title: Longitudinal functional performance among children with cochlear implants and disabilities: a prospective study using the Pediatric Evaluation of Disability Inventory.
abstract: OBJECTIVE
  Functional outcomes are important in children with cochlear implants (CI) and additional disabilities as studies on auditory skill and speech/language development may not identify functional benefits from implantation. This study sought to measure functional performance skills of young children with developmental disabilities post-CI.
  
  
  METHODS
  Eight children with cognitive disabilities undergoing cochlear implantation were enrolled in a prospective study of language and functional abilities; 6 with 1 year follow-up were included in the analysis. Functional performance was measured using Pediatric Evaluation of Disability Inventory (PEDI), providing standardized (mean: 50) and scaled scores (range: 0-100) of functional domains: Self-Care, Mobility and Social Function. The PEDI was administered pre-implant, 6 and 12 months post-implantation along with language testing at the same intervals.
  
  
  RESULTS
  All children had cognitive disability; 5 also had motor delay. The ages at CI ranged from 13.8 to 134 months. For functional abilities, children did not make significant changes in domain-specific standard scores over 1 year. Children made progress in scaled scores by 1-year post-implant. The largest increase for all domains occurred in the first 6 months (7-11.5 point increase). For language abilities, children made a median 5.5-month increase in receptive language age (p=0.06) and 5-month increase in expressive language age (p=0.03) in the first year post-CI with no change in language quotients. Receptive language level was significantly (p<0.05) associated with increasing scores in the domains of Self-Care and Social Function.
  
  
  CONCLUSIONS
  This is the first study to measure daily functional abilities in children with implants and disabilities using a standardized tool. Although our small group of complex children did not have an increase in standard scores (gap-closing trajectories), they made progress in skill development on scaled scores. Receptive language appears to play a key role in social functioning in this population. Functional assessments are informative for treatment planning and identifying specific areas to target intervention.
authors.affiliation: Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States.
authors.forename: Susan
authors.initials: S
authors.lastname: Wiley
authors.forename: Jareen
authors.initials: J
authors.lastname: Meinzen-Derr
authors.forename: Sandra
authors.initials: S
authors.lastname: Grether
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Choo
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Hughes
mesh_terms: D000203:Activities of Daily Living; D002648:Child; D002675:Child, Preschool; D003054:Cochlear Implants; D003072:Cognition Disorders / Q000150:complications* / Q000601:surgery; D002658:Developmental Disabilities / Q000150:complications* / Q000601:surgery; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006319:Hearing Loss, Sensorineural / Q000150:complications* / Q000601:surgery; D006801:Humans; D007223:Infant; D007804:Language Development; D007805:Language Development Disorders / Q000150:complications* / Q000601:surgery; D007807:Language Tests; D008297:Male; D011446:Prospective Studies; D011795:Surveys and Questionnaires