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Links of Prosodic Stress Perception and Musical Activities to Language Skills of Children With Cochlear Implants and Normal Hearing

Torppa, Ritva1,2; Faulkner, Andrew3; Laasonen, Marja2,4,5; Lipsanen, Jari2; Sammler, Daniela6

doi: 10.1097/AUD.0000000000000763
Research Article: PDF Only

Objectives: A major issue in the rehabilitation of children with cochlear implants (CIs) is unexplained variance in their language skills, where many of them lag behind children with normal hearing (NH). Here, we assess links between generative language skills and the perception of prosodic stress, and with musical and parental activities in children with CIs and NH. Understanding these links is expected to guide future research and toward supporting language development in children with a CI.

Design: Twenty-one unilaterally and early-implanted children and 31 children with NH, aged 5 to 13, were classified as musically active or nonactive by a questionnaire recording regularity of musical activities, in particular singing, and reading and other activities shared with parents. Perception of word and sentence stress, performance in word finding, verbal intelligence (Wechsler Intelligence Scale for Children (WISC) vocabulary), and phonological awareness (production of rhymes) were measured in all children. Comparisons between children with a CI and NH were made against a subset of 21 of the children with NH who were matched to children with CIs by age, gender, socioeconomic background, and musical activity. Regression analyses, run separately for children with CIs and NH, assessed how much variance in each language task was shared with each of prosodic perception, the child’s own music activity, and activities with parents, including singing and reading. All statistical analyses were conducted both with and without control for age and maternal education.

Results: Musically active children with CIs performed similarly to NH controls in all language tasks, while those who were not musically active performed more poorly. Only musically nonactive children with CIs made more phonological and semantic errors in word finding than NH controls, and word finding correlated with other language skills. Regression analysis results for word finding and VIQ were similar for children with CIs and NH. These language skills shared considerable variance with the perception of prosodic stress and musical activities. When age and maternal education were controlled for, strong links remained between perception of prosodic stress and VIQ (shared variance: CI, 32%/NH, 16%) and between musical activities and word finding (shared variance: CI, 53%/NH, 20%). Links were always stronger for children with CIs, for whom better phonological awareness was also linked to improved stress perception and more musical activity, and parental activities altogether shared significantly variance with word finding and VIQ.

Conclusions: For children with CIs and NH, better perception of prosodic stress and musical activities with singing are associated with improved generative language skills. In addition, for children with CIs, parental singing has a stronger positive association to word finding and VIQ than parental reading. These results cannot address causality, but they suggest that good perception of prosodic stress, musical activities involving singing, and parental singing and reading may all be beneficial for word finding and other generative language skills in implanted children.

1Logopedics, Cognitive Brain Research Unit,

2Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland;

3Speech Hearing and Phonetic Sciences, University College London, London, United Kingdom;

4Department of Otorhinolaryngology and Phoniatrics, Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland;

5Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland; and

6Otto Hahn Group “Neural Bases of Intonation in Speech and Music,” Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.

ACKNOWLEDGMENTS: The authors thank the personnel, especially speech therapists (Nonna Virokannas, Sari Vikman, Satu Rimmanen, Teija Tsupari), of university hospital CI clinics in Helsinki, Tampere, Turku, and Kuopio, and the students who collected data. The authors also thank Professor Martti Vainio for his help with the prosodic experiments, and Professors Minna Huotilainen and Mari Tervaniemi for their help and advice. Above all, the authors thank the parents and children for their participation.

This research was funded by the Signe and Ane Gyllenberg Foundation, the Finnish Concordia Fund, the Ella and Georg Ehrnrooth Foundation, National doctoral program Langnet, the Finnish Audiological Society, the Finnish doctoral program in language studies, funded by the Ministry of Education and Culture and the Emil Aaltonen Foundation.

R. T. was responsible for experimental design, statistical analyses, performed most of experiments at University of Helsinki, and wrote the first version of the manuscript; A. F. designed the experiments on perception of word and sentence stress, participated in study design and statistical analyses, provided critical revision, and checked English language; M. L. was responsible for supervising students who carried out psychological assessments and I.Q. tests; J. L. was responsible for statistical analyses and provided critical revision; D.S. commented on statistical analyses and provided critical revision. All authors discussed the results and implications and commented on the article at all stages.

The authors have no conflicts of interest to declare.

Received August 16, 2018; accepted May 29, 2019.

Address for correspondence: Ritva Torppa, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, PL 21 (Haartmanink atu 3) 00014 Helsinki, Finland. E-mail:

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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