ACQ Vol 13 No1 2011

This study has several limitations that need to be taken into account when considering its findings. Limited information is provided about the participant. For example, his occupation is not reported. Also, readers in Australia may be unfamiliar with some of the assessments used (although a table of subtest scores over each assessment period is provided which helps the reader to interpret the results, i.e., the participant’s improvement over time). The paper also focused on an impairment level of function; it would have been useful and more comprehensive to provide some report of generalisation through assessment of participation in life roles and quality of life or well-being/distress. The details of treatment and assessment were also unclear; for example, the location of the assessment, whether “language rehabilitation” was undertaken by a speech pathologist, and who completed the assessments were not reported. Thus, some sources of bias cannot be excluded. As the paper did not report on a controlled intervention study, the contributing factors to this participant’s recovery could not be isolated. As with all single case studies, this participant’s pattern of recovery may not be representative of other individuals with similar histories and impairments. Despite these limitations, this paper has a lot to offer the speech pathology clinician. It provides us with some guidelines which we can use to discuss potential recovery patterns with clients and their families. It also suggests that some people with global aphasia may improve in different communication domains at different times, which could help us in more realistically evaluating progress and further potential to improve. The results of this study support what many of us already know through anecdotal evidence – recovery from aphasia can continue for many years. Data from this paper can be used to advocate for treatment funding for people with chronic aphasia. I think the most important information this paper provided me was that long- term longitudinal research with the dysphasic population is possible and valuable. Further single case studies as well as larger group studies will help us to understand how our intervention aids our clients with dysphasia not just during intensive treatment, but over the long term. Factors influencing auditory development in early amplified children with hearing loss Sininger, Y., Grimes, A. & Christensen, E. (2010) Auditory development in early amplified children: Factors influencing auditory-based outcomes in children with hearing loss. Ear Hear , 31 (2): 166–85. Julia Day Hearing loss early in life has shown to have a significant impact on the development of speech, language, and educational progress. Previous studies have demonstrated

that early intervention can mitigate the deleterious effects of early hearing loss on later outcomes (e.g., Moeller, 2000; Yoshinaga-Itano et al., 1998). Other studies have found a relationship between the level of hearing loss and later language outcomes, but no relationship between the age of identification of hearing loss and the development of language (e.g., Fitzpatrick et al., 2007; Wake et al., 2005). Similarly as with language, speech production was also found by these studies to have no relationship with age of intervention. The purpose of this longitudinal study was to determine the effect that the age of fitting (of amplification) had on auditory-based outcomes, including speech perception, speech production, and spoken language. Participants were 44 children identified with bilateral, congenital, sensorineural hearing loss sufficient to require amplification. Exclusionary criteria included additional disability, neonatal factors, reduced cognitive function, auditory neuropathy and late onset loss. The key predictor variables considered were the age the amplification was fitted and the degree of hearing loss. Additional variables included parent–child interaction, home language, and type and intensity of intervention. Outcome measures included speech perception tests (Paediatric Speech Intelligibility test and the Online Imitative Test of Speech Patterns Contrast Perception), a speech production test (Arizona Articulation Proficiency Scale–3) and a spoken language measure (Reynell Developmental Language Scales). Results indicated that the age of fitting amplification had a significant influence on all outcomes measured. Degree of hearing loss predicted speech production and receptive and expressive language but did not predict speech perception outcomes. Use of a cochlear implant was the only other major contributor to speech perception, speech production and language outcomes. Although this study presents some significant findings suggesting that early fitting of amplification predicts auditory- based outcomes for children with hearing impairment, the age of the children at the final testing period and their educational levels were unclear, making it difficult to interpret the longitudinal evidence presented. The authors stated some of the other limitations of the study, such as the issue of selection bias in many longitudinal studies, with families from higher SES more represented than those from lower SES. They also noted that children with hearing impairment often have additional disabilities and this study chose only to look at otherwise typically functioning children with hearing loss. They discussed the importance of studying early factors on later outcomes with all children with hearing loss. Despite these limitations, this study makes a valuable contribution to the growing body of research looking at the complex issue of the age of identification of hearing loss to later outcomes.

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ACQ Volume 13, Number 1 2011

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