Rethinking sound: Computer- assisted reading interven6on with a phonics approach for deaf and hard of hearing (DHH) children using cochlear implants or hearing aids Tänka om ljud: Fonologisk lästräning vid datorn för döva och hörselskadade barn som använder cochleaimplantat eller hörapparat Delstudie 4 Mentzer Linköping University Na6onell Logopedkonferens Jönköping 2014 Interdisciplinary project between the Swedish Disability Ins1tute, HEAD Graduate school HEaring and Deafness, Linköping University Cogni1on, Communica1on and Learning, Lund University Karolinska University hospital, Karolinska InsEtutet Department of Linguis1cs, Stockholm University Linköping Studies in Arts and Science No. 627 Studies from the Swedish Institute for Disability Research No. 63 Rethinking Sound Computer-assisted reading intervention with a phonics approach for deaf and hard of hearing children using cochlear implants or hearing aids Mentzer Study 4 Segmental and suprasegmental proper6es in nonword repe66on An explora6ve study of the associa6ons with nonword decoding in children with normal hearing and children with bilateral cochlear implants Mentzer, Björn Lyxell, BirgiSa Sahlén, Örjan Dahlström, Magnus Lindgren, Marianne Ors, PeSer Kallioinen, Elisabet Engström & Inger Uhlén Elva barn med bilaterala CI Elva barn med NH Clinical Linguis1cs & Phone1cs (in press) 1
Bakgrund Barn med CI läser bäsre än förväntat med hänsyn 6ll sina svaga fonologiska förmågor (Asker- Árnason et al., accepted; Wass, 2008) Även barn med läsa 6ll måsliga hörselskador har uppvisat liknande trend (Park, Lombardino & RiSer, 2013)? Använder barn med CI andra avkodningsstrategier? Är de mer visuellt orienterade? Fokuserar de på ord och bokstavmönsters utmärkande drag Utvecklar de ortografisk lässtrategi 6digare? Syge Beskriver med högre detaljnivå än 6digare Nonordsrepe66on och Nonordsavkodning Associa6oner dem emellan Syge På es mer djuplodande säs än 6digare studie undersöktes HUR barnen använde sin fonologiska bearbetningsförmåga mäs med nonordsrepe66on och HUR denna var associerad 6ll nonordsläsning SäHa fingret på hur barnen använde sin fonologiska förmåga i läsning med höga grav på fonologisk avkodningsförmåga! 2
Mä6nstrument Nonordsrepe66on (Wass, 2008) Fonologiskt arbetsminne Fonemdiskrimina6on Talproduk6on Nonordsavkodning (TOWRE, Byrne et al., 2009) Bokstavskännedom Fonem- grafem 96% strikt ljudenligt stavade (es ljud- es tecken) Baseline 1 4 weeks Baseline 2 4 weeks Post- interveneon Phonological processing & leser knowledge, 8 tasks 5, 6 and 7- year olds 5, 6 and 7- year olds, reference group Design Mild, Moderate to severe hearing loss Normally hearing children Same as B1 + cogni6ve tasks & reading ERP: MMN N400 Interven6on Graphogame Same as B1 + cogni6ve tasks & reading ERP: MMN N400 Här analyserades barnens nonordsrepe66on och nonordsavkodning Vad är phonics? Phonics övar i huvudsak tre förmågor: Fonem- grafemkoppling Ljudning Segmentering Bakgrundsvariabler Table 1. Demographic variables (age and time in months) in children with NH and children with CI Participant NH Age at testing Raven CI Age at testing Raven Age at diagnosis Age at implant Time with CI CI right CI left Processing Strategy 1 F 91 95 F 91 75 2 11 80 C40+ Pulsar FSP 2 F 92 90 F 92 95 9 13 79 C40+ Pulsar FSP 3 M 60 95 F 62 75 19 23 39 Pulsar Sonata FSP 4 M 79 75 M 75 75 12 19 60 Pulsar Pulsar FSP 5 F 73 50 M 73 95 19 21 52 Pulsar Pulsar FSP 6 M 75 75 F 73 95 9 12 63 CI24RE CI24RE ACE 7 F 88 95 F 82 75 18 39 49 CI24RE CI24RE ACE 8 M 67 95 F 65 90 1 8 60 Pulsar Pulsar FSP 9 M 84 95 F 84 95 18 22 61 Pulsar Pulsar FSP 10 M 68 95 F 64 75 2 36 32 Sonata Sonata FSP 11 F 94 95 F 95 50 8 12 82 CI24R(CS) CI24RE ACE Mean 79 90 78 81 10 20 60 Note: NH = normal hearing, CI = cochlear implants, F = female, M = male, mo. = months, C40+ = Med-El, Sonata T1100 = Med-El, CI24RE = Cochlear Nucleus, FSP = Fine Structure Processing, ACE = Advanced Combination Encoder SniSålder 6.5 år SniSålder vid CI- op. 20 mån Spridning: 8-39 mån SniSålder med CI 62 må Spridning 34-82 mån SniSålder vid diagnos 10 mån Spridning 1-19 mån 3
Metod Table 2. Phonological characteristics of the nonwords in the nonword repetition task. Nr. of NW Nr. of syllables Weak syllables Cons. Vow. Stress pattern Clusters Note: Nr. = number, NW = nonwords, Cons. = consonants, Vow. = vowels Prestressed Post-stressed Iamb Trochee Legal Illegal 12 3 12 12 53 36 6 6 4 4 12 4 18 18 67 48 6 6 4 4 Total 24 84 30 30 120 84 12 12 8 8 /'kɑːsɪmɵm/. /'dralabɛlɪ/ /sɛka'lɑ:gb/ Poängberäkning Table Table 3. Scoring 3. Scoring Table 3. and 3. and Scoring levels levels and of and analysis levels of levels analysis of for of analysis the for nonword for the for the the nonword repetition nonword repetition task repetition task task Whole word word Whole word word Segmental Segmental Suprasegmental clusters clusters clusters Percent Table nonwords Percent 3. Scoring nonwords Percent and Percent levels consonants Percent Percent consonants of analysis consonants Percent for the Percent Percent nonword Percent repetition syllable task syllable Percent syllable Percent legal Percent legal and legal legal and illegal and and illegal illegal correct, correct, correct, correct, correct, pcc correct, correct, pcc pcc pcc omissions; omissions; omissions; omissions; clusters clusters clusters correct clusters correct correct correct Whole word Segmental Suprasegmental clusters (max 24) (max (max 24) (max 24) 24) (max 120) (max Percent nonwords (max Percent 120) (max 120) 120) Pre- and Pre- post stressed consonants Percent Pre- Pre- and and and post post post stressed (max 88 each) syllable stressed stressed (max Percent (max (max 88 each) legal 88 88 and each) each) illegal correct, correct, pcc positions positions omissions; positions positions (max clusters correct (max 24) (max 120) (max Pre- 30 pre/post) and (max 30 pre/post) post 30 pre/post) stressed (max 88 each) Percent (max 30 pre/post) Percent Percent vowels vowels Number vowels Number positions Number of of syllable of syllable Number syllable Number of Number of of Percent correct, correct, pvc correct, vowels pvc pvc Number insertions insertions (max 30 insertions of for syllable pre/post) for each for each correct, pvc each Number of omissions insertions for each omissions omissions omissions (max 84) Percent (max (max 84) 84) vowels nonword Number nonword category nonword of category category syllable Number of substitutions (max substitutions substitutions correct, 84) pvc insertions nonword category for each Vowel omissions substitutions Vowel epentheses Vowel epentheses epentheses (max 84) nonword category Vowel substitutions epentheses additions Vowel epentheses additions additions Percent additions Percent phonemes Percent phonemes phonemes Percent Percent syllable Percent syllable number syllable number number Percent correct, correct, phonemes Percent correct correct syllable number additions correct, Percent (max 204) phonemes correct Percent (max=24) syllable number (max correct, (max 204) 204) correct, (max=24) correct correct (max=24) Pcc for each Percent primary stress Pcc (max (max for nonword 204) Pcc 204) for each each category; Percent (max=24) Percent primary stress correct primary stress nonword Pcc Pcc nonword (max category; for for 31/44/45) each category; correct Percent correct (max 24) primary stress stress (max nonword (max 31/44/45) Pvc category; 31/44/45) for (max each correct (max 24) 24) (max 24) Pvc (max Pvc for nonword 31/44/45) Pvc for each for each category; (max 24) each nonword Pvc (max nonword nonword category; for 28 each) category; category; (max 28 each) (max nonword 28 (max each) 28 category; each)! (max 28 each)!!!! 24. /karatɪ'miːbkl/ karati mibkl Children with NH significantly outperformed children with CI on all aspects of segmental and suprasegmental aspects of NWR. The largest difference was found for the whole- word score; NH (Mdn = 54.0%), CI (Mdn = 4.2%), U =.00, z = - 3.99, p <.001, r =.85. As for suprasegmental levels, the smallest difference was obtained on correct primary stress; NH (Mdn = 100%), CI (Mdn = 83.3%), U = 13.0, z = - 3.21, p <.001, r =.68. Men, trots ah barnen med CI hade stora svh ah återge nonord, och som alled konsonanter i synnerhet, så presterade de bähre avseende pcc än CI- barn i andra studier (svenska och engelska): Tidigare implanterade Mätpunkten var direkt ever phonics träning Stavelseomissioner förekom totalt 40 gånger Barnen med CI gjorde 95% av dem 63% av dessa förekom FÖRE den betonade stavelsen och 37% EFTER den betonade stavelsen Barnen med NH utelämnade enbart stavelser EFTER den betonade stavelsen 4
90" 80" Table 6. Analysis of nonword decoding (percent) of TOWRE; (medians, min and max) for children with NH and children with CI. 70" 60" NH CI Sig. 50" 40" 30" 20" NH" CI" Whole words 7.9 (0-41.3) 9.5 (0-28.6) n.s. Barn med CI: fler avkodningsfel i förhållande Ell försök Phonemes 5.8 (0-31.1) 8.1 (0-20.1) n.s. 10" 0" Trials 12.7 (0-46.8) 19.8 (0-47.5) n.s Errors 32.8 (0-59.1) 58.3 (0-81.8) <.05 Note: TOWRE = The Test Of Word Reading Efficiency, NH = normal hearing, CI = cochlear implants. Inga signifikanta skillnader mellan grupperna Utan kluster: median 73% (NH) - 38% (CI), p =.14 Med kluster: median 89% (NH) 50% (CI), p =.19 50" 45" 40" 35" 30" 25" 20" 15" 10" 5" 0" Phoneme" insertions" Phoneme" deletions**" Phoneme" substitutions" Lexicalizations" Figure 2. Nonword decoding errors in TOWRE; number of phoneme insertions, NH" CI" 5
Table 7. Correlation analysis for nonword decoding and nonword repetition in NH children (N = 11) and children with bilateral CI (N = 11) NONWORD DECODING Whole words Phonemes Trials NH CI NH CI NH CI Whole words.76**.43.70**.33.67**.33 Phonemes.83**.51.76**.48.72**.44 s Total.79**.49.71**.50.68**.52 NONWORD DECODING Whole words Phonemes Trials NH NH CI NH CI CI Legal clusters Percent correct.78**.34.77**.35.78**.31 omissions -.55 -.66* -.51 -.59 -.55 -.40 NONWORD REPETITION No clusters.60.51.55.45.51.39 Legal clusters.47.42.36.45.34.48 Illegal clusters.61**.58.57.56.53.56 Vowels Total.82**.46.79**.36.79**.28 No clusters.79**.54.73**.42.76**.32 Legal clusters.49.33.49.25.46.25 NONWORD REPETITION substitutions -.45.03 -.50 -.02 -.45 -.08 Vowel epenthesis -.45. -.40. -.45. additions..00..20..50 Illegal clusters Percent correct.85**.05.88** -.01.85** -.01 omissions -.67*.19 -.74**.35 -.74**.48 Illegal clusters.65*.38.60.32.58.29 Syllable number.78**.50.83**.53.84**.57 Primary stress.24.11.22.08.24.01 Note: NH = normal hearing, CI = cochlear implants, * = p <.05, ** = p <.01 substitutions -.18.25 -.08.14 -.09.12 Vowel epenthesis -.16 -.33 -.18 -.33 -.17 -.41 additions.54.10.59.00.56.00 Note: NH = normal hearing, CI = cochlear implants. * = p <.05, ** = p <.01. SammanfaSning Barn med CI Kvalita6vt annorlunda integrering av fonologiska färdigheter med nonordsläsning Mindre specificerade fonologiska representa6oner - >lexikalisering/gissning Bokstavskännedom än vik6gare Vad tar vi med 6ll kliniken? Fonologisk träning bör omfasa: medvetenhetsträning och produk6on av ord med olika stavelseantal och betoningsmönster konsonantkluster Bokstavsträning och fonem- grafemkoppling Tjänar som visuellt stöd för svårfångade element i talsignalen/ospecificerade fonologiska representa6oner 6
Vidare läsning Publika6oner von Mentzer, C. (2008). Pratvis- datorbaserad usalsträning. Tidskrigen Dyslexi, nr 4. Lyxell, B., Wass, M., Sahlén, Ibertsson, T., Asker- Árnason, L. Uhlén, I., Henricson, C., von Mentzer, C., Mäki- Torkko & Möller, C. (2013). Hearing and cogni6ve development in deaf and hearing impaired children: effects of interven6on. Chapter 4 in Disorders of Peripheral and Central Auditory Processing Handbook of Clinical Neurophysiology, vol. 10. G.G. Celesia (Vol Ed). Nakeva von Mentzer, C., Lyxell, B., Sahlén, B., Wass, M., Lindgren, M., Ors, M., & Uhlén, I. (2013). Computer- assisted training of phoneme- grapheme correspondence for children who are deaf and hard of hearing: Effects on phonological processing skills. Interna6onal Journal of Pediatric Otorhinolaryngology. doi: 10.1016/j.ijporl.2013.10.007 Nakeva von Mentzer, C., Lyxell, B., Sahlen, B., Dahlström, O., Lindgren, M., Ors, M., Kallioinen, P., & Uhlen, I. (2014). Computer- assisted reading interven6on with a phonics approach for children using cochlear implants or hearing aids. Scandinavian Journal of Psychology, 55(5), 448-455. doi: 10.1111/ sjop.12149 Nakeva von Mentzer, C. (2014). Rethinking sound. Computer assisted reading interven6on for deaf and hard of hearing children using cochlear implants or hearing aids. (Doctoral thesis in Disability Research), Linköping University. Linköping. doi: 10.3384/diss.diva- 108902 Nakeva von Mentzer, C., Lyxell, B., Sahlen, B., Dahlström, O., Lindgren, M., Ors, M., Kallioinen, P., & Uhlen, I. (2014). Computer- assisted reading interven6on with a phonics approach for children using cochlear implants or hearing aids Vidare läsning Nakeva von Mentzer, C., Lyxell, B., Sahlen, B., Dahlström, O., Lindgren, M., Ors, M., Kallioinen, P., & Uhlén, I. (2014). The Phonics Approach in Swedish Children using Cochlear Implants or Hearing Aids: Inspec6ng Phonological Gain. Journal of Communica6on Disorders, Deaf Studies & Hearing Aids 2(3). Nakeva von Mentzer, C., Lyxell, B., Sahlén, B., Dahlström, O., Lindgren, M., Ors, M., Kallioinen, P., & Uhlen, I. Segmental and suprasegmental proper6es in nonword repe66on An explora6ve study of the associa6ons with nonword decoding in children with normal hearing and children with bilateral cochlear implants. Clinical Linguis1cs & Phone1cs (in press) TACK 6ll... Barnen i studien!...och forskningsgruppen! Björn Lyxell, BirgiKa Sahlén, Örjan Dahlström, Magnus Lindgren, Marianne Ors, PeKer Kallioinen, Elisabet Engström & Inger Uhlén...och konferensarrangörernaj 7