Age of 8
General data on the case:
- Biographical and case identification data – Adela is the first child of a young hearing family from Iasi. Both parents and her younger brother are hearing.
- Case history (Anamnesis):
- Significant medical data – Adela was born prematurely at 27 weeks with all the associated complications. Because she had a brain hemorrhage, the girl was on the verge of losing her sight and hearing. At birth, she weighed just 700 g and received an APGAR score of 3. Through the universal neonatal hearing screening, a bilateral hearing loss was detected at birth. Further objective measurements (BERA) showed a bilateral hearing loss > 100 dB on both sides.
- There was a hearing aid trial period between 6 months and 18 months with no improvement. At the age of 18 months, she received her first cochlear implant in her left ear and 6 months later, at age 2, she received her second implant on her right side.
- Significant psychological data – Adela is an exceptional child, truly a miracle, who beat all the odds that were against her. At birth, her chances were 1%. She has small cognitive delays but compensates on other levels. She is passionate about geography and cats. With the help of a speech therapist and a good support network at home, she developed particularly good speech and spoken language. Currently, her speech therapist has stopped the sessions because she’s fully recovered.
- Educational setting: When she was 19 months old, Adela’s first implant was activated, and she was already seeing a speech therapist 4 times a week. During the first couple of years after receiving the implants, most of the rehabilitation process took place at home, mainly with her mother, who almost became a speech therapist herself; she attended all national and international speech therapy courses and conferences she was able to attend.
- At the age of 3, Adela started going to a special nursery school for 2 years and then switched to a regular one for another 2 years. Her parents chose to postpone her entry to school for one year because they feared she won’t be able to keep up with her peers. She went to a private school eventually. She is learning English and German intensively and from next year she will start learning Chinese and French.
Significant social data: Adela comes from a moderate-income family. They are 4 people living in a 4-bedroom apartment. Her mother has a university degree and works as a director at a private medical clinic. She chose to give up her job for a while and get fully involved in the auditory-verbal rehabilitation process and when Adela turned 4 she hired a nanny and returned to work. Adela’s father has a degree as well and he works as a computer scientist for a company.
- Age of fitting the first hearing aids and cochlear implants: Adela received bilateral hearing aids right after being diagnosed at 6 months old but showed no improvement. At 18 months, Adela received her first CI which was fitted one month later. The fitting went well, without any issues. She did not wear a hearing aid in the opposite ear before receiving the second CI because it did not seem efficient. At the age of 2, she received her second CI and was fitted a month later. The second fitting went as well as the first one.
How often and what kind of support/rehabilitation does the child/family receive?
After the first CI was activated, Adela and her mother started going to speech therapy 4 times a week. There, the mother was constantly educated on how to support her CI child and stimulate spoken language.
- age when undergoing first cochlear implantation (left or right side): 18 months, left side
- type of implant: On her right side – Nucleus implant with an N6 processor On her left side – a Nucleus implant with an N6 processor
- number of implants (CI and hearing aids): CI1 18 months, CI2 24 months
– current average duration of the CI use (information from the audiologists): 14 hours/day
- other relevant information: No issues/difficulties were reported in using the devices.
What is the procedure for starting speech therapy after CI?
The importance of speech therapy and rehabilitation is discussed with the parents before implantation. There is no official rehabilitation program, so it is up to the parents to choose a speech therapist. Unfortunately, there are very few speech therapists with CI experience so sometimes it can be an accessibility issue.
The Speech Therapy used in rehabilitation
Adela went to a CI-focused speech therapist 4 times a week for a session of about 45 min. The therapy was based only on verbal-oral communication and training the parents in the process of auditory-verbal rehabilitation.
After the first fitting, she started reacting to speech sounds but she only started to vocalize after a few months. She was able to comprehend speech as well as produce full sentences herself, 2 years from getting the implants. Outside therapy, her parents would vocalize absolutely everything that was going on around her. They would ask her questions and teach her to verbalize her answers.
Adela never learned or used sign language or lip-reading. She received regular audiological support and adjustments.
SWOT analysis by Adela’s mother
Strengths: Adela’s mother is thrilled about CI; she’s a big fan. She’s very thankful because it gives her daughter a chance to have a normal life. The fact that the girl received the first cochlear implant at a young age – 1 year and 6 months – increased her chances of having a normal life even more. Adela benefitted from quality speech therapy based on parent training who did everything for her.
Weaknesses: Adela’s case evolved with little to no setbacks. The mother fears that one day her daughter will be terrified not to have access to batteries or chargers. She would like the batteries to last longer.
Opportunities: Over the years, Adela and her mother got to spend quality time together. They traveled to various places to expose her to as many experiences as possible.
Threats: They have had little to no negative experiences in the rehabilitation process. Adela had an incredibly good team (parents – speech therapist – audiologist) helping her every step of the way. She’s an amazing child, who managed to overcome everything. It has been a success story.