Environmental factors supporting language and communication of toddlers with cochlear implants (CIs): a pilot study on the role of acoustic characteristics and participation in online musical activities

INTRODUCTION: Language and communication outcomes in children with cochlear implants (CIs) show large variability. The adequacy of the acoustic environment, specifically the amount of exposure to spoken communication, is a factor potentially responsible for these individual differences. Research shows that music programs and engagement in musical activities could help foster children’s language and communication. In addition to that, early language acquisition processes of young recipients with CIs could be effectively explored combining parent report measures and objective measures of the acoustic setting. Based on this evidence, this study investigates the effects of an online 12-week music program for toddlers with CIs and their mothers, targeted at supporting children’s early vocabulary and communication skills. Moreover, we explore the characteristics of the acoustic environment. METHODS: The program starts three months after children’s CI activation. Activities involve listening, movement, playing instruments, and turn taking and are performed online together with a researcher and by mother and child at home. We present outcomes on eight Italian toddlers (mean age=13.3 months, SD=7.92; mean age at CI activation=15.5 months, SD=8.41) with severe to profound congenital sensorineural hearing loss who completed the music program. Children’s lexical level and gestural repertoire are assessed using the MacArthur Bates Communicative Development Inventory (MBCDI) before implantation (T1), and three (T2), six (T3), and twelve months (T4) after CI activation. Daily exposure time to different acoustic scenes at every mapping session was extracted from the data logs of the children’s CI devices. Children’s auditory skills are evaluated using the Pure Tone Average (PTA) and the Categories of Auditory Performance (CAP). RESULTS: Preliminary analyses with Friedman tests show significant improvements in children’s vocabulary comprehension (χ²=11.60, p<.05) and production (χ²=7.41, p<.05) between T1 and T3 and in children’s gestures between T1 and T3 (χ²= 6.64, p<.05). Children’s auditory skills evaluated with the CAP improved significantly between T1 and T3 (χ²=13.00, p<.01). Linear regressions show that children’s production scores at T3 are predicted by exposure to speech between T2 and T3 (b=0.34, p<.05). Children’s production scores at T3 are also predicted by PTA aided at T1 (b=-0.15, p<.01) and by CAP at T3 (b=6.20, p<.05). CONCLUSION: The improvement observed in toddlers with CIs’ language comprehension and production in the first six months after CI activation could be associated to the adequate exposure to speech and to the early engagement in musical activities with their mothers. Further analyses are needed to explain the contribution of these factors.