Pre-Implantation Communication Treatment for Children with Hearing Loss

描述（由申请人提供）：人工耳蜗植入体（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HL的早期识别和CI可以可行地完成的年龄之间存在时间滞后，通常至少6个月，通常更长。这种滞后，在此期间，儿童没有获得听觉语言输入，发生在一个敏感的时期，前语言沟通的发展（鲁本和施瓦茨，1999年）。许多患有CI的儿童表现出长期的语言结果不如听力正常的同龄人（Belzer & Seal，2009），语言前期可能是优化长期结果的重要时间。迄今为止，很少有研究探讨了有效的沟通干预儿童HL。本研究的目的是评估系统地教授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。核心假设是：（a）父母在关键时期使用视觉、触觉、反应和互动交流支持策略， HL识别和植入之间的语言发展将与植入前和植入后更大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。拟议研究的基本原理是提供有关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）确定植入前使用的哪些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和对照组之间父母使用的沟通支持策略，以及（c）比较各组之间语言前沟通和口语的增长。拟定研究将入组30例重度至极重度、双侧、先天性、感觉神经性HL儿童，这些儿童在24个月前接受CI。儿童将被随机分配到PICT或对照组。将在以下时间对两组儿童进行评估：（a）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6个月的干预：（a）在识别HL和植入之间的滞后时间（语言发育的重要时期）进行，（B）结合与更强语言技能相关的视觉、触觉、反应和互动交流支持策略;及（c）包括有系统的家长训练，可有效教导家长使用沟通支援技巧与其他儿童沟通。拟议的研究是重要的，因为它预计将应用，适应和测试的沟通策略，发现是有效的，在其他人群的儿童，从而推进语言发展领域的HL儿童，那里是一个显着缺乏沟通干预研究。

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.