NATURIST MEDICINE , 2016; Vol. 10 - No.

1: 21-27
ISSN: 1576-3080

Auditory stimulation as a therapeutic

tool in childhood language disorder

María Francisca Alonso-Sánchez one, Waldo Suárez-Zambra 2,

María Jesús Espinoza-Salinas 3, Paula Ramírez-Bustamante 4
one PhD, Prof. School of Speech Therapy, Faculty of Health, Universidad Santo Tomás, Chile.
2 Graduate, Prof. School of Speech Therapy, Faculty of Health, Universidad Santo Tomás, Chile.
3 Bachelor, Prof. School of Phonoaudiology, Faculty of Rehabilitation Sciences, Andrés Bello University.
4 Master, Autonomous University of Madrid.

Received: 12/20/2015 Accepted: Dec 28 2015

SUMMARY The use of music as a therapeutic tool to increase the performance of language skills is

a controversial subject, since, in fact, the studies that pose this problem do not agree on methodology or results. Due to this, a review of
the evidence was carried out to establish the relationship between language and music therapy or music training. A bibliographic search
was carried out in PubMed and Cochranne and, after a methodological analysis, 7 articles were selected. According to the evidence
from the articles found, it is not possible to establish the relationship between musical training or music therapy and increased skills.

Keywords: Language, music therapy, music training, language disorder.

2. 3

Auditory training on specific language impairment

ABSTRACT The use of music as a therapeutic tool to enhance the performance of language skills is a controversial issue, in fact,

studies disagree in methodology and results. Because of this, a review of the evidence was performed to establish the relationship between language
and music therapies or musical training. A literature search in PubMed and Cochranne was performed, after the methodological analysis 7 items were
selected. According to evidence is not possible to establish the relationship between music training and music therapy and increased skills.

Key words: Language, music-therapy, musical training, specific language impairment.

INTRODUCTION tees generate a greater number of synapses per neuron in cortical

Neural plasticity as a product of perceptual training or
learning involves modifications in neural connections (1).
For example, studies with rats indicate that environments
stimulate
regions associated with the domains of the implemented stimulation
(2) (3) (4).
In particular, there is abundant evidence that the
connectivity of the auditory system can be modified according
to sensory stimulation, and these

Correspondence:
Limonares 190, Viña del Mar, Chile. +56 32 2443020 / ma.francisca.alonso@gmail.com

twenty-one
 ALONSO-SáNCHEZ MF, SUáREZ-ZAMBRA W, ESPINOZA-SALINAS MJ, RAMíREZ-BUSTAMANTE P, Auditory stimulation ...
modifications can be maintained over time (5). Reversibility
has been observed in processes of declining plasticity in the
primary auditory cortex, both through pharmacological
exposure and through manipulation of auditory exposure (6).
In fact, using classical even tone conditioning in rats, it was
observed that the increase in synaptic discharges of the
Middle Geniculate Body (CGM), which connects to the
primary auditory cortex, persists over time (7). Similar
changes can be observed in the ventral GCM only in the
short term, but which are associated with generalized
modifications in the receptive field of frequencies. This
plasticity in the receptive fields suggests being a substratum
of short-term mnemonic processes, which participate in the
long-term storage of information in the auditory cortex (8).
In experiments with rats, by means of auditory blocks,
the modification that is generated in the cerebral cortex due
to sensory deprivation has been observed, which suggests
the possibility of modifying cortical functioning to increase
sensitivity at certain frequencies by means of auditory
stimulation (9). And there are records that it is possible to
increase auditory discrimination skills in animals through
training (10).
24
In humans, the rapid distinction of changes in formant
frequencies (also known as dynamic auditory processing) is
proposed as the basis of pathologies such as dyslexia (11)
(12) (13), language disorder (14) and Auditory Verbal
Deafness (15) (16). Thus, it is also stated that 38% of children
with auditory disorders have symptoms of attention deficit
(17). Along these lines, it has been observed that the
perception of music, language, working memory and attention
are interdependent phenomena (18). For this reason, Stein
suggests that similar improvements can be achieved in
children with the use of auditory stimulation techniques (19). In
an electroencephalographic (EEG) study carried out with a
Mismatch Negativity (MMN) assessment, it has been
observed in individuals with learning disorders that a reduction
in amplitude is generated between auditory stimulation
between 222-313 milliseconds in Fz (Frontal) and 240- 293
milliseconds in Cz (Central), in addition to reducing the latency
of the N2 potential and increasing the amplitude P2N2 (1).
Differences in MMN were also observed in healthy humans
after tone training
22
(twenty). The decrease in amplitude of the P1N2 waves and the
latency of the N2 wave are associated with normal development
patterns (21). The accelerated maturation observed through
P1N2 suggests modifications in the non-principal
reticulo-thalamic pathway (22). Likewise, it has been observed
in studies with EEG that musicians have a faster update of
working memory, this measured with the latency of P300, both
in pitch recognition and visual tasks (23) (24) (25 ). Likewise, it
has been observed in children from 10 to 11 years of age
through measurements of the ERAN (early right anterior
negativity) and ELAN (early left anterior negativity) component
around 200 ms, that musical training modulates
neurophysiological mechanisms underlying the syntactic
termination both musical and linguistic. The ELAN component,
associated to the linguistic syntactic structuring, it increased its
amplitude to double in comparison to the children without
musical training; and the ERAN wave, associated with musical
syntactic structuring, was only observed in children with musical
training since this wave normally appears at 13 years (28).
Thus, it is possible to find diversity in the levels of
evidence around the effects of training or therapy with music
or sounds in individuals with language disorders. Because of
this, the objective of this review is to analyze the evidence of
the effectiveness of music-based therapy in children with
language disorders.
MATERIALS AND METHOD
A bibliographic search of the PubMed and Cochranne
databases was performed in October 2015 with the
following terms MeSh (M): M1: "Music / Musical", M2:
"Acoustic", M3: "Auditorium" , M4: "Sound", M5: "training",
M6: "stimulation" M7: "therapy", M8: "sing / singing", M9:
"rithm / percussion / tempo", M10: "melody / melodic ”M11:“
Speech and language impairment / SLI ”and the
combination between them. Within the inclusion criteria, we
considered randomized controlled studies, cohort studies
and controlled case studies in humans. As for the study
participants, individuals up to 15 years of age diagnosed
with specific language disorder (TEL) were admissible
according to the diagnostic characteristics of the DSM-IV.
All interventions were considered
NATURIST MEDICINE , 2016; Vol. 10 - No. 1: 21-27
 ALONSO-SáNCHEZ MF, SUáREZ-ZAMBRA W, ESPINOZA-SALINAS MJ, RAMíREZ-BUSTAMANTE P, Auditory stimulation ...
those therapies that consider as a fundamental basis the
use of music or verbal and nonverbal, melodic and
non-melodic sounds to increase skills. In relation to the
evaluation, the existence of primary results, typical of
language and cognition, and other secondary ones such as
quality of life, social and contextual skills are considered.
Data analysis and assessment of biases were carried out by
two researchers in parallel and independently.
RESULTS
In total, 335 articles were found that associated music
or sounds with the specific language disorder; of these, only
21 performed an intervention or therapy based on these
concepts, as shown in Figure 1. These articles were They
were evaluated in their methodology and results.
The methodological analysis included the type of study,
the number of study subjects, selection biases, hidden
allocation, use of control group, inclusion criteria,
measurement of variables, attrition bias, among others.
Some articles were excluded since they did not present an
intervention related to music or auditory training, or they did
not include subjects with language disorders. The results
obtained are detailed below:
CONCLUSIONS
According to the results obtained, it is not possible to
establish the relationship between musical training or music
therapy and the increase in linguistic skills in subjects with
language disorder. However, it is possible to affirm that
various
Fig. 1: Search results.
NATURIST MEDICINE , 2016; Vol. 10 - No. 1: 21-27
Authors have managed to establish correlations between these
variables. Therefore, it is necessary to continue investigating the
relationship between these variables.
DISCUSSION
From the review of the articles presented in the results,
interesting data about auditory training or musical
stimulation, and how this improves linguistic skills in
subjects diagnosed with TEL. Likewise, it is possible to
analyze the different paradigms for evaluating linguistic
skills and language intervention with the use of musical
tools. In fact, some authors establish neurophysiological
indicators as a linguistic variable, while others focus on the
behaviors presented by the subjects in specific tasks. In the
same way, it is possible to observe the great diversity in the
use of musical tools as a form of intervention, for example,
in some studies, syntactic rules are established to generate
melodic patterns,
A common point of all the articles is that the effects of 25
sound and especially structured sound, that is, music,
enhances and complements the development of language
at all levels. Just as language has its norms, music is
structured by a series of elements that condition it: sound,
rhythm, melody and harmony. Every musical structure,
however basic it may be, is conditioned by these four
elements, just as language is regulated by its own. One of
the relevant points of the study execution is the similarities
that we can find between language and music. Fitch (2006)
points out a series of assimilable aspects between music
and language.
2. 3

24
Author Year Participants
Przybylski [29) 2013 12 children with TEL, 12
controls, 10 dyslexic and 10
controls
Smeets [30) 2014 29 TEL from 60 to 80 me-
ses and 23 subjects between
60 and 90 months without
pathologies
Corriveau [31) 2009 63 7 year olds
with nonverbal IQ below 80 of word reading efficiency, CELF3, Working memory test
points (WISC), 21 with
TEL, 21 controls
comparable in age and 21
linguistically comparable
Kraus [32) 2014 26 school children
public from families
under the poverty
threshold
Jentschke [33) 2005 28 children aged 11
with and without musical
training.
24 children of 5 years, 12 with
TEL and 12 without TEL
Collet [34) 2012 18 children from 6 to 10 years old They were evaluated with WISC-III. Identification,
with TEL
NATURIST MEDICINE , 2016; Vol. 10 - No. 1: 21-27
McArthur [35) 2010 25 children with TEL and 36
controls
26
Evaluation
They were asked to listen to the music while looking at an
image on a screen. When the sequence ended, an
exclamation mark appeared indicating the beginning of the
sentence, which should be judged grammatically.
In SLI pretest and posttest with Peabody Vocabulary test
and Target Vocabulary test after the subjects listened to 4
electronic books, two static and two with video. In
Phonological Working Memory, Digit span and CELF4
controls
Subjects were evaluated with WISC, BPVS (Peabody), Test
batery for children and children´s test of nonword repetition.
Subjects listened to a rhythmic sequence and had to
reproduce it on a space button on a computer
It was evaluated with “Test of oral Word readung efficiency” and
auditory evoked potentials with the stimulus / da / with
measurement of response consistency, speech harmonics and
neural activity
Detection of syntactic transgressions with EEG was evaluated
discrimination and phonological awareness were used
Auditory evoked potentials were used with N1-P2, Nonword
Reading and irregular-word Reading, Repeating sentences,
repeating nonwords, picture vocabulary scale and test for
reception of grammar
Intervention Results
Musical sequences and phrases were presented by ear. Two musical In SLI subjects, the influence of the musical
sequences with the same tones but different rhythms. The regular sequence on grammatical judgment was
sequence is made up of structure determined by intervals of 250-500-750 observed. They performed better after
or 1000 ms. The chaining of each instrument was listening to the regular sequence. The same
500-750-250-500-500-750-250-500 for the drum, and for the maracas result was observed in subjects with
375-125-500-250-250-500-500-500-1000. The irregular sequence is made dyslexia and controls
up of intervals of 125-250-375-500-625-750- or 1375 ms. The chain was
structured with intervals of 625-375-375-500-375- 375- and 1375 for the
drum, and for maracas with 375-125- 750-250-625-375-500-1000. The
linguistic stimuli were 48 grammatically correct and 48 incorrect sentences
Digitized German tales in static and video versions Both formats allow to increase the
expressive vocabulary in children with TEL
Individuals had to beat rhythmically in sync to melodic strings Children with TEL achieved lower
delivered by a metronome performance than controls for age and
abilities. Likewise, they obtained greater
intra-subject variability
Music classes twice a week for 2 years. The classes were group The subjects with better attendance
and the subjects had to learn to use instruments presented better response consistency and
speech harmonics. No relationship with
neural activity was observed.
Subjects with musical training were recruited from specialized Better performance was observed in the
ALONSO-SáNCHEZ MF, SUáREZ-ZAMBRA W, ESPINOZA-SALINAS MJ, RAMíREZ-BUSTAMANTE P, Auditory stimulation ...
music schools subjects with musical training, as well as
worse performance was observed in the
subjects with TEL
Sessions were carried out with 10 blocks of 20 stimuli. The stimuli differed Subjects with TEL increased their
in their latency of presentation phonological performance. These changes
are generalizable
Tone training program, BM tones, vowels and CV discrimination The training did not generate significant
distributed in five stages changes in N1 and P2
 ALONSO-SáNCHEZ MF, SUáREZ-ZAMBRA W, ESPINOZA-SALINAS MJ, RAMíREZ-BUSTAMANTE P, Auditory stimulation ...
Some of the parameters that we can highlight are: 1)
those related to rhythmic patterns that help to accord the
syllabic structure of a word; 2) the hierarchical structure that
both possess and that, in the case of language, would refer
to syntax while in music it would be expressed as harmony;
3) the ideas, emotions or feelings that are to be stated
require a semantic knowledge that allows a conductive
thread of both expressions; 4) within speech, which is the
motor act of language, we include inflections, which deliver
a certain prosody to the message we want to communicate,
which would be related to the melody; 5) the general
structure of music contemplates a beginning, a
development and an end,
In relation to the above, Within the various studies, it is
evident that musical stimulation would improve linguistic skills
in the different evaluated groups (children with or without
linguistic alterations) (Kraus, 2014), and in particular, they
would enhance phonological, syntactic and lecture skills.
radicals of patients with specific language disorders
(Przybylski, 2013; Smeets, 2014; Corriveau, 2009;
Jentschke, 2005; Collet, 2012).
In the aforementioned studies, it is possible to relate
the importance of incorporating musical stimulation
simultaneously with habitual language therapy, since users
with TEL showed improvements in the evaluated variables,
in relation to their linguistic alterations. , therefore, it would
enhance the acquisition of language and speech skills.
The linking of different musical sequences with the
incorporation of different sound frequencies is related to
syntactic discrimination (Przybylski, 2013), being able to
establish a relationship between the musical sequence with
perception and grammatical ordering. And given that the
above has clinical relevance since it is not a commonly
used tool for syntactic stimulation and discourse
enrichment, it could contribute to a more rapid evolution of
users with alterations in these aspects of language and
would open a new window investigative of clinical work in
our country.
Another interesting point to consider is this: Although
the music has a structuring
NATURIST MEDICINE , 2016; Vol. 10 - No. 1: 21-27
and it is even considered a language by the subjects who
have the ability to encode and decode their signs, the use
of this in a therapeutic intervention must be carried out
through a process of reflective planning with viable and
operable objectives, since music and / or its separate
elements may represent a distractor rather than a useful
tool, or it may simply not influence at all. For example,
Smeets in his study highlights that having background
music can be a distraction, on the other hand, if the music
accompanies the reading and emphasizes important points
of it, it can support learning. Therefore, using the same tool
in different ways can have completely different results.
Finally, we must reflect on whether music is related to
the acquisition of a common way of learning skills of greater
cognitive complexity in human beings and that, when
trained together from an early age, it would decrease the
risk of suffering linguistic alterations in these stages. pas
later or in a clinical vision. The incorporation of music or
sound in therapy would be an activator of an indirect path
related to learning, fixation or access to language not only
for emotional aspects, but as a complex and parallel path
that would enhance skills that even today they were only
attributed to spoken language and that in therapeutic terms 27
they have only been used as a tool for generalizing
therapeutic objectives,
BIBLIOGRAPHY
1. Hayes EA., Warrier CM, Nicol TG, Zecker SG.,
Kraus N. Neural plasticity following auditory training in children
with learning problems, Clinical Neuroscience. 2003, 114:
673-684.
2. Greenough WT, Black J, Wallace C. Experi-
ence and brain development. Child Dev. 1897, 58: 539-59.
3. Briones T, Klintsova A, Greenough W. Stability
of synaptic plasticity in the adult rat visual cortex induced by
complex environment exposure. Brain Res.
2004, 1018: 130-5.
25
 ALONSO-SáNCHEZ MF, SUáREZ-ZAMBRA W, ESPINOZA-SALINAS MJ, RAMíREZ-BUSTAMANTE P, Auditory stimulation ...
4. Morris R, Frey U. Hippocampal synaptic plas-
ticity: role in spatial learning or the automatic record- ing of
attended experience? Philos Trans R Soc Lond B Biol Sci. 1997,
352: 1489-503.
5. O'Leary D. Do cortical areas emerge from a
protocortex? Trends Neurosci. 1989, 12 :. 400-6.
6. Hogsden J, Rosen L, Dringenberg H. Phar-
macological and deprivation-induced reinstatement of
juvenile-like long-term potentiation in the primary auditory cortex
of adult rats. Neuroscience. 2011, 186: 208-3.
7. Edeline J, Neuenschwander-el Massioui N,
Dutrieux G. Discriminative long-term retention of rap- idly induced
multiunit changes in the hippocampus, medial geniculate and
auditory cortex. Behav Brain Res, 1990, 39: (2): 145-55.
8. Edeline J, Weinberger N. Thalamic short-term
plasticity in the auditory system: associative return- ing of receptive
fields in the ventral medial geniculate body. Behav Neurosci. 1991,
105: (5); 618-39.
9. Popescu M, Polley D. Monaural deprivation
disrupts development of binaural selectivity in audit- ry midbrain
and cortex. Neuron. 2010, 718-31.
10. Recanzone G, Schreiner C, Merzenich M.
Plasticity in the frequency representation of primary auditory
28 cortex following discrimination training in adult owl monkeys. J
Neurosci. 1993, 13: (1); 87-103.
11. Tallal P. Auditory temporal perception, pho-
nics, and reading disabilities in children. Brain Lang.
1980, 9: (2); 182-98.
12. Galaburda A, Menard M, Rosen G. Evidence
for aberrant auditory anatomy in developmental dyslexia. Proc
Natl Acad Sci US A. 1994, 91: (17); 8010-
3. 13. Ucles P, Mendez M, Garay J. Low-level defensive
processing of non-verbal sounds in dyslexic children. Dyslexia.
2009, 15: 72-85.
14. Tallal P, Piercy M. Defects of non-verbal audi-
tory perception in children with developmental aphasia. Nature.
1973, 241: (5390); 468-9.
15. Phillips D, Farmer M. Acquired word deaf-
ness, and the temporal grain of sound representation in the
primary auditory cortex. Behav Brain Res.
1990, 40: (2); 85-94.
16. Auerbach S, Allard T, Naeser M, Alexander
M, Albert M. Pure word deafness. Analysis of a case with bilateral
lesions and a defect at the prephonemic level. Brain. 1982, 105:
(Pt2); 271-300.
17. Marschark M, Sapere P, Convertino C, Mayer
C, Wauters L, Sarchet T. Are deaf students' reading
26
challenges really about reading? Am Ann Deaf. 2009, 154: (4);
357-70.
18. Strait D, Hornickel J, Kraus N. Subcortical
processing of speech regularities underlies reading and music
aptitude in children. Behav Brain Funct.
2011, 17: (7); 44.
19. Stein J. The sensory basis of reading prob-
lems. Dev Neuropsychol. 2001, 20: (2); 509-34.
20. Näätänen R, NJiang D, Lavikainen J, Reinika-
inen K, Paavilainen P. Event-related potentials reveal a memory
trace for temporal features. Neuroreport.
1993, 5: (3); 310-2.
21. Oades R, Dittmann-Balcar A, Zerbin D. De-
velopment and topography of auditory event-related potentials
(ERPs): mismatch and processing negativ- ity in individuals 8-22
years of age. Psychophysiolo- gy. 1997, 34: (6); 677-93.
22. Boop F, Garcia-Rill E, Dykman R, Skinner R.
The P1: insights into attention and arousal, Pediatr Neurosurg.
1994, 20: (1); 57-62.
23. George E, Coch D. Music training and work-
ing memory: an ERP study. Neuropsychology. 2011, 49: (5);
1083-94.
24. Lee Y, Lu M, Ko H. Effects of skill trainig on
working memory capacity. Learning and Instruction.
2007, 17: (3); 336-344.
25. Besson M, Faïta F. An event-related potential
(ERP) study of musical expectancy: Comparison of musicians
with nonmusicians. J Exp Psychol Hum Percept Perform. 1995,
21: (6); 1278-96.
26. Jentschke S, Koelsch S. Musical training
modulates the development of syntax processing in children.
Neuroimage. 2009, 47: 735-44.
27. Przybylski L, Bedoin N, Krifi-Papoz S, Her-
billon V, Roch D, Léculier L, Kotz SA, Tillmann B. Rhythmic
auditory stimulation influences syntactic processing in children
with developmental lan- guage disorders. Neuropsychology.
2013, 27 (1): 121-31.
28. Smeets DJ, van Dijken MJ, Bus AG. Using
electronic storybooks to support word learning in children with
severe language impairments. J Learn Disabil. 2014, 47 (5):
435-49.
29. Corriveau KH, Goswami U. Rhythmic motor
entrainment in children with speech and language im- pairments:
tapping to the beat. Cortex. 2009; 45 (1): 119-30.
30. Kraus N, Hornickel J, Strait DL, Slater J,
Thompson E. Engagement in community music
classes sparks neuroplasticity and language devel-
NATURIST MEDICINE , 2016; Vol. 10 - No. 1: 21-27
 ALONSO-SáNCHEZ MF, SUáREZ-ZAMBRA W, ESPINOZA-SALINAS MJ, RAMíREZ-BUSTAMANTE P, Auditory stimulation ...
opment in children from disadvantaged backgrounds. Front
Psychol. 2014, 16; 5: 1403.
31. Jentschke S, Koelsch S. Musical training mod-
ulates the development of syntax processing in chil- dren.
Neuroimage. 2009, 15; 47 (2): 735-44.
32. Collet G, Colin C, Serniclaes W, Hoonhorst I,
Markessis E, Deltenre P, Leybaert J. Effect of phono-
NATURIST MEDICINE , 2016; Vol. 10 - No. 1: 21-27
logical training in French children with SLI: perspectives on voicing
identification, discrimination and categorical perception. Res Dev
Disabil. 2012, 33 (6): 1805-18.
33. McArthur GM, Atkinson CM, Ellis D. Can train-
ing normalize atypical passive auditory ERPs in childen with SRD or
SLI? Dev Neuropsychol. 2010; 35 (6): 656-78.
29
27