Cochlear Implants on Small Kids: Is This Our Best Option?

This series is designed to help parents manage specific aspects of bringing up a child with a different learning path. The next few months we’ll be focusing on parents of deaf and hard of hearing kids. Previous articles include: diagnosis, choosing a language to communicate in (part I and part II), keeping devices on kids, sports and activities.

If you’ve recently found out your child qualifies for a cochlear implant, you’ve probably got a lot on your mind. Parents like you have to make tough decisions for their little ones. The stakes and costs can be high, so we spoke with a doctor and a parent to highlight different aspects of the decision process. Dr Lynne Lim HY from the Lynne Lim Ear Nose Throat & Hearing Centre in Singapore gave us key points from a medical standpoint, and Damien Wee shared his family’s experience with his 4-year-old daughter.

How Do Cochlear Implants Work?

The simplest way to describe cochlear implants (CI) is as a replacement part for a non-functioning ear. In terms of sound processing, there are two parts to a cochlear implant, one external and one internal. The external processor picks up sounds and transforms them into electronic signals which are transmitted to the internal electronic device connected to the cochlear nerve. Thus sound is transmitted to the brain, bypassing many ear pathologies. For a diagram and more, check out this video and article at KidsHealth.

When is the Best Time to Undergo the Operation?

Technically the operation can be done as soon as your child is able to withstand general anaesthesia. “The youngest patient I operated was 6 months old, and the oldest 83 years old,” says Dr Lynne. She sometimes admits waiting until children weigh at least 10 kilogrammes, for medical reasons. But the main time constraint is actually linked to language acquisition.

As mentioned in previous articles, a child’s brain soaks up language from 0-3 years. If children aren’t exposed to an accessible language during that time, they will find picking up any language difficult. The so-called “accessible language” doesn’t have to be speech, it can be signed. But that requires the family and extended social network being fluent enough in sign language for the child to develop diversified and structured language patterns. For a glimpse into what this could mean, read Phoebe Tay’s perspective here (as well as additional links).

Many families can’t commit to signing and want their child access to the hearing world as soon as possible. This was the case for Damien’s family. “We are not familiar with sign language so our initial focus was for our daughter to gain access to sound and be able to communicate using speech,” he says. “As she was born profoundly deaf, she would never have access to sound without the implants,” he explained. In their case, the operation was carried out when their little one was 10 months old.

My Child Isn’t Profoundly Deaf: Is this my Only Option?

This is often the trickiest case, as the operation will usually destroy any residual hearing your child may have (for exceptions, read here). If their residual hearing is good enough, methods might be better suited to developing language. This could entail using hearing aids rather than cochlear implants. To see more, you can revert to these previous articles (part I and part II).

The main difficulty is asserting what your child can really hear. In the words of Dr Lynne, “hearing beeps in a soundproof room with good headphones is much easier than listening in real life situations with competing demands for attention, background noise and poor environmental acoustics. So hearing tests can also underestimate the difficulty a patient has with hearing in the real world.”

Another concern is your child’s ability to communicate what they hear, especially when only a few months old. In Damien’s daughter’s case, they had additional hearing evaluation tests (the Auditory Brainstem Response tests) conducted at two different hospitals. “Doctors put probes into her ear,” he recalls, “and adjusted the volume and frequency of the sounds to evaluate the level of sounds her nerves registered. Both tests showed that the level of sound registered was not enough for her to develop speech with regular hearing aids, hence cochlear implants were the best chance for her to be able to hear.”

Photo credit: gfpeck on Flickr

Last but not least, some types of hearing loss can evolve over time. So it might turn out that your child’s form of hearing loss was mild enough for hearing aids in the beginning but not anymore. Staying watchful during those critical years of language acquisition will ensure you’re able to react fast and adapt.

Are there any Long Term Negatives I Should Know About?

Like all invasive operations, there are risks associated with implanting the devices. Some are related to how the body accepts the implants, to others are linked to the fact that the inner ear is affected over the following days. And parents are sometimes advised to have their child vaccinated against meningitis before the operation, as people with cochlear implants have higher risks of contracting the illness in their lifetime. “Once we had made up our minds, we didn’t think about it too much,” admits Damien. “We concentrated on researching and choosing which cochlear implants would be best.”

Another long-term negative that could affect people with CIs is potentially being unable to benefit from future drugs that might “cure” certain forms of deafness. At this stage, it’s difficult to do more than speculate, but you can read more here.

What’s the Future of CIs?

Dr Lynne says “technology is so advanced, CIs can only get better.” This means smaller, thinner implants and processors, fewer wires, better technology for filtering noise,  and longer battery lifespans. In many cases, accessories for activities like swimming. , are already available. Current innovations are even very high tech and somewhat savvy, like the ability to pick up phone calls. Future CIs may not even need an external component or might be able to deliver medication directly into the ear.

Remember these from a recent post? ListenLid also helps keep CIs dry!

Sometimes parents can be tempted to wait for newer innovations instead of opting for cochlear implants. “It’s difficult to find information on the development of these newer innovations, aside from CIs. Even within the CI industry, the three main producers of Cochlear Implants are competitors, so they aren’t always keen to publicize their development plans and results.” Damien was quite pragmatic: “ We do not know when these newer innovations will be commercially available and how reliable they will be. Cochlear implants have proved to work for many people. We needed to make a decision fast so as not to lose the important first few years of language acquisition for our child.”

What Comes Right After the Operation?

We’ve all seen videos of “wow moments” when a child hears for the first time as their implants are turned on. Each kid’s reaction is different, from wonder to fear at this new sense. We compiled a playlist to give you a glimpse.

It’s important to stress that the implants alone are not enough to fully understand sounds. Following the operation, a lot of hard work goes into training the brain to recognise different types of sound.  “Parents should be aware that all kids have different outcomes,” underlines Dr Lynne, citing other physical factors (like cognitive delay and autonomy of the cochlear nerve), medical history (early or late diagnosis) and psychological aspects, particularly motivation.

Every patient Dr Lynne works with has had their own “wow” moment. There are many highs and lows after the operation, but she’s impressed by the hard work and courage her patients display. Some, like the baby she performed her first simultaneous bilateral cochlear implant on, grow up to become top students in their schools. Meanwhile, Damien remembers how four months after the implants were turned on, his daughter was finally doing really well on the Ling Six Sound test: “I was so moved to see her developing her hearing capabilities.”

Other Takeaways

Damien advises getting more than one medical opinion and also speaking with parents whose children have undergone cochlear implant operations. “Getting another professional evaluation helps verify the hearing test results and makes you more confident with your decision. In addition, talking with parents whose children have cochlear implants will give you a better understanding of the social, emotional aspects of the operation or other hearing options,” he says.

Remember, some of the world’s greatest athletes, like Duck-hee Lee, are born deaf.

At the end of the day, you’re going to be teaching your child to reach their full potential and be confident, so you need to be convinced you are making the best choice possible. His little one now speaks three languages she learned living in a multicultural setting, and thanks to the hard work they have all put in, she’s now thriving in a mainstream kindergarten).

For comments or questions, get in touch!

Disclaimer: these blog posts are intended as exploratory articles for parents of recently diagnosed children. They do not constitute medical advice and cannot replace a medical opinion.

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Financial assistance schemes for disability in Singapore

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Having a disability, or caring for a loved one with a disability can be challenging. Physical, mental and emotional challenges aside, having a disability or caring for a loved one with an impairment can be a real financial strain.

Thankfully, in the last decade or so, as Singapore takes significant steps toward creating a more inclusive society where persons with disabilities (PWDs) can truly become empowered and recognised, more funding has been funnelled into helping children with special needs and persons with disabilities.

If you are searching for avenues of financial assistance for PWDs, look no further as we have compiled a list of grants and subsidies you could apply for. The list has been broken down into several categories, namely:

  • Support for Early Education, Study/ Training Bursaries and Grants
  • Transport Cost Subsidies, Assistive Technology
  • Support for the Elderly
  • Saving Schemes
  • Activity Centres and Disability Homes

This list is in no way exhaustive, so if anyone reading this would like to share more information regarding grants, subsidies, or whatever financial assistance schemes that has not been covered here, please let us know in the comments section below so we could update the list to make it as comprehensive as possible.

Support for Early Education by SG Enable

Development Support Programme

The Development Support Programme (DSP) helps kids with mild developmental needs to improve and overcome their language, literacy and social skills when they are in preschool (before six) to prepare them for primary education. On top of the monthly base subsidy of $300 that all Singaporean children are entitled to, parents will also receive further subsidies based on their income per capita.

*Children who are enrolled in an Early Intervention Programme for Infants and Children (EIPIC) are not eligible for DSP.<Link here>

Early Intervention Programme for Infants & Children (EIPIC)

The Early Intervention Programme for Infants & Children (EIPIC) provides social, educational and therapy services for children below the age of 6 who are diagnosed with moderate to severe disabilities. Through this programme, the kids will be able to participate freely in activities that will help with their development growth potential and also help minimise the development of their secondary disabilities. The fees at these EIPIC centres are means-tested, so families will be entitled to subsidies according to their income per capita.

*Applicants will undergo an initial screening before admittance to the programme.

<Link here>

Integrated Childcare Programme (ICCP)

The Integrated Childcare Programme (ICCP) caters to children with mild to moderate disabilities, aged between 2 and 6 years old, by providing them with a conducive environment to learn alongside their peers in an inclusive programme offered in existing childcare centres. The programme aims to better prepare children for integration into primary education. Working mothers will be eligible for subsidies of up to $300, and non-working mothers, up to $150.

<Link here>

Study/ Training Bursaries and Grants

Caregivers Training Grant (CTG)

The Caregivers Training Grant (CTG) is a $200 annual subsidy that helps defray the cost of training caregivers who need to acquire to better care for and cope with the physical and socio-emotional needs of the person with disability whom they are caring for. The caregiver must be a person in charge of the care recipient, who in turn has to be at least 65 years of age or has a disability as assessed by a doctor.

*This grant also falls under Support of the Elderly.

<Link here>

Microsoft Unlimited Potential Professional Certification Training Grant

The Microsoft Unlimited Potential Professional Certification Training Grant enables PWDs with a PCI< $700 or less, based on means-testing, to undergo Microsoft professional training for employment opportunities in IT-related work. The grant funds 50% of the total course fee and other fees relating to the course or up to $3,000 per year, whichever is lower. Applicant is allowed one grant per every two years.

<Link here><Link here>

SPD Bursary Award

The SPD Bursary Award is offered to students with physical or sensory disability, i.e. hearing or visual impairment, from low-income families with a PCI of less than $950, studying in mainstream schools. The quantum of the grant ranges from $300 per year for primary level to $6,000 per year for university level.

Educational Level Quantum of Subsidy
University $6,000 per year
Polytechnic $2500 per year
ITE $850 per year
Pre‐U/Junior College $500 per year
Secondary $400 per year
Primary $300 per year

<Link here>

Wan Boo Sow Charity Fund

The Wan Boo Sow Charity Fund aims to provide financial assistance to needy students studying in polytechnics, PWDs, and homebound elderly. Financial assistance is provided for PWDs for their expenses on education, medical needs, therapy, transport, and purchase of assistive equipment. The percentage of subsidy is tiered based on monthly per capita household income (not more than PCI =$1300) and capped at a maximum of $5,000 per annum.

*This grant also falls under Support for the Elderly

<Link here> 

Transport Costs Subsidies

Taxi Subsidy Scheme

The Taxi Subsidy Scheme aims to defray transportation costs of PWDs by providing taxi subsidies for those of whom are only able to travel by taxi for school and work. Subsidy rates are means-tested, allowing significant subsidies based on monthly household income.

Per Capita Monthly

Household Income

Subsidy Rate
Singapore Citizen Permanent Resident
$0 to $700 50% 25%
$701 to $1,100 40% 20%
$1,101 to $1,600 30% 15%
$1,601 to $1,800 20% 10%
$1,801 to $2,600 0% 0%
$2,601 and above 0% 0%

<Link here>

VWO Transport Subsidy for Persons with Disabilities

The VWO Transport Subsidy for Persons with Disabilities provides subsidised transport options for PWDs for those of whom who regularly use dedicated transport services provided by VWOs to attend their school and care service. Like the Taxi Subsidy Scheme, the VWO Transport Subsidy is provided based on PCI.

Per Capita Monthly Household Income Subsidy Rate

 (Singapore Citizen)

Subsidy Rate

(Permanent Resident)

$0 to $700 80% 55%
$701 to $1,100 75% 55%
$1,101 to $1,600 60% 40%
$1,601 to $1,800 50% 30%
$1,801 to $2,600 30% 0%
$2,601 and above 0% 0%

<Link here>

 

 

Assistive Technology Grants

SG Enable’s Assistive Technology Fund (ATF)/ Special Assistance Fund (SAF)

The Assistive Technology Fund (ATF) provides subsidies for PWDs to acquire, replace, upgrade or repair assistive technology devices that aid in daily living. Successful applicants qualify for a means-tested subsidy of up to 90% of the cost of the required equipment, subject to a lifetime cap of $40,000.

<Link here>

For adults who are unemployed, application is made to Special Assistance Fund SAF. The per capita net monthly household income is ≤$1,300.

* Any other fund administered by NCSS, SG Enable, or Agency for Integrated Care (AIC) for the same purpose would disqualify an applicant from the SAF.

<Link here>

 

SPD’s Assistive Technology Loan Library

The Assistive Technology Loan Library (AT Loan Library) has a wide range of AT devices available for loan or for the purpose of trial use, training and temporary accommodation. Loans are extended to people with disabilities as well as professionals working with people with disabilities. Deposit and nominal renting fees apply.

<Link here>

 

Support for the Elderly

HDB’s Enhancement for Active Seniors (EASE)

The Enhancement for Active Seniors (EASE) programme, part of the Home Improvement Programme (HIP), was rolled out separately and offered to all towns in March 2013. Catered to the elderly, especially those who require assistance for one or more of the Activities of Daily Living (ADL) with  improvement items such as slip-resistant treated tiles, or grab bars, to make flats more elder-friendly and improve mobility and comfort for elderly residents. The programme is greatly subsidised, and depending on the type of flat you live in (as per table below), can cover up to 95% of the total cost.

Per Capita Monthly

Household Income

Subsidy Rate
Singapore Citizen Permanent Resident
$0 to $700 90% 65%
$701 to $1,100 65% 50%
$1,101 to $1,800 40% 30%
$ $1,801 and above 0% 0%

Figures are estimates and subject to change

<link here>

Singapore Silver Pages is a one-stop resource on Community Care information to help you make informed care choices by making it easier to find the information you need. SSP is the first portal to integrate social care, healthcare, mental health and caregiving resources under one roof for seniors, caregivers and care decision makers. The following are some schemes listed in SSP’s portal.

Pioneer Generation Disability Assistance Scheme (PioneerDAS)

The Pioneer Generation Disability Assistance Scheme (PioneerDAS) is part of the Pioneer Generation Package, which honours the contributions of Singapore’s pioneers towards  the development of the country. Under this scheme, pioneers with disabilities can receive $100 a month, which they can use for expenses.  The care recipient must be a pioneer living in Singapore and require permanent help in at least three ADL.

<link here>

Seniors’ Mobility and Enabling Fund (SMF)

The Seniors’ Mobility and Enabling Fund (SMF) provides holistic support for seniors on low income by extending three different subsidies to Singaporean seniors with different needs.

  • The SMF subsidy for Assistive Devices provides financial assistance to those requiring mobility and assistive devices for daily independent living. To qualify for the subsidy, the elderly has to be a Singaporean citizen aged 60 or older, assessed by a medical professional, and making claims for the device in its category for the first time.
  • The SMF subsidy for Transport aids seniors’ transportation cost for attending any day services at the Ministry of Health-funded Eldercare Centres, Dialysis Centres or Day Hospices. The elderly must be assessed to require a wheelchair, any form of special transport, walking aides, or assistance when travelling, and must not be already getting subsidies for the same transport service.
  • The SMF subsidy for Home Healthcare Items alleviates the costs of healthcare items by providing subsidies for products such as milk supplements, adult diapers, and wound dressing. The elderly must be receiving healthcare services at home or at the Singapore Programme for Integrated Care for the Elderly (SPICE) Centre, and must be assessed to determine the type of healthcare items required.

<link here>

 

Caregivers Training Grant (CTG)

The Caregivers Training Grant (CTG) is a $200 annual subsidy that helps defray the cost of training caregivers who need to acquire capabilities  to better care for and cope with the physical and socio-emotional needs of the person with disability whom they are caring for. The caregiver must be a person in charge of the care recipient, who in turn has to be at least 65 years of age or has a disability as assessed by a doctor.

*This grant also falls under Study/Training Bursaries and Grants.

<link here>

Wan Boo Sow Charity Fund

The Wan Boo Sow Charity Fund aims to provide financial assistance to needy students studying in polytechnics, PWDs, and homebound elderly. Financial assistance is provided for homebound frail seniors who require help with expenses ranging from personal care to meals, and even escort services. The percentage of subsidy is tiered based on monthly per capita household income (not more than PCI =$1300) and capped at maximum of $5,000 per annum.

*This grant also falls under Study/ Training Bursaries and Grants.

<Link here>

 

Savings Schemes

Special Needs Savings Scheme

The Special Needs Savings Scheme is a way for parents to set aside funds from their CPF savings by nominating their child with special needs to be entitled to their savings so the child can receive a regular stream of fixed payouts upon their demise.

<link here>

Activity Centres and Disability Homes

Residential Care Services At Children Disability Homes

The Residential Care Services At Children Disability Homes are for children under 16, diagnosed with congenital disabilities, and without caretakers. Not only do these homes provide the children with the option of staying for short or long periods of time, they also enable the children to undergo therapy and training, as well as participate in recreational activities that will help to maximise their abilities. There are four different centres providing different services, so it is important to choose one that best suits the child’s needs. The fees at these disability homes are means-tested, entitling families to subsidies according to their income per capita.

<link here>

Metta Day Activity Centre for the Intellectually Disabled

The Metta Day Activity Centre for the Intellectually Disabled caters to beneficiaries aged between 18 and 55 who are diagnosed with intellectual impairment such as Down’s Syndrome, Autism and developmental delay. Programmes at the activity centre are individually designed to help each person achieve maximum gains in his/ her abilities. Like Residential Care Services at Children Disability Homes, the Metta Day Activity Centre for the Intellectually Disabled is also means-tested for fees, providing families with substantial subsidies.

<link here>

 


We hope this list of financial assistance and/or related schemes PWDs can apply for would be useful. Once again, we recognise that the list is not exhaustive and there might have been updates since our research. We have made deliberate attempts to look for schemes spanning a wide categorical spectrum so as to hopefully provide you with help in the area you are looking for.

Stay up to date  with the Singapore disabilities community

There is a large community of people with disabilities here in Singapore, and they are not always visible to the rest of the population. So if you would like to be to be a part of a community that openly celebrates the beautiful gift and unlimited potential of persons with disabilities and stay up to date with the community, sign up for the newsletter in the link below. Together, we can connect entire communities of people to a world of colours.

Sign up for the Irisada newsletter here.

*This article is written for Irisada in hopes of providing information on financial solutions for PWDs who might need financial assistance.

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