Adaptation of a Rehabilitation Program for Prosody and Its Application on Egyptian Hearing Impaired Children
Condition: Hearing Impaired Children
MeSH terms: Deafness; Hearing Loss
Study type: Interventional

Summary: 
      Prosody is the melody and rhythm of speech, it is used to refer to the supra segmental
      aspects of speech including pitch, loudness and duration. Variations in these features
      achieve different prosodic functions and are perceived by the listener as meaningful changes.
      The role of prosody in language acquisition and effective communication is documented in
      research. Nevertheless, prosodic intervention in children with hearing impairment received
      less attention compared to other speech and language areas.

      The aim of this study is to adapt the "prosody treatment program", an evidence based
      rehabilitation program, and to detect the efficacy of its activities in improving the
      prosodic skills of Egyptian hearing impaired children.

      The "prosody treatment program" is an evidence-based practice targeting receptive and
      expressive prosodic skills in addition to speech production, intelligibility, pragmatics and
      phonology. The program is applied using a systematic approach of providing cues following the
      principles adapted from dynamic temporal and tactile cueing (DTTC) for speech motor learning
      to help accelerate the child's learning of the prosodic skills targeted in this program. The
      program was translated to Arabic and adapted to be suitable for the Egyptian children.
    

Detailed description: 
      Prosody has an important role in several areas of communicative functions including :
      grammatical, pragmatic, affective and/or indexical functions. Prosodic abnormalities extend
      across a wide range of communication disorders. Intact functioning auditory system has a
      fundamental role in language acquisition and development. Children receive the speech of
      others as a source of linguistic input which is considered their target and they gradually
      modify their productions using their own auditory feedback to reach the target utterance.

      Hearing impairment early in life deprives the child of the source of their linguistic input
      affecting various aspects of speech and language development. Speech production of the
      hearing impaired is characterized by various segmental and suprasegmental errors.

      Case studies show that interventions targeting prosody can modify prosody in young children
      with speech and language impairments. Multiple problems of prosody , language, speech and
      voice are found in individuals with prosodic impairments ,therefore it is challenging to
      develop treatment protocols addressing prosody .There are only few published interventions
      targeting prosody .

      Due to lack of well structured comprehensive Arabic programs targeting prosody , this work
      was dedicated towards adaptation of "prosody treatment program" a remediation program
      targeting receptive and expressive prosodic skills and its application on hearing impaired
      children .The proposed program targets two levels: preschool and school aged children.

      The aim of this work was to adapt the "prosody treatment program" program and apply its
      activities in cases of hearing impairment to detect its efficacy in improvement of prosodic
      skills in Egyptian hearing impaired children fitted with hearing aids or cochlear implant
      devices.

      This study was conducted on 55 children with hearing impairment attending the Unit of
      Phoniatrics , in the outpatient clinic of Alexandria Main University hospital. Sample size
      was calculated using two proportions power analysis in NCSS and PASS program a minimum sample
      size required to detect the efficacy of the "prosody treatment program" in improvement of
      prosodic skills of Egyptian hearing impaired children and to detect a difference of 0.5 that
      achieve 80% power with a target significance level at 5%.

      The proposed program is based on " prosody treatment program", a program targeting receptive
      and expressive prosodic skills. It includes activities targeting loudness , word stress
      ,syllable stress ,pitch ,question inflections ,emotions ,sarcasm ,rhythm ,chunking, and
      speaking rate . The program was adapted in order to be appropriate to the Arabic language and
      to the Egyptian children. The program was applied using a systematic approach of providing
      cues to help accelerate the child's learning of the prosodic skills targeted in the program.
      Cues are adapted from the Dynamic Temporal and Tactile Cueing (DTTC) for Speech Motor
      Learning hierarchy. It aims at improving motor planning, and programming speech processing as
      speech and language acquisition progresses.

      The program is divided into two sections according to the age into preschool section and
      school age section.

      A pilot study was conducted on 8 cases with hearing impairment attending the phoniatrics unit
      to check the suitability of the rehabilitation program and modify the needed items.

      All subjects met the specified inclusion and exclusion criteria and were assessed by the
      specified protocol of assessment to evaluate prosodic skills, language skills and cognitive
      abilities before and after intervention.

      Data were analyzed using IBM SPSS software package version 20.0. (Armonk, NY: IBM Corp).
      Qualitative data were described using number and percent. Chi square test was used for
      comparison of qualitative variables in two groups, Fisher exact test was used to compare
      qualitative variables when 50% of cell value was less than 5. McNemar test was used to
      compare nominal variables before and after intervention. The Kolmogorov-Smirnov test was used
      to verify the normality of distribution. Quantitative data were described using mean,
      standard deviation and IQR. Test of significance used included different tests. t test to
      compare between different means. Mann Whitney U test to compare non normally distributed
      quantitative variables in two different groups. Paired t test for comparison of normally
      distributed variables in matched pairs. Wilcoxon signed rank test for pre-post comparison in
      non-normally distributed quantitative variables. Kappa coefficient was used to assess level
      of agreement between two raters. Significance of the obtained results was judged at the 5%
      level.
    

Intervention name(s): Prosody treatment program; Traditional auditory and language rehabilitation
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The "prosody treatment program" is an evidence-based practice targeting receptive and expressive prosodic skills in addition to speech production, intelligibility, pragmatics and phonology. The program incorporates the principles of validated prosodic rehabilitation strategies such as Dynamic Temporal and Tactile Cueing (DTTC), Melodic Intonation Therapy, Lee Silverman Voice Treatment in addition to expert professional practice.
The program was applied using a systematic approach of providing cues to help accelerate the child's learning of the prosodic skills targeted in the program. The program is divided into two sections according to the age into preschool section and school age section.; Auditory rehabilitation therapy included activities targeting auditory skills: sound detection, discrimination, identification and auditory comprehension. Language rehabilitation targeted improving semantics, syntax, pragmatics and phonology.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: a comparative intervention study comparing the effect of prosodic rehabilitation in addition to the traditional language and auditory training on prosodic skills of hearing impaired children in comparison to traditional language and auditory rehabilitation alone.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Hearing impairment; Prosody; Speech rehabilitation; Cochlear implant