In order to provide evidence demonstrating the efficacy of cochlear implantation in the children enrolled in the Pretoria Cochlear Implant Programme (PCIP), an in-depth analysis of the numerous variables involved in determining each individual child’s success with his/her cochlear implant needs to be undertaken. As the PCIP has been operating for over a decade, a standardised database that includes the variables identified by similar cochlear implant programmes world-wide as being related to outcomes of children with cochlear implants and their families, has to be assembled. As the PCIP functions partly as a paediatric cochlear implant programme, an Early Communication Intervention (ECI) approach with the emphasis on the family unit is of critical importance. To address this need, a comprehensive questionnaire was used in a cross sectional study combining qualitative, and predominantly quantitative methods. The aim was to determine the perceptions of parents/caregivers of children with cochlear implants in the PCIP of the children’s outcomes. The questionnaire was further used to gather relevant data pertaining to children and their families’ biographical, medical, environmental, audiological, linguistic and educational histories and current functioning. A total of 45 participants, all mothers of children with cochlear implants, returned questionnaires. Results indicated that several key factors played a role in determining a positive outcome in the children’s audiological, linguistic, social and educational functioning leading to placement in an inclusive educational setting. These included an early age at diagnosis and prompt fitting of hearing aids and subsequent cochlear implantation, the absence of prenatal and perinatal complications including feeding difficulties, a higher level of maternal education, achievement of developmental milestones within normal age norms, the use of an FM system in the primary school phase, access to ECI, the presence of an older sibling to act as a language model, the absence of birth trauma and congenital rubella syndrome as cause of hearing loss, and later (acquired) onset of hearing loss. Children whose cause of hearing loss was non-syndromic and hereditary or unknown, were more likely to have positive outcomes. The clinical implications for the PCIP were synthesised and presented as a developmental systems model, providing guidelines for the entire process from referral to the cochlear implant programme to exiting of the system. The urgency of the need for a universal newborn or infant hearing screening programme as well as reliable systems of early referral to cochlear implant programmes, emerged strongly in the recommendations of the study. / Dissertation (M (Communication Pathology))--University of Pretoria, 2006. / Speech-Language Pathology and Audiology / Unrestricted

This thesis deals with the issue of speech therapy for children of early school age with the cochlear implant. General knowledge about hearing impairment and the possibility of compensation, different types of cochlear implants and especially about the specifics and methodology of following speech therapy are summarized in the theoretical part of the thesis. The practical part consists of research, realized through questionnaires. The research deals with the current situation of speech therapy for children of early school age with a cochlear implant, with a special focus on post-implantation rehabilitation and its complexity. The result of the research demonstrates the complexity of speech therapy only in some speech therapy workplaces. The result of the research also demonstrates that speech therapy is highly individual and depends completely on specific situation and personality and communication skills of each child with a cochlear implant. KEYWORDS Hearing impairment, cochlear implant, cochlear implantation, child with a cochlear implant, early school age, rehabilitation, hearing and speech developement, speech therapy.

The content of this thesis is a theoretical introduction to the topic of hearing impairment, its classification, diagnosis and compensation options. Furthermore the work deals with a cochlear implant as the compensation aid. It describes the entire process of choosing the cochlear implantation candidates, the operation itself, setting of the speech processor and subsequent rehabilitation. The thesis also deals with communication competence and speech development not only of children with hearing impairment but also without hearing disorders. After the performance of the available diagnostic tools used for vocabulary testing, the work describes a research process of identifying the vocabulary level in children with cochlear implants by the use of appropriate passive and active vocabulary test and interprets obtained results. KEYWORDS: cochlear implant, communication skills, passive vocabulary, active vocabulary, a child with a cochlear implant, Test of the passive and active vocabulary

L’objectif principal de ce travail est de recueillir la parole des parents entendants d’un enfant sourd porteur d’un implant cochléaire, sur les représentations de leur parentalité de leur point de vue et sur le rôle joué par l’implant au niveau de la communication et la transmission intergénérationnelle au sein de ces constellations familiales. Le groupe d’étude était composé de 55 parents d’un enfant sourd implanté cochléaire et de 31 parents d’enfants sans handicap. Les stratégies de coping ont été explorées au moyen de l’échelle WCC-R privilégiant la dimension transactionnelle selon la théorie de Lazarus et Folkman. Les représentations de la parentalité ainsi que le rôle de l’implant dans la transmission intergénérationnelle ont été analysés par le biais d’entretiens semi-directifs. Les résultats montrent que ces familles ont tendance à mobiliser un coping plus actif que ne le font des parents d’enfants sans handicap. Ils se positionnent en règle générale sur des savoirs-action leur permettant de faire à face à des situations potentiellement aversives du fait de la surdité de leur enfant. En outre, les parents du groupe d’étude expriment une satisfaction de leur parentalité d’un enfant sourd implanté qui malgré, l’épreuve vécue au moment de l’annonce du diagnostic, se façonne au fil du temps et des expériences partagées avec leur enfant.Ils s’inscrivent pleinement en qualité de parents responsables du projet de l’implant choisi entre autres pour l’avenir de leur enfant et pour partager un sentiment d’aperception tout en cultivant pour certains, par l’apprentissage et la pratique de la LSF, la dimension culturelle naturelle de leur enfant. / The main objective of this work is to gather the voice of hearing parents of a deaf child with cochlear implant, on the representations of their parenthood from their point of view and on the role played by the implant at communication and intergenerational transmission levels within these family constellations.The study group was composed of 55 parents of a cochlear implanted deaf child and 31 parents of children without disabilities. The coping strategies were explored using the WCC-R scale, favoring the transactional dimension according to the Lazarus and Folkman theory. The representations of parenthood and the role of the implant in the intergenerational transmission were analyzed through semi-directive interviews. The results show that these families tend to mobilize a more active coping than the parents of children without disabilities. They generally position themselves on knowledge-action enabling them to deal with potentially aversive situations due to the deafness of their child. Furthermore, the parents of the study group express a satisfaction with their parenting of a deaf child with implants, which, despite the ordeal experienced at the time of the diagnosis, is being shaped over time and through experiences shared with their child. They fully embrace themselves as parents responsible for the implant project chosen – among other reasons – for their child's future and to share a sense of apperception, while cultivating for some of these parents, through the learning and practice of the LSF, the natural cultural dimension of their child.