Can Music Enhance Working Memory and Speech in Noise Perception in Cochlear Implant Users? Design Protocol for a Randomized Controlled Behavioral and Electrophysiological Study

Round 1

Reviewer 1 Report (Previous Reviewer 3)

Comments and Suggestions for Authors

The authors have sufficiently improved the manuscript which is now suitable for publication

Author Response

Dear Reviewer 1,

Thank you once again for your time and thorough review and approval for publication.

Best regards,

Kathrin Mertel, MM, NMT-F

Neurologic Music Therapist

Ph.D. Candidate, Music & Health Science Research Collaboratory (MaHRC)

University of Toronto

Assistant Faculty, The Academy of Neurologic Music Therapy

Reviewer 2 Report (Previous Reviewer 4)

Comments and Suggestions for Authors

Dear Author’s, I read you work entitled “Can Music Training Enhance/Affect Working Memory and Speech-in-Noise Perception in Cochlear Implant Users? Protocol of a study design for a randomized controlled study of EEG Measures of Improvement:

 

Overall, the manuscript is appropriate for the scope of the Journal, and the writing style is appropriate for a scientific manuscript. Good effort by the authors. Ι congratulate the Authors since they did a good job.

 

Thank you.

Author Response

Dear Reviewer 2,

Thank you once again for your time, feedback, and encouragement in the first round of reviewing my manuscript. I’m very grateful that the final version meets the high standards you have set and approved for publication.

Best regards,

Kathrin Mertel, MM, NMT-F

Neurologic Music Therapist

Ph.D. Candidate, Music & Health Science Research Collaboratory (MaHRC)

University of Toronto

Assistant Faculty, The Academy of Neurologic Music Therapy

Reviewer 3 Report (New Reviewer)

Comments and Suggestions for Authors

I  attached the pdf of the manuscript with some comments to bear in mind.

Moreover, I would add the following suggestions:

1. Too much text in the introduction. Please, summarize it, deleting some references (there are too many references and it almost imposible to read all of them). Apart from shortening the introduction, future readers would appreciate it would be easy to follow.

2. It is important to know the etiology of the participants, and the speech performance they had with the CI.

3. How will authors evaluate the working memory? which test will be used?

Comments for author File: Comments.pdf

Author Response

Dear reviewer 3,

Thank you once again for your thorough review and constructive criticism. I tried to address all your points and want to present you my revised manuscript and kindly ask you to review the final version to ensure that it meets the high standards you have set.

Comments in the manuscript:

• I edited your comments and highlighted them in red in my revised document
• The long title was simplified but I retained the acronym "EEG" because similar articles have used it in their headings, indicating that it should be understandable to the journal's readers.

1. Too much text in the introduction. Please, summarize it, deleting some references (there are too many references and it is almost impossible to read all of them). Apart from shortening the introduction, future readers would appreciate it would be easy to follow.

• I shortened the reference list and limited the number of references to 4 collectively
• The introduction was revised to be longer and more detailed based on recommendations from other reviewers to thoroughly explain all aspects of the project.

 

2. It is important to know the etiology of the participants, and the speech performance they had with the CI.

• Etiology will be a part of the demographics
• Speech performance pre- and post will be assessed as part of the behavioral SWIR procedure

3. How will authors evaluate the working memory? which test will be used?

• Working memory performance pre- and post will be assessed as part of the behavioral SWIR procedure. We have clarified how SWIR test incorporates memory recall of the final word of the test sentences.

Best regards,

Kathrin Mertel, MM, NMT-F

Neurologic Music Therapist

Ph.D. Candidate, Music & Health Science Research Collaboratory (MaHRC)

University of Toronto

Assistant Faculty, The Academy of Neurologic Music Therapy

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report (New Reviewer)

Comments and Suggestions for Authors

I attach the last version of the modified manuscript with some additional comments.

Comments for author File: Comments.pdf

Author Response

Toronto, June 18^th, 2024

Dear reviewer 3,

Thank you once again for your thorough review and helpful comments. We revised the manuscript and highlighted the new edits in light green.

According to your comment for the musical background questionnaire:

you should say how this test was created (e.g. some references, and why you did not use some validated questionnaire). As it is not a well-known questionnaire, the different items should appear in an Appendix, for example.

As you suggested, I attached the created questionnaire.

We are familiar with questionnaires such as the MuROoL or MuMu, which index musical background/experience prior to CI implantation or deafness, enjoyment of music with CI, additional devices used, ways music is listened to with a CI, preferred music genres, etc. These surveys mainly focus on music listening/enjoyment and its impact on quality of life post-CI implantation. Moreover, they tend to be extensive (e.g., MuMu: 8 pages).

In our study, we are interested in the effect of music training on speech understanding rather than music enjoyment. We are doing focused, active music training for CI users to examine its impact on speech understanding and quality of life.

While creating this short questionnaire, we drew included from questions on musical background and activity found in the "Munich-Music-Questionnaire German - 2016" (MedEl, developed by S.J. Brockmeier) and the "Questionnaire v3.0 - Music Listening Habits with CI and HA - German Translation" (developed by Cochlear). Additionally, we included a section for participants to evaluate the music training.

We are interested if more participants with musical experience engage in music training and whether this can affect the results. This short questionnaire on participants' musical backgrounds serves as a screening or categorizing tool. Although the questionnaire has been approved by the REB, we acknowledge that it is neither valid nor reliable in its current form and should be viewed as a baseline data collection.

We are very grateful that the final version mostly meets the high standards you have set to be approved for publication.

Best regards,

Kathrin Mertel, MM, NMT-F

Neurologic Music Therapist

Ph.D. Candidate, Music & Health Science Research Collaboratory (MaHRC)

University of Toronto

Assistant Faculty, The Academy of Neurologic Music Therapy

Author Response File: Author Response.docx

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This study project aims to elucidate the neurphysiological underpinnings of speech and music processing after CI in adults. Authors claim to reveal the influence of music training on speech in noise outcome during the rehabilitation process after CI. They presented the study design of using EEG recordings before and after the targeted musical training in deafness treatment. Overall the proposed study is interesting and amy provide valuable data on neuronal proessing after CI.

Comments on the Quality of English Language

English could be improved to better understandning, however, the main idea of the project is clear and experimental design as well as introduction are well descibed.

Reviewer 2 Report

Comments and Suggestions for Authors

The authors describe the background, rationale and method for a behavioral and neurophysiological (EEG) study on the effect of multi-modal (i.e., auditory-motor) music training on speech-in-noise perception in adult listeners with a cochlear implant. The goal is to further elucidate whether and how music training affects speech perception in cochlear implant listeners, which has important practical implications.

The plan has been well-documented, but it still is just a plan – why the authors would be interested in publishing a plan without any data eludes me. If this submission was done to have their rationale checked, or to pre-register their plan, or because of funding regulations, it is an inefficient use of review time and funding, given the APC of this outlet. I recommend rejection for the fact that the article describes an unfinished project with only a detailed introduction. Given the title, the reader will expect an answer – and not ‘expected results’.

Any further attempts to publish this may want to include consideration of the points below.

Main

1.     The program seems to focus on “auditory-motor” plasticity through music instrument playing, a.o., based on L90-91, stating that advanced musical skills help to extract temporal information from speech and thus improve understanding in background noise in young-adult Musicians (with capital M?). Here, according to the plan, the listeners are not all young adults, they presumably will be at best beginning musicians after the program, and the fact that 1-month auditory-motor training improves melodic contour extraction in CI listeners does not guarantee transfer to speech perception skills. Indeed, this all would be more convincing had the authors actually presented some results of the program.  

2.     P2, L57-59 mentions a lack of comparison with a control group in research on training effects of music, yet there does not seem to be space for a control group with non-CI listeners in the present proposal. Furthermore, it needs to be clearly motivated to what extent the authors think WM of adult CI listeners would benefit from music training, given that participants up to 70 years of age are included, and WM capacity / plasticity is likely to vary with age. Added to this, will the groups be matched according to age or years of CI use? If any, the degree of music knowledge/training/affinity of the participants before the start of the program may affect their progress and results. Is this going to be indexed?

3.     The program distinguishes training focused on “pitch” and “timbre”, but uses musical instruments for both, so there will be considerable overlap. How are the effects of “timbre” and “pitch” training results going to be distinguished here? “Timbre-focused” and “pitch-focused” are unclear terms and a more detailed description of the training contents is necessary. About this: P7, L309, “8 one-to-one practice sessions will be held twice a week a 50 min for 4 weeks..” is entirely unclear. Assuming we are not dealing with an intensive program of 16 sessions a week, but with a non-intensive program of 2 sessions a week, see points 1 and 2 above.

Minor:

1. P1, L18, ambiguous sentence: “...will undergo a 4-week neurologic music therapy training for 3 conditions...”. This reads as if the program takes 1 month. However, the flowchart and the text on P7 show a training period of 3 months, so clearer expressions are needed to convey the program duration, and – probably – a figure caption for the chart is necessary?

2. P1, L36-37 “...listening to speech in noisy (SIN) conditions, typical of everyday listening and music appreciation, still poses… (comma after appreciation and third-person “s” after pose.)

3. P2, L66, “[17] showed...”; P2, L68 “...[18] was able to demonstrate...”; P2, L70 “...[19] tested...” and elsewhere in the manuscript. Instead of having just the reference number as the subject of the sentence, similar to P1, L38 “Limb and Roy [1] summarized...” or P3, 1.4, L133 “Ng and colleagues [53] developed...” mentioning the author(s) looks more sympathetic.

4. P3, 1.3, L104 “...understand spoken language and communicate” > “...and to communicate” (?)

5.  P3, L119, “[50] concluded in a mini-review, that the characteristics...” delete comma

6. P3, L124, “attention resources” > “attentional” is used in L126.

7. Style: there are huge pieces of text without any paragraphs, e.g., section 1.2 and 1.5, while section 1.3 finishes with a one-sentence paragraph (or indented section). A bit more balance would improve readability.

8. P3, L140 “...speech intelligibility, ensuring that ….” (insert comma before ensuring)

9. P4, L164-L168. Long sentence, maybe split in two after [59].

10. P4, L190, comma after conditions?

11. P4, According to L170, “...the focus in this proposal will focus (???) on alpha and theta oscillatory activity...”, but, L191-192, “There is no documentation of possible change in alpha-theta oscillatory activity associated with WM capacity and SIN perception after multi-modal musical training”. In view of this, the EEG part seems exploratory at best.

Reviewer 3 Report

Comments and Suggestions for Authors I have had the opportunity to review your manuscript, which focuses on a protocol of study in the field of music perception rehabilitation in cochlear implant patients. I would like to begin by commending your efforts in addressing this important area of research. Your work has the potential to make a valuable contribution to the field. However, I recommend some minor revisions to enhance the clarity and impact of your manuscript.

1. Title Revision: The current title of your manuscript suggests that it is a study, whereas it is actually a protocol for a study. This is somewhat confounding for the reader. I recommend revising the title to more accurately reflect the content of the manuscript, such as "Protocol for Studying the Impact of Music Training on Working Memory and Executive Functioning in Cochlear Implant Patients."; or similar.
2. 1.  
   2. Detailed Description of Methods: While the methods section is comprehensive, ensuring that all aspects of the study design, participant recruitment, intervention, and analysis are clearly described will strengthen the manuscript, this would be facilitated by adhering to international guidelines (E.g. STROBE)
   3. Rigorous Statistical Analysis Plan: A more detailed description of the statistical analysis plan, including how the data will be analyzed to answer the research questions, would be beneficial.
   4. Discussion of Limitations: A discussion of the potential limitations of the study and how they might impact the results and interpretations should be included.
   5. Ethical Considerations: Ensure that ethical considerations, including informed consent and data privacy, are adequately addressed.
3. Inclusion of conflicting opinions: a recent review, concluded that there are no evidence to support the hypothesis that music training has a significant causal effect on speech understanding or speech processing in hearing-impaired populations. (DOI: 10.1177/2331216520985678). This should be discussed.
4. Emphasizing the Relevance of PROMs: In your introduction, it is crucial to address the lack of standardization in evaluating music perception in cochlear implant patients. Patient-Reported Outcome Measures (PROMs) are particularly relevant in this context. I suggest that you emphasize this point and include appropriate citations to support it (e.g. DOI: 10.3390/s22228770)
5.  
6. 1.  
   2. These revisions will help to clarify your study protocol and enhance the manuscript's contribution to the field. I look forward to seeing the revised version of your work.

Sincerely,

Author Response

See attached

Author Response File: Author Response.docx

Reviewer 4 Report

Comments and Suggestions for Authors

Dear Authors,

 

I read your article entitled “Can Music Training Enhance/Affect Working Memory and Speech-in-Noise Perception in Cochlear Implant Users? A Study of EEG Measures of Improvement”. This is a very interesting report upon this subject, but it would be better to see a literature review with the suggested protocol as outcome.

 

Thank you.

Comments on the Quality of English Language

Minor editing of English language required

Author Response

See attached.

Author Response File: Author Response.docx