Visual-motor integration skills of prelingually deaf children: implications for pediatric cochlear implantation

Cross-modal digit span and vocabulary proficiency in deaf or hard-of-hearing children

This study aims to examine the relationship between vocabulary proficiency and short-term memory capacity in deaf or hard-of-hearing (DHH) children. We test the hypothesis that the relationship between vocabulary skills and digit span performance could be strengthened when the digit span task encompasses cross-modal integration processes. A group of DHH children performed two types of auditory digit span tasks. Furthermore, they participated in a standardized vocabulary proficiency test, comprising two subtests: Receptive Vocabulary and Expressive Vocabulary. The verbal digit span served as a significant predictor of Expressive Vocabulary among the DHH children. Simultaneously, the auditory-pointing digit span accounted for a substantial portion of performance variation in both Receptive and Expressive Vocabulary. After considering the impact of the duration of auditory-verbal intervention through regression models, likelihood ratio tests demonstrated that the auditory-pointing digit span persisted as a significant determinant of both receptive and expressive vocabulary skills. A positive influence of the intervention was also confirmed by the present results. This study provides evidence that memory span and the ability to integrate cross-modal information could serve as significant cognitive correlates of vocabulary proficiency in DHH children.

Parent-child sensorimotor coordination in toddlers with and without hearing loss

Infants experience the world through their actions with objects and their interactions with other people, especially their parents. Prior research has shown that school-age children with hearing loss experience poorer quality interactions with typically hearing parents, yet little is known about parent-child interactions between toddlers with hearing loss and their parents early in life. In the current study, we used mobile eye-tracking to investigate parent-child interactions in toddlers with and without hearing loss (mean ages: 19.42 months, SD = 3.41 months). Parents and toddlers engaged in a goal-directed, interactive task that involved inserting coins into a slot and required joint coordination between the parent and the child. Overall, findings revealed that deaf toddlers demonstrate typical action skills in line with their hearing peers and engage in similar interactions with their parents during social interactions. Findings also revealed that deaf toddlers explored objects more and showed more temporal stability in their motor movements (i.e. less variation in their timing across trials) than hearing peers, suggesting further adaptability of the deaf group to their atypical sensory environment rather than poorer coordination. In contrast to previous research, findings suggest an intact ability of deaf toddlers to coordinate their actions with their parents and highlight the adaptability within dyads who have atypical sensory experiences.

Visual Perception and Attentional Skills in School-age Children: A Cross-Sectional Study of Reading Proficiency in the Hearing Impaired

Background

Auditory impairment is one of the common sensory deficits that occur in humans. Hearing loss affects students' ability to communicate and read, which eventually causes social and scholastic stigma. Reading relies heavily on phonics as well as visual attention. Students with normal hearing read by transforming phonic sounds into words. Hearing impaired has little to no phonic ability, making them visual readers who rely on visual cues while reading. Present study sought to investigate factors that affect reading skills in hearing-impaired children.

Material and Methods

A cross-sectional study was conducted in hearing- and hearing-impaired schools of Ludhiana, Punjab, India. After vision screening among all students, sixty students were enrolled via convenient sampling. Higher order of visual perception, attention, and reading ability was investigated.

Results

A total of 60 students were evaluated (30 hearing impaired and 30 age-matched hearing). The hearing group was statistically better than the hearing impaired (p = 0.001), Hearing impaired were better in visual attention (p = 0.001), whereas a correlation was found between reading ability and visual perception, attention skill of hearing- and hearing-impaired students (r = 0.80, P = 0.001).

Conclusion

Present study concludes that hearing-impaired students exhibit issues with visual-motor integration, visual-spatial relationships, and visual sequential memory. Higher visual attention was demonstrated by hearing-impaired students. The results of the current investigation revealed a correlation between visual perception and attention skills and reading competency. Thus, the present study demands that the newly enrolled hearing-impaired students must undergo a thorough ocular evaluation.

Early general development and central auditory system maturation in children with cochlear implants - A case series

OBJECTIVES

A cochlear implant (CI) has the potential to improve the functioning of a deaf child in many aspects. Nevertheless, the dynamics of the general development, beyond the typically measured language abilities, directly after CI, is still unknown, especially if a child is implanted early. In this study we present a methodological framework for assessment of different domains of development, as well as the central auditory nervous system (CANS) maturation in infants and toddlers with a CI.

METHODS

Three children with bilateral congenital hearing loss and a unilateral CI, aged below 2.5 years, participated in a longitudinal study. Children were tested at three time points after cochlear implantation using the Polish Children Development Scale (CDS) consisting of a comprehensive battery of tests, as well as recordings of Cortical Auditory Evoked Potentials (CAEP).

RESULTS

All three children revealed gradual improvement in the overall CDS result as well as most of the CDS subscales. After 9 months of CI experience two younger children showed age-appropriate performance. In CAEP measurements a decrease of latency of the P1 component (an established biomarker of cortical auditory maturation) was observed in the same two children, with one achieving normal ranges of P1 latency after 9 months of CI use.

CONCLUSIONS

Our novel methodological framework can be successfully applied in small children with cochlear implants. It contributes to better understanding of the general development in early implanted children. The preliminary results indicate variability in children's performance in various developmental domains and thus the need to monitor the development of each child individually and holistically.

A possible key role of vision in the development of schizophrenia

Based on a brief overview of the various aspects of schizophrenia reported by numerous studies, here we hypothesize that schizophrenia may originate (and in part be performed) from visual areas. In other words, it seems that a normal visual system or at least an evanescent visual perception may be an essential prerequisite for the development of schizophrenia as well as of various types of hallucinations. Our study focuses on auditory and visual hallucinations, as they are the most prominent features of schizophrenic hallucinations (and also the most studied types of hallucinations). Here, we evaluate the possible key role of the visual system in the development of schizophrenia.

The Role of Statistical Learning in Understanding and Treating Spoken Language Outcomes in Deaf Children With Cochlear Implants

Purpose

Statistical learning-the ability to learn patterns in environmental input-is increasingly recognized as a foundational mechanism necessary for the successful acquisition of spoken language. Spoken language is a complex, serially presented signal that contains embedded statistical relations among linguistic units, such as phonemes, morphemes, and words, which represent the phonotactic and syntactic rules of language. In this review article, we first review recent work that demonstrates that, in typical language development, individuals who display better nonlinguistic statistical learning abilities also show better performance on different measures of language. We next review research findings that suggest that children who are deaf and use cochlear implants may have difficulties learning sequential input patterns, possibly due to auditory and/or linguistic deprivation early in development, and that the children who show better sequence learning abilities also display improved spoken language outcomes. Finally, we present recent findings suggesting that it may be possible to improve core statistical learning abilities with specialized training and interventions and that such improvements can potentially impact and facilitate the acquisition and processing of spoken language.

Method

We conducted a literature search through various online databases including PsychINFO and PubMed, as well as including relevant review articles gleaned from the reference sections of other review articles used in this review. Search terms included various combinations of the following: sequential learning, sequence learning, statistical learning, sequence processing, procedural learning, procedural memory, implicit learning, language, computerized training, working memory training, statistical learning training, deaf, deafness, hearing impairment, hearing impaired, DHH, hard of hearing, cochlear implant(s), hearing aid(s), and auditory deprivation. To keep this review concise and clear, we limited inclusion to the foundational and most recent (2005-2018) relevant studies that explicitly included research or theoretical perspectives on statistical or sequential learning. We here summarize and synthesize the most recent and relevant literature to understanding and treating language delays in children using cochlear implants through the lens of statistical learning.

Conclusions

We suggest that understanding how statistical learning contributes to spoken language development is important for understanding some of the difficulties that children who are deaf and use cochlear implants might face and argue that it may be beneficial to develop novel language interventions that focus specifically on improving core foundational statistical learning skills.

Linear Mixed-Model Analysis to Examine Longitudinal Trajectories in Vocabulary Depth and Breadth in Children Who Are Hard of Hearing

Purpose Children who are hard of hearing (CHH) tend to have reduced vocabularies compared to children with normal hearing (CNH). Prior research on vocabulary skills in children with hearing loss has focused primarily on their breadth of knowledge (how many words are known). Depth of vocabulary knowledge (how well words are known) is not well documented for CHH. The current study used linear mixed models (LMMs) to investigate growth trajectories of vocabulary depth and breadth in CHH relative to age-matched CNH. Method Participants for this study included 155 children (93 CHH, 62 CNH) enrolled in a longitudinal study. Examiners administered a standardized measure of vocabulary knowledge at ages 7, 8, and 9 years. We constructed multiple LMMs with fixed effects for group and age. The models included various combinations of random intercepts for subject and item and random slope for age. Results For depth, CHH showed significant and stable deficits compared to CNH over time. For breadth, CNH showed greater vocabulary breadth, but the group differences diminished with age. For CHH, higher aided audibility, age, and maternal educational level were associated with greater vocabulary breadth and depth. Age at hearing aid fitting was not. Conclusions A major advantage of using LMM is that it allowed us to cope with missing data points while still accounting for variability within and across participants. Assessment of both vocabulary breadth and depth may be useful in identifying school-age CHH who are at risk of delays in language outcomes.

Visual habituation in deaf and hearing infants

Early cognitive development relies on the sensory experiences that infants acquire as they explore their environment. Atypical experience in one sensory modality from birth may result in fundamental differences in general cognitive abilities. The primary aim of the current study was to compare visual habituation in infants with profound hearing loss, prior to receiving cochlear implants (CIs), and age-matched peers with typical hearing. Two complementary measures of cognitive function and attention maintenance were assessed: the length of time to habituate to a visual stimulus, and look-away rate during habituation. Findings revealed that deaf infants were slower to habituate to a visual stimulus and demonstrated a lower look-away rate than hearing infants. For deaf infants, habituation measures correlated with language outcomes on standardized assessments before cochlear implantation. These findings are consistent with prior evidence suggesting that habituation and look-away rates reflect efficiency of information processing and may suggest that deaf infants take longer to process visual stimuli relative to the hearing infants. Taken together, these findings are consistent with the hypothesis that hearing loss early in infancy influences aspects of general cognitive functioning.

Scoping Review of Systems to Train Psychomotor Skills in Hearing Impaired Children

OBJECTIVES

The aim of this work is to provide a scoping review to compile and classify the systems helping train and enhance psychomotor skills in hearing impaired (HI) children.

METHODS

Based on an exhaustive review on psychomotor deficits in HI children, the procedure used to carry out a scoping review was: select keywords and identify synonyms, select databases and prepare the queries using keywords, analyze the quality of the works found using the PEDro Scale, classify the works based on psychomotor competences, analyze the interactive systems (e.g., sensors), and the achieved results.

RESULTS

Thirteen works were found. These works used a variety of sensors and input devices such as cameras, contact sensors, touch screens, mouse and keyboard, tangible objects, haptic and virtual reality (VR) devices.

CONCLUSIONS

From the research it was possible to contextualize the deficits and psychomotor problems of HI children that prevent their normal development. Additionally, from the analysis of different proposals of interactive systems addressed to this population, it was possible to establish the current state of the use of different technologies and how they contribute to psychomotor rehabilitation.

Temporary conductive hearing loss in early life impairs spatial memory of rats in adulthood

INTRODUCTION

It is known that an interruption of acoustic input in early life will result in abnormal development of the auditory system. Here, we further show that this negative impact actually spans beyond the auditory system to the hippocampus, a system critical for spatial memory.

METHODS

We induced a temporary conductive hearing loss (TCHL) in P14 rats by perforating the eardrum and allowing it to heal. The Morris water maze and Y-maze tests were deployed to evaluate spatial memory of the rats. Electrophysiological recordings and anatomical analysis were made to evaluate functional and structural changes in the hippocampus following TCHL.

RESULTS

The rats with the TCHL had nearly normal hearing at P42, but had a decreased performance with the Morris water maze and Y-maze tests compared with the control group. A functional deficit in the hippocampus of the rats with the TCHL was found as revealed by the depressed long-term potentiation and the reduced NMDA receptor-mediated postsynaptic current. A structural deficit in the hippocampus of those animals was also found as revealed the abnormal expression of the NMDA receptors, the decreased number of dendritic spines, the reduced postsynaptic density and the reduced level of neurogenesis.

CONCLUSIONS

Our study demonstrates that even temporary auditory sensory deprivation in early life of rats results in abnormal development of the hippocampus and consequently impairs spatial memory in adulthood.

Dance Movements Enhance Song Learning in Deaf Children with Cochlear Implants

Music perception of cochlear implants (CI) users is constrained by the absence of salient musical pitch cues crucial for melody identification, but is made possible by timing cues that are largely preserved by current devices. While musical timing cues, including beats and rhythms, are a potential route to music learning, it is not known what extent they are perceptible to CI users in complex sound scenes, especially when pitch and timbral features can co-occur and obscure these musical features. The task at hand, then, becomes one of optimizing the available timing cues for young CI users by exploring ways that they might be perceived and encoded simultaneously across multiple modalities. Accordingly, we examined whether training tasks that engage active music listening through dance might enhance the song identification skills of deaf children with CIs. Nine CI children learned new songs in two training conditions: (a) listening only (auditory learning), and (2) listening and dancing (auditory-motor learning). We examined children's ability to identify original song excerpts, as well as mistuned, and piano versions from a closed-set task. While CI children were less accurate than their normal hearing peers, they showed greater song identification accuracies in versions that preserved the original instrumental beats following learning that engaged active listening with dance. The observed performance advantage is further qualified by a medium effect size, indicating that the gains afforded by auditory-motor learning are practically meaningful. Furthermore, kinematic analyses of body movements showed that CI children synchronized to temporal structures in music in a manner that was comparable to normal hearing age-matched peers. Our findings are the first to indicate that input from CI devices enables good auditory-motor integration of timing cues in child CI users for the purposes of listening and dancing to music. Beyond the heightened arousal from active engagement with music, our findings indicate that a more robust representation or memory of musical timing features was made possible by multimodal processing. Methods that encourage CI children to entrain, or track musical timing with body movements, may be particularly effective in consolidating musical knowledge than methods that engage listening only.

Development of joint engagement in young deaf and hearing children: effects of chronological age and language skills

PURPOSE

To evaluate joint engagement (JE) in age-matched children with and without hearing and its relationship to oral language skills.

METHOD

Participants were 180 children with severe-to-profound hearing loss prior to cochlear implant surgery, and 96 age-matched children with normal hearing; all parents were hearing. JE was evaluated in a 10-minute videotaped free play task with parents. Engagement states ranged from the lowest (unengaged) to the highest level (symbol-infused coordinated). Standardized language measures were administered.

RESULTS

Multivariate analyses were conducted between the groups, stratified by chronological and language age. Children who were deaf (Deaf) spent less time in total symbol-infused JE than children with normal hearing (NH) across all ages. The majority of the Deaf group (83%) fell in the lowest language age group, in comparison to 35% of the NH group, and spent significantly less time in symbol-infused JE than hearing children. These delays were also observed in the Deaf group, who fell into the 18-36 month language age. No children in the Deaf group had achieved a language age of > 36 months.

CONCLUSIONS

Young children with and without hearing had different developmental trajectories of JE, which were related to oral language skills.

Diabetes reduces the cognitive function with the decrease of the visual perception and visual motor integration in male older adults

This study investigated the influence of diabetes on cognitive decline between the diabetes and non- diabetes patients and identified the associations between diabetes and cognitive function, visual perception (VP), and visual motor integration (VMI). Sixty elderly men (67.10± 1.65 yr) with and without diabetes (n= 30 in each group) who were surveyed by interview and questionnaire in South Korea were enrolled in this study. The score of Mini-Mental State Examination of Korean version (MMSE-KC), Motor-free Visual Perception Test-Vertical Format (MVPT-V), and Visual-Motor Integration 3rd Revision (VMI-3R) were assessed in all of the participants to evaluate cognitive function, VP, and VMI in each. The score of MMSE-KC in the diabetic group was significantly lower than that of the non-diabetes group (P< 0.01). Participants in the diabetes group also had lower MVPT-V and VMI-3R scores than those in the non-diabetes group (P< 0.01, respectively). Especially, the scores of figure-ground and visual memory among the subcategories of MVPT-V were significantly lower in the diabetes group than in the non-diabetes group (P< 0.01). These findings indicate that the decline in cognitive function in individuals with diabetes may be greater than that in non-diabetics. In addition, the cognitive decline in older adults with diabetes might be associated with the decrease of VP and VMI. In conclusion, we propose that VP and VMI will be helpful to monitor the change of cognitive function in older adults with diabetes as part of the routine management of diabetes-induced cognitive declines.

Deaf children attending different school environments: sign language abilities and theory of mind

The present study examined whether full access to sign language as a medium for instruction could influence performance in Theory of Mind (ToM) tasks. Three groups of Italian participants (age range: 6-14 years) participated in the study: Two groups of deaf signing children and one group of hearing-speaking children. The two groups of deaf children differed only in their school environment: One group attended a school with a teaching assistant (TA; Sign Language is offered only by the TA to a single deaf child), and the other group attended a bilingual program (Italian Sign Language and Italian). Linguistic abilities and understanding of false belief were assessed using similar materials and procedures in spoken Italian with hearing children and in Italian Sign Language with deaf children. Deaf children attending the bilingual school performed significantly better than deaf children attending school with the TA in tasks assessing lexical comprehension and ToM, whereas the performance of hearing children was in between that of the two deaf groups. As for lexical production, deaf children attending the bilingual school performed significantly better than the two other groups. No significant differences were found between early and late signers or between children with deaf and hearing parents.

The ear is connected to the brain: some new directions in the study of children with cochlear implants at Indiana University

Since the early 1980s, the DeVault Otologic Research Laboratory at the Indiana University School of Medicine has been on the forefront of research on speech and language outcomes in children with cochlear implants. This paper highlights work over the last decade that has moved beyond collecting speech and language outcome measures to focus more on investigating the underlying cognitive, social, and linguistic skills that predict speech and language outcomes. This recent work reflects our growing appreciation that early auditory deprivation can affect more than hearing and speech perception. The new directions include research on attention to speech, word learning, phonological development, social development, and neurocognitive processes. We have also expanded our subject populations to include infants and children with additional disabilities.

Achieving developmental synchrony in young children with hearing loss

Children with hearing loss, with early and appropriate amplification and intervention, demonstrate gains in speech, language, and literacy skills. Despite these improvements many children continue to exhibit disturbances in cognitive, behavioral, and emotional control, self-regulation, and aspects of executive function. Given the complexity of developmental learning, educational settings should provide services that foster the growth of skills across multiple dimensions. Transdisciplinary intervention services that target the domains of language, communication, psychosocial functioning, motor, and cognitive development can promote academic and social success. Educational programs must provide children with access to the full range of basic skills necessary for academic and social achievement. In addition to an integrated curriculum that nurtures speech, language, and literacy development, innovations in the areas of auditory perception, social emotional learning, motor development, and vestibular function can enhance student outcomes. Through ongoing evaluation and modification, clearly articulated curricular approaches can serve as a model for early intervention and special education programs. The purpose of this article is to propose an intervention model that combines best practices from a variety of disciplines that affect developmental outcomes for young children with hearing loss, along with specific strategies and approaches that may help to promote optimal development across domains. Access to typically developing peers who model age-appropriate skills in language and behavior, small class sizes, a co-teaching model, and a social constructivist perspective of teaching and learning, are among the key elements of the model.

Parenting Stress among Parents of Deaf and Hearing Children: Associations with Language Delays and Behavior Problems

OBJECTIVE: This study evaluates predictors of both general and context-specific parenting stress in a cross-sectional sample of hearing parents of young deaf and hearing children. DESIGN: Participants were 181 children who were deaf and 92 children with normal hearing. Perceived parenting stress was measured using both general and context-specific measures. Predictors of parenting stress included parent-reported and observed child behavior problems and language delays. RESULTS: After controlling for maternal education and family income, parents of deaf children reported more context-specific but not general parenting stress than parents of hearing children. Both parent-reported and observed behavior problems were higher in the deaf group compared to the hearing group. Children's hearing status related to child behavior problems by way of oral language delays. Furthermore, hearing status related to parenting stress by way of language delays and child behavior difficulties. CONCLUSIONS: Context-specific measures of parenting stress reflect unique challenges of this population. Both language delays and child behavior problems are associated with increased parenting stress. Identification of specific stressors related to parenting a deaf child helps to inform the development of early interventions.

Use of a revised children's implant profile (GOSHChIP) in candidacy for paediatric cochlear implantation and in predicting outcome

The aims of this study were to investigate statistically the way a revised version of the children's implant profile (GOSHChIP) is used to inform candidacy decisions and explore its utility in predicting outcomes in the first three years of implant use. A retrospective case series analysis design was employed. Data were collated for 127 children with a mean age of 4.7 years at implantation. Concerns in a number of areas of the child's pre-implant functioning as rated on the GOSHChIP (spoken or manual communication skills, cognitive abilities, family structure and support, and use of hearing aids) were associated with speech perception and intelligibility outcomes following implantation. In terms of non-verbal cognitive abilities, the score on tests of fluid reasoning skills (sequencing), that contributes to the cognitive factor on the GOSHChIP, was found to significantly predict speech perception and speech intelligibility post implant. The GOSHChIP is a useful tool in making paediatric cochlear implant candidacy decisions, and in forming a guide for counselling parents about the potential benefit their child may receive from an implant.

Cochlear implants and spoken language processing abilities: review and assessment of the literature

Cochlear implants (CIs) process sounds electronically and then transmit electric stimulation to the cochlea of individuals with sensorineural deafness, restoring some sensation of auditory perception. Many congenitally deaf CI recipients achieve a high degree of accuracy in speech perception and develop near-normal language skills. Post-lingually deafened implant recipients often regain the ability to understand and use spoken language with or without the aid of visual input (i.e. lip reading). However, there is wide variation in individual outcomes following cochlear implantation, and some CI recipients never develop useable speech and oral language skills. The causes of this enormous variation in outcomes are only partly understood at the present time. The variables most strongly associated with language outcomes are age at implantation and mode of communication in rehabilitation. Thus, some of the more important factors determining success of cochlear implantation are broadly related to neural plasticity that appears to be transiently present in deaf individuals. In this article we review the expected outcomes of cochlear implantation, potential predictors of those outcomes, the basic science regarding critical and sensitive periods, and several new research directions in the field of cochlear implantation.