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  • Writer's pictureStacy Crouse

Speech Therapy for Children After Cochlear Implant Activation

An SLP gets a new client or student on their caseload who has recently received a cochlear implant and wonders what speech therapy is supposed to look like for that child.

Sound familiar? For SLPs, this scenario can feel overwhelming as they try to figure out how to help "close the gap" when a deaf child may be months (or years) behind their peers in speech and language development.

The reality is that many SLPs have little to no educational or on-the-job experience with providing speech therapy to children with cochlear implants. Even though they have the best intentions for the clients or students, it can be a daunting task. So let's take a closer look at what SLPs can do to maximize therapy sessions with these children.

Goals of Speech Therapy After a Child Receives a Cochlear Implant

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, maybe years, of auditory input.

This makes it incredibly important for cochlear implant recipients to hear as much language as possible once they have the ability to detect sound. In order to place an emphasis on listening, there are some key actionable steps.

Promote wear of the cochlear implant.

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. Strategies to help increase the wear time of cochlear implants:

  • Develop a routine that includes putting on, taking off, and charging the cochlear implant at appropriate times throughout the day.

  • Normalize hearing technology by looking at books, videos, and pictures of other children with cochlear implants.

  • Personalize the device by adding fun and unique accessories (covers, clips, charms, etc.).

  • Utilize approved accessories (or talk with the audiologist about adjustments to the processor or magnet) to ensure that the device stays on when the child is running, jumping, swimming, etc.

  • Make the time that the child is wearing the cochlear implant positive and supportive. Play a favorite game, eat a favorite snack, read a favorite book.

  • Use a sticker chart for the child to earn rewards for wearing their device throughout the day. A 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 (or hearing aid).

A sticker chart for wearing a cochlear implant or hearing aid throughout a day

Provide a variety 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 while still ensuring they're comfortable (e.g., the sounds aren't too loud).

Note that when a cochlear implant is initially activated, the audiologist programs (or "maps") the device to include a relatively narrow range of sound frequencies and intensities. This 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. It's important to be aware of the child's current map settings.

Draw attention to environmental sounds.

Most children who receive cochlear implants have little (or no) prior meaningful experiences with sound. It's important to teach them that sounds exist, sounds are different, sounds have meaning, and sounds 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, school, or outdoors.

A environmental sound listening walk checklist to use with children who are deaf and using cochlear implants or hearing aids to listen

When listening for and talking about environmental sounds, incorporate the sounds into other language you're using with the child. For example, you might point to your ear and say, "I heard that! I heard the door bell."

Provide meaningful speech and language input.

In addition to environmental sounds, providing input to spoken language 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 suprasegmental properties. Prosodic features are the building blocks of successful spoken language understanding and use, so it's key to integrate them into therapy and home activities from day one.

Initial Speech Therapy Goals Following Cochlear Implantation

As discussed above, speech therapy immediately following a cochlear implant activation focuses on

  • Consistent wearing of the cochlear implant

  • Having a range of natural, positive listening experiences.

All that sounds great, but what SLPs really want to know is, how do you write and measure goals in those first months?

There is no easy button; no one universally accepted series of auditory goals that should be targeted immediately following a cochlear implant activation. There are, however, references to help with goal-writing and monitoring auditory (and speech and language) progress for children with cochlear implants.

My favorite reference tool is The Auditory Learning Guide by Beth Walker. It's a free guide to assist you in understanding and following the progression of auditory skill development in the first months and years after cochlear implant activation. It breaks down the advancements of skills at various levels (words, sentences, etc.).

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.

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