Advances in Deafness ManagementAdvances in Deafness Management

Second Language Learning Second Language Learning in Cochlear Implant Usersin Cochlear Implant Users

October 9, 2005October 9, 2005

Ripley K. WONGRipley K. WONGSpeech Therapist In-chargeSpeech Therapist In-charge

Queen Mary HospitalQueen Mary HospitalHong KongHong Kong

Hong Kong ScenarioHong Kong Scenario

Multilingual societyMultilingual society

Two formal languages: English & ChineseTwo formal languages: English & Chinese

Return of sovereignty to PRC in 1997Return of sovereignty to PRC in 1997

Immigrants from Mainland ChinaImmigrants from Mainland China

Maids Maids

needs for learning different languagesneeds for learning different languages

Language Development in HI Language Development in HI ChildrenChildren

HI children develop language at slower HI children develop language at slower rate (Davis et al, 1986)rate (Davis et al, 1986)

Profoundly HI children develop language Profoundly HI children develop language at half the rate of normal hearing children at half the rate of normal hearing children (Carney & Moeller 1998)(Carney & Moeller 1998)

Increasing gap between language age and Increasing gap between language age and chronological age (Miyamoto et al, 1997)chronological age (Miyamoto et al, 1997)

Language DevelopmentLanguage Development

0

2

4

6

8

10

12

4 6 8 10

chronological agela

ngua

ge a

ge

normal hearing HI+CI HI+HA

0

2

4

6

8

10

12

chronologicalAge

Lang

uage

Age

normal hearing Hearing Impaired

Language Development in HI Language Development in HI Children with CIChildren with CI

Language delay compared to NH peers, but rate Language delay compared to NH peers, but rate of language development similar (Miyamoto et al,of language development similar (Miyamoto et al, 1997; Vermeulen et al, 1999) 1997; Vermeulen et al, 1999)

Rate of language development exceeded that of Rate of language development exceeded that of unimplanted HI children (Svirsky et al, 2000)unimplanted HI children (Svirsky et al, 2000)

Different rate of development for different languaDifferent rate of development for different language skills (Ertmer et al, 2003, Young & Killen, 200ge skills (Ertmer et al, 2003, Young & Killen, 2002) 2)

Second Language Learning in Second Language Learning in Hearing Impaired ChildrenHearing Impaired Children

Interference between languagesInterference between languages

Reduced exposure to phonemic patterns / Reduced exposure to phonemic patterns / sound systems of spoken languagessound systems of spoken languages

Difficulty in picking up different phonemic Difficulty in picking up different phonemic patterns of different languagespatterns of different languages

Lack of natural ambient language inputLack of natural ambient language input

Language delay resulting from hearing Language delay resulting from hearing impairment impairment

Bilingual CI UsersBilingual CI Users

Age-appropriate language skills in primary Age-appropriate language skills in primary language and competent in second spokelanguage and competent in second spoken language (Waltzman et al, 2003)n language (Waltzman et al, 2003)CI users can achieve oral proficiency in mCI users can achieve oral proficiency in more than one language (Robbins et al, 200ore than one language (Robbins et al, 2004)4)A CI user acquired Cantonese, Mandarin aA CI user acquired Cantonese, Mandarin and English to a degree comparable to NH nd English to a degree comparable to NH peers (Francis & Ho, 2003) peers (Francis & Ho, 2003)

Case 1Case 1

KCKC

10 years old10 years old

Fitted with bilateral HA at 2;02 y.o.Fitted with bilateral HA at 2;02 y.o.

No spoken language before implantation No spoken language before implantation

CI done at 2 years 10 months (Clarion, S-Series)CI done at 2 years 10 months (Clarion, S-Series)

Moved to an English-speaking country after Moved to an English-speaking country after implantationimplantation

11stst language: English language: English

Case 1Case 1

Returned to HK in 2003 (8;03)Returned to HK in 2003 (8;03)

studying in international schoolstudying in international school

Had Mandarin class in schoolHad Mandarin class in school

Started ST training on Cantonese in Started ST training on Cantonese in February 2004, aged 8;07 (totally attended February 2004, aged 8;07 (totally attended 15 sessions from 2/04 to 12/04)15 sessions from 2/04 to 12/04)

Re-started ST training in 4/05 (attended 5 Re-started ST training in 4/05 (attended 5 sessions from 4/05 to 9/05) sessions from 4/05 to 9/05)

Case 1: Language Assessment Case 1: Language Assessment (English)(English)

Peabody Picture Vocabulary Test (PPVT)Peabody Picture Vocabulary Test (PPVT) At high end of normal range At high end of normal range

Clinical Evaluation of Language Clinical Evaluation of Language Fundamentals (CELF)Fundamentals (CELF) Receptive language: WNLReceptive language: WNL Expressive language: above averageExpressive language: above average 85-115: WNL, average of NH children: 10085-115: WNL, average of NH children: 100

Case 1: Language Development Case 1: Language Development

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20

40

60

80

100

120

140

160

2000年 2001年 2002年 2003年 2004年 2005年

Time at assessment

Scor

e/A

ge E

quiv

alen

t in

mon

ths

PPVT

Receptive Language Score

Expressive Language Score

Total Language score

Age-equivalent(PPVT)

CA

CRVT

2nd Language Performance2nd Language Performance

Case 1: Language Assessment Case 1: Language Assessment (Cantonese)(Cantonese)

Cantonese Receptive Vocabulary Test (CCantonese Receptive Vocabulary Test (CRVT)RVT) At the beginning of treatment: <1;10 (score:2At the beginning of treatment: <1;10 (score:2

2)2) One year after treatment: 2;06 (score: 30)One year after treatment: 2;06 (score: 30)

Raynell Developmental Language Scales Raynell Developmental Language Scales (RDLS)(RDLS) After one year of treatment: After one year of treatment:

VC: 2;01VC: 2;01VE: 1;09VE: 1;09

Case 1: ConclusionCase 1: Conclusion

Slow in acquiring 2Slow in acquiring 2ndnd language language (Cantonese)(Cantonese)

No interference with 1st language No interference with 1st language (English) development(English) development

Factors leading to slow acquisition:Factors leading to slow acquisition: Environmental factor: school, familyEnvironmental factor: school, family Interference from MandarinInterference from Mandarin Personality factor Personality factor

Interference from MandarinInterference from Mandarin

Case 2Case 2

YCYC12 years 2 months old12 years 2 months oldFitted with bilateral HA at 2;06Fitted with bilateral HA at 2;06Lived in Mainland China and spoke Mandarin beLived in Mainland China and spoke Mandarin before implantationfore implantationStudied in school for the deaf with total communiStudied in school for the deaf with total communication in Mainland cation in Mainland CI done at 6 years 10 months and 7 years 6 moCI done at 6 years 10 months and 7 years 6 months (bilateral implantation, MedEl combi 40+ )nths (bilateral implantation, MedEl combi 40+ )Moved to HK in early 2001 (7;07)Moved to HK in early 2001 (7;07)

Case 2Case 2

Started ST training in Cantonese since Started ST training in Cantonese since February 2001 (7;08)February 2001 (7;08)

Enrolled in normal KG and primary schoolEnrolled in normal KG and primary school

Average academic performanceAverage academic performance

Uses mainly Cantonese to communicateUses mainly Cantonese to communicate

Case 2: Language Assessment Case 2: Language Assessment (Mandarin)(Mandarin)

Informal observation (pre-implant, CA: 6;0Informal observation (pre-implant, CA: 6;09)9) Short sentences (mainly 3-4 elements), no coShort sentences (mainly 3-4 elements), no co

mplex/compound sentencesmplex/compound sentences Vocabulary: inadequate in view of his CAVocabulary: inadequate in view of his CA Different speech acts noted (asking questions,Different speech acts noted (asking questions,

making clarification, greetings, labelling, etc) making clarification, greetings, labelling, etc) Not able to understand abstract concept e.g. cNot able to understand abstract concept e.g. c

onditional sentences onditional sentences

Case 2: Language Assessment Case 2: Language Assessment (Cantonese)(Cantonese)

RDLSRDLS Delay in both verbal comprehension and Delay in both verbal comprehension and

verbal expressionverbal expression Delay in verbal comprehension > verbal Delay in verbal comprehension > verbal

expressionexpression

Case 2: Speech Perception Case 2: Speech Perception Assessment (Cantonese)Assessment (Cantonese)

Paediatric Speech Perception TestPaediatric Speech Perception Test Vowel identification: 85%Vowel identification: 85% Consonant identification: 65%Consonant identification: 65% Tone identification: 64%Tone identification: 64% Sentence recognition: 80%Sentence recognition: 80% Connected speech comprehension: 70%Connected speech comprehension: 70% Performance comparable to same aged peers Performance comparable to same aged peers

with Cantonese as 1with Cantonese as 1stst language language

CASE 2: Language Development CASE 2: Language Development (Cantonese)(Cantonese)

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20

40

60

80

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120

140

160

2002 2003 2004 2005

Time at Assessment

Age

in m

onth

s / %

sco

re

CA

RDLS:VC-ageequivalent

RDLS:VE- ageequivalent

vowel

consonant

tone

sentence

connected speech

Case 2: ConclusionCase 2: Conclusion

Delayed development in 2Delayed development in 2ndnd language language (Cantonese) acquisition(Cantonese) acquisition

Possible explanation for the delayPossible explanation for the delay Age at implantationAge at implantation Delay in 1Delay in 1stst language development language development

Constant gap between CA and speech Constant gap between CA and speech perception ability but increasing gap with perception ability but increasing gap with language agelanguage age

Case 2: ConclusionCase 2: Conclusion

Speech Perception ability comparable to Speech Perception ability comparable to other implantees with Cantonese as 1other implantees with Cantonese as 1stst languagelanguage

Development in 1Development in 1stst language slow down language slow down because of complete switch from 1because of complete switch from 1stst language to 2language to 2ndnd language language

Case 3Case 3

KKKK7 years 4 months old7 years 4 months oldFitted with bilateral HA at 2;04Fitted with bilateral HA at 2;04No verbal language before implantationNo verbal language before implantationCI at 3;04 (MedEl Combi 40+)CI at 3;04 (MedEl Combi 40+)Lived in Mainland ChinaLived in Mainland ChinaStudied in normal KG in MainlandStudied in normal KG in MainlandSpeaks MandarinSpeaks Mandarin

Case 3Case 31 year post-implant assessment (11 year post-implant assessment (1stst language, Mandarin)language, Mandarin) RDLS (based on Cantonese Version):RDLS (based on Cantonese Version):

CA:4;04CA:4;04VC: 2;10VC: 2;10VE: 2;05VE: 2;05

Informal observation:Informal observation:Speaking mainly 2-3 element sentencesSpeaking mainly 2-3 element sentencesDeveloped various word classes: verbs, nouns, Developed various word classes: verbs, nouns, adjectivesadjectivesRate of development exceeds increase in ageRate of development exceeds increase in age

Case 3Case 3

Had two months training in Cantonese (July to Had two months training in Cantonese (July to August 2004, age:6;04, 3 years post implant)August 2004, age:6;04, 3 years post implant)Showed significant improvement in vocabulary Showed significant improvement in vocabulary learning by CRVT:learning by CRVT: Before treatment: raw score-3; AE-<1;10Before treatment: raw score-3; AE-<1;10 After treatment: raw score-27; AE-2;02After treatment: raw score-27; AE-2;02

Rate of acquisition exceeded age increaseRate of acquisition exceeded age increaseAbove-average academic achievement in 1Above-average academic achievement in 1stst languagelanguageTreatment suspended because of family Treatment suspended because of family problemproblem

ConclusionConclusion

CI users can acquire 2CI users can acquire 2ndnd spoken language spoken language

Able to perceive the phonemic patterns of Able to perceive the phonemic patterns of 22ndnd language language

Functional use of the 2Functional use of the 2ndnd language language

Delay in 2Delay in 2ndnd language development language development

11stst language development continues as language development continues as long as it was continuously used in daily long as it was continuously used in daily lifelife

ConclusionConclusion

Possible factors affecting 2Possible factors affecting 2ndnd language language acquisitionacquisition Age at implantationAge at implantation Language ability in 1Language ability in 1stst language language Environmental stimulation for 2Environmental stimulation for 2ndnd language language Language similarity, especially phonemic Language similarity, especially phonemic

patternspatterns

Thank YouThank You