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Country Presentation: the Netherlands

Country Presentation: the Netherlands. Anneke Vermeulen University Hospital St Radboud Nijmegen the Netherlands. Contents. CI in the Netherlands Reading skills after Cochlear Implantation Changing educational needs of deaf children. Cochlear Implant centres in the Netherlands.

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Country Presentation: the Netherlands

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  1. Country Presentation:the Netherlands Anneke Vermeulen University Hospital St Radboud Nijmegen the Netherlands

  2. Contents • CI in the Netherlands • Reading skills after Cochlear Implantation • Changing educational needs of deaf children 2

  3. Cochlear Implant centres in the Netherlands • 8 university medical centres: Amsterdam (vu and umc) Groningen Leiden Maastricht Nijmegen Rotterdam Utrecht • Implant Centres are engaged in a formal cooperation Cochleaire Implant Overleg Nederland CI-ON • The CI-ON at a regular basis consults all involved client and patient groups. 3

  4. Cochlear Implant centres in the Netherlands • Cooperations of University Medical Centres with 7 family guidance departments Amsterdam Haren (Effatha Guyot Groep) Middle East NL South East NL (Nijmegen, Hoensbroek, Eindhoven) St Michielsgestel (Viataal) Rotterdam (Aurisgroep) Zoetermeer 4

  5. . . . . . . . . 5

  6. Numbers of CI recipients in NL • 1984 – 2007 total 2000 recipients 700 children (ca 300 in UMC Nijmegen) 1300 adults • In 2006 total 351 115 children 30 children bilateral (20 in UMC Nijmegen) 236 adults 6

  7. Reading Skills after Cochlear Implantation Vermeulen, Van Bon, Schreuder, Knoors, Snik Radboud University Nijmegen, NL • Evaluate the reading comprehension in profoundly deaf childeren with CIs • Assess the role of the two components in the Simple View of Reading Model • Determine the link in the causal chain between post implant auditory speech perception and reading comprehension 7

  8. Reading skills The use of a cochlear implant enables auditory access to spoken language Post implant development of vocabulary has been frequently reported in literature (Robbins, Svirsky, Connor) Development of morpho-syntactic competence has been found to be speech perception based More recently reading skills of deaf children with cochlear implants have been investigated (Geers, Connor and Zwolan, Spencer et al.) 8

  9. Simple View of Reading Model(Hoover & Gough, 1990) How is print transferred to meaning ? Reading = Decoding x Linguistic Comprehension Reading Comprehension is the product of the ability to decode words in the text and the ability to understand (spoken) language 9

  10. Reading Comprehension levelsof deaf children without CIs • 3 th grade (8 yr), 8 to 18 yrs old students (Allen,1986) • 4 th grade (9 yr) 17 yrs of age (Holt,1993) • 4 th grade (9 yr) 17 and 18 yrs (Holt, Traxler, & Allen,1996) • 3 th grade (8 yr) 7 to 20 yrs (Wauters, van Bon, & Tellings, 2006) Reading levels in deaf children without cochlear implants are substantially lower than those in hearing children 10

  11. Reading Comprehension levelsof children with CIs • Within 8 months range, n = 40(Spencer, Tomblin, & Gantz, 1997) • 63% within 1 sd range, n=16 (Spencer, Barker & Tomblin, 2003) • 50% within 1 sd range, n=181(Geers, 2003) • > 1 sd below mean, mean standard score =69.8 (Connor & Zwolan, 2004) • median and mean within 1 sd range, n=27 (Spencer, Gantz & Knutson, 2004) Reading levels in deaf children with cochlear implants are superior to those in childeren without implants 11

  12. Reference data:500 deaf children with hearing aids(Wauters, Van Bon & Tellings, 2006) • Unaided PTA best ear >80 dB Comparable factors in the samples: • Age range • Educational setting / schools • Pre or postlingual onset of deafness • No learing disorders 12

  13. Study group: 50 profoundly deaf children with CIs • Chronological age at reading assessment 7- 22 years • 20 meningitis,18 congenital, 12 unknown • Unaided PTA best ear >115 dB • 25 boys, 25 girls • Parents with normal hearing • Duration of CI use 3 to 11 years mean range • Age at onset of deafness 13 0 – 80 • Duration of deafness 58 5 – 140 13

  14. Assessments • Reading comprehension Multiple choice questions about short texts (Aarnoutse 1996) • Decoding Lexical decision tasks (Wauters 2002) • Receptive vocabulary (Language age in months) Reynell scales (Reynell 1977) Language Tests for Children (Van Bon 1982) • Auditory speech perception (Equivalent Hearing Loss in dB) Gestel-Nijmegen Speech Perception Test (Snik 1997) 14

  15. Reading Comprehension Anneke Vermeulen, Wim van Bon, Rob Schreuder, Ad Snik, Harry Knoors 15

  16. Reading Comprehension Z-scores 16

  17. Reading skills of children with CIs The reading comprehension of the children with CIs was superior to that of the children with conventional hearing aids, In all grades studied. Though the scores were still lagging behind those of hearing peers. 17

  18. Decoding Z-scores 18

  19. Decoding skills of children with CIs The decoding skills of the children with CIs were better than those of the children with conventional hearing aids, at secondary education level. The scores were in the same range as those of hearing peers. 19

  20. The Relation between Reading Comprehension and Decoding Strong relation between RC and Decoding: • Spearman rank correlation: rs=.73, p<.01 • Regression analysis: 13% of the variance in reading comprehension after the variance due to instructional age was removed (Beta=.49, t=3.85, p=.000). Decoding did not explain the superior RC in the children with CIs compared to that in hearing aid users • Ancova: Eliminating the effect of decoding, significant effects of group (F(1,513)=26.63, p<.001) and grade-level (F(3,513)=4.67, p<.005) on reading comprehension. 20

  21. The relation between reading comprehension and language comprehension The receptive vocabulary of the children with CIs developed at a faster rate than that in profoundly deaf children with hearing aids. (in HA children the ratio = 0.5, e.g. Svirsky, Robbins) Receptive vocabulary at 36 months post implant explains 29 % of the variance in reading comprehension scores (Age + Receptive vocabulary: R2 =.51) Strong relation between receptive vocabulary age equivalent and reading comprehension 21

  22. Language Comprehension/Receptive vocabulary(Reijnell/TvK) 1 = Hearing norm < 0,5 = ratio of deaf children with CHA N= 16, prelingually deaf children were able to perform test prior to implantation 22

  23. Association between speech perception and receptive vocabulary 96,00 84,00 72,00 60,00 48,00 Receptive vocabulary delay 36 36,00 24,00 12,00 0,00 -12,00 70,00 80,00 90,00 100,00 110,00 Equivalent Hearing Loss 24 23

  24. The effect of improved auditory speech perceptionon reading comprehension • No relation between auditory speech perception and decoding • No direct relation beteween auditory speech perception and reading comprehension • Strong relation between auditory speech perception and receptive vocabulary Auditory speech perceptionat 24 months explains 12 % of the Variance in Receptive vocabulary scores at 36 months (Age + Auditory speech perception: R2= .45) 24

  25. Structural Equation Modeling: the intervening role of vocabulary in post implant text comprehension Fit indices NC=2.1, χ230=63.994 (p=.000), GFI=.826, AGFI=.618, NFI=.879 25

  26. The effect of CI on reading comprehension Structural equation modelling did not falsify the hypothesis that: post implant auditory speech perception positively affects reading comprehension via receptive vocabulary 26

  27. Educational placement in the Netherlands • Changes in placement in educational setting • Factors involved in choices • Capacities of young children with implants • Changing Needs 27

  28. Dutch data on changes in educational settings, n=370 Vermeulen, Langereis, Van den Broek, 2005 pre implant > 2jaar post implant 28

  29. Educational settingsVermeulen (2007) pre implant n=50 at reading test, in 2002 29

  30. Educational Setting, first grade primary educationchildren with age @ implant  30 monthsVermeulen, Mylanus, Snik, 2007 > 5 jaar post implant 30

  31. Language comprehension CI m 77 age at onset 9.5 months age at CI 77 months, n=16 31

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  33. “Zo hoort het” – Jet Isarin, 2006 • Interview and observations Free cooperation, Contents: loneliness, Solo equipment, Speech & language Listening / looking-listening / listening types • What does the individual child need? • Does the teacher in mainstream education know what to look at? If you didn’t know she was deaf you wouldn’t notice……. Sue: ‘Implants work to well’ 33

  34. School related factors • Mainstream education • Demanding or tolerant • Learning via explicit instruction-communication • Teacher dependent (VO!) • Acoustical environment • Deaf peer group??? • Focusses on childs abilities 34

  35. School related factors • Education for the Deaf • Fast development after CI • Varying abilities between children • protective • Less focus on spoken language • Focuses on what the child misses • Contact with hearing peers??? • School flexible or dogmatic 35

  36. Child related factors • Cognitive level • Communicative abilities • Language level • Speech and intelligibility • Social emotional development • Motivation • Auditory speech perception skills 36

  37. Abilities of children with implants • Large variabillity • Large part of children within hearing range • Other group still 1 a 2 SD below norm • Much better than deaf children without CI Children still miss a lot of information in mainstream classroom situations Do they know (compensate?) Does the child have access to the interactive process of teaching and learning? (Thoutenhoofd) Responsibility for teachers to provide support and monitor functioning (Archbold) 37

  38. Needs of children with implants • The capacities of children with CI demand a different approach than hearing aid users do. • With better devices optimal use becomes even more important Technical support and training Educational / speech and language support and training • Evaluations Identification of areas of concern Development of therapeutic interventions Courses for teachers and speech therapists EAR FOUNDATION and UMCN 38

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