Pre-Implantation Communication Treatment for Children with Hearing Loss

描述(由申请人提供)：人工耳蜗(CI)的开发和实施是治疗儿童听力损失(HL)的一个非常重要的进步。然而，在早期发现HL和完成CI的年龄之间存在一段时间间隔，通常至少6个月，通常更长。在此期间，儿童无法获得听觉语言输入，这一滞后发生在语言前交流发展的敏感期(Ruben&Schwartz，1999)。许多顺式听力障碍儿童的长期语言成绩不如听力正常的同龄人(Belzer&Seal，2009)，语言前阶段可能是优化长期结果的重要时期。到目前为止，很少有研究对HL儿童进行有效的沟通干预。本研究的目的是评估系统地教父母使用沟通支持策略对植入前语言沟通和植入后口语技能的影响。中心假设是：(A)父母在关键时期对视觉、触觉、反应和互动沟通支持策略的使用 HL识别和植入之间的语言前发展将与植入前后更好的儿童沟通技能相关，以及(B)系统的父母培训将导致更多地使用这些策略。这项拟议研究的基本原理是提供有效的植入前沟通治疗(PICT)策略的初步证据，随后可能会在更大范围内进行测试。具体目标包括：(A)确定植入前使用的沟通支持策略预测植入前语言前沟通和植入后口语技能；(B)比较PICT组和对照组父母对沟通支持策略的使用；(C)比较不同组之间语言前沟通和口语的发展。这项拟议的研究将招募30名患有重度至深度、双侧、先天性、感觉神经性HL的儿童，他们在24个月前接受顺铂治疗。儿童将被随机分配到PICT或对照组。将对两组儿童进行评估：(A)在研究开始时，(B)植入前1周，(C)植入后6个月和(D)12个月。PICT组的儿童将接受为期6个月的干预：(A)在发现HL到植入--语言发展的一个重要时期--之间的滞后时间内提供；(B)采用与更强的语言技能相关的视觉、触觉、反应和互动沟通支持策略；以及(C)包括经证明有效的系统家长培训，以教父母在其他儿童群体中使用沟通支持技能。这项研究具有重要意义，因为它有望应用、调整和检验在其他儿童群体中有效的交流策略，从而推动HL儿童语言发展领域的发展，而这方面的交流干预研究严重不足。

DESCRIPTION (provided by applicant): The development and implementation of the cochlear implant (CI) is a highly significant advance in treating hearing loss (HL) in children. However, there is a time lag between early identification of HL and the age at which the CI can feasibly be completed, often at least six months and usually longer. This lag, during which children do not have access to auditory linguistic input, occurs during a sensitive period of prelinguistic communication development (Ruben & Schwartz, 1999). Many children with CIs exhibit long-term language outcomes inferior to their peers with normal hearing (Belzer & Seal, 2009) and the prelinguistic period may be an important time for optimizing long-term outcomes. To date, few studies have examined effective communication interventions for children with HL. The objective of the proposed study is to evaluate the effects of systematically teaching parents to use communication support strategies on pre-implantation preliguistic communication and post-implantation spoken language skills. The central hypothesis is: (a) that parental use of visual, tactile, responsive, and interactive communication support strategies during the critical period of preliguistic development between HL identification and implantation will be associated with greater child communication skills before as well as after implantation, and (b) that systematic parent training will result in greater use of these strategies. The rationale for the proposed stud is to provide preliminary evidence regarding effective pre-implantation communication treatment (PICT) strategies that subsequently may be tested on a larger scale. The specific aims include: (a) determining which communication support strategies used prior to implantation predict pre-implantation prelinguistic communication and post-implantation spoken language skills, (b) comparing parental use of communication support strategies between PICT and control groups, and (c) comparing growth in prelinguistic communication and spoken language between groups. The proposed study will enroll 30 children with severe-to-profound, bilateral, congenital, sensorineural HL who receive CIs before 24 months. Children will be randomly assigned to either PICT or a control group. Children in both groups will be assessed: (a) at the start of the study, (b) 1 week prior to implantation, (c) 6 months and (d) 12 months following implantation. Children in the PICT group will receive 6-months of intervention that: (a) is delivered during the lag time between identification of HL and implantation - an important period of language development, (b) incorporates visual, tactile, responsive and interactive communication support strategies that are associated with stronger language skills; and (c) includes systematic parent training found to be effective in teaching parents to use communication support skills in other populations of children. The proposed research is significant, because it is expected to apply, adapt and test communication strategies found to be effective in other populations of children, thereby advancing the field of language development in children with HL, where there is a striking paucity of communication intervention research.