Neural Prediction to Enhance Language Outcomes in Children with Cochlear Implant

项目摘要/摘要 虽然人工耳蜗植入(CI)是治疗重度至深部感觉神经的最有效方法 听力损失，作为一个群体，CI儿童的表现大约是他们听力正常同龄人的15% 语言衡量标准。最耐人寻味的是，他们的语言结果在个人层面上有很大的差异， 尽管在很小的时候就植入了。使用术前脑磁共振成像(MRI)扫描，完成 作为常规临床评估的一部分，以及人工智能启用的分析方法，我们的研究将构建 预测英语和西班牙语学习中个体水平语言结果的神经预测模型 儿童手术后最多4岁。这些模型的临床实用性也将通过调查进行评估。 模型的预测在多大程度上与儿童对节目的反应程度相关联 强化沟通治疗。我们假设在手术后的4年里， 患有CI的儿童经历了语言发展的三个阶段：1)全球对口语的关注 儿童适应关于语言的电听觉输入，2)对语音模式进行编码 足够的信息来发展基于听觉的词汇表征，以及3)口语的发展 用较长的发音进行口头交流的语言句法。我们还假设大脑的完整性 与高阶认知、听觉和句法加工相关的网络对 单语英语学习CI儿童在这三个阶段的语言结果(目标1)。我们 进一步假设，这些网络在第一个过程中对于类型相似的语言基本上是不变的 阶段，但听觉网络的贡献将延长，并需要更高阶的认知 网络在更大程度上提高了西班牙语-英语双语CI儿童的语言成绩(目标2)。 作为我们当前R21项目的一部分，我们已经开发了标准化的临床评估和随访方案 跨不同的CI中心，将促进实现目标1和目标2所需的调查。目标3 关注神经结果预测和行为治疗之间的相互作用。主要CI中心 该项目将招收单语英语学习的儿童进行密集的，由家长实施的 沟通治疗(PICT)计划，这是迄今为止唯一有效的治疗计划 已经得到了随机对照试验的支持。我们将评估语言的神经预测是否 结果与PICT的语言习得程度成反比。具体地说，我们假设 根据我们的神经预测算法预测的语言障碍越严重，孩子越多 可以从信息和通信技术中受益。我们的翻译研究项目将推动沟通障碍领域的发展 在技术、理论和临床创新方面。它将是第一批证明预测到- 处方方法全面治疗听力损失是可行的，具有成本效益，并可以导致优化 所有CI儿童的语言结果。

PROJECT SUMMARY/ABSTRACT Although cochlear implantation (CI) is the most effective method for managing severe to profound sensorineural hearing loss, children with CI as a group perform at about 15th percentile of their normal-hearing peers on language measures. Most intriguingly, their language outcomes are highly variable at the individual level, despite implantation at a young age. Using pre-surgical brain magnetic resonance imaging (MRI) scans, done as part of the routine clinical evaluation, as well as AI-enabled analytical methods, our research will construct neural predictive models to forecast individual-level language outcomes in English- and Spanish-learning children up to 4 years after surgery. The clinical utility of these models will also be evaluated by investigating the extent to which the models' prediction is associated with the degree to which a child responds to a program of intensive communication treatment. We hypothesize that during the 4 years immediately after surgery, young children with CI follow three stages of language development: 1) global attention to spoken language as the child acclimatizes to electric auditory input about language, 2) encoding of phonological patterns with sufficient information to develop auditory-based lexical representations, and 3) development of spoken language syntax to communicate orally in longer utterances. We also hypothesize that the integrity of brain networks associated with higher-order cognitive, auditory and syntactic processing differentially contributes to language outcomes across these three stages in monolingual English-learning children with CI (Aim 1). We further hypothesize that these networks are largely invariant for typologically similar languages during the first stage, but that the contribution of the auditory network would be prolonged and require higher-order cognitive networks to an even greater extent to language outcomes for Spanish-English bilingual children with CI (Aim 2). As part of our current R21 project, we have developed a standardized clinical evaluation and follow-up protocol across different CI centers that will facilitate the investigations required to achieve Aims 1 and 2. Aim 3 concerns the interaction between neural prediction of outcomes and behavioral treatment. The main CI center of this project will enroll monolingual English-learning children for an intensive, Parent-Implemented Communication Treatment (PICT) program, which is the only treatment program to date whose effectiveness has been supported by a randomized controlled trial. We will evaluate whether neural prediction of language outcomes is inversely related to the degree of language gains from PICT. Specifically, we hypothesize that the more severe the predicted language impairment based on our neural predictive algorithms, the more the child could benefit from PICT. Our translational research program will advance the field of communication disorders in technological, theoretical and clinical innovations. It will be among the first to demonstrate that a predict-to- prescribe approach to holistically treat hearing loss is feasible, cost-effective and can lead to optimization of language outcomes of all children with CI.