Event Abstract

Back to Event

Music-based rehabilitation in cochlear implant users: Insights from brain-plasticity research

Georgios Papadelis1*
  • 1 Aristotle University of Thessaloniki, Department of Music Studies, Greece

A Cochlear Implant (CI) system is a type of auditory prostheses that restores hearing in individuals with severe to profound sensorineural hearing loss. Such a system operates by bypassing the outer ear, the middle ear, and the hair cells of the cochlea to electrically stimulate the surviving neurons of the auditory nerve directly. The pattern of stimulation used in current-day implants tries to mimic the tonotopic representation of the sound within the normal cochlea, with lower frequencies stimulating more apical regions and higher frequencies more basal regions. Details on history, system design, processing strategies, and users’ performance are reported in Wilson & Dorman (2008) and in Zeng et al. (2008). Even the most advanced technologies and signal processing strategies today in the field of CI systems are capable of transmitting only poor or even distorted representations of the sound’s information bearing features, necessary for full-scale perception of the various kinds of auditory stimuli that constitute an integral part of human auditory experience and communication (e.g. speech sounds, environmental sounds, music etc.). Several studies up to day have shown that different kinds of sounds require different amounts of information to be adequately perceived by a listener (Shannon et al., 2004; Wilson et al., 2004). This explains, on the one hand, why high levels of speech understanding has been made possible with current-day CI systems, even though reduced information of the speech signal is delivered to the auditory nerve by an implant system. Nevertheless, on the other hand, perception of sounds still remains sub optimal in poor listening conditions (e.g. noisy or reverberant environments), or with increasing stimulus complexity (e.g. music, competing speakers). Most experimental studies that assessed CI users’ listening abilities through the use of more complex stimuli, especially music, concluded with high variability in test scores among different individuals, even within the same test, and even among users of the same device (Brockmeier et al., 2011; Kang et al., 2009; Looi, 2008). It seems therefore likely that differences in technology among current day CI systems alone may not constitute a dominant factor in defining a user’s hearing quality (also see Gfeller et al., 2008). This pinpoints to the key question of what the brain does under insufficient or distorted sensory input, and, in turn, how neuroplasticity-informed music-based rehabilitation may positively influence the brain’s capacity to adapt to these new circumstances. Several studies up today have demonstrated in both animals and humans that plastic changes occur in auditory cortex following deafness. Brain areas deprived of sensory input usually develop increased responsiveness to the stimulation of other senses such as vision and touch, even with early-stage hearing loss (Macsweeney & Cardin, 2015; Sharma & Glick, 2016). A reverse phenomenon appears to occur with long-term and behaviorally relevant electrical stimulation of the auditory nerve such as that produced by a cochlear implant system, and this has shown to result in a functional reorganization of the auditory pathways and cortices (Middlebrooks, 2005; also see Syka, 2002, for review). Therefore, auditory training for speech has long been suggested as being a necessary process following implantation for maximizing the benefits on speech outcomes for CI users (Ingvalson & Wong, 2013). Both behavioral and neuroimaging studies in normal hearing individuals have provided strong evidence that structured music training does not only benefit musical abilities, but has also the potential to improve general or language-related auditory skills, including brain stem response timing for speech stimuli (Tierney et al. 2013) auditory working memory (George & Coch, 2011), phonological awareness (Moritz et al., 2013), and reading-related skills (Tierney & Kraus, 2013). Mounting experimental evidence also suggests that systematic listening to music and structured music training may considerably benefit basic auditory sensitivity, speech intelligibility, music perception, and enjoyment with music in CI users (Gfeller et al., 2002; Looi et al., 2012). To date, however, there is great heterogeneity among the music-training protocols reported in published studies, as regards a) the profile of the CI users they target at (e.g. pre-lingual vs. post-lingual deafened individuals, or sharply different age-groups), b) the target auditory/musical abilities to be improved c) their pedagogical approach which in most of the cases relies on widely-used music training methods, rather appropriate for normal hearing individuals, c) the test material and the type of tasks they use, and d) monitoring of the effectiveness of training (also see Gfeller, 2016, for review of studies on pediatric populations). It follows that the development of design principles for music-based rehabilitation programs runs its initial stage. At this stage of development we argue that integrating features common in neuroplasticity-based rehabilitation programs, into music-based rehabilitation would considerably boost its effectiveness towards improving an imlantee’s sensitivity, accuracy and speed in detecting and processing those features in the musical stimulus which are important for full-scale perception and appreciation of music. There are three major arguments in support of this view: a) the effectiveness of neuroplasticity-based training programs have already been documented in large populations of individuals with neurological (e.g. age-related dementia) or psychiatric impairments (e.g. schizophrenia) - (Nahum et al., 2013), b) studies in congenitally deaf children that received a cochlear implant demonstrated better central auditory development for early-implanted children (i.e. during the sensitive period of central auditory development and before cross-modal plasticity occurs) as compared to the late-implanted children (Dorman et al., 2007; Gordon et al., 2011; Sharma et al., 2005), c) the beneficial role of audiovisual plasticity on speech recovery, recently demonstrated in post-lingually deaf adult CI users (Barone et al., 2013; Strelnikov et al., 2015), and d) evidence from anecdotal reports of CI users with single-sided deafness indicating a sharp effect of music training in re-establishing connections between existing memory traces for distinctive features of auditory musical events or patterns developed before hearing loss (e.g. the timbre of an instrument’s tone, or the pitch progression of a familiar melody), and the informationally poor electric signal delivered to the auditory nerve via the implant for the same event or pattern.

References

Barone, P., Strelnikov, K., & Deguine, O. (2013). Role of audiovisual plasticity in speech recovery after adult cochlear implantation. In S. Ouni et al. (Eds), Proceedings of the 12th International Conference on Auditory-Visual Speech Processing (pp. 99-104).
Brockmeier, S. J., Fitzgerald, D., Searle, O., Fitzgerald, H., Grasmeder, M., Hilbig, S., … Arnold, W. (2011). The MuSIC perception test: a novel battery for testing music perception of cochlear implant users. Cochlear Implants International, 12(1), 10–20.
Dorman, M. F., Sharma, A., Gilley, P., Martin, K., & Roland, P. (2007). Central auditory development: Evidence from CAEP measurements in children fit with cochlear implants. Journal of Communication Disorders, 40(4), 284–294.
George, E. M., & Coch, D. (2011). Music training and working memory: An ERP study. Neuropsychologia, 49(5), 1083–1094.
Gfeller, K. (2016). Music-based training for pediatric CI recipients: A systematic analysis of published studies. European Annals of Otorhinolaryngology, Head and Neck Diseases, 133, S50–S56.
Gfeller, K., Oleson, J., Knutson, J. F., Breheny, P., Driscoll, V., & Olszewski, C. (2008). Multivariate Predictors of Music Perception and Appraisal by Adult Cochlear Implant Users. Journal of the American Academy of Audiology, 19(2), 120–134.
Gfeller, K., Witt, S., Adamek, M., Mehr, M., Rogers, J., Stordahl, J., & Ringgenberg, S. (2002). Effects of training on timbre recognition and appraisal by postlingually deafened cochlear implant recipients. Journal of the American Academy of Audiology, 13(3), 132–45.
Gordon, K. A., Wong, D. D. E., Valero, J., Jewell, S. F., Yoo, P., & Papsin, B. C. (2011). Use it or lose it? Lessons learned from the developing brains of children who are deaf and use cochlear implants to hear. Brain Topography, 24(3-4), 204–219.
Ingvalson, E. M., & Wong, P. C. M. (2013). Training to improve language outcomes in cochlear implant recipients. Frontiers in Psychology, 4(MAY), 1–9.
Kang, R., Nimmons, G. L., Drennan, W., Longnion, J., Ruffin, C., Nie, K., … Rubinstein, J. (2009). Development and validation of the University of Washington Clinical Assessment of Music Perception test. Ear and Hearing, 30(4), 411–8.
Looi, V. (2008). The effect of cochlear implantation on music perception: A review. OTOLARYNGOLOGIA, (58), 169–190.
Looi, V., Gfeller, K., & Driscoll, V. (2012). Music Appreciation and Training for Cochlear Implant Recipients: A Review. Seminars in Hearing, 33(4), 307–334.
Macsweeney, M., & Cardin, V. (2015). What is the function of auditory cortex without auditory input? Brain, 138(9), 2468–2470.
Middlebrooks, J. C., Bierer, J. A., & Snyder, R. L. (2005). Cochlear implants: The view from the brain. Current Opinion in Neurobiology, 15(4), 488–493.
Moritz, C., Yampolsky, S., Papadelis, G., Thomson, J., & Wolf, M. (2013). Links between early rhythm skills, musical training, and phonological awareness. Reading and Writing, 26(5), 739–769.
Nahum, M., Lee, H., & Merzenich, M. M. (2013). Principles of neuroplasticity-based rehabilitation. Progress in Brain Research (1st ed., Vol. 207). Elsevier B.V.
Shannon, R. V, Fu, Q.-J., & Galvin, J. (2004). The number of spectral channels required for speech recognition depends on the difficulty of the listening situation. Acta Oto-Laryngologica. Supplementum, 124(552), 50-4.
Sharma, A., Dorman, M. F., & Kral, A. (2005). The influence of a sensitive period on central auditory development in children with unilateral and bilateral cochlear implants. Hearing Research, 203(1-2), 134–143.
Sharma, A., & Glick, H. (2016). Cross-Modal Re-Organization in Clinical Populations with Hearing Loss. Brain Sciences, 6(1), 4.
Strelnikov, K., Marx, M., Lagleyre, S., Fraysse, B., Deguine, O., & Barone, P. (2015). PET-imaging of brain plasticity after cochlear implantation. Hearing Research, 322, 180-187.
Syka, J. (2002). Plastic changes in the central auditory system after hearing loss, restoration of function, and during learning. Physiological Reviews, 82(3), 601–636.
Tierney, A., & Kraus, N. (2013). Music training for the development of reading skills. Progress in Brain Research (1st ed., Vol. 207). Elsevier B.V.
Tierney, A., Krizman, J., Skoe, E., Johnston, K., & Kraus, N. (2013). High school music classes enhance the neural processing of speech. Frontiers in Psychology, 4(DEC), 1–7.
Wilson, B. S., & Dorman, M. F. (2008). Cochlear implants: a remarkable past and a brilliant future. Hearing Research, 242(1-2), 3–21.
Wilson, B. S., Sun, X., Schatzer, R., & Wolford, R. D. (2004). Representation of fine structure or fine frequency information with cochlear implants. International Congress Series, 1273, 3–6.
Zeng, F.-G., Rebscher, S., Harrison, W., Sun, X., & Feng, H. (2008). Cochlear implants: system design, integration, and evaluation. IEEE Reviews in Biomedical Engineering, 1, 115–42.

Keywords: music training, music perception, Hearing Loss, Cochlear Implants, brain plasticity

Conference: SAN2016 Meeting, Corfu, Greece, 6 Oct - 9 Oct, 2016.

Presentation Type: Oral presentation in the Symposium in Neurosciences and Music

Topic: Symposium in Neurosciences and Music

Citation: Papadelis G (2016). Music-based rehabilitation in cochlear implant users: Insights from brain-plasticity research. Conference Abstract: SAN2016 Meeting. doi: 10.3389/conf.fnhum.2016.220.00041

Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters.

The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated.

Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed.

For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions.

Received: 29 Jul 2016; Published Online: 01 Aug 2016.

* Correspondence: Dr. Georgios Papadelis, Aristotle University of Thessaloniki, Department of Music Studies, Thessaloniki, 54124, Greece, papadeli@mus.auth.gr