Eric Seneca's blog

Good food, great friends and bilateral #cochlear implants

Last night I had a great dinner with some old college friends I have not seen for a while. It was the first time they had a chance to meet Landon in person. Of course they have been following my post on Landon for years, so they knew the story, but they really got to see him speak and hear in a noisy setting. He was his normal, nine year old self. As we where talking the subject of unilateral versus bilateral implants came up with the question of why bilaterally implant if kids are good with one ear? This is a question I frequently get and it always interesting to answer.

When Landon was implanted, there was much research showing that students with a unilateral implant could achieve high levels of auditory functioning with a single implant. From my research, the issues that seem to be the most concerning to me with the unilateral route was failure of a single implant and sound localization.

As a parent you always wonder, did I make the correct decision. When I got home I started to think about the question deeper and decided to revisit some research on the subject.  At the time, we felt there were many more advantages to bilateral implantation For me, academic outcome is a very good indicator of future success of Landon. I specifically read information on specific outcomes for school age children.

That research uncovered an interesting article, Academic Outcomes for School-Aged Children With Severe–Profound Hearing Loss and Early Unilateral and Bilateral Cochlear Implants. In this study, Sarant, Harris, and Bennet (2015) tested 44 eight year old children with severe to profound hearing loss at birth. These researcher compared the academic performance these implanted children versus normal hearing children. What they found was that implanted children performed lower than expected in comparison to hearing children. Of those 44 children some where bilaterally implanted and some where unilaterally implanted. What the they found was that the children with bilateral implants achieved significantly higher scores in the areas of oral language, math and written languages compared to the unilaterally implanted children. Furthermore, they single greatest predictor of success in their research was the age of second implantation. The younger the child is at the age of implantation, the more likely they are to have later academic success.  They found that, “Bilateral CIs give significant perceptual benefits over unilateral CIs through binaural redundancy (improved speech perception through two ears, because the brain has two opportunities to process the signal), binaural summation (when combined from two ears, the signal is slightly louder), and the headshadow effect (the head shields sound, such that the signal will be softer at the ear further from the source)” (p. 1080).

Of course one study does not make a definitive finding, but given the growing evidence of academic success for students with bilateral implants, it makes me feel more comfortable that my wife and I gave Landon the best chance for success in life.


Sarant, J. Z., Harris, D. C., & Bennet, L. A. (2015). Academic Outcomes for School-Aged Children With Severe--Profound Hearing Loss and Early Unilateral and Bilateral Cochlear Implants. Journal Of Speech, Language & Hearing Research58(3), 1017-1032. doi:10.1044/2015_JSLHR-H-14-0075

Research, writing and camping

As you can see, it has been a little while since my last post. The main reason for this lack of posting is the amount of writing I have been doing for my latest research project. Last summer I spend a good bit of time working on a project to interview a number of parents with children that received pre-lingual cochlear implants. Since that time I have taken a new position at Louisiana State University. Over the past year I have been getting adjusted to my new position and writing up the results of the study. So instead of taking some time to write on this blog, I have been putting all my efforts into producing a manuscript for publication.  

My goal for this manuscript is to document all the work I have been doing with Landon over the years. Mainly, it is a synopsis of my personal journal and experiences with the development of mobile applications and the UME website. As Landon says, I am writing about his ears.

My other major pastime has been to take the entire family camping. Last summer, my wife and I decided to purchase a camper and spend some time on weekends with the kids. We have worked to take them into nature and allow them some unplugged time. We hike, fish, cook and just generally enjoy each other’s company. Over those months we have developed a pretty competitive domino league. Typically, Bella and Landon “win.” There will be more to come in the future, this blog has not been abandoned. 

Meeting Jim Patrick at the #Cochlear Celebration #Cochlear2015

Just wanted to share, my 8 yr old son (bilateral CI's at 1) at the Cochlear Celebration at Disney last month. He went up to Mr. Patrick, shook his hand, and said "Thank you for helping to make my ears". To which Mr. Patrick got down, gave him a big hug, and said "Thank you for telling me that". One of those unforgettable moments. (Jim Patrick is the chief scientist for Cochlear that worked with Dr. Graeme Clark to invent the first multichannel cochlear implant)

#Cochlear #Implant day, he is sounding good

Yesterday was national cochlear implant day.  It was wonderful seeing all the great videos on Facebook from the various children and adults who have been implanted. Landon wanted to make a video so his Mom broke out the iPhone. Here is his message to everyone, as you can see we are still working on trying to get him to pronounce words with some precision. He is getting better at it, but still some work to go. The biggest problem he seems to have is with L’s. His sister, Bella, is pronounced Bewwa. It is something that we need to correct him on almost every time he calls her name, and that is a lot. But, this video shows the little guy working hard to get everything correct. He did a great job!

Reflections from the #cochlear celebration #cochlear2015

Well, today it’s my first day back at work after a wonderful vacation/conference experience in Orlando, Florida. As you can see by my last post it has been some time since I have blogged about cochlear implants. Over the past six months, my career has undergone a position upgrade. I was fortunate enough to be hired as Director of Information Technology for the LSU School of Veterinary Medicine. This position has been challenging and rewarding with a number of positive things happening at the vet school. I am lucky to be able to work with such a fine group of people stretching the boundaries of knowledge on a daily basis. This new position has dominated much of my time over the past eight months, but now as I begin to settle into the new position, I am able to focus back on my research and move it forward.

My wife and I booked our trip to the celebration back in August right after starting my new position at LSU. I knew taking this new position; I would not be able to blog as much as I had in the past. But, I also knew that at some point, I would be able to focus some of my time back on my app research.  To that end, I decided that I would use the celebration to as a goal. I wanted to get the information technology operation at my new position in such a condition that I could focus back on my other work. I have accomplished that goal. Just recently I upgraded the Ling 6 at to version 1.8 removing the ads. I am working on fixing an upgrading some sounds on the Learn to Listen app and I have another project in the works.

I thought the breakout sessions at the celebration were excellent. I got to see neat product advancements for the Nucleus 6 product. I also attended a wonderful lecture on the service that student and professionals to use. I met some great people and heard some interesting stories. I think my one criticism of the celebration is there seems to be a hole in the information being presented. In my opinion, not enough time is spent by the CI vendors to help parents understand how people “learn” language. Because CIs are seen through the lens of a medical procedure, there is much left out about how a student learns and acquires vocabulary.  In the future, I would like to see Cochlear America bring in professionals in the area of education and language development to help parents understand what is going on beyond speech therapy.

Building a new sound app for #cochlear children

Over the past month I have spent a lot of time working on a new mobile app for children. Unfortunately, this has not left me with much blogging time. This new app is working on environmental sounds and trying to help children associate sounds to imagery. What is making this app difficult is that I am trying to design it for a child who cannot read. So, it will require audio instructions throughout the entire app. That is a new concept from a human-computer interaction design aspect for me. I hope to have a prototype completed by the end of next week. Till then, I will keep monitoring the boards and Facebook for issues concerning CIs.

Executive Functioning, the math is right, the conclusions are all wrong #cochlear #implants #research

A few weeks back a number of trade magazines had the following type of headline, “Some Kids With Cochlear Implants Face Cognitive Risks.” [1] That headline is an attention grabber; it conjures up in the mind a correlation between cochlear implantation and cognitive risks. This article cites research coming out of Indiana University looking at 73 children implanted before the age of seven in comparison to 78 children with normal hearing. They report that “Delays in executive functioning have been commonly reported by parents and others who work with children with cochlear implants.” [1] In the article, they go on to state that

“In this study, about one third to one half of children with cochlear implants were found to be at risk for delays in areas of parent-rated executive functioning, such as concept formation, memory, controlled attention, and planning,” he said. “This rate was two to five times greater than that seen in normal-hearing children.”

This information was widely reported on multiple CI parents’ websites and the reaction was strong. Many felt the study had no validity because it did not compare CI children to deaf non-implanted children. Still others, I believe, correctly defined the issue. The problem was not the study, it was the headline used by the authors. After reading the headline, article and reviewing the poster presentation for the study, the news article without a doubt puts forward a false correlation, one the researchers did not present in their poster. I guess that should not be a surprise, sensationalism in journalism, but I also think there is a fundamental misunderstanding about children with cochlear implants and their learning curve. To illustrate, lets explore the idea of executive functioning.

What is Executive Functioning? Executive functioning is the application and synthesis of acquired information. In education we like to call it higher order thinking or crucial thinking. Here is a commonly accepted taxonomy for learning called Bloom’s revised taxonomy. If you look at the graph, you will see the various levels of cognition as defined by Bloom. What we call lower-order thinking are simply memorization and understanding a concept. As you progress up the taxonomical triangle, you see that you move from simply acquiring information to applying, analyzing, evaluating and creating with that information.

Executive function would exist at the upper parts of the triangle. It's a learned activity. Students need to be explicitly taught to use these skills. Most speech therapy focuses on sound and the acquisition of words, but in many cases do not give the student the opportunity to apply that information in real and meaningful ways. Much of what I have observed through my own son’s speech therapy is behavioral in nature and exists at a lower taxonomical level. At first this is completely necessary. A child with a CI needs to learn how to identify sound. Their brains need a period where they can start to integrate the auditory sense. But, at some unknown point, their brains understand how to use sound, but in many cases we just keep feeding in lower order information.

What is suspect in this study and many is the idea of the control group and how we as educators go about helping children with CIs. Maybe the reason we continue to find issues with the development of CI children is because our measure and approaches to their education are all wrong. As researchers and educators, we are trained to look at a norm, see a deviation, develop a plan to address that deviation and then compare to the norm to see how the intervention worked. This concept of basic scientific method works as long as the norm you look at is the correct norm. Our math can be completely right, the method sound, the treatment and control group intact, and the conclusion can be all wrong.

Comparing CI children to normal hearing children would seem to be a very good methodology, but it is not. CI children have too many factors different from normal hearing children to ever truly meet their milestones in the compressed time one learns spoken language. The mainstreaming goal is to fast pace a CI student so they can catch up, but the problem with this approach, learning does not happen that way. We learn langue over a long period of time through a recursive process of informed trial and error. During that period a child constructs their own understanding of language through years of exploration, correction, reflection and resolution of ideas and concepts. Understanding words and sounds is a lower order thinking process, but putting together meaningful language requires us to adapt and synthesis language through meaningful social experiences. We do not learn higher order thinking from approaches that ask us to simply identify and memorize.

Finally, maybe it is time for CI researchers to identify a new control group, high performing CI children that were implanted at age one or less. Throughout the literature I continue to see studies that compare CI subjects that have a wide variation in implantation date. For instance a 2011 study that came to the same results about executive functioning risks, looked at children that had been implanted before the age of seven, but the mean implantation age was 33.7 months. So on average, for this study, the average child was functionally deaf for the first three years of their life. Then at age three, they are implanted and introduced to sound. Then over a period of time they are measured for executive functioning and we find a deficiency. That does not seem to me to be a sound method in that we know from the literature factors such as socio-economic status and age of implantation can have significant influence on results. Throughout the literature we see children implanted at a very young age performing high on most scales. We need to recognize that CI children have different developmental experiences and patterns. Those patterns need to be identified and applied to subsequent generations of research as the control.


The summer semester has begun #cochlear #learning #education

It has been a busy couple of weeks. The week before and after the beginning of a semester is always a lively and active time. Getting new students ready for their journey can be a daunting task, but worth the efforts. The duties in my office has not allowed me much time for scholarship for this site, but as the normal summer cycle begins to take hold, there will be much more time for research and writing. I have used the past two weeks to really dive into the current round of information that has been from the current study. All in all, I have had 42 parents accept my invitation to participate in my research. I am really excited about what I am seeing in the results and I am coding the data furiously. I have converted my and my wife’s personal journal about our experiences in the first year of Landon’s life into an ethnographic timeline. It is amazing to see how the experiences we have resemble many of other parents during that first year. I am working hard on the manuscript a bit at a time and hope to have a first draft of it by the end of the summer. I am taking a week in July of personal time off from work to concentrate just on writing. More on that later…

Learning styles, auditory versus visual learners #cochlear #geauxtigers #lionup

You may have run into a this type of conversations in the past, “I am a visual learning while someone else says, “Well, I am an auditory learner.” This idea of learning styles have been much debated in the educational literature for decades, but despite countless efforts to determine ways to enhance learning through styles, not much progress has been made. Much of what we know about learning comes from this idea of identifying the way a child learns best and then presenting content and material in that manner.  If you look at this concept of auditory versus visual learning, there is no evidence to support the conclusion that learning styles exist. In 2009 a team of experts in the psychology of learning found that although many studies purport to find evidence of the existing of auditory or visual learners, most of those studies to not meet the criteria of basic scientific validity.

In the world of learning and education, many of us have known for a while that learning is not dictated by one dominate source of input. Learning occurs all the time with a multitude of stimuli processed by our brains. Language acquisition is a process of situated cognition. Putting children in situations that require them to understand the vocabulary and then apply that vocabulary in their diction will yield the best results. So what does this mean for our auditory versus visual aspects of language learning? It seems that it gives us an idea that the playing field is level. If one approaches the problem of learning language from either perspective, then there is a high likelihood that outcomes will be achieved regardless of the path. Understanding yours or your child’s learning style may not give you the desired outcomes. It seems that what you put in, is what you get out in many cases.


What the Eyes Reveal, a review #cochlear #ASL

When I woke up this morning, I began to think of the day’s events. During breakfast, my wife introduced me to a post from one of the Facebook groups that we belong to about ASL. The post was from a user and it was recommending watching a video on ASL language. The video was by Dr. Laura-Ann Petitto entitled What the Eyes Reveal. The discussion that resulted between my wife and I was very interesting as we are wanting to introduce our family to ASL. She and I have some differeing viewpoints on the issue. Needless to say, the video sparked a health debate on the parents group about some assertions by Dr. Petitto. I decided to take some time at lunch today and watch the video, which I thought was very interesting and thought provoking. I could not resist posting my comments to Facebook. Here is what I wrote,

I would not draw too many conclusion from the video. The speaker described many assumptions that I would characterize as easily dismissible. For instance, at one point the speaker lays out the assumption that language acquisition can only be accomplished via auditory stimulus. I would suggest that is an old way of looking at the issue. I think it would be more accurate to say that if your end goal of language for a child is spoken language, then auditory stimulus is the best route to accomplish that goal. Conversely, if the goal is a visual language, then visual language will more than likely be the best path. The human brain is wired from birth to be bimodal, we all hear and see as part of a typical state of human existence. The development of spoken, and the word spoken is really important here, is best done through auditory, not visual means. There is a lot of empirical evidence to support that assertion. That is not to say that deaf individuals cannot develop high levels of language.

The idea that language equals patterns the brain is evolutionarily wired to detect seems to make sense to me. But, if one sense is deprived, the brain adapts and builds neural pathways to adjust for the lack of stimulus. The issue with the video is that it does not address essential questions of dominance. CI children who are first implanted are visually dominate. The absence of visual language stimuli during that period post implantation is meant to balance the equation. Even the presenter agreed that children must be taught to use their CIs. It is to allow time for their brains to learn to process this new form of stimulus. Once the brain has learned to process both auditory and visual stimuli equally, like most of us do from the womb, then introduction of visual language makes sense. I do not think anyone can tell you based on our current understanding at what point in development that happens post-implantation. Pre-lingual CI children have a different developmental patterns than that of a deaf child with sign language and a hearing child and those patterns are ill defined in the literature. I think that is a really important point.

Additionally, another issue I have in the video is that the presenter blurs the lines between learning English and learning spoken English. Those are two different things entirely. The one subject they demonstrated in the video was non-verbal. Visual languages are not well equipped to develop spoken language.

Just a personal commentary, the depriving of food part was ridiculous and silly and detracted from the arguments being presented by the scholar in the video.

I will take some time to look into the work for Dr. Petitto, she is an accomplished scholar. I wish Gallaudet would address is the idea of helping auditory parents with deaf children develop listening and speaking skills with implants as well as ASL skills. That maybe a step to far at this point, but I believe Dr. Petitto's research is leading use in that direction. It is one thing to speak of language acquisition, its another to talk about spoken language acquisition. I do not see how this line of inquiry address some central concerns of that auditory parents have for their deaf children. How do we effectively communicate with our children and make them part of our culture as well as Deaf culture. Here is the video, I invite you to watch Dr. Petitto’s presentation and draw your own conclusions.



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