Using Music to Support and Enhance Speech & Language in Children with Cochlear Implants

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  • All CI children discussed were prelingually-deafened before they were implanted
  • http://www.kidshealth.org.nz/images/Speech%20sound%20development%20chart%20copy.jpgAge levels for speech sound development for normal hearing
  • Abnormal resonance: example would be hyper or hypo nasality.Prosody: such as inflection and phrasing. Prosody example: Ends of clauses in speech are marked by syllable lengthening and a drop in pitch (Saffran 2004)Children with CI perceived vowel place extremely well immediately after implantation, most perceived initial voicing at chance level until 2 to 3 years after implantation (after which scores improved by 60 to 70%). Manner: HOW is the sound producedPlace = place of articulation (e.e. t versus k) is the most difficult to identify. Bilabial, labiodental, etc.Voicing: Are the vocal cords vibrating? (f vs. v)…try with me!! Ffff vvvvvvThe hierarchy in speech pattern contrast perception and production was similar between the implanted and the normal-hearing children.LARGE INDIVIDUAL DIFFERENCES AMONG CHILDREN WITH Cis (Tyler, 1997).
  • Have website to uiowa website with listening examples of cochlear implant language development. Use Children #3 and #4.Abnormal resonance and difficulty with the use of syllable and word-level stress may continue to be a problem for children with Cis.When implantation occurs during the preschool period, the rates of speech and expressive and receptive language development accelerate to match those of normal children, although gaps may remain, since the children did not start hearing until after the first three critical years.Intelligibility, vocabulary, and syntax all benefit from implantation, although children appear to dwell at the two-word stage for a longer than normal period of time.Age at implantation seems to have a significant effect on outcome in these studies, which children implanted earlier achieving higher outcome levels.
  • (for prelingually deaf children)Components of an integrated approach to cochlear implant rehabilitation…3 equal categories. Rehabilitative strategies should seek to achieve overall communicative competence, listening, speaking, language, and pragmatics.Other factors, such as environmental support for audition, family commitment, educational emphasis, expectations, and quality of the rehabilitation program as also viewed as essential determinants of the child’s auditory performance with a cochlear implant.
  • Objective:Study factors contributing to comprehension/production of English by prelingually-deafened children after 4 to 7 years of CI useSooooo, do more things to encourage/support mainstream class placement and emphasize speech and auditory skills (….we can do this through music!)
  • The development of auditory awareness and the ability to attend to various environmental and speech soundsThe ability to imitate what is heard through the integration of speech perception and speech productionThe development of a connection between what is heard and what it representsThe integration of auditory skills as a foundation for understanding and processing new information through spoken language.
  • A hierarchy of listening skills, beginning with simple detection of sound, discrimination, identification, and comprehension of meaningful auditory information
  • Knowing all of this, why would we use music to with the CCI?Correlations between speech measures and general attitude toward music show that children who are involved and enjoy music are more likely to be those who demonstrate greater competency with aural/oral skillsWork on Better Music Perception = better speech? Better speech = better music perception?
  • IN NH CHILDRENSyntax processing in language and music has been shown to rely on overlapping neural resources
  • Who: NH 4-5 year oldsCorrelations between phonological awareness, musical perceptual skills, and nonverbal reasoning were also observed.
  • First of all, before we talk about music with Cis, we must first make sure that we are aware of the current music marketing out there for children with Cis.Showcases all of the positives, and they don’t warn them that there might be some negatives.References such as articles by Dr. Gfeller
  • Music is a habilitation method: Introducing new concepts of sound, like temporal and frequency-related characteristics, is a crucial part of the habilitation of a child with a cochlear implant.Trehub 2009: The motivation of children with implants for listening to music or melodious speech is evident well before they understand language. Within months after receiving their implant, they prefer singing to silence. They also prefer speech in the maternal style to typical adult speech (like Giovanna said, infant over adult-directed speech).
  • While music fundamentally differs from speech, music does share several similarities to spoken language. In both speech and music, sounds of varying frequency, duration, and timbre unfold over time to communicate a message, whether concrete or abstract. Both convey prosodic information (such as inflection and phrasing). Figure 1. a. the words “happy birthday” recited in a normal speaking voice; b. the same words using to the familiar melody; c. the same melody played by a solo piano.One major difference in speech and music is the distribution of spectral energy. In human speech, the spectral energy is often distributed over many frequencies and their respective harmonic partials. However in music, the spectral energy of a pitched musical note emphasizes the fundamental and its harmonic partials.
  • The perception of change in pitch direction is crucial to the comprehension of a melody. Cochlear implant recipients often have greater difficulty perceiving small pitch intervals, such as those in the lower left-hand melody, as well as difficulty perceiving changes in pitch direction, such as those in the lower right-hand melody.The ability to detect the direction and interval in changes of pitch is crucial in identifying melodic contours. Also, the implant users performed slightly worse in the lower frequency musical range. In addition, implant users’ performance was significantly lower for contours involving interval changes of one or two semitones compared to those contours with five semitone changes between notes. Implant subjects correctly identified “flat” (no pitch change) contours and least often identified “falling” (descending) contours. (Galvin and Fu)
  • Objectives: To examine the ability of congenitally deaf children to recognize music from incidental exposure and the relations among age at implantation, music listening, and word recognition.Design: Seventeen child implant users who were 4 to 8 yr of age were tested on their recognition and liking of musical excerpts from their favorite television programs. They were also assessed on open- set recognition of three-syllable words. Their parents completed a questionnaire about the children’s musical activities.Results: Children identified the musical excerpts at better than chance levels, but only when they heard the original vocal/instrumental versions. Children’s initiation of music listening at home was associated with younger ages at implantation and higher word recognition scores.Younger age at implantation increases children’s engagement with music, which may enhance their progress IN OTHER AUDITORY DOMAINS.
  • Results: Music group showed appreciable progress in discriminating the pair of notes an in different levels of speech perception tests and also demonstrated significant familiarity in both determining pitch differences and in melody appraisal. Although their open-set speech perception outcomes were not statistically different from their non-trained peers’ the effect of rhythmic and pitch training sessions was remarkable on the modified open-set speech perception scores by the 3rd month of CI use. This might be an indicator of the positive effect of auditory attention training by musical tasks at early states of implant use. Auditory training not only improves the performance in the targeted listening task, but also the improvement often generalized the auditory tasks that were not explicitly trained. The association between musical training and word recognition is also explained by the effect of focused music listening on training of auditory attention. In other words, learning that occurs in the parameters of music may transfer to other auditory contexts such as verbal memory and sensitivity to prosody.
  • Music as a motivation for language rehab? For sprasegmentals? For syntax? Mainstream/focus on speech/auditory skills are indicators/predictors of greatest success for CI language learning
  • Discuss comparison/close association of music and language systems.Listening, turn-takingInstrument game: listen to two verrrrry different instruments: Bells and Drum
  • Present auditory signal first! If a child gets information visually, there will be little motivation to listenSignal “listen” shift from looking to listeningProvide “acoustic highlighting”. Emphasize key words.Use visual clarifiers: Make a direct connection between a word and what it representsSpeak Slowly…speech is comprised of very discrete bits of acoustic information presented at a very rapid rate (but don’t speak TOO slowly)Allow processing time…Understanding speech is a complex, multi-step cognitive process)
  • Can use all of these with songs!!
  • 
Anne Wallace and Danielle Kelsay, Clinical Coodinators

Listen and Speak Up: This summer preschool program was created to promote the spoken language skills of children with hearing impairments regardless of their communication mode. It takes place at The University of Iowa's Department of Communication Sciences and Disorders. The preschool meets two mornings a week for six weeks during the summer.The structure for Listen and Speak Up includes thematically-based group sessions to promote communication skill development in natural learning situations, as well as individual sessions (two 30-minute speech/language therapy sessions each day and one 30-minute audiological diagnostic session each week) to focus attention on each individual child's needs. Music therapy provides a unique opportunity to focus on listening / music while reinforcing child's auditory to speech production and language goals. Parent conferences are held weekly.Music therapy, twice a week for thirty minutes each time
  • Using Music to Support and Enhance Speech & Language in Children with Cochlear Implants

    1. 1. Using music to enhance and support Speech and Language IN children with cochlear implants<br />Rachel Smith November 10, 2009<br />
    2. 2. Presentation Outline<br /><ul><li>Language development of NH vs. CI
    3. 3. Music perception of children with CIs vs. NH children
    4. 4. Using music to enhance and support language skills in the music classroom and/or music therapy setting</li></li></ul><li>
    5. 5. Milestones of literacy development<br />Paul 2007<br />
    6. 6. Speech development with CI<br /><ul><li>Abnormal resonance and difficulty with the use of syllable and word-level stress may continue to be a problem for CI (Bernthal 2009)
    7. 7. Many CIsfail in perceiving speech prosody and music (as it is highly dependent on capability to encode pitch information) (Petersen 2009)
    8. 8. Hierarchy of phonetic-feature production paralleled that of perception:
    9. 9. Vowels first, voicing last, and manner and place of articulation in-between (Kishon-Rabin 2002)</li></li></ul><li>Children with CI Language Skills<br />http://www.uiowa.edu/~clrc/cochlear/index.html#<br />Audio samples from University of Iowa <br />lots of variability<br />Expressive and receptive language development accelerate to match NH peers<br />Outcomes vary<br />Bernthal, 2009<br />Paul, 2007<br />
    10. 10. Domains of cochlear implant rehabilitation<br />McConkey Robbins<br />
    11. 11. Geers 2003<br />Who:<br />181 8- and 9-year olds<br />Objective:<br />Looks at factors that may influence language use with 4 to 7 years of CI use<br />Results:<br />More than ½ exhibited language skills similar to NH peers <br />Primary rehabilitative factors associated with linguistic outcome:<br />1. Amount of mainstreaming<br />2. Education emphasis on speech and auditory skills.<br />
    12. 12. Four components of therapy<br />McConkey Robbins<br />
    13. 13. Hierarchy of listening skills<br />McConkey Robbins<br />
    14. 14. Why Music?<br />Large proportion of children who use implants are involved in some type of formal or informal music activity<br />Music enjoyment can be optimized<br />Correlations between speech measures and general attitude toward music<br />Gfeller 1998<br />
    15. 15. Jentschke 2009<br />Compared neural correlates of language-and music-syntactic processing between children with and without long-term musical training<br />Results suggest: <br />The neurophysiological mechanisms underlying syntax processing in music and language are developed earlier, and more strongly, in children with musical training<br />
    16. 16. Marin 2009<br />Children with music training showed enhanced language abilities, particularly in morphologic rule formation and memory for words<br />In children, musical training has been positively associated with prosodic and pronunciation abilities, phonological awareness, reading and mathematical skills, as well as general IQ<br />
    17. 17. Be cautious of CI marketing<br /><ul><li>Be informed and be able to suggest references and people with whom the parents/children can talk to about music with their implant</li></li></ul><li>Why use music with children with CIs?<br />The psychological effects of being able to accomplish a hearing-related task can add to the self-esteem of children…<br />…which, in turn, can help prevent and reduce anxiety<br />Music is a habilitation method: Introducing new concepts of sound is a crucial part of the habilitation of a child with a CI<br />Abdi 2001<br />
    18. 18. Why Music? (continued)<br /><ul><li>Donnelly 2001</li></li></ul><li>Donnelly 2001<br />Some possible difficulties: melodic contour<br />
    19. 19. Mitani, et al. 2007<br /><ul><li>Objective: Examine the relations among age at implantation, music listening, and word recognition
    20. 20. Who: 17 CI users 4-8 years of age
    21. 21. Tested on: their recognition and liking of musical excerpts, open-set recognition of three-syllable words. Parents filled out questionnaire.
    22. 22. Results
    23. 23. Identified excerpts at better than chance levels (but only when they heard the original versions).
    24. 24. Music listening at home associated with younger ages at implantation and higher word recognition scores</li></li></ul><li>Conclusions from Mitani et al.<br />Music listening, especially focused music listening, may involve the training of auditory attention…<br />…one consequence of which is the promotion of word recognition and verbal learning<br />Learning that occurs in the context of music listening may transfer to other auditory but nonmusical contexts.<br />
    25. 25. Yucel 2009: Family-oriented musical training for children with CIs<br />9 CCI with training and 9 CCI without training (control)<br />Determine whether pitch and rhythm perception improve more rapidly through training and to assess the impact of training on speech perception<br />Method<br />Conclusion:<br />Music training program helps appreciation of music and may enhance their progress in other auditory domains after cochlear implantation in children.<br />
    26. 26. Using Music to Support Language Skills<br />Expressive and Receptive Language Skills<br />Using music for enunciation and articulation<br />E.g. “Bubbles” song<br />Music may help the child with the sequencing of sounds and words within songs, which can facilitate, stimulate, or refine speech (Zoller, 1991)<br />
    27. 27. Using music to enhance auditory skills<br />Sound/No Sound <br />When does the instrument play?<br />Sound discrimination <br />Instrument game – Different or the same?<br />
    28. 28. McConkey Robbins<br />During music activity with CCI, practice essential communication habits<br />
    29. 29. Incorporating language practice/learning within other academic areas<br /><ul><li>Use the child’s curriculum for auditory skill development (McConkey Robbins)
    30. 30. Colors, Letters, Words, Social Skills, Numbers, Reading
    31. 31. Can implement these things in music by: picking appropriate instruments, incorporating vocabulary in the songs, using music during daily routine activities (getting in line, sharing, clean-up, etc.)</li></li></ul><li>Similarities between HA & CI listeners<br /><ul><li>Same sequence of auditory learning (e.g. begin with detection)
    32. 32. Vowel perception superior to consonants
    33. 33. Wide individual differences
    34. 34. Background noise problematic</li></ul>McConkey Robbins<br />
    35. 35. References<br />Abdi, S., Khalessi, M.H., Khorsandi, M., Gholami, B. (2001). Introducing music as a means of habilitation for children with cochlear implants. International Journal of Pediatric Otorhinolaryngology. 59, 105-113. <br />Bauman-Waengler, J. (2008). Articulatory and Phonological Impairments: A Clinical Focus. Third Edition. Boston: Pearson. <br />Bernthal, J. (2009). Articulation and Phonological Disorders: Speech Sound Disorders in Children. Sixth Edition. Boston: Pearson. <br />Donnelly, P., Limb, C. (2000). Music perception in cochlear implants. In J. Niparko (Ed.), Cochlear Implants: Principles and Practices. Philadelphia: Lippincott Williams and Wilkens.<br />Geers, A., Nicholas, J., Sedey, A. (2003). Language skills of children with early cochlear implantation. Ear and Hearing. <br />Gfeller, K., Witt, S., Spencer, A, Stordahl, J., Tomblin, B. (1998). Musical involvement and enjoyment of children. Volta Review. 100(4).<br />Jentschke, S. (2009). Musical training modulates the development of syntax processing in children. NeuroImage. 47.<br />Kishon-Rabin, L. (2002). Development of speech perception and production in children with cochlear implants. Ann Otol Rhinol Laryngol. Supplement. 189.<br />Marin, M. (2009). Effects of early musical training on musical and linguistic syntactic abilities. The Neurosciences and Music III – Disorders and Plasticity: Ann. N.Y. Acad. Sci. 1169.<br />McConkey Robbins, A. (2000). Rehabilitation after cochlear implantation. In J. Niparko (Ed.), Cochlear Implants: Principles and Practices. Philadelphia: Lippincott Williams and Wilkens.<br />Mitani, C, et al. (2007). Music recognition, music listening, and word recognition by deaf children with cochlear implants. Ear and Hearing. Supplement. <br />Paul, R. (2007). Language Disorders from Infancy through Adolescence: Assessment and Intervention. Third Edition. St. Louis: Mosby Elsevier.<br />Petersen, B. (2009). Reestablishing speech understanding through musical ear training after cochlear implantation: a study of the potential cortical plasticity in the brain. Ann. N.Y. Acad. Sci. 1169.<br />Saffran, J. (2004). Musical learning and language development. Music Perception. 21(3). <br />Trehub, . (2009). Music in the lives of deaf children with cochlear implants. The Neurosciences and Music III – Disorders and Plasticity: Ann. N.Y. Acad. Sci. 1169.<br />Tyler, R., et al. (1997). Speech perception by prelingually deaf children using cochlear implants. Otolaryngology – Head and Neck Surgery. 117(3).<br />Yucel, E., Sennaroglu, G., Belgin, E. (2009). The family oriented musical training for children with cochlear implants: speech and musical perception results of two year follow-up. International Journal of Pediatric Otorhinolaryngology. 73.<br />Zoller, M. (1991). Use of music activities in speech-language therapy. Language, Speech, and Hearing Services in Schools. 22.<br />

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