New Year Goals for Clinicians Working with Children wearing Cochlear Implants

As a new semester of school approaches, it is a good time for clinicians and parents to review a child's IEP; to get a mid-year reading on the child's progress toward his or her stated goals. Yet, as experienced educators know, it is not just the child's progress we assess, but our own development as clinicians. Many of us have on our caseloads children with cochlear implants, but are unsure of the modifications we should be making to progressively challenge a student's listening development. Using principles from a chapter I published recently in Cochlear Implants – Principles and Practices (2009; John Niparko, Editor), I offer some practical tips for clinicians: 1) Integrate perception and production goals. Therapy activities should contain both a listening and speaking component whenever possible, allowing the clinician to cover considerably more training in each session; 2) Develop a "dialogue' rather than "tutorial" therapy style. Rather than the clinician serving as the dominant conversational partner (as in a tutorial format), the dialogue format emphasizes turn-taking and switching of roles by child and clinician. The demands placed on the child differ when the child is the listener vs. the speaker; 3) Utilize communication sabotage. First described by Lucas-Arwood in the child language literature, communication sabotage is used to teach the child that s/he must be prepared for the unexpected and that listening is unpredictable; 4) Use drills consistently but judiciously, following a "quick, fun, get-it-done" approach. Drills are important for rapid motor practice of speech targets and for achieving many repetitions of a target in a short period of time. But, just as hitting against a backboard is good practice for tennis strokes but unsatisfying in and of itself, so drills are a critical component of intelligible speech work but should not be confused with real-world communication. As a last word, I am glad to be blogging again, following a period of technology breakdowns that took considerable time to resolve. The main theme I extracted from that experience? Back up, back up, back up! Happy Near Year.