Predicting the Future: A Case Study in Prognostication Purpose Clinicians are regularly asked to make long-term prognoses. The aim of the current report was to present one systematic approach to doing so. A case example from a malpractice case involving a child fitted with a cochlear implant was presented. Implantation occurred at age 17 months (activation 1 month ... Clinical Focus
Newly Published
Clinical Focus  |   September 19, 2017
Predicting the Future: A Case Study in Prognostication
 
Author Affiliations & Notes
  • Peter Flipsen, Jr.
    Pacific University, Forest Grove, OR
  • Disclosure: Peter Flipsen Jr. was a paid consultant for the case being reported. See “A Real-World Example” section for more detail.
    Disclosure: Peter Flipsen Jr. was a paid consultant for the case being reported. See “A Real-World Example” section for more detail.×
  • Correspondence to Peter Flipsen Jr.: flipsen@pacificu.edu
  • Editor-in-Chief: Krista Wilkinson
    Editor-in-Chief: Krista Wilkinson×
  • Editor: Dawna Lewis
    Editor: Dawna Lewis×
Article Information
Development / Speech, Voice & Prosodic Disorders / Hearing Disorders / Hearing Aids, Cochlear Implants & Assistive Technology / Cultural & Linguistic Diversity / Professional Issues & Training / Speech, Voice & Prosody / Newly Published / Clinical Focus
Clinical Focus   |   September 19, 2017
Predicting the Future: A Case Study in Prognostication
American Journal of Speech-Language Pathology, Newly Published. doi:10.1044/2017_AJSLP-17-0022
History: Received February 14, 2017 , Revised May 11, 2017 , Accepted May 30, 2017
 
American Journal of Speech-Language Pathology, Newly Published. doi:10.1044/2017_AJSLP-17-0022
History: Received February 14, 2017; Revised May 11, 2017; Accepted May 30, 2017

Purpose Clinicians are regularly asked to make long-term prognoses. The aim of the current report was to present one systematic approach to doing so. A case example from a malpractice case involving a child fitted with a cochlear implant was presented. Implantation occurred at age 17 months (activation 1 month later), but due to a procedural error, the implant was not functional for 19 months. The problem was ultimately rectified, but the legal case hinged largely on whether the child would be able to make up for the lost time.

Method A review of the literature on long-term outcomes in children with cochlear implants was conducted. Using 4 studies measuring outcomes 7–10 years later, outcomes were compared between children implanted at age 17–18 months and those implanted at age 36–37 months.

Results Analysis suggested no potential impact on nonverbal cognitive skills. However, analysis in the areas of speech perception, word comprehension, speech intelligibility, and reading suggested that after 7–10 years, this child would potentially continue to be approximately 1–2 years behind where she might otherwise have been.

Conclusions This case illustrated the possibility of deriving a long-term prognosis using a systematic examination of the existing outcomes literature. Such an approach is consistent with our mandate to engage in evidence-based practice.

Acknowledgments
Thanks to KG and her family for allowing the dissemination of this report and to two anonymous reviewers for their insightful comments. The report that provided the basis for the study was previously presented as a poster at the 2016 annual convention of the American Speech-Language-Hearing Association in Philadelphia, PA.
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