Current Practices in Pediatric Cochlear Implantation Technological advances, specifically cochlear implants, have significantly impacted the treatment of children with severe to profound hearing loss. There are, however, very few professional guidelines or resources providing direction for hearing healthcare providers who are serving children with cochlear implants. The following article discusses a comprehensive management protocol for interdisciplinary ... Article
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Article  |   March 2009
Current Practices in Pediatric Cochlear Implantation
Author Affiliations & Notes
  • Tamala S. Bradham
    Vanderbilt Bill Wilkerson Center, Nashville, TN
  • Geneine Snell
    Vanderbilt Bill Wilkerson Center, Nashville, TN
  • David Haynes
    Vanderbilt Bill Wilkerson Center, Nashville, TN
  • © 2009 American Speech-Language-Hearing Association
Article Information
Hearing Aids, Cochlear Implants & Assistive Technology / Articles
Article   |   March 2009
Current Practices in Pediatric Cochlear Implantation
SIG 9 Perspectives on Hearing and Hearing Disorders in Childhood, March 2009, Vol. 19, 32-42. doi:10.1044/hhdc19.1.32
SIG 9 Perspectives on Hearing and Hearing Disorders in Childhood, March 2009, Vol. 19, 32-42. doi:10.1044/hhdc19.1.32
Abstract

Technological advances, specifically cochlear implants, have significantly impacted the treatment of children with severe to profound hearing loss. There are, however, very few professional guidelines or resources providing direction for hearing healthcare providers who are serving children with cochlear implants. The following article discusses a comprehensive management protocol for interdisciplinary teams providing cochlear implant services for children.

Introduction
Technological advances, specifically cochlear implants, have significantly impacted the treatment of children with severe to profound hearing loss. Many organizations, including the American Speech-Language Hearing Association (ASHA), the National Association of the Deaf (NAD), and the National Institutes of Health (NIH), and the William House Cochlear Implant Study Group, all have position papers or guiding documents pertaining to cochlear implants; however, there are no published “best practices” or “standard of care” guidelines for cochlear implants. NIH published a consensus document on cochlear implants in 1995 when Nucleus was the only FDA approved cochlear implant system. A technical report on cochlear implants was written in 1986 and then revised in 2003 by ASHA. The Joint Audiology Committee on Clinical Practice, of which ASHA was a member, also published The Joint Audiology Committee Clinical Practice Statements and Algorithms, which included statements on cochlear implant assessments for adults and children (ASHA, 1999).
With the lack of evidence based-standard of care, patients are seen as needed by the audiologists and the schools or early intervention systems are responsible for developing and implementing the aural (re)habilitation program. Cochlear implant programs typically use the Food and Drug Administration (FDA) guidelines and the cochlear implant manufacturer's recommendations as much as possible in developing their cochlear implant program (see Table 1). In this paper, we will present a best practice model for teams to consider when implementing a pediatric cochlear implant program. We will describe the candidacy, follow-up management, practice management, and outreach/marketing issues that should be considered.
Table 1. FDA Guidelines for the Current Cochlear Implant Systems
FDA Guidelines for the Current Cochlear Implant Systems×
Company Age Hearing Loss Sentence Scores Word Scores Auditory Development Hearing Aid Use
Advanced Bionics
Harmony 12-23 months Profound SNHL AU (90 db HL) Lack of auditory development as indicated on IT-MAIS or MAIS 3 months
2 years - 3 years, 11 months Profound SNHL AU (90 db HL) 20% or less on MLNT (live voice) Lack of auditory development as indicated on IT-MAIS or MAIS 6 months
4- 17 years Profound SNHL AU (90 db HL) 30% or less on HINT-C 12% or less on PBK 6 months
Cochlear Americas
Freedom 12-23 months Profound SNHL AU (90 db HL) Lack of auditory development as indicated on IT-MAIS or MAIS
2 years - 4 years, 11 months Severe to Profound SNHL AU (70 dB HL) 30% or less on MLNT (live voice) Lack of auditory development as indicated on IT-MAIS or MAIS
5 - 17 years Severe to Profound SNHL AU (70 dB HL) 30 % or less on LNT Lack of auditory development as indicated on IT-MAIS or MAIS
Med El
Maestro 12 months - 4 years, 11 months Profound SNHL AU (90 db HL at 1k Hz and above) 20% or less on MLNT Lack of auditory development as indicated on IT-MAIS or MAIS
5 years to 17 years Profound SNHL AU (90 db HL at 1k Hz and above) 20% or less on LNT Lack of auditory development as indicated on IT-MAIS or MAIS
Table 1. FDA Guidelines for the Current Cochlear Implant Systems
FDA Guidelines for the Current Cochlear Implant Systems×
Company Age Hearing Loss Sentence Scores Word Scores Auditory Development Hearing Aid Use
Advanced Bionics
Harmony 12-23 months Profound SNHL AU (90 db HL) Lack of auditory development as indicated on IT-MAIS or MAIS 3 months
2 years - 3 years, 11 months Profound SNHL AU (90 db HL) 20% or less on MLNT (live voice) Lack of auditory development as indicated on IT-MAIS or MAIS 6 months
4- 17 years Profound SNHL AU (90 db HL) 30% or less on HINT-C 12% or less on PBK 6 months
Cochlear Americas
Freedom 12-23 months Profound SNHL AU (90 db HL) Lack of auditory development as indicated on IT-MAIS or MAIS
2 years - 4 years, 11 months Severe to Profound SNHL AU (70 dB HL) 30% or less on MLNT (live voice) Lack of auditory development as indicated on IT-MAIS or MAIS
5 - 17 years Severe to Profound SNHL AU (70 dB HL) 30 % or less on LNT Lack of auditory development as indicated on IT-MAIS or MAIS
Med El
Maestro 12 months - 4 years, 11 months Profound SNHL AU (90 db HL at 1k Hz and above) 20% or less on MLNT Lack of auditory development as indicated on IT-MAIS or MAIS
5 years to 17 years Profound SNHL AU (90 db HL at 1k Hz and above) 20% or less on LNT Lack of auditory development as indicated on IT-MAIS or MAIS
×
Candidacy
Marketplace for Children
Despite the substantial benefit the procedure can provide recipients, cochlear implantation is an underutilized service. To address this fact, one of the Public Health Application and Outreach goals from Healthy People 2010, Objective 28:13b [8], is to increase the number people who are deaf or very hard-of-hearing who use cochlear implants. The NIDCD's Healthy Hearing Progress Report (2004) notes that only 2 of every 1,000 adults who are deaf or very hard-of hearing received a cochlear implant. For children, Bradham and Jones (2008) reported that only 55% of the children who are candidates for cochlear implantation between ages birth through 6 were recipients of this technology.
Evaluations needed
The cochlear implant candidacy assessment varies from center to center. Based on the current FDA guidelines (see Table 1), children must present with a significant hearing loss, demonstrate a lack of auditory development with appropriately fit hearing aids, and have no medical contraindications for surgery. Due to this, a cochlear implant program needs at least an audiologists and a surgeon. The minimal tests needed to determine candidacy are audiological testing at two points in time to demonstrate degree of hearing loss and (lack of) auditory development. The patient must also undergo a medical evaluation.
Evidence based practices tells us though that this is not enough to achieve the potential outcomes that cochlear implant technologies can provide. Each child must also undergo a speech-language-auditory evaluation by a highly qualified speech-language pathologist in the area of pediatric deafness; educational assessments which may include a visit with the early interventionists or school personnel; psycho-educational testing to help with establishing appropriate expectations; occupational therapy assessment because many of these children also have other sensory-motor issues; and a family assessment by a social worker. If the following assessments were not completed at the time of identification of hearing loss, then they may also be recommended, as needed, during the candidacy testing: ophthalmology assessment, vestibular assessment, cardiology evaluation, genetic counseling, developmental pediatrician evaluation, and neurological assessment.
Due to the FDA guidelines, audiological testing for determining if a child would benefit from a cochlear implant is relatively straight-forward. Specifically, each child should have audiometric information and speech perception measures for each ear (see Table 2). Speech-language-auditory evaluation should also be completed prior to implantation to obtain a baseline measurement of the child's current functioning level in these skill areas. Testing protocols should be established and implemented at cochlear implant centers and include vocabulary, language, articulation, and auditory comprehension testing (see Table 3). In addition, academic testing may be included if applicable so that additional recommendations can be formulated for educational agencies. Following implantation, both formal and informal testing should be completed at 6-month post-activation and at yearly intervals thereafter. Given pre- and post-testing information, the implant team is able to measure benchmarks for success in all areas.
Table 2. Audiological Procedures Used During the Cochlear Implant Process
Audiological Procedures Used During the Cochlear Implant Process×
Visit Description Procedures CPT Codes Time
Inquiry CI Packet mailed 15 min
Case history Insurance and release forms Cochlear implant information
Candidacy Assessment Audiological Assessment Otoscopic examination 1 hour
Tympanograms 92567
Ipsilateral and contralateral acoustic reflexes 92568
OAE, limited 92587
Ear Specific information (Pure tones and speech)
Comprehensive audiometry 92557
OR Conditioned play audiometry 92582
OR Visual reinforcement audiometry 92579
ABR (if one has not been performed, or poor reliability) 92585 Separate appointment
Evaluation of Hearing aids and Counseling Electroacoustic Analysis of Hearing Aids 1.5 hour
Binaural 92595
Monaural 92594
Hearing Aid Check
Binaural
Monaural
Real Ear Measurements (to verify appropriate amplification and settings)
Evaluation of Aural Rehabilitation Status
Aided thresholds binaural, right ear only, left ear only
Best Aided Condition - Aided Speech Recognition (60 dB SPL; Words - Closed set, Words - open set, and sentences)
Questionnaires
MAIS or IT-MAIS
Expectations Questionnaire
Meadow-Kendall Questionnaire
Case History
Review device(s), expectations, candidacy, and evaluation process
Educational Consultation Questionnaires with EI or school provider(s) Site Visit, if possible 1-3 hours
Day of Surgery Audiological Testing and Consultation Auditory Evoked Potential Testing in OR 92585, 95920 1 hour
Equipment orientation
Warranty information
Programming Initial Activation (2 day process) Day 1 1.5 hrs
At post medical surgeon's visit - 2 weeks post operative Telemetry Test
Program Sound Processor(s) (using VRA, CPA, or Standard methods) Under 7 yrs, 92601; over 7 yrs, 92602
Neural Evoked Resources and/or 92584
Electric Evoked Acoustic Reflexes 92868
Day 2 1.5 hrs
Telemetry Test
Program Sound Processor(s) Under 7 yrs, 92603; over 7 yrs, 92604
Neural Evoked Responses and/or 92584
Electric Evoked Acoustic Reflexes 92868
Two Week Follow-up Program Sound Processor(s) Under 7 yrs, 92603; over 7 yrs, 92604 1 hour
Neural Evoked Responses and/or 92584
Electric Evoked Acoustic Reflexes, if needed 92868
One Month Follow-up Evaluation of Aural Rehabilitation Status 92626 1 hour
Aided air conduction thresholds (use C to mark responses on audiogram)
SAT/SRT
MAIS or IT-MAIS and/or other questionnaires
Telemetry Test
Program Sound Processor(s), if needed under 7 yrs, 92603; over 7 yrs, 92604
Two Months Follow-Up, if needed Aided air conduction thresholds 1 hour
Telemetry Test
Program Sound Processor(s) Under 7 yrs, 92603; over 7 yrs, 92604
Three Months Follow-Up Case History and/or questionnaires (assessing for red flags) 1.5 hours
Aided air conduction thresholds
Telemetry Test
Program Sound Processor(s) Under 7 yrs, 92603; over 7 yrs, 92604
If needed, Neural Evoked Responses and/or 92584
Electric Evoked Acoustic Reflexes 92868
Six Months Follow-Up Evaluation of Aural Rehabilitation Status 92626 45-60 minutes
Aided air conduction thresholds (use C to mark responses)
SAT/SRT
MAIS or IT-MAIS and/or other questionnaires
Aided Speech Recognition (60 dB SPL; Words - Closed set, Words - Open set, and sentences)
Telemetry Test
Program Sound Processor(s) under 7 yrs, 92603; over 7 yrs, 92604 45 minutes
If needed, Neural Evoked Responses and/or 92584
Electric Evoked Acoustic Reflexes 92868
Table 2. Audiological Procedures Used During the Cochlear Implant Process
Audiological Procedures Used During the Cochlear Implant Process×
Visit Description Procedures CPT Codes Time
Inquiry CI Packet mailed 15 min
Case history Insurance and release forms Cochlear implant information
Candidacy Assessment Audiological Assessment Otoscopic examination 1 hour
Tympanograms 92567
Ipsilateral and contralateral acoustic reflexes 92568
OAE, limited 92587
Ear Specific information (Pure tones and speech)
Comprehensive audiometry 92557
OR Conditioned play audiometry 92582
OR Visual reinforcement audiometry 92579
ABR (if one has not been performed, or poor reliability) 92585 Separate appointment
Evaluation of Hearing aids and Counseling Electroacoustic Analysis of Hearing Aids 1.5 hour
Binaural 92595
Monaural 92594
Hearing Aid Check
Binaural
Monaural
Real Ear Measurements (to verify appropriate amplification and settings)
Evaluation of Aural Rehabilitation Status
Aided thresholds binaural, right ear only, left ear only
Best Aided Condition - Aided Speech Recognition (60 dB SPL; Words - Closed set, Words - open set, and sentences)
Questionnaires
MAIS or IT-MAIS
Expectations Questionnaire
Meadow-Kendall Questionnaire
Case History
Review device(s), expectations, candidacy, and evaluation process
Educational Consultation Questionnaires with EI or school provider(s) Site Visit, if possible 1-3 hours
Day of Surgery Audiological Testing and Consultation Auditory Evoked Potential Testing in OR 92585, 95920 1 hour
Equipment orientation
Warranty information
Programming Initial Activation (2 day process) Day 1 1.5 hrs
At post medical surgeon's visit - 2 weeks post operative Telemetry Test
Program Sound Processor(s) (using VRA, CPA, or Standard methods) Under 7 yrs, 92601; over 7 yrs, 92602
Neural Evoked Resources and/or 92584
Electric Evoked Acoustic Reflexes 92868
Day 2 1.5 hrs
Telemetry Test
Program Sound Processor(s) Under 7 yrs, 92603; over 7 yrs, 92604
Neural Evoked Responses and/or 92584
Electric Evoked Acoustic Reflexes 92868
Two Week Follow-up Program Sound Processor(s) Under 7 yrs, 92603; over 7 yrs, 92604 1 hour
Neural Evoked Responses and/or 92584
Electric Evoked Acoustic Reflexes, if needed 92868
One Month Follow-up Evaluation of Aural Rehabilitation Status 92626 1 hour
Aided air conduction thresholds (use C to mark responses on audiogram)
SAT/SRT
MAIS or IT-MAIS and/or other questionnaires
Telemetry Test
Program Sound Processor(s), if needed under 7 yrs, 92603; over 7 yrs, 92604
Two Months Follow-Up, if needed Aided air conduction thresholds 1 hour
Telemetry Test
Program Sound Processor(s) Under 7 yrs, 92603; over 7 yrs, 92604
Three Months Follow-Up Case History and/or questionnaires (assessing for red flags) 1.5 hours
Aided air conduction thresholds
Telemetry Test
Program Sound Processor(s) Under 7 yrs, 92603; over 7 yrs, 92604
If needed, Neural Evoked Responses and/or 92584
Electric Evoked Acoustic Reflexes 92868
Six Months Follow-Up Evaluation of Aural Rehabilitation Status 92626 45-60 minutes
Aided air conduction thresholds (use C to mark responses)
SAT/SRT
MAIS or IT-MAIS and/or other questionnaires
Aided Speech Recognition (60 dB SPL; Words - Closed set, Words - Open set, and sentences)
Telemetry Test
Program Sound Processor(s) under 7 yrs, 92603; over 7 yrs, 92604 45 minutes
If needed, Neural Evoked Responses and/or 92584
Electric Evoked Acoustic Reflexes 92868
×
Table 3. Annual Comprehensive Speech-Language and Auditory Skill Assessment Protocol
Annual Comprehensive Speech-Language and Auditory Skill Assessment Protocol×
Age range Areas of Assessments
Voice Fluency Oral Mechanism Auditory Articulation/Phonology Language Cognition/Academics
Birth-3 years Informal Assessment Informal Assessment VBWC Speech Mechanism Screenings Auditory Development Checklist (VBWC) 2 Phonemic Inventory2 Rossetti Infant Toddler Scales 2 Sensorimotor Tasks (Miller et al., Uzgiris and Hunt)
Oral Speech Mechanism Screening Examination - Revised Early Speech Perception (ESP) Test2 Arizona Articulation Proficiency Scale - Third Revision (as applicable) MacArthur Index of Communicative Development2 Cottage Acquisition Scales for Listening, Language & Speech 1
Communication/Language Sample Pre-Verbal (0-12 months)
Bloom-Lahey Semantic Analysis - one and two word utterance stage Pre-Sentence (12-24 months)
Language Assessment and Remediation Screening Procedure (LARSP) - above two-word utterance stage Simple Sentence (24-48 months)
Record of Communicative Functions
3-5 Years Informal Assessment Informal Assessment Oral Speech Mechanism Screening Examination - Revised ESP Test2 Arizona Articulation Proficiency Scale - Third Revision Battery 1 Bracken Basic Concepts
Auditory Perception Test for the Hearing Impaired (APT/HI) Red Flags2 Identifying Early Phonological Needs in Children with Hearing Loss1 MacArthur Index of Communicative Development (as applicable) Reynell Developmental Language Scales Cottage Acquisition Scales for Listening, Language & Speech1
Battery 2 Simple Sentence (24-48 months)
Expressive One-Word Picture Vocabulary (EOWPVT-R) Complex Sentence (48+ months)
Receptive One-Word Picture Vocabulary (ROWPVT-R) Sounds & Speech
Communication/Language Sample2 Teacher Assessment of Grammatical Structures (TAGS)1
Bloom-Lahey Semantic Analysis - one and two word utterance stage Test of Early Reading Ability (TERA-3) 1
LARSP - above two-word utterance stage
Assigning Structural Stages - complex sentence structures
Record of Communicative Functions
VBWC Semantic Idiosyncratic Language Pattern Checklist
Test of Early Language Development (TELD-3) 1
5-18 Years Informal Assessment Informal Assessment Oral Speech Mechanism Screening Examination - Revised ESP Test2 Goldman Frostoe Test of Articulation Battery 1 Bracken Basic Concepts
APT/HI Test2 KLPA-2: Khan Lewis Phonological Analysis-2nd Edition (as applicable) Clinical Evaluation of Language Fundamentals (CELF-4) Diagnostic Achievement Battery (DABS-4) as applicable
Oral Written Language Scales Written Portion Only (OWLS) The Phonological Awareness Test (for children who are not reading yet)
Battery 2 Gray Oral Reading Tests (GORT-4)
Comprehensive Assessment of Spoken Language (CASL) OWLS Cottage Acquisition Scales for Listening, Language & Speech 1
Communication/Language Sample2 Simple Sentence (24-48 months)
Assigning Structural Stages - complex sentence structures Complex Sentence (48+ months)
Record of Communicative Functions Sounds & Speech
VBWC Semantic Idiosyncratic Language Pattern Checklist TAGS1
At the six month (mid-year) assessment time
CASL or CELF-4 (opposite of what you did at the annual evaluation session) 1
If you cannot give the CASL, then give EOWPVT-R and ROWPVT-R 1
1 Note: Only at 6 months,
Note: Only at 6 months,×
2 Both six months and annually
Both six months and annually×
Table 3. Annual Comprehensive Speech-Language and Auditory Skill Assessment Protocol
Annual Comprehensive Speech-Language and Auditory Skill Assessment Protocol×
Age range Areas of Assessments
Voice Fluency Oral Mechanism Auditory Articulation/Phonology Language Cognition/Academics
Birth-3 years Informal Assessment Informal Assessment VBWC Speech Mechanism Screenings Auditory Development Checklist (VBWC) 2 Phonemic Inventory2 Rossetti Infant Toddler Scales 2 Sensorimotor Tasks (Miller et al., Uzgiris and Hunt)
Oral Speech Mechanism Screening Examination - Revised Early Speech Perception (ESP) Test2 Arizona Articulation Proficiency Scale - Third Revision (as applicable) MacArthur Index of Communicative Development2 Cottage Acquisition Scales for Listening, Language & Speech 1
Communication/Language Sample Pre-Verbal (0-12 months)
Bloom-Lahey Semantic Analysis - one and two word utterance stage Pre-Sentence (12-24 months)
Language Assessment and Remediation Screening Procedure (LARSP) - above two-word utterance stage Simple Sentence (24-48 months)
Record of Communicative Functions
3-5 Years Informal Assessment Informal Assessment Oral Speech Mechanism Screening Examination - Revised ESP Test2 Arizona Articulation Proficiency Scale - Third Revision Battery 1 Bracken Basic Concepts
Auditory Perception Test for the Hearing Impaired (APT/HI) Red Flags2 Identifying Early Phonological Needs in Children with Hearing Loss1 MacArthur Index of Communicative Development (as applicable) Reynell Developmental Language Scales Cottage Acquisition Scales for Listening, Language & Speech1
Battery 2 Simple Sentence (24-48 months)
Expressive One-Word Picture Vocabulary (EOWPVT-R) Complex Sentence (48+ months)
Receptive One-Word Picture Vocabulary (ROWPVT-R) Sounds & Speech
Communication/Language Sample2 Teacher Assessment of Grammatical Structures (TAGS)1
Bloom-Lahey Semantic Analysis - one and two word utterance stage Test of Early Reading Ability (TERA-3) 1
LARSP - above two-word utterance stage
Assigning Structural Stages - complex sentence structures
Record of Communicative Functions
VBWC Semantic Idiosyncratic Language Pattern Checklist
Test of Early Language Development (TELD-3) 1
5-18 Years Informal Assessment Informal Assessment Oral Speech Mechanism Screening Examination - Revised ESP Test2 Goldman Frostoe Test of Articulation Battery 1 Bracken Basic Concepts
APT/HI Test2 KLPA-2: Khan Lewis Phonological Analysis-2nd Edition (as applicable) Clinical Evaluation of Language Fundamentals (CELF-4) Diagnostic Achievement Battery (DABS-4) as applicable
Oral Written Language Scales Written Portion Only (OWLS) The Phonological Awareness Test (for children who are not reading yet)
Battery 2 Gray Oral Reading Tests (GORT-4)
Comprehensive Assessment of Spoken Language (CASL) OWLS Cottage Acquisition Scales for Listening, Language & Speech 1
Communication/Language Sample2 Simple Sentence (24-48 months)
Assigning Structural Stages - complex sentence structures Complex Sentence (48+ months)
Record of Communicative Functions Sounds & Speech
VBWC Semantic Idiosyncratic Language Pattern Checklist TAGS1
At the six month (mid-year) assessment time
CASL or CELF-4 (opposite of what you did at the annual evaluation session) 1
If you cannot give the CASL, then give EOWPVT-R and ROWPVT-R 1
1 Note: Only at 6 months,
Note: Only at 6 months,×
2 Both six months and annually
Both six months and annually×
×
Determining Candidacy
The candidacy criteria have changed dramatically since the first multichannel system was approved. Once FDA approves the device and it is commercially available, the surgeon can determine how to best use the product. For example, the cochlear implant is approved for all people with significant permanent hearing loss including children down to 12 months of age. Many children younger than 12 months of age, however, are being implanted as well as people who have more residual hearing. The “clinically acceptable” candidacy criteria are evolving with improved technologies and outcome based studies. Due to this, when determining candidacy criteria, the professionals should ask the following questions:
  1. “Is physical implantation of the device possible and/or advisable given the medical status of the patient?

  2. “Is it likely that an individual will receive more communication benefit from the cochlear implant than from a hearing aid or alternatively from no hearing prosthesis at all?”

  3. “Do the necessary supports exist in the individual's psychological, family, educational, and rehabilitative situation to keep a cochlear implant working and integrate it into the patient's life? If not, can they be developed?” (ASHA, 2004).

Another question that implant programs are starting to ask is “Is it cost effective to implant this patient?” There is enough evidence-based research that can assist the teams in answering this question. For example, we know that the age of implantation has a significant effect on the child's outcome in successful usage of the cochlear implant system.
After asking all the above questions, the cochlear implant team members should be able to determine if the patient is a cochlear implant candidate. The team may also want a more formal tool to use in determining candidacy such as the Children's Implant Profile (Hellman, Chute, Kretcshmer, Nevins, Parisier, & Thuston, 1991), Cochlear Implant Candidacy - Children (CICC; Bradham, Lambert, Turick, & Swink, 2003), Graded Profile Analysis (Daya, Figueirido, Gordon, Twitchell, Gysin, & Papsin, 1999), Modified ChIP (Barnes, Lundy, Schuh, Foley, & Maddern, 2000). The information from this form can be helpful in 1) identifying areas for further counseling to the patient and 2) providing an overall “objective” number, which can be used in the team report for insurance authorization.
Follow-up
Surgery
Once a child is considered to be a cochlear implant candidate, it is recommended that they visit the hospital child life program, if available. These highly specialized providers will help prepare the child and his/her siblings for the surgery by explaining what will happen on the day of the surgery using developmental age-appropriate materials and games to prepare them. Today, many surgeons no longer shave the hair around the surgical site. Furthermore, the surgery for a single-stage procedure now takes less than 2 hours though it will be longer until the family sees their child in recovery. Most centers continue to use a “pressure” type of head dressing on the surgical site. It is important for the child to wear the dressing around the surgical site for 24 hours to minimize potential swelling or bruising. During the surgery, the audiologist can perform auditory evoked potential testing using the cochlear implant system to determine the presence of neural responses. Additionally, implant programs are starting to use this time while the child is in surgery to counsel the family on the equipment use and care, warranty information, and to review what to expect on the initial stimulation visit to help prepare them for that special day.
Audiological Services
At the post operative medical appointment prior to seeing the surgeon, we recommend conducting the initial stimulation of the device. This first visit should include auditory evoked potential testing and behavior responses using Visual Reinforcement Auditory or Conditioned Play Audiometry if possible. If the child is a recipient of simultaneous cochlear implantation, then we recommend only stimulating one device the first day, load the same program on all positions, and review product information. When they return the next day, the second cochlear implant system should be programmed, the first implant should be reprogrammed with multiple programs, and any additional counseling needed. The changes in the programs require frequent visits to the cochlear implant system during the first month. Depending on the family needs, a two month post initial stimulation visit with the audiologist may be needed. An example of one audiological protocol is presented in Table 2.
Speech-Language-Auditory Therapy
Therapy services established prior to the child receiving a cochlear implant is highly recommended. The therapy routine can be established, children and their families understand the expectations and counseling and guidance are provided before, during and after the procedure. Individual therapy pre-and post-implant should emphasize developing listening skills for learning. Parents/caregivers and all family members are encouraged to be equal partners in the therapy process. This equal partnership promotes carry-over of activities to other environments and provides families with the tools they need to develop listening and spoken language skills. The therapist should be continually assessing progress during each session in order to achieve maximum benefit from the device.
Red Flags
Because of ongoing assessment and diagnostic therapy, the team is able to constantly monitor progress through established benchmarks. Areas of concern or “red flags” may arise during this monitoring. These warning signs may include a notably slower rate of progress than anticipated, the child refusing to wear the device during all waking hours, and regression of skills. If “red flags” are uncovered, the implant team begins the investigation or search for the possible root causes. In the newly revised edition of The Auditory Performance Test - Hearing Impaired Revised test, there is a section on identifying red flags that may be helpful to the cochlear implant team. If red flags are identified, the team may recommend reprogramming the device or an integrity check of the internal equipment, utilizing behavior charts to increase the amount of time the child is wearing the device, incorporating different therapy strategies, increasing the amount or type of therapy being provided, adding sensory modalities, consulting with colleagues or referring to other professionals.
Program Management
FTE for Cochlear Implant Program
According to Backous and Littman (2003), they reported from a national survey that 44% of the centers surveyed had 1 FTE, 27% had 2 FTE, and 12% had 3 FTE to run their cochlear implant programs. Forty-four percent scheduled 2.5 to 3 hours for an initial stimulation and 47% saw their patient back the next day for additional programming. Carolyn Brown, Former Director of the Children Cochlear Implant Program at UNC in Chapel Hill, reported that to have adequate staff, a pediatric program should have approximately 80 cochlear implant patients per audiologist (personal communication, March 9, 2004). Further inquiry revealed that a program should have one audiologist to 100 total adult cochlear implant patients (Advanced Bionics, personal communication). In 2002, Garber and colleagues reported an average of approximately 2.5 FTE audiologists dedicated to cochlear implants programs. Furthermore, the study reported approximately 5.5 hours being used for audiological candidacy testing per patient, approximately 2.5 hours per programming session, and the mean number of follow-up programming visits per patient was 9.3. Due to changes in technology, 2 hours would be more appropriate for programming appointments: 30-45 minutes for history, aided audiogram, and speech perception tests; 30-45 minutes for programming sound processors; and 15-30 minutes for report writing, follow-up phone calls, and repairs. For initial activations, the audiologist would spend approximately 45 minutes programming, 30 minutes counseling on how to use the system, and then 15 minutes for report writing and filling out warranty information.
Marketing
There are many ways to market a program: forums and community talks, newsletters, articles in the newspapers, television interviews, the internet, and word-of-mouth from patients and their families. These are all ways to help educate people about hearing loss and cochlear implants. It is important to repeat these efforts on a continuous cycle because technology changes. Additionally, each cochlear implant manufacturer has a “find a clinic near you” on their Web site. These are very helpful to both professionals and consumers who are looking for a center for cochlear implant services.
Future of Cochlear Implants
As technology is refined, there will be less audiological follow-up needed to provide appropriate care for cochlear implant patients. There is discussion of the development of remote and/or self programming techniques, some of which are currently being used in pilot programs. As the age of implantation decreases, less speech-language services will be required due to being able to take advantage of natural language development. The educating of children with hearing loss will also change. There is much discussion on literacy development in children with hearing loss, in which more research is needed. There will probably be a shift in the future that the SLPs and teachers of students who are deaf will need to focus more on the “other disabilities” rather than the hearing loss. There will be an increase case-load of multiple disabilities where there will need to be more collaboration with occupational and physical therapists. Furthermore, with reimbursement for services continuing to decline, more innovative practice patterns will have to be employed for cochlear implants to remain open for services.
References
American Speech-Language-Hearing Association. (1999). Joint audiology committee clinical practice statements and algorithms [Guidelines]. Retrieved March 11, 2009 from www.asha.org/policy
American Speech-Language-Hearing Association. (1999). Joint audiology committee clinical practice statements and algorithms [Guidelines]. Retrieved March 11, 2009 from www.asha.org/policy×
American Speech-Language-Hearing Association. (2004). Cochlear implants [Technical Report]. Retrieved on December 1, 2008 from www.asha.org/policy
American Speech-Language-Hearing Association. (2004). Cochlear implants [Technical Report]. Retrieved on December 1, 2008 from www.asha.org/policy×
Allen, S.G. (2007). Auditory Perception Test for the Hearing Impaired. San Diego, CA: Plural Publishing.
Allen, S.G. (2007). Auditory Perception Test for the Hearing Impaired. San Diego, CA: Plural Publishing.×
Backous, D. D., & Littman, T.A. ( 2003, April). Practice patterns for programming and aural rehabilitation in American cochlear implant centers. Paper presented at the Cochlear Implants in Children 9th Symposium, Washington, DC.
Backous, D. D., & Littman, T.A. ( 2003, April). Practice patterns for programming and aural rehabilitation in American cochlear implant centers. Paper presented at the Cochlear Implants in Children 9th Symposium, Washington, DC.×
Barnes, J., Lundy, L., Schuh, M., Foley, J., & Maddern, B. ( 2000, February). Modified children's implant profile (ChIP 2000): Nine factors import to implant use and success for children up to 12 years of age. Paper presented at the 6th International Cochlear Implants Conference, Miami, FL.
Barnes, J., Lundy, L., Schuh, M., Foley, J., & Maddern, B. ( 2000, February). Modified children's implant profile (ChIP 2000): Nine factors import to implant use and success for children up to 12 years of age. Paper presented at the 6th International Cochlear Implants Conference, Miami, FL.×
Bradham, T.S., & Jones, J. (2008). Estimated Prevalence of Pediatric Cochlear Implant Candidates in the United States. International Journal of Pediatric Otorhinolaryngology, 72(7), 1023–1028. [Article] [PubMed]
Bradham, T.S., & Jones, J. (2008). Estimated Prevalence of Pediatric Cochlear Implant Candidates in the United States. International Journal of Pediatric Otorhinolaryngology, 72(7), 1023–1028. [Article] [PubMed]×
Bradham, T. S., Lambert, P. R., Turick, A., & Swink, N. ( 2003, April). New tool in determining cochlear implant candidacy: Preliminary data using the children implant candidacy criteria (CICC). Cochlear Implants in Children 9th Symposium, Washington, DC.
Bradham, T. S., Lambert, P. R., Turick, A., & Swink, N. ( 2003, April). New tool in determining cochlear implant candidacy: Preliminary data using the children implant candidacy criteria (CICC). Cochlear Implants in Children 9th Symposium, Washington, DC.×
Bradham, T. S., Stith, J., Lambert, P. R., Anderson, D., & Bradham, W. S. ( 2003, April). New tool in pediatric assessment of cochlear implant candidacy, Paper presented at the Cochlear Implants in Children 9th Symposium, Washington, DC.
Bradham, T. S., Stith, J., Lambert, P. R., Anderson, D., & Bradham, W. S. ( 2003, April). New tool in pediatric assessment of cochlear implant candidacy, Paper presented at the Cochlear Implants in Children 9th Symposium, Washington, DC.×
Daya, H., Figueirido, J. C., Gordon, K. A., Twitchell, K., Gysin, C., & Papsin, B. C. (1999). The role of a graded profile analysis in determining candidacy and outcome for cochlear implantation in children. International Journal of Pediatric Otorhinolaryngology, 49(2), 135–142. [Article] [PubMed]
Daya, H., Figueirido, J. C., Gordon, K. A., Twitchell, K., Gysin, C., & Papsin, B. C. (1999). The role of a graded profile analysis in determining candidacy and outcome for cochlear implantation in children. International Journal of Pediatric Otorhinolaryngology, 49(2), 135–142. [Article] [PubMed]×
Garber, S., Ridgely, S., Bradley, M., & Chin, K. (2002). Payment under public and private insurance and access to cochlear Implants. Arch Otolaryngology Head Neck Surgery, 128, 1145–1152. [Article]
Garber, S., Ridgely, S., Bradley, M., & Chin, K. (2002). Payment under public and private insurance and access to cochlear Implants. Arch Otolaryngology Head Neck Surgery, 128, 1145–1152. [Article] ×
Hellman, S. A., Chute, P. M., Kretcshmer, R. E., Nevins, M. E., Parisier, S. C., & Thuston, L. C. (1991). The development of a Children's Implant Profile. American Annals of the Deaf, 36(2), 77–81. [Article]
Hellman, S. A., Chute, P. M., Kretcshmer, R. E., Nevins, M. E., Parisier, S. C., & Thuston, L. C. (1991). The development of a Children's Implant Profile. American Annals of the Deaf, 36(2), 77–81. [Article] ×
National Institute on Deafness and Other Communication Disorders. (2004). Healthy People 2010 Hearing Health Progress Review. Retrieved December 1, 2008, from http://www.nidcd.nih.gov/health/healthyhearing/what_hh/progress_review_04.asp
National Institute on Deafness and Other Communication Disorders. (2004). Healthy People 2010 Hearing Health Progress Review. Retrieved December 1, 2008, from http://www.nidcd.nih.gov/health/healthyhearing/what_hh/progress_review_04.asp×
Table 1. FDA Guidelines for the Current Cochlear Implant Systems
FDA Guidelines for the Current Cochlear Implant Systems×
Company Age Hearing Loss Sentence Scores Word Scores Auditory Development Hearing Aid Use
Advanced Bionics
Harmony 12-23 months Profound SNHL AU (90 db HL) Lack of auditory development as indicated on IT-MAIS or MAIS 3 months
2 years - 3 years, 11 months Profound SNHL AU (90 db HL) 20% or less on MLNT (live voice) Lack of auditory development as indicated on IT-MAIS or MAIS 6 months
4- 17 years Profound SNHL AU (90 db HL) 30% or less on HINT-C 12% or less on PBK 6 months
Cochlear Americas
Freedom 12-23 months Profound SNHL AU (90 db HL) Lack of auditory development as indicated on IT-MAIS or MAIS
2 years - 4 years, 11 months Severe to Profound SNHL AU (70 dB HL) 30% or less on MLNT (live voice) Lack of auditory development as indicated on IT-MAIS or MAIS
5 - 17 years Severe to Profound SNHL AU (70 dB HL) 30 % or less on LNT Lack of auditory development as indicated on IT-MAIS or MAIS
Med El
Maestro 12 months - 4 years, 11 months Profound SNHL AU (90 db HL at 1k Hz and above) 20% or less on MLNT Lack of auditory development as indicated on IT-MAIS or MAIS
5 years to 17 years Profound SNHL AU (90 db HL at 1k Hz and above) 20% or less on LNT Lack of auditory development as indicated on IT-MAIS or MAIS
Table 1. FDA Guidelines for the Current Cochlear Implant Systems
FDA Guidelines for the Current Cochlear Implant Systems×
Company Age Hearing Loss Sentence Scores Word Scores Auditory Development Hearing Aid Use
Advanced Bionics
Harmony 12-23 months Profound SNHL AU (90 db HL) Lack of auditory development as indicated on IT-MAIS or MAIS 3 months
2 years - 3 years, 11 months Profound SNHL AU (90 db HL) 20% or less on MLNT (live voice) Lack of auditory development as indicated on IT-MAIS or MAIS 6 months
4- 17 years Profound SNHL AU (90 db HL) 30% or less on HINT-C 12% or less on PBK 6 months
Cochlear Americas
Freedom 12-23 months Profound SNHL AU (90 db HL) Lack of auditory development as indicated on IT-MAIS or MAIS
2 years - 4 years, 11 months Severe to Profound SNHL AU (70 dB HL) 30% or less on MLNT (live voice) Lack of auditory development as indicated on IT-MAIS or MAIS
5 - 17 years Severe to Profound SNHL AU (70 dB HL) 30 % or less on LNT Lack of auditory development as indicated on IT-MAIS or MAIS
Med El
Maestro 12 months - 4 years, 11 months Profound SNHL AU (90 db HL at 1k Hz and above) 20% or less on MLNT Lack of auditory development as indicated on IT-MAIS or MAIS
5 years to 17 years Profound SNHL AU (90 db HL at 1k Hz and above) 20% or less on LNT Lack of auditory development as indicated on IT-MAIS or MAIS
×
Table 2. Audiological Procedures Used During the Cochlear Implant Process
Audiological Procedures Used During the Cochlear Implant Process×
Visit Description Procedures CPT Codes Time
Inquiry CI Packet mailed 15 min
Case history Insurance and release forms Cochlear implant information
Candidacy Assessment Audiological Assessment Otoscopic examination 1 hour
Tympanograms 92567
Ipsilateral and contralateral acoustic reflexes 92568
OAE, limited 92587
Ear Specific information (Pure tones and speech)
Comprehensive audiometry 92557
OR Conditioned play audiometry 92582
OR Visual reinforcement audiometry 92579
ABR (if one has not been performed, or poor reliability) 92585 Separate appointment
Evaluation of Hearing aids and Counseling Electroacoustic Analysis of Hearing Aids 1.5 hour
Binaural 92595
Monaural 92594
Hearing Aid Check
Binaural
Monaural
Real Ear Measurements (to verify appropriate amplification and settings)
Evaluation of Aural Rehabilitation Status
Aided thresholds binaural, right ear only, left ear only
Best Aided Condition - Aided Speech Recognition (60 dB SPL; Words - Closed set, Words - open set, and sentences)
Questionnaires
MAIS or IT-MAIS
Expectations Questionnaire
Meadow-Kendall Questionnaire
Case History
Review device(s), expectations, candidacy, and evaluation process
Educational Consultation Questionnaires with EI or school provider(s) Site Visit, if possible 1-3 hours
Day of Surgery Audiological Testing and Consultation Auditory Evoked Potential Testing in OR 92585, 95920 1 hour
Equipment orientation
Warranty information
Programming Initial Activation (2 day process) Day 1 1.5 hrs
At post medical surgeon's visit - 2 weeks post operative Telemetry Test
Program Sound Processor(s) (using VRA, CPA, or Standard methods) Under 7 yrs, 92601; over 7 yrs, 92602
Neural Evoked Resources and/or 92584
Electric Evoked Acoustic Reflexes 92868
Day 2 1.5 hrs
Telemetry Test
Program Sound Processor(s) Under 7 yrs, 92603; over 7 yrs, 92604
Neural Evoked Responses and/or 92584
Electric Evoked Acoustic Reflexes 92868
Two Week Follow-up Program Sound Processor(s) Under 7 yrs, 92603; over 7 yrs, 92604 1 hour
Neural Evoked Responses and/or 92584
Electric Evoked Acoustic Reflexes, if needed 92868
One Month Follow-up Evaluation of Aural Rehabilitation Status 92626 1 hour
Aided air conduction thresholds (use C to mark responses on audiogram)
SAT/SRT
MAIS or IT-MAIS and/or other questionnaires
Telemetry Test
Program Sound Processor(s), if needed under 7 yrs, 92603; over 7 yrs, 92604
Two Months Follow-Up, if needed Aided air conduction thresholds 1 hour
Telemetry Test
Program Sound Processor(s) Under 7 yrs, 92603; over 7 yrs, 92604
Three Months Follow-Up Case History and/or questionnaires (assessing for red flags) 1.5 hours
Aided air conduction thresholds
Telemetry Test
Program Sound Processor(s) Under 7 yrs, 92603; over 7 yrs, 92604
If needed, Neural Evoked Responses and/or 92584
Electric Evoked Acoustic Reflexes 92868
Six Months Follow-Up Evaluation of Aural Rehabilitation Status 92626 45-60 minutes
Aided air conduction thresholds (use C to mark responses)
SAT/SRT
MAIS or IT-MAIS and/or other questionnaires
Aided Speech Recognition (60 dB SPL; Words - Closed set, Words - Open set, and sentences)
Telemetry Test
Program Sound Processor(s) under 7 yrs, 92603; over 7 yrs, 92604 45 minutes
If needed, Neural Evoked Responses and/or 92584
Electric Evoked Acoustic Reflexes 92868
Table 2. Audiological Procedures Used During the Cochlear Implant Process
Audiological Procedures Used During the Cochlear Implant Process×
Visit Description Procedures CPT Codes Time
Inquiry CI Packet mailed 15 min
Case history Insurance and release forms Cochlear implant information
Candidacy Assessment Audiological Assessment Otoscopic examination 1 hour
Tympanograms 92567
Ipsilateral and contralateral acoustic reflexes 92568
OAE, limited 92587
Ear Specific information (Pure tones and speech)
Comprehensive audiometry 92557
OR Conditioned play audiometry 92582
OR Visual reinforcement audiometry 92579
ABR (if one has not been performed, or poor reliability) 92585 Separate appointment
Evaluation of Hearing aids and Counseling Electroacoustic Analysis of Hearing Aids 1.5 hour
Binaural 92595
Monaural 92594
Hearing Aid Check
Binaural
Monaural
Real Ear Measurements (to verify appropriate amplification and settings)
Evaluation of Aural Rehabilitation Status
Aided thresholds binaural, right ear only, left ear only
Best Aided Condition - Aided Speech Recognition (60 dB SPL; Words - Closed set, Words - open set, and sentences)
Questionnaires
MAIS or IT-MAIS
Expectations Questionnaire
Meadow-Kendall Questionnaire
Case History
Review device(s), expectations, candidacy, and evaluation process
Educational Consultation Questionnaires with EI or school provider(s) Site Visit, if possible 1-3 hours
Day of Surgery Audiological Testing and Consultation Auditory Evoked Potential Testing in OR 92585, 95920 1 hour
Equipment orientation
Warranty information
Programming Initial Activation (2 day process) Day 1 1.5 hrs
At post medical surgeon's visit - 2 weeks post operative Telemetry Test
Program Sound Processor(s) (using VRA, CPA, or Standard methods) Under 7 yrs, 92601; over 7 yrs, 92602
Neural Evoked Resources and/or 92584
Electric Evoked Acoustic Reflexes 92868
Day 2 1.5 hrs
Telemetry Test
Program Sound Processor(s) Under 7 yrs, 92603; over 7 yrs, 92604
Neural Evoked Responses and/or 92584
Electric Evoked Acoustic Reflexes 92868
Two Week Follow-up Program Sound Processor(s) Under 7 yrs, 92603; over 7 yrs, 92604 1 hour
Neural Evoked Responses and/or 92584
Electric Evoked Acoustic Reflexes, if needed 92868
One Month Follow-up Evaluation of Aural Rehabilitation Status 92626 1 hour
Aided air conduction thresholds (use C to mark responses on audiogram)
SAT/SRT
MAIS or IT-MAIS and/or other questionnaires
Telemetry Test
Program Sound Processor(s), if needed under 7 yrs, 92603; over 7 yrs, 92604
Two Months Follow-Up, if needed Aided air conduction thresholds 1 hour
Telemetry Test
Program Sound Processor(s) Under 7 yrs, 92603; over 7 yrs, 92604
Three Months Follow-Up Case History and/or questionnaires (assessing for red flags) 1.5 hours
Aided air conduction thresholds
Telemetry Test
Program Sound Processor(s) Under 7 yrs, 92603; over 7 yrs, 92604
If needed, Neural Evoked Responses and/or 92584
Electric Evoked Acoustic Reflexes 92868
Six Months Follow-Up Evaluation of Aural Rehabilitation Status 92626 45-60 minutes
Aided air conduction thresholds (use C to mark responses)
SAT/SRT
MAIS or IT-MAIS and/or other questionnaires
Aided Speech Recognition (60 dB SPL; Words - Closed set, Words - Open set, and sentences)
Telemetry Test
Program Sound Processor(s) under 7 yrs, 92603; over 7 yrs, 92604 45 minutes
If needed, Neural Evoked Responses and/or 92584
Electric Evoked Acoustic Reflexes 92868
×
Table 3. Annual Comprehensive Speech-Language and Auditory Skill Assessment Protocol
Annual Comprehensive Speech-Language and Auditory Skill Assessment Protocol×
Age range Areas of Assessments
Voice Fluency Oral Mechanism Auditory Articulation/Phonology Language Cognition/Academics
Birth-3 years Informal Assessment Informal Assessment VBWC Speech Mechanism Screenings Auditory Development Checklist (VBWC) 2 Phonemic Inventory2 Rossetti Infant Toddler Scales 2 Sensorimotor Tasks (Miller et al., Uzgiris and Hunt)
Oral Speech Mechanism Screening Examination - Revised Early Speech Perception (ESP) Test2 Arizona Articulation Proficiency Scale - Third Revision (as applicable) MacArthur Index of Communicative Development2 Cottage Acquisition Scales for Listening, Language & Speech 1
Communication/Language Sample Pre-Verbal (0-12 months)
Bloom-Lahey Semantic Analysis - one and two word utterance stage Pre-Sentence (12-24 months)
Language Assessment and Remediation Screening Procedure (LARSP) - above two-word utterance stage Simple Sentence (24-48 months)
Record of Communicative Functions
3-5 Years Informal Assessment Informal Assessment Oral Speech Mechanism Screening Examination - Revised ESP Test2 Arizona Articulation Proficiency Scale - Third Revision Battery 1 Bracken Basic Concepts
Auditory Perception Test for the Hearing Impaired (APT/HI) Red Flags2 Identifying Early Phonological Needs in Children with Hearing Loss1 MacArthur Index of Communicative Development (as applicable) Reynell Developmental Language Scales Cottage Acquisition Scales for Listening, Language & Speech1
Battery 2 Simple Sentence (24-48 months)
Expressive One-Word Picture Vocabulary (EOWPVT-R) Complex Sentence (48+ months)
Receptive One-Word Picture Vocabulary (ROWPVT-R) Sounds & Speech
Communication/Language Sample2 Teacher Assessment of Grammatical Structures (TAGS)1
Bloom-Lahey Semantic Analysis - one and two word utterance stage Test of Early Reading Ability (TERA-3) 1
LARSP - above two-word utterance stage
Assigning Structural Stages - complex sentence structures
Record of Communicative Functions
VBWC Semantic Idiosyncratic Language Pattern Checklist
Test of Early Language Development (TELD-3) 1
5-18 Years Informal Assessment Informal Assessment Oral Speech Mechanism Screening Examination - Revised ESP Test2 Goldman Frostoe Test of Articulation Battery 1 Bracken Basic Concepts
APT/HI Test2 KLPA-2: Khan Lewis Phonological Analysis-2nd Edition (as applicable) Clinical Evaluation of Language Fundamentals (CELF-4) Diagnostic Achievement Battery (DABS-4) as applicable
Oral Written Language Scales Written Portion Only (OWLS) The Phonological Awareness Test (for children who are not reading yet)
Battery 2 Gray Oral Reading Tests (GORT-4)
Comprehensive Assessment of Spoken Language (CASL) OWLS Cottage Acquisition Scales for Listening, Language & Speech 1
Communication/Language Sample2 Simple Sentence (24-48 months)
Assigning Structural Stages - complex sentence structures Complex Sentence (48+ months)
Record of Communicative Functions Sounds & Speech
VBWC Semantic Idiosyncratic Language Pattern Checklist TAGS1
At the six month (mid-year) assessment time
CASL or CELF-4 (opposite of what you did at the annual evaluation session) 1
If you cannot give the CASL, then give EOWPVT-R and ROWPVT-R 1
1 Note: Only at 6 months,
Note: Only at 6 months,×
2 Both six months and annually
Both six months and annually×
Table 3. Annual Comprehensive Speech-Language and Auditory Skill Assessment Protocol
Annual Comprehensive Speech-Language and Auditory Skill Assessment Protocol×
Age range Areas of Assessments
Voice Fluency Oral Mechanism Auditory Articulation/Phonology Language Cognition/Academics
Birth-3 years Informal Assessment Informal Assessment VBWC Speech Mechanism Screenings Auditory Development Checklist (VBWC) 2 Phonemic Inventory2 Rossetti Infant Toddler Scales 2 Sensorimotor Tasks (Miller et al., Uzgiris and Hunt)
Oral Speech Mechanism Screening Examination - Revised Early Speech Perception (ESP) Test2 Arizona Articulation Proficiency Scale - Third Revision (as applicable) MacArthur Index of Communicative Development2 Cottage Acquisition Scales for Listening, Language & Speech 1
Communication/Language Sample Pre-Verbal (0-12 months)
Bloom-Lahey Semantic Analysis - one and two word utterance stage Pre-Sentence (12-24 months)
Language Assessment and Remediation Screening Procedure (LARSP) - above two-word utterance stage Simple Sentence (24-48 months)
Record of Communicative Functions
3-5 Years Informal Assessment Informal Assessment Oral Speech Mechanism Screening Examination - Revised ESP Test2 Arizona Articulation Proficiency Scale - Third Revision Battery 1 Bracken Basic Concepts
Auditory Perception Test for the Hearing Impaired (APT/HI) Red Flags2 Identifying Early Phonological Needs in Children with Hearing Loss1 MacArthur Index of Communicative Development (as applicable) Reynell Developmental Language Scales Cottage Acquisition Scales for Listening, Language & Speech1
Battery 2 Simple Sentence (24-48 months)
Expressive One-Word Picture Vocabulary (EOWPVT-R) Complex Sentence (48+ months)
Receptive One-Word Picture Vocabulary (ROWPVT-R) Sounds & Speech
Communication/Language Sample2 Teacher Assessment of Grammatical Structures (TAGS)1
Bloom-Lahey Semantic Analysis - one and two word utterance stage Test of Early Reading Ability (TERA-3) 1
LARSP - above two-word utterance stage
Assigning Structural Stages - complex sentence structures
Record of Communicative Functions
VBWC Semantic Idiosyncratic Language Pattern Checklist
Test of Early Language Development (TELD-3) 1
5-18 Years Informal Assessment Informal Assessment Oral Speech Mechanism Screening Examination - Revised ESP Test2 Goldman Frostoe Test of Articulation Battery 1 Bracken Basic Concepts
APT/HI Test2 KLPA-2: Khan Lewis Phonological Analysis-2nd Edition (as applicable) Clinical Evaluation of Language Fundamentals (CELF-4) Diagnostic Achievement Battery (DABS-4) as applicable
Oral Written Language Scales Written Portion Only (OWLS) The Phonological Awareness Test (for children who are not reading yet)
Battery 2 Gray Oral Reading Tests (GORT-4)
Comprehensive Assessment of Spoken Language (CASL) OWLS Cottage Acquisition Scales for Listening, Language & Speech 1
Communication/Language Sample2 Simple Sentence (24-48 months)
Assigning Structural Stages - complex sentence structures Complex Sentence (48+ months)
Record of Communicative Functions Sounds & Speech
VBWC Semantic Idiosyncratic Language Pattern Checklist TAGS1
At the six month (mid-year) assessment time
CASL or CELF-4 (opposite of what you did at the annual evaluation session) 1
If you cannot give the CASL, then give EOWPVT-R and ROWPVT-R 1
1 Note: Only at 6 months,
Note: Only at 6 months,×
2 Both six months and annually
Both six months and annually×
×
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