Speech Therapy After Cochlear Implant Activation

A Speech-Language Pathologist (SLP) gets a new client or student on their caseload who has recently received a cochlear implant and wonders, "What am I supposed to do in therapy?"

Sound familiar? It can feel very overwhelming to figure out how to help "close the gap" when a child is months (or even years) behind their peers in speech and language development.

The reality is that it is common for SLPs to have very limited experience providing therapy to children with cochlear implants.. And those first few months after a cochlear implant is activated can be a daunting task for SLPs.

The focus in (and outside of) therapy after a child receives a cochlear implant is simply listening. Why? By the time a child receives an implant, they have already missed countless language learning opportunities.... months and maybe years of input.

This makes it incredibly important for them to hear as much language as possible, now that they do have the ability to detect sound. In order to place emphasis on listening, there are some key actionable steps.

Increase Cochlear Implant Use

Start by educating others on the importance of the child achieving as much device use as possible. Empower parents and professionals with methods to help the child wear their implant. There are many strategies to help with increasing wear of cochlear implants, including developing a routine, normalizing hearing technology by looking at books, videos, and pictures of other children wearing devices, and personalizing the device by adding a fun cover, for example.

Initially, a sticker chart might also be useful to use with some children to earn rewards for wearing their device throughout the day. This printable sticker chart allows parents, professionals, and caregivers to collaborate and work toward the same goal of increasing the wear time of the cochlear implant and/or hearing aid.

Lots of Listening Experiences

A primary focus of intervention for children with newly activated cochlear implants is detecting sound within positive and natural listening experiences. The first therapy sessions should focus on exposing the child to a wide variety of sounds and speech.

When a cochlear implant is activated, the audiologist programs or "maps" the device to include a relatively narrow range of sound frequencies and intensities. Why? This practice helps to not overwhelm the child and ensures greater comfort and acceptance of the device. Over time the audiologist will change the map to include a wider range of sound detection.

Environmental Sounds

Because most children who receive cochlear implants have little to no prior meaningful experiences with sound, it's important to teach them that sounds have meaning and help us navigate and understand our environment.

This can be done informally at nearly any point during a child's day. Closing cabinets, knocking on the door, and turning on a faucet are all examples of environmental sounds. For a more structured activity, you can take the child on a "listening walk" around the home or school. Create awareness that objects make sounds, and that those sounds differ from one another.

You may also explore simple noise-makers (such as bells or other toy instruments) with the same purpose. For these activities, provide the auditory input before pointing to your ear and saying something like, "I heard that! I heard the ____." Not only will the child begin to make associations between objects and their sounds, but also learn that sounds vary in properties of loudness, pitch, and duration.

Speech Input

In addition to noises and environmental sounds, providing input to spoken language (speech) is even more crucial for children with newly activated cochlear implants. Hearing variation of pitch, loudness, and duration in speech provides a newly implanted child with opportunities to differentiate sounds and attach meaning to them.

There are tons of play-based activities that can facilitate the use of variation of suprasegmentals. Prosodic features are the building blocks of successful spoken language understanding and use, so it's key to integrate them into intervention in therapy and at home from day one.

Goals for the Newly-Implanted Child

Now that we know the early focus is on wearing the cochlear implant and providing quality auditory input, it's time for one more frequently-asked question:

"What goal(s) do you write for a child with a newly activated cochlear implant?"

While there is no one right answer, I have a great reference to help guide goal-writing in the months and years following cochlear implantation. If you haven't already, check out The Auditory Learning Guide by Beth Walker. It's an excellent, free tool to assist you with seeing the progression of and writing goals for auditory skill development in the first months after activation, and years beyond!

Therapy for children that have recently received a cochlear implant does not have to be worrisome for SLPs. With a few age-appropriate toys and activities that you likely already have, you can set up successful sessions that keep listening at the forefront.