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Ana Speaks

Rehabilitation is a complex process and the use of technology gives it a whole new dimension. I was witness to the fact that getting used to hearing sounds was a painful process for my child, not just in the sense that a very loud sound or signal could cause a temporary pain. When your child is experiencing this, you are particularly sensitive. One has to be cautious and careful, watch the child's needs and reactions and not leave everything to the care of the rehabilitation experts. One needs to be an active participant, not a passive observer.

Ever since the surgery, we banned the baby talk in our family, although it was hard for everyone to follow this rule. We tried to speak clearly, articulately, slowly and distinctly, with the least possible use of gestures. Above all, we tried to talk to her all the time, so that she would accumulate the sounds and melody of speech and perceive verbal communication as a necessity. If we ran out of relevant stories, we talked about anything we could think of, any time, just to let her hear our voices. In addition to this, the complex rehabilitation program was carried out, both at the institution and at home, as we designed it.

When a child reaches a certain age, and in my opinion it is the age of two to two and a half years, it becomes aware of verbal communication although it cannot hear or speak. This is the most painful period for you. You can see that the child looks at you in an open and mature way, tries to understand you when you talk, but there is no comprehension. It makes a conscious effort that does not yield the desired results. The child's maturity is way beyond its ability to communicate and the child is obviously aware of this in some way. In our case, this period was relatively short because it coincided with the surgery. Very quickly, Ana learned the meanings of some basic words that helped her grasp the essence of what we were saying. We could not completely eradicate the use of gestures that helped us achieve better comprehension. This period lasted a couple of months, approximately between the fifth and tenth month after the processor was first put on.

After two or three weeks, we noticed Ana's first reactions to the sound. When she heard that something had fallen down, she would turn around and look for it. When she heard the noise of children playing on the street, she would turn towards the window. She reacted with surprise and sometimes even with fear. The empirical learning and searching for the source of sound was a long process for her. Where does the sound come from? The speech processor and the implant in one ear do not allow the user to listen in stereo and easily recognize the source of the sound. This makes orientation in space, and not just in sonic space, difficult. We showed her where a certain sound came from by pointing and used the gesture to indicate listening. She learned this quickly and proudly showed us that she could hear a sound and determine where it came from. On Sundays, when going to the church, we reduced the force of the program, fearing the loud sound of organ and church bells, but it was really unnecessary. At the church, she basked in the sound and sonority, with an great span of sounds, from speech to choir singing to organ to bells. We never observed any negative reaction on her part. She sat still for an entire hour, watching the service with interest.

Three months after the first fitting (four months after the surgery) Ana started to respond to the sound of her name, which we could not believe and checked it again and again. The first three months were difficult; although the doctor told us everything was fine, we were not sure about the surgery's success. After all, the successful outcome is not just a matter of finding a good surgeon and proper programming of the processor, but of complex perceptive mechanisms. We feared that her reactions might be coincidental, like the reactions before the surgery, which were misleading about her condition.

After four months, she began to say her first words, but only vocals: "au(t)o" (car), "a(v)io(n)" (plane), "i(m)a" (there is), "(n)e(m)a" (there is not), "(m)a(m)a" (Mum), "(t)a(t)a" (Dad), "(b)a(k)a" (Grandma) etc. Thus mama, tata and baka sounded the same –"a-a". Those were her first words and they came in that order. Her progress was slow and it took a while (nine months) before she started to pronounce consonants properly. Her vocabulary gradually expanded. She put together simple compounds of two or three words, which were often incomprehensible. Then, after one year of speaking unrelated words, she started to put together simple phrases. After that, the progress was rapid and unlimited. In this period, she had problems with the pronunciation of certain phonemes, e.g. "k", "b", "h", "r" or "-n" "-en", "-m" at the end of the words, which we corrected and stabilized through persistent work.

At first, lip-reading was a great assistance in listening, but she rarely completely relies on that today. She lip-reads only marginally more than we (involuntarily) do. Lip-reading was the path of least resistance.

From spring to autumn 2000, we made a great breakthrough. One of the most significant aspects of progress was whispering. Ana became so good at controlling her speaking, that she started to whisper to us. She used whispering for the same communication situations we used it for, imitating us. It is interesting that no expert (except for her individual audio-rehabilitation specialist) paid any attention to this fact, although they had probably never encountered such phenomenon. However, they were quick to make superficial statements on clumsiness and balance disorders of deaf children, although Ana was very skillful and talented at sports.

In the summer, there were still a lot of incomprehensible elements in her speech, but I believe she is not far behind her hearing peers today. Maybe she is at the level of those whose speaking skills are not so developed. She absorbs words in any environment and we do not have to subject her to a toilsome drill of learning words and phrases that other deaf children have to go through. She does not pick up words by learning them, but simply by listening. It amazes us when she says a word that is no longer common in our environment and have not been used at home for years. For instance, one day she started to use the expression kuzis ("y'know") with a charmingly soft pronunciation of "z" and "s". We wondered where she had picked it up - probably at the kindergarten. After many years, we started to use this word again.

We had many surprises when riding in the car, which we had to do very often. In spring, while I was driving slowly around SUVAG searching for a place to park, she suddenly said, "Daddy, there is no place", and a minute later, when we found it, "There's a place". It was a big surprise. This was neither an answer to a question nor a request. We were particularly happy when she uttered sentences that were not previously learned or exercised, but that she put together on her own. We were also surprised when we heard her talking in her sleep. Her talk was meaningful and articulate.

Little drummer

Songs, poems and recitations that she has been learning from the first day of her rehabilitation play an important role in the development of Ana's listening and speaking skills. She first began to learn recitations that were connected with simple motions. She was a quick learner, but she initially recognized them more by their rhythm and intonation than by their meaning. She can now recite many poems and songs, with rhythm and melody, but without the real melody. Interestingly enough, she has a good ear (at least that is what I call it, although I do not know how would the experts call it). During a one-week stay in Belgium with her relatives from Slavonia who had been living abroad for a long time, she picked up their original Ikavian accent in the pronunciation of the word cetiri (four), where the emphasis is placed on the second syllable. The same thing happened with the word haljina (dress) where she adopted their pronunciation. She could not have heard this accent and pronunciation at home, even though her mother and her grandmother are from Slavonia, and she knew how to pronounce numbers with our accent long before that.

Hansel and Gretel, the old witch and the hut

We have not noticed any particular preference on her part for music on the radio or TV. She does not pay it any special attention. Only music connected to dancing attracts her interest. Nevertheless, she likes to press the keys of the piano and she is no stranger to drums either. Sometimes she plays with a tambourine, after she saw her Mum use it in the theater in Krleza's play. She did not like the way her Dad played the tambourine, but rather imitated the rhythm and motions of her mother in Kraljevo, a play by Miroslav Krleza. I cannot tell whether it was just a game or because of her sense of rhythm and "ear". In order to help Ana's progress, we tell her many stories. The greatest storyteller is her Grandmother Eva, followed by Grandmother Ruza, Mom, Aunt Zeljka and, occasionally, Dad. Since I am not very good at telling stories, it is in fact Ana who tells me stories, by constantly correcting me. Videotapes are another medium for stories. She gets so absorbed in the stories that she makes drawings of certain episodes. Hansel and Gretel, the old witch and her hut made of sweets is one of her favorite motives.

Ana has been interested in numbers for some time and now she can count to ten. She can recite the entire alphabet, knows the names of basic colors and some others, in fact, she knows so many things that it is hard to name them all. After all, she is a four-year-old.

Playing with the cell phone, Hvar 1999

The telephone has riveted Ana's attention since she was two, not just as a toy. At the age of two and a half, she imitated our gestures, facial expressions and voices and had make-believe conversations over the phone, babbling verbosely and incomprehensibly in an invented language. Gradually she started to utter some basic short phrases that we used in telephone conversations and ended with a short "Bye-bye". Sometimes it seemed like she heard the person on the other end. However, this only became true later. She also uses a GSM cell phone, although people with implants can experience some sound disturbances if a GSM phone is used within a 4-meter range.

From spring 2000, she started to use the telephone efficiently, and since the summer, she has been able to hear through the phone receiver and respond normally. Her conversations are simple. She holds the phone receiver next to the microphone so we do not use a special phone designed for the speech processor. She is not very patient with this type of communication. Her phone conversations are generally very short because she gets bored. The conversation is a little longer only when she is excited and wants to share something. The telephone is no longer a toy for her and she often refuses to talk. She has better things to do.

It is amazing how quickly you get used to the fact that your child can hear you. I am so used to it that even when she is in the bathtub and does not wear the device, I talk to her as if she could hear me. It is forgetfulness, but it feels nice.

About Gestures

Inability to communicate leads one to use gestures, mimicking and grimaces. Sometimes it looks like a caricature. Although it makes communication easier, it does not contribute to the development of speech communication. We try to use much fewer gestures than we used in the beginning, which was not a smart idea, but was necessary, easy and convenient. When I was unable to express myself, I resorted to gestures more often than my wife did. It took me some time to become disciplined and stop using gestures when communicating with Ana. However, we use particular gestures when trying to convince her to put her speech processor on. Although we stopped using gestures in everyday communication, she unfortunately resumed using them, imitating the behavior of children at SUVAG, but also of staff. It took a long time before some people grasped that our child could hear with the aid of the cochlear implant and the speech processor. This was also the path of least resistance for both children and adults.

She sometimes uses mute periods, namely periods when she does not have the processor or refuses to put it on, to reject communication altogether. She simply refuses to look at you, and if you try to get her attention, she turns her head away. As a rule, we avoid nudging as a means of attracting attention and we are forced to wait for her initiative. Naturally, there are some situations when we have to get her attention by any means.

A story from our stay in America is a good example of our disciplined gesture-control, but also of Ana's communication skills and understanding. We met a couple from Zagreb at a reception for Fullbright scholars, and had a long conversation with them. Ana skipped and ran around us, while we warned her that she might fall down the stairs. In short, this was a standard situation involving parents with a small child at a formal event. After returning to Zagreb, we met the lady we spoke with at the reception at SUVAG, where she worked as a rehabilitation specialist. We were all surprised, she in particular, because she could not have told, either from our behavior nor form Ana's, that Ana was deaf. This was despite the fact that Ana had not spoken a word, because she could not speak. We generally did not publicly reveal her handicap, we acted if she could hear everything and many of our acquaintances did not know that Ana was deaf. We did not try to hide it, but we did not advertise it either. Those who suspected it usually did not ask.

About Sign Language

Working with Ana and studying some other methods we came to the saddening conclusion that we should have taught her sign language in parallel, because it would have helped her to progress more quickly. Sign language provides a structure that can be a matrix for further development of listening and speaking skills. We could have used sign language for the purpose of formulating and structuring speech exclusively, not as a means of symbolic communication. In any case, the experts are divided into two almost irreconcilable factions favoring either the verbotonal method or sign language. Before we knew about the implant, we strongly opposed the use of sign language as a substitute for speech, fearing that our child would end up in a mute ghetto. We were over-influenced by the mutual intolerance of the two factions in Zagreb, where there was no one who would reasonably advocate "bilinguality".

The empirical data on the use of sign language with children who have cochlear implants varies. In America, parents told us to be cautious about the use of sign language, because it could make a child lazy and likely to avoid speaking. Conversely, others told us that the sign language their child had learned had helped them a lot after the surgery, because they translated statements to and from sign language, which had a major impact on the speed of progress in speech and spoken communication.

It is impossible to predict how Ana will relate to members of the hearing-impaired community who communicate with sign language. She does and, at the same time, does not belong to that community. She will have to make up her own mind. With all of the responsibilities and work ahead of her, and us, we have no stamina to teach her how to communicate with sign language as well.