Boosting syntax training with temporally regular musical primes in children with cochlear implants

Examining methodological influences on the rhythmic priming effect: A commentary on Kim, McLaren, and Lee (2024)

The rhythmic priming effect (RPE) refers to improved language performance (typically grammaticality judgements) following regular rhythmic primes compared to various control conditions. This effect has been observed primarily in French, but also in English and Hungarian. However, a recent implementation by Kim, McLaren & Lee (2024), aiming to replicate the RPE in English (Chern, Tillmann, Vaughan & Gordon, 2018), was not successful, inviting a discussion about the conditions under which the RPE could be observed. We here discuss features of Kim et al.'s (2024) implementation that might have reduced the probability of observing the RPE. Compared to Chern et al. (2018), and numerous other studies reporting the RPE, additional delays after the primes and before each sentence were introduced by Kim et al. (2024). This change might have limited beneficial prime effects, which persist, but decay over time. Further, their instruction to "relax and have some rest" might have reduced attentive processing of the primes and related entrainment. Finally, their sample was small (n =16 per experiment) and with a large age range for investigating typically developing children (7-12y), potentially reducing experimental effects due to development-related individual variations. These methodological changes and sample characteristics are discussed in relation to previous research on the RPE, and entrainment in general. This discussion prompts the need for future research to investigate conditions leading to the RPE, with the aim to shed light on underlying mechanisms. Better understanding the RPE will be critical for the use of rhythmic priming within clinical and educational settings.

Speech-in-noise, psychosocial, and heart rate variability outcomes of group singing or audiobook club interventions for older adults with unaddressed hearing loss: A SingWell Project multisite, randomized controlled trial, registered report protocol

BACKGROUND

Unaddressed age-related hearing loss is highly prevalent among older adults, typified by negative consequences for speech-in-noise perception and psychosocial wellbeing. There is promising evidence that group singing may enhance speech-in-noise perception and psychosocial wellbeing. However, there is a lack of robust evidence, primarily due to the literature being based on small sample sizes, single site studies, and a lack of randomized controlled trials. Hence, to address these concerns, this SingWell Project study utilizes an appropriately powered sample size, multisite, randomized controlled trial approach, with a robust preplanned statistical analysis.

OBJECTIVE

To explore if group singing may improve speech-in-noise perception and psychosocial wellbeing for older adults with unaddressed hearing loss.

METHODS

We designed an international, multisite, randomized controlled trial to explore the benefits of group singing for adults aged 60 years and older with unaddressed hearing loss (registered at clinicaltrials.gov, ID: NCT06580847). After undergoing an eligibility screening process and completing an information and consent form, we intend to recruit 210 participants that will be randomly assigned to either group singing or an audiobook club (control group) intervention for a training period of 12-weeks. The study has multiple timepoints for testing, that are broadly categorized as macro (i.e., pre- and post-measures across the 12-weeks), or micro timepoints (i.e., pre- and post-measures across a weekly training session). Macro measures include behavioural measures of speech and music perception, and psychosocial questionnaires. Micro measures include psychosocial questionnaires and heart-rate variability.

HYPOTHESES

We hypothesize that group singing may be effective at improving speech perception and psychosocial outcomes for adults aged 60 years and older with unaddressed hearing loss-more so than participants in the control group.

Experience with the cochlear implant enhances the neural tracking of spectrotemporal patterns in the Alberti bass

Cochlear implant (CI) users experience diminished music enjoyment due to the technical limitations of the CI. Nonetheless, behavioral studies have reported that rhythmic features are well-transmitted through the CI. Still, the gradual improvement of rhythm perception after the CI switch-on has not yet been determined using neurophysiological measures. To fill this gap, we here reanalyzed the electroencephalographic responses of participants from two previous mismatch negativity studies. These studies included eight recently implanted CI users measured twice, within the first six weeks after CI switch-on and approximately three months later; thirteen experienced CI users with a median experience of 7 years; and fourteen normally hearing (NH) controls. All participants listened to a repetitive four-tone pattern (known in music as Alberti bass) for 35 min. Applying frequency tagging, we aimed to estimate the neural activity synchronized to the periodicities of the Alberti bass. We hypothesized that longer experience with the CI would be reflected in stronger frequency-tagged neural responses approaching the responses of NH controls. We found an increase in the frequency-tagged amplitudes after only 3 months of CI use. This increase in neural synchronization may reflect an early adaptation to the CI stimulation. Moreover, the frequency-tagged amplitudes of experienced CI users were significantly greater than those of recently implanted CI users, but still smaller than those of NH controls. The frequency-tagged neural responses did not just reflect spectrotemporal changes in the stimuli (i.e., intensity or spectral content fluctuating over time), but also showed non-linear transformations that seemed to enhance relevant periodicities of the Alberti bass. Our findings provide neurophysiological evidence indicating a gradual adaptation to the CI, which is noticeable already after three months, resulting in close to NH brain processing of spectrotemporal features of musical rhythms after extended CI use.

Meta-Analysis Exploring the Effects of Music Training in Cochlear Implant Users by Age

BACKGROUND AND OBJECTIVES

The present study aimed to explore meaningful change in the musical performance of cochlear implant (CI) users according to age after receiving music training compared to the other CI users who did not receive any music training and normal hearing (NH) listeners. Materials and.

METHODS

Article search was conducted from five journal databases. In accordance with PICOS criteria, 29 articles and 15 articles were included for the CI and NH groups, respectively. A total of 44 articles consisting of 407 CI users and 486 NH participants were then analyzed. Using the data gathered from pre- and post-training, meta-analysis was applied by the random-effects model, and then piecewise meta-regression was employed.

RESULTS

CI users with music training showed better performance than those without the training across all ages. The curve change in musical performance when training showed that the CI users was similar to the general pattern of NH performance, indicating that the CI users gained benefits from music training and developed perceptual ability, even though it was not as high as the level of NH counterparts.

CONCLUSIONS

This finding supports the benefits of active engagement with music for both CI users and NH listeners, while noting the important role of music as one of the primary aural rehabilitation approaches.

Regular rhythmic primes improve sentence repetition in children with developmental language disorder

Recently reported links between rhythm and grammar processing have opened new perspectives for using rhythm in clinical interventions for children with developmental language disorder (DLD). Previous research using the rhythmic priming paradigm has shown improved performance on language tasks after regular rhythmic primes compared to control conditions. However, this research has been limited to effects of rhythmic priming on grammaticality judgments. The current study investigated whether regular rhythmic primes could also benefit sentence repetition, a task requiring proficiency in complex syntax-an area of difficultly for children with DLD. Regular rhythmic primes improved sentence repetition performance compared to irregular rhythmic primes in children with DLD and with typical development-an effect that did not occur with a non-linguistic control task. These findings suggest processing overlap for musical rhythm and linguistic syntax, with implications for the use of rhythmic stimulation for treatment of children with DLD in clinical research and practice.

Effectiveness of rhythmic training on linguistics skill development in deaf children and adolescents with cochlear implants: A systematic review

OBJECTIVE

This review compiles the scientific evidence to date on the effectiveness of musical/rhythmic training for improving and/or enhancing the development of language skills in deaf children aged 6-16 years with cochlear implants.

METHODS

PubMed, ScienceDirect, and Web of Science were used for the research following the PRISMA protocol.

RESULTS

The reviewed studies indicate that rhythmic training can improve language skills (perception, production, and comprehension) in this population, as well as in other cognitive skills.

CONCLUSION

Although further research is still needed, the current evidence can help identify new and more effective early intervention methods for deaf children.

Does rhythmic priming improve grammatical processing in Hungarian-speaking children with and without developmental language disorder?

Research has described several features shared between musical rhythm and speech or language, and experimental studies consistently show associations between performance on tasks in the two domains as well as impaired rhythm processing in children with language disorders. Motivated by these results, in the current study our first aim was to explore whether a short exposure to a regular musical rhythm (i.e., rhythmic priming) can improve subsequent grammatical processing in preschool‐aged Hungarian‐speaking children with and without developmental language disorder (DLD). Second, we investigated whether rhythmic priming is specific to grammar processing by assessing priming in two additional domains: a linguistic but non‐grammatical task (picture naming) and a non‐linguistic task (nonverbal Stroop task). Third, to confirm that the rhythmic priming effect originates from the facilitating effect of the regular rhythm and not the negative effect of the control condition, we added a third condition, silence, for all the three tasks. Both groups of children showed better performance on the grammaticality judgment task in the regular compared to both the irregular and the silent conditions but no such effect appeared in the non‐grammatical and non‐linguistic tasks. These results suggest that (1) rhythmic priming can improve grammatical processing in Hungarian, a language with complex morphosyntax, both in children with and without DLD, (2) the effect is specific to grammar and (3) is a result of the facilitating effect of the regular rhythm. These results could motivate further research about integrating rhythmic priming into traditional speech‐language therapy. A video abstract of this article can be viewed at https://youtu.be/zKzGuIjZyvU.

No Evidence That Music Training Benefits Speech Perception in Hearing-Impaired Listeners: A Systematic Review

As musicians have been shown to have a range of superior auditory skills to non-musicians (e.g., pitch discrimination ability), it has been hypothesized by many researchers that music training can have a beneficial effect on speech perception in populations with hearing impairment. This hypothesis relies on an assumption that the benefits seen in musicians are due to their training and not due to innate skills that may support successful musicianship. This systematic review examined the evidence from 13 longitudinal training studies that tested the hypothesis that music training has a causal effect on speech perception ability in hearing-impaired listeners. The papers were evaluated for quality of research design and appropriate analysis techniques. Only 4 of the 13 papers used a research design that allowed a causal relation between music training and outcome benefits to be validly tested, and none of those 4 papers with a better quality study design demonstrated a benefit of music training for speech perception. In spite of the lack of valid evidence in support of the hypothesis, 10 of the 13 papers made claims of benefits of music training, showing a propensity for confirmation bias in this area of research. It is recommended that future studies that aim to evaluate the association of speech perception ability and music training use a study design that differentiates the effects of training from those of innate perceptual and cognitive skills in the participants.

Crucial Music Components Needed for Speech Perception Enhancement of Pediatric Cochlear Implant Users: A Systematic Review and Meta-Analysis

BACKGROUND

Although many clinicians have attempted music training for the hearing-impaired children, no specific effects have yet been reported for individual music components. This paper seeks to discover specific music components that help in improving speech perception of children with cochlear implants (CI) and to identify the effective training periods and methods needed for each component.

METHOD

While assessing 5 electronic databases, that is, ScienceDirect, Scopus, PubMed, CINAHL, and Web of Science, 1,638 articles were found initially. After the screening and eligibility assessment stage based on the Participants, Intervention, Comparisons, Outcome, and Study Design (PICOS) inclusion criteria, 18 of 1,449 articles were chosen.

RESULTS

A total of 18 studies and 14 studies (209 participants) were analyzed using a systematic review and meta-analysis, respectively. No publication bias was detected based on an Egger's regression result even though the funnel plot was asymmetrical. The results of the meta-analysis revealed that the largest improvement was seen for rhythm perception, followed by the perception of pitch and harmony and smallest for timbre perception after the music training. The duration of training affected the rhythm, pitch, and harmony perception but not the timbre. Interestingly, musical activities, such as singing, produced the biggest effect size, implying that children with CI obtained the greatest benefits of music training by singing, followed by playing an instrument and achieved the smallest effect by only listening to musical stimuli. Significant improvement in pitch perception helped with the enhancement of prosody perception.

CONCLUSION

Music training can improve the music perception of children with CI and enhance their speech prosody. Long training duration was shown to provide the largest training effect of the children's perception improvement. The children with CI learned rhythm and pitch better than they did with harmony and timbre. These results support the finding of past studies that with music training, both rhythm and pitch perception can be improved, and it also helps in the development of prosody perception.

Music perception and training for pediatric cochlear implant users

INTRODUCTION

Cochlear implants (CIs) are biomedical devices that restore sound perception for people with severe-to-profound sensorineural hearing loss. Most postlingually deafened CI users are able to achieve excellent speech recognition in quiet environments. However, current CI sound processors remain limited in their ability to deliver fine spectrotemporal information, making it difficult for CI users to perceive complex sounds. Limited access to complex acoustic cues such as music, environmental sounds, lexical tones, and voice emotion may have significant ramifications on quality of life, social development, and community interactions.

AREAS COVERED

The purpose of this review article is to summarize the literature on CIs and music perception, with an emphasis on music training in pediatric CI recipients. The findings have implications on our understanding of noninvasive, accessible methods for improving auditory processing and may help advance our ability to improve sound quality and performance for implantees.

EXPERT OPINION

Music training, particularly in the pediatric population, may be able to continue to enhance auditory processing even after performance plateaus. The effects of these training programs appear generalizable to non-trained musical tasks, speech prosody and, emotion perception. Future studies should employ rigorous control groups involving a non-musical acoustic intervention, standardized auditory stimuli, and the provision of feedback.

Absence of Rhythm Benefit on Speech in Noise Recognition in Children Diagnosed With Auditory Processing Disorder

Auditory processing disorder (APD) is a specific deficit in the processing of auditory information along the central auditory nervous system. It is characterized mainly by deficits in speech in noise recognition. APD children may also present with deficits in processing of auditory rhythm. Rhythmic neural entrainment is commonly present in perception of both speech and music, while auditory rhythmic priming of speech in noise has been known to enhance recognition in typical children. Here, we test the hypothesis that the effect of rhythmic priming is compromised in APD children, and further assessed for correlations with verbal and non-verbal auditory processing and cognition. Forty APD children and 33 neurotypical ones were assessed through (a) WRRC, a test measuring the effects of rhythmic priming on speech in noise recognition, (b) a battery of auditory processing tests, commonly used in APD diagnosis, and (c) two cognitive tests, assessing working memory and auditory attention respectively. Findings revealed that (a) the effect of rhythmic priming on speech in noise recognition is absent in APD children, (b) it is linked to non-verbal auditory processing, and (c) it is only weakly dependent on cognition. We discuss these findings in light of Dynamic Attention Theory, neural entrainment and neural oscillations and suggest that these functions may be compromised in APD children. Further research is needed (a) to explore the nature of the mechanics of rhythmic priming on speech in noise perception and why the effect is absent in APD children, (b) which other mechanisms related to both rhythm and language are also affected in this population, and (c) whether music/rhythm training can restore deficits in rhythm effects.

Musical Training for Auditory Rehabilitation in Hearing Loss

Despite the overall success of cochlear implantation, language outcomes remain suboptimal and subject to large inter-individual variability. Early auditory rehabilitation techniques have mostly focused on low-level sensory abilities. However, a new body of literature suggests that cognitive operations are critical for auditory perception remediation. We argue in this paper that musical training is a particularly appealing candidate for such therapies, as it involves highly relevant cognitive abilities, such as temporal predictions, hierarchical processing, and auditory-motor interactions. We review recent studies demonstrating that music can enhance both language perception and production at multiple levels, from syllable processing to turn-taking in natural conversation.

The CI MuMuFe - A New MMN Paradigm for Measuring Music Discrimination in Electric Hearing

Cochlear implants (CIs) allow good perception of speech while music listening is unsatisfactory, leading to reduced music enjoyment. Hence, a number of ongoing efforts aim to improve music perception with a CI. Regardless of the nature of these efforts, effect measurements must be valid and reliable. While auditory skills are typically examined by behavioral methods, recording of the mismatch negativity (MMN) response, using electroencephalography (EEG), has recently been applied successfully as a supplementary objective measure. Eleven adult CI users and 14 normally hearing (NH) controls took part in the present study. To measure their detailed discrimination of fundamental features of music we applied a new multifeature MMN-paradigm which presented four music deviants at four levels of magnitude, incorporating a novel "no-standard" approach to be tested with CI users for the first time. A supplementary test measured behavioral discrimination of the same deviants and levels. The MMN-paradigm elicited significant MMN responses to all levels of deviants in both groups. Furthermore, the CI-users' MMN amplitudes and latencies were not significantly different from those of NH controls. Both groups showed MMN strength that was in overall alignment with the deviation magnitude. In CI users, however, discrimination of pitch levels remained undifferentiated. On average, CI users' behavioral performance was significantly below that of the NH group, mainly due to poor pitch discrimination. Although no significant effects were found, CI users' behavioral results tended to be in accordance with deviation magnitude, most prominently manifested in discrimination of the rhythm deviant. In summary, the study indicates that CI users may be able to discriminate subtle changes in basic musical features both in terms of automatic neural responses and of attended behavioral detection. Despite high complexity, the new CI MuMuFe paradigm and the "no-standard" approach provided reliable results, suggesting that it may serve as a relevant tool in future CI research. For clinical use, future studies should investigate the possibility of applying the paradigm with the purpose of assessing discrimination skills not only at the group level but also at the individual level.

Rhythmic and textural musical sequences differently influence syntax and semantic processing in children

Effects of music on language processing have been reported separately for syntax and for semantics. Previous studies have shown that regular musical rhythms can facilitate syntax processing and that semantic features of musical excerpts can influence semantic processing of words. It remains unclear whether musical parameters, such as rhythm and sound texture, may specifically influence different components of linguistic processing. In the current study, two types of musical sequences (one focusing on rhythm and the other focusing on sound texture) were presented to children who were requested to perform a syntax or a semantic task thereafter. The results revealed that rhythmic and textural musical sequences differently influence syntax and semantic processing. For grammaticality judgments, children's performance was better after regular rhythmic sequences than after textural sound sequences. In the semantic evocation task, children produced more numerous and more various concepts after textural sound sequences than after regular rhythmic sequences. These results suggest that rhythm boosts perceptual and cognitive sequencing required in syntax processing, whereas texture promote verbalization and concept activation in verbal production. The findings have implications for the interpretation of musical priming effects and are discussed in the frameworks of dynamic attending and conceptual processing.

Rhythmic pattern facilitates speech production: An ERP study

Rhythm affects the speech perception of events unfolding over time. However, it is not clear to what extent the rhythm could affect the processes of sentence speech production. In this event-related potential (ERP) study, we examined whether a particular rhythmic pattern could affect the planning of speech production before articulation. We recorded electrophysiological (EEG) and behavioural (reaction time) data while participants read aloud a target speech in Chinese. Target speeches were sentences or phrases consisting four characters, with regular (e.g., the 2 + 2 pattern; numbers in the brackets represent the number of syllables) or irregular (e.g., 1 + 3) rhythmic patterns, which were preceded by congruent or incongruent musical rhythmic patterns formed by simple pure tones with different temporal intervals. Behavioural and ERP findings indicated a rhythmic priming effect in comparing congruent and incongruent conditions in the regular target speeches, but not in the irregular ones. An early component (N100) that was elicited in response to target speeches that were rhythmically mismatched to primes was linked to the detection of hierarchical linguistic units, which did not conform to expectations. A later negative component (N400) was thought to reflect the violation of expectation on rhythmic pattern in speech production. These findings suggest that rhythmic pattern constrains grammatical and prosodic encoding during speech production, and support the hypothesis that speakers form a grammatical or a prosodic abstract frame before articulation.

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.

New evidence of a rhythmic priming effect that enhances grammaticality judgments in children

Musical rhythm and the grammatical structure of language share a surprising number of characteristics that may be intrinsically related in child development. The current study aimed to understand the potential influence of musical rhythmic priming on subsequent spoken grammar task performance in children with typical development who were native speakers of English. Participants (ages 5-8 years) listened to rhythmically regular and irregular musical sequences (within-participants design) followed by blocks of grammatically correct and incorrect sentences upon which they were asked to perform a grammaticality judgment task. Rhythmically regular musical sequences improved performance in grammaticality judgment compared with rhythmically irregular musical sequences. No such effect of rhythmic priming was found in two nonlinguistic control tasks, suggesting a neural overlap between rhythm processing and mechanisms recruited during grammar processing. These findings build on previous research investigating the effect of rhythmic priming by extending the paradigm to a different language, testing a younger population, and employing nonlanguage control tasks. These findings of an immediate influence of rhythm on grammar states (temporarily augmented grammaticality judgment performance) also converge with previous findings of associations between rhythm and grammar traits (stable generalized grammar abilities) in children. Taken together, the results of this study provide additional evidence for shared neural processing for language and music and warrant future investigations of potentially beneficial effects of innovative musical material on language processing.