Children with profound hearing impairments are receiving cochlear implants at an increasingly younger age resulting in the need for early therapeutic support and intervention. Besides the obvious concerns regarding speech and language development, children with cochlear implants are also at risk for motor and balance deficits. This was a retrospective, longitudinal, experimental holistic single case study. The aim was to determine the impact of Ayres Sensory Integration® on occupational performance in a child with bilateral cochlear implants within the first four years after implantation. Six objectives were addressed. Quantitative and qualitative methods were used including designing an observation tool, administering stardardised tests, conducting a parent interview and obtaining perspective from the cochlear team to obtain rich in-depth knowledge and perspective. Pre- and post-intervention results were compared to determine changes in sensory perception, sensory reactivity, motor development and participation in occupations. Intervention adhered to the fidelity requirements of Ayres Sensory Integration®. Results indicated that there were positive changes in the child’s sensory processing and participation in occupations. Ayres Sensory Integration® was therefore an effective therapeutic approach for this child with cochlear implants. The cochlear team gained valuable insights and the parents indicated that occupational therapy intervention had a significant impact on the whole family unit. This study can contribute to the professional body of knowledge by building onto the knowledge base and skills repertoire regarding the application of therapeutic principles to children with cochlear implants. The occupational therapist can make a valuable contribution to the cochlear team. Optimal integration of sensory input can assist with promoting cochlear usage, not only for acquiring language, but also for developing age-appropriate skills at a critical stage of development to facilitate successful participate in childhood occupations. / Dissertation (MOccTher)--University of Pretoria 2020. / Occupational Therapy / MOccTher / Unrestricted

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Introduction: Cochlear Implants (CI) are designed to address severe to profound hearing loss. When implantation occurs after language develops, it is referred to as post-lingual (PL) implantation. Currently, no interventions have been identified to address the communication challenges that young adults with PL-CIs may face after they complete post-CI rehabilitation services. This study analyzes if an individualized intervention plan is beneficial for a person with PL-CIs when experiencing changing communication demands in the transition to college or the workforce. Methodology: Baseline assessments were conducted; the results of which allowed for the establishment of four co-constructed goals. These goals were targeted in four intervention sessions focused on use of listening strategies. Results: Accuracy improved, and all goals were met. Clinicians observed success in independent strategy use. Participant noted a value in individualized intervention. Conclusion: The participant noted a benefit in an individualized intervention plan to support changing communication demands with PL-CIs.

The current literature reports that oral language development is not a realistic goal for autistic cochlear implant users (ACI). This is curious, due to the general success of cochlear implants and the fact that many autistic individuals develop strong spoken language skills. Therefore, this study aimed to examine clinician and caregiver insights into spoken language development in the ACI population with the aim of elucidating the factors that influence the poor outcomes reported in the literature. We predicted that cochlear implant function would not be the limiting factor in ACI language development, but that device use and sensory atypicalities might have significant impacts. Participants were two speech-language pathologists (SLPs), six audiologists (AuDs), and one dually certified SLP/AuD. Additionally, six mothers and their ACI children participated in the study. All participants, excepting one ACI parent, took a survey and then participated in a 30–60-minute interview about their experience either caring for or working with ACIs and their insights into their language development. We also collected language samples in ACI participants. Quantitative analysis included computing descriptive and inferential statistics, where appropriate, concerning language abilities, sensory processing, anxiety, and survey responses regarding factors associated with cochlear implant (CI) use. We also engaged in qualitative thematic analysis of caregiver and clinician interviews. Quantitative and qualitative results were then integrated to triangulate findings. In important ways, our results are inconsistent with current literature concerning ACIs. For instance, caregiver and clinician statements, as well as quantitative results suggested that it was very possible for ACIs to develop spoken language, when given the right conditions. Qualitative themes that shed light on the factors important to positive language-related outcomes in ACIs included: a) finding (and advocating for) access to care; b) sensory processing difficulties; c) differentiating between autism and hearing loss, and the spectra of both conditions. One specific and novel finding showed that sensory profiles—especially sensory seeking versus sensory averse—may have a significant impact on a child’s oral language development following cochlear implantation and should be considered when counseling families on possible outcomes. These findings provide new insight into and concrete future directions for supporting the ACI population.

The impact of the diagnosis and the reality of being hearing impaired could trigger uncomfortable feelings at different times in the client's life. With the cochlear implant, these feelings will still be a reality, as the implant does not heal the hearing impairment. Psychological interventions could assist the client during this healing process. The process of cochlear implants could also bring other challenges into the client's life. Expectations of quick healing play a major role and should be addressed throughout the process of implantation and rehabilitation. This is another opportunity for the psychologist to intervene. This research shows that the role of the psychologist could be expanded not only to evaluate but also to bring about change. The treatment model gives a logical and workable explanation of how and where the psychologist may intervene in the process of cochlear implantation. This model was tested and adapted by the cochlear implant team at the University of Pretoria over a period of ten years. The model may be used as a template for new teams. Intervening as described in the model presents the opportunity to address various different needs as they occur. The qualitative research design proved to be a fitting method to explore the experiences of the participants from their own viewpoints. The qualitative research is also congruent with a systemic perspective and emphasises social context, multiple perspectives, complexity, recursion and holism. This study aims to develop a complementary psychological treatment programme and create awareness within professionals working with hearing impairment of the complexity of systems. The study shows that one can only understand the behaviour of any given system by tracking changes that occur within that system and its subsystems and by tracking changes between that system and the larger whole. In this study three different therapeutic interventions are used on three different case studies, two children from different age groups and an adult, to accommodate the multiple realities of the different systems. The aim of the study with cochlear implantees and their families is to stimulate new leads and avenues of enquiry that may be used as a basis for further research. / Psychology / Thesis (D.Litt. et Phil. (Psychology))