The British Deaf Association Policy on Cochlear Implants

Basic Principles
1. The British Deaf Association fully supports the rights of adults - either deaf from birth, or having become deaf - to choose to have cochlear implant surgery.
2. The BDA also supports the rights of parents (having received all relevant information beforehand) to act in the best interests of their deaf children, and will continue to regard children and adults who use cochlear implants as members of the Deaf Community.
3. The BDA does not accept the negative medical model of deafness as a pathological defect to be cured or eradicated. A successful education and quality of life is practical without being dependent on verbal language alone.

Action PointsIt is the BDAs policy to press for the following urgent measures:
i. A comprehensive, sustained investigation to be conducted by qualified independent credible teams of researchers, to provide information on the long-term effects of cochlear implants. This should compare children with and without cochlear implants, providing both with exactly the same financial and personal support.
ii. Deaf children to be taught about 'Deafness' and 'hearing' whilst at school and to be made aware of Deaf culture and the Deaf Community.
iii. The number of Deaf teachers, Deaf school governors and Deaf inspectors in Deaf education to increase and immediate discussion to take place regarding the assessment of an acceptable standard of Sign Language skills for hearing teachers as part of their training.
iv. All Sign Language used in schools with deaf children to be of a standard appropriate for a full education, in order to ensure better opportunities for those at school, and to ensure proper recognition of the language.
v. A nationally approved curriculum for Deaf cultural studies to be developed for Deaf and hearing schools, together with a nationally recognised course of study in Sign Language.
vi. A network of appropriately trained Deaf people to be established to provide information, advice and support to parents of deaf children, including information about the life experience and culture of the British
vii. Sign Language classes to be readily available for parents of Deaf children, wherever they live.The BDA recognises that cochlear implant programmes for deaf children are already widespread. The Association's policy towards these programmes is:
viii. That deaf people's views should be sought in developing the Code of Practice for cochlear implants.
ix. Appropriately trained Deaf people should contribute to the work of cochlear implant assessment teams to provide a Deaf perspective*.*Some BDA members are concerned that, by taking part in assessment teams, they are seen to support the surgery itself. This is an acutely felt dilemma., would Deaf people be accepted as equals? Would their views be respected? This issue has yet to be resolved.
x. Deaf children should be involved in discussing potential cochlear implantation where possible. They and their parents should have access to trained Deaf advocates to provide support and advice and reflect the needs of Deaf people.
xi. The BDA to consult with Deaf people with additional needs (e.g. visual impairment) and their relevant organisations to ascertain their views on cochlear implants.
xii. Hearing parents of deaf children to be encouraged to participate in the BDA and in Deaf Community activities.

The consensus BDA view is that we are unable to recommend cochlear implants for children.We will work to ensure that comprehensive, objective and independent research is carried out, and that cochlear implant teams ensure that full information on Deafness, the Deaf Community, Deaf Culture and Sign Language is presented to parents in an effective way, and that parents are provided with an understanding of Deaf people's perspectives before the BDA can reconsider its position.

Deaf Culture and Community

Many parents of deaf children, through no fault of their own, view deafness negatively. They are worried for their children. How will they grow up? What kind of life can they have? Will it always be a lonely struggle if their child cannot hear? The BDA believes it is crucial that parents of deaf children are quickly made aware of the existence of a Deaf culture and community which is available to provide information and support.The CommunityThere are many thousands of people in the UK who consider themselves members of the Deaf Community, who share the common experience of being Deaf*, use a shared language (British Sign Language), and have a shared sense of identity. Some hearing people, perhaps having relatives or friends who are Deaf, also see themselves as belonging to this Community.In many ways this Community is like an ethnic minority. It does not consider itself as a medical category, something to be "cured". Indeed, to understand the issues it is more positive to accept this model rather than the medical model. A majority of Deaf people feel most at ease in communicating amongst other Deaf people. They can use their own language fluently, and without the anxiety of trying to follow verbal conversations when in fact, lipreading is mainly guesswork and experience.Sign Language has its own grammar, structure, and syntax. Deaf people can express themselves best in this language, feeling at no disadvantage and having complete confidence that their message is being understood, and that they themselves fully understand.As with other minority cultures, there are Deaf sports clubs, drama societies, arts groups, travel clubs, a broadcasting council, social clubs, religious, academic and professional societies etc. These thrive throughout the UK, and throughout the world. The Deaf World Games are held every four years, the World Federation of the Deaf Congress takes place every four years, and numerous international events are held every year. Deaf people are teachers, psychologists, nursery nurses, car mechanics, computer programmers, hairdressers, and many other things!*For the purposes of this paper we have used the convention proposed by Woodward in 1982, which uses the lower case when referring to the audiological condition of not hearing and the upper case Deaf when referring to a particular group of people who share a Sign Language and culture.The Effects of DeafnessOne major difference between Deaf culture and ethnic minority culture is that 90 per cent of deaf children are born into hearing families. Consequently, it is not surprising that parents very often aspire for their children to share their hearing culture as fully as possible. In pursuing this goal, they may decide that Sign Language and Deaf culture are inappropriate for their child, and that all their efforts should be directed to encouraging oral/aural communication.Even when deaf children acquire a reasonable level of spoken English, and are able to lip-read well it may often be at the expense of general educational, social and emotional development. There remains an inequality in the relative access which Deaf people have to hearing culture. Deaf culture allows Deaf people to feel themselves entirely integrated into their own society, rather than being disadvantaged members of a society which categorises them in a negative way - concentrating on a sensory deficiency rather than on shared positive attributes. More importantly, it also gives them the confidence and maturity to make a choice: to take part in one or both communities.By attempting to maximise deaf children's access to hearing culture, cochlear implant surgery lays an enormous burden of expectation on a child who may be too young to aid parents who don't know how to appreciate any distinction between Deaf and hearing cultures. Parents, teachers and other professionals have to devote tremendous energies and resources to give a child the maximum chance of benefiting from the surgery. In the end, the child will still be deaf, and may have little or nothing more to show from years of therapy and urgings to understand hearing culture than being able to identify that a noise is being made - all at the probable expense of the deaf child's educational and personal development in the crucial formative years.The ExperienceThe BDA has grave concerns that implantees may suffer psychological damage from their failure to live up to unrealistic expectations. This position is not taken in reaction against hearing culture; it is based on the painful first-hand experience of many Deaf people, (including those who are partially deaf) who have throughout their childhood worn hearing aids, which have contributed little or nothing to their speech and development, but which are seen as essential tools in the battle to assimilate Deaf people into a hearing world*.* This view does not hold throughout the Deaf Community: as with any democratic group, there are varying views. Some people, especially those with a degree of useful hearing, are reliant on hearing aids, even though they may gain little from them, and are happy to benefit from whatever access to the hearing world is offered. But they still choose to retain their primary identity as a Deaf person, and Sign Language as a first language.It is, therefore, with a sense of profound relief that Deaf people discover a community in which this battle has never been waged, and where they are whole human beings, measuring up to standards which apply equally to all the community's members. The longer it takes for Deaf people to find this community, the more likely they are to suffer feelings of isolation and inadequacy at their reduced status in a hearing world.The medical profession's overwhelmingly pathological view of deafness is not shared by the Deaf Community, which views itself as a linguistic minority, and takes pride in its distinct language and culture. It does, obviously, recognise that medically there is a difference between someone who can hear and someone who cannot. But this is seen in the healthier, more practical context of a social model of Deafness.However, the choice at present is between the high cost and time-consuming process of cochlear implantation, where Sign Language and access to the Deaf community may be discouraged, and the other options open to parents, including a co-operative approach between oral and Sign Language education. The BDA feels that, even when cochlear implantation takes place, it is every Deaf child's right to have access to Sign Language, and to a culture in which it can play a full role and feel at ease.

Technical Aspects ofCochlear Implants

Whilst the BDA believes strongly in the value of the potential support to be offered to parents by those adults who have a lifetime experience of being Deaf, it recognises that those who care for deaf children should have as much information as possible about the technical aspects of cochlear implants. Historical Development Instruments designed to make Deaf people hear have been around for at least 360 years. Beginning with funnels, and moving on to natural horns and metal trumpets, they became current in the 18th and l9th centuries, with owners including Beethoven and Queen Alexandra. Later, 'conversation tubes' were developed with flexible piping and a flared metal end.These primitive objects were often hailed as victories: Audigtne-Verrier Cornet claimed he could 'conquer deafness' in 1885 with a large metal bell connected to a long fluff-covered tube.In this century the electronic hearing aid has become internationally available and used, reaching its present state of development with the production of a small kidney-shaped receiver worn behind the ear, connecting to a moulded plastic ear-piece, and more recently with "in-the ear' type of hearing aid.Cochlear implant surgery was first carried out in 1957 in Paris by Dr Eyries, but the implantee discontinued using it after one year. The first American implantation was made in 1961, followed in the 1970s by more widespread programmes in France, Britain, Australia and Austria. By the end of the 1980s, at least 600 children had been implanted, despite deep concern being expressed by Deaf organisations including the World Federation of the Deaf.At first, the cochlear implant was a 'single-channel' transmitter, but by 1990 a '22-channel' transmitter had been developed, allowing greater differentiation of sounds to the user. The main group of people to have implants were adults who had become deaf after acquiring speech and language skills, and there remains a high degree of unanimity about the beneficial results of this surgery for this group.In brief, a cochlear implant is an electrode, or series of electrodes, which stimulates the auditory nerve. Sound is picked up by a microphone (usually worn above the ear), passed to a sound processor (kept in a pocket or hung around the neck), which then passes a tiny electrical current into the ear. It is this current which gives the 'sensation' of hearing.The operation on deaf children has enabled some to gain a sensation of sound, and parents have noted improvements in their speaking abilities.Cochlear Implant Teams - Implantation criteriaAll teams contacted by the BDA state that potential implantees must be checked to determine whether:

a) their cochlea has been damaged (by meningitis, for example);
b) their auditory nerve can still function;
c) they already gain some hearing from hearing aids. Current policy rules out operations on people who use hearing aids, since the surgery destroys all residual hearing;
d) a child has no significant learning difficulties and is psychologically stable;
e) have the full support of both parents and teachers.

At present, teams of surgeons, audiological physicians, paediatric audiologists, hearing, speech and language therapists, teachers and social workers for Deaf people, counsellors, psychologists, physicists and paediatricians co-ordinate to agree whether an implant for a child should go ahead.The Position of Deaf peopleSome within the BDA feel that Deaf people should also play a part in these teams, so that a Deaf point of view can be available to parents and professionals. They feet it is particularly important that parents of Deaf children are made aware of the potential side effects of implant surgery: the lack of concrete evidence (particularly in social, emotional and educational areas) of the operation's success with deaf children, and the potential hazards that may yet appear in implantees. These include septic infection, damage to the facial nerve, disorganisation of taste, tinnitus, and the possible long-term effects of stimulating the brain electronically with an alien object, quite apart from any psychological effects.Others are concerned that, by agreeing to take part in the teams, they are seen to support the surgery itself. This is an acutely felt dilemma: would Deaf people be accepted as equals? Would their views be respected? This issue has not yet been resolved.The BDA would also wish to consider further the implications of the Children Act 1989, which states that children's wishes should be taken into account on any decision which affects their wellbeing. In practice, Local Authorities and other agencies defer to the wishes of the parents until the child is of an age where the Gillick principle applies. This principle stems from the decision of a judge to over-rule the parents of a 13-year old girl, since it was felt that the girl was mature and stable enough to decide issues for herself, against her parents' wishes.In the case of most Deaf children being considered for implantation, this principle would not apply, since they are normally aged between two and five years, and the Gillick principle generally comes into consideration for teenagers. Even then, courts may not deem Deaf teenagers to be 'mature and stable enough', due to their lack of understanding of Deaf people.The question unanswered by the Children Act is whether it is legally and morally defensible to perform surgery on a child who is too young to agree to the decision, even though there is no medical need to do it, and this agreement would be compulsory at a later age. It remains open to debate whether cochlear implants are indeed in the best interests of Deaf children.The BDA will vigorously pursue its policy towards enabling parents of Deaf children to make a better-informed decision in such matters. It will continue to advocate in the strongest possible terms that Deaf people should be involved in the decision making process.The medical profession, on the whole, sees deafness as a condition to be 'corrected', despite the fact that many Deaf people themselves accept their deafness. Consequently any operation which brings the Deaf person closer to a hearing state is seen as beneficial. If cochlear implants can be moved forward in partnership with Deaf people, then they will stand a greater chance of success is the theory. There is a danger that, if the role of Deaf people is neglected, implanted children will find themselves in a limbo between the Deaf and hearing worlds, with inadequate support from either, having had expectations of their improved ability to hear and speak quite falsely raised.There are also financial considerations in the medical model. Surgical programmes will only receive funding if the demand for them is apparent, and consistent. Manufacturers of new drugs, surgical appliances and instruments are compelled to proclaim the benefits of their products in order to remain in business. This consideration already applies at cochlear implant centres in the UK: they are under instructions to carry out a certain number of operations per year in order to justify their funding, and are in competition with one another for potential implantees. This feature should not be overlooked.Another financial calculation is made by the manufacturers Cochlear (UK) Limited. If profoundly Deaf children are enabled to use speech and language - the argument goes - then the sums of money expended on the operation, the equipment and the subsequent years of therapy (currently estimated at around £25,000 per implantee) will be 'recouped'. The theory is that the Deaf person will be better able to access services, get and retain employment, and will have no need of special schools, Sign Language interpreters, video-based information, or all the other support services which are currently provided for Deaf people.The BDA believes this calculation presumes more effectiveness for cochlear implants than can realistically be expected currently. All agree that the child will remain Deaf, and (as with 'care in the community') support services may wither or disappear, but the need for them will remain; the claim that such an operation will save money long term, therefore, must be refuted.Cochlear implant surgery is still in its infancy. The technical capacities of the implant, and the consequent effects on the implantee are still unknown.The BDA strongly recommends that more research is carried out into the subject over a longer period of time before it is assumed that deaf children will benefit from cochlear implants.

Recent Investigations

Given the comparative newness of cochlear implant surgery, there is little detailed research available on the long-term effects of implants. The,BDA has, however, commissioned its own reports:
a) A Limited Investigation into Children with Cochlear Implants, by Doreen Woodford, March 1994
This report included findings from interviews with implanted children, their parents, teachers and relevant professionals.The children often appeared to enjoy their implants, and could appreciate some sounds but had not begun to understand speech through aural means alone. Some had been disappointed that the implant did not live up to expectations.Parents generally viewed deafness as a sad deprivation, and saw implants as a means to restore what is lost. Many were unaware of Deaf Culture and the Deaf Community, and felt above all that improved hearing would equal greater happiness for their child. Whilst some were familiar with the existence of a Deaf community, they continued to long for 'easy' and 'normal' conversations with their child, and lay stress on the value of hearing danger signals. (The BDA has always promoted the use of Sign Language between hearing parents and Deaf children, as the best way for both to converse easily and normally. There is also no evidence that Deaf people are more at risk from cars etc through not hearing them)Some parents had wished their children to move from signing to orally-based schools, which had not materialised, and others felt their younger children were being neglected due to the concentration of attention on the implanted child. There was a concern that the high levels of support from professionals may not be possible, if the numbers of implantees continues to increase.Some had unrealistic expectations of the implant, but the majority had been satisfied with it, and felt that communication had become easier with their child.Teachers on the whole were committed to making cochlear implants a success for their pupils, but were discovering tensions where Sign Language was the prime communication method, since they were being urged to drop Sign Language for implanted children. Some were anxious about medical decisions overwhelming educational ones. They cast doubt on progress seen in children having been attributable to implants, although many teachers felt that implants should be carried out at the youngest possible age, if at all.

The implant centres agreed that implantees would be able to perceive sound, but whether this will develop into discrimination of sounds and perception of speech depends on their own commitment, and that of their parents. Each centre felt that children should be in an environment where verbal communication is emphasised.Centres were concerned that the current level of funding from Local Authorities and private sources may not last, and that new centres may open without properly qualified staff. Another concern is that some schools are poorly equipped to assess audiological data.The manufacturer of all UK implants, Cochlear (UK) Limited, refers to a 'lifetime financial obligation' as an element of the operation.

b) An Investigation into the Position Regarding Cochlear Implants in the USA, by Ian Depledge, May 1994
This report was compiled from interviews with American Deaf and hearing people who have studied the subject of cochlear implants.It details the decision of the US Food and Drug Administration in 1990 to approve the Nucleus 22-channel implant for children from the age of two years. At that time, some 2000 children had been implanted with this device worldwide, the majority in the US. The National Association of the Deaf (NAD), the BDAs "sister" organisation in the USA, responded by calling the FDA decision 'unsound scientifically, procedurally and ethically', and argued that parents of deaf children should consult Deaf people for advice, rather than relying only on medical professionals. Crucially, the FDA had failed to consult Deaf people at all.In an interview with Dr Harlan Lane, distinguished University Professor at Northeastern University, Dr Lane said that he did not feel cochlear implants were appropriate for children who were born profoundly deaf, and his own research showed that implants do not make spoken language adequately accessible to these children. Nor do they meet the psychological, educational and linguistic needs of these children in order for them to become successful, healthy Deaf adults.Dr Lane opposes what he sees as experimentation on children, before proper research has been carried out. He questioned whether implants do genuinely improve a child's quality of life. He felt that parents may be disappointed if a cochlear implant does not deliver its promises.In his paper 'The Cochlear Implant Controversy', (1994) Dr Lane writes: "There is not a single published case, after nine years of experimentation with the multichannel implant and more than a thousand implanted children, of a single deaf child acquiring oral language with an implant."He casts doubt on the procedural methods of cochlear implant teams in the US, who pool results in order to show an average improvement across several implanted children's cases. Some of these may be children who became deaf after the development of spoken language and, therefore, are more likely to show high readings. Other tests ignore results from children who show no improvement, he believes, and others make the goals to be obtained so elementary that they are of no consequence.Nancy J Bloch, Executive Director at the National Association of the Deaf, explained her organisation's attitude in opposing implantation of children under 18 years. The organisation does not oppose continuing research, and accepts the right of adults to make a decision to have an implant themselves. The NAD's principal quarrel is with the FDA, which took its decision on cochlear implants without reference to Deaf people themselves. The NAD has research information on implanted children, showing that 55 out of 75 children (73%) surveyed in Florida had discontinued using their implant. This figure may be so high due to a lack of follow-up care and therapy.John K Niparko, an ear surgeon, said that he believes only 1 % of Deaf people would really benefit from a cochlear implant.Arthur Roehrig, who is Deaf-blind, commented that just as blind people prefer to read Braille at 300 words per minute rather than read blown up words on a computer screen at a far slower pace, most Deaf people would prefer to remain Deaf and communicate fluently using Sign Language rather than trying to hear a limited range of distorted, artificial sounds.lan Depledge's American study concluded that by focusing on the ear of a deaf child, implantation will delay the acquisition of a language and damage the possibility of a normal childhood; that implantation technology is experimental and under-researched, and its effects unknown; that it is ethically improper and morally wrong to carry out invasive surgery on children who cannot decide for themselves; and that diversity of culture is a good thing: consequently science should not be used to transfer a child from a minority group to the majority group.

Education

As a result of the BDA's investigations into the situation of cochlear implants for deaf children, it became clear that issues relating to the education of all those who are deaf needed to be examined in much more depth. Many parents had said that they were considering implants for their children because current educational provision was not all that they wished, and the area of education for deaf children was one which caused the greatest concern to BDA members.In the UK the educational provision for deaf children varies widely from area to area. There are specialist schools for children who are deaf, and others which have partially hearing units. The educational methods using different forms of communication include:

Oral teaching (no Sign Language used);
Total Communication (a combination of BSL, Signed English and speech, lipreading, reading and writing);
Bilingualism (a child learns British Sign Language, and then - once fluent - moves on to learn spoken and written English as a second language).

Much of the collected data shows an alarmingly low reading age. These worrying statistics, however, mask the true situation: that Sign Language is the first and preferred means of communicating for Deaf people, and that the average signing age of Deaf people is probably in line with their hearing peers' reading age. Due to insufficient research, there is no means of verifying this in a statistical report.The BDA is concerned to note that at present, there is no national requirement for hearing teachers of deaf children to be assessed for their Sign Language competence, that there is no nationally recognised school curriculum for Sign Language and Deaf Cultural Studies, and that there continue to be few teachers, school governors, and inspectors who are themselves Deaf. Additionally, parents who are extremely motivated to learn Sign Language may often find no classes available to them.The BDA feels it is urgent that this situation is acknowledged, and that steps are taken to provide deaf children with access to Sign Language. This applies equally to children who use cochlear implants. Even the best estimates (so far unproved) of children's appreciation of speech and language suggest that this will take several years to achieve. If, in the meantime, the child also has no Sign Language input, then their chances of developing linguistic skills in a broad sense will be radically reduced.Professionals in cochlear implant teams are already putting pressure on parents and educational establishments to move away from Sign Language, if they have previously used this with their child, or not to begin using Sign Language.The BDA feels this is misguided advice, and strongly recommends that Sign Language be encouraged in both the child's home and school life.

The BDA

Finally, the question has been asked 'Why should the BDA become involved in this debate?" To understand, it is important to look at history.The BDA was founded in 1890 in response to a concerted international attack on Sign Language. A congress of hearing educators of deaf children had met in Milan in 1880, and passed a resolution banning the use of Sign Language in education throughout the world. Later, a Royal Commission on the education of deaf (and blind) children confirmed this decision, without consulting Deaf people themselves.The philosophy behind these moves was this: that deaf children may be distracted from learning spoken language if they use Sign Language, and that deaf children should be assimilated into the hearing world at all costs. The emphasis was, as now, on the acquisition of speech rather than language.The magazine Deaf Mute took up the challenge, urging Deaf people to unite in defense of their own interests. A National Conference of Adult Deaf and Dumb Missions and Associations took place in London in 1890, where a national society was formed, aiming to 'elevate the education and status of the Deaf and Dumb in the United Kingdom'.This was the first organisation in the UK which truly represented the aims and aspirations of Deaf people, rather than the fate which hearing people decided for them. The British Deaf and Dumb Association (BDDA) consequently entered a hostile world, where the majority of educationalists opposed the core belief of the association, that Sign Language is the obvious language for Deaf people, being designed for the eye, rather than the ear.For the next 81 years, the BDDA continued as a wholly voluntary organisation, representing the interests of its members by promoting Sign Language and establishing a focus for Deaf culture in the UK. In 1971, the word 'dumb' was dropped from the title, since it had clearly negative connotations. At that time the BDA appointed its first salaried staff, and became a professionally-run charity, providing a number of services to the community and promoting its belief in the fundamental value of Sign Language more widely.The BDA has an Executive Council made up entirely of Deaf people. All policy decisions are consequently made by Deaf people, and an annual meeting of members debates the major issues confronting the Association using a democratic voting system.To carry out the members' decisions, the BDA runs departments of Sign Language Services, Advocacy, Education, Health Promotion, Information and Marketing and Youth Services. It also runs an Interpreter Agency and the London Deaf Access Project, which produces information videos in Sign Language for Deaf people.In each of these areas Deaf people's interests are of prime importance, and the BDA takes every care to ensure that it acts with the full support of its members, as a counterbalance to the narrow views of some sections of the hearing community, which seek to impose different standards onto Deaf people.
In 1980, following the BDA congress of that year, the organisation took a further step forward. It began to mobilise the support of the hearing community in realising its objectives. That is, to advance and protect the interests of Deaf people, to develop pride, identity and leadership qualities and awareness of rights and responsibilities; to strengthen the Deaf Community and thereby enable Deaf people to take their place not just within the Deaf community but as full members of the wider society.Throughout the 104 years of the BDA's existence, the debate has continued between those who oppose the use of Sign Language and those who support it. It remains a debate anchored in the opposing views of 'normalcy'. Many people still argue that for Deaf people to fulfil their role as members of a wider society it is essential for them to conform to the majority template: to use spoken language, even if they are often left at a significant disadvantage in trying to do so.It is precisely because information is denied to Deaf people from aural and written sources that the work of the BDA is so crucial, and why Sign Language communication is so highly valued by Deaf people. This situation will not change in the foreseeable future, even taking the most optimistic forecasts of cochlear implant teams into account.In recent years, many areas of society have changed to accommodate people whose physical abilities do not match this template. Wheelchair users have increasing access to public buildings and transport. Ethnic minorities receive information in their own language. The BDA's role is now to convince legislators and the general public that Deaf people have an equal right to such provision, that British Sign Language is a distinct language, and is the most effective means for Deaf people to receive information and to communicate. For linguists, this is not a debate; it is a scientifically proven fact. But the controversy still rages.The drive to 'normalise' Deaf people, by increasing the quantity of sound which can be sensed, carries with it the danger of alienating the Deaf person from their own self-identity, and their own natural community and its living language, without allowing full integration and access to hearing society. It also raises ethical problems, which have not yet been fully debated.Equally important, Sign Language is a part of a vibrant and distinct culture. The BDA knows that greater integration of Deaf and hearing people is achievable if this language and culture are recognised and accepted by the hearing world, and wishes to share its knowledge, expertise and experience to support in partnership those who care for deaf children.Implanted children will remain deaf, and are likely to remain cut off from many aural and written sources of information which hearing people take for granted, and the need for the work of the BDA will be as great if not greater - than ever.This report was based on work of the 'British Deaf Association Cochlear Implants Working Party'.Working Party Members:Austin Reeves, Ian Depledge, Liz Scott Gibson with the support of Alan Murray, Jeff McWhinney and Doreen Woodford.