Life is Bliss - Lily's Cochlear Implant Journey

Cochlear Implants before 12 months? Here's a new study showing benefits.

I have long believed that implanting kids before 12 months of age was an important and necessary approach for optimizing long-term speech outcomes.  Lily was implanted 7.8 years ago at the age of 10 months.  We would have done it earlier if the surgeon would have agreed.  

Eight years later, the age of 12 month is still used as a guideline for implantation.  

Here's a new study detailing the benefits of implanting kids before 12 months of age.  

 

 

Cochlear Implants in Noise: SNR loss in children using the BKB-SIN

Lily just finished her semi-annual visit to the audiologist.  We arrived with what turned out to be a broken headpiece, and fortunately, were able to order a new one for delivery the next day.  The headpiece had been cutting in and out for the previous few days and created a number of difficult listening situations with just one side.  

With a loaner headpiece, Lily went into the booth for tests.  

In quiet, Lily does very well.  Tonight, Lily was asking if she hears as well as a "typically" hearing person.  When we said yes, pretty much, she was quite proud.  However, noise continues to be a challenge.  Especially when the noise is variable.  

At the audiologist, Lily took an interesting test - BKB-SIN.  The BKB-SIN is a speech-in-noise test that uses BKB (Bamford-Kowal-Bench) sentences, recorded in four-talker babble. The BKB-SIN can be used to estimate SNR loss in children.   Lily's results were as follows.  Essentially, it says for Lily to get 50% accuracy, the signal has to be at least +9db above the noise floor or +11.5 db more than a normally hearing person (in a bilateral hearing situation).  

BKB-SIN Right CI only   SNR for 50% correct:   SNR loss re: normal Left CI only   SNR for 50% correct:   SNR loss re: normal Bilateral CI’s   SNR for 50% correct:   SNR loss re: normal	+14.5 dB 17 dB   +9.5 dB 12 dB   +9 dB 11.5 dB

An individual with normal hearing sensitivity would be expected to score 50% correct at a signal to noise ratio of -2.5 dB.  The SNR loss is the difference between the signal to noise ratio at which Lily scored 50% correct and -2.5 dB.

Cochlear Implant Balance Research Study

We've participated in various cochlear implant research studies over the past five years because we feel it's important to give back and help advance the field.  

Last week, Lily was in a balance study at Boystown that was trying to determine if there was a connection between cochlear implantation and balance issues.  The researchers asked Lily to walk, hop, stand on a balance board, spin around in the dark, do eye tests while shaking her head and twist her head for some kind of nerve measurement.  

We learned that Lily had great balance and eye sight.  The physical therapist said that knowing she reads really well and can ride a bike without training wheels also indicates that there are no balance issues. All in a days work!

 

Boystown Run 2013

Grateful to walk in the Boystown Run/Walk this morning to raise money for the Boystown Cochlear Implant Center.   It was cold and rainy, but Lily loved running the kids 400m, and then we all completed the Family 1-mile.  

We also saw Lily's Audiologist Jeff.  He's very patient with me.  I'm always asking a million questions about how we can help Lily hear better.   

Of course, Lily wore her waterproof Advanced Bionics Neptunes.  It was a perfect day to play/hear in the rain.   

Boystown hooks up 500th Cochlear Implant

Great story about Boystown celebrating their 500th cochlear implant, featuring our Audiologist Jeff Simmons and ENT Rodney Lusk.  Congrats!  That is a lot of hearing.   Dr Lusk himself has done more than 800 implants.  We're lucky to have such a great resource in the region.  

Boystown Run 2012

We love attending the annual Boystown Run each Memorial Day, which raises money for their Cochlear Implant program.  

All decked out in our Advanced Bionics - Bionic Ear Association T-shirts, we completed the 1-mile this year with everyone running the last stretch.  It's always important to have a big finish.

Advanced Bionics Neptune Cochlear Implants - Programming - The beeping has stopped

Lily has excellent audiologists who make mapping her Cochlear Implants a breeze.  

The only big change we made in the conversion from BWP to Neptunes was turning off the audible alarm. Lily is a very good reporter when her CIs are off or not working.  So when she mentioned that she was irritated with one of her little friends always telling her that her CIs were beeping, we felt comfortable turning off the sound. 

The beeping has been a major part of our CI experience and we recommend it highly for little ones. In the early days, I thought the beeping would drive us crazy, but it turned out that the beeping was a huge help in keeping the CIs on at all times   

 

 

Quantity of Communication Matters

We've understood that quantity of communication REALLY matters since the beginning of Lily's hearing journey.  Now one of our favorite researchers, Mary Pat Moeller, has recently given a presentation on just that topic.

According to ASHA member Sophie Ambrose and her co-presenters Mark VanDam and Mary Pat Moeller, all from Boystown in Omaha, the research shows that quantity of communication matters for hard of hearing children. Children whose parents engaged them in more conversations were likely to have stronger language skills than toddlers whose parents engaged them in fewer conversations.

Previous research has indicated that to promote parent–child conversations and to otherwise facilitate the language development of toddlers with hearing loss, parents should use speech that is child-friendly, such as short, simple sentences, and talk about things of interest to the child.

Audiologist - 9th Best Job for 2011

According to careercast.com  - Audiologist is the 9th best job for 2011.   Good work environment, low stress, low physical demand and strong hiring outlook. Average income: $63,208.00

Audiology Visit - 2.6 years post CI activation

We made our semi-annual visit to the Audiologist this week. 

Lily was tested in the sound booth first.  Left/Rt ear thresholds (quietest electric stimulation she could recognize) at 250 Hz 25dB/10dB, 500 Hz 15db/10db, 1000 Hz 15db/15db, 2000 Hz 30db/25db, 4000 Hz 15db/10db, 6000 Hz 30db/25db.   

Then they plug her in to the computer and adjust the map (software on her CIs).  Lily saw the cord and said, "Look, I have a leash."  Every electrode was tested on both sides.  Those around the 2000 Hz and 6000 Hz were adjusted up to see if we could improve Lily's thresholds in those frequencies. The rest were working well and only slightly adjusted.

They also did a Nu-Chips test which is a open-set word recognition/repetition test (R: 24/25 and L: 24/25) and a TAC Subtest 6 where she had to remember four critical elements and then match it to a picture (14/15).

Conclusion - Lily continues to do very well!

Mapping Thresholds

We've had a debate with our Audiologist since the beginning of Lily's mappings about what "thresholds" are ideal. Thresholds are the lowest level where sound is detected and where ever the map/software is set, the sound will be boosted so the person can hear it more easily. (probably didn't get this explanation quite right)

So when we read about our friend Briggs and how he is hearing at 15dbs across all decibels, we asked more questions.

Our Audiologist has always said between 20-30dBs is ideal and that too much below that level, the "useless" sounds may get in the way of speech.

However, at our last visit, our Audiologists tried a different strategy to set thresholds on Lily's maps and it improved the levels at 250Hz, 500Hz and 1000Hz from 30dB, 25dB and 15dB, to 15dB, 15dB and 10dB respectively.   The levels at 2000Hz, 4000Hz and 6000Hz remained at 25dB, 20dB and 25db.

Our Audiologst said he was very happy with the results and Lily's hearing has seemed to improve slightly.  She was listening to a vey quiet song and asked why they were singing about Souls and not Soul Sisters.

 

Babylab - 36-38 months

Diagnostic Impressions

Lily produced 200 complete and intelligible utterances in this sample, and her mean length of utterance was 4.63 morphemes. Lily's sample was compared to a data base of 30 children with normal hearing (age range 2.8 to 3.5) who were matched on a number of utterances in the sample.  When matched on this dimension, Lily's scores were one standard deviation above the mean on utterance length and complexity and number of different words used. This is an encouraging finding, supporting the impression that Lily is using complex utterances that include varied vocabulary terms.  She was comparable to the normative sample on intelligibility of spontaneous utterances; 97% were fully intelligible to the transcriber.

The table below lists the types of bound morphemes that were used spontaneously by Lily, along with error rates.  Lily is using a variety of word endings, including some that are particularly complex for her age (e.g. friendly, passer, Mister Beary).  A total of 10 morpheme omissions were observed in the sample, and the most common omission involved the contracted copula or auxiliary (she/'s  not feeling well; I think that one/'s too big).  Lily asked a variety of questions, that involved use of auxiliary/modal verb forms (e.g. Can we take off her diaper? Should we put on the clothes in here? Do you want some more dessert?  Won't we go with Mister Beary?).   Later in the session, Lily asked a "Why" question, and demonstrated that auxiliary inversion in complex questions is still emerging (e.g. Why it has claws?).  She appropriately answers Why questions starting with "because" and providing reasons.  Occasionally, she showed word order differences when using particles (e.g. She turned off it).  In general, Lily demonstrates strong grammatical development for a child of her age.  An example of one of the most complex utterances produced was:  Maybe we can go to Omaha after we go to the doctor/z with you.  This sentence was produced during a pretend sequence, and included a temporal conjunction.

Number Occ.  - Number Omit - % of Oblig. Content

• /'D - 1 - 0 - 100
• /'LL - 2 -0  - 100
• /'M - 11 - 1 - 91
• /'NT - 1 - 0 - 100
• /'S - 15 - 6 - 71
• /3S - 7 -1 - 87
• /ED - 0 - 1 - 0
• /ER - 1 - 0 - 100
• /EZ - 1 - 0 - 100
• /ING - 15 - 0 - 100
• /LY - 1 - 0 - 100
• /S - 16 - 2 - 88
• /Y - 1 - 0 - 100
• /Z - 3 - 0 - 100

Lily also demonstrated advanced development on the PLS-4.  This measure was administered across two sessions.  Lily scored well above average for her age on both subtests.  Standard scores were 138 for auditory comprehension and 142 for expressive communication (average = 100 with a standard deviation of 15).   On the receptive scale, she demonstrated emerging understanding of the concept of rhyming, and clear ability to identify words that share initial sounds.  It was encouraging to see her practice (/s/ - /s/...sun!).  She also demonstrated recognition of agrammatical sentences and an ability to modify them.  A particularly impressive aspect of her performance on the expressive scale was her responses to story retell opportunities.  For example, after listening to the Buddy Story, she started her retell with, "Once upon a time, there was a puppy named Buddy and one night..."  She appears to be developing well in terms of narrative skills.

As noted earlier, Lily has progressed well in speech production, resulting in spontaneous utterances that are easily understood most of the time.  She often fronts the back sounds [k/g], producing them as [t/d].  This phonological process is often observed in children of this age. Sometimes when Lily is formulating multi-word sentences, she produces each word with similar timing, resulting in a staccato rhythm.  Her mother reported that this is observed only occasionally at home, and appears to be when she is really thinking about what she is trying to say.

Lily's mother provides rich input to her daughter throughout their interactions.  Complex pretend episodes with sequences and role assignments are observed when they play. Use of mental state terms (e.g. pretend, think, know, remember) was seen often in both mother and child talk.  In summary, Lily is making excellent progress in all aspects of spoken language development. She scored above age expectations of the majority of measures gathered in these sessions.  It is encouraging to see the impressive changes in Lily's understanding and use of spoken language.

SLP Quarterly Summary

Our fabulous private SLP provides us with quarterly speech reports.  Here's an excerpt:

Current Goals

• Increased discrimination of words through listening alone that differ in only one feature of the initial or final consonant
• Three part auditory memory tasks
• Use of age-appropriate grammatical markers
• Monitor distance listening abilities

Progress

Lily continues to make nice gains. We've worked this quarter on Lily's ability to listen and understand recorded messages.  This is a listening challenge that Lily has enjoyed as it's involved listening and following directions to different songs and recorded stimuli. 

In addition we've worked on Lily ability to discriminate words that differ in only one feature in larger set sizes. At last date collection, Lily was able to discriminate between words differing in only one feature of the initial or final consonant in sets of 4 with 80% accuracy.

We also assessed her distance listening.  Lily was making some auditory confusion between /m/ and "oo" at distances between 3 and 15 feet, as well as a no response to /s/ at 30 feet.  Ideally she would be able to identify all Ling sounds at a distance of 45 feet.  Due in part to testing, Lily's parents took her to have her map adjusted.  At the next testing, she was consistent on all Ling sounds between 0 and 35 ft.  

Lily's expressive language continues to develop nicely. She is using her contactable "to be" verbs, past tense and irregular past tense with greater frequency and with a high level of accuracy.   We will continue this quarter focusing on her expressive/receptive language, auditory comprehension and will add a peripheral focus on her speech articulation. 

Lily is approximately 90% intelligible to a familiar listener but does demonstrate some sound substitutions that are developmentally appropriate for her age including /t/ for /k/ and /d/ for /g/.  We'll begin putting an emphasis on these sounds to give her greater exposure to hearing them as well as opportunities to practice them.

IEPs and a LIttle Reflection

We are knee deep in IEP (Individualized Education Plan)  planning, our first one since Lily turned three.  An IEP lays out what Lily's goals and objectives will be for the next year and the services that will be provided to meet those goals.  It also describes any technology the school will provide to help her meet those goals. 

Last week we received all of Lily's test scores from our public school.  To say she did super fabulous, would about capture the results. 

Are there areas that still could use our focus?  Sure.  Has she built a foundation on which to grow and thrive for the future. Yes!  Do I wish I could have seen this day when I spent months crying about Lily's future.  Yes.  Did I realize this moment would come when she was three?  No. 

Do I remember vividly our "CI expectation counseling appointment" when they asked us our goals for Lily and we said mainstreamed by kindergarten, secretly hoping that it would be much earlier. 

Then the counselor said "Well...that is the Gold Standard" and implied that it was not very likely.  Then she showed us a scale that had "All Signing" on one side and "All Auditory Learner" on the other, and implied that the chance for us to have an all auditory learner was slim.  

So to her I say meet Lily, an all Auditory Learner who is busting nearly every talking and listening curve.  As Carol Flexer says, "It's all about the brain."  Give these kids good access to sound and they should thrive.  

Don't tell parents to set your expectations low.  Did I say that loud enough.  Don't tell parents to set your expectations low.   Tell them to set their expectations high.  It's better to shoot for the moon and miss, than to shoot for the lamppost and hit it.  However,  we also need to tell parents 'this is what it is going to take (eg 30,000 words a day)" and "here are all the tools to help your kid achieve the unachievable."  

Baby Lab - 34 months

Update from the Baby lab at 34 months. 

1. We are mesmerized!  What a delightful communicator Lily is!

2.  We continue to observe increased abstraction in her ideas and language use:

    a.  "I wonder who's coming."

    b.  "No, I'm just pretending."

    c.  "I think we are all ready."

    Use of mental terms and phrases following them. 

    d.  Because logically following why.

3.  We notice that your clarification strategy is now a question (what did you say?), which gives Lily a chance to clarify her speech.

4.  More advancement in pronouns. Today we heard:  everyone, we, they, their, own, along with others we have heard before.

5.  Imagination and pretending are so sophisticated.

    a.  Pick scenes and imaging events. 

    b.  "And a rolling pin, in case we need to roll it out" (language for planning her play) Imaginary bakery.

    * Questioning about others:  "Do you like hot dogs?"

6.  Excellent growth in grammar - length, complexity, marking word endings and past tense.

7. Vocabulary sophistication and elaborated description.

    a.  "On a bright sunny day"

    b.  "Teeny tiny little babies"

    c.  "a meal"

    d.  "accessories"

8.  Time concepts - before, one o'clock, I'm gonna check what time it is. 

Baby Lab - 32 months

Recent notes from the Baby Lab at 32 months.

1. Way to go Mom. You are giving her natural opportunities to reason and it is paying off.

    a.  Lily accurately predicted that ice cream will melt in the microwave.

    b.  She predicted the need for forks and spoons to eat and then used imaginary utensils. 

    c.  Saying "I forgot" (sometimes as "I ...got" meaning forget).

2.  Pretty consistent today in contracted be verb "he's" "That's Daddy"  "Where's Mommy?"

3.  Continued refinement of speech - "upstairs" - producing complex forms.  Any errors appear developmental.

4.  Nice advancement in pronoun use - Heard you + yours in same idea - Heard he/his - Mom noted plural: us. 

5.  Use of conjoining words - and, because - Knows to use because in answers to why - may not fully reason yet, but is emerging.

6.  Performed songs and finger plays.  Whooo-hoo! What a memory.  

7.  Correcting accuracy of comments mom makes - No, it's too big!

8.  Developing number concepts. Commenting on time.  Went towards clock in lab and said "I'm checking the time."  "It's five o'clock."

9.  References to past tense/Daddy came home

10.  More impressive noun phrase elaboration: "in that chair" "his bus" "on your side"

11.  finishing mom's utterances during story telling.

12.  Using internal state terms in advance of age:

    - Remember, think, forgot/forget, know, I'm thinking!

Baby Lab - 30 months

Lily Observations in the Baby Lab. 

1.  Lily continues to expand the length of her spontaneous utterances.  Some new complexity observed.

    a.  Embedded "wh" pronoun and past irregular - "Look what I found"

    b.  Semi-auxiliary - "Lemme see; Lemme stand"

    c.  Consistency increasing for +s on plurals and tz on possessives  - "comb baby's hair"

    d.  New forms of negation - "I have no crackers."

    e.  Reflexive pronouns - "by myself"

    f.  Noun phrase elaboration - "Your big spoon"

2.  Nice verbal planning observed today! -  "I gonna heat it up"  "Lemme heat up my soup"  "Now eat my soup"

3.  Exciting to see how specific her vocabulary is and how rapidly she picks up new words (jeans, pacifiers, alphabet soup).

    a.  Strong phonological (speech) development supports word learning.

    b.  She attempts difficult words - "Alphabet soup"

4.  Mom continues to provide beautiful recasts - You are filling in the details in your models that sets the stage for additional grammar.

5.  Some complex ideas emerging in her language.  "I know..."  "Now I...(time concept)"  "What else?"

6.  Speech intelligibility is strong for her age - It may vary when attempting a mouthful of ideas.

7.  Additional colloquial ideas - "There ya go, babe"

Audiology Report - 18 months post implants

Here are the highlights from our latest audiology visit in November. 

Results from today's testing indicated speech awareness thresholds (SATs) at 25db HL for the right side and 30 dB HL for the left side. Additionally, speech recognition thresholds (SRTs) were obtained at 20 dB HL for the right ear and at 20-25 dB HL for the left ear.  In the bilateral condition, an SRT was obtained at 20dB HL.  (For the audiologists that read this blog, we're always open to suggestions on how to make this better)

Responses to narrowband noise were obtained today at 30 dB HL and at 35 dBHL with the left processor.  Lily appeared to tire of testing before a more complete audiogram could be obtained.   An audiogram done in May was consistent with these findings. 

The NU-Chips test was administered.  Right CI only - 14/15 - 93%, Left CI only - 100%, Bilateral CIs 14/15 (93%).  The two Lily missed were comb and she touched ham instead of hand.   

Modifications to the Map:  Lily's maps have been stable for quite some time. At this visit, the T and M levels were globally increased approximately 5 cu's on both sides. 

COMMENTS:    Lily continues to make exceptional progress with her cochlear implants.  She is now able to participate in closed-set speech perception tasks. On the NU-CHIPS, which is a task that required Lily to identify words with the same number of syllables, similar vowel and varying consonant, she scored 93%-100%  Lily is ready for a more difficult closed-set task at her next appointment. 

MacArthur Bates Word Inventory - 28.5 Months

For Lily’s latest scores on the MacArthur Bates Communicative Development Inventory (MBCDI), she was credited with 603 words. 

For girls at 28 months, this word score places her between the 75th and 80th percentile. These are normally hearing kids/girls - Whooo Hoo!!!   The MBCDI ends at 30 months of age – and they see ceiling effects (kids are learning lots of words that are not represented on the scale). 

While this is not a test of overall language proficiency, speech or listening, it is a very interesting measure in language/vocabulary growth. 

Very Thankful

We are so thankful this year for all the blessings we've been given.  Lily is thriving. She is talking, listening and is a very happy kid.  She says funny things, is sensitive and passionate.  She is a typical two year old, except we think she is brilliant, beautiful and hilarious.  So we are biased. 

We are thankful for all the support our family and friends (who are like our family too) have given us and all the love they give to Lily.  We are also thankful for all the professional support we've received this year.  Lily's team members have become our life long friends and we are glad to be on this journey with you.    

Happy Thanksgiving. 

Baby Lab - 28.5 months

I can't believe that Lily's had her Advanced Bionics Cochlear Implants for 18 months already.  She speaks very well and non-stop these days. 

Lily comes up with original thoughts, long compound sentences and can make up complex pretend sequences which are amazing Mary Pat in the Babylab. 

Here is our latest report.

1.  Lily built off mom's model and asked her first "why" question in the lab.

2.  Great job of supporting "thinking and feeling" words and supporting Lily's recall (remember when...)

3.  I heard her talk about "pretend" using the word for pretend.  Wow!

4.  You support her imagination in such interesting ways.  She is captivated when you pretend together.

5.  She is able to navigate this pretend world with your support, which results in a lot of talk not tied to here and now. 

6.  What interesting problem solving - sit on Mommy's lap to avoid the truck traffic.

7.  Very diverse vocabulary use - (neighbors) - with a lot of specifics.  I heard many adjectives today in her noun phrases. 

8.  Very positive to hear the speech clarity.  Her words are well formed.  Blends at the end of words - whoops and ones (nz)

9.  We are hearing additional colloquial expressions.  Whoops! yup..there ya go. 

10.  Continuing to increase utterance length. This is just magical to watch.

11.  Lily said "by himself."

12.  Think about acoustic highlighting on /h/ (in here)

 

Daddy, I Want Play Baby Lab

Last night Lily rushed into the house saying "Daddy, I want play Baby Lab." She asked me to put on her "vest" and get her babies. At the baby lab in Boys Town Lily wears a vest that has microphones built into it so that Mary Pat and gang can hear and record her utterances during the lab. We found a vest and went to our play room. She then told me I was "pretend Mary Pat" and we had a grand time playing games and practicing saying words. Who knew speech therapy could be so fun ;-) 

Baby Lab - 27 months old

Here are the results of the latest Baby lab study.  Lily got some rave reviews!  She also wore her pink tutu for our trip to Omaha, so maybe that helped her chat it up.  Mary Pat said no other kid had ever shown up with a pink tutu.  We thought it would make studying Lily's tape a little more exciting for the researchers.  :)

1.  Lily was such a chatterbox today.   [Is that the highest complement or what?]

2.  Asked lots of questions - who? what that?  what do?  which one? where barb (outside here and now)? Where Goofy? What do now? What wrong? Mommy?  Yes/No (Mommy you want a feed her?)

3.  Vocabulary explosion very evident in number of different words and concepts she is using.

4.  Another nice jump in speech skills.

    -  prosody (sure!)(counting rhythm)

    - well formed words - the average for 2 year olds is 50% intelligible; we understood >90% of multi-word utterances.

    - producing blends in lots of words.

    - nice use of ending sounds in words (can be a challenge at this age)

    - beautiful repertoire of consonants

5.  Exploding grammar

    - plurals marked

    - + ing on verbs

    - verb phrases (I'm making sausage)(want get)

    - all multi words utterances

    - tons of multi-word utterances

    - joining words "and"

    - S+V+O

    - Two verbs in lots of her verb phrases

    - Expanding pronouns (her, us, me, he, that, it)

6)  She's strategically copying Mom for new ideas (it seems)

7)  Discourse is getting colloquial "Sure" Whoops! others

8)  Mom - outstanding interactions - Airplane pretend sequence is a classic!

426 Words +++

We've just finished filling out the MacArthur-Bates word inventory and identified 426 words that Lily knows and says.  Then of course there are hundreds of words she says that aren't on this list.  It was only a few months ago that this new word inventory seemed overwhelming.  Now it is easy to see the words she doesn't know on this list, because they are getting fewer and fewer. 

Of course learning language is never ending.  Found a word in a WSJ caption last week that I couldn't even pronounce, let alone understand.  Not sure where a kid with normal hearing would be on the word inventory list, but we're pretty excited for Lily on soaking up all this vocabulary. 

It's hard to know the words Lily knows and doesn't know.  We played "what is this" for hours today because it was so rainy.  Lily kept asking for "More."  We'd run from room to room to outside to the basement to the garden and everywhere in between asking "what is this" and "what am I doing" or some version of that.   I am sure the neighbors thought we were nuts.     

Baby Lab - 25.5 Months - "Curve Buster"

Since we returned from the Moog Center, Lily's language has exploded.  She went from one and two words, to three, four and five word sentences.    The Director of the Baby Lab Study called Lily a "curve buster," meaning that Lily is doing extremely well and "busting the curve" in her research study.  We'll take it!!  Here is the report from the Baby Lab yesterday.

1.  Mom reports major explosion in utterance length and we observed the same today.
    a.  Moog School strategy of requiring imitation of Mom's expansions and that worked.

2.  Observations today:
    a.  Nice changes in clarity of speech - Majority of words understandable and most were in multi-word phrases, which is really cool.
    b.  She is breaking into grammar big time.
          1.  a + noun
          2.  Pronouns (I, her, me)
          3.  noun+verb+object (I want cake)
          4.  all/"doin" (ing in natural form)
          5.  Location terms (on bus Mommy)
          6.  Nicely formed questions:  Where shoes go?  What's dat Mommy?  Yes-No with Nice inflections!
          7.  New function words "it" "a"
          8.  Plural endings!  Toy+s, Boot+s
   c.  Major growth in Vocabulary and range of concepts expressed.
   d.  Unbelievable pretending.  Imagining raining and running away.  Putting on pretend sunglasses.  Assigning roles to mom.
   e.  Lily using desire terms (want, need)
   f.  Mom's input is so ideal; I notice how well you shape her utterances so naturally.
   g.  Natural expressions; hey, nope.
   h.  Quality of comprehension.  WOW!  "Tap" the cup, make the cup "fly" and "smell" the shoes.

Baby Lab Transcript - 24 months

Here is an interesting language sample during the Baby Lab from which the researchers are able to dissect Lily's language.   We play in a room full of toys, including a play kitchen.  You can see lots of language learning "strategies" in this discussion including repetition, reinforcement, expansion, and clarifying.   You can also see I use a lot of "wanna" and "gonna."  Is that my Midwest accent?   Note to remember:  Speak better when being recorded in the Baby Lab.

M Do you wanna get some food out?
C baby.
M Oh baby.
M Should we get some food for the baby?
+ Lily understands and goes to cabinet.
C out.
M You remember.
M you remember where the food is.
C out_out_out.
M Oh you got all the food.
M What do you see in there?
C [o].
M hmmm.
C oh_no {/a:no/}.
M Oh no!
C hmmm.
M What/'s that?
C X.
M Is that chicken?
C X {/IshIn/} {holds up cone}.
M ice_cream!
M Do/3s a baby eat ice_cream?
C yeah.
M Yeah?
C baby {heads to feed baby}.
M Here baby.
M What kind of ice_cream is that?
C X.
M Is it strawberry?
M Or is it chocolate?
C X {nice attempt at chocolate /tautau/}[pcf].
+ giggles and shows mom what she found.
M You found>
M Ope that/'s the chicken.
M It look/3s like chocolate, but it/'s chicken.
M Hey what/'s that?
C X {popcorn /paupau}[pcf].
M You/'re right, it/'s popcorn.
M oh maybe baby want/3s popcorn.
C there go {dE go} {hands to baby}.
M There you go baby.
C X {aIshIn}[pcf].
M Ice_cream.
C there.
M there.
M Okay what else for baby?
M Anything?
C wash {very clear}.
M you wanna wash?
M Okay wash the dish/s.
C hmm.
C no.
M No?
M You just gonna put it down?
C soup_soup_soup {with sh}.
M Uh_huh you are very strong.
C soup.
M soup?
M you wanna make some more soup?
M Here you can pour the little soup into the big soup.
M You are right, yep {commenting on her placement of dishes}.
M I wonder if there/'s any spoon/s?
M Hmmm.
M Here, here/'s a spoon.
M anything else?
M Oh you got them out again?
M Did you wanna put it in this side?
M Op Lily look.
C Hmm.
M What/'s that?
C egg {final consonant omitted}.
M Egg, you/'re right.
M Should we cook the egg on the stove?
M Oh you/'re gonna put it in the microwave?
M Good idea.
M That/'s where mommy make/3s her egg/s.
C mmm.
M Is it all_done?
C all_done [im].
M All_done.

Baby Lab Update - 24 Months

The update of the Baby Lab came this time as an extensive report.  It confirmed what we knew, that Lily’s expressive vocabulary is rapidly growing and that she is "very tuned in to word learning."  We are so grateful to be involved in this study.   It is also interesting that this language sample was a few weeks ago and Lily's language has already changed so much since then. 

Here is a Communication Sample Description from the report:

Lilly communicated frequently during the play session with her mother.  A language sample transcript was prepared based on 15 minutes of their interaction.  This provided 271 maternal utterances and 105 child utterances. 

1. The majority of Lily’s conversational turns consistent of words and word attempts.
2. Although most of her utterances were single words, she produced ten 2-word combinations, and one 3-word combination.  Near the end of the session, Lily produced additional 2-word combinations, such as cracker down (to report that the cracker fell down), want it (to answer do you want it?), more mommy, and Mickey Donald (to request toys).  During our last session (6 weeks ago), Lily was not yet combining words, so this is a fairly recent development.  There were several instances of chaining of words, as well.  This suggests that Lily is moving toward the two-word stage.
3. It was notable that Lily is appropriately answering a variety of questions.  Today these included:   “Who/What is that? What color is that?  Do you want…? Where does this fit? How many do you want?”  Lily’s mother remarked that her daughter is increasingly conversational, able to take turns and answer questions across several exchanges.  Lily has learned to count and name colors.  She has begun to use spatial terms (off, on, back, front). 
4. Lily uses /hmm/ for a variety of purposes.  She sometimes seems to be taking a turn, commenting or asking for information.  Today’s sample contained 24 examples of these.  She is using these less often than we observed in the session 6 weeks ago.
5. Lily produces a wide array of consonant and vowel sounds in her word approximations.  She often simplifies two syllable words to cvcv forms (like papa for popcorn or dEdo for there go).  She marks some words with final consonants (nope, out, wash).  Usually words with final consonants ended with /p, t, n or sh/.  She is producing some appropriate diphthongs in familiar words. 
6. Lily spontaneously imitates some words and simple phrases.  It was interesting to observe her imitating both the prosody and the phonetic content of some models.
7. Lily attempted blend production in flower (fwawa); she produced a fricative on the end of blocks (bash). 
8. Lily has begun to refer to herself by name, using an n/l substitution.
9. Lily demonstrates strong play skills; she engaged in sequences of feeding baby dolls and she cooperated with her mother in going on an imaginary car ride. 

Lily’s mother provides a language rich environment for her daughter.  It is a pleasure to watch the number of strategies she uses to expand Lily’s utterances, promote thinking, and encourage conversation.  Lily is clearly benefiting from the language input provided by her family.  Lily responded readily to comments and questions, showing that she is able to comprehend auditory messages with ease. 

On the communicative temptations of the CSBS, nearly all of Lily’s communicative messages were words.  She commented (that, mommy Lily, yellow, Donald, wet), requested (more, bubble, blow), answered (Do you want bubbles?…no, Mickey), and used social phrases (thank you).  It is encouraging to see the increasing concepts and ideas that Lily is able to convey as her language skills advance.  Lily is making excellent progress in response to her family and her intervention programs.

Boys Town Cochlear Implant Run

We survived the Boys Town Cochlear Implant Run.  Lily's Dad ran the five-mile race and the rest of us walked the one-mile race, very quickly.  Then it was off to face/arm painting (a first for Lily) and a visit with our audiologist Jeff who was staffing the information booth.  Jeff is a pro.  He always answers all of my questions very seriously, including those I start with, "Is it true that...? and I read on the CI Circle that..."  

A couple of pictures to summarize the day. 

Cochlear Implant Mapping At BoysTown

Lily had her mapping appointment yesterday to adjust her computer program to make sure she was getting access to all sound frequencies. The map is remaining pretty consistent between visits which is good news. We have been going fairly regularly, first a mapping every month, then every three months. Now we're not due back for six months. The best news though is that she's consistently responding to speech sounds in the sound booth at 20 decibels and tones between 20 and 30dBs. 

To test the levels they pump either a voice or a specific frequency tone into the booth and watch to see if she responds by looking in the direction of the sound. When she responds the operator activates a visual stimulus to reinforce the action. In this case a dancing Minnie Mouse or Winnie The Pooh doll. Lily quickly mastered the game and by the end was saying "Minnie" or "Pooh" when she heard the tone in addition to turning to the sound. Our trip to DisneyWorld earlier this year is paying dividends.

Here's a pic of Lily and Mom in the booth taken on the closed circuit TV that allowed Dad to watch what was happening.

Baby Lab - 22.5 months

The Baby Lab was great today.  Here is the report.

1.  CVC - Consonant Vowel Consonant in bus and pot for spot. 
2.  Using sh in syllables - we just started hearing sh last time.
3.  Noticed a lot of nice answering no, yeah, a word instead of hmmm.  Starting to build a conversation. 
4.  Ki (pig) gigi for chicken.  Starting to hear more back of the mouth sounds.
5.  Used an f in imitation of Farmer Fred (fwr- fred : fwawa - farmer.  Making correct syllable numbers. 
6.  Words and word attempts are more frequent than babble. --  This was very interesting. They said kids start by babbling and incorporating a few words.  Then they move to mostly words, incorporating a few babbles.  Who knew?
7.  While playing with the barn, Lily was attempting word combinations (not yet clear to us.  Consonants dropping out in longer strings is natural)
8.  Such nice expansions - She says hat and you give a model and immediately "stretch her taffy."   So natural and fun to watch. --  Mary Pat calls expansion  stretching or pulling the taffy. 
9.  Vocabulary continues to explode.  Yeah!!

Great Day!

Boys Town Memorial Day Run - Join Us!

Every year Boys Town National Research Hospital holds a Memorial Day Run to raise money and awareness for its Cochlear Implant Center. It's a really well run event with over 2,500 runners and walkers. There's a Children's 1-Mile Fun Run, a 1-Mile Walk/Run and the 5-Mile Walk/Run. Here's a Memorial Day Run Video from the event.

Last year, we met several friends and pushed our kids the 5 miles in their strollers. This year, I've decided to take a run at the run, while Lily and her Mom will likely gather a group to walk the race. It's a really fun time with children's activities and trophies for winners. Here's a pic from last year where Lily got to say hello to Dr. Lusk, her CI surgeon.

If you'd like to participate or donate, here's the registration link. Hope to see you there!

Baby Lab Report - 21 months

Another good baby lab report.  Lily was really tired, but amazingly enough she used more words than ever.  Here is the summary:

Wonderful talkative session.

1.  Majority of spontaneous talk was words.  The words are getting clearer (opa has two syllables now - open, more = consonant + vowel, Minnie was close, etc.).  Likes telling you what she sees and does; names ojects and actions. Uses words socially - hello, yeah/no

2.  Diversifying vocabulary (dad vs. man vs girl vs Minnie)  Maybe emerging chains (a: boom)

3.  Vocabulary is exploding - Mom counts 70+ words expressively.

4.  Starting to hear fricatives (sh) - horse (shush)

5.  Jargon sequences (foreign language sounds) are cool.

6.  Comprehension is great. She identified 24 objects + verbs today!  Wow!

The Bliss of Blogging

We attended a S.E.E.D.S (Social, Emotional, and Educational Session) workshop held at Boys Town last week. About once a quarter a workshop covering a variety of topics facing parents of children with hearing loss is held. One of the topics this time around was "The Parent Factor: Taking Care of Mom & Dad." The session was an opportunity to talk with parents and professionals about the tips and techniques we've used in getting through the tough times. 

One of the things that seems to have worked for us is this blog. There's something comforting in sharing what you're going through with others and keeping our friends and family close to this amazing little girl. We started as a way to document Lily's life to give her something when she got older as a testament to how far we've all come. We love hearing our friends reference or comment about what they've read on the blog. It makes us feel good to know that what we're writing about is interesting to others as well. Along the way we've also met people from all over the world who've read Lily's story, some seeking advice, others offering words of encouragement. All in all it's been well worth the time and effort. So keep the comments, suggestions, and feedback coming and we'll keep spreading the Bliss. 

Audiology Visit - 9 months out

Went to a mapping appointment yesterday to check Lily's CIs.  We started by going into the booth and testing each side individually.  Results were 20-35db, depending on various sounds, noise levels and speech.   The 35dbs came on Lily's  right side when we think she started ignoring the sounds.  So all in all, improved from last time about 5-10 dbs.  I always suggest turning her CIs up.  However, our Audiologist said that Lily was hearing in the optimum range (20-30dbs) and that since Lily is bilateral, it is louder when she has both of them on (bilateral summation).   The Audiologist also said that below 20dbs there is not much to hear and that the noise can actually interfere with speech perception which comes around 45dbs. I'd still like her to be hearing at 20dbs or better for all sounds.  Maybe next time. They tweaked her maps just a little in the high pitches.  We are returning in three months, then six months and then yearly or as needed.  The picture below is of Lily and her Mom in the sound booth. We again had the opportunity to have Lily's appointment online so friends and family could watch. So cool. Think of all the possibilities this creates.