Connor C M, Hieber S, Arts H A, Zwolan T A
University of Michigan, Ann Arbor, USA.
J Speech Lang Hear Res. 2000 Oct;43(5):1185-204. doi: 10.1044/jslhr.4305.1185.
This study examines the relationship between the teaching method, oral or total communication, used at children's schools and children's consonant-production accuracy and vocabulary development over time. Children who participated in the study (N = 147) demonstrated profound sensorineural hearing loss and had used cochlear implants for between 6 months and 10 years. Educational programs that used an oral communication (OC) approach focused on the development of spoken language, whereas educational programs that used a total communication (TC) approach focused on the development of language using both signed and spoken language. Using Hierarchical Linear Modeling (HLM) we compared the consonant-production accuracy, receptive spoken vocabulary, and expressive spoken and/or signed vocabulary skills, over time, of children who were enrolled in schools that used either OC or TC approaches, while controlling for a number of variables. These variables included age at implantation, preoperative aided speech detection thresholds, type of cochlear implant device used, and whether a complete or incomplete active electrode array was implanted. The results of this study indicated that as they used their implants the children demonstrated improved consonant-production accuracy and expressive and receptive vocabulary over time, regardless of whether their school employed a TC or OC teaching method. Furthermore, there appeared to be a complex relationship among children's performance with the cochlear implant, age at implantation, and communication/teaching strategy employed by the school. Controlling for all variables, children in OC programs demonstrated, on average, superior consonant-production accuracy, with significantly greater rates of improvement in consonant-production accuracy scores over time compared to children in TC programs. However, there was no significant difference between OC and TC groups in performance or rate of growth in consonant-production accuracy when children received their implants before the age of 5 years. There was no significant difference between the OC and TC groups in receptive spoken vocabulary scores or in rate of improvement over time. However, children in the TC group achieved significantly higher receptive spoken vocabulary scores than children in the OC group if they received their implant before the age of 5 years. The TC group demonstrated superior scores and rates of growth on the expressive vocabulary measure (spoken and/or signed) when compared to the OC group if they received their implants during their preschool or early elementary school years. There was no significant difference if the children received their implants during middle elementary school. Regardless of whether children were in the OC or TC group, children who received their implants during preschool demonstrated stronger performance, on average, on all measures over time than children who received their implants during their elementary school years. The results of this study suggest that children may benefit from using cochlear implants regardless of the communication strategy/teaching approach employed by their school program and that other considerations, such as the age at which children receive implants, are more important. Implications and future research needs are discussed.
本研究探讨了儿童学校所采用的教学方法（口语或全交流法）与儿童辅音发音准确性及词汇发展随时间变化之间的关系。参与该研究的儿童（N = 147）表现出严重的感音神经性听力损失，且已使用人工耳蜗6个月至10年。采用口语交流（OC）方法的教育项目侧重于口语发展，而采用全交流（TC）方法的教育项目则侧重于使用手语和口语的语言发展。我们使用分层线性模型（HLM），在控制多个变量的同时，比较了采用OC或TC方法的学校中儿童随时间推移的辅音发音准确性、接受性口语词汇、表达性口语和/或手语词汇技能。这些变量包括植入时的年龄、术前助听语音检测阈值、所使用的人工耳蜗装置类型，以及植入的是完整还是不完整的有源电极阵列。本研究结果表明，随着使用人工耳蜗，儿童的辅音发音准确性以及表达性和接受性词汇随时间推移都有所提高，无论其所在学校采用的是TC还是OC教学方法。此外，儿童人工耳蜗使用表现、植入时年龄与学校采用的交流/教学策略之间似乎存在复杂的关系。在控制所有变量后，OC项目中的儿童平均表现出更高的辅音发音准确性，与TC项目中的儿童相比，辅音发音准确性得分随时间的提升率显著更高。然而，对于5岁前接受人工耳蜗植入的儿童，OC组和TC组在辅音发音准确性表现或提升率方面没有显著差异。OC组和TC组在接受性口语词汇得分或随时间的提升率方面没有显著差异。然而，如果在5岁前接受人工耳蜗植入，TC组儿童的接受性口语词汇得分显著高于OC组儿童。如果在学前或小学早期接受人工耳蜗植入，与OC组相比，TC组在表达性词汇测量（口语和/或手语）上的得分和增长率更高。如果在小学中期接受人工耳蜗植入，则没有显著差异。无论儿童是在OC组还是TC组，学前接受人工耳蜗植入的儿童在所有测量指标上随时间推移的平均表现总体上都优于小学阶段接受植入的儿童。本研究结果表明，无论学校项目采用何种交流策略/教学方法，儿童使用人工耳蜗可能都会受益，其他因素，如儿童接受植入的年龄，更为重要。文中还讨论了研究的意义和未来的研究需求。
