Auditory Interventions

What's Right for My Child?

By Sheila Frick, OTR, with Colleen Hacker, MS, OTR/L

The therapeutic use of music has long been scientifically supported. Since the mid-1900's when Alfred Tomatis began his work with the therapeutic 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 parent to decide which of the various therapies may be beneficial for their child. Naturally, when researching any one method of auditory intervention, a parent will be met with the 'bias' that one particular method of auditory intervention is the method best suited to the challenges for which treatment is being sought.

What then are the choices most commonly available to a family seeking treatment, which involve auditory interventions? The following provides an overview of auditory intervention methods in common practice in the United States.

There are several distinctions between the types of sound therapy programs in common practice. Some programs are clinic-based while others are conducted as home programs. Some programs are 'passive input' unless used in conjunction with other forms of therapy. Other programs inherently contain an active component. Each intervention usually requires a training or certification for the practitioner beyond their already established professional background. Parents should be careful to note a practitioner's professional background and advanced training.

THE TOMATIS METHOD

Dr. Alfred Tomatis, a French Ear, Nose, and Throat specialist, was one of the first practitioners to develop an approach for treating listening difficulties. Tomatis originally defined the role of the ear as the 'integrator' in that the ear was significant in structuring organization at all levels 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 could 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 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
• The role of the auditory system relates self-to-self, others, and the universe
• The brain needs sound energy to enable the thinking process and the development of integration

Tomatis developed the first auditory training or listening training device using 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 clinic-based program, requiring the use of specialized equipment and the expertise of a practitioner trained in the Tomatis approach.

AUDITORY INTEGRATION - THE BERARD METHOD

Most of the clinically based auditory training techniques are based on the early work of Tomatis, including that of Dr. Guy Berard, 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 pop 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 benefitted 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.

With the advent of new technology, similar tools have become available on compact disc. Although similar they 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)

THE SAMONAS METHOD

The SAMONAS method is another such tool, which has combined the ideas of Tomatis with advances in both technology and physics. Ingo Steinbach, a German sound engineer, developed this method with a broad background in music, physics, and electronics. 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 heard in the concert hall. He realized that sound reflects the space that it is recorded in, 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 also the instrumentation. He uses only natural instruments, which produce tones rich in harmonics. Additionally, Steinbach believes that sound carries intention and that the musicians' state is reflected in their work. For this reason, he only records when he feels that the musicians are playing from a place 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 distance of sounds as well other detailed information about the sound source. In addition to the spectral activation, there are also brief passages on the CDS with intensive filtering, during which almost nothing but the overtones are heard. Listening to these 'high extension' passages trains the ear to pay attention to the upper ranges in the sound spectrum. Again, the higher tones are the parts of the sound spectrum that captivate attention and hold interest. These recordings are identified as SAMONAS, 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 are incorporated into entry level practice of the use of modulated sound such as Integrated 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 as well as training in more sophisticated pieces of equipment used in SAMONAS Sound Therapy. To use the title trained in Samonas a therapist must complete a 5 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.org or www.Samonas.com

INTEGRATED LISTENING is a term used to imply combined use of a number of electronically altered compact discs. Currently, EASE, and 'entry level SAMONAS' CDs fall under this terminology. With the rapid growth of sound therapy, it is likely that other products will also be included in the future. Integrated Listening implies that the listening programs are individualized to each client and are ideally 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 other sensory integrative techniques seems to increase the effectiveness of both treatment modalities. An accompanying decrease in the time necessary to meet treatment goals in the areas of modulation, balance and movement perception, exploration of the environment, sense of physical competence, and drive to challenge one's praxis and sequencing abilities as well as social competence and language abilities is commonly experienced.

Integrated Listening programs can be carried out at home, school or in the clinic with ongoing support from a therapist who is trained in their use. A typical program may be in place for 2-6 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.

Another home listening program is just being introduced in the United States and Canada, the LISTENING FITNESS PROGRAM. This program provides listening training using sound stimulation, 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. It is most commonly used as a clinic-based tool. 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 his/her voice and body through voice exercises (humming, singing, reading in a microphone). The total program lasts about 60 hours; listening times vary per individual. Close monitoring and coaching are provided throughout the program.

Listening Fitness Instructors are carefully screened, trained and supervised for 1 year by a highly qualified training ream 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.

Given the sheer volume of information available on auditory interventions a parent has a formidable and unenviable task in selecting the clinician and type of program most suitable for a child's specific needs. Reality is that each of the forms of auditory intervention available has something to offer and that each may have 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 most beneficial.

Further information can be obtained by contacting Therapeutic Resources in Madison, WI (608-278-7075) for more detailed information on Integrated Listening, Auditory Integration Training, Samonas, Listening Fitness, and the Interactive Metronome.

Sheila Frick, the director of Therapeutic Resources, was recently elected to the Board of Directors of the Society for Auditory Intervention Techniques (SAIT) which is dedicated to the enhancement of the quality of life for individuals with special needs through Auditory Integration and other Auditory-based Interventions. As a non-profit group they strive to provide information for parents regarding auditory techniques through a quarterly Newsletter and provide information on-line through their web site: elaine.teleport.com/sait/table/html#ait.

Sheila also has 'coined' the term Integrated Listening and has taught this entry-level technique to over 800 therapists in the United States, Canada, United Kingdom and the Netherlands. Sheila has also introduced the work of Ingo Steinbach (Creator of SAMONAS) to the Sensory Integrative community in the United States and currently works as a clinical Teacher in the five day core training along side Ingo Steinbach. Due to her strong commitment to clinical Excellence she continues to strive to seek new tools which can be integrated into the fabric of occupational therapy and Sensory integrative frames of reference.

If you have any questions, please contact NeuroTherapeutics in Oregon, or by phone at 503-657-8903. Our mailing address is PO Box 1126 * Oregon City, Oregon 97045.