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Inclusion Criteria

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Method
Search Procedures The following search procedures were used to locate the studies that met the inclusion criteria; however, applicable studies may have potentially been overlooked. Electronic searches of various databases included Cochrane Library, Academic Search Premier, Google Scholar, CINAHL, CREDO reference, LexisNexis, and ASHA. The keywords used were aural rehabilitation, cochlear implants, language development, phonological awareness, phonemic awareness, literacy, hearing loss, and deaf.
Inclusion Criteria A comprehensive search was used to locate the studies meeting the selected criteria: (a) the studies involved children using CIs (b) the studies involved children ages 2 to 16 years old, (c) the studies used children with …show more content…

Although the studies did not specifically aim at the same aspects of PA, the studies did conclude that CI usage has some effect on the development of PA skills.
Limitations
One of the main limitations of this study was that only one of the four studies was longitudinal. Tye-Murray (2015) explains that HL can have long-lasting effects and three of the included studies only occurred during a short time period. The second limitation was that the studies did not measure PA with the same assessment tools, which could jeopardize the data and overall AR when working with this population.
Future Directions The purpose of this systematic review was to determine the impacts CI usage has on the PA skills of children with HL. The research included in this study provided substantial information to answer this research question but identified the need for further research. Three of the four studies were short-term, and to indicate the long-term benefits of CI usage, more research needs to be conducted on the continuing effects that CI usage has on PA skills. Although only one study explored the impacts of age of implantation, a critical age needs to be identified for greatest benefits. Finally, all four of the studies concluded that PA skills can be developed by CWHL, but the research did not provide a definite AR therapy. Research needs to explore the most beneficial AR intervention to provide CWHL the opportunity for greatest

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