The Penny

Example is not the main thing in influencing others. It is the only thing.

[Sunday, October 4, 2009]

Musical Training for Children with CIs

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, 1043-1052.

This study included a group of 18 children who received Advanced Bionics cochlear implants and were activated with the HiRes strategy. All were enrolled in an auditory verbal learning program. Nine of the children made up the experimental group; nine made up the control group. The two groups had similar audiograms in three conditions: unaided, aided (hearing aided), aided (CI). The experimental group may have been a little older, but there seems to be an error in the age of the control group, so I don't know. They were about the same age (no significant difference, anyway).

The experimental group participants were given a keyboard and instructions for a music training program. The parent-led training was supposed to take about 10 minutes each day, and it involved pitch and rhythm tasks.

All of the children were evaluated pre-implant, and post implant at 1, 3, 6, 9, 12, and 24 months. They used several assessments: the Ling 6 sound test, a word identification test (spondees), a sort of open-set measure involving Mr. Potato Head, and a sentence test. At 12 and 24 months, they administered a musical stages profile, which covered detection of and reaction to environmental and musical sounds, exposure to music, participation in a musical environment, melody and dynamic changes, pitch differences, rhythmical changes, and emotional aspects of music. The parents also completed the MAIS or IT MAIS and the MUSS, which look at everyday functioning with sound and speech, and with their listening devices.

At 24 months post implant, the MAIS/IT MAIS, MUSS, Ling, word identification, and Potato Head results were pretty similar between groups. The music group children did better on the Potato Head task early on, but the control group caught up by 12 months post implant. Although the music group appeared to do slightly better, there were no significant differences on the sentence scores.

At 12 months post implant, there was a significant difference between the groups in the area of exposure to music. No differences in the other areas of the musical stages profile. But at 24 months post implant, there were many significant differences. There were differences on 20 of the 26 questions. This included better reactions to sounds, more exposure to music, better skills with melody and dynamic changes, better skills with rhythmical changes, and increased reaction to the emotional aspects of music. Some children in the control group did well on all of these, as well as the music group. But the music group as a whole did better than the control group as a whole.

So this shows that music training can help children with cochlear implants increase their reactions to and skills with music.

But I have a problem.

OK, the listening/speech measures were fairly objective. The child either repeated the spondee correctly or he didn't. The child either picked up the correct Potato Head body part of he didn't. But the music stages profile was a parent questionnaire. The parents answered questions like "Does your child react to lively music?" and "Does your child ever spontaneously clap hands to music?" Of course, the parents would not deliberately falsify information (I hope!), but knowing your child is in the music group could introduce bias. Maybe an "occasionally" becomes a "frequently."

This research would have been much stronger if someone actually evaluated the children's musical abilities rather than having the parents think back on how their child did with these things. Also, having filled out the questionnaire at 12 months post implant (when there were significant differences only in exposure to music), the parents would have known what the researchers were looking for the next time around, even if they didn't remember specific questions (and there were only 26 questions). Some of the questions rely on the parents' own musical ability (such as "Does your child sing the correct tune and all the words to any song?"), which was not evaluated. Rhythm, which kids with CIs pick up well, can fool you into thinking that the pitch ("tune") was correct. I can't figure out why these researchers went with this weak questionnaire, which doesn't even appear to be norm-referenced. It looks like the researchers made it up, because it says to write feedback beside unclear/difficult questions so that they can improve the questionnaire.

I went into this article very interested, and I was excited to see those significant differences on the music stages profile results, but then I looked at the actual music stages profile questions and was disappointed.

On the other hand, children in both groups got 4s and 5s (out of 5) on the questionnaire. So children with CIs that do not provide fine structure information can develop some musical skills, from their parents' perspectives. That's worth a big old YAY to them!


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