Benefit of Cochlear Implantation in Children with Multiple-handicaps: Parent's Perspective

Abstract Introduction The cochlear implants centers in the world are studying the cochlear implantation in children with multiple handicaps. Objective To develop a questionnaire to analyze the subjective benefits of the cochlear implantation in multiple handicapped children according to their parent's perspective. Methods A questionnaire was applied to 14 families of multiple handicapped children, aging from 2-12 years old and having from 11 months to 11 years of implant use. Results The social-emotional abilities were improved because of many factors, such as: auditory exposure, which happened in 84% of the children; recognition of their own names, which increased in 56%; and development of eye contact, in 28% of the subjects. Other benefits appeared to be: music appreciation and more attention and adherence to other therapies and school activities. Besides, some children became interested in objects, playing with other children, and more adapted to daily routines. Thirty-five percent of the children acquired oral language, mainly the bilaterally implanted, while 14% of them were engaged in sign language. Although all of the children showed a significant improvement in communication, the emotional issues of some families and the severity of the handicaps negatively impacted the outcomes. In spite of the families' acknowledgement of some benefits, the diagnosis of autism spectrum disorder caused frustration, requiring a readjustment of the expectations. Conclusion The questionnaire turned out to be an adequate tool to reveal the social-emotional benefits of cochlear implantation. Although oral language was not the major outcome in these cases, the cochlear implant benefits involved the whole family. All of the families recommended the implant to other children in a similar situation.

Benefit of Cochlear Implantation in Children with Multiple-handicaps: Parent's Perspective.

Introduction The cochlear implants centers in the world are studying the cochlear implantation in children with multiple handicaps. Objective To develop a questionnaire to analyze the subjective benefits of the cochlear implantation in multiple handicapped children according to their parent's perspective. Methods A questionnaire was applied to 14 families of multiple handicapped children, aging from 2-12 years old and having from 11 months to 11 years of implant use. Results The social-emotional abilities were improved because of many factors, such as: auditory exposure, which happened in 84% of the children; recognition of their own names, which increased in 56%; and development of eye contact, in 28% of the subjects. Other benefits appeared to be: music appreciation and more attention and adherence to other therapies and school activities. Besides, some children became interested in objects, playing with other children, and more adapted to daily routines. Thirty-five percent of the children acquired oral language, mainly the bilaterally implanted, while 14% of them were engaged in sign language. Although all of the children showed a significant improvement in communication, the emotional issues of some families and the severity of the handicaps negatively impacted the outcomes. In spite of the families' acknowledgement of some benefits, the diagnosis of autism spectrum disorder caused frustration, requiring a readjustment of the expectations. Conclusion The questionnaire turned out to be an adequate tool to reveal the social-emotional benefits of cochlear implantation. Although oral language was not the major outcome in these cases, the cochlear implant benefits involved the whole family. All of the families recommended the implant to other children in a similar situation.

Important factors in the cognitive development of children with hearing impairment: case studies of candidates for cochlear implants.

Introduction The factors that affect the development of children with and without hearing disabilities are similar, provided their innate communication abilities are taken into account. Parents need to mourn the loss of the expected normally hearing child, and it is important that parents create bonds of affection with their child. Objective To conduct a postevaluation of the development and cognition of 20 candidates for cochlear implants between 1 and 13 years of age and to observe important factors in their development. Methods The following instruments were used in accordance with their individual merits: interviews with parents; the Vineland Social Maturity Scale; the Columbia Maturity Scale; free drawings; Bender and Pre-Bender testing; and pedagogical tests. Results The results are described. Conclusion Parental acceptance of a child's deafness proved to be the starting point for the child's verbal or gestural communication development, as well as for cognitive, motor, and emotional development. If the association between deafness and fine motor skills (with or without multiple disabilities) undermines the development of a child's speech, it does not greatly affect communication when the child interacts with his or her peers and receives maternal stimulation. Overprotection and poor sociability make children less independent, impairs their development, and causes low self-esteem. Further observational studies are warranted to determine how cochlear implants contribute to patient recovery.

Important Factors in the Cognitive Development of Children with Hearing Impairment: Case Studies of Candidates for Cochlear Implants

Introduction The factors that affect the development of children with and without hearing disabilities are similar, provided their innate communication abilities are taken into account. Parents need to mourn the loss of the expected normally hearing child, and it is important that parents create bonds of affection with their child. Objective To conduct a postevaluation of the development and cognition of 20 candidates for cochlear implants between 1 and 13 years of age and to observe important factors in their development. Methods The following instruments were used in accordance with their individual merits: interviews with parents; the Vineland Social Maturity Scale; the Columbia Maturity Scale; free drawings; Bender and Pre-Bender testing; and pedagogical tests. Results The results are described. Conclusion Parental acceptance of a child's deafness proved to be the starting point for the child's verbal or gestural communication development, as well as for cognitive, motor, and emotional development. If the association between deafness and fine motor skills (with or without multiple disabilities) undermines the development of a child's speech, it does not greatly affect communication when the child interacts with his or her peers and receives maternal stimulation. Overprotection and poor sociability make children less independent, impairs their development, and causes low self-esteem. Further observational studies are warranted to determine how cochlear implants contribute to patient recovery...

Condições de personalidade preditivas de resultados com implante coclear em pacientes pós-linguais com longo tempo de privação auditiva / Conditions of personality predicting results with cochlear implant in post-lingual patients with long-time hearing deprivation

Introdução: Nos indivíduos com surdez pós lingual um dos temas mais questionados acerca da eficiência dos resultados do implante é o tempo de privação auditiva. No grupo de implante coclear do HCFMUSP encontramos implantados, com longo tempo de privação sensorial, porém não necessariamente com maus resultados audiológicos. Objetivo: Identificar condições de personalidade preditivas de bons resultados em pacientes pós linguais com longo tempo de privação auditiva. Método: Estudo retrospectivo de série de casos. Foram analisados testes de Wartegg, realizados no pré IC, em pacientes com perda pós lingual e que tinham privação auditiva superior a 10 anos na ocasião da cirurgia. Os resultados do teste foram relacionados e comparados aos seus resultados auditivos, dois anos pós implante coclear. Resultados: A incidência da surdez e o tempo de privação não interferiram nos resultados. Quanto às condições de personalidade, pacientes com bons resultados audiológicos apresentaram ego bem estruturado, facilidade nos intercâmbios afetivos favorecendo o enfrentamento de situações difíceis e a concretização de ideias além de espontaneidade na projeção de seus conteúdos. Os que apresentaram resultados insatisfatórios, tem visão pouco clara de si mesmos, dificuldade nos contatos interpessoais, na produção de acordo com seu potencial, pouca assertividade, tendências auto-agressivas, além de não se mobilizarem de acordo com as situações. Conclusão: A avaliação psicológica pré operatória pode identificar condições de personalidade diferenciadas nos pacientes com bons resultados audiológicos, ainda que apresentem longo tempo de privação auditiva.

Introduction: In the individuals with post-lingual deafness, one of the mostly questioned topics about the efficiency of the results of the implant is the time of hearing deprivation. In the cochlear implant group of HCFMUSP [Clinics Hospital of the Medical School of the University of São Paulo], we found implanted patients with long time sensorial deprivation, but not necessarily with poor audiological outcomes. Objective: To identify conditions of personality predicting good results in post-lingual patients with long-time hearing deprivation. Method: Retrospective study of cases series. We reviewed Wartegg's tests carried out prior to IC, in patients with post-lingual loss and who had hearing deprivation for longer than 10 years upon surgery. The test's results were related and compared to their auditory outcomes, two years after cochlear implant. Results: The deafness incidence and the time of deprivation do not interfere with the results. As for the conditions of personality, patients with good audiological results presented a well-structured ego, easiness for affective interchanges which favors the facing of difficult situations and concretization of ideas, besides spontaneity in the projection of their contents. Those who presented unsatisfactory results have not a very clear view of themselves, difficulty for interpersonal contacts, production according to their potential, poor level of assertion, self-aggressive tendencies in addition to no response according to the situations. Conclusion: The preoperative psychological evaluation may identify conditions of differentiated personality in patients with good audiological results, although they have a long-time deprivation.

Implante coclear na adolescência: quatro candidatos, quatro percursos ao implante coclear / Cochlear implantation in adolescents: four candidates, four routes to cochlear implantantion

A seleção do candidato e a adaptação pós-implante coclear em adolescentes é assunto nuito discutido entre profissionais por suas inerentes dificuldades e peculiaridades...

The candidate selection and post implant adaptation in adolescents is a widely discussed issue among professionals due to its inherent difficulties and pecu liarities...