Deficits in auditory perception and hearing loss affect all individuals regardless of age, race, gender, socioeconomic class, and more. According to the National Institute of Deafness and Other Communication Disorders, “2 to 3 out of every 1,000 children in the United States are born with a detectable level of hearing loss in one or both ears” (2021, line 1). Traditional verbally expressed and auditorily processed communication may not be easily accessible to individuals with auditory deficits or an extreme degree of hearing loss. Therefore it is important to use alternate forms of communication such as sign language, visual supports, augmentative and alternative communication devices, vibrations, and other elements of music. Music therapy (MT) provides those who live with impaired hearing and deficits in auditory perception the opportunity to build a positive self-image, improve self-esteem, improve communication, and more through uniquely designed music-based interventions. MT is an effective mode of treatment because trained and board certified music therapists (MT-BCs) provide music-based stimulation through tactile touch, vestibular stimulation, and visuals. All of which are unique to each individual and their degree of hearing loss.
In order to provide individualized MT interventions to children and adolescents, MTs strive to understand human auditory processing and how best to provide additional stimulation for those who are hard of hearing. Music reaches these individuals in many creative and effective ways. Research suggests that in order for MT-BCs to communicate effectively with other professionals and parents, they must have technical knowledge in regards to hearing aids and cochlear implants (CIs), how young children develop auditory perception, and typical communication goals established by speech-language pathologists and audiologists (Gfeller et. al, p.39). The human experience of music does not simply occur through aural vibrations and auditory perception. Humans experience music through other senses, such as tactile touch, vestibular stimulation, and sight. In order to treat clients with a wide range of hearing deficits, MT-BCs must understand equipment, how sound is processed for individuals with hearing impairments, and assess how this affects their presentation during MT treatment.
While discussing the mechanics of hearing aids and CIs, which have helped those with hearing loss significantly, it is important to understand how music is perceived through these devices and by the individuals using them. It is important to note that hearing aids and CIs were originally developed to assist those who had difficulty identifying speech, not music. Kirchberger (2016, p.1) defines dynamic range and compression in music as “the level difference between the highest and lowest-level passages of an audio signal. Dynamic range compression (or dynamic compression) is a method to reduce the dynamic range by amplifying passages that are low in intensity more than passages that are high in intensity.” This informs the MT-BC which musical passages are effective for clients with varying levels of hearing loss. Dynamic compression is controlled primarily by recorded musical passages, however, with this knowledge, an MT-BC can select and adjust specific musical elements if presenting live musical interventions. If using recorded music, hearing aid listeners will receive a dual dose of compression which is not always beneficial or aesthetically pleasing. As an MT-BC, it is important to understand how hearing aids work, and to anticipate how recorded music may be experienced by young clients. MT-BCs should adjust session plans and interventions to meet the preference of the client and find the appropriately compressed music that is aesthetically comfortable for them, if not performing and accommodating while presenting live.
The experience of hearing impaired and CI users varies considerably. Each individual’s experience needs to be considered carefully by the treating MT-BC. This information would be gathered during the assessment phase and clinically influences the techniques and interventions presented to the client. In an MT session, hard-of-hearing children may rely on visual cueing from the therapist demonstrating different rhythmic patterns, tempo, dynamics, and other musical elements for a full musical experience. Each child with hearing impairments has varying degrees of ability to perceive pitches, varying ways of hearing music, and varying degrees of perception of music. Again, hearing aids and CIs are formatted for speech sounds, not musical pitches. Therefore, an MT-BC should be aware of each child’s preference for timbres and choose instruments accordingly. MT-BCs provide interventions using a variety of instruments, sounds, and rhythms during all stages of the therapy process. MT-BCs provide tactile rhythmic stimulation, tonal interventions, and instrumental variety.
Early intervention, especially through MT, can improve the quality of life for both the hearing-impaired child and the family as a whole. According to research, MT “is an attractive method through which children’s attention is enhanced, abolishes the shyness and social withdrawal of children, enhances children’s expressive abilities towards the uncommon vocabularies, and it doesn’t only enhance the segmental aspect of phonological development, but also the supra-segmental level of development; as it helps in recognition and discrimination of different pitch direction, proper timing of utterance and tonicity” (Bassiouny, et. al, p.109-110). This means that any child or adolescent with hearing impairments, speech and language deficits, or in need of additional support, speech-specific elements of music can provide opportunity for support. Pitch direction, timing, and melodic flow can be used to teach clients how to ask, “how are you?” to say, “my name is ___,” and more. Not only do music-based interventions address many logistical aspects of speech, as stated above, but music can also encourage and improve other forms of communication for the child. MT is indicated for children with hearing impairments provided the MT-BC appropriately assesses how the client is processing music through assistive devices, and chooses music stimuli accordingly.
-Kathryn Trujillo
References
Quick statistics about hearing. (2021, March 25th). National Institute of Deafness and Other Communication Disorders. https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing
Adamek, M., Darrow, A. (2018). Music in special education. The American Music Therapy Association. (3rd ed., pp. 319-351). The American Music Therapy Association.
Bassiouny, S., Saleh, M., Elrefaie, D., & Girgis, M. (2017). Using music therapy in (Re)habilitation of prelingual cochlear implant children. Journal of Scientific and Technical Research, p.1-6. DOI: 10.26717/BJSTR.2017.01.000127
Du, M., Jun, J., Li, Z., Man, D., & Jiang, C. (2020). The effects of background music on neural responses during reading comprehension. Scientific Reports, 10, p. 1-11.
Gfeller, K., Driscoll, V., Kenworthy, M., & Voorst, T. (2011). Music therapy for preschool cochlear implant recipients. Music Therapy Perspectives, 29, p.1-11.
Kirchberger, M. & Russo, F. (2016). Dynamic range across music genres and the perception of dynamic compression in hearing-impaired listeners. Sage, 20, p.1-16. 10.1177/2331216516630549