Speech rehabilitation in children with cochlear implants using a multisensory (French Cued Speech) or a hearing-focused (Auditory Verbal Therapy) approach

Abstract

IntroductionEarly exposure to a rich linguistic environment is essential as soon as the diagnosis of deafness is made. Cochlear implantation (CI) allows children to have access to speech perception in their early years. However, it provides only partial acoustic information, which can lead to difficulties in perceiving some phonetic contrasts. This study investigates the contribution of two spoken speech and language rehabilitation approaches to speech perception in children with CI using a lexicality judgment task from the EULALIES battery. Auditory Verbal Therapy (AVT) is an early intervention program that relies on auditory learning to enhance hearing skills in deaf children with CI. French Cued Speech, also called Cued French (CF), is a multisensory communication tool that disambiguates lip reading by adding a manual gesture.MethodsIn this study, 124 children aged from 60 to 140 months were included: 90 children with typical hearing skills (TH), 9 deaf children with CI who had participated in an AVT program (AVT), 6 deaf children with CI with high Cued French reading skills (CF+), and 19 deaf children with CI with low Cued French reading skills (CF-). Speech perception was assessed using sensitivity (d’) using both the hit and false alarm rates, as defined in signal-detection theory.ResultsThe results show that children with cochlear implants from the CF- and CF+ groups have significantly lower performance compared to children with typical hearing (TH) (p < 0.001 and p = 0.033, respectively). Additionally, children in the AVT group also tended to have lower scores compared to TH children (p = 0.07). However, exposition to AVT and CF seems to improve speech perception. The scores of the children in the AVT and CF+ groups are closer to typical scores than those of children in the CF- group, as evidenced by a distance measure.DiscussionOverall, the findings of this study provide evidence for the effectiveness of these two speech and language rehabilitation approaches, and highlight the importance of using a specific approach in addition to a cochlear implant to improve speech perception in children with cochlear implants.

Language profile of children with cochlear implants: comparative study about the effect of age of cochlear implantation and the duration of rehabilitation

“…Our results are coinciding with the results of Ertmer and Goffman [24] who found that the expressive skills were not significantly improved for prelingual children after one year of post cochlear implantation therapy. Furthermore Van Bogaert el al [25] displayed that auditory verbal therapy post cochlear implantation considered basic requirement for children's language development, they found that children with CI who enrolled in an auditory-focused speech rehabilitation approach showed significant improvement of their speech perception performance. The advantage of appropriate duration of auditory and speech therapy after cochlear implantation in improving hearing and oral communication was emphasized by other authors [26].…”

An examination of the influence of Cued Speech proficiency on segment and cluster accuracy in French-speaking children with cochlear implants

“…But some studies have also demonstrated longer-term benefits of a Cued Speech education: children who have been exposed to Cued Speech have better performance to phonological awareness tasks than their peers (e.g. Charlier & Leybaert, 2000;LaSasso et al 2003), and better performance to audio-only speech perception tasks (Kos et al, 2009;Van Bogaert et al, 2023). The hypothesis explored in this paper is that Cued Speech education provides children with hearing impairment with better phonological representations, which will translate into better speech production skills.…”

“…To that aim, phoneme and cluster accuracy in French children with cochlear implants is compared across different levels of Cued Speech proficiency. As suggested by Colin et al (2015;2017), and more recently Van Bogaert et al (2023), the child's individual ability to decode manual cues (i.e. Cued Speech proficiency) is a key factor when studying the effects of Cued Speech exposure.…”

“…CS+, CS-, TH groups). Statistical analysis following the method described in Van Bogaert et al (2023), which consists in, first, modelling the mean performance and variability of TH children according to age, and second, situating the performance of children with hearing impairment with reference to typically-hearing peers of the same age.…”