Dallas Cochlear Implant Program, Callier Advanced Hearing Research Center, The University of Texas at Dallas, Dallas, Texas 75235, USA.
Ear Hear. 2011 Feb;32(1 Suppl):84S-92S. doi: 10.1097/AUD.0b013e3181ffd5b5.
This report focuses on how speech perception, speech production, language, and literacy performance in adolescence are influenced by a common set of predictor variables obtained during elementary school in a large group of teenagers using cochlear implants (CIs).
Time-lag analyses incorporating seven common predictor variables associated with the elementary school test period were evaluated. The elementary school-age variables included five contributors across the performance domains: gender, performance intelligence quotient, family size, socioeconomic status, and duration of deafness (operationally defined as the time period between the age of implantation and the onset of deafness). Regression analyses then examined how communication mode in early elementary grades influenced skills exhibited in high school and how this influence was mediated by information capacity of immediate memory.
High correlations occurred between outcome measures collected at CI-E session and similar measures collected at CI-HS (values ranging from 0.75 to 0.83), indicating that the relative standing of individuals on these outcomes is highly stable over time. The best performers in elementary grades exhibit the best outcomes in high school, and early difficulties tend to persist throughout the elementary and high school years. The most highly related outcome areas were language and reading/literacy (values ranging from 0.74 to 0.88). These skills seem closely linked, and CI children who demonstrate the best vocabulary and syntax skills in elementary grades achieved the highest literacy performance in high school. Speech perception and speech production skills are also highly correlated with one another (r = 0.69 to 0.87), suggesting that the most direct result of improved auditory input from a CI is the child's ability to produce intelligible speech. The lowest correlations are observed between reading/literacy and speech perception (r = 0.30 to 0.54) or speech production (values ranging from 0.31 to 0.58). CI-E verbal rehearsal speed is an independent and powerful predictor of each early performance outcome, accounting for between 13% and 30% of the variance in early outcomes above and beyond that accounted for by gender, family size, socioeconomic status, performance intelligence quotient, duration of deafness, and the CI-E sign enhancement ratio. Group mean scores for language, reading, and social adjustment were generally within an SD of normative samples of typically developing age-mates with normal hearing.
Use of sign to enhance spoken communication negatively influenced verbal rehearsal speed, which was a strong predictor of all early outcomes, which in turn strongly influenced later outcomes. These analyses suggest that early communication mode exerts a powerful influence on early outcomes that persist into later years. Speech perception, speech intelligibility, language, literacy, and psychosocial adjustment far exceeded that reported for similar groups before the advent of CI technology.
本报告重点介绍了在一组使用人工耳蜗(CI)的青少年中,通过小学期间获得的一组共同预测变量,如何影响青少年时期的言语感知、言语产生、语言和读写能力表现。
评估了与小学测试期相关的七个共同预测变量的时滞分析。小学年龄变量包括表现领域的五个贡献者:性别、表现智商、家庭规模、社会经济地位和耳聋持续时间(操作定义为植入年龄和耳聋发作之间的时间段)。回归分析然后检查了早期小学阶段的沟通模式如何影响高中时的技能表现,以及这种影响如何被即时记忆信息容量所介导。
CI-E 会议收集的结果测量值与 CI-HS 会议收集的类似测量值之间存在高度相关性(数值范围为 0.75 至 0.83),这表明个体在这些结果上的相对地位在时间上高度稳定。在小学阶段表现最好的人在高中阶段表现最好,早期的困难往往会持续整个小学和高中阶段。相关性最高的领域是语言和阅读/读写(数值范围为 0.74 至 0.88)。这些技能似乎密切相关,在小学阶段表现出最佳词汇和语法技能的 CI 儿童在高中阶段表现出最高的读写能力。言语感知和言语产生技能也彼此高度相关(r=0.69 至 0.87),这表明来自 CI 的改善听觉输入的最直接结果是儿童能够产生清晰的言语。阅读/读写和言语感知(r=0.30 至 0.54)或言语产生(数值范围为 0.31 至 0.58)之间的相关性最低。CI-E 言语复述速度是每个早期表现结果的独立且强大的预测因子,占早期结果方差的 13%至 30%,超过了性别、家庭规模、社会经济地位、表现智商、耳聋持续时间和 CI-E 符号增强比的解释。语言、阅读和社会适应的组平均分数通常在具有正常听力的典型发育年龄同伴的正常范围内。
使用手语来增强口语交流对言语复述速度产生负面影响,而言语复述速度是所有早期结果的有力预测因子,而早期结果又强烈影响后期结果。这些分析表明,早期的沟通模式对持续到后期的早期结果产生了强大的影响。言语感知、言语可理解度、语言、读写能力和心理社会适应能力远远超过了 CI 技术出现前类似群体的报告。