Importance of Early Intervention

Question 1

How many children per 1000 are born with significant or permanent hearing loss?

Answer 1

Roughly 1 in 1000 births is born with profound hearing loss with two or three newborns born with partial hearing loss

Question 2

Are infants equipped for language even before birth?

Answer 2

Yes
Partly due to brain readiness, and also because of auditory experiences in the uterus
Newborns prefer to hear speech over other sounds

Question 3

What is the effect of hearing loss?

Answer 3

Speech and language acquisition
Communication
Academic achievement
Social functioning
Emotional difficulties
Delay in cognitive skills
Economic burden

Question 4

Will hearing loss affect the brain development?

Answer 4

Yes
Infant are born with billions of neurons with trillions of connection that in the case of auditory cortex await auditory stimulation to strengthen them
If it is not getting stimulation, brain development will be affected

Question 5

During the first few years of life, does the developing brain largely depend on external stimulation to form meaningful neural connections and a functional network?

Answer 5

Yes
Can support behavioral learning

Question 6

Does the brains ability to undergo neural wiring and re-wiring change over the years?

Answer 6

Yes
The brain demands many practice opportunities to develop neural connections

Question 7

Is neural organization a bottom-up maturation process?

Answer 7

Yes
The quality of the lower-level maturation, stimulation, and practice influences the quality of the higher-level maturation
The cortex matures in stages:
Level one of the cortex matures by the time an infant is approximately 12 months of age (set-up stage)
The second stage of cortical development has the brain now controlling its own plasticity as the child masters skill after skill (controls how the brain develops and the connections that are made)
Subsequent stages continue the maturational process to age 17–19 years

Question 8

Do all of the stages rely on the set-up stage?

Answer 8

Yes
Subsequent stages will be affected if the set-up stage is not properly developed

Question 9

What is neuroplasticity?

Answer 9

Refers to the brain’s ability to organize itself and develop neural connections with repeated stimulation
Fire together, wire together
Can be structural plasticity (physical changes; synapses that are connecting the neurons) or functional plasticity (move function from a damaged area in the brain to another area)

Question 10

What are the three means by which plasticity occurs in the brain?

Answer 10

Synaptic plasticity (refers to the brain’s ability to create new interconnecting neurons through learning and practice)
Neurogenesis (refers to the birth and proliferation of new neurons in the brain)
Functional compensatory plasticity (describes a situation in which a region of the brain demonstrates sensory reassignment; giving jobs to different parts of the brain)

Question 11

What is pruning?

Answer 11

The brain is constantly laying down new pathways and rearranging existing routes
Connections between neurons that are inefficient or infrequently used fade away, while those connections that frequently utilized will be strengthened

Question 12

What is synaptic pruning?

Answer 12

More technically known as apoptosis or programmed cell death, eliminates the weaker synaptic contacts while stronger connections are kept and strengthened
Brain is constantly monitoring what is being used and what is not

Question 13

Are there sensitive or critical periods in the cortex due to heightened levels of neuroplasticity?

Answer 13

Yes
Neuroplasticity is high in the first few years of life due to a major increase in synaptogenesis
Why this is the most optimal time to fit a child with a CI
Need to start intervention as soon as possible

Question 14

What is the sensitive period?

Answer 14

The age in which you can provide speech information to a deaf child so they can still develop the skill of language (about 3.5 years)
Difficult, but not impossible
Beyond this, outcome will not be as great

Question 15

What is the critical period?

Answer 15

More rigid
No longer possible to develop speech and language after you pass it
About 7 years

Question 16

What defines the critical period?

Answer 16

When the brain is best able to absorb language

Question 17

What happens in the absence of sounds?

Answer 17

Re-organization of the cortex can occur (cross-modal reorganization) which reduces auditory neural capacity
Other functions or capacities can take over the part of the brain for hearing

Question 18

How can a CI help in the sensitive period?

Answer 18

Critical not only for optimal speech and language development, but also to prevent re-organization of the cortex
Early amplification or cochlear implantation stimulates a brain that has not yet been reorganized, thereby allowing it to be more receptive to auditory input, resulting in greater auditory capacity

Question 19

Can early exposure to sounds facilitate auditory development and promote faster rate of language development in children born with hearing loss?

Answer 19

Yes

Question 20

How do children perform if they are implanted at an age less than 24 months?

Answer 20

Develop speech similar to that of normal hearing children
Have comparable performance to their normal hearing peers in language development
Were able to go to mainstream school and achieve education levels similar to their normal hearing peers