JPM | Free Full-Text | Hearing and Language Skills in Children Using Hearing Aids: Experimental Intervention Study
[ad_1]
1. Introduction
The objective of this study was to verify the effectiveness of speech therapy intervention, focusing on the auditory and linguistic skills of Brazilian children aged between 6 and 8 years who use a digital sound amplification device for at least 4 h per day.
2. Methodology
Type of study: Experimental study with a control group with children aged between 6 and 8 years who attended the Hearing Health Reference Service (SASA) of the Brazilian Unified Health System (SUS) in the State of Santa Catarina between January and April 2023.
Inclusion criteria: For the initial study screening, diagnostic information was collected from audiological exams and auditory rehabilitation of all children aged between 6 and 8 years with mild to severe bilateral hearing loss and prelingual deafness, who use a personal sound amplification device (PSAP), and who were admitted during the study period and referred for evaluation and intervention.
Exclusion criteria: Children with neurological changes, autism spectrum disorder (ASD), or other neurodevelopmental disorders or syndromes, or who had already undergone an intervention to adapt their hearing aid prior to the present study, were excluded from this research.
Population: After selecting the children, their guardians were contacted via telephone and an invitation to participate in the study was offered. After recruitment, consent to participate in the study was given by the guardian signing a consent form. Following this, anamnesis and exams, including questions about hearing difficulty, physical and laboratory examinations, associated diseases, clinical history, and whether the child is a PSAP user, were obtained from the SASA database. After obtaining the data, the research agenda was structured according to compatibility with the family and the availability of municipality transport for weekly care logistics.
Protocols: Protocol applications were carried out at the beginning and end of the intervention for the intervention group (IG) and control group (CG). The protocols consist of the assessment of auditory and linguistic skills and are approved instruments for this age group and application in the Brazilian population. Four protocols were used: IT-MAIS, TFDF, GASP, and a language category classification test.
The Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) questionnaire evaluates responses to speech sounds and environmental sounds exclusively through the auditory sensory pathway. It consists of open and closed questions whose main goal is to evaluate speech auditory perception. The assessment was based on information provided by the child’s parents or guardians in response to 10 questions that assessed three main areas: vocalization behavior, attention to sounds, and meaning attribution based on the sound.
The phoneme discrimination test with a figure (TFDF) was applied to evaluate the phonemic discrimination ability through minimal pairs, and the final score was classified as adequate or altered, according to age, as per criteria proposed in the literature. It is a test that incorporates 30 minimum pairs (60 words), represented by pictures and organized into presentation cards. To explain the test tasks, four demonstration items are part of the test. The 30 minimum pairs were organized into 40 presentations, of which 30 contain two different words and 10 contain two identical words. The TFDF tasks consist of listening to two words (which can be different or the same) and pointing to the card containing the pictures that represent them.
The Glendonald Auditory Screening Procedure (GASP) is a speech perception test composed of three levels and five tests that assess the ability to detect language sounds, vowel discrimination, length discrimination, word recognition, and sentence comprehension with the use of an individual sound amplification device. To verify the development of auditory recognition in a closed set and listening comprehension, test 5 of the GASP was analyzed, which assesses the ability of auditory recognition in a closed set and is composed of monosyllabic, disyllabic, trisyllabic, and polysyllable words, totaling 12 words presented through figures.
To classify expressive language categories, the Brazilian version of the American Reynell Developmental Language Scales (RDLS) instrument was applied. This instrument is composed of two scales for evaluating oral language, the verbal comprehension scale and the expression scale. These scales aim to compare the relationship between oral comprehension performance and oral expression performance.
Intervention: The intervention consisted of six speech therapy sessions lasting 60 min each (six sessions is the minimum to stimulate the skills proposed in the study). The CG was instructed to stimulate auditory skills of sound detection and discrimination in the family environment, as well as receiving parental guidance to promote bonding with children.
Data analysis: Data were organized in Microsoft Excel® and later exported and analyzed using StataMP® software, version 14.0 (StataCorp., College Station, TX, USA). To characterize the sample, descriptive analyzes were presented, with absolute and relative frequencies and their respective 95% confidence intervals (95% CI). As it was a small sample, for pre- and post-intervention analysis, Student’s t-test was used for non-parametric samples. Comparative analysis was carried out between the intervention and control groups using Student’s t-test for independent and non-parametric samples. A comparative analysis was also carried out using Student’s t-test, for paired and independent samples, in order to obtain the mean and 95% CI. For statistical significance, a p-value of less than 0.05 was considered. Values obtained via Student’s t-test were used when significance was verified in the same way as the non-parametric test.
This study was approved by the Research Ethics Committee (CEP) of the Universidade Federal de Santa Catarina. CAAE: 64315322.7.0000.0121. As the sample consisted of subjects under 18 years of age, the consent form was signed by the legal guardian.
3. Results
Sixteen children participated in this study (IG (n = 10) and CG (n = 6)). The mean age of participants was 6 years, with birth period of between 2005 and 2006. The CG had four withdrawals due to difficulties with the municipality’s transport logistics. Two sessions were required to apply protocols before the intervention period. Children from the IG underwent six speech therapy sessions between February and April 2023.
The GASP expressive language and speech perception tests were non-sensitive instruments to differentiate the children’s development in this study. In the expressive language classification test, only one child changed from category 4 to 5, the others remained in the same category. Likewise, using the GASP instrument, when observing the initial values, children in both groups maintained their respective classification.
To analyze the follow-up time (the difference in dates between the first and second sessions of the protocol application), the CG had a mean interval of 38 days between the first and second evaluation, while the IG had a mean interval of 55 days.
4. Discussion
In line with the purpose of this study, the results of applying the protocols and speech therapy intervention, used as a proposal for developing the auditory and linguistic skills of this population, indicate that the stimulation of skills linked to the scientific protocols used constitutes a positive process in the development of the assessed skills.
Regarding the IT-MAIS protocol, when analyzed by group (IG and CG), the CG showed a significant increase in the mean score, while the IG also showed an increase in the mean score, albeit not significant, post-intervention. All questions used in the IT-MAIS questionnaire are instruments for reflection regarding the child’s use of a PSAP, as well as regarding its handling and levels of use in the family environment. All those responsible, when answering the IT-MAIS questionnaire twice, were guided and led to new approaches and management strategies regarding the PSAP and dialogue with the child. The study did not show a significant increase in the IG score after intervention, but both groups responded very similarly.
The two groups (CG and IG) did not present relevant results for the GASP protocol or the expressive language category test. The GASP is a test that evaluates the ability of auditory recognition in a closed set and is composed of monosyllabic, disyllabic, trisyllabic, and polysyllabic words. It totals twelve words presented through pictures, and the expressive language category test, which is composed of two scales for evaluating oral language: the verbal comprehension scale and the expression scale. The two tests were not sensitive to the changes that occurred between the groups and after intervention in the IG, and the analysis showed that only one participant in the IG showed a change from category 4 to category 5; the others remained in the same category.
As for the TFDF protocol, which assesses phoneme discrimination ability through minimal pairs, a significant difference was found, with an improvement in the score of the IG, which went from 23 to a score of 28.1 on average, while in the CG there was no significant difference.
The IG intervention sessions were based on goals that focused on developing reciprocity of action and communication and promoting attention skills and perception of self and others, as well as intentional communication. All of these skills were stimulated through playful activities, scientifically supported and with therapeutic resources, so that, in the long term, IG children achieved better percentages in auditory and language skills.
The results reiterate the importance of children with hearing loss and PSAP users attending an intervention to stimulate auditory skills. Such actions, in the intervention context, have repercussions on daily family life, with an important positive impact on children’s communication, providing support for therapeutic guidance for a more effective intervention from the perspective of comprehensive and personalized care.
A limitation of this study is the lack of protocols that are based on scientific evidence, which prove in advance the reliability of taking risks and can demonstrate significant changes in the auditory and linguistic skills of deaf children.
This study was based on the literature and, with protocols used for children with delayed language development and the lack of a specific validated protocol, it was necessary to use four questionnaires to fulfill the study’s purpose. However, the study demonstrated that the TFDF and IT-MAIS protocols showed the most significant change during the proposed intervention. Thus, this structure, with the necessary therapeutic objectives, has led children with hearing loss to better ways of communicating with, and learning about, the world they live in.
5. Conclusions
This study found that an intervention with six stimulation therapy sessions in the studied population tended to improve the communication skills of children who use a PSAP. The IT-MAIS and TFDF auditory and linguistic skills assessment protocols presented important applicability in the verification and conduct of research follow-up. The GASP and expressive language category test protocols did not detect improvements in the auditory and linguistic skills of children targeted in this study.
Considering this context, in order to guarantee the sustainability of public policies through the provision of specialized care for children who use a PSAP, the authors hope that the results of this study might influence the course of the SUS’s investment policy. Strategies such as welcoming the patient and offering specialized care to stimulate hearing skills, in addition to more effective healthcare, highlight several concerns of parents regarding the implications of communication changes for their children’s relationships with other people and their consequences for their quality of life and future.
[ad_2]