Speech Therapy For Children With New Cochlear Implants
Many Speech Language Pathologists (SLPs) aren't sure where to start when a client or student on their caseload first receives a cochlear implant, as it can feel like an intimidating task to help a child who is months or years behind their peers in speech and language development to "close the gap" using a seemingly complicated and technical device. Additionally, it is very common for SLPs to have only worked with a small number of children with cochlear implants in their career. Often those first few months after a cochlear implant is activated can be the most daunting for an SLP with limited experience.
However, the most important goal after a child receives a cochlear implant is simple- listening. By the time a child receives an implant, they have already missed countless language learning opportunities, making it incredibly important for them to hear as much language as possible when they do have the ability to detect sound. Start by educating other professionals working with the child about the importance of wear during all waking hours. Empower parents with ways to help their child tolerate their implant, such as developing a routine with the implant, looking at pictures of other children wearing implants, or adding a cover (such as this) to the processor to personalize it.
Secondly, the primary focus of intervention for children with newly activated cochlear implants is detecting sound by way of positive listening experiences. The first therapy sessions should focus almost exclusively on exposing the child to a wide variety of sounds and speech. When a cochlear implant is activated, the audiologist programs or "maps" the cochlear implant to include a relatively narrow range of sound frequencies and intensities than the implant will eventually support, as to not overwhelm the child and ensure greater comfort and acceptance of the device. Over time the audiologist will change the map to include a wider range of sound detection.
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. For example, you might take the child on a "listening walk" around their home or school so that you can create awareness that objects make sounds and that those sounds are different from one another. You could also explore noise makers (such as bells or other toy instruments) with the same purpose. For both of 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 their properties, such as loud vs. quiet, high pitch vs. low pitch, and short vs. long.
However, in addition to noises and environmental sounds, there is another key component to early listening experiences for children with cochlear implants. Providing input to speech is crucial for the same reasons as mentioned above. Engaging in structured play while using a wide variety of pitches, loudnesses, and sound durations in your voice will provide input for the child across the spectrum of sounds they have access to. Making sounds that are very different from each other enables a newly implanted child to more easily differentiate the sounds and attach meaning to them. For example, you might be playing with bubbles and while the bubbles are rising in the air you could say, "up....up....up" using an increasingly rising intonation for each repetition of the word "up." Likewise, when the bubbles begin to fall you could say "doooowwwnnn" with falling intonation. In doing so, you're making the two sounds very different from each other in terms of pitch (rising vs. falling) and duration (short intermittent sounds vs. one long sound).
There will be more to come on this topic in future posts, but in the meantime, I encourage you to check out the Auditory Learning Guide created by Beth Walker. It is an excellent (and free!) tool to assist you with writing goals for auditory skill development. 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 with a heavy focus on listening.