We Need Current Info Before Writing Off Cochlear Implants

[Drew's Dad]

Wow. Talk about twisting viewpoints! One says use sign if the child has proven to be an oral failure at age 4 or 5. The other says incorporate it from the very beginning to prevent language acquisition delays. Those are two very separate methods, and fall on opposite ends of the pole.

I could draw circle diagrams of where the statements are consistent if you'd like. Unfortunately, however, I don't know how to post it.

 

[jillio]

I could draw circle diagrams of where the statements are consistent if you'd like. Unfortunately, however, I don't know how to post it.

You can draw all the diagrams you want, it still boils down to rick's post stating that if a child hasn't developed orally by the age of 4 or 5, then introduce ASL. That is the premise of functioning on the oral failure law, and it denies deaf children the opportunity to fuction at optimal capacity because you deny them toal access to language.

Shel, on the other hand, says by all means expose them to oral language, but expose them to ASL from the very beginning so they don't suffer the language delays when the above approach is used. If you cannot understand the differences in the two philosophies, I strongly suspect it is simply because you don't want to.

 

[shel90]

In the prior post you say you made an assumption, in the beginning of this post you defend your assumption as "valid", and in the end of this post you state that you did not make an assumption.

You're just scrambling to find any possible way to avoid admitting that you took Cloggy's post and looked for any way you could to try to "prove" that your way is right and thier way is wrong.

You weren't there, made an assumption (or not), conveniently ignore Cloggy's later description and characterization of the event, and supposedly conclusively determine that the language has failed based on "years of research".

End of my input on this particular issue. Others can make up their own mind on whether a child using a sign when they haven't learned a word yet indicates a failure with oral language.[/QUOTE]

What do u mean by that? If the child uses a sign, they havent learned a word yet? Signing are words themselves so I am confused by what you mean by that.

 

[shel90]

Pehaps you should re-read some of shel's posts. No where does she agree with the fact that one should wait until a child is 4 or 5 years old before exposing them to ASL. As a matter of fact, she advocates against waiting becase it serves nothing more than to create language delays that are detrimental to the child's development.

Right...no way, I accept the idea of introducing ASL later on if the child doesnt succeed in developing a proficient language from the oral only approach!!!! If people dont understand where I am coming from with this belief...this is what I see with my students, yes even those with CIs...thier parents got them into speech therapy and oral education immediately as soon as their diagnosis was made...well around the ages of 4 and 5, it was apparent that they are not picking up language from the oral only method so they send them to a signing environment..Think all is well? Not always..because the kids are at 4 or 5 years old, they are already 3 to 4 years behind in language development and have to start at square one with learning ASL as if they were infants. Then, by the time they are 6 or 7 or even 8 years old, their language development is at 3 or 4 years old and then they have to start learning how to read and write in ANOTHER language. It is hard enough for a hearing 3 or 4 year old to learn how to read and write in their own language but for deaf kids to have to learn a 2nd language through print is extremely challenging for them and eventually frustrations become so common, they end up losing motivation for learning. Since deaf children from deaf families have been exposed to signing since birth, by the time they are 5 or 6, they are ready to tackle on literacy skills even though it is in another language. Same thing for Spanish speaking children who know little or no English being ready to learn to acquire English and then read and write it. Both groups already have a strong L1 language to help them learn a 2nd language. If the child doesnt have a strong L1 language then...will be very difficult even though instruction is taught via ASL.

 

[rick48]

And, why is it again that oral language skills should be the first priority?

That is a parental decision best made by the parents based upon the individual needs and circumstances involving their child. Again, as I have said before, there is no one way or correct way to raise any child, let alone a deaf child. If that opinion bothers you then consider the following advice, "[p]osting to a public forum has as an inherent feature the risk of receiving replies that may contradict your particular viewpoint. If you are unable to accept this, then perhaps you need to limit yourself to those environments that are as limited in viewpoint as you yourself are."
Rick

 

[rick48]

You can draw all the diagrams you want, it still boils down to rick's post stating that if a child hasn't developed orally by the age of 4 or 5, then introduce ASL. That is the premise of functioning on the oral failure law, and it denies deaf children the opportunity to fuction at optimal capacity because you deny them toal access to language.

Shel, on the other hand, says by all means expose them to oral language, but expose them to ASL from the very beginning so they don't suffer the language delays when the above approach is used. If you cannot understand the differences in the two philosophies, I strongly suspect it is simply because you don't want to.

Actually, if you read my post, I clearly stated: "Taking Shel's example and assuming that the child has been deaf since birth or at most infancy, by age 4-5 they should be trying other strategies or methods other than oral only."

I dealt with the specific example Shel gave and you have erroneously extrapolated it into a general position. I used the age that Shel had given. No where did I state that you MUST wait until the child is 4-5 BEFORE employing strategies or methods other than oral only. If the parents are involved and actively monitoring and evaluating their child's progress with not just oral, but any strategy or method, I would hope that would have considered and began employing other strategies or methods by age 4-5 if the one they initially chosen is not working

 

[rick48]

I could draw circle diagrams of where the statements are consistent if you'd like. Unfortunately, however, I don't know how to post it.

Drew's Dad,

You are right in your analysis.
BTW I went to your website and it is great. What a tremendous resource you and others are providing with your blogs! Keep up the good work for I am certain the parents who are considering a ci for their child, will thank you for what you are doing!
Rick

 

[kayla123]

That's a wonderful situation, R2D2. It provides an atmosphere for natural language acquisition, rather than the forced sort of learning involved int he more formal therapies. And I'm sure you benefitted from it much more than you would have had you been sitting in formalized AV sessions.

Jillio, have you ever sat in on an AV lesson? I'm not sure but my guess is no. It's all about playing games and learning at the same time. It's not as cut throat as you think. Most of the time my daughter dos'ent want to leave when the hour is up. It is not forced by no means. To her it's experiencing with new games every week and for me it's learning how to make play time a learning experience at home with her.

 

[R2D2]

Right...no way, I accept the idea of introducing ASL later on if the child doesnt succeed in developing a proficient language from the oral only approach!!!! If people dont understand where I am coming from with this belief...this is what I see with my students, yes even those with CIs...thier parents got them into speech therapy and oral education immediately as soon as their diagnosis was made...well around the ages of 4 and 5, it was apparent that they are not picking up language from the oral only method so they send them to a signing environment...

I agree with you - I would not want to raise my child like that. The first 3 years is very important as far as language (either spoken or sign) acquisition is concerned and for this reason if I ever had a deaf child, we'd be doing both forms of communication.

 

[deafdyke]

Even more telling, is the fact I don't need any accomodation.

sr171soars, yes but what percentage of oral-only people function that well that they don't need accomondations? Although oral onlies don't need the services of a 'terp, they may need to use other accomondations, like FM system, ORAL 'terps, and other things like that. And that sort of stuff doesn't come cheap.

Oral skilled deaf people are considered to be "less expensive" to society than sign only skilled deaf people in monetary terms. I read somewhere that they consider CIs to be the second most cost effective medical procedure ever.

On the other hand what if you argued that Sign onliers (who are DEFINTLY in the minority) are "less expensive" b/c they aren't technology dependant the way oral onliers are. Technology raises the soaring cost of healthcare.

 

[R2D2]

sr171soars, yes but what percentage of oral-only people function that well that they don't need accomondations? Although oral onlies don't need the services of a 'terp, they may need to use other accomondations, like FM system, ORAL 'terps, and other things like that. And that sort of stuff doesn't come cheap.


On the other hand what if you argued that Sign onliers (who are DEFINTLY in the minority) are "less expensive" b/c they aren't technology dependant the way oral onliers are. Technology raises the soaring cost of healthcare.

I'm not sure what your point is. No one is saying that those who are oral skilled don't cost anything to society. But that society prefers the most cost effective option for maintaining and educating us individuals who are, let's face it, costly from birth anyway.

Technology may be expensive if you look at it by itself, but you have to look at the bigger picture in terms of analysing the cost benefits that it brings in the long run. Studies have shown that the CI has been very cost effective to society overall, even with the variability in the results of individuals.

 

[jillio]

That is a parental decision best made by the parents based upon the individual needs and circumstances involving their child. Again, as I have said before, there is no one way or correct way to raise any child, let alone a deaf child. If that opinion bothers you then consider the following advice, "[p]osting to a public forum has as an inherent feature the risk of receiving replies that may contradict your particular viewpoint. If you are unable to accept this, then perhaps you need to limit yourself to those environments that are as limited in viewpoint as you yourself are."
Rick

Can't you come up with anything original?

 

[jillio]

Jillio, have you ever sat in on an AV lesson? I'm not sure but my guess is no. It's all about playing games and learning at the same time. It's not as cut throat as you think. Most of the time my daughter dos'ent want to leave when the hour is up. It is not forced by no means. To her it's experiencing with new games every week and for me it's learning how to make play time a learning experience at home with her.

I have sat in on more AV sessions than I can count. And it is a forced situation of language development, because every situation is turned into something educational with intent. It is not the same unstructured atmosphere as with hearing parents/hearing children or deaf parents/deaf children. Play in and of itself is a learning experience without structure, and it is a necessary experience for healthy psychological development for the child and a healthy parent child relationship.

 

[LTHFAdvocate]

Actual device failure rates are quite low. A large study published in 2005 by the University of Michigan found that 5.1 percent of their surgeries are revision surgeries, that is, to replace an existing device and less than half of those were for internal electrode failure, which means over several years at a very large implant center, only 2.5 percent of their annual procedures are to replace devices where the electrode failed. There is an abstract summarizing this paper available on pubmed.org

Keep in mind that those numbers are for devices that were manufactured over many years, and the technology keeps improving. The failure rates cited at the recent CI 2007 conference in Charlotte for the newest generation of CIs is under 1 percent when you eliminate trauma as the reason for the device failure.

That's not to say it never happens. Of the 600 appeals we handled last year, I think 15 were to replace devices with internal failures. But the original poster is correct that it is REALLY important to distinguish reasons for bad outcomes, as there are many reasons for bad outcomes other than the device itself.

Someone mentioned etiology, specifically ossification, is occasionally associated with less than optimal outcomes. This is true, a couple of other etiologies associated with below average outcomes are Waardenburg Syndrome and Auditory Neuropathy. Waardenburg has to do with the density of neural ganglion which is really unpredictable in those patients, and Auditory Neuropathy results have to do with white noise being generated in the unimplanted ear -- assuming the patient doesn't have a bilateral implant, which obviously solves this problem. Note that there are people with Waardenburg and AN who get perfectly good results with either one or two implants, just as there are those with meningitis who get great results it is just that these are a couple of sources of HI that I've heard that can be associated with less than perfect CI results.

Sheri

 

[R2D2]

This is true, a couple of other etiologies associated with below average outcomes are Waardenburg Syndrome and Auditory Neuropathy. Waardenburg has to do with the density of neural ganglion which is really unpredictable in those patients, Note that there are people with Waardenburg and AN who get perfectly good results with either one or two implants,

That's interesting - I never heard that. I have Waardenburgs syndrome but the CI has worked out very well for me. I did find a paper on Pub Med that involved a study of children within Waardenburgs who were implanted and it found they had above average results so obviously there is variability even within questionable groups.

 

[jillio]

Actual device failure rates are quite low. A large study published in 2005 by the University of Michigan found that 5.1 percent of their surgeries are revision surgeries, that is, to replace an existing device and less than half of those were for internal electrode failure, which means over several years at a very large implant center, only 2.5 percent of their annual procedures are to replace devices where the electrode failed. There is an abstract summarizing this paper available on pubmed.org

Keep in mind that those numbers are for devices that were manufactured over many years, and the technology keeps improving. The failure rates cited at the recent CI 2007 conference in Charlotte for the newest generation of CIs is under 1 percent when you eliminate trauma as the reason for the device failure.

That's not to say it never happens. Of the 600 appeals we handled last year, I think 15 were to replace devices with internal failures. But the original poster is correct that it is REALLY important to distinguish reasons for bad outcomes, as there are many reasons for bad outcomes other than the device itself.

Someone mentioned etiology, specifically ossification, is occasionally associated with less than optimal outcomes. This is true, a couple of other etiologies associated with below average outcomes are Waardenburg Syndrome and Auditory Neuropathy. Waardenburg has to do with the density of neural ganglion which is really unpredictable in those patients, and Auditory Neuropathy results have to do with white noise being generated in the unimplanted ear -- assuming the patient doesn't have a bilateral implant, which obviously solves this problem. Note that there are people with Waardenburg and AN who get perfectly good results with either one or two implants, just as there are those with meningitis who get great results it is just that these are a couple of sources of HI that I've heard that can be associated with less than perfect CI results.

Sheri

So if the internal electrode is still working, but the patient receives no benefit from the devise, it is still considered to be successful? Does that also mean that the purpose of implantation is simply to provide the patient with a working electrode and not to provide usable auditory function at some level? I may be confused, but I thought CI was to assist the deaf with gaining that which they do not have. Of course, I guess they didn't have an electrode prior to surgery either, so they were given something they did not have. Just seems to me that if a devise is intended to accomplish a specific purpose, and it doesn't accomlish that for which it was intended no matter how well the individual parts are working on a mechanical level, it hasn't been very successful. Of course, I am looking at things from the deaf person who has been implanted perspective, not the manufacturer wishing to sell more implants perspective.

 

[R2D2]

So if the internal electrode is still working, but the patient receives no benefit from the devise, it is still considered to be successful?

I've heard of people who had soft failures being re-implanted and getting success the next time around. It's just that it isn't always able to be determined why the implant isn't working well for them even though it appears to be "working" - maybe with further technical research more reasons can be discovered.

I don't think though that such people are pushed out the doors and told to get on with it and that they are imagining things. Surgeons take their problems seriously.

 

[jillio]

I've heard of people who had soft failures being re-implanted and getting success the next time around. It's just that it isn't always able to be determined why the implant isn't working well for them even though it appears to be "working" - maybe with further technical research more reasons can be discovered.

I don't think though that such people are pushed out the doors and told to get on with it and that they are imagining things. Surgeons take their problems seriously.

Absolutely. I was merely trying to point out that success is a very subjective thing and it is dependent upon individual perspective. A manufacturer's definition of success is completely different from the patient's definition. And personally, because this is a surgery that is elective, and is undertaken to provide benefit to the patient, we need to look at more than mechanical success when assessing an overall rate.

 

[R2D2]

Absolutely. I was merely trying to point out that success is a very subjective thing and it is dependent upon individual perspective. A manufacturer's definition of success is completely different from the patient's definition. And personally, because this is a surgery that is elective, and is undertaken to provide benefit to the patient, we need to look at more than mechanical success when assessing an overall rate.

Yep, I concur. And success is subjective even among those whose implants are to all intents and purposes working in every way. A person that used to have very good hearing and was an involved musician might feel very dissatisfied with their implant even though they might hear speech and sounds reasonably well, whereas a deaf adult who has never heard sound might be extremely thrilled by the environmental only sounds that they hear.

 

[jillio]

Yep, I concur. And success is subjective even among those whose implants are to all intents and purposes working in every way. A person that used to have very good hearing and was an involved musician might feel very dissatisfied with their implant even though they might hear speech and sounds reasonably well, whereas a deaf adult who has never heard sound might be extremely thrilled by the environmental only sounds that they hear.

Agreed.