Beck: Hi Amy. Thanks so much for you time this morning.
Robbins: Good Morning Doug. Nice to be with you.
Beck: Amy, you are one of the few speech-language pathologists I know of, in a private practice setting, primarily addressing the needs of children with cochlear implants (CIs).
Robbins: Yes, well there are a few of us, but not too many!
Beck: Amy, before we get to the issues at hand, would you please spend a moment or two reviewing your professional background?
Robbins: Sure. I got my bachelors degree at Hollins College in Roanoke, Virginia, in 1977. I attended Leed University in England, where I earned a diploma in Lingustics and Phonetics and then earned my masters from Purdue in 1979, in Speech Sciences.
Beck: And I believe you worked at Boys Town in the early 1980s?
Robbins: Yes, I was the Supervisor of Aural Rehab at Boys Town National Research Hospital in Omaha, Nebraska, from 1979 to 1983. Then I was a consultant for 3M during the mid-1980s when they were involved with cochlear implants. I was at the Indianapolis Medical Center from 1983 to 1996, and since1997, Ive had my speech-language private practice.
Beck: Thats wonderful. I love to hear about SLPs in private practice. I believe theres a great potential theremuch like audiology 20 years ago. Where do your patients come from?
Robbins: Thats a great question. The implant centers in the area refer patients to me, as does our St. Joseph satellite school in Indy, and other schools. I also get referrals from our states 0-3 state intervention system, and Im a consultant for Advanced Bionics, so I get referrals through those channels too.
Beck: Amy, do you see more children in your cochlear implant practice now, than you did 5 years ago?
Robbins: Yesabsolutely. There are more kids being implanted than ever before and perhaps more importantly, the majority will be mainstreamed. The mainstream process is such an important goal, that those of us providing supportive speech-language and aural rehabilitative services are indeed getting busier. Additionally, the SLP is considered the expert by many school systems in this process, and that too, is a referral source for us.
Beck: Amy, I wonder if you can tell me some key points for audiologists or SLPs working with implanted children?
Robbins: First, as they say at Johns Hopkins, the cochlear implant is an opportunity, not a cure. Second, dont forget what you know about children with hearing aids, but dont let it hold you back. Third, raise your expectations for children with cochlear implants youll be amazed!
Beck: What expectations do you have for the typical CI child?
Robbins: In general, the CI transforms profoundly deaf children into hard of hearing childrenand thats how typical CI kids perform, like hard of hearing children. So I expect a dramatic and noticeable chance in communication following implantation. Of course, that assumes that the child has no additional handicaps and in reality, about 40 percent of deaf children do have additional handicaps and these children are also receiving implants with increasing frequency. So for children without additional disabilities, many of the cochlear implant children have highly intelligible speech, they perform appropriately academically and they do very well socially, but again, they are not normal hearing children.
Beck: And that is an important distinction, because we would not anticipate the majority of children with CIs to present as if they had normal hearing or normal behaviors. Seems to me that even the best CI children will need to have maximal auditory cues, occasional help with notes, visual cues from the speaker, and other supports in the classroom?
Robbins: Thats right. Of course, their performance is highly variable, and although we cannot turn a deaf child into a normal hearing child, we can certainly improve their hearing through the use of cochlear implants, to the point where theyll generally need much less in-class support than other deaf children.
Beck: Amy, what about speech and language development in CI children?
Robbins: Another good question. If the child is implanted early, before age two, I expect theyll have a delay with respect to speech and language, but many, if not most, do catch up to their normal hearing peers. Children implanted later in life, will have a greater delay and the later theyre implanted, the more gaps theyll have to overcome in language, knowledge and experience too. So again, early implantation is the best.
Beck: Yes, I know the research literature supports that too. So in general, as soon as we identify and confirm profound deafness in a child, you advocate cochlear implantation as quickly as is possible?
Robbins: This is what I tell parents -- If youre going to choose a cochlear implant for your child, sooner is better than later. Now is better than next month, and next month is better than next year. The results are clear, earlier implantation yields better results with respect to speech and language issues. Remember, the task of auditory learning for congenitally deaf children is to construct an entire linguistic system, using the acoustic cues availableand if there are less cues available for a longer period of time, the results will be negatively impacted. If a child does gain early access to the auditory cues of spoken language, he or she learns to use them more efficiently, with less difficulty regarding speech and language.
Beck: What about implanted children and telephones? What percentage of implanted kids use the telephone?
Robbins: Most of the early implanted kids use the phone, some better and some worse, but the phone is very important to them and they enjoy using it, just like hearing children. Of course, as you can imagine, their ability to hear on the phone is usually a little less than their ability to hear live and in person, but some do very well.
Beck: Going back to the issue of early implantation, what percentage of the children youll see in 2005, are likely to be implanted younger than age 3 years?
Robbins: Well, unfortunately, many are still implanted after age three. I would guess that within my caseload, probably only 1/3rd of them will be implanted before age three.
Beck: That really surprises me.
Robbins: Yes, I know. Although professionals who deal with these issues daily are aware of the benefits of early implantation and the improved outcomes attributable to early implantation, some parents, pediatricians and school personnel are hesitant to implant very young children. There seems to be a pattern of wait until the childs really having trouble before an implant is recommended. By that time, were dealing with gaps and delays in communication that may have long lasting and/or permanent consequences.
Beck: What can you tell me about the later implanted children, which you and Mary Jo Osberger Ph.D., reported on recently, at the CI-2005 meeting in Dallas?
Robbins: We looked at two groups of children, each with 8 or 9 subjects implanted at about age 8. These kids had residual hearing in the profound range, and the teams working with those children chose to watch and wait and fit the kids with traditional hearing aid amplification, but by age 8 years they were implanted. These are the toughest kids to work with!
The kids in the experimental group were recently fit with the Advanced Bionics Hi-Resolution sound processing while the control group data came from a study done earlier, using the Advanced Bionics Clarion with conventional sound processing We matched them for; pre-implant PB-K scores, MLNT, Word and Phoneme scores and for age of implant, again, age 8 years.
Beck: So in essence, it was a retrospective design, yet it allowed you to have an experimental group, and a control group?
Robbins: Exactly. So it was apples-to-apples, but it had a time lag between the sets of data collection. The study was titled Pediatric Performance with Hi-Resolution Sound Processing.
Beck: What did you find?
Robbins: We found that children fit with state-of-the-art, HiRes sound processing, did better across the board than those fitted with earlier generation processing strategies. We looked at results over time. At three months post-fitting, three of the four open-set word measures showed a statistically significant difference, with the HiRes kids outperforming the conventional kids.
Beck: Weve all seen new technology introduced based on the Gee Whiz effectthat is; the technology was really neat and excitingbut unfortunately, the outcomes information was lacking, if present at all! I think its wonderful that youve gone through the process to actually compare the instruments and document the results.
Robbins: Thanks, Doug.
Beck: Amy -- thanks so much, youve been very generous with your time, and I really do appreciate the information and your time.
Robbins: My pleasure Doug. Nice to work with you, too.
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