Predictors of Spoken Language Development Following Pediatric Cochlear Implantation
Predictors of Spoken Language Development Following Pediatric Cochlear Implantation
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DOI：
10.1097/aud.0b013e3182503e47
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发表时间：
2012-09-01
期刊：
影响因子：
3.7
通讯作者：
van Wieringen, Astrid
中科院分区：
文献类型：
--
作者：
Boons, Tinne;Brokx, Jan P. L.;van Wieringen, Astrid
目的：尽管植入人工耳蜗的聋儿能够发展良好的语言技能，但结果的巨大差异仍然是一个值得关注的问题。本研究的第一个目的是评估儿童的语言技能与CI建立基准。第二个目的是估计植入时的最佳年龄，以便为儿童提供最大的机会，使其在植入后获得良好的语言技能。第三个目的是获得更深入的了解变异的原因，以设置优化的康复过程中的语前聋儿童CIs.Design的建议：接受和表达的语言发展的288名儿童谁收到CI的年龄5岁进行了分析，在一项回顾性多中心研究。结果指标为植入后1年、2年和3年时的语言能力（LQs），采用Spellell发展语言量表和Schlichting表达语言测试。独立的预测变量是9个儿童相关的，环境和听觉因素。一系列的多元回归分析确定的表达和接受的语言成果的方差的金额，可归因于每个预测因素时，控制其他variables.Results：简单的线性回归与年龄在第一次拟合和独立样本t检验表明，儿童植入前的两个年龄比儿童植入在年龄较大的所有测试中表现显着更好。平均LQ为0.78，SD为0.18。与两岁以前植入的其他聋儿相比，植入后3年内LQ低于0.60（= 0.78-0.18）的儿童被标记为弱表演者。使用第二个CI或助听器进行侧旁刺激以及没有其他残疾与更好的语言结果相关。环境因素的影响，包括多语言，父母的参与和沟通模式随着时间的推移而增加。植入后三年，总的多元回归模型占52%的接受性语言成绩的方差和58%的表达性语言scores.Conclusions的方差：在语言测试成绩的基础上，这一大群孩子，一个LQ为0.60或更低被认为是一个风险标准，有问题的语言发展与其他聋哑儿童使用CI。智商低于0.60的儿童应该受到更密切的监测，也许他们的康复计划应该重新考虑。改善的语言结果与两岁以下的植入、对侧刺激、单语、父母的充分参与和父母的口头交流有关。存在额外的学习障碍对语言发展有负面影响。了解这些变异的原因可以帮助临床医生和家长为CI儿童创造最佳的语言习得环境。
Objectives: Although deaf children with cochlear implants (CIs) are able to develop good language skills, the large variability in outcomes remains a significant concern. The first aim of this study was to evaluate language skills in children with CIs to establish benchmarks. The second aim was to make an estimation of the optimal age at implantation to provide maximal opportunities for the child to achieve good language skills afterward. The third aim was to gain more insight into the causes of variability to set recommendations for optimizing the rehabilitation process of prelingually deaf children with CIs.Design: Receptive and expressive language development of 288 children who received CIs by age five was analyzed in a retrospective multicenter study. Outcome measures were language quotients (LQs) on the Reynell Developmental Language Scales and Schlichting Expressive Language Test at 1, 2, and 3 years after implantation. Independent predictive variables were nine child-related, environmental, and auditory factors. A series of multiple regression analyses determined the amount of variance in expressive and receptive language outcomes attributable to each predictor when controlling for the other variables.Results: Simple linear regressions with age at first fitting and independent samples t tests demonstrated that children implanted before the age of two performed significantly better on all tests than children who were implanted at an older age. The mean LQ was 0.78 with an SD of 0.18. A child with an LQ lower than 0.60 (= 0.78-0.18) within 3 years after implantation was labeled as a weak performer compared with other deaf children implanted before the age of two. Contralateral stimulation with a second CI or a hearing aid and the absence of additional disabilities were related to better language outcomes. The effect of environmental factors, comprising multilingualism, parental involvement, and communication mode increased over time. Three years after implantation, the total multiple regression model accounted for 52% of the variance in receptive language scores and 58% of the variance in expressive language scores.Conclusions: On the basis of language test scores of this large group of children, an LQ of 0.60 or lower was considered a risk criterion for problematic language development compared with other deaf children using CIs. Children attaining LQs below 0.60 should be monitored more closely and perhaps their rehabilitation programs should be reconsidered. Improved language outcomes were related to implantation under the age of two, contralateral stimulation, monolingualism, sufficient involvement of the parents, and oral communication by the parents. The presence of an additional learning disability had a negative influence on language development. Understanding these causes of variation can help clinicians and parents to create the best possible circumstances for children with CIs to acquire language.