The concept of providing music therapy for those who have hearing impairments or use a cochlear implant seems like a far-off and impractical concept to many people. This is a big misconception because most people believe that a large percentage of individuals with hearing impairments can not hear at all, which is not true. Although having a hearing impairment is a far greater communication and sensory handicap that hearing people realize, there are still many challenges that can be overcome. Alice Ann Darrow (1989, p. 61) writes that “blindness” is ‘an environmental handicap’ while deafness is a social disorder that keeps one from people”. This post is going to cue in on how individuals with cochlear implants are able to enjoy music and what methods of music therapy work best when working with these individuals.
Cochlear implants (CI) focus on transmitting only sounds that are essential to speech recognition. This means that most aspects of music are not transmitted, making it difficult for individuals with CIs to percieve timber and pitch (Hidalgo, Pesnot, Marquis, Roman, & Schön, 2019). The one aspect of music that is transmitted the best is rhythm (Gfeller & Knutson, 2003). Rap music is a common preference of teenagers with implants and line dancing music is a common preference of adults with implants because both rap and line dancing music usually have strong, steady beats (Gfeller & Knutson, 2003). Rap music also typically has rhythmically spoken lyrics over the steady beat. This is important to note because the rhythmicity of the words make the songs more easily recognizable. Individuals with cochlear implants have an easier time identifying songs with lyrics and a harder time identifying instrumental songs.
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Since cochlear implants focus mainly on speech, individuals with cochlear implants can also have a hard time discriminating timber of instruments, tone quality, and pitches. These difficulties can vary based on relative health of the auditory nerve, the cause of deafness, whether a full insert of the implant was possible, whether all the implant channels are active, the age at implantation, cognitive and perceptive abilities, etc. For implant users, it is easier to compare the timbre of instruments to each other rather than listening to an instrument alone. The skill of instrument identification could possibly strengthen after listening practice (Gfeller & Knutson, 2003). Some people with cochlear implants say that the tone quality of most instruments sound “unnatural or tinny” (Gfeller & Knutson, 2003). Differentiating pitches, when listening or singing, is perceived to be one of the most difficult aspects of music listening for implant recipients. Studies show that adults with CIs are more self-conscious than children about singing in public and that they find it very difficult to sing along with an external pitch (Gfeller & Knutson, 2003).
Listening to music and having repeated exposure to music stimuli can play a major role in how music can affect someone’s life (Gfeller & Knutson, 2003). With repeated exporesure, music would be able to be used in daily life and be more easily enjoyed by individuals with CIs. There is already emerging evidence that specific music training is able to improve music perception for people who use CIs (Jiam, Deroche, Jiradejvong, & Limb, 2019). The existing studies have used in-person training models and have not tapped into online resources yet (Jiam, Deroche, Jiradejvong, & Limb, 2019).
Music therapy can be extremely beneficial for those utilizing cochlear implants. One thing music therapists’ have to be very specific about when doing music therapy with individuals with CIs is the environment. Unlike when recording an acapella piece or singing with a choir, a music therapist would not want a very acoustic room. The room should be filled with many things that will absorb sounds and echoes. Without things like carpets and curtains, the sound will bounce around and cause distortion (Gfeller & Knutson, 2003). It is also important for therapists to dive into their patient musical preference. Just like individuals without CIs, individuals with CIs all like listening to different types of music. Music therapists’ want the patients to enjoy what they are listening to, not be turned away from it.
The four basic types of music therapy interventions used for patients with CIs are listening to music, moving to music, singing, and playing instruments (Gfeller & Knutson, 2003). Listening to music can be functional in many ways, such as providing opportunities for social interaction or even working on speech recognition. Moving to music also is a great avenue for increasing social interaction in a group setting. Singing can target many different essential areas, like socialization, articulation, and exploring one’s voice. Joining a choir can be a very social experience. Singing or saying rhythmic chants like “Going on a Bear Hunt” or “5 Little Ducks” can focus on the range of their speaking voice and articulation of speech. Using vocal exercises or therapeutic singing, music therapists can assess vocal intonation, vocal quality, range, awareness of nasal quality, volume of speech and singing voice, pitch matching, melody imitation, free vocalization, and can also exercise the diaphragm (Darrow, 1989, p. 64). Playing musical instruments is a fun way to work on understanding the sounds you are listening to and specifically focusing on those musical elements like instruments, tone quality, and pitches.
Music therapy can benefit those with hearing impairments in so many ways, especially when it comes to speech, language, and socialization. It is crucial as a music therapist when working with someone with a cochlear implant to understand how the implant works, what other factors in their life could affect therapy, and what objectives are most realistic for the patient to try and achieve.
-Amanda Brennen, MT Intern
References
Darrow, A. A. (1989). Music therapy in the treatment of the hearing-impaired. Music Therapy Perspectives, 6, 61–70.
Gfeller, K., & Knutson, J. F. (2003). Music to the Impaired or Implanted Ear.
Hidalgo, C., Pesnot-Lerousseau, J., Marquis, P., Roman, S., & Schön, D. (2019). Rhythmic Training Improves Temporal Anticipation and Adaptation Abilities in Children with Hearing Loss during Verbal Interaction. Journal of Speech, Language, and Hearing Research, 62(9), 3234–3247
Jiam, N. T., Deroche, M. L., Jiradejvong, P., & Limb, C. J. (2019). A Randomized Controlled Crossover Study of the Impact of Online Music Training on Pitch and Timbre Perception in Cochlear Implant Users. Journal of the Association for Research in Otolaryngology : JARO, 20(3), 247–262.
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