1. Advances in Deafness Management Second Language Learning in Cochlear Implant Users October 9, 2005 Ripley K. WONG Speech Therapist In-charge Queen Mary Hospital Hong Kong

2. Hong Kong Scenario Multilingual society Two formal languages: English & Chinese Return of sovereignty to PRC in 1997 Immigrants from Mainland China Maids  needs for learning different languages

3. Language Development in HI Children HI children develop language at slower rate (Davis et al, 1986) Profoundly HI children develop language at half the rate of normal hearing children (Carney & Moeller 1998) Increasing gap between language age and chronological age (Miyamoto et al, 1997)

4. Language Development

5. Language Development in HI Children with CI Language delay compared to NH peers, but rate of language development similar (Miyamoto et al, 1997; Vermeulen et al, 1999) Rate of language development exceeded that of unimplanted HI children (Svirsky et al, 2000) Different rate of development for different language skills (Ertmer et al, 2003, Young & Killen, 2002)

6. Second Language Learning in Hearing Impaired Children Interference between languages Reduced exposure to phonemic patterns / sound systems of spoken languages Difficulty in picking up different phonemic patterns of different languages Lack of natural ambient language input Language delay resulting from hearing impairment

7. Bilingual CI Users Age-appropriate language skills in primary language and competent in second spoken language (Waltzman et al, 2003) CI users can achieve oral proficiency in more than one language (Robbins et al, 2004) A CI user acquired Cantonese, Mandarin and English to a degree comparable to NH peers (Francis & Ho, 2003)

8. Case 1 KC 10 years old Fitted with bilateral HA at 2;02 y.o. No spoken language before implantation CI done at 2 years 10 months (Clarion, S-Series) Moved to an English-speaking country after implantation 1 st language: English

9. Case 1 Returned to HK in 2003 (8;03) studying in international school Had Mandarin class in school Started ST training on Cantonese in February 2004, aged 8;07 (totally attended 15 sessions from 2/04 to 12/04) Re-started ST training in 4/05 (attended 5 sessions from 4/05 to 9/05)

10. Case 1: Language Assessment (English) Peabody Picture Vocabulary Test (PPVT) At high end of normal range At high end of normal range Clinical Evaluation of Language Fundamentals (CELF) Receptive language: WNL Receptive language: WNL Expressive language: above average Expressive language: above average 85-115: WNL, average of NH children: 100 85-115: WNL, average of NH children: 100

11. Case 1: Language Development

12. 2nd Language Performance

13. Case 1: Language Assessment (Cantonese) Cantonese Receptive Vocabulary Test (CRVT) At the beginning of treatment: <1;10 (score:22) At the beginning of treatment: <1;10 (score:22) One year after treatment: 2;06 (score: 30) One year after treatment: 2;06 (score: 30) Raynell Developmental Language Scales (RDLS) After one year of treatment: After one year of treatment: VC: 2;01 VE: 1;09

14. Case 1: Conclusion Slow in acquiring 2 nd language (Cantonese) No interference with 1st language (English) development Factors leading to slow acquisition: Environmental factor: school, family Environmental factor: school, family Interference from Mandarin Interference from Mandarin Personality factor Personality factor

15. Interference from Mandarin

16. Case 2 YC 12 years 2 months old Fitted with bilateral HA at 2;06 Lived in Mainland China and spoke Mandarin before implantation Studied in school for the deaf with total communication in Mainland CI done at 6 years 10 months and 7 years 6 months (bilateral implantation, MedEl combi 40+ ) Moved to HK in early 2001 (7;07)

17. Case 2 Started ST training in Cantonese since February 2001 (7;08) Enrolled in normal KG and primary school Average academic performance Uses mainly Cantonese to communicate

18. Case 2: Language Assessment (Mandarin) Informal observation (pre-implant, CA: 6;09) Short sentences (mainly 3-4 elements), no complex/compound sentences Short sentences (mainly 3-4 elements), no complex/compound sentences Vocabulary: inadequate in view of his CA Vocabulary: inadequate in view of his CA Different speech acts noted (asking questions, making clarification, greetings, labelling, etc) Different speech acts noted (asking questions, making clarification, greetings, labelling, etc) Not able to understand abstract concept e.g. conditional sentences Not able to understand abstract concept e.g. conditional sentences

19. Case 2: Language Assessment (Cantonese) RDLS Delay in both verbal comprehension and verbal expression Delay in both verbal comprehension and verbal expression Delay in verbal comprehension > verbal expression Delay in verbal comprehension > verbal expression

20. Case 2: Speech Perception Assessment (Cantonese) Paediatric Speech Perception Test Vowel identification: 85% Vowel identification: 85% Consonant identification: 65% Consonant identification: 65% Tone identification: 64% Tone identification: 64% Sentence recognition: 80% Sentence recognition: 80% Connected speech comprehension: 70% Connected speech comprehension: 70% Performance comparable to same aged peers with Cantonese as 1 st language Performance comparable to same aged peers with Cantonese as 1 st language

21. CASE 2: Language Development (Cantonese)

22. Case 2: Conclusion Delayed development in 2 nd language (Cantonese) acquisition Possible explanation for the delay Age at implantation Age at implantation Delay in 1 st language development Delay in 1 st language development Constant gap between CA and speech perception ability but increasing gap with language age

23. Case 2: Conclusion Speech Perception ability comparable to other implantees with Cantonese as 1 st language Development in 1 st language slow down because of complete switch from 1 st language to 2 nd language

24. Case 3 KK 7 years 4 months old Fitted with bilateral HA at 2;04 No verbal language before implantation CI at 3;04 (MedEl Combi 40+) Lived in Mainland China Studied in normal KG in Mainland Speaks Mandarin

25. Case 3 1 year post-implant assessment (1 st language, Mandarin) RDLS (based on Cantonese Version): RDLS (based on Cantonese Version):CA:4;04 VC: 2;10 VE: 2;05 Informal observation: Informal observation: Speaking mainly 2-3 element sentences Developed various word classes: verbs, nouns, adjectives Rate of development exceeds increase in age

26. Case 3 Had two months training in Cantonese (July to August 2004, age:6;04, 3 years post implant) Showed significant improvement in vocabulary learning by CRVT: Before treatment: raw score-3; AE-<1;10 Before treatment: raw score-3; AE-<1;10 After treatment: raw score-27; AE-2;02 After treatment: raw score-27; AE-2;02 Rate of acquisition exceeded age increase Above-average academic achievement in 1 st language Treatment suspended because of family problem

27. Conclusion CI users can acquire 2 nd spoken language Able to perceive the phonemic patterns of 2 nd language Functional use of the 2 nd language Delay in 2 nd language development 1 st language development continues as long as it was continuously used in daily life

28. Conclusion Possible factors affecting 2 nd language acquisition Age at implantation Age at implantation Language ability in 1 st language Language ability in 1 st language Environmental stimulation for 2 nd language Environmental stimulation for 2 nd language Language similarity, especially phonemic patterns Language similarity, especially phonemic patterns

29. Thank You