Care Pathway for Rehabilitation Team (Following allocation of Cochlear Implant surgery date)

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1 Care Pathway for Rehabilitation Team (Following allocation of Cochlear Implant surgery date) Home information session (Carried out by a member of the CI team) Rehabilitationist allocated to family Cochlear Implant surgery carried out. Initial appointment with Rehabilitationist (Equipment) Discuss and demonstrate how to use processor. Make arrangements for rehab sessions and confirm contact details for local services. Initial Programming appointment with Audiologists Rehabilitation appointments 3 months of fortnightly rehab appointments (approx 6 sessions) Communication Choice Joint discussion with family regarding preferred/appropriate pathway in addition to liaison with local professionals. Auditory Verbal Therapy Auditory Oral Approach Total Communication Rehabilitation will be offered for the first two years of CI use. Formal reports will be provided at 1 year and 2 years of CI use. At Manchester Auditory Implant Programme we strive to deliver an individual needs-led service. The frequency and location of support that is offered will be agreed with each family dependent on their clinical needs and personal preferences.

2 Auditory Verbal Therapy This approach emphasises auditory skills. Children learn to listen and develop spoken language without the need to rely on Sign or lip reading. The therapist s role is to coach and guide parents in ways to encourage the development of listening skills in everyday situations. To develop spoken language, primarily through the use of listening alone, and communication skills necessary for integration into the hearing community. In terms of education, the goal is for the children to develop the skills they need to be successful in the mainstream classroom environment. Children develop language skills through the early, consistent and successful use of amplification. To develop listening, speech and spoken language following natural developmental patterns. Parent involvement is key to this approach. Families need to regularly attend sessions so the therapists can coach and guide parents in teaching their child to listen and develop spoken language through play in everyday situations. Families are also expected to incorporate on-going training into the child s daily routine and play activities, with listening integrated into everyday situations. This approach requires regular sessions with the AV therapist to give guidance and coaching to the parents in their work with the child. The therapist will also liaise with local professionals and carry out school visits where appropriate.

3 Auditory Oral Approach This approach encourages children to learn spoken language through use of both verbal and non-verbal means, including lip reading. To develop spoken language and communication skills necessary for integration into the hearing community. In terms of education, the goal is for the children to develop the skills they need to be successful in the mainstream classroom environment. Children develop language skills through the early, consistent and successful use of amplification and lip reading. Any spoken language approach requires a commitment on the part of the parents and families to work with professionals to stimulate their child s spoken language development throughout their child s day. There is a need for high-level parental involvement as learning language doesn t just happen in therapy a few times a week. Language happens all day long and the primary teacher is the parent. Families will need to participate in on-going rehabilitation appointments aimed to guide parents to provide children with optimal speech/language stimulation, at the correct level for their child. The therapist will also liaise with local professionals and carry out school/nursery visits to encourage communication skills in all environments.

4 Total Communication This approach encourages using every, and all, means to communicate. Children are exposed to a formal sign language system (often SSE), finger spelling, natural gestures, lip reading, and spoken language (and possibly other technology to aid communication). The idea is to communicate and teach in any manner that works. The child s simultaneous use of speech and sign is encouraged. To provide an easy, least restrictive communication method between the child and their family, friends, teachers and school peers. This may be the most appropriate approach if a child is struggling to develop expressive spoken language (e.g. due to oro-motor issues (weakness, cerebral palsy)). Other children may need this approach to encourage understanding of language (e.g. due to cognitive or processing difficulties). Language (spoken, sign or a combination of the two) is developed through exposure to spoken language, a formal signing system and lip reading. This approach requires commitment from family members to learn the chosen sign language system to ensure the child develops their language skills, and can communicate fully with their family. Families will need to attend some sessions at the Cochlear Implant Programme, however they will also need support from other areas, so the CI Programme therapist may not have as much direct input. Liaison with local professionals and school/nursery visits will be carried out to ensure that amplification is being used in the best possible way, and he development of listening skills is being targeted as part of the child s communication package.

5 Children with Complex / Additional Needs The package of care for children with complex needs will be tailored to the needs of the individual child and their family. There needs to be consideration of the child s other needs and the priority of each area. It may be that once a child has a cochlear implant, and is therefore accessing sound, other needs become the priority for rehabilitation. In these cases, once we are sure that the processor is set appropriately to allow the best access to sound possible it may be that the CI Programme role is more one of support to local professionals. For some of these children it may also be that travelling to the CI Programme is very difficult and this is also taken into account when deciding the most appropriate care package. If appropriate the majority of sessions will be carried out in the child s local setting. Sign Bilingual Route This is a separate route where children develop two separate languages one spoken (English) and one manual (British Sign Language) with their separate grammars and syntax. This is only possible if children have consistent access to adults who are fluent BSL users and adults who are fluent in the spoken language. Families aiming for this route may still use aspects of AVT or the auditory-oral approach above to encourage the development of the child s listening skills and spoken language Families with English as a Second Language Interpreters can be arranged, if necessary, to support families with English as a second language within their rehabilitation appointments. It is parental choice as to whether parents use English or their home language within and outside of sessions.

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