The following is a conversation with Manal Sabri, a Speech-Language Pathologist at Jenny’s Clinic who is experienced in cochlear implant rehabilitation and bilingual speech therapy.
What are the typical decision pathways for parents of a deaf or profoundly hard of hearing child?
As a parent, learning your young child is deaf or hard of hearing is so difficult. Big decisions follow, along with intense speech and language therapy. Parents need to choose a pathway for their child – whether they want their deaf or hard of hearing child to communicate by sign language or spoken language, or both.
These are three main pathways:
- Sign language: With this approach, parents choose to have their child learn to communicate primarily by using sign language. Sometimes families start with this approach and move to using spoken language.
- Spoken language: children use hearing aids or cochlear implants to learn the different sounds and speech patterns, and communicate using spoken language.
- Total communication: Children use both spoken language and sign language to communicate.
For families who choose the pathway of spoken language or total communication for their child, many try hearing aids first. But if the child has a severe or profound hearing loss, hearing aids won’t provide sufficient auditory input. It is at that point that parents generally consider cochlear implants.
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What are cochlear implants?
A cochlear implant is an electronic hearing device that consists of two parts: a surgically implanted device and an external sound processor that is usually worn behind the ear. The two parts work together to provide the child with auditory input. The external piece collects the sound, turns it into digital information, then sends it to the implanted piece. The implanted piece turns the digital information into electrical signals that stimulates the auditory nerves, which send signals directly to the brain, which can then process the digital signals as sound.
It really is fascinating because the information sent to the child’s brain isn’t real sound like what we hear through our ears. It is electrical signals, and the brain knows how to process it.
How can Jenny’s Clinic help families that decide on cochlear implants?
At Jenny’s Clinic, we believe that each family and each child is unique. Intervention is tailored to the family’s and the child’s needs. We can work with you every step of the way. We are adept at providing all the information you need to choose a path forward when you learn your child is deaf or hard of hearing, and providing emotional support as you make this important decision and move forward. We are also expert at early intervention for families who are on the path to decide on cochlear implants for their deaf or hard of hearing child.
We can start therapy when children have hearing aids, whether or not the child will go on to get cochlear implants. We can also teach parents about cochlear implants and what they need to do even before their child gets the implants.
We also provide free consultations for parents. If you would just like to talk to someone familiar with hearing loss and cochlear implants, you can call Jenny’s Clinic to schedule a free 15-minute phone session with myself or another Speech Therapist.
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How is speech therapy tailored for children with cochlear implants?
When parents envision their child becoming verbal — whether the child already has or is getting cochlear implants — speech therapy focuses on listening, the processing of auditory input, and using that input to understand and produce speech.
Speech therapy for children who are deaf or hard of hearing starts with auditory rehabilitation. We have to teach them what everything sounds like – water, birds, cars, thunder, dogs barking and all the other crucial and ambient sounds in our word – in addition to the sounds of words. Hearing children learn these sounds through exposure over time, but for children with cochlear implants, knowing these sounds doesn’t come naturally; they have to learn them. At Jenny’s Clinic, we also teach families strategies to use throughout the day while talking with their child in order to make the most of their hearing.
According to the National Institute on Deafness and Other Communication Disorders (NIDCD), more than 90% of parents that have children who are deaf or hard of hearing are hearing themselves. Many hearing parents choose the hearing pathway for their child because they want their child to be part of the hearing community and because they themselves don’t know how to sign fluently and usually none of their family or extended family know how to sign.
For me, this process is very rewarding; it’s amazing to teach a child every single sound. Empowering parents by giving them the knowledge, skills, and strategies needed to help their child is my passion!
What is early intervention for children who are deaf or profoundly hard of hearing, and why is it so important?
“Early intervention” is providing help and services to the patient as early as possible. For the best outcomes, we have to intervene as close as possible to the diagnosis. The less time lapses between the diagnosis of hearing loss and the beginning of therapy, the better the outcomes. When a family chooses cochlear implants, the sooner the child gets the implant (currently as early as 12 months of age) and intervention, the better the outcome will be.
Research shows that generally children who were implanted before 18 months followed by intense speech therapy had better outcomes and were more able to recognize sounds and produce speech.
At Jenny’s Clinic, we believe it’s important to intervene even before children receive the cochlear implant. We use the time before the implantation to teach signs, educate, and provide emotional support for parents. It’s important that families become more comfortable and knowledgeable about what therapy will entail so that they are ready to start using the strategies after the implant.
A critical part of intervention and therapy is parent coaching and training. The hardware of the cochlear implant won’t make a child become hearing overnight. Instead, it just provides child access to sound. Intensive therapy and support from parents is what will help child understand what he or she is hearing. We like to attribute of 30% of the success with cochlear implants to the hardware and 70% of the success to therapy and parent coaching of the child.
According to research, these are some of the key factors that produce better outcomes in speech therapy for children with cochlear implants:
- Early implantation of the cochlear implants
- High parental and family involvement
- Lack of other disabilities that the child and family need to address
What expertise do you bring, as a Speech-Language Pathologist at Jenny’s Clinic?
I have a daughter, who is now 7 years old, who received bilateral cochlear implants six years ago. I have been through this process with her, from the diagnosis, the decision making of getting a cochlear implants, the surgery, to speech therapy services that included parental training – and it inspired me to change my career from software engineer to speech therapist. I’m bilingual, Arabic-English speaker, and it was very important to my husband and me for our daughter to speak both languages. So I used the parent coaching I received during her speech therapy services and I made my own Arabic material for her. I was her speech therapist for Arabic before actually becoming a certified speech therapist.
Because of this experience, in addition to earning my degree in Speech-Language Pathology from the University of Arizona, I completed additional clinical and course work to earn a Bilingual Certificate in Speech-Language Pathology. I studied how monolingual and bilingual children acquire and learn language. Then I decided to combine my knowledge and passion of bilingualism and cochlear implants and wrote my master’s thesis on the phonological development (which is the acquisition of sounds) in a bilingual child with cochlear implants.
I bring my personal experience with everything from dealing with insurance, to troubleshooting the cochlear implants, to trying to keep the implants on a young child at all times, to the specialized therapy techniques. I want to help parents as much as I can – I would love to help them the way I was helped. I want to give them the skills and tools they need, and I’m very passionate about it.
What is it like to be a parent of a child with cochlear implants?
Not easy. When my daughter was very young, like most parents, I thought she had normal hearing. It was heartbreaking to learn she had a profound hearing loss. It crossed my mind that she would never have friends, go to college, or listen to music. But with a great support team who taught me a lot of skills to help my daughter, I didn’t feel helpless. With every success, we celebrated.
With the right support and right education, addressing a child’s profound hearing loss or deafness no longer feels impossible, especially for families with a good early intervention team.
Given my experience, I really try to empower parents. It makes a big difference in their attitude about the situation. I help them develop an attitude of ‘I can do this. I can see how I am helping my child.’
Therapy for cochlear implants is a commitment. It becomes part of your daily routine. Once you learn the strategies, you might start to sing about everything (brushing teeth, eating, tying shoes, getting in the car). When you sing, a child is almost always more interested in what you’re saying, and he or she wants to sing too.
I started baby signs even before I knew my daughter had a hearing loss. I recommend it for all parents because (in my experience) baby signs reduce frustration for all kids. Signs are easier than words for toddlers. And we use these signs later on, once the child has access to sound, to teach the meaning of sounds and words. For instance, hearing babies learn what a bird is by sight and sound. When they recognize a bird, you give them a sign for a bird. Hearing children can make the connection between the sight, sign, and the sound of a bird. For deaf or hard of hearing children this process is facilitated by therapy. Once a child gets cochlear implants, he or she has to be taught to associate the bird’s sound with the sight and sign of the bird and then the verbal production of the word “bird.”
The more effort you, as a parent, put into it, the more you get. And you have to be patient and stick with it. Speech therapy for children with cochlear implants generally requires several years, but the timeframe isn’t the same for every child. It depends on parent involvement and how quickly the child picks up the skills.
What programs for families with children with cochlear implants does Jenny’s Clinic offer?
This fall, Jenny’s Clinic will start a regular family cochlear implant therapy group in Tucson, Arizona. This will be one of the only therapy groups in the Tucson area for families of children with cochlear implants. We will focus on children ages 3 through 5 years, since 3 years old is the age when state-supported early intervention services typically end.
The group will be based on auditory-verbal therapy to build listening skills that help children expand their spoken and listening language. We will also teach parents strategies for helping their children with cochlear implants learn these important auditory skills. It will also build community: parents can meet other parents; children can interact and share experiences with other children with cochlear implants; and parents and children alike can learn what works for each other. I look forward to working with new families in this group!