Therapeutic Listening

THERAPEUTIC LISTENING General information

WHAT IS THERAPEUTIC LISTENING?

Therapeutic Listening was developed by Occupational Therapists Sheila Frick, OTR/L and Colleen Hacker, OTR/L and uses sound training in combination with sensory integrative techniques, which emphasize vestibular stimulation and postural movement strategies and allow therapists to approach the auditory and vestibular system directly. Sound training uses electronically altered music that has been designed to produce specific effects on listening skills when the child follows a prescribed program. Listening skill difficulties are the inability to accurately perceive process and respond to sounds and are often found to be an integral part of other perceptual, motor, attention and learning difficulties affecting a large number of our children. Therefore, listening becomes a function of our whole body, not just our ear. Hearing, a function of the ear is passive and does not involve the direction of attention to sound. Sound is received by the ear and passed along like a microphone. Listening is active and requires the desire to communicate and the ability to focus the ear on certain sounds selected for discrimination and interpretation.

HISTORY USED TO DEVELOP THERAPEUTIC LISTENING:

Therapeutic Listening integrates a number of electronically altered compact discs, based on the ideas and technology created by Alfred Tomatis, Guy Berard and Ingo Steinback, within a sensory integrative frame of reference. Tomatis developed his theory in regard to the development of hearing in utero and the impact of an auditory stimulus on all aspects of development including movement processing. He recognized the sensory integrative value of an auditory stimulus.

Dr. Guy Berard trained and worked with Dr. Tomatis. Berard developed his own device and protocol to reduce the time required to produce results. He emphasized the auditory stimulus impact on behavior and language.

Ingo Steinback was influenced by Dr. Tomatis. He developed Samonas sound therapy which is based on the principles of music therapy in accordance with development aspects and natural laws of physics related to sound. He emphasizes the global impact of specific auditory stimulus on physical, emotional, and energetic development.

• Children and Adults with Sensory Integration Disorder, Tactile or Auditory Defensiveness, and/or Vestibular processing disorders
• Children with Developmental Delays, Autism, ADHD, Learning Disabilities, PDD, and other delays

• Lack of biological foundation for social engagement. Facial expression, vocalization, eye contact.
• Lack of foundation for interaction: localization, orientation, filtering for salient features. The ones that can't filter the extra stuff in their environment, keeping the child from orienting and engaging in everything!
• History of chronic middle ear infection or chronic fluid in the middle ear.
• Regulation issues (disturbances in sleep wake cycles, hunger and thirst patterns, bowel and bladder control, and other homeostatic functions)
• Sensory defensiveness: spatial awareness, vestibular, touch, localizing touch, sound, where you are in your environment.
• A history of difficulty grading responses to sensation; too much or too little control
• Difficulty grading functional range of arousal states (routine needed child)
• Vestibular-auditory-visual integration dysfunction: TRIAD
• Disorders of praxis-coordination, motor planning, have to have time and space, sequencing, etc.
• Bilateral motor coordination difficulties: don't have center or rotation abilities
• Appropriate as preparation for other TX programs: get them ready for vision therapy

• Has difficulty understanding speech in noisy situations
• Has trouble hearing in groups
• Has trouble listening
• Becomes anxious or stressed when required to listen
• Is easily distracted
• Has difficulty following directions
• Seems to hear, but not understand what people say
• Has trouble remembering what people say
• Have poor speech or language skills
• Have poor reading or phonics skills
• Have poor spelling skills
• Discrepancy between verbal and performance scores and IQ tests
• Has impulsive behavior
• Is disorganized
• Have poor peer relations
• Has poor self-esteem

HOW THERAPEUTIC LISTENING WORKS:

The sound stimulation used in Therapeutic Listening appears to set up the nervous system, preparing ground for emergent skills. The music causes the muscles in the middle ear to contract, helping to discriminate and modulate sound input. In addition, there are tiny bones in the middle ear that vibrate when sound is provided, stimulating the movement (vestibular) and hearing (auditory) sensory receptors in the inner ear. This sensory information is sent throughout the central nervous system causing a multitude of reactions. There are four nerves, which are impacted by sound therapy and travel from the inner ear to the brain and back to other parts of our body. For example, when providing sound therapy you may stimulate the facial nerve. The facial nerve innervates the muscle in the middle ear as well as the muscle of facial expression.

Along with this nerve also travels the glossopharyngeal nerve, which controls the motor components of one's voice. Therefore, the muscles of the ear, which are designed to extract the human voice from a noisy background (listening), are linked with the muscles of facial expression and voice production. When you are talking with someone you rely on the non-verbal facial expressions of the person who is listening to you. So, again these same muscles are necessary for producing clear articulation and for hearing accurately and efficiently. So, through the use of sound therapy, such as Therapeutic Listening, you are stimulating the muscles of the ear as well as the muscles of the mouth, because the nerves that innervate these muscles are the same nerves.

Therapeutic Listening is unique because:

• Uses a developmental and SI framework
• Uses the organized sound patterns inherent in music.
• Controlled sensory input
• Uses music that is electronically altered to elicit a specific response: the parts of the music that would naturally cause you to orient and attend are heightened and exaggerated. This causes the brain to attend to certain parts of the music.
• Provides sensory input to both ends of the auditory-vestibular continuum: when you go in with sound, you will impact the vestibular system.
• Offers repeated opportunities for orienting and attending: the modulation in the music gives you this.
• Focuses on problems in spatial/temporal organization (gives a complete sense of time and space)
• Focuses an postural organization and breath regulation (core)
• Provides a "just right" challenge to evoke the highest level of adaptive response.
• Provides a catalyst for eliciting emergent skills: for example if you were afraid to move, now you feel safe moving, you will move more.

• VESTIBULAR-VIBRATION-SEE AND FEEL
• AUDITORY-VIBRATION-FEEL AND HEAR
• PROPRIOCEPTIVE-VIBRATES JOINTS
• TACTILE-TOUCHES SKIN

ONLY DIFFERENCE IN MOVEMENT AND SOUND IS THE VELOCITY OF THE VIBRATION. You feel sound all the time. It is a movement experience.

Vibration crosses all sensory modalities.

DESCRIPTION OF EQUIPMENT USED:

• Therapeutic Listening consists of a series of CD's prescribed specifically for each child over specifically designed headphones and work on a variety of skills. Listening time consists of 2 times a day, each for 30 minutes, with a minimum of 3 hours between listening times.
• Headphones: why they are special: frequency range of 22-23,000HZ they are picking up higher and lower frequencies to capture the full spectrum of sound. Your brain perceives the lower and higher frequencies and picking this up, even if you don't hear it, your brain is listening!
• Impedance of 150 ohms-slows down the sound so that it isn't mottled, so it is crystal clear and sharp.
• Open Ear System: you can hear background sounds to learn about space around you
• Circumaural (no ear buds): better quality
• Quality of the delivery system is key to the crispness of sound, the headphones are important.
• CD player: portable player, equal in both ears from loud to soft. Turn it up, and then slowly turn it down.
• Background noise-no hisses or pops
• Random or shuffle mode-don't let child accommodate to order of music, keep it novel to the brain.
• Battery Operated
• Special Features- hold (keep features where you have set them), turn off the shock protection or bass boost
• The CD's are electronically altered or passed through a high-low filter. This means that the frequencies at which the sounds are heard vary. Some CD's jump from very high frequencies to very low frequencies and back. Other CD's do the same, but the variance is much less and therefore not as intensive for the listener. Here are some examples of CD's and the skills that are being worked on:
  > EASE 1 and 2: hypersensitivity to sound, movement and/or touch or defensive responses to sensory input in general
  > Mozart for Modulation: supports organized body movement, attention within the environment, active engagement, language
  > Kidz Jamz (Grape): helps with postural organization, sensory modulation and attention difficulties
  > Vivaldi for Modulation: supports focus and concentration supports suck-swallow-breath, heart rate and respiration, improves processing of auditory input in complex auditory environments.

• Decreased tactile hypersensitivity or defensiveness
• Decreased oral hypersensitivity with increased exploration and acceptance of different foods
• Improved self-regulatory behavior such as a more regulated sleep cycle, more regulated hunger thirst cycle, more regulated such-swallow-breathe pattern, more regulated respiratory control and decreased stress
• Improved balance
• Improved coordination of movement within the environment
• Increased postural organization
• Increased motor skills, both gross and fine
• Improved bilateral motor patterns
• "Emergence" of motor planning
• Improved spatial-temporal organization
• Improved handwriting
• Improved visual-motor skills
• Improved timing of motor execution
• Increased and more elaborate social interactions, with better "timing"
• Discrimination of the dimensionality and directionality of spatial concepts
• Improved components of communication such as greater range of non-verbal communication
• Improved/clearer articulation, greater emotional and verbal expression and improvements in pragmatic language

• Protocol: 30 minutes each listening session. 2 times a day. MIN separation of 3 hours between listening times.
• This is where you start.
• Is this critical that 3 hours separate, what if it is 4, 5, 6 hours? Depends on the child and when they can listen actively. Can't be in periphery world though (TV, Nintendo, lining up cars, some reading). It is ACTIVE listening; using the body with it can help tremendously. Doing vision therapy body movement exercises, swinging, crossing midline, bdpq or arrow charts, etc are good to do at the same time.
• Some need it in morning to get going, then afternoon before homework.
• Don't do right before bed, usually don't do after dinner (6pm).
• Different protocols depending on the style of the music, such as Grape Jamz is alerting, don't do it before bed.
• Chants is more relaxing & can do with calming needs.
• Don't get too close to bedtime.
• For use under the headphones, except under two years old then no headphones.

If you are interested in doing Therapeutic Listening with your child or for an adult with these issues, then please see Dr. Clopton or Heidi Clopton to set up a consultation visit and fill out a questionnaire. The cost is $200 and if you are in weekly therapies here at Center of Development or in Vision therapy, the cost is refunded when you complete the program.

For more information and research information please go to vitallinks.net or search for Sheila Frick or Therapeutic Listening on the web. There is plenty of research and case reports on the internet to read to support Therapeutic Listening.

Parts adapted from "Listening with the Whole Body" by Sheila M. Frick, OTR/L, and Colleen Hacker, MS. OTR/L.

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