Phonetic inventory development in young cochlear implant users 6 years postoperation

Non-Users and Limited Users of Cochlear Implants in Pediatric Patients: A Retrospective Cross-Sectional Study

To determine the prevalence of non-use and limited use of cochlear implants. To find out the reasons for the same. This study was carried out among the paediatric patients who underwent cochlear implantation under the SHP* scheme in Civil Hospital, Ahmedabad between 2013 and 2020.

STUDY DESIGN

Retrospective cross-sectional study.

STUDY SETTING

Civil Hospital Ahmedabad.

SAMPLE SIZE

150 paediatric patients. Patients were selected based on a random number generator. The data was collected through a telephonic interview based upon a preformed questionnaire. The study indicates that out of a total 150 participants, 109 (72.7%) used their cochlear implant regularly while 41 (27.3%) did not. Major issue faced by the participants was in the external device -damage to the device and monetary issues for its repair. The participants who have dropped the usage of their implants faced issues mostly after 2 years of usage. The age group of less than 3 years showed 15.6% of non-usage, while the age group of 3-6 years showed an increase to 34.5% of non-users. The age group of more than 6 years showed an even higher proportion (41.3%) of non-users. It is recommended that the government ensures the follow-up of the patients undergoing cochlear implantation for at least 2 years after the surgery. The proportion of non-users in the consecutive increasing age groups saw a rise in number. Therefore, it is recommended to divert the resources towards lower age groups to facilitate a better outcome.

The production of /s/-stop clusters by pre-schoolers with hearing loss

Producing word-initial /s/-stop clusters can be a challenge for English-speaking pre-schoolers. For children with hearing loss (HL), fricatives can be also difficult to perceive, raising questions about their production and representation of /s/-stop clusters. The goal of this study was therefore to determine if pre-schoolers with HL can produce and represent the /s/ in word-initial /s/-stop clusters, and to compare this to their normal hearing (NH) peers. Based on both acoustic and perceptual analysis, we found that children with HL had little /s/-omission, suggesting that their phonological representation of these clusters closely aligns with that of their NH peers.

Voice Onset Time of Greek Stops Productions by Greek Children with Cochlear Implants and Normal Hearing

INTRODUCTION

Research on voice onset time (VOT) production of stops in children with CI versus NH has reported conflicting results. Effects of age and place of articulation on VOT have not been examined for children with CI. The purpose of this study was to examine VOT production by Greek-speaking children with CI in comparison to NH controls, with a focus on the effects of age, type of stimuli, and place of articulation.

METHODS

Participants were 24 children with CI aged from 2;8 to 13;3 years and 24 age- and gender-matched children with NH. Words were elicited via a picture-naming task, and nonwords were elicited via a fast mapping procedure.

RESULTS

For voiced stops, children with CI showed longer VOT than children with NH, whereas VOT for voiceless stops was similar to that of NH peers. Also, in both voiced and voiceless stops, the VOT differed as a function of age and place of articulation across groups. Differences as a function of stimulus type were only noted for voiced stops across groups.

CONCLUSIONS

For the voiced stop consonants, which demand more articulatory effort, VOT production in children with CI was longer than in children with NH. For the voiceless stop consonants, VOT production in children with CI is acquired at a young age.

Acoustic characteristics of sibilant fricatives and affricates in Mandarin-speaking children with cochlear implants

The purpose of the study was to examine the acoustic features of sibilant fricatives and affricates produced by prelingually deafened Mandarin-speaking children with cochlear implants (CIs) in comparison to their age-matched normal-hearing (NH) peers. The speakers included 21 children with NH aged between 3.25 and 10 years old and 35 children with CIs aged between 3.77 and 15 years old who were assigned into chronological-age-matched and hearing-age-matched subgroups. All speakers were recorded producing Mandarin words containing nine sibilant fricatives and affricates (/s, ɕ, ʂ, ts, tsʰ, tɕ, tɕʰ, tʂ, tʂʰ/) located at the word-initial position. Acoustic analysis was conducted to examine consonant duration, normalized amplitude, rise time, and spectral peak. The results revealed that the CI children, regardless of whether chronological-age-matched or hearing-age-matched, approximated the NH peers in the features of duration, amplitude, and rise time. However, the spectral peaks of the alveolar and alveolopalatal sounds in the CI children were significantly lower than in the NH children. The lower spectral peaks of the alveolar and alveolopalatal sounds resulted in less distinctive place contrast with the retroflex sounds in the CI children than in the NH peers, which might partially account for the lower intelligibility of high-frequency consonants in children with CIs.

Intelligibility of Word-Initial Obstruent Consonants in Mandarin-Speaking Prelingually Deafened Children With Cochlear Implants

PURPOSE

This study assessed the intelligibility of obstruent consonants in prelingually deafened Mandarin-speaking children with cochlear implants (CIs).

METHOD

Twenty-two Mandarin-speaking children with normal hearing (NH) aged 3.25-10.0 years and 35 Mandarin-speaking children with CIs aged 3.77-15.0 years were recruited to produce a list of Mandarin words composed of 17 word-initial obstruent consonants in different vowel contexts. The children with CIs were assigned to chronological age-matched (CA) and hearing age-matched (HA) subgroups with reference to the NH controls. One hundred naïve NH adult listeners were recruited for a consonant identification task that consisted of a total of 2,663 stimulus tokens through an online research platform. For each child speaker, the consonant productions were judged by seven to 12 different adult listeners. An average percentage of consonants correct was calculated across all listeners for each consonant.

RESULTS

The CI children in both the CA and HA subgroups showed lower intelligibility in their consonant productions than the NH controls. Among the 17 obstruents, both CI subgroups showed higher intelligibility for stops, but they demonstrated major problems with the sibilant fricatives and affricates and showed a different confusion pattern from the NH controls on these sibilants. Of the three places (alveolar, alveolopalatal, and retroflex) in Mandarin sibilants, both CI subgroups showed the lowest intelligibility and the greatest difficulties with alveolar sounds. For the NH children, there was a significant positive relationship between overall consonant intelligibility and chronological age. For the children with CIs, the best fit regression model revealed significant effects of chronological age and age at implantation, with their quadratic terms included.

CONCLUSIONS

Mandarin-speaking children with CIs experience major challenges in the three-way place contrasts of sibilant sounds in consonant production. Chronological age and the combined effect of CI-related time variables play important roles in the development of obstruent consonants in the CI children.

Covert contrasts and categorical perception: a comparison of two measurement tools

This study considers adults' perception of subtle differences in the error productions of /r/ and /l/ in young children. Given that these two phonemes share a common substitution [w], the potential covert contrast between these three sounds was investigated. The utility of two perceptual rating scales was compared: a linear visual analogue scale (VAS) and a triangular scale that considered the possibility of covert contrast among /r,l,w/. Adult listeners rated speech productions from children with cochlear implants (CIs) and speech age-matched children with normal hearing (NH) as they produced VCV or CV productions with /r,l,w/ in syllable-initial position. Mahalanobis distances of the listener ratings for each stimulus on each rating scale were calculated for analysis. Ultimately, there was no difference between the ratings of the two speaker populations. However, there was a significant difference in the amount of variability captured with each scale. The triangular scale reliably captured more variability in the productions than the linear VAS. The significant effect of scale type on the spread of listeners' responses provides support for the claim that the type of rating system used can capture different aspects of a listener's perceptions, thereby suggesting that the type of rating system used in a study may significantly influence that study's findings.

Effect of telepractice on pediatric cochlear implant users and provider vowel space: A preliminary report

Clear speaking styles are goal-oriented modifications in which talkers adapt acoustic-phonetic characteristics of speech to compensate for communication challenges. Do children with hearing loss and a clinical provider modify speech characteristics during telepractice to adjust for remote communication? The study examined the effect of telepractice (tele-) on vowel production in seven (mean age 4:11 years, SD 1:2 years) children with cochlear implants (CIs) and a provider. The first (F1) and second (F2) formant frequencies of /i/, /ɑ/, and /u/ vowels were measured in child and provider speech during one in-person and one tele-speech-language intervention, order counterbalanced. Child and provider vowel space areas (VSA) were calculated. The results demonstrated an increase in F2 formant frequency for /i/ vowel in child and provider speech and an increase in F1 formant frequency for /ɑ/ vowel in the provider speech during tele- compared to in-person intervention. An expansion of VSA was found in child and provider speech in tele- compared to in-person intervention. In children, the earlier age of CI activation was associated with larger VSA in both tele- and in-person intervention. The results suggest that the children and the provider adjust vowel articulation in response to remote communication during telepractice.

Effects of Device Limitations on Acquisition of the /t/-/k/ Contrast in Children With Cochlear Implants

OBJECTIVES

The present study investigated how development of the /t/-/k/ contrast is affected by the unique perceptual constraints imposed on young children using cochlear implants (CIs). We hypothesized that children with CIs would demonstrate unique patterns of speech acquisition due to device limitations, rather than straightforward delays due to a lack of auditory input in the first year of life before implantation. This study focused on the contrast between /t/ and /k/ because it is acquired early in the sequence of development, requires less advanced motor control than later-acquired place contrasts, is differentiated by spectral cues (which are particularly degraded when processed by CIs), and is not easily differentiated by visual cues alone. Furthermore, perceptual confusability between /t/ and /k/ may be exacerbated in front-vowel contexts, where the spectral energy for /k/ is shifted to higher frequencies, creating more spectral overlap with /t/.

DESIGN

Children with CIs (n = 26; ages 31 to 66 mo) who received implants around their first birthdays were matched to peers with normal hearing (NH). Children participated in a picture-prompted auditory word-repetition task that included over 30 tokens of word-initial /t/ and /k/ consonants. Tokens were balanced across front-vowel and back-vowel contexts to assess the effects of coarticulation. Productions were transcribed and coded for accuracy as well as the types of errors produced (manner of articulation, voicing, or place of articulation errors). Centroid frequency was also calculated for /t/ and /k/ tokens that were produced correctly. Mixed-effects models were used to compare accuracy, types of errors, and centroid frequencies across groups, target consonants, and vowel contexts.

RESULTS

Children with CIs produced /t/ and /k/ less accurately than their peers in both front- and back-vowel contexts. Children with CIs produced /t/ and /k/ with equal accuracy, and /k/ was produced less accurately in front-vowel contexts than in back-vowel contexts. When they produced errors, children with CIs were more likely to produce manner errors and less likely to produce voicing errors than children with NH. Centroid frequencies for /t/ and /k/ were similar across groups, except for /k/ in front-vowel contexts: children with NH produced /k/ in front-vowel contexts with higher centroid frequency than children with CIs, and they produced /k/ and /t/ with equal centroid frequencies in front-vowel contexts.

CONCLUSIONS

Children with CIs not only produced /t/ and /k/ less accurately than peers with NH, they also demonstrated idiosyncratic patterns of acquisition, likely resulting from receiving degraded and distorted spectral information critical for differentiating /t/ and /k/. Speech-language pathologists should consider perceptual confusability of consonants (and their allophonic variations) during their assessment and treatment of this unique population of children.

Objectively measured teacher and preschooler vocalizations: Phonemic diversity is associated with language abilities

Over half of US children are enrolled in preschools, where the quantity and quality of language input from teachers are likely to affect children's language development. Leveraging repeated objective measurements, we examined the rate per minute and phonemic diversity of child and teacher speech-related vocalizations in preschool classrooms and their association with children's end-of-year receptive and expressive language abilities measured with the Preschool Language Scales (PLS-5). Phonemic diversity was computed as the number of unique consonants and vowels in a speech-related vocalization. We observed three successive cohorts of 2.5-3.5-year-old children enrolled in an oral language classroom that included children with and without hearing loss (N = 29, 16 girls, 14 Hispanic). Vocalization data were collected using child-worn audio recorders over 34 observations spanning three successive school years, yielding 21.53 mean hours of audio recording per child. The rate of teacher vocalizations positively predicted the rate of children's speech-related vocalizations while the phonemic diversity of teacher vocalizations positively predicted the phonemic diversity of children's speech-related vocalizations. The phonemic diversity of children's speech-related vocalizations was a stronger predictor of end-of-year language abilities than the rate of children's speech-related vocalizations. Mediation analyses indicated that the phonemic diversity of teacher vocalizations was associated with children's receptive and expressive language abilities to the extent that it influenced the phonemic diversity of children's own speech-related vocalizations. The results suggest that qualitatively richer language input expands the phonemic diversity of children's speech, which in turn is associated with language abilities.

American Cochlear Implant Alliance Task Force Guidelines for Determining Cochlear Implant Candidacy in Children

This article summarizes the available evidence on pediatric cochlear implantation to provide current guidelines for clinical protocols and candidacy recommendations in the United States. Candidacy determination involves specification of audiologic and medical criteria per guidelines of the Food and Drug Administration. However, recommendations for a cochlear implant evaluation also should maintain flexibility and consider a child’s skill progression (i.e., month-for-month progress in speech, language, and auditory development) and quality of life with appropriately fit hearing aids. Moreover, evidence supports medical and clinical decisions based on other factors, including (a) ear-specific performance, which affords inclusion of children with asymmetric hearing loss and single-sided deafness as implant candidates; (b) ear-specific residual hearing, which influences surgical technique and device selection to optimize hearing; and (c) early intervention to minimize negative long-term effects on communication and quality of life related to delayed identification of implant candidacy, later age at implantation, and/or limited commitment to an audiologic rehabilitation program. These evidence-based guidelines for current clinical protocols in determining pediatric cochlear implant candidacy encourage a team-based approach focused on the whole child and the family system.

The Acquisition of Acoustic Cues to Onset and Coda Voicing Contrasts by Preschoolers With Hearing Loss

PURPOSE

Children with hearing loss (HL), including those with hearing aids (HAs) and cochlear implants (CIs), often have difficulties contrasting words like " b each" versus " p each" and "do g " versus "do ck " due to challenges producing systematic voicing contrasts. Even when acoustic contrasts are present, these may not be perceived as such by others. This can cause miscommunication, leading to poor self-esteem and social isolation. Acoustic evidence is therefore needed to determine if these children have established distinct voicing categories before entering school and if misperceptions are due to a lack of phonological representations or due to a still-maturing implementation system. The findings should help inform more effective early intervention.

METHOD

Participants included 14 children with HL (eight HA users, five CI users, and one bimodal) and 20 with normal hearing, all English-speaking preschoolers. In an elicited imitation task, they produced consonant-vowel-consonant minimal pair words that contrasted voicing in word-initial (onset) or word-final (coda) position at all three places of articulation (PoAs).

RESULTS

Overall, children with HL showed acoustically distinct voicing categories for both onsets and codas at all three PoAs. Contrasts were less systematic for codas than for onsets, as also confirmed by adults' perceptual ratings.

CONCLUSIONS

Preschoolers with HL produce acoustic differences for voiced versus voiceless onsets and codas, indicating distinct phonological representations for both. Nonetheless, codas were less accurately perceived by adult raters, especially when produced by CI users. This suggests a protracted development of the phonetic implementation of codas, where CI users, in particular, may benefit from targeted intervention.

Consonant and vowel production in the spontaneous speech productions of children with auditory brainstem implants

Auditory brainstem implantation provides hearing sensations in children and adults with anomalies of the auditory nerves. In children, perceptual benefits have been established, and research already demonstrated (limited) effects on children's speech production. The current study extends the literature by scrutinizing the phonological development of three children with ABI. Spontaneous speech samples were used to establish their phonemic inventories of vowels, word-initial consonants and word-final consonants, both independently of the target phoneme and relative to the target phoneme. The three children produced all vowels with longer device use and larger vocabulary size. Word-initial and word-final consonants appeared in the three children's spontaneous productions. However, the segmental accuracy was only moderate in the children's productions.

Vowel Production in Prelingually Deafened Mandarin-Speaking Children With Cochlear Implants

Purpose The purpose of this study was to characterize the acoustic profile and to evaluate the intelligibility of vowel productions in prelingually deafened, Mandarin-speaking children with cochlear implants (CIs). Method Twenty-five children with CIs and 20 age-matched children with normal hearing (NH) were recorded producing a list of Mandarin disyllabic and trisyllabic words containing 20 Mandarin vowels [a, i, u, y, ɤ, ɿ, ʅ, ai, ei, ia, ie, ye, ua, uo, au, ou, iau, iou, uai, uei] located in the first consonant-vowel syllable. The children with CIs were all prelingually deafened and received unilateral implantation before 7 years of age with an average length of CI use of 4.54 years. In the acoustic analysis, the first two formants (F1 and F2) were extracted at seven equidistant time locations for the tested vowels. The durational and spectral features were compared between the CI and NH groups. In the vowel intelligibility task, the extracted vowel portions in both NH and CI children were presented to six Mandarin-speaking, NH adult listeners for identification. Results The acoustic analysis revealed that the children with CIs deviated from the NH controls in the acoustic features for both single vowels and compound vowels. The acoustic deviations were reflected in longer duration, more scattered vowel categories, smaller vowel space area, and distinct formant trajectories in the children with CIs in comparison to NH controls. The vowel intelligibility results showed that the recognition accuracy of the vowels produced by the children with CIs was significantly lower than that of the NH children. The confusion pattern of vowel recognition in the children with CIs generally followed that in the NH children. Conclusion Our data suggested that the prelingually deafened children with CIs, with a relatively long duration of CI experience, still showed measurable acoustic deviations and lower intelligibility in vowel productions in comparison to the NH children.

Assessing consonant production in children with cochlear implants

OBJECTIVE

The objective of this study was to investigate the development of consonant inventory and accuracy in pediatric cochlear implant (CI) recipients and compare their performance to typical hearing (TH) children.

METHODS

One hundred and twenty nine children with CIs, implanted between 6-38 months of age, and 30 age-matched children with TH participated in this study. Spontaneous speech samples were collected at 3.5 and 4.5 years chronological age and the first 100 different words spoken by each participant were transcribed. Two consonant production measures were subsequently calculated to assess consonant acquisition and mastery. The percentage of Consonants Correct (CC) was used for measuring accuracy and Consonant Diversity (CD), an inventory measure, was used to identify the number of different consonants spoken by each participant. Repeated measures analyses of variance were conducted to examine the differences in consonant production scores based on presence of CI (participants with CI versus typical hearing (TH) participants), and chronological age at data collection (3.5 years versus 4.5 years).

RESULTS

CI recipients displayed lower consonant production scores compared to TH children. Children with the most device experience (32-38 months at 3.5 years) performed on par with their TH peers.

CONCLUSIONS

The two measures used in this study together appear capable of comprehensively describing the changes in consonant production skills of children. Results from this study indicate that while most CI participants display lower scores compared to TH children, many of the CI users are able to produce speech sounds on par with TH children.

Speech Production Accuracy and Variability in Monolingual and Bilingual Children With Cochlear Implants: A Comparison to Their Peers With Normal Hearing

Purpose This study investigates consonant and vowel accuracy and whole-word variability (also called token-to-token variability or token-to-token inconsistency) in bilingual Spanish-English and monolingual English-speaking children with cochlear implants (CIs) compared to their bilingual and monolingual peers with normal hearing (NH). Method Participants were 40 children between 4;6 and 7;11 (years;months; M _age = 6;2), n = 10 each in 4 participant groups: bilingual Spanish-English with CIs, monolingual English with CIs, bilingual Spanish-English with NH, and monolingual English with NH. Spanish and English word lists consisting of 20 words of varying length were generated, and 3 productions of each word were analyzed for percent consonants correct, percent vowels correct, and the presence of any consonant and/or vowel variability. Results Children with CIs demonstrated lower accuracy and more whole-word variability than their peers with NH. There were no differences in rates of accuracy or whole-word variability between bilingual and monolingual children matched on hearing status, and bilingual children had lower accuracy and greater whole-word variability in English than in Spanish. Conclusions High rates of whole-word variability are prevalent in the speech of children with CIs even after many years of CI experience, and bilingual language exposure does not appear to negatively impact phonological development in children with CIs. Contributions to our understanding of underlying sources of speech production variability and clinical implications are discussed.

The Acoustics of Word-Initial Fricatives and Their Effect on Word-Level Intelligibility in Children With Bilateral Cochlear Implants

OBJECTIVES

Previous research has found that relative to their peers with normal hearing (NH), children with cochlear implants (CIs) produce the sibilant fricatives /s/ and /∫/ less accurately and with less subphonemic acoustic contrast. The present study sought to further investigate these differences across groups in two ways. First, subphonemic acoustic properties were investigated in terms of dynamic acoustic features that indexed more than just the contrast between /s/ and /∫/. Second, the authors investigated whether such differences in subphonemic acoustic contrast between sibilant fricatives affected the intelligibility of sibilant-initial single word productions by children with CIs and their peers with NH.

DESIGN

In experiment 1, productions of /s/ and /∫/ in word-initial prevocalic contexts were elicited from 22 children with bilateral CIs (aged 4 to 7 years) who had at least 2 years of CI experience and from 22 chronological age-matched peers with NH. Acoustic features were measured from 17 points across the fricatives: peak frequency was measured to index the place of articulation contrast; spectral variance and amplitude drop were measured to index the degree of sibilance. These acoustic trajectories were fitted with growth-curve models to analyze time-varying spectral change. In experiment 2, phonemically accurate word productions that were elicited in experiment 1 were embedded within four-talker babble and played to 80 adult listeners with NH. Listeners were asked to repeat the words, and their accuracy rate was used as a measure of the intelligibility of the word productions. Regression analyses were run to test which acoustic properties measured in experiment 1 predicted the intelligibility scores from experiment 2.

RESULTS

The peak frequency trajectories indicated that the children with CIs produced less acoustic contrast between /s/ and /∫/. Group differences were observed in terms of the dynamic aspects (i.e., the trajectory shapes) of the acoustic properties. In the productions by children with CIs, the peak frequency and the amplitude drop trajectories were shallower, and the spectral variance trajectories were more asymmetric, exhibiting greater increases in variance (i.e., reduced sibilance) near the fricative-vowel boundary. The listeners' responses to the word productions indicated that when produced by children with CIs, /∫/-initial words were significantly more intelligible than /s/-initial words. However, when produced by children with NH, /s/-initial words and /∫/-initial words were equally intelligible. Intelligibility was partially predicted from the acoustic properties (Cox & Snell pseudo-R > 0.190), and the significant predictors were predominantly dynamic, rather than static, ones.

CONCLUSIONS

Productions from children with CIs differed from those produced by age-matched NH controls in terms of their subphonemic acoustic properties. The intelligibility of sibilant-initial single-word productions by children with CIs is sensitive to the place of articulation of the initial consonant (/∫/-initial words were more intelligible than /s/-initial words), but productions by children with NH were equally intelligible across both places of articulation. Therefore, children with CIs still exhibit differential production abilities for sibilant fricatives at an age when their NH peers do not.

Alveolar and Postalveolar Voiceless Fricative and Affricate Productions of Spanish-English Bilingual Children With Cochlear Implants

PURPOSE

This study investigates the production of voiceless alveolar and postalveolar fricatives and affricates by bilingual and monolingual children with hearing loss who use cochlear implants (CIs) and their peers with normal hearing (NH).

METHOD

Fifty-four children participated in our study, including 12 Spanish-English bilingual CI users (M = 6;0 [years;months]), 12 monolingual English-speaking children with CIs (M = 6;1), 20 bilingual children with NH (M = 6;5), and 10 monolingual English-speaking children with NH (M = 5;10). Picture elicitation targeting /s/, /tʃ/, and /ʃ/ was administered. Repeated-measures analyses of variance comparing group means for frication duration, rise time, and centroid frequency were conducted for the effects of CI use and bilingualism.

RESULTS

All groups distinguished the target sounds in the 3 acoustic parameters examined. Regarding frication duration and rise time, the Spanish productions of bilingual children with CIs differed from their bilingual peers with NH. English frication duration patterns for bilingual versus monolingual CI users also differed. Centroid frequency was a stronger place cue for children with NH than for children with CIs.

CONCLUSION

Patterns of fricative and affricate production display effects of bilingualism and diminished signal, yielding unique patterns for bilingual and monolingual CI users.

Mandarin compound vowels produced by prelingually deafened children with cochlear implants

OBJECTIVE

Compound vowels including diphthongs and triphthongs have complex, dynamic spectral features. The production of compound vowels by children with cochlear implants (CIs) has not been studied previously. The present study examined the dynamic features of compound vowels in native Mandarin-speaking children with CIs.

METHODS

Fourteen prelingually deafened children with CIs (aged 2.9-8.3 years old) and 14 age-matched, normal-hearing (NH) children produced monosyllables containing six Mandarin compound vowels (i.e., /aɪ/, /aʊ/, /uo/, /iɛ/, /iaʊ/, /ioʊ/). The frequency values of the first two formants were measured at nine equidistant time points over the course of the vowel duration. All formant frequency values were normalized and then used to calculate vowel trajectory length and overall spectral rate of change.

RESULTS

The results revealed that the CI children produced significantly longer durations for all six compound vowels. The CI children's ability to produce formant movement for the compound vowels varied considerably. Some CI children produced relatively static formant trajectories for certain diphthongs, whereas others produced certain vowels with greater formant movement than did the NH children. As a group, the CI children roughly followed the NH children on the pattern of magnitude of formant movement, but they showed a slower rate of formant change than did the NH children.

CONCLUSIONS

The findings suggested that prelingually deafened children with CIs, during the early stage of speech acquisition, had not established appropriate targets and articulatory coordination for compound vowel productions. This preliminary study may shed light on rehabilitation of prelingually deafened children with CIs.

Consonant Acquisition in Young Cochlear Implant Recipients and Their Typically Developing Peers

PURPOSE

Consonant acquisition was examined in 13 young cochlear implant (CI) recipients and 11 typically developing (TD) children.

METHOD

A longitudinal research design was implemented to determine the rate and nature of consonant acquisition during the first 2 years of robust hearing experience. Twenty-minute adult-child (typically a parent) interactions were video and audio recorded at 3-month intervals following implantation until 24 months of robust hearing experience was achieved. TD children were similarly recorded between 6 and 24 months of age. Consonants that were produced twice within a 50-utterance sample were considered "established" within a child's consonant inventory.

RESULTS

Although the groups showed similar trajectories, the CI group produced larger consonant inventories than the TD group at each interval except for 21 and 24 months. A majority of children with CIs also showed more rapid acquisition of consonants and more diverse consonant inventories than TD children.

CONCLUSIONS

These results suggest that early auditory deprivation does not significantly affect consonant acquisition for most CI recipients. Tracking early consonant development appears to be a useful way to assess the effectiveness of cochlear implantation in young recipients.

Production of word-initial fricatives of Mandarin Chinese in prelingually deafened children with cochlear implants

PURPOSE

This study examined the production of fricatives by prelingually deafened Mandarin-speaking children with cochlear implants (CIs).

METHOD

Fourteen cochlear implant (CI) children (2.9-8.3 years old) and 60 age-matched normal-hearing (NH) children were recorded producing a list of 13 Mandarin words with four fricatives, /f, s, ɕ, ʂ/, occurring at the syllable-initial position evoked with a picture-naming task. Two phonetically-trained native Mandarin speakers transcribed the fricative productions. Acoustic analysis was conducted to examine acoustic measures including duration, normalised amplitude, spectral peak location and four spectral moments.

RESULT

The CI children showed much lower accuracy rates and more diverse error patterns on all four fricatives than their NH peers. Among these four fricatives, both CI and NH children showed the highest rate of mispronunciation of /s/. The acoustic results showed that the speech of the CI children differed from the NH children in spectral peak location, normalised amplitude, spectral mean and spectral skewness. In addition, the fricatives produced by the CI children showed less distinctive patterns of acoustic measures relative to the NH children.

CONCLUSION

In general, these results indicate that the CI children have not established distinct categories for the Mandarin fricatives in terms of the place of articulation.

Initial Stop Voicing in Bilingual Children With Cochlear Implants and Their Typically Developing Peers With Normal Hearing

PURPOSE

This study focuses on stop voicing differentiation in bilingual children with normal hearing (NH) and their bilingual peers with hearing loss who use cochlear implants (CIs).

METHOD

Twenty-two bilingual children participated in our study (11 with NH, M age = 5;1 [years;months], and 11 with CIs, M hearing age = 5;1). The groups were matched on hearing age and a range of demographic variables. Single-word picture elicitation was used with word-initial singleton stop consonants. Repeated measures analyses of variance with three within-subject factors (language, stop voicing, and stop place of articulation) and one between-subjects factor (NH vs. CI user) were conducted with voice onset time and percentage of prevoiced stops as dependent variables.

RESULTS

Main effects were statistically significant for language, stop voicing, and stop place of articulation on both voice onset time and prevoicing. There were no significant main effects for NH versus CI groups. Both children with NH and with CIs differentiated stop voicing in their languages and by stop place of articulation. Stop voicing differentiation was commensurate across the groups of children with NH versus CIs.

CONCLUSIONS

Stop voicing differentiation is accomplished in a similar fashion by bilingual children with NH and CIs, and both groups differentiate stop voicing in a language-specific fashion.

Acoustic properties of vowel production in prelingually deafened Mandarin-speaking children with cochlear implants

The present study examined the acoustic features of vowel production in Mandarin-speaking children with cochlear implants (CIs). The subjects included 14 native Mandarin-speaking, prelingually deafened children with CIs (2.9-8.3 yr old) and 60 age-matched, normal-hearing (NH) children (3.1-9.0 years old). Each subject produced a list of monosyllables containing seven Mandarin vowels: [i, a, u, y, ɤ, ʅ, ɿ]. Midpoint F1 and F2 of each vowel token were extracted and normalized to eliminate the effects of different vocal tract sizes. Results showed that the CI children produced significantly longer vowels and less compact vowel categories than the NH children did. The CI children's acoustic vowel space was reduced due to a retracted production of the vowel [i]. The vowel space area showed a strong negative correlation with age at implantation (r = -0.80). The analysis of acoustic distance showed that the CI children produced corner vowels [a, u] similarly to the NH children, but other vowels (e.g., [ʅ, ɿ]) differently from the NH children, which suggests that CI children generally follow a similar developmental path of vowel acquisition as NH children. These findings highlight the importance of early implantation and have implications in clinical aural habilitation in young children with CIs.

Number processing and arithmetic skills in children with cochlear implants

Though previous findings report that hearing impaired children exhibit impaired language and arithmetic skills, our current understanding of how hearing and the associated language impairments may influence the development of arithmetic skills is still limited. In the current study numerical/arithmetic performance of 45 children with a cochlea implant were compared to that of controls matched for hearing age, intelligence and sex. Our main results were twofold disclosing that children with CI show general as well as specific numerical/arithmetic impairments. On the one hand, we found an increased percentage of children with CI with an indication of dyscalculia symptoms, a general slowing in multiplication and subtraction as well as less accurate number line estimations. On the other hand, however, children with CI exhibited very circumscribed difficulties associated with place-value processing. Performance declined specifically when subtraction required a borrow procedure and number line estimation required the integration of units, tens, and hundreds instead of only units and tens. Thus, it seems that despite initially atypical language development, children with CI are able to acquire arithmetic skills in a qualitatively similar fashion as their normal hearing peers. Nonetheless, when demands on place-value understanding, which has only recently been proposed to be language mediated, hearing impaired children experience specific difficulties.

Vowel discrimination by hearing infants as a function of number of spectral channels

Reduced spectral resolution negatively impacts speech perception, particularly perception of vowels and consonant place. This study assessed impact of number of spectral channels on vowel discrimination by 6-month-old infants with normal hearing by comparing three listening conditions: Unprocessed speech, 32 channels, and 16 channels. Auditory stimuli (/ti/ and /ta/) were spectrally reduced using a noiseband vocoder and presented to infants with normal hearing via visual habituation. Results supported a significant effect of number of channels on vowel discrimination by 6-month-old infants. No differences emerged between unprocessed and 32-channel conditions in which infants looked longer during novel stimulus trials (i.e., discrimination). The 16-channel condition yielded a significantly different pattern: Infants demonstrated no significant difference in looking time to familiar vs novel stimulus trials, suggesting infants cannot discriminate /ti/ and /ta/ with only 16 channels. Results support effects of spectral resolution on vowel discrimination. Relative to published reports, young infants need more spectral detail than older children and adults to perceive spectrally degraded speech. Results have implications for development of perception by infants with hearing loss who receive auditory prostheses.

Emergence of speech sounds between 7 and 24 months of cochlear implant use

OBJECTIVES

To investigate the process of speech development in five 42-month-old children with profound deafness who received cochlear implants (CIs) between 19 and 36 months of age and five normal hearing (NH) age mates.

METHODS

Conversational samples were collected and transcribed. Sounds produced correctly within meaningful words (target sounds) and recognizable sounds produced in spontaneous productions (target-less sounds) were analyzed for all 10 children.

RESULTS

Revealed that there was overlap in the total number of vowels and consonants produced by the two groups. The differences between the two groups were more evident in the target condition, whereas the two groups were more similar in the target-less condition.

DISCUSSION

The similarities documented in the target-less repertoire of CI and NH children underscore the importance of examining the emerging sound system to predict the end-point sound system in children with CIs. Using target and target-less speech sound comparisons offers a supplementary view of the emergent process of speech sound development and is a valid method of analysis. Results suggest that early implantation may help some children with profound deafness develop speech sounds in a manner similar to NH age mates.

Consonant development in pediatric cochlear implant users who were implanted before 30 months of age

This study provided a yearly record of consonant development for the initial 4 years of cochlear implant (CI) use and established a precedent for using a standardized articulation test, the Goldman-Fristoe Test of Articulation-2 (Goldman, R., & Fristoe, M. [2000]. Goldman-Fristoe Test of Articulation-2. Circle Pines, MN: American Guidance Services). The study used CI age as a referent for 32 children who received their CI before 30 months of age. Consonants produced by 70% of the children were listed, as were the most common error types, which were consonant omissions and substitutions. Using consonant repertoire lists and standard scores, the study revealed that children with CIs had acquisition patterns that were similar to their peers when the duration of CI experience was similar to the chronological age norms of typically developing children. The results revealed that CI users need time to coordinate their articulatory organizing principles with the input they receive from their CI. It is appropriate to use length of CI use as a proxy for chronological age during the first 4 years when comparing articulation development with hearing peers.

Listen up: children with early identified hearing loss achieve age-appropriate speech/language outcomes by 3 years-of-age

OBJECTIVES

Age-appropriate speech/language outcomes for children with early identified hearing loss are a possibility but not a certainty. Identification of children most likely to achieve optimal outcomes is complicated by the heterogeneity of the children involved in outcome research, who present with a range of malleable (e.g. age of identification and cochlear implantation, type of intervention, communication mode) and non-malleable (e.g. degree of hearing loss) factors. This study considered whether a homogenous cohort of early identified children (≤ 12 months), with all severities of hearing loss and no other concomitant diagnoses could not only significantly outperform a similarly homogenous cohort of children who were later identified (>12 months to <5 years), but also achieve and maintain age-appropriate speech/language outcomes by 3, 4 and 5 years of age.

METHODS

A mixed prospective/retrospective comparative study of a homogenous cohort of 45 early identified (≤ 12 months) and 49 late identified (> 12 months to < 5 years) children with hearing loss was conducted. The children all attended the same oral auditory-verbal early intervention programme. Speech/language assessments standardized on typically developing hearing children were conducted at 3, 4 and 5 years of age.

RESULTS

The early identified children significantly outperformed the late identified at all ages and for all severities of HL. By 3 years of age, 93% of all early identified participants scored within normal limits (WNL) for speech; 90% were WNL for understanding vocabulary; and 95% were WNL for receptive and expressive language. Progress was maintained and improved so that by 5 years of age, 96% were WNL for speech, with 100% WNL for language.

CONCLUSIONS

This study found that most children with all severities of hearing loss and no other concomitant diagnosed condition, who were early diagnosed; received amplification by 3 months; enrolled into AV intervention by 6 months and received a cochlear implant by 18 months if required, were able to "keep up with" rather than "catch up to" their typically hearing peers by 3 years of age on measures of speech and language, including children with profound hearing loss. By 5 years, all children achieved typical language development and 96% typical speech.

Production of contrast between sibilant fricatives by children with cochlear implants

Speech production by children with cochlear implants (CIs) is generally less intelligible and less accurate on a phonemic level than that of normally hearing children. Research has reported that children with CIs produce less acoustic contrast between phonemes than normally hearing children, but these studies have included correct and incorrect productions. The present study compared the extent of contrast between correct productions of /s/ and /∫/ by children with CIs and two comparison groups: (1) normally hearing children of the same chronological age as the children with CIs and (2) normally hearing children with the same duration of auditory experience. Spectral peaks and means were calculated from the frication noise of productions of /s/ and /∫/. Results showed that the children with CIs produced less contrast between /s/ and /∫/ than normally hearing children of the same chronological age and normally hearing children with the same duration of auditory experience due to production of /s/ with spectral peaks and means at lower frequencies. The results indicate that there may be differences between the speech sounds produced by children with CIs and their normally hearing peers even for sounds that adults judge as correct.

Spoken word recognition in adolescent cochlear implant users during quiet and multispeaker babble conditions

OBJECTIVE

To assess overall speech intelligibility in adolescent cochlear implant speakers during quiet and multispeaker babble conditions.

STUDY DESIGN

A cross-sectional assessment of intelligibility incorporating group (auditory-oral versus total communication speakers), sentence context (high versus low contexts), and background conditions (quiet versus multispeaker babble).

SETTING

A camp designed to assess adolescents over a concentrated period.

PARTICIPANTS

Fifty-seven adolescents who participated in an earlier study when they were 8 to 9 years old examining functional outcomes of speech perception, speech production, and language were asked to participate in follow-up study.

METHODS

Speech intelligibility was assessed by asking the adolescents to repeat sentences. Sentences were digitally edited and played to normal hearing listeners who either provided broad transcriptions of sound accuracy or wrote down the words they understood when the sentences were presented in quiet and in multispeaker babble.

MAIN OUTCOME VARIABLE

The dependent variables were percent correct consonants, vowels, and total words identified.

RESULTS

Very few substitutions or omissions occurred, resulting in high levels of accuracy for consonants and vowels. Speech intelligibility in quiet was significantly greater than in the multispeaker babble condition. Multispeaker babble decreased performance uniformly across sentence context for the 2 groups.

CONCLUSION

Accurate consonant production based on measures of substitutions and omissions fails to account for distortions and allophonic variations. Reductions in speech intelligibility relative to the phoneme correct productions suggest that the allophonic variations related to distortions may influence naive listener's ability to understand the speech of profoundly deaf individuals.

A new measurement tool for speech development based on Ling's stages of speech acquisition in pediatric cochlear implant recipients

OBJECTIVES

With the rapid increase of pediatric cochlear implantation (CI), there exists a need for a standardized assessment tool regarding speech and communication skills in children with CI. However, the current testing tools are not appropriate for the longitudinal evaluation of young children after CI. The aims of this study were to describe a progressive testing tool developed for the evaluation of speech acquisition and production in young children who have undergone CI and to examine its validity.

METHODS

Sixty children younger than six years of age with CI participated in this study. A Korean version of Ling's stages (K-Ling) was developed based on the Ling speech teaching model to longitudinally assess phonologic and phonetic developments in young children after CI. The K-Ling, the Categories of Auditory Performance (CAP), and the Sequenced Language Scale for Infants (SELSI) were performed in the children with CI preoperatively and three, six, and 12 months postoperatively. Correlations among these three testing tools were analyzed.

RESULTS

Auditory, language, and speech skills assessed using the CAP, SELSI, and K-Ling improved continuously for 12 months in young children following CI. Strong correlations were obtained among K-Ling's level, CAP scores, and the equivalent age of SELSI; correlation indices ranged from 0.540 to 0.800.

CONCLUSIONS

The K-Ling was a valid evaluation tool regarding speech development in young children who are using CI and who are in the early stages of speech development. Longitudinal assessments of phonetic and phonologic developments may be attainable in young children using the K-Ling.

Speech production accuracy and variability in young cochlear implant recipients: comparisons with typically developing age-peers

PURPOSE

The speech production accuracy and variability scores of 6 young cochlear implant (CI) recipients with 2 years of device experience were compared with those of typically developing (TD) age-peers.

METHOD

Words from the First Words Speech Test (FWST; Ertmer, 1999) were imitated 3 times to assess the accuracy and variability of initial consonants, vowels, and words. The initial consonants in the 4 sets of the FWST followed a typical order of development.

RESULTS

The TD group produced targets with high accuracy and low variability. Their scores across FWST sets reflected the expected order of development. The CI group produced most targets less accurately and with more variability than the TD children. Relatively high accuracy for the consonants of Sets 1 and 2 indicated that these phonemes were acquired early and in a typical developmental order. A trend toward greater accuracy for Set 4 as compared with Set 3 suggested that later-emerging consonants were not acquired in the expected order. Variability was greatest for later-emerging initial consonants and whole words.

DISCUSSION

Although considerable speech production proficiency was evident, age-level performance was not attained after 2 years of CI experience. Factors that might influence the order of consonant acquisition are discussed.

Single word and sentence intelligibility in children with cochlear implants

This study examined the intelligibility of speech produced by 17 children (aged 4-11 years) with cochlear implants. Stimulus items included sentences from the Beginners' Intelligibility Test (BIT) and words from the Children Speech Intelligibility Measure (CSIM). Naïve listeners responded by writing sentences heard or with two types of responses to the word recordings; open transcription (CSIM-T) and closed set multiple choice (CSIM-MC). Percentage of items understood, averaged across three naïve judges, were compared across the three measures. Additionally, scores were examined for any relationships with chronological age, age of implantation, and amount of implant experience. Strong positive correlations were observed among all three intelligibility tasks. Scores on all three tasks were found to be significantly different from each other. A significant correlation was obtained between intelligibility and amount of implant experience, but not with chronological age or age of implantation. Results suggest that judging the intelligibility of speech produced by children with cochlear implants using both single word and sentence levels would provide a better overall estimate of their intelligibility. The results also emphasize the vital role of auditory input in the development of intelligible speech.

A comparison of the consonant production between Dutch children using cochlear implants and children using hearing aids

OBJECTIVES

The main purpose of the present study was to compare the consonant error patterns of Dutch prelingually deaf CI children with prelingually hearing-impaired hearing aid (HA) children. The authors hypothesized that subjects using conventional hearing aids would have poorer consonant production skills. Additionally, the impact of the age at implantation (CI) and the degree of hearing loss (HA) was determined.

METHODOLOGY

This is a comparative study of 29 prelingually deaf CI children (m.a. 9;0 y) and 32 prelingually hearing-impaired HA children (m.a. 9;11 y) who received their first hearing aid before the age of 2 years. Nineteen CI children were implanted before the age of 5 years. Nine HA children had thresholds above 90dB (range: 91-105dB), 15 between 70 and 90dB (range: 72-90dB) and 8 below 70dB (range: 58-68dB). Speech samples of all the children were elicited by means of a picture naming test and were video-recorded for further phonetic and phonological analysis.

RESULTS

Considerably more phonetic and phonologic errors were observed in the HA children with thresholds above 70dB (range: 72-105dB). No notable differences could be found between deaf CI children and HA children with thresholds below 70dB. Even children implanted after the age of 5 years showed significantly fewer phonetic and phonological errors than HA children.

CONCLUSION

The consonant production of implanted children is more adequate than the consonant production of HA children with a hearing loss of 70dB or more. In addition, the results also indicate that even after the age of 5 years, implantation can still have an advantageous effect on a child's consonant production.

Accuracy of consonant-vowel syllables in young cochlear implant recipients and hearing children in the single-word period

PURPOSE

Attaining speech accuracy requires that children perceive and attach meanings to vocal output on the basis of production system capacities. Because auditory perception underlies speech accuracy, profiles for children with hearing loss (HL) differ from those of children with normal hearing (NH).

METHOD

To understand the impact of auditory history on emergence of speech capacities, the authors compared consonant-vowel (CV) syllable accuracy in early words in 4 NH children and 4 children with HL who received cochlear implantation (CI) before age 2 years. Participants were video-recorded monthly for 6 months following word onset. CV vocalizations were coded perceptually with broad phonetic transcription. Observed-to-expected ratios of CV productions and accuracy were tested with chi-square analysis. An ordered multinomial model tested level of accuracy, including both accuracy and error patterns.

RESULTS

Most frequently produced sequences were most accurately produced across group and time. NH children were more accurate overall than children with CI. Both groups improved accuracy over time by decreasing partially accurate productions (accurate consonant-inaccurate vowel). Both groups favored CV patterns with compatible place of articulation between consonant and vowel in absolute frequency and level of accuracy.

CONCLUSION

Differences in emergence of CV syllable accuracy arise from differences in auditory perception between the NH and CI groups.

Transcribing the speech of children with cochlear implants: clinical application of narrow phonetic transcriptions

PURPOSE

The phonological systems of children with cochlear implants may include segment inventories that contain both target and nontarget speech sounds. These children may not consistently follow phonological rules of the target language. These issues present a challenge for the clinical speech-language pathologist who uses phonetic transcriptions to evaluate speech production skills and to develop a plan of care. The purposes of this tutorial are to (a) identify issues associated with phonetic transcriptions of the speech of children with cochlear implants and (b) discuss implications for assessment.

METHOD

Narrow transcription data from an ongoing, longitudinal research study were catalogued and reviewed. Study participants had at least 5 years of cochlear implant experience and used spoken American English as a primary means of communication. In this tutorial, selected phonetic symbols and phonetic phenomena are reviewed.

CONCLUSIONS

A set of principles for phonetic transcriptions is proposed. Narrow phonetic transcriptions that include all segment possibilities in the International Phonetic Alphabet and extensions for disordered speech are needed to capture the subtleties of the speech of children with cochlear implants. Narrow transcriptions also may play a key role in planning treatment.

Articulation skills in Turkish speaking children with cochlear implant

OBJECTIVE

The benefits of using cochlear implant (CI) on speech perception and production have been documented. The aim of this study is to investigate the effect of age of cochlear implantation performed and length of auditory experience with CI on the development of articulation skills in prelingual children with CI.

METHODS

For this purpose, 14 children with CI were administered through the standardized articulation test named AAT (Ankara Articulation Test). In order to evaluate the development of articulation skills, AAT was applied to each child with CI at the first and the fourth years of CI. The test group was selected among those congenitally hearing impaired children who had used hearing aids bilaterally before the age of one and a half, and received intervention after fitting hearing aids. The test group was divided into two subgroups: Group 1 consisted of the children implanted at and below the age of 3 and Group 2 consisted of the children implanted after the age of 3. Evaluations of articulation skills between groups and within groups were performed in the first and fourth years of implantation. In the study, nonparametric statistics have been used to compare the test scores. Mann-Whitney U-test and Wilcoxon test have been used in the comparisons made between groups and within groups, respectively.

RESULTS

While there has not been observed any statistically significant difference between the first year articulation skills of children with CI at and below the age of three and children with CI above the age of 3, for the fourth year this difference has been found to be statistically significant.

CONCLUSIONS

The results demonstrate the importance of the early application of CI and length of auditory experience with CI in the development of articulation skills.

Effects of frequency allocation on lexical tone identification by Mandarin-speaking children with a cochlear implant

CONCLUSION

Frequency allocation with extended frequency ranges yielded significantly higher accuracy in pediatric CI recipients' lexical tone identification. These findings suggest that frequency allocation with extended frequency ranges may be useful in improving lexical tone recognition for at least some pediatric CI recipients.

OBJECTIVES

To assess the effects of frequency allocation on lexical tone identification by Mandarin-speaking children with a cochlear implant (CI).

SUBJECTS AND METHODS

In a prospective study, 15 prelingually deafened children between 7.17 and 16.17 years of age served as participants. Using Med-el CI devices, each participant's accuracy in lexical tone identification was compared in two conditions: first, the experimental condition, i.e. use of the extended frequency range from 233 to 8501 Hz; second, the control condition, i.e. use of the participant's clinically assigned frequency range from 300 to 8404 Hz.

RESULTS

The group mean of pediatric CI users' accuracy in lexical tone identification was 88.02% (SD = 6.31%) in the experimental condition and 83.82% (SD = 9.84%) in the control condition. The group mean was 4.20% (SD = 5.48%) higher in the experimental condition than that in the control condition; this difference was statistically significant (t(14) = 2.97, p=0.010).

Long-term trajectories of the development of speech sound production in pediatric cochlear implant recipients

PURPOSE

This study characterized the development of speech sound production in prelingually deaf children with a minimum of 8 years of cochlear implant (CI) experience.

METHOD

Twenty-seven pediatric CI recipients' spontaneous speech samples from annual evaluation sessions were phonemically transcribed. Accuracy for these speech samples was evaluated in piecewise regression models.

RESULTS

As a group, pediatric CI recipients showed steady improvement in speech sound production following implantation, but the improvement rate declined after 6 years of device experience. Piecewise regression models indicated that the slope estimating the participants' improvement rate was statistically greater than 0 during the first 6 years postimplantation, but not after 6 years. The group of pediatric CI recipients' accuracy of speech sound production after 4 years of device experience reasonably predicts their speech sound production after 5-10 years of device experience.

CONCLUSIONS

The development of speech sound production in prelingually deaf children stabilizes after 6 years of device experience, and typically approaches a plateau by 8 years of device use. Early growth in speech before 4 years of device experience did not predict later rates of growth or levels of achievement. However, good predictions could be made after 4 years of device use.

The effect of modern standard arabic orthography on speech production by Arab children with hearing loss

This article examined the effect of Modern Standard Arabic orthography on speech production quality (syllable stress and vowels) by 23 Arabic-speaking children with severe or profound hearing loss aged 8-12 years. Children produced 15 one-syllable minimal pairs of words that differed in vowel length (short vs. long) and 20 two-syllable minimal pairs differing in stress pattern. Each word was produced in three tasks: reading partially or fully vowelized words and imitation of aural stimuli. Results showed that fully vowelized words ensured vowel production: high-quality productions appeared on 99%, 74%, and 59% of productions on reading fully vowelized words, partially vowelized words, and on imitation, respectively. Moreover, correct vowel production affected correct consonant production. Correct production of stress was best on reading fully vowelized words, appearing on 54%, 21%, and 33% of productions for fully vowelized words, partially vowelized words, or imitation, respectively. Findings suggest the need to present fully vowelized written texts when teaching speech production to children with hearing loss. Such presentations enable more accurate productions that result in more intelligible speech.

Production of consonants by prelinguistically deaf children with cochlear implants

Consonant production following the sensory restoration of audition was investigated in 22 prelinguistically deaf French children who received cochlear implants. Spontaneous speech productions were recorded at 6, 12, and 18 months post-surgery and consonant inventories were derived from both glossable and non-glossable phones using two acquisition criteria. The results showed that children initiated appropriate production of consonants after six months of implant use. Stops and labials were the most frequently produced speech sounds, whereas glides and palatals were still infrequent after 18 months. Speech accuracy also improved throughout the study. Consonant visibility appeared to influence the order of acquisition in the first months following the implantation and, as experience with auditory information increased, patterns of development tended to resemble those seen in children with normal hearing. Finally, a signed mode of communication and oral rehabilitation programs prior to implantation were better outcome predictors than age at implantation.

Profiles of vocal development in young cochlear implant recipients

PURPOSE

The main purpose of this investigation was to examine the effects of cochlear implant experience on prelinguistic vocal development in young deaf children. Procedure A prospective longitudinal research design was used to document the sequence and time course of vocal development in 7 children who were implanted between 10 and 36 months of age. Speech samples were collected twice before implant activation and on a monthly basis thereafter for up to 2 years. Children's vocalizations were classified according to the levels of the Stark Assessment of Early Vocal Development--Revised (SAEVD-R; S. Nathani, D. J Ertmer, & R. E. Stark, 2006).

RESULTS

The main findings were (a) 6 of 7 children made advancements in vocal development after implantation; (b) children implanted between 12 and 36 months progressed through SAEVD-R levels in the predicted sequence, whereas a child implanted at a younger age showed a different sequence; (c) milestones in vocal development were often achieved with fewer months of hearing experience than observed in typically developing infants and appeared to be influenced by age at implantation; and (d) in general, children implanted at younger ages completed vocal development at younger chronological ages than those implanted later in life. Specific indicators of benefit from implant use were also identified.

CONCLUSION

The time course of vocal development in young cochlear implant recipients can provide clinically useful information for assessing the benefits of implant experience. Studies of postimplantation vocal development have the potential to inform theories of spoken language development.

Prosody and voice characteristics of children with cochlear implants

This descriptive, longitudinal study involved the analysis of the prosody and voice characteristics of conversational speech produced by six young children with severe to profound hearing impairments who had been fitted with cochlear implants. A total of 40 samples were analyzed using the Prosody-Voice Screening Profile (PVSP; Shriberg, L. D., Kwiatkowski, J., & Rasmussen, C. (1990). Prosody-Voice Screening Profile (PVSP). Tuscon, AZ: Communication Skill Builders). Overall, the children presented with noticeable problems with stress and resonance quality. There were some difficulties noted with rate, loudness, and laryngeal quality, but there were no consistent difficulties with phrasing or pitch. This suggested that prosody and voice characteristics in this population are different from those typically observed in children with severe to profound hearing impairments though some problem areas remain. Some developmental trends were also observed. These findings suggest that cochlear implants offer some significant benefits to children with hearing impairment in terms of prosody and voice outcomes.

Factors affecting the acquisition of vowel phonemes by pre-linguistically deafened cochlear implant users learning Cantonese

This paper describes the development of vowel inventories in 12 pre-linguistically deafened Cantonese-speaking cochlear implant users. The aim of the research was to understand the role of linguistic, perceptual and articulatory factors in determining the rate and order of vowel acquisition in this population of children. Rate and order of vowel acquisition were reported against two criteria. The "targetless" criterion for production required at least two correct productions of a vowel in a sample of speech. The second or "target" criterion required that a vowel first met the targetless criterion and was further produced correctly in the appropriate phonological context at least 50% of the time. Factors associated with articulatory difficulty were shown to explain the composition of pre-implant vowel inventories. Subsequent to receiving an implant, all children demonstrated a steady and systematic expansion in the size of their vowel inventories though the rate of acquisition varied between individuals. The order of vowel acquisition was affected by a combination of linguistic and articulatory factors. The paper concludes by discussing the clinical implications of these findings for helping children develop good spoken language skills subsequent to receiving an implant.

Control of voice-onset time in the absence of hearing: a review

The relation between partial or absent hearing and control of the voicing contrast has long been of interest to investigators, in part because speakers who are born deaf characteristically have great difficulty mastering the contrast and in part for the light it can cast on the role of hearing in the acquisition and maintenance of phonological contrasts in general. One of the phonetic characteristics that distinguish voiced from voiceless plosives in English (p/b, t/d, k/g) is voice onset time (VOT): the interval from plosive release to the onset of voicing of the following vowel. This article first reviews research on VOT anomalies in the speech production of prelingually and postlingually deaf speakers. Then it turns to studies of the mechanisms in speech breathing, phonation and articulation that underlie those anomalies. In both populations of speakers, there is a tendency for the difference between voiced and voiceless VOT to be reduced, to the point for many speakers that there is in effect a substitution of the voiced for the voiceless cognate. The separation of the cognate VOTs can be enhanced when some hearing is restored with a cochlear implant. Both populations also present anomalies in speech breathing that can hinder the development of intraoral pressures and transglottal pressure drops that are required for the production of the VOT contrast. Its successful management further requires critical timing among phonatory and articulatory gestures, most of which are not visible, rendering the VOT contrast a particular challenge in the absence of hearing.

Speech intelligibility of pediatric cochlear implant recipients with 7 years of device experience

Speech intelligibility of 24 prelingually deaf pediatric cochlear implant (CI) recipients with 84 months of device experience was investigated. Each CI participant's speech samples were judged by a panel of 3 listeners. Intelligibility scores were calculated as the average of the 3 listeners' responses. The average write-down intelligibility score was 71.54% (SD = 29.89), and the average rating-scale intelligibility score was 3.03 points (SD = 1.01). Write-down and rating-scale intelligibility scores were highly correlated (r = .91, p < .001). Linear regression analyses revealed that both age at implantation and different speech-coding strategies contribute to the variability of CI participants' speech intelligibility. Implantation at a younger age and the use of the spectral-peak speech-coding strategy yielded higher intelligibility scores than implantation at an older age and the use of the multipeak speech-coding strategy. These results serve as indices for clinical applications when long-term advancements in spoken-language development are considered for pediatric CI recipients.

Children's consonant inventories after extended cochlear implant use

Qualitative descriptions of the consonant inventories of 12 children who have used cochlear implants for at least 5 years are provided, together with description of sound correspondences between children's systems and the ambient language (English). Productions of English words were elicited in a picture-naming task, and a consonant inventory for each child was determined. Results showed that the consonant inventories of children who use cochlear implants are not simply subsets of the inventory of the ambient language, but rather unique sets of segments that may include consonants not in the ambient inventory. Comparison of the inventories of oral communication users and total communication users revealed qualitative differences between the 2 groups, based on the presence or absence of both English and non-English sound segments. Inventories of oral communication users tended to contain more English segments (e.g., alveolar fricatives, velar stops, velar nasals) than did the inventories of total communication users. Conversely, specific non-English segments, such as uvular stops, tended to occur in the inventories of total communication users more than in inventories of oral communication users. Therefore, a complete understanding of the phonological systems of children who use cochlear implants depends on full accounts of their segment inventories. Such understanding may affect decisions regarding habilitation procedures, insofar as successful acquisition of a linguistic system involves not only the inclusion of all ambient sound segments, but also the exclusion of all nonambient ones.