Speech, vocabulary, and the education of children using cochlear implants:Oral or total communication?

This study examines the relationship between he teaching method, oral or to tal communication, used at children's schools and children's consonant-prod uction accuracy and vocabulary development over time. Children who particip ated in the study (N = 147) demonstrated profound sensorineural hearing los s and had used cochlear implants for between 6 months and 10 years. Educati onal programs that used an oral communication (OC) approach focused on the development of spoken language, whereas educational programs that used a to tal communication (TC) approach focused on the development of language usin g both signed and spoken language. Using Hierarchical Linear Modeling (HLM) we compared the consonant-production accuracy, receptive spoken vocabulary , and expressive spoken and/or signed vocabulary skills, over time, of chil dren who were enrolled in schools that used either OC or TC approaches, whi le controlling for a number of variables. These variables included age at i mplantation, preoperative aided speech detection thresholds, type of cochle ar implant device used, and whether a complete or incomplete active electro de army was implanted. The results of this study indicated that as they used their implants the ch ildren demonstrated improved consonant-production accuracy and expressive a nd receptive vocabulary over time, regardless of whether their school emplo yed a TC or OC teaching method. Furthermore, there appeared to be a complex relationship among children's performance with the cochlear implant, age a t implantation, and communication/teaching strategy employed by the school. Controlling for all variables, children in OC programs demonstrated, on av erage, superior consonant-production accuracy, with significantly greater r ates of improvement in consonant-production accuracy scores over time compa red to children in TC programs. However, there was no significant differenc e between OC and TC groups in performance or rate of growth in consonant-pr oduction accuracy when children received their implants before the age of 5 years. There was no significant difference between the OC and TC groups in receptive spoken vocabulary scores or in rate of improvement over time. Ho wever, children in the TC group achieved significantly higher receptive spo ken vocabulary scores than children in the OC group if they received their implant before the age of 5 years. The TC group demonstrated superior score s and rates of growth on the expressive vocabulary measure (spoken and/or s igned) when compared to the OC group if they received their implants during their preschool or early elementary school years. There was no significant difference if the children received their implants during middle elementar y school. Regardless of whether children were in the OC or TC group childre n who received their implants during preschool demonstrated stronger perfor mance, on average, on all measures over time than children who received the ir implants during their elementary school years. The results of this study suggest that children may benefit from using cochlear implants regardless of the communication strategy/teaching approach employed by their school pr ogram and that other considerations, such as the age at which children rece ive implants, are more important. implications and future research needs ar e discussed.