Central Annals of Otolaryngology and Rhinology

Review Article *Corresponding author

Transfer Effects between Musical

Laure-Hélène Canette, LEAD, Institut Marey I3M, 64
rue de Sully, 21000 Dijon, France, Email:

Training and Linguistic Skills Submitted: 08 October 2016

Accepted: 05 December 2016

in Deaf Children with Cochlear

Published: 08 December 2016
ISSN: 2379-948X
Copyright

Implants © 2016 Canette et al.

OPEN ACCESS

Laure-Hélène Canette1*, Danilo Spada1, Marion Pineau1, Barbara

Keywords
Tillmann2, and Emmanuel Bigand1 • Cochlear implant
1 • Children
Laboratoire d’Etude de l’Apprentissage et du Développement (LEAD – CNRS UMR
• Musical training
5022), Université de Bourgogne, France • Language
2
Centre de Recherche en Neurosciences de Lyon (CNRL – CNRS UMR 5292), Université • Transfer of learning
Lyon 1, France

Abstract
Cross-domain transfer effects between musical training and language processing are well documented and this finding has clinical implication for different
pathologies, such as dyslexia. Only few studies have examined the impact of musical training on linguistic abilities in cochlear-implanted children. The
present review investigates whether musical training facilitates language processing in cochlear-implanted children. Priming studies demonstrated that linguistic
processing can benefit from prior exposure to rhythmic musical sequences. This was found by combining rhythmic primes and linguistic exercises in short and
long-term paradigms. Other studies have compared musician and non-musician cochlear-implanted children, or have assessed several abilities before and
after a musical training. They revealed better performance in linguistic tasks for musically trained children. Although these studies differ in many characteristics,
they highlight the possibility of transfer effects from music training to language processing in cochlear-implanted children. These findings can be understood
in light of different theoretical frameworks: the Dynamic Attending Theory appears to be useful for the interpretation of priming, while the expanded OPERA
hypothesis and the auditory scaffolding hypothesis are relevant to understand training studies.

ABBREVIATIONS can generate an infinite number of different musical pieces. This

highlights the importance of combinatory processes in music.
CI: Cochlear Implant(ed); NH: Normal-Hearing Musical sounds thus have abstract syntactic-like functions that
INTRODUCTION are strongly context-dependent [4].

Music is a pleasant activity that brings together numerous
abilities in different domains, notably cognitive, motor, affective
and social abilities. Recruiting these abilities with music
could modify the brain and thus lead to positive transfers to
non-musical domains [1]. For example, several studies have
investigated transfer effects for language, motor abilities and
motor rehabilitation, socialization of infants, or emotional
regulation [2].
Language shares various acoustic and structural
characteristics with music [5]. Similarly to music, speech
transmits information based on pitch, timbre, and temporal
dimension (tempo, rhythm, metric). It also contains elements that
are structurally organized and develops over time. At a cognitive
level, both music and language processing require memory,
attention and temporal integration in order to create a mental
representation and form expectations for upcoming events [6].

Music is a complex acoustic structure that evolves through
time. It can be described at different levels of organization [3].
The basic characteristics of musical sounds deal with pitch,
timbre (i.e., spectral structure), duration and loudness, but
a critical aspect of musical structure lies in the way musical
events are patterned through time. Higher levels of musical
organization, such as melodic contour, musical phrase, and
metrical structures, emerge from this patterning. It is worth
noting that in most musical idioms, a very limited number of
musical events (i.e., 12 pitch classes in Western tonal music)
Given these shared characteristics, numerous studies have
demonstrated some transfer between music and language
in normal-hearing (NH) adults and children by comparing
musically trained and untrained participants (for a review,
see [7]). This comparison however, does not allow to conclude
whether observed differences are caused by musical training
or by differences existing before musical training. Longitudinal
studies by contrast investigated the effects of a musical training
in two random groups of non-musicians; one group followed a
musical training program and the other followed a stimulating
non-musical activity. Longitudinal studies confirm that

Cite this article: Canette LH, Spada D, Pineau M, Tillmann B, Bigand E (2016) Transfer Effects between Musical Training and Linguistic Skills in Deaf Children
with Cochlear Implants. Ann Otolaryngol Rhinol 3(12): 1152.

Central
musical training can improve different linguistic skills, such as
phonological awareness [8], speech segmentation [9], reading
skills and pitch discrimination in speech [10], as well as speech-
in-noise perception [11]. Interestingly, Degé & Schwarzer’s study
[8] reported comparable effects of training on phonological
awareness, whether the program was specific speech-based
(phonological skills program) or non-specific (music program).
Musical training has further been used as a therapeutic tool
for speech rehabilitation in different pathologies. In dyslexic
children, a musical training program was found to improve
phonological awareness and reading skills, by enhancing
temporal processing and rhythmic skills [12]. Other studies
demonstrated an enhancement of auditory syntactic processing
(grammatical judgments) after listening to a musical rhythmic
prime versus a non-rhythmical prime or environmental sounds
in children with dyslexia and specific language impairment
[13,14].This same musical priming approach applied to children
with developmental language disorders had positive effects on
reading performance (i.e., reading words and pseudo-words with
two syllables) [15]. In addition, rhythmic priming paradigm has
been used to restore a physiological marker of syntactic error
perception in patients suffering from Parkinson’s disease and
patients with basal ganglia lesions [16,17].
To what extent similar finding could be observed with deaf
children with cochlear implants (CI)?
Developed for severely to profoundly deaf individuals, the
implanted devices are constituted by electrodes that directly
stimulate a limited number of areas of the basilar membrane.
This sparse sampling of the place code, necessarily leads to an
impoverished spectral resolution. By contrast, the temporal
information of the signals at slower scales (the envelope of the
bandpass signal) are relatively well preserved and transmitted
as train of pulses to the auditory nerve. This sparse information
allows for speech perception. When using vocoded speech (i.e. a
simulation of the perception via CI), it has been shown that only
a few bands are necessary to preserve intelligibility of speech in
quiet [18]. As pitch plays an important role in segregating target
speech from background noise, the loss in pitch resolution due
to the CI has a direct impact on speech perception in presence of
background noise [19].
Language acquisition in CI children is delayed and depends
on different external factors. Earlier age at implantation has been
shown to be associated with better language acquisition [20].
Children implanted before the age of 18 months show significantly
higher rates of comprehension and expression than children
implanted after 18 months [21]. Nevertheless, the majority of
early implanted children do not perform as well as NH children
when tested for language understanding and for receptive and
active vocabulary [22]. Furthermore, other factors account
for language acquisition: residual hearing before implantation
and wearing of hearing aids before 6 months, parent-child
interactions, socioeconomic status [21, 22]. Consequently, an
important variability is observed across children, even with early
implantation.
Children experience specific difficulties in speech-in-noise
perception (e.g., [23]), prosody perception (e.g., [24]) and
Ann Otolaryngol Rhinol 3(12): 1152 (2016)
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speech comprehension on the phone [25]. The CI remains also
limited for music perception [26]. In comparison to NH listeners,
pediatric CI users experience difficulties in various aspects of
music perception [27]: pitch ranking [28], song identification
and recognition [29-31], timbre discrimination [27], and rhythm
discrimination [27]. Nevertheless, some studies have provided
encouraging evidence that music could be used in rehabilitation
programs to stimulate auditory perception, notably reaching
beneficial effects on the perception of musical material (in
children: [32]).
The transfer of learning effects from music training to
language processing in CI users has been poorly studied with
experimental designs up to now. In CI adults, two studies
[33,34] using a melodic contour training program demonstrated
improved melodic contour identification, which was directly
trained, as well as improvement for various aspects of speech
perception (not trained). In a pilot study with two patients using
a sensorimotor training (i.e., patients had to produce the auditory
patterns on a keyboard), Patel [33] measured positive effects on
speech perception in noise and on prosody perception. Testing a
larger sample of CI adults with a training protocol that was only
perceptual, Lo et al., [34] did not show beneficial effects for the
perception of speech in noise, but showed improved perception
of prosody and of consonants in quiet.
This review focuses on training of CI children with two
types of interventions, depending on the involved time scale: (1)
short-term exposure to musical material with rhythmic priming
paradigms, and (2) long-term exposure to music in a study
comparing children who were musically trained and children
who were not (that is, musician and non-musicians based on
musical training in a specialized institution), and in studies using
a specific musical training program and measuring linguistic
skill performance before and after. We will then discuss three
theoretical frameworks that might account for the experimental
results.
SHORT-TERM EXPOSURE TO MUSICAL MATERIAL:
RHYTHMIC PRIMING PARADIGMS
Cason et al., [35] studied exposure to auditory rhythmic
primes before language processing in deaf children with hearing
device and children with CI. Children listened to a rhythmic
prime sequence (played with percussion sounds) followed by a
sentence that could metrically match or mismatch the metrical
structure of the musical prime. The children had to vocally
reproduce the rhythmic prime and had to repeat the heard
sentence. A baseline condition, without prime, was also part of
the experiment. Adding a baseline condition aimed for better
understanding of matching/mismatching condition effects by
controlling a possible cognitive cost due to the mismatching.
Phonological accuracy was assessed in terms of percentage of
correct production for vowels, consonants, syllables and words.
Children showed greater accuracy in the matching condition than
in both the mismatching and baseline conditions for syllables and
consonants, and in the matching condition compared to baseline
condition for vowel and word accuracy. There was no significant
difference between the mismatching condition and the baseline
condition. Listening to a matching rhythmic prime thus enhances
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subsequent phonological perception and the production of
spoken sentences. Importantly, this result pattern also depends
on children’s hearing aids: only CI users benefited from rhythmic
priming. It is interesting to note that the experimental procedure
asked children to reproduce the prime sequence and thus
perform a vocal action in relation with the perceived auditory
information, aiming to tap into processes linked to auditory-
motor coupling. This allowed to strengthen the perceptual effect
and to familiarize children with the motor act required for speech
production. Adding the reproduction task was based on results
of another study testing NH adults [36], which demonstrated
better phonological processing in the group who performed
vocal audio-motor training to the primes than in the group who
didn’t perform this training. Audio-motor training thus increases
auditory priming effects.
Another study went one step further aiming to associate
short-term effects and long-term effects using a rhythmic priming
paradigm in conjunction with a linguistic training program on
syntax processing [37]. This study focused on morpho-syntactic
processing in CI children aged from 5 to 10 years old. The children
performed a linguistic training program focusing on receptive
language skills; they performed morpho-syntactic exercises
that were separated by the presentation of rhythmic musical
sequences or non-rhythmic auditory sequences (environmental
sounds). This training occurred once a week during 16 weeks.
Two groups participated in the study, with a cross-over design:
one group started with the regular musical sequences during 8
weeks, and continued with non-rhythmical sequences also during
8 weeks, whereas the other group did the training in the reversed
order. Performance was compared between pre-tests and post-
tests before and after each of the trainings. Results revealed that
children’s performance improved for grammaticality judgments
and syntactic comprehension, and also for words and non-words
repetition task after training sessions involving regular rhythmic
sequences, but only for syntactic comprehension after the other
training. There was also an enhancement for some attentional
measures. This study demonstrates that listening to rhythmic
musical patterns can optimize language rehabilitation effects.
LONG-TERM EXPOSURE TO MUSIC
To evaluate musical training effects in CI users, two types
of studies have been conducted; either by comparing musicians
versus non-musicians [38], or by designing an experimental
musical training program and assessing abilities before and after
training using longitudinal paradigms [39-41].
Comparing musician and non-musician CI children: A
cross sectional study
Rochette et al., [38] compared two groups of profoundly deaf
children (with hearing aids or hearing aid with CI) recruited in a
specialized institute for children with hearing impairment. One
group (14 children) performed weekly music lessons for a period
of 1.5 to 4 years, and the other group (14 children) did not receive
musical training. All children received standard rehabilitation
programs. Musically trained children performed better than non-
musically trained children in auditory scene analyses, working
memory and phonetic discrimination. Musical training can thus
have effects on auditory cognition (auditory working memory)
Ann Otolaryngol Rhinol 3(12): 1152 (2016)
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and on a linguistic skill (phonetic discrimination). For the latter,
additional analyses taking into account the influence of music
lessons, chronological age, duration of deafness, length of device
use, perceptual threshold, and type of device they use, revealed
that only music lessons accounted for the observed group
differences, suggesting a transfer effect of musical training to this
linguistic skill. 
Musical trainings: longitudinal studies
Torppa et al., [39] examined prosody perception by collecting
two measures over 16 months in early CI children practicing
musical or non-musical activities. Children were between 4 and
13 years old. Two groups of CI children participated in the study:
one group practiced dance or music lessons (N=8) whereas the
other group was engaged in non-musical activities (N=13). In
addition, a group of NH children matched for age, gender and
musical/non-musical activities to the CI children (N=21) was
included. The main result was that the CI music group performed
better than the other CI group in prosody perception tasks.
For word stress perception, musical activity was the strongest
predictor, taking into account F0, intensity and duration
perception, digit span, performance intelligence quotient and
music group. For sentence stress perception, the performance of
the CI music group and the NH group were similar, whereas that
of the CI non-music group was lower than that of the NH group.
The authors highlighted links between prosody perception tasks
and auditory tasks: firstly, a link between intensity discrimination
and word stress perception; secondly F0 discrimination was the
strongest contributor for sentence stress perception. This result
is coherent with the observation that intensity discrimination
and F0 discrimination were equivalent between the NH group
and the CI music group, whereas the CI group without music
training showed lower performance than these two groups.
Finally, this result is also observed for forward digit span, and
further, in this task, the CI music group improved between the
two measurements, whereas the CI non-music group did not
improve.
Two other studies set up a specific musical training program,
and evaluated different abilities before and after the program in
order to measure potential improvements due to the program.
Yucel et al., [40] studied whether a musical training program
based on pitch and rhythm perception (discrimination) can
affect speech perception. It was a family centered program,
using a take-home electric keyboard, with different levels of
difficulty. Eighteen profoundly hearing-impaired children with
unilateral cochlear implantation participated in the study, 9
in the music group and 9 in the control group. Assessment of
speech perception occurred at pre-implant and 1,3,6,12,24
months post switch-on. Assessment focused on sound and word
identification tests, comprehension of verbal instructions and
sentence repetition. Furthermore, parents completed report
scales about musical perception, behavior related to auditory
perception and to speech production. No differences were found
between the two groups concerning speech perception tasks
at the different evaluation times, except at 3 months. Although
the performances of the music group improved more rapidly,
only one difference appeared  between the two groups at 3
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months post switch-on, notably for the comprehension of verbal
instructions test. This might reveal a positive effect of music
training on speech perception development at the beginning of
the implant. The results obtained from questionnaires indicated
positive effects of musical training on daily listening attitudes:
on the basis of parent’s reports, children in the music group
were more interested in listening to music, more attentive to
musical and rhythmical changes, more able to follow the melody
of songs, and differed in terms of emotional reactions to music.
The authors interpreted the lack of effects on speech perception
by the absence of contralateral hearing aids. Pitch perception is
indeed better with this type of device used in conjunction with
CI than with CI alone, and using both types of devices would
promote music perception [42,43] and thus musical training.
Another interpretation can be proposed. The musical training of
this study was based on perceptual discrimination but children
did not produce music. Based on previous findings (see [44] for a
comparison between active and passive music classes in infancy),
we can postulate a greater effect when musical training engages
children in audio-motor actions such as playing instruments,
singing or dancing with the beat.
Roman et al., [41] used an auditory training program based
on environmental and abstract sounds, voices and music.
Beyond testing trained and untrained abilities, they aimed to
assess whether the auditory training can transfer to a non-
trained linguistic ability, in particular phonetic discrimination.
The authors compared a trained group (experimental group)
to an untrained group (control group). The experimental
group performed 20 individual weekly sessions of 30 minutes.
Each group was assessed two times, before and after training,
regarding their performance in identification, discrimination,
auditory scene analysis, auditory memory and phonetic
discrimination. Children in the experimental group showed a
significant improvement of directly trained auditory abilities
(identification, discrimination and auditory memory), as well as
in the non-trained phonetic discrimination ability, whereas the
control group did not show any significant improvement. These
results revealed a transfer effect from auditory training to a
linguistic skill. Improved auditory abilities might permit phonetic
discrimination enhancement. Furthermore, this improvement in
phonetic discrimination was stronger in younger children: age
was the best predictor for phonetic discrimination improvement.
This result highlights the importance of early training
intervention.
THEORETICAL FRAMEWORKS ADDRESSING
POTENTIAL LINKS BETWEEN MUSIC AND
LANGUAGE PROCESSING
The link between music and language processing can be
traced back to infancy. Infants possess early receptive musical
skills [45] and can entrain to musical rhythms [46]. Moreover
they show preferences to the melody of speech, singing and music,
and they move in rhythm and manifest interest and happiness
[47, 48]. Musicality plays an important part in early mother-
infant communication: infants synchronize their responses
to their mother with rhythmic patterns of vocalization, body
movements and gestures [47,48]. In these proto-conversations,
infants adjust, for example, own arm movements to the syllabic
Ann Otolaryngol Rhinol 3(12): 1152 (2016)
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rhythm of adult speech [49], and the role of rhythmic tactile
communication has been shown for children with sensory loss,
including deafness [50]. A proto-musical competence, coupling
manual and vocal rhythmic gestures, leads to a proto-language,
by engaging overlapping processes in the brain. The fundamental
place of musicality in childhood and the contribution of music
and rhythm processing for language and communication suggest
the hypothesis of potential transfer effects of one trained ability
on the processing of the other. To further explain transfer effects
between musical training and language processing in particular,
we focus on three theoretical frameworks based on empirical
research conducted with children and adults. By stimulating
perceptual and cognitive processes, also involved in language
perception, music training can enhance these processes and
therefore language ability.
The expanded OPERA hypothesis and the SEP
hypothesis
According to the original OPERA hypothesis [51,52], adaptive
plasticity in speech processing networks is induced by musical
training when 5 conditions are gathered: (1) Overlap  of brain
networks that processes music and speech, (2) Precision: music
places greater requirements on these networks than speech,
(3) Emotion: pleasantness of music, (4) Repetition: frequent
repetition of actions related to several sessions of music practice,
and (5) Attention: focused attention is required during the
musical activity. When these conditions are combined, the
speech processing networks function with higher precision and
this plasticity profits to speech processing. Whereas the original
OPERA hypothesis focuses on the fact that music training requires
enhanced sensory processing, the expanded OPERA hypothesis
[33] goes further by also considering the demands that music
training places on cognitive processing. Indeed, the expanded
OPERA hypothesis unifies the OPERA hypothesis – centered on
sensory processing – with Strait and Kraus [53] and Besson et
al., [7] studies. According to these authors, music and speech
involve both auditory working memory and auditory attention
with overlapping brain networks. By enhancing these skills,
music training can have an impact on speech processing. In sum,
the expanded hypothesis suggests that music training can elicit
plasticity in speech processing networks. Music training enhances
speech processing when it involves greater requirements than
speech on shared sensory or cognitive processes, in the context
of emotion, repetition and attention.
Fuji and Wan [54] developed a rhythm-specific extension of
the OPERA hypothesis named SEP hypothesis. This framework
adds two components to Patel’s framework to explain how and
why musical rhythm can benefit speech and language processing:
(1) Sound Envelope Processing and (2) Synchronization
and Entrainment to a Pulse. The hypothesis is based on
the observation of overlapping brain resources for rhythm
perception and production in music and speech. A rhythm-based
training program may thus stimulate brain networks underlying
communication via sound envelope processing as well as
synchronization and entrainment to a pulse.
The auditory scaffolding hypothesis
The auditory scaffolding hypothesis, proposed by Conway,
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Pisoni and Kronenberger [55], proposes a link between sound
and cognitive sequencing abilities. Because sound is a temporal
and sequential signal, hearing sounds exposes to serially ordered
events, and by this way supports the development of general
cognitive sequencing abilities. According to this hypothesis, in
deaf children, because of a lack of early auditory stimulation,
cognitive sequencing abilities are affected. The authors
demonstrated impaired motor sequencing skills (fingertip
tapping task) and visual sequential learning in children with CI
compared to age-matched NH children. A period of early auditory
deprivation thus affects non-auditory sequencing abilities, which
impacts spoken language.
In this context, by taking into account that musical training
boosts sequencing skills, it might be possible to improve these
skills in CI children using music, and as a consequence enhance
language skills because sequencing is also involved in language
perception [56].
The Dynamic Attending Theory
According to the Dynamic Attending Theory (DAT) [57-
59], attention is not distributed equally over time but develops
in cycles, and tends to synchronize with regularities in
environmental sounds (music, speech, etc.). Attentional resource
distribution might depend on cerebral rhythm synchronization
with external temporal structures. This synchronization, by
modulating the attentional rhythm, might allow listeners to
develop expectations about when incoming events will occur, to
make more attentional resources available at specific time points,
and as a consequence improve processing. This framework,
initially proposed for music, also applies to speech [60-62].
Priming studies can be understood within Jones’ framework.
Exposure to an auditory rhythm providing predictable cues
induces temporal expectancies: by entraining internal oscillators,
the regular events of the prime orient attention over time.
This phenomenon then facilitates sequencing and temporal
segmentation of speech, and thus benefits syntax processing.
Speech is indeed tied to time and require temporal processing
and cognitive sequencing [62]. In patients, an impaired temporal
processing affects speech processing. Because music has as
clear metrical structure (and more clearly established than in
language), the impaired temporal processing can benefit from
the musical stimuli in order to boost speech processing. This
priming effect can occur with a matching rhythmic prime [35],
but also without this direct and strict agreement between the
prime and the subsequent sentence [13,14,16,17]. In this case,
the rhythmic prime is designed to boost internal oscillators at
an appropriate rhythm for speech processing (stressed syllables
occurrence [63]).  subsequent language processing and potential long-term effects
DISCUSSION & CONCLUSION
The studies presented here suggest that different language
abilities can benefit from music training in CI children. The
results highlight the cross-domain impact of musical training on
language processing. According to the here reviewed theoretical
frameworks, transfer effects from musical training to language
processing might occur thanks to shared sensory and cognitive
abilities between these two domains. By boosting these abilities,
Ann Otolaryngol Rhinol 3(12): 1152 (2016)
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musical training should lead to speech enhancements. The
expanded OPERA hypothesis highlights both sensory and
cognitive processing, with auditory working memory and
auditory attention, whereas the auditory scaffolding hypothesis
focuses on cognitive sequencing abilities. Furthermore, the
expanded OPERA hypothesis emphasizes the role of cerebral
plasticity in speech perception networks due to musical training.
This is in line with studies indicating that language and music
recruit shared neural resources [5,64].
While some results suggest that enhancing speech abilities by
musical training is possible in CI children, the direct comparison
of these results is difficult because the studies differ by numerous
characteristics. These differences highlight the complexity of this
research domain (for a review about music training, see Gfeller
[65]).
(1) Characteristics of the children  participants: types of
hearing aids (unilateral or bilateral CI, contralateral hearing
device), age, age at implantation, duration of CI use.
Regarding hearing devices, four studies [37,39-41] included
only CI children, whereas the two other studies [35, 38] included
not only CI children but also children with hearing aids. Cason et
al., [35] did not obtain the same results in CI users and in hearing
device users, showing the importance of distinguishing these two
populations.
For age range, in Torppa et al., [39], it was very large (4 to
13 years old), thus including children with different language
levels and different durations of implantation, whereas age range
was more reduced in Rochette et al., [38]: 8; 6 years in average
(SD=1).
For duration of CI use, Yucel et al., [40] followed children
after switch-on whereas other studies assessed children several
years after implantation. Taking into account duration of CI use is
important because perception is very different just after switch-
on than after many years of CI use.
(2) About experimental design: cross-sectional studies or
longitudinal studies with specific musical training, duration and
frequency of the training, person who take charge of the training
(professor, parents), type of group control (CI children, NH
children, type of activity completed by the control group).
Studies are very different in terms of duration of exposure
to music: 1) Cason et al., [35] studied short term effects with a
priming paradigm, 2) Bedoin et al., [37] combined short-term
priming impact and speech rehabilitation, 3) the other studies
[38-41] measured long-term trainings, from some months to one
or more years. Data from priming studies suggest an effect on
on language when it is used within a language rehabilitation
program. Data from training studies suggest long-term effects on
language processing.
Most of studies included a control group, who was not
musically trained [38,40,41] or performed non-musical activities
[39]. It is indeed crucial to include a control group to disentangle
developmental effects from training effects in long-term studies.
Including a control group that follows a non-musical activity
such as painting seems to be also important for controlling
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motivational effects (e.g., [12]) Moreover, one study included NH
children as a control group [39]. Finally, Bedoin et al., [37] did a
cross-over design. This design allows counterbalancing the order
of the two trainings across patients and to hold each training
condition as the effect of an intra-individual factor.
(3) About musical training: active or passive training, musical
characteristics targeted, and pedagogy.
Each study used a different training approach. Studies used
different training exercises (discrimination in Yucel et al., [40];
interacting with instruments, sensorimotor activities, memory
and analyzing emotional value of musical pieces in Rochette et
al., [38]). Most of the long-term studies used active trainings
that engaged not only perception but also demanded the child
to be active, except in Yucel et al., [40]. In NH infants, Gerry et
al., [44] have demonstrated that an active musical training is
more effective than a passive training on the development of
prelinguistic communicative gestures and social behavior. In
addition, audio-motor training influences rhythm perception in
music [66]. In this context, and also suggested by Cason et al.,
[35,36] in a priming approach, using audio-motor activities in
musical training appear relevant in order to maximize training
effects.
An important question is: what does “music training” refer
to? Some studies target one or several aspects of basic musical
characteristics and connect them to the assessed language skills.
Priming studies [35,37] focused on rhythm (in line with the DAT)
in link with sentence perception and segmentation, while Yucel et
al., [40] proposed training based on pitch and rhythm perception
and assessed prosody perception. Other studies [38,39] did not
target a specific musical characteristic, but the training was based
on musical lessons in which several musical characteristics were
manipulated via different activities (playing instruments, singing,
dancing). Roman et al., [41] integrated music sound training with
more general sound training (combined with action).
(4) About measures: linguistic domains assessed and tools
used to measure speech performances (experimental quantified
tests, questionnaires).
Different speech abilities were studied. Two studies
investigated phonetic discrimination, one with a retrospective
approach [38] and the other with a longitudinal approach
using pre- and post-tests  [41]. Torppa et al., [39] focused on
prosody perception (using perceptual tests), Yucel et al., [40]
assessed other aspects of speech perception (sound and word
identification tests, comprehension of verbal instructions and
sentence repetition) and speech production using questionnaires,
and Bedoin et al., [37] studied morpho-syntactic processing.
These observations raise questions about what kind of speech
abilities can benefit from musical training, and future studies
should systematically manipulate the different aspects and levels
involved in speech perception and production.
Furthermore, it is important to consider the initial degree
of hearing loss and the hearing threshold achieved with the CI,
and information about speech discrimination and language
development. By providing a clinical picture of children, these
information’s could allow for a better understanding of measured
effects. In addition, measures about sensory and cognitive
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abilities, thought to be important for transfer effects according
to the different theoretical frameworks presented above, should
also be acquired in order to better understand potential transfer
effects with its extensions and limitations.
In sum, the use of music as a rehabilitation tool with CI children
seems to be promising, but the domain needs further studies.
Much more remains to be done in order to determine exactly
which speech abilities can benefit or not from music training, by
which means (e.g., shared sensory vs. cognitive processing) this
effect takes place, and what kind of music training is the most
appropriate to produce this effect. Future studies could thus
allow creating and improving music rehabilitation programs,
and musical training could be a complementary tool to classic
language rehabilitation.
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Cite this article

Canette LH, Spada D, Pineau M, Tillmann B, Bigand E (2016) Transfer Effects between Musical Training and Linguistic Skills in Deaf Children with Cochlear Im-
plants. Ann Otolaryngol Rhinol 3(12): 1152.

Ann Otolaryngol Rhinol 3(12): 1152 (2016)

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