Age-sensitive associations of segmental and suprasegmental perception with sentence-level language skills in Mandarin-speaking children with cochlear implants

Language profile of children with cochlear implants: comparative study about the effect of age of cochlear implantation and the duration of rehabilitation

PURPOSE

The analysis of different language domains and exploration of variables that affect the outcomes of cochlear implantation would help to document the efficacy of cochlear implantation and intervention programs. The aim of this work was to examine the language profile of children with Cochlear Implants (CI) and to assess the effect of age at the time of cochlear implantation and the impact of duration of rehabilitation on the development of linguistic abilities for cochlear implanted children.

METHODS

The study was conducted on 46 Arabic speaking children using unilateral CI who are receiving regular post-cochlear auditory and language rehabilitation in the phoniatrics unit, Kasr Alaini hospital. A Proficient Preschooler Language Evaluation (APPEL TOOL) was applied for the assessment of different language domains.

RESULTS

Children who received post implant rehabilitation for ≥ 2 years showed significant improvement in all subtests' scores of APPEL tool than children who received same rehabilitation for ≤ 1 year. There was no significant difference of language scores between children who have received CI before age of 3 years and those who have been implanted after age of 3 years.

CONCLUSION

This study showed that the language profile of CI children was beneficially affected by the longer duration of therapy post implantation.

School adjustment of adolescents with sequential bilateral cochlear implants in mainstream school

OBJECTIVES

Little is known about the school adjustment of adolescents with sequential bilateral cochlear implants (CIs) in mainstream educational settings. This study aims to investigate the school adjustment of adolescents with sequential bilateral CIs, in comparison to those of age-matched adolescents with typical hearing (TH), to explore the relationships between individual variables and school adjustment in the bilateral CI group, and to assess the factors leading to strong school adjustment in the bilateral CI group.

METHODS

Twenty-five adolescents with sequential bilateral CIs and 30 adolescents with TH, aged 13-19 years, participated in this study. The adolescents completed the school adjustment scale (SAS).

RESULTS

The two groups were not significantly different on overall SAS scores. However, the TH group scored higher on the SAS than the sequential bilateral CI group with regard to communication skills and relationships with peers. In the bilateral CI group, SAS scores significantly correlated with open-set sentence and receptive vocabulary scores. Receptive vocabulary scores were a significant predictive factor for the level of school adjustment for the bilateral CI group.

CONCLUSION

Adolescents who received sequential bilateral CIs adapted well to mainstream schools. However, they did experience barriers to communication and to make friends in mainstream schools, and their level of school adjustment was affected by their receptive vocabulary skills.

Phonological Awareness and Working Memory in Mandarin-Speaking Preschool-Aged Children With Cochlear Implants

PURPOSE

Cochlear implants (CIs) provide significant benefits for profoundly deaf children in their language and cognitive development. However, it remains unclear whether Mandarin-speaking young children with early implantation can develop age-equivalent phonological awareness (PA) skill and working memory (WM) capacity as their normal hearing (NH) peers. The aim of this study was to investigate PA and WM in preschool-aged children with or without hearing loss and to examine the relationship between the two basic skills.

METHOD

The data were collected from 16 Mandarin-speaking preschoolers with CIs and 16 age-matched children with NH. All preschool participants were instructed to complete four phonological detection tasks and four digit span tasks. Linear mixed-effects modeling was performed to evaluate PA and WM performances between two groups across different tasks.

RESULTS

CI preschoolers showed comparable performances on par with NH controls in phonological detections and visual digit spans. In addition, Pearson correlation analysis revealed a positive relationship between phonological detections and auditory digit spans in preschool-aged children with CIs.

CONCLUSION

With early implantation, the congenitally deaf children were capable of developing age-appropriate PA skill and WM capacity, which have practical implications for aural rehabilitation in this special pediatric population.

Voice Emotion Recognition by Mandarin-Speaking Children with Cochlear Implants

Objectives

Emotional expressions are very important in social interactions. Children with cochlear implants can have voice emotion recognition deficits due to device limitations. Mandarin-speaking children with cochlear implants may face greater challenges than those speaking nontonal languages; the pitch information is not well preserved in cochlear implants, and such children could benefit from child-directed speech, which carries more exaggerated distinctive acoustic cues for different emotions. This study investigated voice emotion recognition, using both adult-directed and child-directed materials, in Mandarin-speaking children with cochlear implants compared with normal hearing peers. The authors hypothesized that both the children with cochlear implants and those with normal hearing would perform better with child-directed materials than with adult-directed materials.

Design

Thirty children (7.17-17 years of age) with cochlear implants and 27 children with normal hearing (6.92-17.08 years of age) were recruited in this study. Participants completed a nonverbal reasoning test, speech recognition tests, and a voice emotion recognition task. Children with cochlear implants over the age of 10 years also completed the Chinese version of the Nijmegen Cochlear Implant Questionnaire to evaluate the health-related quality of life. The voice emotion recognition task was a five-alternative, forced-choice paradigm, which contains sentences spoken with five emotions (happy, angry, sad, scared, and neutral) in a child-directed or adult-directed manner.

Results

Acoustic analyses showed substantial variations across emotions in all materials, mainly on measures of mean fundamental frequency and fundamental frequency range. Mandarin-speaking children with cochlear implants displayed a significantly poorer performance than normal hearing peers in voice emotion perception tasks, regardless of whether the performance is measured in accuracy scores, Hu value, or reaction time. Children with cochlear implants and children with normal hearing were mainly affected by the mean fundamental frequency in speech emotion recognition tasks. Chronological age had a significant effect on speech emotion recognition in children with normal hearing; however, there was no significant correlation between chronological age and accuracy scores in speech emotion recognition in children with implants. Significant effects of specific emotion and test materials (better performance with child-directed materials) in both groups of children were observed. Among the children with cochlear implants, age at implantation, percentage scores of nonverbal intelligence quotient test, and sentence recognition threshold in quiet could predict recognition performance in both accuracy scores and Hu values. Time wearing cochlear implant could predict reaction time in emotion perception tasks among children with cochlear implants. No correlation was observed between the accuracy score in voice emotion perception and the self-reported scores of health-related quality of life; however, the latter were significantly correlated with speech recognition skills among Mandarin-speaking children with cochlear implants.

Conclusions

Mandarin-speaking children with cochlear implants could have significant deficits in voice emotion recognition tasks compared with their normally hearing peers and can benefit from the exaggerated prosody of child-directed speech. The effects of age at cochlear implantation, speech and language development, and cognition could play an important role in voice emotion perception by Mandarin-speaking children with cochlear implants.

Discourse Prosody in Children's Rhyme Speech Produced by Prelingually Deaf Mandarin-Speaking Children With Cochlear Implants

Purpose This study aimed to obtain a comprehensive understanding about how Mandarin-speaking children with cochlear implants (CIs) performed speech prosody in a connected discourse and to what extent their prosodic scenario differed from those normal-hearing (NH) peers. Method Fifteen prelingually deaf Mandarin-speaking children with unilateral multichannel CIs were chosen and 15 age-matched NH controls were recruited. Speech samples were spontaneously elicited by children's rhyme speech genre and subject to phonetic annotation. Acoustic analysis was conducted on all speech samples, mainly focusing on the measurements of duration and fundamental frequency (F0). Tempo measures included temporal fluency, syllable-lengthening, and rhythm metrics, whereas melodic measures included both local and global F0 variations under different prosodic domains. Results The CI children generally achieved compatible temporal performance with the NH children in spontaneous discourse, except that they were somewhat arbitrary when operationalizing lengthening strategy and pausing strategy at different prosodic boundaries. With regard to melodic performance, CI children may not sufficiently modulate local phonetic nuances of F0 variation, and meanwhile, they performed atypically in the global F0 declination pattern and overall F0 resetting pattern, failing to signal the specific structure of children's rhyme discourse. Early age at implantation and longer CI experience did not play a significant role in the temporal performance of the CI children but did facilitate their articulation of dynamic pitch variation in the spontaneous discourse to some extent. Conclusion CI children did exhibit atypical prosodic patterns in discourse context, especially the overall mapping between the prosodic manifestation and the discourse structure.

Bimodal Benefits for Lexical Tone Recognition: An Investigation on Mandarin-speaking Preschoolers with a Cochlear Implant and a Contralateral Hearing Aid

Pitch perception is known to be difficult for individuals with cochlear implant (CI), and adding a hearing aid (HA) in the non-implanted ear is potentially beneficial. The current study aimed to investigate the bimodal benefit for lexical tone recognition in Mandarin-speaking preschoolers using a CI and an HA in opposite ears. The child participants were required to complete tone identification in quiet and in noise with CI + HA in comparison with CI alone. While the bimodal listeners showed confusion between Tone 2 and Tone 3 in recognition, the additional acoustic information from the contralateral HA alleviated confusion between these two tones in quiet. Moreover, significant improvement was demonstrated in the CI + HA condition over the CI alone condition in noise. The bimodal benefit for individual subjects could be predicted by the low-frequency hearing threshold of the non-implanted ear and the duration of bimodal use. The findings support the clinical practice to fit a contralateral HA in the non-implanted ear for the potential benefit in Mandarin tone recognition in CI children. The limitations call for further studies on auditory plasticity on an individual basis to gain insights on the contributing factors to the bimodal benefit or its absence.