Contributions of musical approaches to the development of auditory, speech, and language skills of children and adolescents with cochlear implants: a scoping review

Said, Paula Martins; Lopes, Natália Barreto Frederigue; Razabone, Luciana Castilho; Abramides, Dagma Venturini Marques

doi:10.1590/1982-0216/20232568523

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REVIEW ARTICLES • Rev. CEFAC 25 (6) • 2023 • https://doi.org/10.1590/1982-0216/20232568523 copy

Contributions of musical approaches to the development of auditory, speech, and language skills of children and adolescents with cochlear implants: a scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

to map, through a scoping review, the contributions of musical approaches to developing auditory, speech, and language skills in children and adolescents using cochlear implants (CIs).

Methods:

a review conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews (PRISMA-ScR) and registered in PROSPERO, under the review registration number CRD42020205581. A bibliographic search was carried out in databases in 2020 and updated in August 2023. No date or language limits were applied.

Literature Review:

altogether, 1,351 studies were found through the search strategy. After the eligibility assessment based on the PCC strategy, 11 studies were selected and analyzed in full text.

Conclusion:

the studies have demonstrated that musical approaches contribute to developing auditory, speech, and language skills in children and adolescents using CIs.

Keywords:
Music; Music Therapy; Cochlear Implantation; Perception; Deafness

Databases	Descriptors e Keywords
MEDLINE/PubMed, Scopus	“Music” OR “Music Therapy” OR “Pitch Perception” OR “Music Education” OR “Music Training” OR “Musical Simulation” OR “Music Perception” OR “Music activities” OR “Musical exposure” OR “Auditory training” OR “Auditory perception” OR “Sing”	AND	“Cochlear Implantation” OR “Hearing loss” “Hearing aids” OR “Deaf”	AND	“Child” OR “Adolescent” OR “Infant” “Pre-lingual” OR “Children” OR “Pediatric”
Web of Science, CINHAL	“Music” OR “Music Therapy” OR “Auditory Perception” OR “Music Education” OR “Music Training” OR “Music Perception” OR “Music Activities”	AND	“Cochlear Implants” OR “Hearing loss” OR “Hearing aids”	AND	“Infant” OR “Pre-lingual” OR “Children” OR “Pediatric”
EMBASE	“Music” OR “Music Therapy” OR “Auditory Perception” OR “Music Training” OR “Music Perception”	AND	“Cochlear Implants” OR “Hearing loss” OR “Hearing aids”	AND	“Children” OR “Pediatric”
Science Direct	“Music” OR “Music Therapy” OR “Music Education” OR “Music Training”	AND	“Cochlear Implants”	-	“Infant” OR “Children” OR “Pediatric”
WHO-ICTRP, ClinicalTrials.gov	Music” OR “Music Therapy” OR “Music Training”	AND	“Cochlear Implants” OR “Hearing loss”
LILACS	“Music” OR “Música” OR “Musique” OR “Música”	AND	“Cochlear implants” OR “Implante coclear” OR “Implant cochléaire” OR “Implante coclear”

Authors	Sample	Intervention	Objectives	Results
Torppa et al. (2014a)²⁶26. Torppa R, Faulkner A, Huotilainen M, Järvikivi J, Lipsanen J, Laasonen M et al. The perception of prosody and associated auditory cues in early-implanted children: the role of auditory working memory and musical activities. Int J Audiol. 2014a;53(3):182-91. https://doi.org/10.3109/14992027.2013.872302 PMID: 24460045. https://doi.org/10.3109/14992027.2013.87...	42 children (4 to 13 years old), divided into 2 groups: experimental group - composed of 21 children using unilateral CI, exposed to musical activities; and control group - 21 children with normal hearing, not exposed to musical activities.	Experimental group: subdivided into 2, comprising 8 children exposed to home musical activities once or twice a week e.g., singing, playing a musical instrument, or other musical activity, such as music appreciation (listening); and 9 children exposed to music classes weekly. Musical activities were evaluated through questionnaires addressed to parents and daycare center/school staff. The 42 children were assessed twice with standardized protocols over 16 months: digit test, prosody, duration pattern discrimination, intensity, and fundamental frequency.	To investigate prosodic perception in early implanted children concerning auditory discrimination, auditory working memory, and exposure to music.	There was an improvement in the prosodic perception of participants who had music classes and musical activities at home. Children with CI who were exposed to music performed statistically equivalent to the control group, except in the digit test.
Lo et al. (2020)²⁷27. Lo CY, Looi V, Thompson WF, McMahon CM. Music training for children with sensorineural hearing loss improves speech-in-noise perception. J Speech Lang Hear Res. 2020;63(6):1990-2015. https://doi.org/10.1044/2020_JSLHR-19-00391 PMID: 32543961. https://doi.org/10.1044/2020_JSLHR-19-00...	30 children (6 to 9 years old) were divided into two groups: 16 children with typical hearing (without exposure to musical training) and 14 children with CI or bilateral hearing loss (with exposure to musical training).	Weekly music therapy group sessions and intervention through an application used at home.	To assess whether musical training promotes musical and speech development. Pseudo-randomized clinical study.	The authors concluded that musical training promotes musical and speech development.
Innes-Brown et al.(2013)²⁸28. Innes-Brown H, Marozeau JP, Storey CM, Blamey PJ. Tone, rhythm, and timbre awareness in school-age children using cochlear Implant and hearing aids. J Am Acad Audiol. 2013;24(9):789-806. https://doi.org/10.3766/jaaa.24.9.4 PMID: 24224987. https://doi.org/10.3766/jaaa.24.9.4...	20 children aged 9 to 13 years divided into two groups: experimental group - 11 children with hearing impairment (6 used unilateral CI and 5 bilateral hearing aids) and control group - 9 children with typical hearing development.	All children participated in a weekly lunchtime music club at school, consisting of 45 minutes of class for 1 year, with vocal games, integration of auditory, visual, and kinesthetic learning modes, and other musical learning approaches, such as the Kodály method. Standardized tests were used to assess pitch discrimination, rhythm, and timbre recognition administered 4 times over 1 year.	To determine a baseline for the performance of hearing-impaired children on standardized musical perception tests (rhythm, pitch, and timbre) and determine whether exposure to structured music would have an effect on musical perception.	The results highlight the importance of temporal cues for musical perception. There was no correlation between test performance and music club participation. However, teachers reported that participation improved children's confidence, social development, and engagement in music lessons generally.
Good et al. (2017)²⁹29. Good A, Gordon KA, Papsin BC, Nespoli G, Hopyan T, Peretz I et al. Benefits of music training for awareness of emotional speech prosody in deaf children with cochlear Implant. Ear Hear. 2017;38(4):455. https://doi.org/10.1097/AUD.0000000000000402 PMID: 28085739. https://doi.org/10.1097/AUD.000000000000...	18 children and adolescents using CI, aged 6 to 15 years, divided into two groups: experimental group - 9 children exposed to music classes. Control group - 9 children exposed to art classes.	9 children were exposed to musical training (piano lessons, singing, and other musical approaches): 5 with unilateral CI and 4 with bilateral CI. 9 children were exposed to art classes (painting): 4 with unilateral CI and 5 with bilateral CI. The training period was 6 months for both groups. Measures were taken before during and after training to evaluate musical perception (Montreal Battery for Evaluation of Amusia - MBEA) and emotional prosody of speech: identification of the emotional intention of a semantically neutral sentence under audio-only and audiovisual conditions.	To evaluate whether children using CI obtain similar benefits when exposed to musical training.	The results showed that musical training improved the perception of music elements and the emotional prosody of speech. The group exposed to visual artistic activities did not improve these skills.
Hidaldo et al. (2017)³⁰30. Hidalgo C, Falk S, Schön D. Speak on time! Effects of a musical rhythmic training on children with hearing loss. Hear Res. 2017;351:11-8. https://doi.org/10.1016/j.heares.2017.05.006 PMID: 28552493. https://doi.org/10.1016/j.heares.2017.05...	31 children divided into two experiments: 16 children with typical hearing development aged 5 to 6 years (Experiment 1). 15 children aged 5 to 9 years using CIs and/or hearing aids (Experiment 2).	Experiment 1: naming task to evaluate temporal adaptation in speech interaction applied 30 minutes after a 30-minute rhythmic musical training session. Experiment 2: The test was administered twice, 30 minutes after a rhythmic musical training session and 30 minutes a week after a conventional speech therapy session. 1-week break between sessions. Rhythmic exercises such as body percussion, clapping, and playing maracas, among other musical approaches. Test made by a virtual game to name drawings. Virtual opponent.	To investigate temporal adaptation in speech interaction in children with normal hearing and children with CI and/or hearing aids and whether musical training can improve these skills in children with hearing loss.	The results showed the importance of musical rhythmic training for improving the temporal capacity of children with hearing impairment.
Polonenko et al. (2017)³¹31. Polonenko MJ, Giannantonio S, Papsin BC, Marsella P, Gordon KA. Musical awareness improves in children with bilateral cochlear Implant or bimodal devices. J Acoust Soc Am. 2017;141(6):4494-507. https://doi.org/10.1121/1.4985123 PMID: 28679263. https://doi.org/10.1121/1.4985123...	50 children aged 6 to 18 years: 16 with typical hearing development, 26 bilateral CI users, and 8 with bimodal adaptation (CI + hearing aid). Divided into two groups: an experimental group - exposed to musical activities; and a control group - not exposed to musical activities.	The experimental group was exposed to music theory classes, instrumental practice of at least one non-percussive instrument, and singing lessons.	To verify whether musical perception correlates the benefits of music classes with the development of auditory and musical perception. Tests were used to analyze the perception of discrimination of similar melodies, changes in pitch, rhythm, and memorization.	They concluded that children who participated in musical training were faster and more accurate in perceiving music, regardless of their hearing condition.
Bedoin et al. (2018)³²32. Bedoin N, Besombes AM, Escande E, Dumont A, Lalitte P, Tillmann B. Boosting syntax training with temporally regular musical primes in children with cochlear Implant. Ann Rehabil Med. 2018;61(6):365-71. https://doi.org/10.1016/j.rehab.2017.03.004 PMID: 28506442. https://doi.org/10.1016/j.rehab.2017.03....	10 children using unilateral and bilateral CI aged 5 to 10 years, divided into two groups for evaluation.	The children were exposed to 16 weeks of morphosyntactic training (similar to speech therapy training), including 8 sessions with computerized musical interventions (rhythmic training) and 8 with morphosyntactic training. Pre- and post-training measures: performance tests in receptive syntactic processing with morphosyntactic tests (grammatical judgment and syntactic comprehension), nonword repetition, visuospatial attention, and memory.	To propose a long-term training program to improve the syntactic processing of children using CIs.	Musical activities improved performance in syntax comprehension, grammatical judgment, and repetition of nonwords in musical training. Effects were observed for attention tasks, especially fast and accurate sequential analysis, but not for memory tasks.
Torppa et al. (2018)³³33. Torppa R, Faulkner A, Kujala T, Huotilainen M, Lipsanen J. Developmental links between speech awareness in noise, singing, and cortical processing of music in children with cochlear Implant. Music Percept. 2018;36(2):156-74. https://doi.org/10.1525/mp.2018.36.2.156 https://doi.org/10.1525/mp.2018.36.2.156...	43 children divided into two groups: experimental group - 21 children using unilateral CI, aged 4 to 13 years. Control group - 22 children with typical hearing development.	12 children in a group exposed to musical interventions, such as singing lessons, and 9 not undergoing musical interventions. Measurements: a) computerized tests to evaluate perception and recognition of words, timbre, and intensity, throughout 14 to 17 months. b) brain responses in the mismatch negativity (MMN) and P3a-evoked potential (ERP). ERP 75 minutes, including placement and removal of the EEG cap. The behavioral experimental session took 30 to 45 minutes.	To evaluate how children with CI who sing informally develop in the perception of speech in noise compared to those who do not sing.	Speech perception in children using CIs improved mainly due to tests with longer intervals of grade changes. The results suggest that singing and playing musical instruments may have the potential to improve speech perception in noise in children with CI.
Yang et al. (2019)³⁴34. Yang J, Liang Q, Chen H, Liu Y, Xu L. Singing proficiency of members of a choir formed by prelingually deafened children with cochlear implant. J Speech Lang Hear Res. 2019;62(5):1561-73. https://doi.org/10.1044/2019_JSLHR-H-18-0385 PMID: 31021668. https://doi.org/10.1044/2019_JSLHR-H-18-...	18 children divided into two groups: 10 children using unilateral CI, aged 7 to 13 years. 8 children with typical hearing, matched for age.	Children using CI had 21 months of formal musical training before starting choir rehearsals, for 2 weeks rehearsing just one song for 3 hours a week plus 1 hour of training at home. The children in the other group were not exposed to musical training, only choir rehearsal. Measurements: after 2 weeks of rehearsal, all children recorded a file with the music rehearsed with voice only, without accompaniment. Acoustic and metrics were analyzed to quantify tuning accuracy and musical performance.	To assess the singing proficiency of children using CIs.	Choir members with CI demonstrated high accuracy in pitch and time measurements and performance similar to children with typical hearing. They concluded that well-directed musical activities can be an effective strategy for developing oral skills, including the use of the singing voice, for post-implantation CI users.
Abdi et al. (2001)³⁵35. Abdi S, Khalessi MH, Khorsandi M, Gholami B. Introducing music as a means of habilitation for children with cochlear implants. Int J Pediatr Otorhinolaryngol. 2001;59(2):105-13. https://doi.org/10.1016/S0165-5876(01)00460-8 PMID: 11378185. https://doi.org/10.1016/S0165-5876(01)00...	14 children with unilateral and bilateral CI, aged 2 to 12 years, divided into two groups: 9 children 2 to 6 years old. 5 children 6 to 12 years old. No control groups.	The children participated in weekly music classes based on the Orff method. In the period from 3 to 13 months, once a week. Measures: questionnaire for parents and rehabilitation professionals.	To evaluate the feasibility of methods that use music as a means of enabling children using CI.	All children improved their musical skills and musical perception ability. There was involvement and reports of family satisfaction at the end.
Torppa et al.(2014b)³⁶36. Torppa R, Huotilainen M, Leminen M, Lipsanen J, Tervaniemi M. Interplay between singing and cortical processing of music: a longitudinal study in children with cochlear implants. Front Psychol. 2014b;5:1389. https://doi.org/10.3389/fpsyg.2014.01389 PMID: 25540628. https://doi.org/10.3389/fpsyg.2014.01389...	43 children, aged 4 to 13 years, divided into 2 groups: experimental group - 21 children with unilateral CI. Control group: 22 normal hearing, not exposed to musical interventions.	The experimental group was exposed to musical interventions, such as singing lessons, held at home, weekly, for 1 hour, for 1 year before the study collection began. Measures: ERP recording twice (at 2 moments 14-17 months apart) to compare MMN (pre-attentive discrimination) and P3a (attention to salient sounds) with changes in piano tone, timbre, duration, and gaps.	To evaluate whether singing can facilitate auditory perception and attention in children with CI.	Results show an interaction between MMN, P3a, brain development, implantation, and singing, expanding neural networks for attention and more accurate neural discrimination associated with singing.

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[1] Corresponding author: Dagma Venturini Marques Abramides, Faculdade de Odontologia de Bauru, FOB-USP, Alameda Octávio Pinheiro Brisola, 9-75, CEP: 17012-901 - Bauru - São Paulo, Brasil, E-mail: dagmavma@usp.br