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June 26, 2005

Implants help deaf students learn

From: Connecticut Post, CT - Jun 26, 2005

CHUCK SLATER, Correspondent

BRIDGEPORT — The slight, dark-haired youngster stood in a Skane School hallway, attempting a farewell to a visitor. He seemed to mouth some words, then, his facial muscles struggling, he said: "Bye ... bye." It was a breakthrough for 4-year-old Cesar Aguilar.

Earlier, in a nearby room, blond Daniel Daku Jr., also 4, heard a teacher call his name — and responded.

Another breakthrough.

Cesar and Daniel are special students, even for the Skane School, which integrates developmentally delayed students into the general population in its pre-kindergarten and kindergarten classes. Both boys are deaf. Both hear sounds with the aid of cochlear implants. And both are the beneficiaries of a Bridgeport program that is almost unique in urban public schools. A cochlear implant is a marvel of electronic technology that, when placed in the cochlear — the shell-shaped organ behind each ear — and teamed with an external microphone attached behind the ear, allows those with severe to profound hearing loss to hear.

The latest devices have 22 electrodes that stimulate the auditory nerves. The original experimental models in the 1980s had only eight.

By 1990, the devices, already used to help adults, were approved for children as young as 2. The age is now a year old.

Use of implants in the young is growing far faster than among adults, many of whom prefer the deaf culture in which they have lived. According to industry sources, of the 45,000 children nationwide with severe to profound hearing loss in June 2004, about 12,400, or 28 percent, were cochlear implant recipients.

Projections suggest there will be 52 percent penetration among children by 2006. For the 455,000 adults, the corresponding statistics are 4 and 6 percent.

About two years ago, two of these little statistics arrived on the doorstep of Honey Sacks, the director of speech, language and hearing for the Bridgeport school district.

"We had had older children [with cochlear implants] and they had to go away for training," Sacks said. "Then we get these two babies. "We had to make choices — do we send them away or train them within the system? They were 3-year-olds. What could we do to keep them within the community?"

Sacks sought the support of her boss, John DiDonato, assistant superintendent for student support and special education services. "His only question was, 'Can you find it in your budget?' " Sacks said.

It was a valid concern. There is nothing inexpensive about cochlear implants and the necessary subsequent training.

Purchase and implantation of the devices can run into the middle five figures, although Medicaid and some private health insurance companies cover most of the cost. But years of special training are needed for someone to hear a semblance of what the average individual does.

That costs money. In Bridgeport, city budget pressures always strike the school system the hardest.

"Bridgeport is the largest city in Connecticut," Sacks said. "A typical urban area. We don't have a lot of resources. We do have a lot of problems."

None of that was going to stop Sacks and her already-stretched-thin staff of 25.

Sacks had a plan: To integrate the cochlear youngsters into a standard classroom, but provide them with extra support. She also had a team. Speech pathologist Susan Latino would find a few hours a week to work with each boy despite her 90-student caseload. Language teacher Elizabeth Feiner and audiologist Nancy Case would make the boys a priority, as would each child's classroom teacher and teaching assistant.

Brought in to guide them in the special methods needed to train implanted youngsters was a consultant, Lois Heymann, of Nyack, N.Y., an expert in hearing loss whose multi-sensory approach has proved highly effective in dealing with cochlear implant recipients.

"It was a strong team," Sacks said. "You couldn't find better people."

"You need people who are willing to learn," agreed Heymann, who also convinced a teenage girl in the school system to return to an implant she had stopped using.

Heymann gave a six-hour lecture for the teachers at Skane and the nearby Blackham School about dealing with auditory challenges. Then she went about adapting classrooms for Cesar and Daniel.

The idea was to mute noises that impede the learning process. Acoustic tiles were placed on classroom walls.

Anti-static carpeting with padding was placed on the floor where possible. Where there was no carpet, all chair legs were inserted into tennis balls to eliminate scraping. Heavy drapes are next on the agenda.

"The human ear can discriminate, listen to a conversation and block out extraneous noise," Heymann explained. "Cochlear implants bring in everything at one level."

To further facilitate hearing, the class teacher uses a microphone and speakers are affixed to walls throughout the room. "The beauty of the setup," Heymann said, "is that it not only facilitates hearing for those with cochlear implants, but also makes things easier for children with poor attention spans and those easily distracted."

Another beauty is the relatively minor price tag of the total program.

"It was thousands of dollars well spent," Sacks said. "In the scheme of things, it was not expensive to do it the way we did it. "Our outside consultant is training others on our staff to train the teachers. It's not a per-child cost," she said. "This all can be applied to the next generation, and we will have the trained people to do it.

"My feeling is the next generation of hard-of-hearing will be wearing cochlear implants. It's magic to give a child ears," Sachs said.

Public school systems do not appear to be mobilizing for that next, hard-to-train and expensive-to-educate generation. "I didn't know of any other public system in the area training these children," Sacks said, "but I understand that both Orange and New Canaan have a child they are working with. "I don't think, however, anyone else has a program in place that can follow the children and grow as the need does."

Heymann's auditory-verbal approach includes such things as talking directly to a child, but covering one's mouth so he or she cannot employ lip-reading skills. Thus, the child must hear and repeat the sound and respond to it if appropriate. This teaches them the power of words, something that comes so early and easily to those who can hear.

Cesar attends morning and afternoon sessions at Skane and both he and Daniel will go to summer school. There is a lot of catching up to be done.

Cesar is in a class of 12. "He's playing with sounds," Latino, the speech pathologist, said. "He says 'm ... m ... moo,' like a 6-month-old.

"Cesar has to learn how to listen. He has to go back through the early stages of learning," Latino said. "We have to teach him how to detect sounds, to discriminate different sounds and different words.

"He is very shy," she said, "and when he came here, he was always fearful of new people. But he has a great sense of humor and enjoys toys.

"He is easily distracted. The sound-proofing in the room really helps," Latino said.

"He's coming along," Linda Leo, his classroom teacher, said.

Daniel is in a class of six because of developmental issues beyond his hearing and gets special attention from another speech pathologist, Jessica Lockavitch.

"Cesar has a few words. Daniel makes his wants known through pictures," Latino said. "He's a guy who likes having a good time and he responds to things he doesn't like. But it's a challenge to get him to respond auditorally."

For Cesar's mother, Miriam, a native of Guatemala, a few words have meant a big change since she learned her little boy was totally deaf three and a half years ago. She spent the night crying, she recalled. "At 8 months, he wasn't making any sounds," Miriam said. "When I would call him or talk to him, he wouldn't respond. He didn't cry at all.

"I thought maybe he didn't hear in one ear," she said. "Then the doctor examined him when he was a year old and said he was deaf in both ears.

"I didn't expect that," she said.

"First they tried putting him in hearing aids," she said. "But in a six-month trial he didn't hear."

So, before his third birthday, Cesar underwent the implant operation. And after his birthday, with no ill effects from the surgery, the device was turned on. "I thought he would hear right away," his mother said.

He didn't, though. Before enrolling full-time at Skane, Cesar had to be bused an hour and a half each way to Hartford twice a week for training. "He would leave at 6 in the morning and be home at 5 at night," his mother said. "I hated it."

And now at Skane? "I'm very pleased," she said. "They are giving him everything he needs.

"He is just a nino pequeno, a little kid."

A little kid for whom "bye ... bye" is a big breakthrough.

And cause for a full-team celebration.

"When we have a breakthrough," Latino said, "the whole team is so excited. The e-mails fly back and forth."

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