Intersection of Cochlear implants and English as a L2

Written by: Dain Hong / Aural Rehabilitation / November 2019

I recently began working with a client who is a new English learner with a cochlear implant (CI)*. He was born without hearing in both ears, and received a cochlear implant in one ear at an early age. With speech therapy not being readily accessible in his home country, he navigated with little support, independently associating meaning to foreign noises he would hear from the CI. Now in Canada, he is learning English for the first time and is accessing speech therapy to refine pronunciation. 

Such an intersection of cochlear implants and English as a L2 has challenged me to revise my communication approach with this client in message composition and delivery, as well as modify my assessment and intervention approaches, all the while taking into account relevant cultural considerations.

Increasing message accessibility: Content

In communicating with the client, I ensure that my message is accessible. While communication involves not only the sending but also the receiving of the message, I find that I am often in the former role. This seems to be so as the cultural expectations with which the client is familiar keeps him from engaging actively in the learning process. The client seems to see our relationship resembling a medical hierarchy where I educate and he follows, rather than as a collaborative approach that requires active participation from both parties. Language difference is an additional barrier to his voluntary sharing of thoughts. 

While providing him direct opportunities to speak and express his ideas, I make sure that my message is easy to understand. With regards to the content, I use simple vocabulary and sentence structure. As I do with other clients, I avoid technical terms and jargon that may be overwhelming and mystifying. With the concept of the lesson itself being new, it is crucial for the words describing it to be elucidating rather than confounding. For example, in talking about the tongue placement for sounds /t d n l/, I choose to say “bump” rather than “alveolar ridge.”

Moreover, while long and complex sentences can make me seem like an expert, it doesn’t help get the message across. For this reason, I strive to use shorter sentences with clear subject, verb and object categories. I also make an effort to bring the most important information to the beginning of the sentence. Rather than using a roundabout approach, with the excuse of setting up the background, I start with what it is I want to draw attention to, and clearly provide relevant details subsequently. 

Google translate has been helpful in allowing me to translate key terms to the client’s L1. Despite the client’s nodding while I speak, I confirm that that the client has understood by using the word equivalent in his language. Though the English representation of the client’s L1 may take patience for both parties to grasp, as their pronunciation is represented using the English alphabet, using the client’s L1 confirms comprehension. 

Increasing message accessibility: Delivery

In addition to modifying the content, I refine my delivery to ensure effective delivery of my message. Improving message accessibility can be as easy as turning to face the client as I speak so that he can access visual cues from my lips. Looking at the client while I speak also provides me knowledge of how my client is interacting with my message: is he attending, or is his attention elsewhere? Did he understand me, or are his furrowed eyebrows telling me otherwise? Generally, making eye contact with the person I am directing my message to is a way of respecting them. 

Furthermore, I make sure to raise my volume while talking to the client as the specifics of his hearing are beyond of my knowledge. With awareness that only one ear is receiving sound, as the other is unaided, louder will always be more beneficial. One consideration with volume is to raise it in a friendly manner as to not come across as yelling, and I find I soften my tone by adding more intonation and complementing it with a smile. 

When I am not translating key words into the client’s L1, I emphasize them in my short phrases as to draw more attention to them. I highlight these important words in my speech by saying them louder, with greater pitch inflections and stretching the vowels in them to make them longer. 

Modification of assessment and intervention

On top of raising awareness to the content and delivery of my message, I ensure that the assessment and intervention approaches are relevant. As an articulation assessment in English would not be representative of the sounds used in the client’s L1, with accent being a confounding factor, I use sentences from the client’s L1. Accessing Youtube videos of the client’s L1 speakers saying simple 2-4 word sentences, I listen to each sentence together with the client, ask the client to repeat after them, and then record sound differences I perceive between the recording and the client’s production. Although imitation of a production may positively affect his results, as copying is not equivalent to reading, I get a sense of the client’s stimulability to sounds through repetition. 

With regards to intervention approaches, I make sure to include words in the client’s language rather than adding another layer of new information. With our target already being new (i.e. ensuring voicelessness in p; making sure the /p/ doesn’t become a /b/), it would be overwhelming for the client to acclimatize to foreign terms. Thus, keeping usage of basic English p-initial words to a minimum, I focus more on the p-initial words used in the client’s L1. 

Overall, while an intersection of a client’s hearing level with their familiarity of English may make effective therapy sessions seem out of reach, as communication experts, we return to the main intention of communication—to understand and be understood. By ensuring accessibility of my message through modifying my content and delivery, as well as making therapy relevant by frequently referencing the client’s L1, I begin to create a connection with the client, an indispensable component to treatment efficacy.    

*Client has consented to clinician sharing his experience. 

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