Subjects

In order to be in included in this study, each child and each parent had to fulfill certain criteria. Inclusion criteria for each child were as follows:

1. Age between two to three years old;

2. No known disability other than deafness;

3. Speech awareness threshold no poorer than 40 dB with the CI.

Regarding the second criterion, the children's educational and developmental assessments in their personal files were searched for evidence of any disability other than deafness and then considered in terms of inclusion or exclusion in the study. In addition, a screening process was carried out by the researcher to double check the information on the children: The parents completed a questionnaire called “The Infant/Toddler’s Sensory Profile” (Dunn, 1997, 1999), which evaluates the child’s sensory processing abilities and how these abilities support or interfere with functional performance. The sensory profiles were analyzed by the researcher (after learning how to do it from an occupational therapist). The researcher’s background in

working with learning disabled children gave her additional familiarity with the area of sensory profiling. Only children, who scored within the normal range, were considered for inclusion in this study.

The importance of the third criterion lies in the fact that once the child has a speech-awareness level of 40 dB, he/she is definitely responsive to the environment.

The researcher is aware of the fact that due to the limited number of the subjects, it was impossible to control the implant manufacturer variable. Four subjects had the same type of implant and one had another type (see Table 3.2). However, as mentioned in section 2.3.2, there is currently no evidence that CI devices manufactured by different companies differ in their music perception outcomes.

Another uncontrolled variable due to the small sample size was the language acquisition philosophy of the settings. The children included in this investigation were drawn from educational centers which adhere to different language acquisition philosophies: oral communication (exclusively auditory-verbal), total communication (combination of verbal and signing), and cued speech (verbal with supplemental hand gestures). This will be discussed in the discussion chapter.

The inclusion criteria for each parent were as follows:

1. Normal hearing;

2. A working knowledge of Hebrew;

3. No cognitive or psychological impairments of any kind, e.g., mental retardation, alcoholism, etc.

The premise for the first inclusion criterion for the parents is that the probability of a child with CI and hearing parents to be exposed to music at home is greater than if he/she has parents who are deaf. Therefore, normal hearing for the parents was important because many questions in the questionnaires related to the music experiences at home. An additional requirement for the parents was that they have a working knowledge of Hebrew in order for them to be able to answer the questionnaires and be interviewed. Many languages other than Hebrew (e.g., Arabic and Russian), are spoken in Israel. Children with CI from non-Hebrew speaking families are treated in the educational centers for children with HI and might be potential candidates for this study. However, since the researcher does not speak and/or read those languages and therefore it would be impossible for her to analyze the parent questionnaires or interviews in those languages, parent's working

knowledge of Hebrew only was set as an inclusion criterion. This limited the number of potential subjects. In regard to the third inclusion criterion: since cognitive or psychological impairment of any kind affects all areas of the parent's as well as the child's functioning, this criterion was selected to avoid the impact of such a variable.

The information needed on the parents was provided by the principal and the psychologist of “Micha” and “Shemaya”.

Recruiting the subjects for this study was a long and difficult process, due to a number of factors. The younger the child is when implanted, the more advantage can be taken of this rapid learning stage. In general, the brain learns most quickly when it is young (see section 2.2.7). For this reason, the researcher was interested in undertaking a study with a focus on young children. At the time the elaborated proposal was submitted to Aalborg University, children in Israel were implanted at the minimum age of two years. As data accumulated that the cochlear implant was exceedingly safe and effective, the acceptable age for implantation was lowered.

Currently, children as young as twelve months can be implanted. One of the inclusion criteria for the subjects was that speech awareness thresholds would be at levels no poorer than 40 dB with the CI. Following the implantation, each child reaches this level of hearing at a different time, and this can be within two months or more because of individual differences. However, in order to carry out this study and answer its questions, it was impossible to work with children who were as young as one year and a few months of age because they lacked the more developed communicative interactions investigated in this study (e.g, turn-taking and synchronization). Therefore, the researcher decided to choose children who were at least two years of age, a fact that immediately limited the number of potential subjects who matched the inclusion criteria and resulted in an arduous process of recruiting subjects in three different cities. In addition, the researcher limited herself to a maximum traveling distance of 100km to reach the different educational settings for carrying out the clinical trials. All these restrictions further complicated the recruiting process.

Ten children were referred by the staff at the different settings, as potential participants in accordance with the inclusion criteria set by the researcher. Five children were excluded from the clinical trials for the following reasons:

1. Two children did not score within the normal range on the Infant/Toddler Sensory Profile- Clinical Edition (Dunn, 1997, 1999).

2. One child dropped out after one session; another child dropped out after two sessions, both due to lack of cooperation from the parents, who had personal difficulties continuing to bring the child to the sessions.

3. The fifth child had problems with the cochlear implant after two sessions. The staff discovered that he did not hear with the implant as he should have and therefore, he was discontinued from participation in the study.

Finally, five children- four girls and one boy- participated in the clinical trials.

Three girls and the boy completed all 16 sessions while one girl, Z, completed only 11 sessions due to her lack of cooperation which stemmed from a difficult phase at home and kindergarten, and some emerging resistance towards cooperating with adults.

In order to provide a more complete picture, background data on the children is presented in Table 3.2. Four children were diagnosed as having severe to profound hearing impairment by six to seven months of age; the detection of hearing impairment for one child, who is an adopted child, is not known exactly. Her parents discovered it only when she was 10 months old but they said she might have already had a hearing impairment before that. Additional information regarding each child’s treatment is presented in Table 3.3.

The background data of the parents are presented in Table 3.4. The data was not obligatory, but rather optional. These data will be relevant for the discussion of parent questionnaires and interviews.

Table 3.2. Background data of the subjects^a

aAll children were Jewish Israelis, born in Israel. ^bChildren’s names appear in abbreviated form. ^cAll of the subjects were implanted unilaterally. None of them used a hearing aid in the non-implanted ear.

Subject^b

C Ay O Af Z

Gender F F F M F

Date of birth 14.11.02 29.4.03 9.2.04 24.12.02 11.6.03

Age at detection of hearing loss

At birth At birth 6 months 7 months During first year

of life

Etiology CMV Genetic Unknown Genetic Unknown

Age at implantation

(in months)

20 21 16 31 24

Age at onset of research

(in months)

26 27 24 36 27

Manufacturer^c Cochlear Cochlear Advanced

Bionics Cochlear Cochlear

Implant Nucleus 24 Nucleus 24 HiRes 90K Freedom

contour Nucleus 24

Speech

processor ^{Sprint Sprint Platinum Freedom Freedom}

Data on cochlear implant

Speech coding strategy

ACE ACE HiRes ACE ACE

Table 3.3. Treatment information of the subjects individual sessions a week of speech and language from a teacher of the deaf. In addition, once a week Ay and C came to “Shemaya”- the nursery school for children with HI, for about 30 minutes of speech therapy from a qualified speech therapist.

Table 3.4. Parent background data (optional for parent)

Parent of - Mother/