Perspectives of adults with cochlear implants on current CI services and daily life.

This paper reports on a survey and interviews carried out with adults who have gone through the cochlear implantation pathway. It explores their experiences of current services, the assessment process for implantation, and the impact on their daily lives, including views and experiences on communication, independence and confidence. It also explores, in today's financially challenging climate, their awareness of current funding issues and the value of their implant to them.

Cochlear implantation in children with complex needs: the perceptions of professionals at cochlear implant centres.

OBJECTIVE: To explore the views of cochlear implant centre teams about the process of referral, assessment and rehabilitation for children with complex needs. METHODS: An on-line survey of cochlear implant centres in the UK and in the Netherlands was carried out, with both quantitative and qualitative questions. The survey was designed and piloted by four professionals in each country, experienced in working in cochlear implant services, and with complex children. The open qualitative responses were analysed independently for the emergent themes. RESULTS: Seven centres from Netherlands and eight from UK responded. The proportion of children reported with complex needs ranged from under 10% to between 40 and 60%. Children with complex needs were more likely to be later referred than the norm, and to take longer to assess. There was little agreement about the assessments used prior to implantation, or in follow-up. The most commonly seen additional disability was visual, followed by motor/physical challenges and autistic spectrum disorders. The most reported challenge was assessment, followed by parental expectations, and wearing the system. The least reported concern was educational management. The major goal was seen to be hearing and sensory input, rather than speech and language attainment. All centres commented on the importance of parental observation. CONCLUSION: There is a need for a consensus on the assessment of these children, with the development of more objective parent led observation measures to collect long-term data across centres. Closer collaboration with educators, particularly those with other expertise, would facilitate long-term management and asssessment. Data logging, now available, will help monitor wearing and use of system.

LEAPing on with language: An on-line language programme to support classroom teachers and parents of primary school children (aged 5-11 years).

The Leaping on with Language programme provides a combination of strategies and activities to accelerate children's spoken language use from simple sentences to complex language. Using a conversational philosophy it expands the building blocks of language (vocabulary, grammar, speech), whilst emphasising the importance of developing independent social communication and acknowledging a child's developing self esteem and self identity between the ages of 4-11. Three pilot projects evaluated the programme with a total of 51 delegates. The outcomes were hugely positive. Changes in behaviour were reported from the 3rd pilot 1 month later. Comments regarding the length of training, practical strategies and more film clips were implemented. Leaping on with language is now a free to access resource available on line.

Parent interaction course in order to enhance communication skills between parents and children following pediatric cochlear implantation.

OBJECTIVE: To assess the effect of a parent interaction training course on the communication skills of parents of young implanted children. The training course was designed to help parents to be less controlling in their interactions with their deaf children and to facilitate the development of spoken language. STUDY DESIGN: Prospective study comparing the communication skills of parents of deaf children fitted with cochlear implants before and after a parent interaction training course. SETTING: Pediatric tertiary referral center for cochlear implantation. METHODS: Video samples were taken of parents interacting with their children 1 month before the course (ranging from 15 days to 2 months) and after the course (ranging from 15 days to 1 month). Video samples were then transcribed orthographically and parents' turns in the interaction were assigned to one of two categories: (a) initiations--the parent initiates conversation or introduces a new topic and (b) responses--the parent responds to the child's previous turn. 12 months after completion of the course, the process was repeated in order to establish the relative permanence of changes in behavior. HYPOTHESIS: The parents' turns would shift from a predominance of initiations to a predominance of responses as a result of attendance on the course. This would demonstrate that the parents were less controlling of their children in communication and were exhibiting more contingent behavior--responding to their child's initiations rather than expecting the child to respond to theirs. PATIENTS: The study involved 17 parents of 11 implanted children. The mean age at implantation was 4 years (range: 2.2-6.3 years). The implant experience of the children ranged from 2 to 23 months at the time of the study. All children used total communication. RESULTS: The post-course initiations were half those of the pre-course ones (median from 14 decreased to 7) and the responses were almost double following the course (median from 8 increased to 14). Both differences were statistically significant (P < 0.05). 12 months after the course, the responses score remained high with a median score of 16.5. However, a slight but significant increase in the initiation scores was also noted (median from 7 to 8.5). Parental satisfaction of the course was found to be high as no families failed to attend on any of the occasions despite the great distances some of them had to travel. CONCLUSION: The format of the parent interaction training course was found to be highly acceptable to the parents and the components covered proved to be effective in promoting positive changes in parental communication behavior. Clinicians need to provide a responsive environment for implanted deaf children and help others to do the same. The training course provided a very useful forum to share insights and skills and to evaluate ways of enhancing the communication between parents and children following cochlear implantation.