February 10, 2009 Features

Pediatric Cochlear Implants

Knowledge and Skills of Speech-Language Pathologists

Although school-based speech-language pathologists are essential to the educational success of children with cochlear implants (CIs), results from the Watson and Martin (1999) and Iverson (2005) surveys show that school-based SLPs generally perceive their knowledge and skills related to CIs to be limited.

In an effort to justify state funding for the training and support of SLPs serving pediatric CI recipients in North Carolina, a 35-item questionnaire was developed based on review of these two studies to ascertain the CI knowledge and skill levels for SLPs in the state.

The new survey [PDF] included questions related to four categories:

  • Characteristics and demographics of school-based SLPs working with students with CIs SLPs' training in and knowledge of CIs
  • Provision of (re)habilitation/improvement of communication skills
  • Audiological and other support available to school-based SLPs

The survey was mailed to 629 SLPs in North Carolina from the mailing lists of the Speech Language and Hearing Area Resource Exchange, Eastern Area Health Education Center, and Department of Public Instruction. In addition, questionnaires were sent out to those attending a Project E.A.R. symposium on CIs.

Survey Respondent Demographics

For the 227 who responded, the average number of years working as an SLP was 14.2 years. The majority (61.1%) worked in the school setting. The overwhelming majority of respondents (84.1%) indicated that their highest degree earned was a master's degree. The response rate for the school setting is 61.1% (138) and the response rate for the highest degree is 84.1% (191).

Of the 217 individuals answering the question on graduate training related to evaluating or treating children with hearing loss, 80.6% had received graduate training, but 19.4% reportedly received none. More than two-thirds (145) reported the most common type of graduate training for hearing loss was through coursework.

Of the 221 participants who indicated whether or not they had graduate training related to the evaluation and treatment of children with CIs, 80.5% had none. The graduate training results from the current study are somewhat poorer relative to those reported by Iverson (63%) and Watson and Martin, who reported that "more than half" of their respondents had no coursework or in-service related to CIs. The possible increase in the number of respondents who have not had graduate training in evaluating and treating children with CIs is significant and speaks to the need for training and professional resources for professionals serving this population.

With respect to those reporting continuing education hours related to aural rehabilitation accumulated within the past five years, the majority (52.2%) stated no hours; 25.7% indicated more than three hours; 9.7% reported one hour; 7.5% responded two hours, and 4.9% indicated three hours.

When each participant was asked how many pediatric CI recipients they had evaluated or treated over the past 10 years, 45.8% indicated none. Thirty-eight percent indicated that they had evaluated or treated one to three implant recipients and 15.9% reported seeing four or more implant recipients. For 85% of the respondents, this population represented 10%–25% of their overall workload. The remaining 15% of respondents indicated that pediatric implant recipients represented 26%–50% of their workload.


Respondents were asked to rate their knowledge of CIs using a scale with the following descriptors: "no knowledge," "limited knowledge," "moderate knowledge," and "thorough knowledge." Table 1 [PDF] presents the reported knowledge base of respondents in 14 designated areas. Of greatest concern would be areas in which large numbers of respondents report limited or no knowledge. Few SLPs (approximately 17%) reported having limited or no information related to the effects of profound hearing loss on speech and language development; however, 60%–85% of SLPs reported little or no knowledge in all other areas including those related to CI candidacy, surgery basics, device components, and CI function, troubleshooting, and use.

Respondents were asked to use the same scale to rate their ability to help a child with a CI improve speech, language, speechreading, and auditory skills (see Table 1 [PDF]). Approximately 50%–75% of SLPs reported little or no knowledge related to these skill areas.

When asked about audiology support, 10% indicated no audiology support, 43.6% indicated audiology consultation support, 40.5% indicated an audiologist on staff, and 5.9% indicated consultant and on-staff audiology support. Few of the questionnaire respondents (8.9%) reported receiving assistance from Project E.A.R.


A comparison of the information from the current and previous studies reveals similar findings. Approximately one-third (31%) of the respondents to the current questionnaire reported having had a pediatric CI recipient on their caseload in the prior year--similar to Watson and Martin's finding of 31% who had one or more CI recipients on their caseload across the years, but somewhat higher than Iverson's 19%. Of those reporting pediatric CI clients in the current study, 85% indicated that the number of implant clients represented no more than 25% of their overall client caseload, a figure similar to Iverson's finding of 93% indicating that children with CIs make up less than 25% of their caseload.

One area of concern in the current study and the Watson and Martin study is the percentage of professionals (15.3% from this study, 13.9% from Watson and Martin) who reported that they had provided services to children with CIs even though they had no formal education related to implants.Excellent resources are available for SLPs serving pediatric CI clients. Others SLPs have implemented special programs such as Project E.A.R and Hearts for Hearing to meet these needs.

As reported in the current and prior two studies, a large percentage of SLPs have limited knowledge and skills related to CIs and yet are required to provide these services to children on their caseload. Given the rapid changes in CI technology and rehabilitative strategies, professionals need quick access to a variety of training resources. These training needs should be considered and addressed by professional associations, CI companies, and universities in order to provide professionals with a battery of information to build their knowledge and skills when working with the pediatric CI population. 

Co-authors: Deborah Culbertson, PhD, CCC-A, is a clinical associate professor of audiology at East Carolina University (ECU). Her clinical, teaching, and research interests are in the area of aural rehabilitation. Contact her at culbertsond@ecu.edu. Suzanne Hudson, PhD, is an associate professor in the ECU Department of Biostatistics. Contact her at hudsons@ecu.edu. Deborah Bengala, MS, CCC-SLP, is a clinical associate professor of speech-language pathology at ECU. Contact her at bengalad@ecu.edu. Rhonda Joyner, MS, CCC-A, is manager of the Department of Speech-Language Pathology and Audiology at Pitt County Memorial Hospital. Contact her at rjoyner@pcmh.com

Janel Cosby,  is a fourth-year PhD student in audiology at East Carolina University. Her research interests are aural rehabilitation, auditory training, and electrophysiology outcomes in hearing aid users and cochlear implant recipients. Contact her at jlc0208@ecu.edu.

cite as: Cosby, J. (2009, February 10). Pediatric Cochlear Implants : Knowledge and Skills of Speech-Language Pathologists. The ASHA Leader.

Selected References

Dillman, D. A. (1999). Survey Implementation. In Mail and internet surveys: The Tailored Design Method (2nd ed.), pp. 149–193. New York, NY: The John Wiley Company.

Iverson, S. (2005). A survey to identify therapists' preparedness for providing (re)habilitative therapy for cochlear implant users.Unpublished thesis, in manuscript stage.

Teagle, H. F. B., & Moore, J. A. (2002). School-based services for children with cochlear implants. Language, Speech, and Hearing Services in Schools, 33, 162–171.

Watson, M. M., & Martin, K. (1999). Providing services to children with cochlear implants in the public schools: Results of a survey of speech-language pathologists. Journal of Educational Audiology, 7, 1–7. 


Project E.A.R (Enrichment through Auditory-Oral Resources) provides training for professionals working with the pediatric CI population, including:

  • Annual CI symposium
  • Regional workshops
  • In-services to school practitioners, administrators, and classroom teachers
  • E-mail and phone consultations with professionals such as early interventionists and teachers of those with hearing impairments
  • A lending library for professionals and parents to obtain treatment materials and resource books
  • Collaboration with other North Carolina agencies to help provide additional training

For additional information, contact cochlear@ecu.edu.

Hearts for Hearing provides training and resources to practitioners working with children with hearing impairment:

  • Week-long professional immersion programs to provide strategies and techniques for collaboration between team members
  • Roundtable discussions with professionals on best practices and research in the areas of listening and speech-language outcomes for children with hearing loss.

For more information about Hearts for Hearing, contact Teresa.Caraway@heartsforhearing.org.

Web Resources

Professional Preparation in Cochlear Implants offered through the Childrens's Hospital of Philadephia Web site

Academy for Listening and Spoken Language

Advanced Bionics, the Listening Room

Cochlear Americas, or Habilitation Outreach for Educators, Parents, and Adults

Internet Exclusive Resources



Language, Speech, and Hearing Services in Schools

American Speech-Language-Hearing Association. (2004) Technical Report: Cochlear Implants. ASHA Supplement 24

American Speech-Language-Hearing Association. (2001). Scope of practice in speech-language pathology. Rockville, MD: Author. (Aural Rehabilitation Section)

Professional Organizations

ASHA Special Interest Division 7: Aural Rehabilitation and Its Instrumentation

ASHA Special Interest Division 9: Hearing and Hearing Disorders in Children

Academy of Rehabilitative Audiology

AG Bell Association for Deaf and Hard of Hearing

Educational Audiology Association

Network of Educators of Children with Cochlear Implants (NECCI)

Cochlear Implant Websites

Advanced Bionics

Cochlear Corporation


Other Cochlear Implant Resources

The Listening Center at Johns Hopkins
Cochlear implant troubleshooting guides

Acoustic simulations of sound heard through a cochlear implant

House Ear Institute

University of California-Irvine, Hearing and Speech Lab

National Institute on Deafness and Other Communication Disorders

University of Texas at Dallas, Cochlear Implant Laboratory

Cochlear Implants: Navigating a Forest of Information...One Tree at a Time
Information about cochlear implants from the Laurent Clerc National Deaf Education Center at Gallaudet University.

Free On-Line Training Modules

Audiology Online

Selected Readings

Connor, C. C., Hieber, S., Arts, H. A., & Zwolen, T. A. (2000). Speech, vocabulary, and the education of childen using cochlear implants: Oral or total communication. Journal of Speech, Language, and Hearing Research, 43, 1185–1204.

Discolo, C. M. (2002). Pediatric Cochlear Implants. American Journal of Audiology, 11, 114–118.

Ertmer, D. J. (2002). Technological Innovations and Intervention Practices for Children With Cochlear Implants. Language, Speech, And Hearing Services In Schools, Vol. 33, 218–221.

Moore, J. and Teagle, H. (2002). An Introduction to Cochlear Implant Technology, Activation and Programming. Language, Hearing and Speech Services in Schools. Vol. 33, 153–161. 


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