An Overview of Auditory Interventions

Tue 3-20-2001

Sheila M. Frick OTR/L

The therapeutic use of music has a long history. Since the mid-1900's when Alfred Tomatis began his work with the application of sound to treat specific symptoms and behaviors, there has been a veritable explosion in the types of auditory interventions available. As the effectiveness of sound as a treatment modality continues to achieve credibility, the rapid growth of this field of therapy will likely gain even more momentum. While the growth of auditory tools is both promising and exciting, it can be challenging for the therapist and parent to choose the most potentially effective therapeutic strategy for a specific child.

The following provides an overview of auditory intervention methods in common practice in the United States. There are several distinctions between Sound therapy programs. Some programs are clinic-based, some home based, some Provide only passive input unless used in conjunction with other forms of therapy, other programs inherently contain an active component. Interventions usually require a training or certification for practitioners beyond their already established professional background. Parents should be careful to note a practitioner's professional background and advanced training.

The Tomatis Method

Alfred Tomatis, MID, a French Ear, Nose and Throat specialist, was the first practitioner to develop an approach for treating listening difficulties. Tomatis originally defined the role of the ear as the 'integrator' because the ear was significant in structuring organization at all levels of the nervous system. He recognized the close relationship between the auditory and vestbular systems and the importance of both as integrators of the nervous system. He connected listening to the development of receptive and expressive language, learning, motor control and motivation. Through his clinical work with opera singers and factory workers, Tomatis recognized that the voice can only produce what the ear can hear, a principle now known as the "Tomatis effect". His study of the ear led to the conviction that, beyond hearing, the auditory system and vestibular system work together to detect and analyze movement. He described the function of the vestibular portion as picking up and discriminating the larger movements of the body, which we can see and feel. Similarly, the auditory system registers and regulates the finer movements of sound waves, which pass through the air and are funneled into the ear.

In the 1950's Tomatis developed a listening technique to 're-educate the ear' based upon the following four principles:

• Motivational and emotional needs begin with listening.
• Listening plays a fundamental role in language.
• Through it's close connection with the vestibular system, the auditory system relates self to self, to others, and to the universe
• The brain needs sound energy to enable the thinking process and integration

Tomatis developed the first auditory training or listening training device, the electronic ear. This device uses progressively filtered sound, specifically those sounds rich in high frequencies (i.e. classical music, the mother's voice, Gregorian chants) to effect change. Tomatis was the first to recognize the importance of high frequency audition. He spoke of high frequency sound as charging the brain. The Tomatis method of auditory training is a chnic-based program, requiring the use of specialized equipment and the expertise of a practitioner trained in the Tomatis approach.

Auditory Integration: Berard Method

Most of the clinically based auditory training techniques are based on the early work of Tomatis, including that of Guy Berard, MID, a French medical doctor who studied and worked with Tomatis.

Berard felt that the original protocol of Tomatis was too lengthy and developed a different method of filtering sound. This technique, which uses filtered popular music in which sound frequencies are electronically modulated at random intervals for random periods of time, is called Auditory Integration Training (AIT). Berard believes that hypersensitive hearing causes auditory processing problems. Berard and his technique gained worldwide recognition in 1990 with the publication of Annabel Stehli's biographical account of her daughter Georgie. The Sound of a Miracle describes how Georgie, diagnosed with severe autism, greatly benefited from a course of 20 AIT treatments with Berard. AIT is a clinic based program; implementation relies upon the use of the Audiokinetron, a device developed by Berard for filtering music and upon a practitioner with specialized training.

Both the Tomatis and Berard programs are delivered by specific machines using earphones. With the advent of new technology, similar altered music has become available on compact disc. The discs do not replace either the Tomatis Method or the Berard Method. The compact discs do provide a less intense way to access both the auditory and vestibular systems to impact neural function and integration and are easily available to clinicians in a variety of practice arenas.

www.autism.org/ait2.html (not maintained by Vital Links)

The Samonas Method

The SAMONAS method is another listening approach, which has combined some of the ideas of Tomatis with advances in both technology and physics. Ingo Steinbach, a German sound engineer with a broad background in music, physics, and electronics developed this method. All of the recordings used in Steinbach's work are based on the SONAS (System of Optimal Natural Structure) principle, which make it possible to maintain the valuable elements and Structure of natural sounds throughout the entire process of recording, processing and reproduction. The choice of music is based on the principles of music therapy. Most selections are classical music and some include nature sounds.

Steinbach wanted his recordings to be as realistic and as spatially expansive as the sounds one hears in the concert hall. He realized that sound reflects the space in which it is recorded, and that choosing the space for recording was a critical factor in the quality of the recording. He also paid particular attention to the music used and the instrumentation. He uses only natural instruments, which produce tones rich in harmonics. Additionally, Steinbach believes that sound carries intention and that the musician's state of mind is reflected in his/her work. For this reason, he only records when he feels that the musicians are playing with a sense of joy. Steinbach also developed a special device called the envelope shape modulator which enhances the upper frequency range of the music, thereby 'spectrally activating' the recordings, The higher frequencies provide information about directional distances of sounds as well as other detailed information about the sound source. In addition to the spectral activation, there are also brief passages on the CDs with intensive filtering so that almost nothing but the overtones are heard. Listening to these 'high extension' passages theoretically trains the ear to pay attention to the upper ranges in the sound spectrum. The higher tones are the parts of the sound spectrum that captivate attention and hold interest. These recordings are identified as SAMONAS, which stands for Spectrally Activated Music of Optimal Natural Structure.

Steinbach creates several different levels of compact disc with varying intensities of spectral activation and filtering. The less intense compact discs are available to therapists with an understanding of the implication of filtered sound. These lower level CDs can be incorporated into entry-level practices in the use of modulated sound such as Therapeutic Listening® (see below).

The more intense compact discs require a longer more intensive training period which provides the therapist with more advanced information regarding sound and training in more sophisticated pieces of equipment used in SAMONAS Sound Therapy. To use the title "trained in Samonas" a therapist must complete a five day training course; a year of practical experience and then present documented case studies for peer review. Those who are looking for a therapist with appropriate qualifications may use the therapist database that will be available Beginning February 2000 on the web at: www.Samonas.com

Therapeutic Listening®

Therapeutic Listening® is a term used to describe combined use of a number of electronically altered compact discs in a prescribed manner, but with equipment that can be used in many environments. Sheila Frick, OTR designed this program. Therapeutic Listening TM implies that the listening programs are individualized to each client and are suited for application in home and school settings. Maximum effectiveness in treatment outcomes is promoted by daily use. The use Of Modulated and filtered music in conjunction with sensory integrative Occupational therapy techniques seems to increase the effectiveness of both treatment modalities. There is commonly a decrease in the time necessary to meet treatment goals in the areas of: modulation, balance and movement perception; an increase in exploration of the environment, sense of physical competence, and drive to challenge one's practice and sequencing abilities; and improved social competence and language abilities.

Therapeutic Listening ® programs can be carried out at home, school or in the clinic with ongoing support from a therapist who is trained in their application. A typical program may be in place for two to six months for initial gains; however, many individuals continue past this time frame or find several of the compact discs useful as part of an ongoing sensory diet. Currently, EASe, and 'entry level SAMONAS' CDs fall under this use. With the rapid growth of sound therapy, it is likely that other products will also be included in the future.

Listening Fitness

Another home listening program, the Listening Fitness program, is just being introduced in the United States and Canada. This program provides listening training using sound stimulation. It is designed by Paul Madaule who worked closely with Dr. Tomatis and has used the Tomatis method for over 30 years. While the Listening Fitness program shares some similarities with the Tomatis Method, it differs substantially in assessment procedures, audio equipment, and focus and is not regarded as being equivalent. It can be a useful part of a home treatment regimen where the goal is to help an individual to develop and improve both receptive and expressive listening. Like the other listening techniques, Listening Fitness includes a passive phase of intervention. Unlike the other auditory based home programs, Listening Fitness provides an active component or the 'expressive phase'. This is where one gains control over voice and body through voice exercises (humming, singing, reading in a microphone). The total program lasts about 10 weeks With usually 1 hour of listening a day and a short interruption between the 2 phases. Close monitoring and coaching are provided throughout the program.

Listening Fitness Instructors are carefully screened and trained, and are supervised for I year by a highly qualified training team of consultants from the Listening Centre in Toronto. Founded over 20 years ago by director Paul Madaule, the author Of When Listening Comes Alive, the Listening Centre is a leader in the field of listening. Currently the Listening Fitness program is being used with children with listening and learning difficulties. At this point in time it is not being used with individuals with a medical or neurological diagnosis Such as Autism ADD, or other neurological disorders.

"A clinician trained I in Several different forms of auditory intervention I on might reflect less specific bias in methodology. . . "

Interactive Metronome

Recent clinical studies are indicating that another auditory based intervention which is quite different from all of the above listening techniques may also be effective with individuals who experience difficulties with motor planning and sequencing. Interactive Metronome is based on the premis that neural timing difficulties underlie difficulties with learning, cognitive and social skill and interfere with praxis. Occupational therapists have understood that motor planning and sequencing are key facets in the development Of functional skills. They have traditionally addressed these difficulties with sensory integrative techniques.

A new PC-based interactive version of the traditional music metronome is now being introduced as a viable tool for individuals with a broad variety of challenges. From existing studies and clinical reports, the most promising areas Of use include treatment for persons with difficulties in motor planning and sequencing, rhythmicity and timing, primary motor control, language and speech, learning and cognition and social development and communication. Stanley 1. Greenspan, MD, a psychiatrist and clinical professor of psychiatry at the George Washington University Medical School, is (lie Director of Research for the Scientific Advisory Board of the Interactive Metronome. He states that "the ability to plan and sequence action emerges early in the first year of life. It is essential for adaptive motor delopment and language development." He goes on to state that "it is essential for complex social behavior involving a number of sequential steps, such as sharing toys, complex greeting patterns, or simply playing with others." In a letter to parents of children with special needs. Greenspan states that "the soon to be published research using this tool strongly indicates new hope that the new method may enable children to improve underly processing abilities for motor planning and sequencing, strengthening their most fundamental learning capabilities."

A program utilizing the Interactive Metronome entails 15 hours of treatment. The typical training schedule is 3 times a week. In the Studies, treatment protocols of less than 3 times a week were not known to be as effective. More detailed review of current research can be found at the site: www.interactivemetronome.com (not maintained by Vital Links)

Summary

Given the volume of information available on auditory interventions a parent has a formidable task in selecting the clinician and type of program most suitable for a child's specific needs. Each of the forms of auditory intervention available has something to offer and each has points of applicability. A clinician trained in several different forms of auditory intervention might reflect less specific bias in methodology and be helpful in guiding the parents through the method of training or the proper sequencing of treatments that will be most beneficial.

For more detailed information on Therapeutic Listening TM Auditory Integration Training, Samonas Listening Fitness and Interactive Metronome, contact Vital Links at 608-270-5424.

Sensory Integration Quarterly Spring/Summer 2000 Published by sensory Integration International

References
Frick, S. (2000) Listening with the Whole body. Madison, Wl. Vital Sounds, Inc. (In Press)
Madaule, P. (1994) when listening comes alive. Norval, Ontario Canada. Moulin Publishing.
Steinbach, 1. (1997). SAMONAS sound Therapy. Fakenham, England. The Whole Idea.
Tomatis, A. (1 996) The ear and lan- guage. Norval, Ontario, Canada. Moulin Publishing.

For more information check out www.Samonas.com. (not maintained by Vital Links.)