquisition. Those maintaining that sign language can be beneficial to children with cochlear implants believe that with careful attention and planning, spoken language development can be maximized in a signing environment, and that sign language use can support the development of spoken language.
As sign language use is taken under consideration for use with implanted children, it is necessary to acknowledge there are various categories of sign use for students with implants, and that the role of sign language for a child may change at various stages post-implantation. Some children may start out using sign language as a foundation to early language development, with sign use diminishing as spoken language skills emerge. Some children may continue to utilize a combination of sign and spoken language. Some students may focus on spoken language with some sign language as a support. Some students may be sign language communicators with spoken language developed as a support to sign use. Where a child falls on the auditory-visual continuum is unique to the characteristics of each child, and planning for each child must be done on an individual basis.
The Laurent Clerc National Deaf Education Center is implementing and evaluating programs responsive to the individual communication/language characteristics of each student. At the core of our planning is designing a program that balances the development of functional listening and speech skills via cochlear implants, with access to a challenging educational and social environment for the child. We believe that children with cochlear implants should be provided with the opportunity to develop skill in sign language and knowledge of the Deaf culture. The components of our program include the following:
- Family Education and Counseling — Specialists are available to help families obtain information to understand the technology of a cochlear implant and make decisions regarding whether or not a cochlear implant is an appropriate choice for their child. Once a student receives a cochlear implant, families participate in workshops on an on-going basis. These workshops are designed to answer questions and to demonstrate how families can support their child's spoken language development at home.
- Auditory and Speech Skill Training — Based on each child's IFSP/IEP, individualized auditory and speech development support services are provided using a systematic building of listening and speech skills to support students in integrating increasingly complex and challenging spoken language into their educational program and their lives outside of school.
- Assistive Technology in the Classroom — Computer, audiotape, and videotape technology are used in the classroom to facilitate the development and use of auditory and speech skills.
- Student Counseling — Direct counseling services are provided for students before, during, and after the cochlear implant process.
- Collaboration with Implant Centers — Collaboration with hospital cochlear implant centers is available to coordinate therapy approaches and support carryover of therapy techniques from the clinic, to the school and the home.
- Device Monitoring — Basic troubleshooting services are provided by Clerc Center Audiologists. Additional replacement parts are maintained at school. On-site mapping services are available to make necessary adjustments to a speech processor or to reprogram a speech processor. Any mapping decisions/changes are made in collaboration with each child's cochlear implant center.
- Spoken Language Enrichment — A spoken language resource teacher works with students either individually or in small groups to facilitate spoken language skills in a natural setting. The student's speech/language/audition IEP goals are addressed through integrated activities that are supportive of the class curriculum.
- Student Workshops and Support Groups — Workshops are offered to support students going through the process of receiving a cochlear implant to prepare the student and his/her classmates. For those students with cochlear implants, workshops are offered throughout the school year related to care and maintenance of the technology and strategies for optimal use. Student support groups offer students with cochlear implants an opportunity to share experiences and to problem solve.
At the national level, the CIEC is designing family and professional training resources. An e-document Cochlear Implants: Navigating a Forest of Information...One Tree at a Time is available at: http://clerccenter2.gallaudet.edu/. This document, also available in Spanish provides families and professionals with information on cochlear implants. An additional e-document, Cochlear Implants and Sign Language: Putting It All Together, a compilation of presentations from a national conference hosted during April, 2002 at Gallaudet University can be found at: http://clerccenter.gallaudet.edu/Products/Sharing-Ideas/CI/index.html. Visit the CIEC website at: http://clerccenter.gallaudet.edu/CIEC/index.html to find out more about upcoming professional workshops during March and June, 2004: Cochlear Implants and Sign Language: Making it Happen.
The coming generations of deaf children entering our schools will have increased access to sound than previous generations. It is the responsibility of everyone involved to plan accordingly to utilize this potential, yet at the same time respond to and respect the diversity of these children.
Editor's Note: This article is published in the Spring, 2004 Educational Audiology Review (EAR). This version is slightly revised and is published here with permission of the authors and the Educational Audiology Review. ---Editor