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A brief introduction to Therapeutic Listening

 

Therapeutic listening is a sensory integration modality used to treat children with autism and other sensory processing disorders.

What is Therapeutic Listening?

 
Therapeutic Listening (TL) is an expansion of Sensory Integration. It is an auditory intervention that uses the organized sound patterns inherent in music to impact all levels of the nervous system.Auditory information from Therapeutic Listening CD's provides direct input to both the vestibular and the auditory portions of the vestibular-cochlear continuum. The emphasis of TL is on blending sound intervention strategies with vestibulo-proprioceptive, core development, and breath activities so as to sustain grounding and centering of the body and mind in space and time.Providing these postural, movement, and respiratory activities as part of the TL program is critical.
 
Listening Skills 
 
To the untrained eye, it is often difficult to assess listening skills. Since we cannot directly observe internal listening processes, we must infer listening function through behavioral clues. This task is especially difficult due to the extremely wide range of behaviors associated with poor listening skills and the fact that the behaviors are not linked to listening in an obvious way such as cupping one's hand behind the ear. 
 
Therapeutic Listening
coupled with SI tends to speed the emergence of:
  • Attention
  • Organized behavior
  • Self regulation
  • Postural control
  • Bilateral coordination
  • Praxis
  • Fine motor control
  • Oral motor/articulation
  • Social skills
  • Communication
  • Visual motor integration
Sara was adopted by American parents from a Russian orphanage at the age of four and spoke no English when she began school at age five. Her pre-intervention status showed that she could only attend to tasks for 5-10 minutes and had tactile hypersensitivity - she
disliked hugs and was a picky eater - refusing certain textures and temperatures of food. Sara had extreme difficulty calming herself for sleep, was easily frustrated and prone to tantrums, and had extreme difficulties with transitions. She also had minimal eye contact
with others and a high, shrill voice which she could not modulate. After initial testing, her occupational therapist saw her every other week and started her on a Therapeutic Listening program which was implemented by her parents 2X/day and 7 days a week from August 2004 to March 2005. Dramatic changes in her ability to process sensation are shown in her pre and post SIPT scores. Although she had a continued tendency to reverse some letters and numbers, Sara’s handwriting showed marked improvement in both her fine motor control and her ability to use space.
Sara’s parents and therapist observed many exciting changes over the course of her therapy including increased appetite and willingness to try new foods, increased tolerance for touch, increased eye contact, increased attention to task, and increased ability  to achieve a quiet-alert state. Sara spontaneously began to grade her voice and whisper and even began hugging her grandmother. Everyone knew her listening skills had improved when she reported hearing a clock ticking and birds chirping for the first time. Through her drawings Sara clearly showed how her world had come alive. Gail Heucker, OTR  
My World Comes Alive - Sara’s Story  Sara’s SIPT Scores August 2004 & March 2005 Numbers - August 2004 Numbers - March 2005 Draw-A-Person August 2004 Draw-A-Person February 2005.
 
For example, when children with Central Auditory Processing Disorder (CAPD) were compared with typical peers, researchers found large differences in classroom, social-emotional, and disinhibition behaviors (Burleigh, McIntosh, & Thompson, 2002). Although poor listening skills do not necessarily point to a diagnosis of CAPD, this list illustrates the wide range of behaviors that are associated with listening difficulties. By providing precise input simultaneously to both ends of the vestibular-cochlear continuum, Therapeutic Listening can have a positive impact on sensory function and on the nervous system as a whole. As listening skills improve, not only is an individual better able to negotiate interaction with others through an enhanced ability to hear and understand speech sounds, but he or she is also better able to orient and attend to salient sensory information and regulate physiological state.  Having a solid foundation in these important skills then frees up valuable cortical resources for connection, engagement, communication, new learning, and other higher level skills. “Perception is much more than simply sensing stimuli from the outside world. It is an enormous factor in personality development.Even the smallest ongoing perception problem canlead to a cascade ofevents that can result in apsychologically traumaticlife” (Ratey, 2002, p. 82).“If your hearing is crippledby an undiagnosed auditoryproblem, the naturalconclusion is that you areeither stupid, indifferent, or both” (Ratey, 2002, p. 7).Although initially his development seemed typical, at 13 months of age Adam completely stopped all verbal responses to social cuesand about the same time stopped sleeping. His mother, Jenny reported, "He would scream for hours in a very high pitched squeal. We would take turns with him through the night. He was afraid of everything. Whenever he saw smoke or steam or dust he would panic." Hitting and banging his head became a regular occurrence and all attempts at offering comfort were fiercely resisted. “That was the hardest part," said Jenny. "There was nothing I could do."
 
Adam was terrified of people and when someone looked at him he would quickly cover his eyes. He hated being touched and showed no signs of affection. Any attempts at communication consisted of grunts and sounds. Although he often did not register pain,his mother and father felt that he was in great pain all the time. His appetite was poor and his diet was limited to eight starchy foods.Adam was diagnosed with autism and, at the age of two, his parents brought him to the clinic for an occupational therapy evaluation.Through clinical observation and a sensory history it was determined that Adam had severe sensory defensiveness. A Therapeutic Listening program in combination with the Wilbarger Touch Pressure Protocol was implemented.With his sensory defensiveness, wearing headphones was not easy for Adam. Jenny used many strategies to familiarize him with the listening protocol. "I would wear them on my head while I was cooking or just around the house" she said with a smile. Playing the CD as background music also helped Adam acclimate to the music.Within the first month significant changes in sensory modulation occurred. His mother noted, "When Adam was screaming I would put the music on and he would begin to calm and relax. Sometimes he'd even fall asleep." He also began to sleep through the night.Babbling and eye contact were increasing. Although still cautious, his tolerance of having others in his physical space began tochange and he began to explore moving his body over different surfaces in the clinic space.In three months, Adam's previously terrifying relationship with the world was beginning to take on new meaning. His food repertoire increased by 10 different foods. Different textures and tactile experiences were becoming objects of interest. As I talked with his parents,I watched Adam intermittently kissing and rubbing his mother's face with great joy and giggles. "It feels wonderful" said Jenny with a tear in her eye. And though there were bridges yet to cross, it was touching to see how far this little boy had come.Genevieve Jereb, OTR
My World Becomes Interesting - Adam’s Story Behavioral Difficulties Observed in Children with CAPD Classroom Behaviors Social-Emotional Behaviors Disinhibition Behaviors Daydreaming/Forgetfulness Increased anxiety and tension Irritability Excessive talking in class Low self confidence Hyperactivity Inability to sit still Increased frustration Impulsivity Difficulty with time concepts Attention seeking Disobedience Inability to complete work Temper tantrums Rowdiness Dislike  of school Easily upset in new situations Oppositional behavior
 
References
Ayres, A.J. (1972). Sensory integration and learning disorders. Los Angeles: Western Psychological.Burleigh, J.M., McIntosh, K.W., & Thompson, M.W. (2002). Central auditory processing disorders. In A.C.Bundy, S.J. Lane, & E.A. Murray (Eds.). Sensory integration: Theory and practice (2nd ed., pp. 141-161).Philadelphia: F.A. Davis Ratey, J.J. (2002). A user's guide to the brain: Perception, attention, and the four theaters of the brain.NewYork: Vintage. It was so exciting to bring Therapeutic Listening to the state orphanage in Romania. Of the 25 special needs kids there,three children each week were selected for intensive programming.The most immediate and noticeable result was the improvement in attention and focus observed in many of the children who had extreme difficulty with these skills. One girl who was described as non-verbal started imitating my English! I asked the translator what Romanian word would be useful and they said "appa" (which means water). It was a Helen Keller moment when the girl said "appa" and I spilled water into her hands which she immediately splashed onto her face. Another little boy absolutely craved the music. He burst into our treatment room repeatedly to ask if it was his turn for "musica". I saw this boy everyday for two weeks - he would not be denied - and he was a delight. Although his medical records indicated that he had an IQ of 37, by the end of the second week he was completing progressively more challenging Mighty Minds shape puzzles. He was able to remember the color, size, and shaped needed for each puzzle while propelling himself in prone across the room on a scooter board. By the end of our stay he was noticibly less fearful of new movement experiences. Linda Westlin, OTR Therapeutic Listening in Romania  Therapeutic Listening on the Children’s Miracle Network Ethan has a diagnosis of Down's syndrome. He was 2½ years old when he made his debut on the Children's Miracle Network telethon. In 4 months time, Ethan had made significant gains in his communicative abilities, use of his right hand, and walking mobility. Ethan is now exploring and interacting more in his environment. Children's Miracle Network purchased Therapeutic Listening equipment for Hurley Children's Rehabilitation in Flint, Michigan, an outpatient hospital-based facility, to be used in a lending library program.This lending library program allowed the therapists to set up Therapeutic Listening programs and send home the equipment with the families, so the child's listening program could be done per protocolinstead of in treatment sessions alone.
After 1-3 months of using the lending library equipment, families are given the option of purchasing their own equipment for continued use. Due to observed remarkable gains, families are reported to continue 90% of the time. It has proven to be a very successful set-up, made possible by Children's Miracle Network.