Effect Of Music Integrated Phonological Awareness Program On Preschool Cochlear Implant Users

Study Overview
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Brief Summary
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The aim was to observe the effect of the music integrated phonological awareness program on preschool cochlear implant users and to compare the phonological awareness skills of the study group with the control group before and after the online training.

Detailed Description
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This study was designed to determine the benefit of music integrated phonological awareness programs for children using cochlear implants. In addition, the phonological skills and language skills of children using cochlear implants and children with normal hearing were compared in the pre and post-training results. Test of Early Language Development (TELD-3), The Phonological Awareness Scale of Early Childhood Period (PASECP), Mismatch Negativity (MMN) was used in this study. This study was carried out with follow-up patients in the Audiology, Language and Speech Disorders Clinic of xxx University - Medical Faculty, Department of Otorhinolaryngology. The study was performed with the approval of Ethics Committee, and written informed consent was obtained from all patient families (138955/ July 2021). There are 9 female and 14 male cochlear implant users in the study group; 9 female and 14 male children with normal hearing in the control group. Children ranging in age from 5 to 7 who also have 5-6 years old language skills without any neurological problems were included in the study. Cochlear implant mappings of all children were checked before the training. SPSS 25.0 (IBM) was used for statistical analysis. Pre and post-training comparisons of The Phonological Awareness Scale of Early Childhood Period, SMRT, and Mismatch Negativity tests were analyzed with the Wilcoxon test. The correlation of numerical measurements with each other was examined with Spearman Correlation. The differences in the numerical measurements used in the research according to the binary demographic categories were analyzed with the Mann-Whitney U test. The differences according to the multiple categories were analyzed using the Kruskal Wallis H test. The significance level (α=0,05) was used.

Official Title
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Effect Of Music Integrated Phonological Awareness Program On Preschool Cochlear Implant Users

Conditions
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Telerehabilitation

Intervention / Treatment
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* Other: Music-Integrated Phonological Awareness training program
* Diagnostic Test: Spectral-Temporally Modulated Ripple Test (SMRT)
* Diagnostic Test: The Phonological Awareness Scale of Early Childhood Period (PASECP)
* Diagnostic Test: Mismatch Negativity Test
* Diagnostic Test: Early Language Development (TELD-3)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: For children with hearing loss Bilateral severe sensorineural hearing loss Having unilateral or bilateral cochlear implants, Having a chronological age in the range of 5-7 years, Not having started primary school. Using the cochlear implant and regularly To receive regular training in the auditory rehabilitation center For children with normal hearing: To have normal hearing, To have receptive and expressive language skills compatible with the chronological age in the language test to be performed. Not starting primary school Exclusion Criteria: In case of not having any without being accepted for control and study, Having additional disability Using drugs affecting the auditory system

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 7 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: This study was designed to determine the benefit of music integrated phonological awareness programs for children using cochlear implants. In addition, the phonological skills and language skills of children using cochlear implants and children with normal hearing were compared in the pre and post-training results.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Study group<br>There are 9 (35,8%) female and 14 (64,2%) male preschool cochlear implant users in the study group. Children ranging in age from 5 to 7 who also have 5-6 years old language skills. | Other: Music-Integrated Phonological Awareness training program<br>* We would like to observe the effect of the music integrated phonological awareness program on preschool cochlear implant users and to compare the phonological awareness skills of the study group with the control group before and after the online training. The program is prepared as 10 lessons. Participants were guided through online training for 5 weeks, with 20-minute sessions conducted weekly. The training was carried out via Zoom, a free virtual interview program. Each family had a computer.<br>Diagnostic Test: Spectral-Temporally Modulated Ripple Test (SMRT)<br>* Spectral-Temporally Modulated Ripple Test (SMRT) was used to assess the spectral discrimination ability of the study group.Speech stimuli were presented at a calibrated presentation level of 60 dB SPL in a quiet room. The child was positioned at 0° azimuth and 1-meter from the loudspeaker.<br>Diagnostic Test: The Phonological Awareness Scale of Early Childhood Period (PASECP)<br>* The Phonological Awareness Scale of Early Childhood Period (PASECP) was used to measure the sound awareness and sound discrimination skills of study group pre-post training. The test has 8 sub-dimensions.<br>Diagnostic Test: Mismatch Negativity Test<br>* Mismatch Negativity (MMN) was used to evaluate the central auditory system.The test was used for electrophysiological recordings of the study group.The standard stimulus presented as /ba/ (%80), and the rare stimulus presented as /da/ (%20) frequency. The onset (rise) and offset (fall) times of the stimuli are 10 ms, and the plateau time is 50 ms. The interval between stimuli for both responses was 1.1 ms. A 0.1-30 Hz filter was applied. The speech stimuli intensity was 70 dB SPL. Speech stimuli were presented at a 1-meter distance from the participant, with speakers placed at an angle of 0°.<br>Diagnostic Test: Early Language Development (TELD-3)<br>* Test of Early Language Development (TELD-3) measured children's receptive and expressive language skills both group for inclusion criteria.<br>|
| Experimental: Control group<br>There are 9 (35.8%) female and 14 (64,2%) male preschool children with normal hearing in the control group. Children ranging in age from 5 to 6 who also have age-appropriate language skills. | Diagnostic Test: The Phonological Awareness Scale of Early Childhood Period (PASECP)<br>* The Phonological Awareness Scale of Early Childhood Period (PASECP) was used to measure the sound awareness and sound discrimination skills of study group pre-post training. The test has 8 sub-dimensions.<br>Diagnostic Test: Early Language Development (TELD-3)<br>* Test of Early Language Development (TELD-3) measured children's receptive and expressive language skills both group for inclusion criteria.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline in the phonological awareness skills at 3 Months | The Early Childhood Phonological Awareness Scale (PASECP) was used to measure sound awareness and sound discrimination skills of preschool children whose language age is between 60-72 months. The test has 8 sub-dimensions. There are 8 test items in the first sub-dimension and 10 test items in the other sub-dimensions, with a total of 78 test items. If the answers given by the children to the scale items are correct (1), if incorrect (0), they are coded into the answer key. The test is administered to children individually. The application time for each child takes approximately 15 minutes. High scores of the child indicate that his/her phonological awareness is good. | baseline and 3 months | 
| Change from Electrophysiological at 3 Months | Mismatch Negativity (MMN) was used to evaluate the central auditory system. Neuron-Spectrum-5 (4/EPM) (Neurosoft, Ivanoco, Russia) was used for the electrophysiological recordings of the study group. Speech stimuli were used as stimuli. Amplitude and latency changes were observed in the Mismatch Negativity test before and after the training. The increase in amplitudes and shortening of latencies after training indicate that the central auditory system has developed. | baseline and 3 months | 
| Change from baseline in the spectral discrimination ability at 3 Months | Spectral-Temporally Modulated Ripple Test (SMRT) was used to assess the spectral discrimination ability of the study group. The test was performed using SMRT software. Waveform broadband noise with spectral-temporal modulation was used. In each trial, three ripple sounds were presented. Two stimuli were reference signals with an intensity of 20 ripple/octave (rpo) and another stimulus was a target signal with a lower rpo intensity. The initial intensity of the target signal was 0.5 rpo and was replaced by a step size of 0.2 rpo. Adaptive running terminated after ten reverses.Spectral-Temporally Modulated Ripple Test was calculated over the last six reversals. Three runs were completed for each child, and the final threshold was determined by averaging the three runs. Having a low rpo value was an indication of good spectral resolution of the children. | baseline and 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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music, Phonological awareness training, cochlear implant, telerehabilitation, mismatch negativity