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CS - Cochlear Implantation

Cued Speech is English made visible, so it fits perfectly with education and literacy - and with the use of cochlear implants.

CS can give language and communication in English before an implant and ‘fill in the gaps’ after an implant. 

It only takes about 20 hours to learn CS so your baby can learn English without delay.

Won’t hearing aids or cochlear implants be enough? 

They might; some children do well, but others gain only a partial understanding of English. There's always a delay before an implant. Also hearing aids and implants don’t work well if there is a lot of background noise or if the speaker is any distance from the listener.  In these cases the speaker’s words may be too indistinct for the deaf child to understand.  There are also times in your baby or child’s life when it is impractical to wear an aid or implant.  Using CS in addition to an implant can give your child access to full language even when he or she can’t hear it all properly. 


How is CS different from using BSL?

BSL is a completely different language to English; CS on the other hand IS English but visual English rather than spoken English. 

When to use CS:

1. Before an implant to ensure that language development and communication is not delayed.

2. Continue after an implant:

  • to help as your baby or child learns to listen
  • to give on-going help in situations where listening conditions are poor (when there is background noise etc.)
  • when the implant is not used (in the bath etc).

3.        If your child is not making good progress with the implant alone:

  • ask about Cued Speech use if your child, like A-J in the story, is not keeping up with hearing peers or is struggling to fully understand. 

Cued Speech is effective with children at home and at school.  Regardless of how much a child can hear prior to, or with, an implant, CS can be used a part of a continuum of support to ensure full access to English at all times.

It takes only about 20 hours to learn Cued Speech. 

Language Learning - How CS helps

If you are a hearing person you think in a ‘spoken’ language which you learnt because the people who cared for you when you were a baby - usually your parents - talked with you. They, often unconsciously, ‘taught’ you the names of familiar objects, feelings and actions and the grammar you needed to turn your thoughts into sentences. Yet all the tens of thousands of words in our heads are made up of only 44 different sounds or ‘phonemes’ - the sound-based units of English.

Deaf children who cannot hear these sounds, or only hear some of them, and who do not have the benefit of Cued Speech, do not learn English fully or learn it with great difficulty.

When you use Cued Speech you turn the 44 phonemes of speech into visible units which, like speech sounds, can be combined into words, sentences ….language. So when parents use Cued Speech when talking with their deaf baby he or she can learn English, easily and naturally - regardless of what they can hear. With Cued Speech deaf children can join in with the rest of the family.  Also with unambiguous communication, parents can be effective as language models, just as they are with their hearing children.

With a full understanding of English deaf children can more easily communicate with the general public. 

Also because the 44 phonemes of Cued Speech are exactly the same as the 44 phonemes of speech (indeed they are speech with an added ‘cue’) deaf children can learn to read using the same techniques as hearing children and have equal literacy levels.

Because Cued Speech is just speech with an added ‘cue’ it is uniquely helpful paired with cochlear implantation. 

  • Over 90% of deaf children are born to hearing parents that have no ready way of communicating with their baby.1
  • Without Cued Speech deaf children can have problems understanding English2, low literacy levels3, and may become isolated at home4
  • Deaf children brought up with Cued Speech can think in English and they can use this internal language to learn to read and write.  Research and case studies show that, with Cued Speech, deaf children, can have literacy levels equivalent to hearing children5.
  • A survey in the USA of 32 deaf adults brought up with Cued Speech found high levels of self-esteem and self-confidence, which they credited to Cued Speech.  The vast majority reported that they were always included in family conversations and activities6.
  • Once a deaf child starts school a Teaching Assistant (or Communication Support Worker) who is trained in Cued Speech can use it to give them full access to the curriculum.

One Family's Story

Charlotte Lynch, a Teacher of the Deaf in Devon, explains how one implanted little girl has benefited from Cued Speech.

A-J is 7 years old, and has a cochlear implant. She attends her local school in Devon. She was implanted at the age of 18 months and although she was hearing sounds across the frequency range at 30-40dB, she did not make the expected progress with her speaking and listening skills in the four years post-implant. It became apparent that there were underlying difficulties hindering her progress. Following investigations and assessments, a language disorder was diagnosed at the age of 6.

We first introduced Cued Speech to A-J a few months before the diagnosis of language disorder had been confirmed. I had hesitated to introduce this as she had made slow progress with both her British Sign Language skills and her speaking and listening and I wondered if we were overloading her with yet another thing.

However, after discussion with her school and parents, the two TAs working with A-J and mum agreed to an introductory session with our Cued Speech tutor. After only half a day’s training the TAs immediately started putting this into practice and picked up the system incredibly quickly. They have had very little formal teaching of the system but both gained the Level 1 exam within less than a year and one went on to pass the Level 2 Cued Speech exam a month later!

Whilst visual phonics had been used previously at single sound level, Cued Speech was able to take phonics a step further and make blending sounds together possible. A-J absorbed cueing as just another visual sign and picked it up straight away. She was fascinated by all the displays of handshapes and cue script [written handshapes showing the cues] that went up around the room. Very quickly her eye contact improved and she began to vocalise much more clearly and copy what was cued to her. It did not take her long to cue and say the names of all the children in her class, starting with simple one syllable names and progressing to multi-syllabic names.

In one to one sessions she works on becoming familiar with vocabulary on the THRASS chart, [phonics teaching materials] cueing the words and putting them into a sentence. She loves breaking down the words into separate sounds, and understands that phonemes can be represented by different combinations of graphemes.

A-J has been able to access the full programme of Letters and Sounds on an equal basis with her hearing peers and fully participates in group literacy activities. This includes the teaching of high frequency words and putting them into meaningful contexts. Although the school have not adopted Cued Speech for hearing children, A-J works with other children in small groups for Letters and Sounds and TAs have noted the benefits for hearing children too who pick up the cueing alongside her.  A-J’s knowledge of English has progressed rapidly and I was amazed to see her do an internet search recently looking up her favourite TV character at the time: ‘Venom Black Spiderman’. The combination of BSL and English and her interest in reptilian creatures meant that she understood the word venom which she demonstrated through BSL. She was also able to spell the word herself and took pride in showing off her new found vocabulary!.

Cued Speech fits in beautifully with the bilingual policy in Devon. Interestingly A-Js BSL skills have accelerated at the same time as her Cued Speech and the two together seem to complement each other. A-J can now cue her own reading book (pink and red band) and is beginning to read with increased understanding. BSL helps her to talk about the meanings and Cued Speech develops her awareness of how English structure works.

Since the introduction of Cued Speech, huge gains have been noted in eye contact, speech discrimination, word blending, literacy skills and behaviour. A-J’s mum wishes she had been introduced to Cued Speech earlier. There is still a long way to go, and it will be interesting to observe how her language develops over the next few years.


First published in the January 2012 magazine of the British Association of Teachers of the Deaf.

A-J’s mum Laura and TA Andrea can be found talking about their experience of using Cued Speech on YouTube.

 

A professional view:

Ruth Campbell, Ph.D. (Professor Emeritus, Department of Cognitive, Perceptual and Brain Sciences Division of Psychology and Language Sciences University College London) writes*:

The importance of Cued Speech is that it opens up the world of spoken language to the deaf child in a clear and simple way, from the outset.  This has, as Cornett envisioned, the potential to allow a form of the traditionally spoken language to develop naturally in a deaf child, via a communication modality that the child and the child’s caregiver can use easily, fluently, and collaboratively.

‘[Research] has shown conclusively that children exposed consistently to Cued Speech gained and maintained a headstart over deaf children of similar intelligence and skill who did not have Cued Speech.  Those who started using Cued Speech before school were even more likely to forge ahead, often with literacy levels and styles indistinguishable from hearing children...

...Because Cued Speech makes speech segments (phomenes) visible and discrete, it can be of special use in the earliest stages of reading (e.g. decoding) which require the child to develop automated abilities in isolating and identifying speech segments and mapping them to letter forms.  This is where the deaf child who does not have access to the full phonological structure of the spoken language faces a significant and fundamental hurdle.  Does the privileged access to the segmental structure of speech afforded by Cued Speech help the deaf child to clear this obstacle to fluent reading and spelling?  This was Cornett’s goal, and that goal has been supported empirically by the work that Alegria and Leybaert, with collegues led by Périer, started in Belgium 20 years ago.  That body of work, with French speakers, has shown conclusively that children exposed consistently to Cued Speech gained and maintained a headstart over deaf children of similar intelligence and skill who did not have Cued Speech.  Those who started using Cued Speech before school were even more likely to forge ahead, often with literacy levels and styles indistinguishable from hearing children. 

‘The importance of Cued Speech is that it opens up the world of spoken language to the deaf child in a clear and simple way, from the outset.  This has, as Cornett envisioned, the potential to allow a form of the traditionally spoken language to develop naturally in a deaf child, via a communication modality that the child and the child’s caregiver can use easily, fluently, and collaboratively.

 

*In the foreword to the book, Cued Speech and Cued Language for Deaf and Hard of Hearing Children (edited by Carol J. LaSasso, Kelly Lamar Crain and Jacqueline Leybaert).

Because this understanding is sound-based it is uniquely beneficial for deaf children both pre- and post-cochlear implant.

 

References
 
1.       Mitchell & Karchmer (2004) Parental hearing status for deaf and hard of hearing students, Sign Language Studies, 4(2), 138-163.
 
2.       Department for Education figures in 2011 show that 77% of deaf children are starting school having failed to achieve a good level of development in the early years foundation stage assessment, with 56% of them in the lowest 20% of achievement. National Curriculum Assessments at Key Stage 2 in England 2010/11. www.education.gov.uk/rsgateway/DB/SFR/S001047/index.shtml
 
3.       Most deaf children leave mainstream school at 16 with a reading age of 9. The Deaf School Child, Language and Cognitive Function, 1979, Conrad, R.  A government-funded review in 1999 concluded ‘We have no evidence to demonstrate an overall significant improvement since Conrad’s study’.
 
4.   ‘It is estimated that 81% of parents with a deaf child never learn to communicate fully with their child.’ Deaf young people and their families, 1995, S. Gregory et al.  The BAC Counselling Reader, 1996, H Ratna. 
 
5.   Use of Internal Speech in Reading by Hearing Impaired Students in Oral, Total Communication and Cued Speech Programs, 1989, Wandel, Jean. E., Doctoral Dissertation, Columbia University, New York.
 
6.   Experiences & Perceptions of Cueing Deaf Adults in the US, 2010, Crain & LaSasso.  Cued Speech and Cued Language for Deaf and Hard of Hearing Children, Plural Publishing, 2010.


Below are the links to some research supporting the use of Cued Speech with a cochlear implantation.

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