The clinical relevance of an assessment protocol administered on children with cochlear implants

Abstract

Some children with severe to profound hearing loss are implanted with a cochlear implant on the hypothesis that short-term outcomes in auditory receptive skills can be utilized into greater social independence and quality of life. In order to measure the outcomes and progress achieved from cochlear implants, effective assessment protocols are vital. The purpose of assessment after cochlear implantation, is to monitor an individual child’s rate of progress in speech and language acquisition, with reference to other cochlear implant users; to collect data on the range of linguistic benefits observed against cochlear implant users over time and to investigate and amend unforeseen difficulties. Furthermore, the outcome measures provide concrete information to the multidisciplinary team, and parents, and for collection of prevalence data for further research, which is crucial for funding purposes. The dynamic and natural approach to assessment has been recommended as the most effective, to ensure a holistic assessment in young children with cochlear implants. The aim of the current study was to determine the relevance of an assessment protocol proposed by the Pretoria Cochlear Implant Programme. The protocol was administered on eight children in the transitional stage of spoken language development, within an inclusive educational setting. A descriptive research design was selected in order to describe the qualitative results obtained during the study. The following assessments were included in the protocol: A questionnaire on background information, an aided audiogram (with cochlear implants and hearing aids), speech discrimination, Speech in Noise Test; Developmental Assessment Schema (Auditory Communication), Developmental Assessment Schema (General Development), Rossetti Infant-Toddler Language Scale, Reynell Developmental Language Scales III (Verbal Comprehension), Speech Intelligibility Rating, Voice Skills Assessment, Preschool Literacy Assessment, Mother Infant Communication Scale, Caregiver-Child Interaction, Meaningful Auditory Integration Scale, Meaningful Use of Speech Scale and Profile of Actual Linguistic Skills. The results indicated that all the vital areas of assessment are included in the protocol, and under-evaluation is not a concern. Some of the areas of assessment overlap in the protocol, ensuring that the cross-check principle is being applied. The information gained from the assessment protocol can be used effectively for future intervention planning and adaptations can be made where necessary. Moreover, it was concluded that the administration and interpretation of the assessment protocol is time efficient and can be used effectively within a clinical setting. Cultural barriers did not have an effect on the administration and interpretation of the assessment protocol, however, linguistic barriers can influence the outcome of the results obtained. In summary, the assessment protocol has been found to be innovative, time effective, user-friendly, informative and relevant for the assessment of young cochlear implant users in the transitional stage of verbal linguistic development. Recommended changes for the assessment protocol were suggested, as well as recommendations for the educational setting. It was suggested that the questionnaires be available in all South African languages and that some of the protocols only be used if age-appropriate. Another recommendation was that the Listening Progress (LiP) and a pragmatic profile should be included in the protocol. Furthermore, it was suggested that an assistant audiologist could be involved to ensure more accurate and quicker hearing assessments.