Researchers, clinicians, and cochlear implant (CI) manufacturers are engaged in ongoing work to understand what makes music sound like music to a person with a CI. The nature of music experiences and the skill set achievable by children using CIs are debated, but after researching the effects of music on auditory learning and the positive effects music therapy can have on those with cochlear implants. Reifinger conducted a study to determine whether a treatment program using music notation would improve the verbal rhythmic and intonational accuracy of hearing impaired children, and to determine the degree of transfer to other reading and verbal skills. Thirty-five children with hearing impairment, ages 3 through 12 years, participated in a treatment program for 40 consecutive days. The study was initiated to investigate the use of music notation training in facilitating non-linguistic elements of speech with children with hearing impairment. This study also sought to determine the degree of improvement and transfer in speech rhythm and inflection in these children when music notation was paired with spoken and written language. The study found positive results were obtained in speech prosody, stimulation, generalization, and music learning, all areas which enhance the personal esteem of the children with hearing impairment (Reifinger, 2018).
Auditory stimulation is essential during infancy and early childhood for the normal development and maturation of the central auditory neural pathways. Neural responses in the auditory pathways of most children receiving a cochlear implant after age three and a half reportedly do not typically reach normal levels, even after years of experience with the implant. Darrow (1989) and her colleagues began to focus research on children who had received a cochlear implanted between thirteen and twenty-four months because they had significant language delay. One of the most consequential topics within their research is to develop post-implant auditory training programs that use music to help optimize the hearing acuity attained by cochlear implant recipients. Darrows research study analyzed the results of eighteen experimental studies involving children ranging in age from four to nine years and concluded that students who received music training experienced significantly greater gains in phonological skills compared to peers who did not participate in music.
Another area of study is the effect music can have on improving one’s ability to distinguish background noise after receiving a cochlear implant. Hearing background noise is accomplished by following the particular pitch range and timbre of a target voice, such as that of the teacher’s voice in a noisy classroom. It is also accomplished by focusing on the direction of the sound, which can be aided by bilateral implants. Music therapy can focus on improving pitch and timbre perception with musical sounds and therefore may improve pitch and timbre perception of speech sounds. Interventions included exploring vocal and instrumental timbres, moving to musical sounds, remembering and producing rhythmic patterns and timbres, determining emotional content of pieces, and writing and performing simple rhythm pieces are exercises used in Reifinger’s studies. Results indicated that compared with peers having similar hearing impairments who received no music instruction, the group of students that participated in music education showed significantly greater ability to discriminate between two similar vowel or consonant speech sounds, which is particularly important because it suggests that a sharpening of the language perception skills of children with hearing impairment may be achieved with music training.
Barton and Robbins (2015) working as clinicians with young children with CIs see the potential that music has to jumpstart the mechanisms required to process and produce spoken language, as well as other important developmental skills. The Oxford dictionary defines ‘jumpstart’ as: ‘to give an added impetus to something that is proceeding slowly’. They view music as valuable, not just at the initial stages of CI use, but across the lifespan of the listener. Barton and Robbins broke down the effects music can have on increasing hearing capabilities after a cochlear implants into core values music therapists aim to achieve.
The first value Barton mentions is attention. The assumption is that music as an auditory stimulus has the ability to attract attention. Music training provides a mechanism for education in the auditory domain, enhancing the ability to direct “spotlight.” This is a critical skill, because what we hear is determined by how well we listen and by our capacity to direct our attention to the input of highest interest while monitoring our surroundings for changes that require immediate attention. The second assumption is that music can modulate and regulate emotion. The ability to identify and understand emotion is the very essence of communication. Unfortunately, children with CIs often have difficulty extracting the subtle emotional cues that are present in spoken language. Because music embodies a wide range of emotions and has the capacity to evoke moods and feelings, explored the notion that music could provide more salient emotional cues than spoken language for CI children (Barton, 2015).
Growing evidence indicates that experience with sound may provide a sort of scaffolding for the development of general cognitive skills that depend on the representation of temporal or sequential patterns. Hearing is the primary gateway for perceiving sequential patterns of input that change over time (rather than over space, as in vision).
The image above (Staum, 1987) shows an example of music interventions that can be used to build or “scaffold” language into rhythmic interventions. By beginning with simple rhythmic patterns therapists can help patients to hear and feel this rhythm. Therapist will help patients by adding simple syllables to the rhythmic patterns. As patients begin to feel more comfortable with identifying and pronouncing sounds like “pah” “mah” or “tah”, the therapists can start to add simple words to the rhythmic pattern. As the patients vocabulary grows, the music therapists can begin to add different simple rhythms together to create sentences. Even though it is a process starting with clapping simple rhythms, the outcome can help patients with CI speaking in full sentences.
There is also the assumption that music has the potential to condition and prompt behavior without requiring conscious will. Perception, the assumption is that music training can affect the perceptual mechanisms necessary for language comprehension. This is especially relevant for children with receptive and expressive language impairments. CIs are designed to provide sufficient information for the user to attain high levels of speech recognition and production (Crain, et al 2017). However, music requires more fine structure timing and pitch cues than speech. Thus, for children using CIs, pitch discrimination and production can be difficult because of spectral limitations of the device. Some studies have shown that music training can improve pitch perception in children with CIs. Even though we are in the beginnings of learning more and more about the effect music can have on improving those with hearing impairments, research continues to back up to significant success music therapy can have on discerning background noise, increasing discernment in emotional tone, and rhythmic patterns and timbres.
-Macy Fehl, Music Therapy Intern
References
Barton, C., & Robbins, A. M. (2015). Jumpstarting auditory learning in children with cochlear implants through music experiences. Cochlear Implants International: An Interdisciplinary Journal, 16, S51–S62. https://doi.org/10.1179/1467010015Z.000000000267
Crain, K. L., LaSasso, C., & Leybaert, J. (2010). Cued Speech and Cued Language for Deaf and Hard of Hearing Children. Plural Publishing, Inc.
Darrow, A. A. (1989). RMT-BC, Music Therapy in the Treatment of the Hearing-Impaired, Music Therapy Perspectives, (6)1, 61–70 https://doi.org/10.1093/mtp/6.1.61
Reifinger, J. L. (2018). Music Education to Train Hearing Abilities in Children with Cochlear Implants. Music Educators Journal, 105(2), 57–63. https://doi.org/10.1177/0027432118809404
Staum, M. J. (1987). Music Notation to Improve the Speech Prosody of Hearing Impaired Children. Journal of Music Therapy, 24(3), 146–159.