Cued speech in the stimulation of communication: an advantage
in cochlear implantation
Ch. Descourtieux *, V. Groh, A. Rusterholtz, I. Simoulin, D. Busquet
Codali, 47 rue de ja6el, Paris, 75015, France
Accepted 2 September 1998
Iternational Journal of Pediatric Otorhinolaryngology
Volume 47, Issue 2
Pages 205-207
in cochlear implantation
Ch. Descourtieux *, V. Groh, A. Rusterholtz, I. Simoulin, D. Busquet
Codali, 47 rue de ja6el, Paris, 75015, France
Accepted 2 September 1998
Iternational Journal of Pediatric Otorhinolaryngology
Volume 47, Issue 2
Pages 205-207
In the first 3 years of the deaf child’s life, the habilitative project aims to establish elaborate multi-modal communication, which in turn facilitates
the child’s cognitive development and subsequent access to a structured linguistic system. Codali, a Paris-based oral program, seeks this very objective, with one pertinent particularity: that of using cued speech from the outset to render communication meaningful, all of this in the service of developing oral language. Our hypothesis has been from the start that the visual channel can replace the auditory channel in the perception of the totality of elements in the chain of speech. The deaf child can achieve a comparable level of language to that of a hearing child and he follows the same linguistic evolution (transparency).
Cued speech facilitates oral communication and permits the deaf child access to a fully structured linguistic model. This notion of model is fundamental:
it implies the child’s capacity to memorize linguistic elements in their correct form (lexical and syntactic). In the very principles of its conception, cued
speech renders visible the syllabic organization of our linguistic system. Several recent studies emphasize the importance of the syllable as the basic
unit of speech, perceived even by hearing babies as early as 3–4 months. A deaf baby who receives cued speech develops this skill as well. Little by
little, he attaches meaning to the hand configurations and even reproduces some of these cues to name and evoke things. In the same way, the child
develops a stock of vocabulary words.
Recent work by the Belgian team of Alegria, Leybaert, Charlier, and Hage emphasizes the importance of phonological representations which appear to play, in the case of hearing children, a large role in the acquisition of reading skills. Cued speech completes the partial representations which deaf children receive from lipreading. Complementing lipreading with visual representation
of all the phonemes, cued speech emphasizes the pertinent contrasts by means of which we construct the phonological grid necessary to analysis
of speech.
In our work with very young children, we have noted that specific strategies favor this access to phonology, rendering it attainable by all children. For example, the deliberate choice of a vocabulary of both mono and bisyllabic words placing a specific cue in relief facilitates access to an arbitrary yet meaningful phonetic code (my examples are in French), i.e. aime, oui, non, bobo, aie, and coucou. From this semantic code learned, at first globally, the child must learn to extract phonemes to construct his phonological grid. In order to hasten this process, words will be presented, most often in binary pairs, to teach the child to discriminate:
Fine contrasts at the level of cues (both configuration and position) words which read identically on the lips but are cued differently (once again, my examples are in French), i.e. papa and maman.
Fine contrasts at the level of labial images: words with different labial images having identical cues, i.e. chat and chaud.
Fine contrasts at the level of the sequence of elements: words of different lengths demonstrating the importance of the order of the elements, i.e. chocolat and coca cola.
Since 1992, with the implantation of a postlingually deafened adolescent, Codali has been confronted with the impact of this new technology on its habilitative project: will cued speech, which stimulates the visual channel, ease to be useful, perhaps even be contraindicated in the long habilitative
process both pre- and post-implant?
In 1994, several children, all congenitally profoundly deaf, have been implanted. The results obtained with these children have helped us to refine our position. Here are several cases, by way of example:
Vincent: implanted at 2 years, 9 months.
Before implantation, Vincent has rich lexical comprehension and phonetic discrimination that is already precise. He uses cues to express himself, as he
produces almost no prattle. After 6 months of implant use, Vincent understands by audition alone the words of his already extensive vocabulary. After 2 years of implant use, he can follow a conversation without lipreading.
He speaks with intelligible speech.
Mathilde: implanted at 5 years, 9 months.
Before her implantation, Mathilde understands a short, ordinary conversation by means of lipreading and cued speech. She has developed a good vocabulary for her age and her degree of deafness. After 6 months of implant use, Mathilde has a perfect score by means of audition alone on a closed list of 12 words and she understands several words on an open list. She has developed auditory feedback which improves the quality of her speech. Today Mathilde is 7 years old. She understands sentences on an open list and is beginning to use the telephone.
Maxime: implanted at 2 years, 8 months.
Before his implantation, Maxime understands simple short sentences in context. He has acquired a rich stock of vocabulary for his age. He expresses
himself orally, thanks to residual hearing in the low frequencies. After 6 months of implant use, Maxime identifies the majority of words on a closed list by means of audition alone, and he understands some ordinary words on open list. His oral language is becoming increasingly rich and his articulation more precise. The study of these three cases has led us to some preliminary conclusions: the children who have a comprehension of words by the visual
channel before implantation manage after 6 months of implant use to understand these words by the auditory channel alone. The phonological
grid acquired by the visual channel appears to be tranferable to the auditory one. However, during the first months of implant use, the auditory capacity is limited to the recognition of words known prior to implantation. Auditory perception of an implanted child remains imperfect and therefore the identification of new words necessitates the continued use of cued speech so that phonological representations remain correct. After a year of auditory habilitation with the implant, Vincent and Mathilde are now capable of learning new words by auditory means alone. Not enough time has yet elapsed for Maxime to have reached this stage.
The example of Francois, implanted at 2 years, 11 months, illustrates perfectly the importance that should be accorded to the visual channel
after implantation. Before his implantation, Francois had a structured mode of communication that was essentially nonverbal. He shows interest in the face and in lipreading. He recognizes in context a few highly differentiated configurations of cued speech. In the closed list test of 12 words with lipreading and cued speech he has a score of zero. He produces meaningless prattle without much variation. After 6 months of implant use, Francois begins to be motivated to communicate orally. Cued speech continues to be used as a complement to lipreading and hearing. He oralizes spontaneously the words he understands, accompanied by their cues. On the closed list test,
his score becomes positive: greater than 50%. He develops a stock of everyday words by combined visual and auditory channels. However, not a
single word is recognized by audition alone. This example shows us that oral comprehension does not develop exclusively by the auditory channel
but that it necessitates an audio-visual complementarily.
At the present moment, many teams are noting that congenitally profoundly deaf children who receive early implants rapidly develop an efficient auditory perception of environmental sounds but progress more slowly as a rule in the domain of speech. The development of deaf children who have received cued speech intensively disproves these findings, insofar as analysis of speech is
concerned. In fact, the results obtained from our population suggest that:
The more the young child has developed oral communication by the visual channel (cued speech) prior to implantation, the more analysis of phonetic and linguistic elements by auditory means will occur rapidly after implantation.
Additionally, if linguistic acquisitions have been limited or even inexistent prior to implantation, it is indispensable and efficient to continue to have recourse to the visual channel (cued speech) in association with the auditory
channel in order to build phonological representations and to develop oral language.
For these reasons, cued speech remains, for us, a beneficial tool in implant habilitation, facilitating speech perception by the auditory channel on the part of early-implanted, congenitally deaf children .
