Longitudinal functional performance among children with cochlear implants and disabilities: A prospective study using the Pediatric Evaluation of Disability Inventory

Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States.
International journal of pediatric otorhinolaryngology (Impact Factor: 1.19). 02/2012; 76(5):693-7. DOI: 10.1016/j.ijporl.2012.02.022
Source: PubMed


Functional outcomes are important in children with cochlear implants (CI) and additional disabilities as studies on auditory skill and speech/language development may not identify functional benefits from implantation. This study sought to measure functional performance skills of young children with developmental disabilities post-CI.
Eight children with cognitive disabilities undergoing cochlear implantation were enrolled in a prospective study of language and functional abilities; 6 with 1 year follow-up were included in the analysis. Functional performance was measured using Pediatric Evaluation of Disability Inventory (PEDI), providing standardized (mean: 50) and scaled scores (range: 0-100) of functional domains: Self-Care, Mobility and Social Function. The PEDI was administered pre-implant, 6 and 12 months post-implantation along with language testing at the same intervals.
All children had cognitive disability; 5 also had motor delay. The ages at CI ranged from 13.8 to 134 months. For functional abilities, children did not make significant changes in domain-specific standard scores over 1 year. Children made progress in scaled scores by 1-year post-implant. The largest increase for all domains occurred in the first 6 months (7-11.5 point increase). For language abilities, children made a median 5.5-month increase in receptive language age (p=0.06) and 5-month increase in expressive language age (p=0.03) in the first year post-CI with no change in language quotients. Receptive language level was significantly (p<0.05) associated with increasing scores in the domains of Self-Care and Social Function.
This is the first study to measure daily functional abilities in children with implants and disabilities using a standardized tool. Although our small group of complex children did not have an increase in standard scores (gap-closing trajectories), they made progress in skill development on scaled scores. Receptive language appears to play a key role in social functioning in this population. Functional assessments are informative for treatment planning and identifying specific areas to target intervention.

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Available from: Susan Wiley, Mar 12, 2015
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    • "This suggests that no matter what kind of disability is experienced, it creates problems for both the children and the parents in terms of participation and/or integration in social life. Also, social support plays an important role in reducing the strain that is experienced by mothers of the disabled children[42]. Family function played a central role in both the physical and the psychological health of caregivers. These findings suggest that health care providers who work with families of children with long-term disabilities should develop interventions that support and nurture the family as a whole. "
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    ABSTRACT: Purpose of review: Over the last decade, the selection criteria for cochlear implantation have expanded to include children with special auditory, otologic, and medical problems. Included within this expanded group of candidates are those children with auditory neuropathy spectrum disorder, cochleovestibular malformations, cochlear nerve deficiency, associated syndromes, as well as multiple medical and developmental disorders. Definitive indications for cochlear implantation in these unique pediatric populations are in evolution. This review will provide an overview of managing and habilitating hearing loss within these populations with specific focus on cochlear implantation as a treatment option. Recent findings: Cochlear implants have been successfully implanted in children within unique populations with variable results. Evaluation for cochlear implant candidacy includes the core components of a full medical, audiologic, and speech and language evaluations. When considering candidacy in these children, additional aspects to consider include disorder-specific surgical considerations and child/caregiver counseling regarding reasonable postimplantation outcome expectations. Summary: Cochlear implants are accepted as the standard of care for improving hearing and speech development in children with severe-to-profound hearing loss. However, children with sensorineural hearing loss who meet established audiologic criteria for cochlear implantation may have unique audiologic, medical, and anatomic characteristics that necessitate special consideration regarding cochlear implantation candidacy and outcome. Individualized preoperative candidacy and counseling, surgical evaluation, and reasonable postoperative outcome expectations should be taken into account in the management of these children.
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    ABSTRACT: Objective: To assess daily functional skills among young cochlear implant (CI) recipients with additional disabilities. Methods: Children with CI and developmental disabilities and a hearing control group containing similar ages and similar disabilities were enrolled in a cross-sectional study of language and functional skills. Daily functional skills were measured using the Pediatric Evaluation of Disability Inventory (PEDI), which provides standard and scaled scores in Self-Care, Mobility, and Social Functioning domains. Language was assessed using the Preschool Language Scales, 4th edition which provides standard scores and age equivalents. Results: Fourteen children with CIs and seven hearing controls were included in this analysis. Most children in this study (90.5%) had cognitive disabilities and 57% had motor disabilities. Compared with the hearing controls, children with CIs were less likely to have functional independence in any PEDI domain. Children with CI had significantly lower median social functioning standard scores compared with controls (17.3 vs. 27.5, P = 0.009). After controlling for nonverbal cognitive abilities and language level, the difference was no longer significant (19.1 vs. 24, P = 0.3). Among children with CI, age at implant and duration with device were not associated (P > 0.4) with PEDI scores. Discussion: Although children with CI and developmental disabilities had similar functional skills as hearing children with similar disabilities regarding the PEDI domains of Self-Care and Mobility, they had lower Social Function standard scores. This lower social functioning among children with implants may be related to lower language levels and possible language deficits seen in the CI group. Regular assessments of functional abilities coupled with language abilities are essential in providing every child with the opportunity for maximizing the potential for independence.
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