Sound localisation and Interaural Time Sensitivity with bilateral CI

PhD

Sound localisation and Interaural Time Sensitivity with bilateral CI

http://dspace.mit.edu/bitstream/handle/1721.1/35548/73726471.pdf?sequence=1

MULATING BILATERAL COCHLEAR IMPLANT PROCESSING IN NORMAL-HEARING LISTENERS

Thesis

SIMULATING BILATERAL COCHLEAR IMPLANT PROCESSING IN NORMAL-HEARING LISTENERS

PATRICIA LING MOY

http://www.bu.edu/dbin/binaural/pubs/Moy04.pdf

EFFICIENCY OF BINAURAL CUES IN A BILATERAL COCHLEAR IMPLANT LISTENER

EFFICIENCY OF BINAURAL CUES IN A BILATERAL COCHLEAR IMPLANT LISTENER

PACS: 43.66.Ts

Laback B.1; Pok S.M.; Schmid K.; Deutsch W. A.; Baumgartner W. D.

http://www.sea-acustica.es/Sevilla02/ppagen004.pdf

Benefits of bilateral cochlear implants and/or hearing aids in children

Benefits of bilateral cochlear implants and/or hearing aids in children

Ruth Y. Litovsky, Patti M. Johnstone, Shelly P. Godar

http://www.waisman.wisc.edu/~litovsky/publications/litovsky_et_al_ija_2006.pdf

Using the Observer-Based Psychophysical Procedure to Assess Localization Acuity in Toddlers Who Use Bilateral Cochlear Implants

Using the Observer-Based Psychophysical Procedure to Assess Localization Acuity in Toddlers Who Use Bilateral Cochlear Implants

Full article

http://faculty.washington.edu/lawerner/IHL/page11/files/grieco-calebetal08.pdf

Bimodal Devices and Bilateral Cochlear Implants: A Review of the Literature

Bimodal Devices and Bilateral Cochlear Implants: A Review of the Literature

Carol A. Sammeth, Ph.D, CCC-A

http://www.onici.be/recenteinfo/Sammeth%20(cochlear)%20Bimodal%20Devices%20&%20Bilat%20Cochlear%20Implants%20Review.pdf

Article Bi-lateral CI

Amplification of interaural level di®erences improves sound localization for cochlear implant users with a contralateral

hearing aid
Tom.Francart@med.kuleuven.be,Tim.Vandenbogaert@med.kuleuven.be,
Marc.Moonen@esat.kuleuven.be,Jan.Wouters@med.kuleuven.be

ftp://ftp.esat.kuleuven.ac.be/pub/SISTA/ida/reports/08-110.pdf

===============================================================
Localization ability with bimodal hearing aids and bilateral cochlear implants
Bernhard U. Seebera, Hugo Fastl

http://www.mmk.ei.tum.de/publ/pdf/04/04see3.pdf

===============================================================
Poster:
Simulating Bilateral Cochlear Implant Processing In Normal Hearing Listeners
Patricia L. Moy and H. Steven Colburn, Ph.D.

http://www.bu.edu/dbin/binaural/pubs/MC03.pdf

===============================================================
Speech recognition by bilateral cochlear implant users in a cocktail-party setting
Philipos C. Loizoua
, Yi Hu, Ruth Litovsky and Gongqiang Yu, Robert Peters, Jennifer Lake, Peter Roland

http://www.utdallas.edu/~loizou/cimplants/bilateral_JASA_jan09.pdf

===============================================================
Bimodal Devices and Bilateral Cochlear Implants: A Review of the Literature
Carol A. Sammeth, Ph.D, CCC-A

http://www.onici.be/recenteinfo/Sammeth%20(cochlear)%20Bimodal%20Devices%20&%20Bilat%20Cochlear%20Implants%20Review.pdf

===============================================================
Benefits of bilateral cochlear implants and/or hearing aids in children
Ruth Y. Litovsky, Patti M. Johnstone, Shelly P. Godar

http://www.waisman.wisc.edu/~litovsky/publications/litovsky_et_al_ija_2006.pdf

===============================================================
EFFICIENCY OF BINAURAL CUES IN A BILATERAL COCHLEAR IMPLANT LISTENER
PACS: 43.66.Ts
Laback B.1; Pok S.M.; Schmid K.; Deutsch W. A.; Baumgartner W. D.

http://www.sea-acustica.es/Sevilla02/ppagen004.pdf
===============================================================
Thesis
SIMULATING BILATERAL COCHLEAR IMPLANT PROCESSING IN NORMAL-HEARING LISTENERS
PATRICIA LING MOY

http://www.bu.edu/dbin/binaural/pubs/Moy04.pdf

===============================================================
PhD

http://dspace.mit.edu/bitstream/handle/1721.1/35548/73726471.pdf?sequence=1


===============================================================
Using the observer-based psychophysical procedure to assess localization acuity in toddlers who use bilateral cochlear

implants.
Grieco-Calub TM, Litovsky RY, Werner LA.

http://faculty.washington.edu/lawerner/IHL/page11/files/grieco-calebetal08.pdf

===============================================================

Bilateral Cochlear Implants Are Definitely Superior To 1

2 Bilateral Cochlear Implants Are Definitely Superior To 1

A study of cochlear implant patients seen by Indiana University School of Medicine physicians is the first research to show evidence that cochlear implants in both ears significantly improves quality of life in patients with profound hearing loss and that the cost of the second implant is offset by its benefits.
The study, which appears in the May issue of the journal Otolaryngology-Head and Neck Surgery, found that improvements in factors that contribute to quality of life including such critical abilities as hearing in noisy environments, focusing on conversations, and speaking at an appropriate volume resulted when cochlear devices were implanted in both ears.
This study may have a significant impact for profoundly deaf individuals who hope to have their health insurance providers pay for bilateral rather than the standard single cochlear implant. The study authors found the benefits of the second implant outweighed the added cost of the second device.
"We didn't know that cognitive skills and emotional issues would so significantly improve with the implantation of a second cochlear device. In addition to the physiological improvements we saw in patients who had bilateral implants, we found that patients were able to function better in noisy environments and definitely felt better about themselves," said senior study author Richard Miyamoto, M.D., Arilla Spence DeVault Professor and chairman of the Department of Otolaryngology-Head and Neck Surgery.
Dr. Miyamoto is the immediate past president of the American Academy of Otolaryngology-Head and Neck Surgery. First author of the study is Bradford G. Bichey, M.D., MPH, a former research fellow and resident at the IU School of Medicine and currently an otolaryngologist in Marion, Ind.
"Profoundly deaf individuals who were born with hearing, their families, physicians, and health insurance providers now have the data they need," said Dr. Miyamoto. "There is definite improvement after one implant and there is a significant added bump in sound and speech perception after the second implant. Emotional well being improves. And we found a favorable cost utility analysis. Our hope is that with these findings more health insurance companies will cover the cost of bilateral implants and bring a superior quality of life to a large number of individuals."
Approximately 1.4 million American are deaf in both ears and experience significant impairment in communication with the hearing world according to the study authors. The IU School of Medicine cochlear program is one of the largest in the country. IU physicians have implanted more than 1,500 cochlear devices over the past quarter century at Indiana University Hospital and Riley Hospital for Children.
----------------------------Article adapted by Medical News Today from original press release.----------------------------
This study was funded by the IU School of Medicine's Department of Otolaryngology-Head and Neck Surgery.
Source: Cindy Fox AisenIndiana University-------------------------------------------------------------------------------------

Light CI

Friday, August 10, 2007

Making Deaf Ears Hear with Light

A laser-based approach could make cochlear implants, which currently use electrical signals, more effective.

By Michael Chorost

About 100,000 profoundly deaf people now hear with cochlear implants, which work by stimulating the auditory nerve with a string of electrodes implanted in the inner ear. While the devices enable many users to converse easily and use telephones, they still fall short of restoring normal hearing. Now scientists at Northwestern University are exploring whether laser-based implants could one day outperform today's electrical version.

The mammalian ear uses neural firing rates as one way of encoding sound. As part of a project funded by the National Institute for Deafness and Other Communication Disorders (NIDCD), Claus-Peter Richter and his colleagues at Northwestern have demonstrated that they can control firing rates in the auditory nerve of animals using infrared laser radiation. They are now trying to establish that it's safe to use for long periods of time and that it can manipulate neural firing rates with enough precision to send useful information to the brain.

With conventional cochlear implants, electrical signals spread in the wet, salty environment of the body, muddying the signal. That makes it difficult to trigger specific populations of nerves inside the cochlea. Further complicating matters, simultaneous pulses in different locations merge with each other, stimulating the cochlea everywhere instead of in the desired locations.

Engineers work around the problem by triggering only one or two of the 16 or 24 electrodes in the inner ear at a time. It's done so rapidly that the user has the illusion that all of the electrodes are firing, but the result is still a relatively crude simulation of normal hearing. To many cochlear implant users, voices sound mechanical and music sounds washed out.

An infrared laser, on the other hand, can be beamed at nerve fibers with pinpoint accuracy. Furthermore, the directional nature of laser light means that optical pulses in different places won't interfere with each other. The increased precision of neural stimulation would make voices and music sound more natural, and users would be able to converse in noisy environments more easily.

While it's not yet clear why infrared radiation can trigger activity in the auditory nerves, Richter hypothesizes that it heats the cells slightly, opening ion channels in the cell walls and sending an electrical signal down the length of the neuron.

A major question is whether it's safe to stimulate nerves in this way for long periods of time. So far, Richter and his colleagues have shown that auditory nerves in anesthetized gerbils can be stimulated with infrared laser radiation for up to six hours without damage. At present it's not feasible to run the tests for longer, but Richter is planning long-term studies in animals with permanently implanted devices.

The researchers are also figuring out how to precisely control neuron activity with lasers. The ear encodes pitch and loudness not just by firing nerves in particular places, but also by modifying the rate at which they fire. So far, Richter has shown that laser radiation can reliably make neurons fire up to 250 times per second, which is comparable to the rate at which early-model conventional cochlear implants drive neurons.

Human trials are years away, but there are several ways in which infrared technology might be used to build a working cochlear implant. One is to use fiber optics instead of electrodes in an array inserted inside the cochlea, somewhat similarly to the way conventional cochlear implants now use electrodes. Early trials of such a system might involve replacing one or two electrodes of a conventional implant with fiber optics to test their effect. Another is to put an optical fiber bundle in front of the cochlea's round window to stimulate auditory neurons without opening the cochlea. (The round window is a thin membrane in the cochlea that absorbs fluid displacement as sound waves travel through it.)

An even more futuristic possibility is to use gene therapy to make auditory neurons responsive to particular wavelengths of light. At MIT, Ed Boyden has been altering nerve cells' genes so that they fire when exposed to one wavelength of light and stop firing when exposed to another. According to Richter, this approach would require less power to activate cells, which might be safer in the long run. Of course, this approach carries all the caveats that typically accompany gene therapy and would require a way to precisely deliver gene therapy to the relevant auditory cells.

"If proven safe and efficacious, optical stimulation could open up ultra-high density stimulation interfaces for the peripheral nervous system," says Boyden. "The process of combining optics and neurons may also pave the way for many future innovations - moving beyond the ubiquitous electrode to new modalities of neural control."

Age at implantation ...........

From here.....

Age at implantation and development of vocal and auditory preverbal skills in implanted deaf children

M.E. Taita, T.P. Nikolopoulosb, , and M.E. Lutmanc
a The Ear Foundation, Nottingham, United Kingdom
b Department of Otorhinolaryngology, Athens University, Greece
c Institute of Sound and Vibration Research, University of Southampton, United Kingdom
Received 13 September 2006; revised 16 December 2006; accepted 18 December 2006. Available online 18 January 2007.





Summary

Background

Preverbal vocal and auditory skills are essential precursors of spoken language development and they have been shown previously to predict later speech perception and production outcomes in young implanted deaf children.

Objectives

To assess the effect of age at implantation on the development of vocal and auditory preverbal skills in implanted children.

Methods

The study assessed 99 children, 33 in each of three groups (those implanted between 1 and 2 years; 2 and 3 years; and 3 and 4 years). Preverbal skills were measured in three areas: turn taking, autonomy and auditory awareness of spoken language, using the Tait video analysis method.

Results

The youngest implanted group made an exceptional progress outperforming in all measures the two other groups (p < 0.01), 6 and 12 months post-implantation, whereas there was no such difference before implantation. In the youngest group there was also significantly greater use of an auditory/oral style of communication: 85% of the group by 12 months post-implantation compared with 30% and 18% of the two older groups.

Conclusions

Vocal and auditory preverbal skills develop much more rapidly in children implanted between 1 and 2 years in comparison with older implanted children and reach a significantly higher level by 6 and 12 months post-implantation. In addition, younger implanted children are significantly more likely by 12 months post-implantation to adopt an auditory/oral mode of communication. These findings favour cochlear implantation as early as between 1 and 2 years, provided that correct diagnosis and adequate hearing-aid trial have been achieved

Keywords: Language development; Speech perception; Cochlear implant; Prediction; Vocal; auditory; Communication; Preverbal; Observation; Interaction; Deaf; Children; Outcome

Overview of studies regarding bi-lateral CI

The Validity of Probability Samples in Research on Deafness

The Validity of Probability Samples in Research on Deafness
by Crain, Kelly Lamar

American Annals of the Deaf - Volume 151, Number 2,

Reference Issue 2006, pp. 114-120

Gallaudet University Press
American Annals of the Deaf 151.2 (2006) 114-120 _________________________________________________________________ [Access article in PDF]

The Validity of Probability Samples in Research on Deafness

Kelly Lamar Crain Thomas N. Kluwin

Abstract

This article addresses the problem of small nonprobability samples in research in the education of the deaf and hard of hearing in the face of a current and increasing emphasis on "scientifically based research" as required by recent No Child Left Behind (NCLB) federal legislation.

The authors examine the gains and losses in information generated using non-probability samples in our field, describe the conditions required for generalizable research results, and identify several factors in the field of research in the education of the deaf that limit the ability to generate probability samples.

Finally, the authors consider possible solutions to the problem, including more creative recruitment strategies, alternate research designs, and alternate reviewing strategies. While the recent focus on "scientific" approaches to educational research has not met with universal acceptance, some general requirements do appear with emphasis on randomized trials, more controlled interventions, and more careful sampling procedures (Feuer & Towne, 2002; Reyna, 2002).

Nonetheless, there is currently a continuing debate on what constitutes adequate evidence in educational research and how it should be interpreted (Darling-Hammond, 2003; Feuer & Towne, 2002). While there is no single test for evaluating the quality of evidence in educational research, there is a strong push for experimental research as the gold standard. In special education, the debate has come down to a "generalist" approach, which tries to define the quality of research in terms of the research questions being asked (Odom, Brantlinger, Gersten, Horner, Thompson, & Harris,...

Cochlear implantation and cued speech internationally

Anne Worsfold, Executive Director, Cued Speech Association UK

How can we ensure that implanted children reach their potential? Research and case studies from Europe and America suggest that the early and constant use of Cued Speech by family members and professionals can significantly improve the children's ability to benefit from the implant.

Cued Speech and Cochlear Implantation are frequently described as `perfect partners' because Cued Speech gives sound-by-sound access to spoken language by visual means, perfect for optimising language development prior to implantation and for supporting the child in the early years post implantation.

A French study (1) shows that children who had full and consistent exposure to Cued Speech prior to implantation performed considerably better in a number of tests than children brought up aurally or with French Sign Language. Tests showed that both three and five years after implantation Cued Speech children had significantly better:

• perception of words in open lists
  
• speech intelligibility (measured on the Nottingham scales).
  

In Spain Cued Speech is the norm in some cochlear implant centres with several specifically recommending its use. In addition, the Complemented Oral Model (Modelo Oral Complementada, MOC) project in southern Spain uses Cued Speech within an oral programme and many of the children in the programme are implanted (at present they have 20 children between 11 and 18 months). The aim is not just to provide first class support for the children but also to publish research. The programme has now been running for over twelve years and early results are outstanding, with some areas of linguistic development better than age appropriate.(2)

From America Jane Smith writes: `For nearly 20 years, I have been a communication specialist with deaf children who have cochlear implants (CIs). The vast majority of these deaf children use Cued Speech.

Although CIs have been an amazing breakthrough for the deaf, outcomes differ from child to child. I would not take the chance of denying a child a visual representation of spoken language until I was sure that they were learning everything through listening. Cued Speech helps clarify and verify what is heard; it actually accelerates the learning of language and listening.

Many deaf children who receive CIs perceive environmental sounds but progress in the perception of speech is much slower. Deaf children who use Cued Speech perceive speech more quickly.

Until recently, most of my students were receiving CIs after age three - after they had acquired language. I observed that children who used Cued Speech had a `phonological grid' already internalised when they began to listen with their CIs. They were able to learn auditorily what they had internalised visually already. Progress in learning to listen came quickly because they already had this internal grid of phonemes. Cued Speech helps children interpret the sounds they are hearing via electrical stimulation as the same sounds they are seeing through Cued Speech.

For children aged three and under who learn Cued Speech at the same time as they get their implant, Cued Speech is also a huge benefit. Cued Speech develops an internal phonological model of speech and language that facilitates reading later. The child not only hears but also sees syllables and stress patterns. A child can see morphological structures that are difficult to hear - plurals, possessives and tenses for example.

After a certain amount of time - which varies for all kids, Cued Speech children learn vocabulary and academic information through listening alone. Many parents drop the use of Cued Speech at home (except at bath time or at the pool) but continue to have their child use it in school in the mainstream via a Cued Speech transliterator. This is because Cochlear Implants have not conquered the obstacles of noise, distance and the speed and amount of information delivered in an academic classroom.

Most of my CI/Cued Speech kids have advanced language, vocabulary and listening abilities. Examples include: a second grader who received the highest score in her grade on a standardised state test in a high-performing elementary school last spring and a first grader who is the best reader in her class.

These examples are outstanding but unusual for deaf children (or any child for that matter). Their success can be attributed to their innate talent and possibly more importantly to the use of Cued Speech with their cochlear implant.'(3)

In England successful case studies include Alexandra who had very delayed language until her parents started to cue. Over the next two years she quickly caught up and prior to the implant her mother wrote that `professionals recognised that her receptive language with Cued Speech appeared to be age appropriate and questions were raised as to whether Alexandra might have become so dependent on this form of communication that she might experience difficulty in adjusting. In fact, the transition from cueing to fully oral communication happened completely smoothly. After as little as three months, the clarity of her speech improved significantly and other people started to understand her. Cued Speech continued to be valuable in language acquisition for some months to come, reinforcing the links between the language she knew visually and the new sounds she was hearing. Even now it is still invaluable in noisy situations, when the implant is not in use and in breaking down the sounds in words which hearing children also find difficult!

`It is now 4« years since we learned how to Cue and 2« years since Alexandra received her Cochlear Implant. Her progress has been everything we could have hoped for. Her reading age and vocabulary are both above her chronological age and her personality has become more settled. Deafness has ceased to be an insurmountable problem. The only regrets we have are that she didn't receive the benefits of Cued Speech and her Cochlear Implant much earlier.'

At Alexandra's 12 month post implant assessment her Teacher of the Deaf wrote: `In my 30 years experience of working with profoundly deaf children, I have never witnessed the remarkable progress that Alexandra and her parents have made throughout this year, following implant. In my opinion, Alexandra is a little girl who is now totally oral/aural, in her ability to develop speech and language and shows listening levels which one would not normally anticipate until at least two or three years of wearing her processor'.

Why is Cued Speech so successful? Hearing people use their knowledge of the sounds of English when they learn to cue. Deaf children brought up with Cued Speech work in the opposite way. They acquire an internal model of sound-based English through Cued Speech - even if they can't hear it. Once the implant gives them access to speech sounds these can be plotted onto the model of sound-based English they have already internalised. Belgian research - and many case studies - demonstrates that children brought up with Cued Speech can think in sound-based language.(4)

It is this visual access to sound-based language that enables a deaf child to acquire an understanding of spoken language without delay pre-implant and also uniquely primes the child for the acquisition of spoken language when it becomes available post implant. As Jane Smith, with her 20 years experience, said: `Cued Speech helps clarify and verify what is heard; it actually accelerates the learning of language and listening'.

By Anne Worsfold with grateful thanks to Maureen Brenton and Pat Cove for their translations of source documents.

For details about cueing in the UK contact:

Cued Speech Association UK

9 Duke Street

Dartmouth Devon

TQ6 9PY

Telephone (voice and text) 01803 832 784

Fax 01803 835 311

Email info@cuedspeech.co.uk

Web www.cuedspeech.co.uk

References

1. Study produced by Nadine Cochard, Marie-Noelle Calmels, Geraldine Pavia, Christine Landron, Helene Husson, Anne Honegger, Bernard Fraysse. Text by Nadine Cochard (Paediatric Unit of cochlea implants - CHU/CESDA Toulouse)
   
2. MOC website www.uma.es/moc or
   email Prof. Santiago Torres monreal@uma.es.
   
3. First published in the magazine of the National Cued Speech Association (USA)
   
4. Various research including:
   
   Leybaert, J. & Charlier, B. (1996), `Visual Speech in the Head: The Effect of Cued Speech on Rhyming, Remembering and Spelling. Journal of Deaf Studies and Deaf Education, Vol. 1, pp. 234-248.
   

March 2005

Article about early implantation and bilateral CI.

Found an interesting article...

Article: Implantation of prelingually deaf patients...

Most impressive graph is this one:

CI story by Frances Parsons

(Frances M. Parsons is retired Associate Professor of History of Art and Coordinator of International Collections at Gallaudet University in Washington, DC)
---------------------------------------------------------------------------------------------

To: Sarah Wainscott, Director of Early Intervention and Preschool Programs

I came. I saw. I was conquered by the living evidence of how cochlear implant technology helps those toddlers at the River School. Words cannot describe how I felt when I finally visited the River School. I want to share this letter with anybody who wants to know about how cochlear implants benefit toddlers but are unable to get more information. The controversy about cochlear implants, especially in children, rages on with no let up. I have listened to pros and cons and met failures and successes. The most negative comment was "Those CI children at residential or day schools for the deaf could not speak!"

While sitting in waiting rooms at Johns Hopkins and elsewhere, I asked those happy looking mothers how they felt about spoken communication with their children. Their remarks: "It is a miracle." "My own daughter speaks our first language." "Close bonding between us." "CI makes our family life easy." "CI gives us HOPE!" et cetera. That was when I began to hear about the River School, but unbelievably just where the school was located remained in a shroud of obscurity, as though to avoid vicious attacks from those who are anti-CI. Finally I spotted a report about the River School that had been left on a rack at J.H.U. I had been under the impression it was located somewhere in Maryland, but it turned out to be in NW Washington, D.C.--a short drive to from my home! I lost no time making an appointment to visit, to observe, and to get the truth.

A turning point comes when one is able to actually see how children benefit from CIs. I watched how CI children talked with their hearing mothers. The younger the kids are when implanted, the better they hear and speak. It has been known that babies get brain stimulation from their earliest days as their parents communicate to them, whether signing or speaking...

"Seeing is believing" also applies to the difference of communication--sign-speak or speak. Some mothers, influenced by deaf "qualified experts" and ASL linguists, are encouraged to speak-sign to their children, who usually respond in signing and often without voice. Other mothers veer toward speech only. It is incredible to see the easy flow of spoken language between mothers and very young children with CI, as though the children have normal hearing.

Sarah Wainscott was as gracious a hostess as Debra Neumann, escorting me and explaining the school's policy, program, professional training, and parents' participation. Before I continue, I want to say that the philosophy and the difference between Le Clerc National Deaf Education Center at Kendall and the river school is amazing. It is unbelievable to see how those CI children talk a blue streak and their voices sound good. They listen without lip-reading intensively. In spite of my using a CI for the last two years at my very advanced age, I was not able to read their lips like I have done for years with hearing children, who, like CI kids, don't realize how the deaf depend on lip-reading slow speech! I felt lost by their rapid speech and had to ask Sarah to transliterate!

In the gym room, a very young girl ran to the other side, and when Sarah called out she whirled around and listened to Sarah. I was floored in sheer surprise because, in spite of my CI, I would have had to run across the room to lip-read Sarah! That girl made no more effort to hear and listen than normal hearing kids do.

Sarah Wainscott had previously taught at Gallaudet in the Education Department during her doctoral program, and as a part time employee. Two things have slowed her work on that dissertation. She now directs this special school as well as mothering an unwanted deaf boy, John, from Latvia, whom she adopted. His story is a long and beautiful one, but I must try to condense it here, but I will store that story in the file at Gallaudet Archives.

Three years earlier John was two years old when he was found as an unwanted street boy who came down with meningitis which left him profoundly deaf. He, as a ward of the state, was hospitalized for 6 months when no one visited him. Then he was transferred to an orphanage. A clinic discovered his deafness when he was then 32 months old. He underwent CI surgery and remained for six months before he was transferred to the Home for Defective Children. He was over three with no language. Through the help of the Cochlear Corporation, Dr. Niparko and Dr. Lehnhardt learned about John. Sarah heard of him.

In spite of being aware of the difficulties, Sarah and her husband, Bill, took him in, knowing the great challenge they faced to use knowledge, love, patience and teaching with strong family bonding. John stopped biting, scratching, throwing things, and rebelling against adults. Surprisingly he did not carry out his phenomenal tantrums on children. The Wainscotts started out with signing until he quieted down, and then worked on his listening and speech. His implant was a success. Amazing results took place. He functions well with children and teachers.

I saw John as a quiet but happy boy with a wonderful command of expressive English skills of a two-year old and is steadily improving. He primarily uses spoken English with occasional use of signs to understand something new or when communication breaks down. He enjoys playing with his best friend, a hearing child. In spite of a difficult adjustment with traumatic survival, he was able to telescope 30 months of skills to 19 months in America and especially at the River School.

Parents play a large role of continuing spoken communication with their children at home, rather than allowing teachers to be pseudo parents. There are no assistants or sub teachers. Heavy use of computers to assist with speech or reading is avoided. Sarah points out that they fully integrate deaf and hearing children together, sardine packing them with sensory experiences, dramatic play, as well as lots of activities and collaborative learning. The more the CI children learn from the consistency of speech language pathologists who support language and emphasize listening and speech skills all day long, the better they learn and remember.

Another beautiful highlight at that school is Christa Lopez. My first impression of her was she could easily win a beauty pageant, but she is actually a CI teacher--the most perfect role model for the CI children and for encouragement of their hearing parents. On achieving a M.S. in Education from the University of South Carolina and a B.A. in Special Ed. from Loyola Marymount University, she had taught hearing students in a regular classroom as well as deaf and hearing preschoolers. She also educates the River School staff. She is indeed the Star in the West!

The River School does not practice a traditional oral program of a heavy emphasis on isolated speech training and separate the deaf from the hearing (as a child. my four years of Alexander Graham Bell theory was the worst experience I ever had). For a long time oral deaf schools and schools for the deaf provided only one speech pathologist who gave lessons about 20 minutes in length once or twice a week to about 50 pupils. The River School has highly qualified speech pathologists with a masters degree, each concentrating on two to three toddlers at every hour and every day through the 11 month program. All the hearing peers are constantly exposed to CI children, with the hourly and daily focus of spoken language and literacy. (The school emphasizes literacy, too.)

Unlike Le Clerc National Deaf Education Center at Kendall, which has been mostly dominated in decision making by the deaf, the River School is independent of this influence, representing families who want to be heard, not to be advised by the deaf, and to support spoken language for their deaf progeny. The River school represents a clean break from years of isolating the deaf from the hearing, by integrating deaf CI children with their hearing peers. It is like new wine in new bottle. The younger toddlers and babies are when they are implanted, the better chance they have of learning English, but this theory was suppressed by the ASL Mafia.

Many deaf teachers use ASL and bilingual communication and drove out many speech therapists and audiologists from schools for the deaf. Hearing teachers were not welcomed unless they accepted and used ASL. ASL linguists have had a most damaging impact on education for the deaf.

I could rattle off like a model A Ford, but, to summarize the whole outlook, the River School provides many more wonderful programs, especially the development of spoken language and literacy as well as interaction between everybody at the school. The heavy emphasis is on ENGLISH! This program is flexible with the use of signs as a bridge to spoken language or speak/sign as an assistance for hearing impaired infants and toddlers. Two River School pupils are hereditary deaf of oral trained deaf fathers, and they speak well in spite of their knowing signs. They and John are the three who know signing. Speaking of English, fortunately there are deaf people like Bruce Gross, Tom Bertling, Greg Bland who are hereditary deaf teachers, social workers, writers, friends, etc and they strongly support English, based on their own experiences. Some of them have a cochlear implant.

Nancy Mellon is the Director and Founder of that School. The school started from her experience as a mother of a deaf son and she was frustrated with the limited options given. Currently there are four mothers with deaf progeny on staff, thus giving the family friendly feeling! In January, 2000, the River School opened with ten children, and is mushrooming to 120 children with about 25 CI children being enrolled in their programs for the Fall of 2003. They hope to move to a larger building across the street.

Also there are growing trends of various kinds of technologies like the deaf having Tel Cap that they can talk to a telephone and read captioned answers. Or the deaf read the spoken words from Viable Realtime Translation, a remote system designed for the educational setting for students with hearing loss or CI attending colleges and universities (and possibly for elementary and kindergarten schools). This method is more accurate than less qualified service providers, and gives high quality services for equal access to education. (FYI: look up Welcome to Viable Technologies)

I was asked if I were to live my life over again, would I like to have the philosophy of the River School? I have had wonderful years from the time I entered Berkeley School for the Deaf in California, enjoyed associating amiably with all kinds of deaf people, and respected our different signs and speech ability. I was a global campaigner for encouraging schools to accept sign language and I co-existed in the hearing world. I still have close friends, supporters, and allies who are seniors, baby boomers, and members of younger generations. I was a 43-45 and 64-67 student and a contented professor at Gallaudet University until the '80 when ASL linguists took over with iron clad control. Dr. Merrill, the past president of Gallaudet University, implemented the setup of Gallaudet University Regional Centers to offer courses in English, Psychology, Sociology, Museum, Mathematics, etc. Instead, GURC and the Clerc Center provide extension courses solely for "professionals" in ASL Linguistics, Deaf Studies, Deaf Education and Interpreting ASL. So Dr. Merrill's dream was thwarted.

If I had been born in 2000, I would prefer going to a school like the River School for the sake of early brain stimulation and communicate in English.

Yours for a better world

Frances Parsons