Negative intraoral air pressures of deaf children with cochlear implants: Physiology, phonology, and treatment

The primary purpose of this investigation was to examine deaf children's use of negative intraoral air pressures (-P_o's) from a physiological and a phonological perspective, with the hope of gathering insight into the strategies these children use to produce speech. A secondary purpose was to compare the effectiveness of two methods of treating these deviant productions. Subjects were four profoundly deaf children, age 6:6-9:2, who used cochlear implants and had demonstrated persistent use of -P_o's. P_o's were collected during production of CV syllables with initial [p] and [b] and a variety of vowel contexts. Two of the children used -P_o's more often before low than high vowels. We suggest that this vowel-based pattern may result when deaf children learn to lower their larynges in response to visible jaw lowering cues. Another child presented with a pattern of more frequent -P_o's before front than back vowels, suggesting that she may have expanded her pharynx anteriorly as she attempted to achieve an anterior tongue placement. Two children also clearly used -P_o's more frequently for voiced than voiceless stops, possibly resulting from a tendency to use the degree rather than the timing of vocal fold adduction to distinguish voiceless and voiced phonemes. Two of the children were enrolled in a single-subject multiple baseline study to compare the effectiveness of traditional articulation treatment and visual-feedback treatment. The child who was a far less proficient talker demonstrated rapid and sustained change, whereas the better talker demonstrated minimal change with treatment. This study provides evidence that (a) deaf children use speech production strategies quite unlike those of normally hearing children and (b) deviant speech behaviors of deaf children should be treated before they become part of functional phonological systems. This work highlights the need to consider the unique speech behaviors of deaf children, and their reliance on alternate feedback mechanisms, when developing assessment and treatment procedures.