Implications of developmental plasticity for the language acquisition of deaf children with cochlear implants

doi:10.1016/S0165-5876(98)00125-6

International Journal of Pediatric Otorhinolaryngology

Volume 46, Issues 1–2, 15 November 1998, Pages 71-80

https://doi.org/10.1016/S0165-5876(98)00125-6 Get rights and content

Abstract

The study of language acquisition in profoundly deaf children with cochlear implants informs us about the developmental plasticity of the auditory system. Sensory activity leads to neural development, and the sustained effects of sensory inactivity can lead to a loss of responsiveness. These effects may be reversed by the subsequent provision of sensory stimulation, such as that delivered by cochlear implants. Behavioral and electrophysiological research on the effects of speech deprivation on language acquisition shows that the age and modality of language acquisition is an important determinant of adult linguistic performance. Studies on profoundly deaf children deprived of speech stimulation, and then provided with a cochlear implant giving them access to the speech frequencies, shows that congenitally deaf children implanted under the age of around 5 years are likely to perform better on speech perception and speech production tasks than children implanted at an older age. Further investigation is required to understand why these large individual differences exist. In addition, other key issues for research are the effects of compensatory visual and somatosensory development prior to implantation, whether there is a maturational delay that approximates to the period of speech deprivation prior to implantation, and whether there are a number of sensitive periods that together describe the cascade of processes that underlies language acquisition.

Section snippets

Overview

This review argues that there are three major tenets of developmental plasticity. First, sensory activity leads to neural development, and this is often known as the `glow and grow' theory. Second, the sustained effects of inactivity (sensory deprivation) can lead to a loss of responsiveness and selectivity in the auditory system. Third, the effects of inactivity may be reversed by the subsequent provision of sensory stimulation, and this is related to studies showing the protective effect of

Language acquisition and developmental plasticity

The recent electrophysiological literature briefly reviewed in Section 1shows that the brain continues to adapt and reorganize in response to environmental change. The following section discusses the physiological evidence in the light of the literature on language acquisition and associated sensitive periods. The reader is also referred to two recent reviews which provide a broadly physiological [22]and a rehabilitative [23]perspective.

Lenneberg [24]made a major contribution to the literature

Implications for future research

There appears to be a number of sensitive periods of language acquisition, rather than a single critical period as suggested by Lenneberg [24]. Moreover, the physiological data shows that learning and concomitant neural reorganization carries on into adulthood, albeit at a slower rate. Sensory activity leads to neural development, and the sustained effects of inactivity can lead to a loss of responsiveness in the auditory system. These effects may be reversed by the subsequent provision of

Acknowledgements

I would like to thank Dr Alan Palmer, Dr David Moore, Professor Quentin Summerfield, Mrs Sue Archbold, Ms Sharon Phipps, Dr Steve Mason and Ms Dee Dyar for constructive criticism. I also thank the two reviewers, whose comments enabled me to improve the quality of this paper. Parts of this review were presented at the International Conference on Language Development in Cochlear Implanted Children, December 8–9, 1996.

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This study used the Mandarin Children with Cochlear Implants: Parental Perspectives questionnaire (MPP), which assessed the communication capability, auditory perception, self-independence, level of happiness with family, social interaction, academic performance, outcome assessment for CI, and level of family support in children with CIs. Both univariate and multiple linear regression analyses were performed to identify the relationship of CI in children and the socio-demographic backgrounds of their guardians with hearing-related QoL in children with CI.
A total of 124 responses were collected, and they indicated satisfaction and improvement across all aspects of the MPP Questionnaire. Statistical analysis revealed that an earlier age of cochlear implantation (≤3 years old) could improve the communication capabilities, self-independence, social interaction performance, and academic performance of children with CIs. In addition, children with CI from the urban regions demonstrated better social interaction performance than that by those from the rural regions of China.
CIs can improve hearing-related QoL in children with pre-lingual or congenital hearing loss entering the mainstream education system in China. This study showed that early age of cochlear implantation was critical for successful long-term auditory development and academic achievement in children with CIs in China. Therefore, healthcare professionals and educators in China should advocate for CI for children with severe congenital or pre-lingual hearing loss.
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The aim of this study was to determine whether the auditory skills presented by five-year-old children can predict their performance in auditory processing (AP) tests at seven years old.
Thirty-five children were evaluated for AP at two different times. At evaluation 1, the children were between 5 years 2 months and 6 years 1 month of age, and at evaluation 2, they were between 7 years 1 month and 7 years 8 months of age. The interval between the evaluations ranged from 18 to 23 months. After evaluation 2, the 7-year-olds were classified according to their performance on central AP tests. The children were divided into three groups: GI included nine children with at least two AP tests that scored two standard deviations below the mean and the presence of a speech complaint; GII included 18 children with at least two AP tests that scored two standard deviations below the mean and no speech complaints; and GIII included eight children with no more than one test scored two standard deviations below the mean and no speech disorders complaint. The analysis was performed considering each test individually and as a battery of applied tests. From the results obtained, a discriminant analysis was performed to assess the differences in test performance between the groups when the children were 5 years old.
The discriminant analysis showed that with the results obtained during evaluation 1, it was possible to predict which group 74.3% of the children would be classified into after evaluation 2. The percentage of correct classifications for each group was 77.8% for GI, 66.7% for GII and 87.5% for GIII. That is, 87.5% of the children who were classified as GIII after evaluation 2 had already demonstrated good auditory performance in the tests applied at 5 years of age.
Children who exhibited lower scores on AP tests at 7 years of age had demonstrated poor auditory perception at 5 years of age. This finding is relevant because it offers the possibility of stimulating or training these auditory skills in preschoolers to foster their development.
Cerebral plasticity: Windows of opportunity in the developing brain
2017, European Journal of Paediatric Neurology
Neuroplasticity refers to the inherently dynamic biological capacity of the central nervous system (CNS) to undergo maturation, change structurally and functionally in response to experience and to adapt following injury. This malleability is achieved by modulating subsets of genetic, molecular and cellular mechanisms that influence the dynamics of synaptic connections and neural circuitry formation culminating in gain or loss of behavior or function. Neuroplasticity in the healthy developing brain exhibits a heterochronus cortex-specific developmental profile and is heightened during “critical and sensitive periods” of pre and postnatal brain development that enable the construction and consolidation of experience-dependent structural and functional brain connections.
In this review, our primary goal is to highlight the essential role of neuroplasticity in brain development, and to draw attention to the complex relationship between different levels of the developing nervous system that are subjected to plasticity in health and disease. Another goal of this review is to explore the relationship between plasticity responses of the developing brain and how they are influenced by critical and sensitive periods of brain development. Finally, we aim to motivate researchers in the pediatric neuromodulation field to build on the current knowledge of normal and abnormal neuroplasticity, especially synaptic plasticity, and their dependence on “critical or sensitive periods” of neural development to inform the design, timing and sequencing of neuromodulatory interventions in order to enhance and optimize their translational applications in childhood disorders of the brain.
literature review.
We discuss in details five patterns of neuroplasticity expressed by the developing brain: 1) developmental plasticity which is further classified into normal and impaired developmental plasticity as seen in syndromic autism spectrum disorders, 2) adaptive (experience-dependent) plasticity following intense motor skill training, 3) reactive plasticity to pre and post natal CNS injury or sensory deprivation, 4) excessive plasticity (loss of homeostatic regulation) as seen in dystonia and refractory epilepsy, 6) and finally, plasticity as the brain's “Achilles tendon” which induces brain vulnerability under certain conditions such as hypoxic ischemic encephalopathy and epileptic encephalopathy syndromes. We then explore the unique feature of “time-sensitive heightened plasticity responses” in the developing brain in the in the context of neuromodulation.
The different patterns of neuroplasticity and the unique feature of heightened plasticity during critical and sensitive periods are important concepts for researchers and clinicians in the field of pediatric neurology and neurodevelopmental disabilities. These concepts need to be examined systematically in the context of pediatric neuromodulation. We propose that critical and sensitive periods of brain development in health and disease can create “windows of opportunity” for neuromodulatory interventions that are not commonly seen in adult brain and probably augment plasticity responses and improve clinical outcomes.
The effect of age at cochlear implantation outcomes in Saudi children
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Citation Excerpt :
Notable differences in speech perception and production were initially demonstrated for children who received a cochlear implant under the age of about 5–6 years compared with children who received a cochlear implant after that age. These differences were attributed to a period of relative plasticity in the auditory system [17,22]. Recent work has focused on a critical or sensitive period wholly within the infancy/preschool-age stage of life.
To determine for the effect of age (late versus early age) on the cochlear implant outcomes; in terms of language development, auditory skills, speech perception, and production outcomes).
67 children were included in the study out of 93 implanted cases in the study period. Children were classified into 2 groups according to age at time of implantation. Group 1 contained 43 children who were implanted before the age of 5 years. Group 2 contained 24 children who were implanted after the age of 5 years. All children were evaluated pre-operatively and at 3, 6, 12, 24 months device experience using the language screening test, Standardized Arabic Language test, Listening Progress Profile (LiP Test), the Monosyllabic-Trochee-polysyllabic Test (MTP), and the meaningful Auditory Integration Scale (MAIS) Test. Charts with incomplete data were excluded.
Only 67 children had complete data out of 93 patients. The mean age (in months) for Group 1 was (43.37 ± 8.63) and for Group 2 was (70.38 ± 9.97) at time of implantation. Significantly higher mean values were detected for Group 2 in comparison to Group 1 in the pre-operative period. No significant difference was detected after 2 years evaluation using the test battery for language development and auditory skills.
Children who were implanted under the 5 years of age had a better outcome in the form of better auditory skills, speech perception, and language production. Limited resources and the absence of a national hearing screening program in Saudi Arabia result in the late presentation of children for evaluation and intervention of hearing problem; this late intervention reduces the benefits the late – implanted children derive from cochlear implantation.
The role of linguistic and environmental factors on grammatical development in French children with cochlear implants
2014, Lingua
Citation Excerpt :
Age at implantation represents one of the most widely researched issues in the field of pediatric cochlear implantation. For pre-lingually deaf children, neurobiological considerations suggest that age at implantation is the best predictor of the rate of language development because of the possible plasticity of the brain (Baumgartner et al., 2002; Robinson, 1998). The critical period view precludes grammatical progress at pace with typical development, claiming that even if children are implanted around 2 years of age, they are unlikely to acquire a sufficiently large vocabulary within the critical time span of 24–36 months to get grammatical development started since the critical time span has been missed.
This study investigates grammatical development in French children with prelingual deafness after two to four years of cochlear implant (CI) use. We analyze to what extent lexical, prosodic and environmental factors play a role in the acquisition of grammar. Transcriptions of spontaneous language in thirty-four CI users (17 boys, 17 girls) were analyzed and compared to those of typically developing children (TD) matched on robust auditory experience in similar standardized situations. The interactions between language components (i.e., lexicon, prosody and grammar) were found to be similar to the interaction observed in typical children. The rate of grammatical development was significantly slow and strongly associated with environmental factors (e.g., socio-cultural level of the family). This suggests that late acquisition has no major consequences on the developmental patterns but that environmental factors play an important role in smoothing the path to adult language. Such results are compatible with a socio-cognitive view of language development, according to which language acquisition is a gradual process reflecting interactions between maturation and social experience.
A Theory of the Transition to Critical Period Plasticity: Inhibition Selectively Suppresses Spontaneous Activity
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Citation Excerpt :
Many sensory and sensorimotor systems exhibit sequences of critical or sensitive periods that progress from simpler to increasingly more complex aspects of experience (Cang et al., 2005; Hensch, 2004; Brainard and Doupe, 2000; Werker et al., 2009; Hernandez and Li, 2007; Scott et al., 2007). In the auditory system, for example, a cascade of CPs induces plasticity for tonotopy, bandwidth tuning, binaural integration, directionality, phoneme discrimination, audio-visual matching, and semantic and syntactic development (Barkat et al., 2011; Insanally et al., 2009; Popescu and Polley, 2010; Werker et al., 2009; Robinson, 1998; Lenneberg, 1967). An appealing hypothesis is that these sequences of CPs may correspond to sequences of reductions in the spontaneous-to-evoked activity ratio along hierarchies of cortical areas (Felleman and Van Essen, 1991; Sharpee et al., 2011), switching the factors most strongly driving learning in each area from internally to externally generated (Tritsch et al., 2007; Moody and Bosma, 2005; Katz and Shatz, 1996; Hooks and Chen, 2006).
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Implications of developmental plasticity for the language acquisition of deaf children with cochlear implants

Abstract

Section snippets

Overview

Language acquisition and developmental plasticity

Implications for future research

Acknowledgements

Trends Neurosci.

Dev. Brain Res.

Hear. Res.

Hear. Res.

Cogn. Sci.

Cogn. Psychol.

Brain Res.

Otolaryngol. Head Neck Surg.

Brain Lang.

Brain Lang.

Adult auditory learning and training

Ear Hear.

Mechanisms of visual plasticity: Hebb synapses NMDA receptors, and beyond

Physiol. Rev.

The reorganization of somatosensory cortex following peripheral nerve damage in adult and developing animals

Ann. Rev. Neurosci.

Single-unit responses in the inferior colliculus: effects of neonatal unilateral cochlear ablation

J. Neurophysiol.

Neonatal cochlear hearing loss results in developmental abnormalities of the central auditory pathways

Acta Oto-Laryngol. (Stockholm)

Positron emission tomography of auditory sensation in deaf patients and patients with cochlear implants

Ann. Otol. Rhinol. Laryngol.

Bilateral electrical stimulation of a congenitally deaf ear and of an acquired deaf ear

Acta Oto-Laryngol. (Stockholm)

Auditory event-related potentials in post- and prelingually deaf cochlear implant recipients

Am. J. Otol. Suppl.

Cortical reorganization in deaf children

J. Clin. Exp. Neuropsychol.

Maturation of human cortical auditory function: differences between normal-hearing children and children with cochlear implants

Ear Hear.

Effects of sensory restriction upon the responses to cortical stimulation in rats

J. Comp. Physiol. Psychol.