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Music Recognition, Music Listening, and Word Recognition by Deaf Children with Cochlear Implants Chisato Mitani, Takayuki Nakata, Sandra E. Trehub, Yukihiko Kanda, Hidetaka Kumagami, Kenji Takasaki, Ikue Miyamoto, and Haruo Takahashi Objectives: To examine the ability of congenitally deaf children to recognize music from incidental exposure and the relations among age at implantation, music listening, and word recognition. they would have experienced with normal hearing or with hearing aids. Congenitally deaf children who received an implant at a young age would not experience an adult’s sense of loss with respect to music, but their musical input would be similarly impoverished. Child implant users, unlike their adult counterparts, are involved in a variety of musical activities, including listening, singing, dancing, and instrument lessons (Gfeller et al., 1998; Nakata et al., 2005b; Vongpaisal et al., 2006), which implies that their musical experiences and skills differ from those of adults. Vongpaisal et al. (2006) evaluated implanted children’s and adolescents’ ability to identify popular songs in a closed-set task. They found that children and teens, all of whom were congenitally or prelingually deaf, could identify the songs based on excerpts from the original and instrumental recordings. Nevertheless, these listeners failed to recognize synthesized piano versions of the main melody that younger hearing children could recognize. Familiarity with popular songs often arises from deliberate listening by means of portable digital devices (e.g., MP3 players), stereo systems, or radios. For the most part, however, musical exposure is incidental rather than deliberate, arising from the presence of music in a variety of contexts such as television, movies, computer games, and public spaces. Nevertheless, incidental musical exposure often results in the ability to recognize or reproduce the themes or background music from movies or television programs (Nakata et al., 2005b; Schellenberg & Trehub, 2003). Comparable incidental exposure to music may have very different consequences for deaf implant users. To examine the consequences of incidental music listening, Nakata et al. (2005b) evaluated the ability of children with implants to recognize the theme songs from familiar TV programs. Congenitally deaf children 4 to 9 yr of age successfully identified excerpts from the original recordings, but they were unable to recognize excerpts from original instrumental versions without the lyrics. In the present study, we sought to replicate and extend those findings. In addition to evaluating the recognition of music from popular children’s television programs with a larger sample of children with implants, we sought to examine relations among other factors Design: Seventeen child implant users who were 4 to 8 yr of age were tested on their recognition and liking of musical excerpts from their favorite television programs. They were also assessed on openset recognition of three-syllable words. Their parents completed a questionnaire about the children’s musical activities. Results: Children identified the musical excerpts at better than chance levels, but only when they heard the original vocal/instrumental versions. Children’s initiation of music listening at home was associated with younger ages at implantation and higher word recognition scores. Conclusions: Child implant users enjoy music more than adult implant users. Moreover, younger age at implantation increases children’s engagement with music, which may enhance their progress in other auditory domains. (Ear & Hearing 2007;28;29S–33S) Cochlear implants enable many deaf individuals to achieve improved speech perception and production skills relative to what is possible with hearing aids. The situation is very different for music perception because of signal-processing strategies that transmit insufficient information about pitch (Gfeller et al., 2005 Wilson et al., 2005). One consequence is that implant users, both adults (Fujita & Ito, 1999; Gfeller et al., 2000b) and children (Stordahl, 2002; Vongpaisal et al., 2006), cannot recognize a familiar melody based its pitch patterning. Postlingually deaf adults typically lose interest in music after implantation (Gfeller et al., 2000; Leal et al., 2003), even if they were music aficionados beforehand. Obviously, the musical input that they receive through their implants differs radically from the music that Graduate Course in Humanistic Studies Specialized Research into Humanistic Studies, Department of Psychology, Nagasaki Junshin Catholic University, Nagasaki, Japan (C.M., T.N.); Department of Psychology, University of Toronto at Mississauga, Mississauga, Ontario, Canada (S.E.T.) and Division of Otorhinolaryngology, Department of Translational Medical Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (Y.K., H.K., K.T., I.M., H.T.). 0196/0202/07/282 Supplement-0029S/0 • Ear & Hearing • Copyright © 2007 by Lippincott Williams & Wilkins • Printed in the U.S.A. 29S 30S EAR & HEARING / APRIL 2007 such as age at implantation, at-home music listening, and word recognition. In general, younger ages at implantation have been associated with better language progress (Houston et al., 2003; Lin & Peng, 2003; Oh et al., 2003), but the impact of early implantation on music perception, memory, and enjoyment is unknown. It is also unclear whether musical exposure and training have transfer effects on the nonmusical skills of child implant users, as they do for hearing children. For example, young children who received 1 to 3 yr of piano or voice lessons as part of an experimental treatment showed improvement in IQ scores (Schellenberg, 2004), academic achievement (Gardiner et al., 1996), or self-esteem (Costa-Giomi, 2004) compared to a matched control sample. Moreover, brief episodes of listening to age-appropriate music generate short-term improvement on nonmusical tasks (Schellenberg et al., 2007). Comparable consequences for child implant users would depend on their ability to perceive, remember, and enjoy music. Such abilities could create an important role for music in aural habilitation. METHODS Subjects The participants were 17 congenitally deaf children who were 4 to 8 yr of age (mean ⫽ 6.5) at the time of music-recognition testing and 4 to 9 yr (mean ⫽ 6.5) at word-recognition testing. Before implantation, all children used bilateral hearing aids. Their surgery was at 2 to 7 yr of age (mean ⫽ 3.8), and their use of an implant exceeded 1 yr (range, 1.2– 4.10). Children used a cochlear nucleus implant with the ACE (n ⫽ 12) or SPEAK (n ⫽ 3) coding strategy or an Advanced Bionics implant with the MPS (n ⫽ 1) or SAS (n ⫽ 1) strategy. Twelve children used hearing aids in their unimplanted ear. All children communicated exclusively by oral means. They attended regular classes in community schools, except for one child who attended an auditory/oral school for the deaf. All parents were native speakers of Japanese. Apparatus and Stimuli Testing was conducted in a double-wall, soundattenuating booth. Music stimuli consisted of theme songs from 14 popular television programs for children. There were three versions of the songs: (1) original, which corresponded exactly to the version that appeared on television; (2) instrumental, which was identical to the original version except for the absence of the sung portion; and (3) a synthesized flute version of the main melody. The melody version preserved the timing of the original song and TABLE 1. Words (with English translations) from the word recognition task Nezumi (mouse) Sakana (fish) Piano (piano) Kemuri (smoke) Megane (glasses) Yaoya (vegetable store) Tamago (egg) Daruma (traditional good-luck doll) Atama (head) Gorira (gorilla) Kitsune (fox) Hiyoko (chick) Kuruma (car) Usagi (rabbit) Ichigo (strawberry) Suika (watermelon) Maiku (microphone) Banana (banana) Karasu (crow) Hanabi (fireworks) Senaka (back) Tsukue (desk) Tomato (tomato) Rakuda (camel) Kyabetsu (cabbage) corresponded to the portion that was sung. Musical materials were presented by means of a laptop computer (Macintosh iBook) and loudspeaker. Before testing began, the music was adjusted to a comfortable listening level for each child. The word recognition task consisted of 25 common, three-syllable words (Table 1). The materials (CD for the Evaluation of Fitting Condition with Hearing Aids, TY-89) are often used in Japan to facilitate hearing-aid fitting (Yonemoto, 1995). Procedure Children were tested on music-recognition and word-recognition tasks on different days. Before music-recognition testing, the experimenter consulted with the children and their parents to determine the TV programs that each child watched regularly. On that basis, we selected three to five programs. Musical excerpts were presented in blocks of trials, beginning with the original versions, followed by the instrumental versions, and ending with the melody versions. Each block had two trials of the relevant version of each of the three to five songs. Within each block of trials, excerpts were presented in random order except that no song occurred twice in succession. Children were asked to pay close attention to each song and to identify the program by clicking on one of the three to five images on the computer monitor that depicted characters (and titles) from each program. The experimenter presented the excerpts only when children were attentive. Each excerpt started at the beginning of the recording and continued until the child responded or the excerpt ended (55– 65 sec). Children were told to guess if they were unsure. After their selection, they rated how much they liked each excerpt on a 5-point unidimensional scale in which 1 corresponded to “do not like at all” and 5 corresponded to “like very much.” Accompanying EAR & HEARING, VOL. 28 NO. 2 SUPPLEMENT depictions of ice cream cones clarified the meaning of different points on the rating scale. Parents completed a questionnaire about children’s musical activities (e.g., singing, listening), affective responses to music, and initiation of music listening. On a separate occasion, before or after the musicrecognition task, children completed the word-recognition task as part of a routine clinical assessment. They were tested without their hearing aid (i.e., cochlear implant only), and the words were presented at 70 dB SPL. Children were required to repeat each of 25 words presented in succession. Their responses were scored as correct if they were intelligible reproductions, regardless of articulation proficiency. RESULTS Because children differed in the number of songs on which they were tested (3, 4, or 5), performance (proportion correct) was corrected for the proportion of correct responses that would be expected by chance (0.33, 0.25, and 0.20 in the cases of 3, 4, and 5 songs, respectively). The proportion corresponding to chance responding was subtracted from the numerator (proportion of songs correctly identified) and denominator (perfect performance). A score of 1 indicated perfect performance, 0 indicated performance expected by chance, and negative values indicated performance below chance. Accuracy on the original versions (mean ⫽ 0.346, SD ⫽ 0.44) significantly exceeded chance levels, t(16) ⫽ 3.46, p ⬍ 0.01, but performance on instrumental (mean ⫽ 0.03, SD ⫽ 0.19) and melody (mean ⫽ ⫺0.05, SD ⫽ 0.24) versions was at chance levels. Appraisals of the excerpts were significantly more favorable than the neutral midpoint (3) for original, instrumental, and melody versions (mean ⫽ 3.46, 3.43, and 3.63, respectively, all p values ⬍0.05). Performance on word recognition was highly variable, ranging from 32% correct for one child to 100% for four others. Parent questionnaires revealed that all children participated in musical activities. Most sang spontaneously, but only nine initiated music listening. The difference in age at implantation between children who initiated music listening (mean ⫽ 37.44 months, SD ⫽ 11.61) and those who did not (mean ⫽ 52.63 months, SD ⫽ 19.41) approached conventional levels of significance [t(15) ⫽ 1.99, p ⫽ 0.066]. In addition, music-listening initiators had significantly higher word-recognition scores (mean ⫽ 89.33% correct, SD ⫽ 14.00) than noninitiators (mean ⫽ 70.63, SD ⫽ 19.54, t(15) ⫽ 2.29, p ⬍ 0.05. This effect was not mediated by age at implantation or duration of implant use because word recognition was uncorrelated with age at surgery or implant experience. 31S DISCUSSION When congenitally deaf children with cochlear implants heard recorded music from their favorite television programs, they identified the music at better than chance levels from a closed response set. Successful recognition occurred for renditions that incorporated all features of the original music—instruments, timing, and vocals— but not for renditions that retained the instrumental portions without the vocals. Children were also unable to identify synthesized flute renditions that retained the pitch patterning and timing of the main melody (i.e., the portion that is sung) but differed in other respects (i.e., flute rather than voice and no accompaniment). Their difficulty recognizing songs from the melody alone is consistent with previous reports by Stordahl (2002), Nakata et al. (2006), and Vongpaisal et al. (2006). The ability of child implant users to identify instrumental renditions from deliberate listening experience (i.e., focused attention to popular recordings), as in Vongpaisal et al. (2006), and their inability to do so from incidental listening experience (i.e., while focusing on television programs) highlight the differential impact of these exposure contexts on hearing and hearing-impaired children. For children with normal hearing, incidental listening or “overhearing” commonly results in successful auditory learning, just as incidental observation leads to successful visual learning. For implant users, however, following the dialogue and narrative thread of a television program takes a great deal of effort, which diminishes the cognitive resources available for learning and memory. Even “star” adult implant users note the great concentration that underlies their stellar performance on speech perception tasks (Wilson et al., 2005). Children’s favorable appraisals of the musical excerpts are consistent with Vongpaisal et al. (2006), but they contrast with the unfavorable appraisals reported by Stordahl (2002). Participants’ selection of TV programs for the current study and pop songs for Vongpaisal et al. (2006) may account for their positive appraisals. Although child implant users in Vongpaisal et al. provided favorable ratings for original and instrumental versions, they provided neutral ratings for the melody versions, which implies that their recognition of the materials affected their appraisals. In the present study, however, all versions were rated equally favorably, regardless of children’s failure to recognize instrumental and melody versions. In short, music listening, even in the laboratory, was a positive experience for the present participants. Perhaps their young age (4 – 8 yr) compared to the implanted 32S EAR & HEARING / APRIL 2007 listeners in Vongpaisal et al. (8 –18 yr of age) accounts for the differences. Children’s positive attitudes toward music were corroborated by parental questionnaires. Despite the poor pitch resolution reported for implant users (Fujita & Ito, 1999; Vandali et al., 2005; Wilson et al., 2005), several children sang regularly and gleefully. From other research, however, it is clear that the singing of children with implants is substantially out of tune (Nakata et al., 2006). Nine children regularly initiated music listening. Moreover, musiclistening initiation was associated with younger ages at implantation and with enhanced word recognition. What can account for the association between age at implantation and favorable inclinations toward music? Presumably, some age-at-implant differences arise from listeners’ need to adapt to drastic changes from the input experienced before the implant (via amplification) and the input experienced after the implant (Fu & Shannon, 1999). As listeners get older, their representations of sound patterns in their environment become entrenched and resistant to change (Johnson & Munakata, 2005). Early childhood seems to be a period of enhanced perceptual flexibility. For example, hearing infants acquire novel sound patterns more readily than adults do (Hannon & Trehub, 2005; Kuhl et al., 2003). Ease of auditory learning would promote greater interest in music and greater familiarity with it. What underlies the unexpected association between music listening and word recognition? Based on the modest association between these factors in a small sample of children, our proposals are necessarily speculative. Music listening, especially focused music listening, may involve the training of auditory attention. In other words, learning that occurs in the context of music listening may transfer to other auditory but nonmusical contexts. For example, music lessons for individuals with normal hearing are associated with enhanced verbal memory (Ho et al., 2003) and sensitivity to prosody (Thompson et al., 2004). Regular music listening by young cochlear implant users may provide incidental training of auditory attention, one consequence of which is the promotion of word recognition and verbal learning. Accordingly, the present study provides impetus for further exploration of the role of music in aural habilitation. ACKNOWLEDGMENTS Funding for this study was provided by a grant from the Canadian Institutes for Health Research to Sandra E. Trehub. The authors are grateful to the staff members of the Nagasaki Bell Hearing Center for their continuing cooperation and to the parents of the children who participated in this study. Address for correspondence: Dr. Sandra E. Trehub, Department of Psychology, University of Toronto at Mississauga, Mississauga, Ontario, Canada, L5L 1C6. E-mail: [email protected]. Received December 17, 2005; accepted May 1, 2006. REFERENCES Costa-Giomi, E. (2004). 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