Written by Katie Gray, OTR/L
Combining traditional therapy strategies with Therapeutic Listening can increase the rate at which changes take place.
What is Therapeutic Listening?
Therapeutic listening is a sound-based intervention that was developed to support people of all ages who experience difficulties with sensory processing. It provides stimulation to the auditory system through the use of specifically altered music. This music is designed to stimulate the nervous system and the areas of the brain we use to listen and process sensory information. Therapeutic Listening is different from other listening based interventions as it focuses on the brain connections that the auditory system has to access the nervous system and affect changes throughout the whole body.
What does the intervention look like?
A trained therapist selects music based on child’s individualized goals and clinical picture. The child listens to the music two times a day for thirty minutes, seven days a week with at least three hours in between sessions. For those over the age of two, music is played over specialized headphones designed to play specific frequencies. Music selection is modified by therapist every two weeks based on client’s response to music.
What equipment is needed?
- Specialized headphones
- Music – either used through the app, CD, or microSD chips
- Player – determined based on mode of music selection
What are the benefits?
Per the developers of Therapeutic Listening, Vital Links, the program may benefit a wide variety of individuals, including those experiencing difficulties with:
- poor attention
- difficulties interacting with peers and limited play skills
- challenges with transitions or changes in routine
- difficulty communicating [both verbal and non-verbal]
- struggles with sleep, bowel and bladder control, and eating
- trouble following directions
- challenges perceiving and navigating space
- poor timing and sequencing of motor skills
- difficulties with irritability, mood
- difficulties with regulating their energy level [i.e. too low arousal or hyperactive]
- postural insecurity [fear of heights, playing on playground equipment]
- abnormal responses to various sensory stimuli [sounds, touch, taste, pain]
- poor praxis and motor planning: coming up with an idea, planning, and completing the task
- difficulty responding to sounds and verbal directions
How long do people participate in therapeutic listening?
Participation time is individualized, though most participate for several months.
Special considerations for the use of Therapeutic Listening
It is not advised to use Therapeutic Listening in those with schizophrenia, auditory-evoked seizures, tic disorders, or in those with active ear infections. It is not recommended to use therapeutic listening while engaged in screen time.
Unlock the OT toolbox
Just as with all tools in an OT’s tool box, Therapeutic Listening is not meant to be a standalone intervention, instead it is incorporated as an addition to the interventions already being used by a therapist. Combining traditional therapy strategies with Therapeutic Listening can increase the rate at which changes take place. If you think your child could benefit from Therapeutic Listening please consult with a trained occupational therapist near you.
Written by Jessica Addeo
Therapeutic Listening is a music based sensory program that is often recommended to our clients. It can be somewhat difficult to explain in detail in a quick conversation and your therapist may say something like it is “modulated music” or it helps with sensory processing. Often this is somewhat vague and parents are left with many questions. This post is meant to unpack what this program is, so that as a parent you can better understand why it was chosen to be used with your child. Even if your child is not currently using Therapeutic Listening, I urge you to keep reading. As you learn more about the program you may want to ask your therapist to give it a try!
There are several options when choosing an auditory based intervention. Other programs include “The Listening Program” and “Integrated Listening Systems [iLs]”. “Tomatis” is another auditory based intervention [Therapeutic Listening was based on some ideas from this program]. At Positive Steps, many of our therapists have been trained in Therapeutic Listening and for this reason it is the program that we use. As with anything, if you have questions about other listening programs bring this up to your therapist and he or she can help you navigate the information.
A basic tenet of Therapeutic Listening is that listening is more than just listening. Our auditory system works in conjunction with all the other sensory systems and many areas of the brain. This is how and why Therapeutic Listening can impact a child’s behavior, self-regulation and overall organization skills. Listening is defined as “the process of detecting sound and organizing and integrating it for use with information from other senses”. This experience involves the whole brain and body and allows us not only to communicate with one another but also with the environment around us. For example, if you are walking on a quiet path and you hear leaves rustle nearby, you turn to look. You do this without thinking, you are hardwired to hear the sound and orient your eyes, body, and attend to it to “survive”. In an instant your auditory system [in conjunction with the vestibular and visual system] deduces what is the sound, how far away is it, where is it and is it important for me to pay attention to? Similarly, you also know when to filter out sound that isn’t pertinent to you. For example, when you are eating dinner with a friend in a busy restaurant you can choose to eavesdrop and listen to the conversation at the table next to you, but you can also choose to listen just to what your friend is saying. For children with sensory processing difficulties this can all be problematic. When the teacher rings a bell to indicate that center time is over and it is now time to line up for gym class, they do not orient to this sound and follow the directions. Or when a teacher is giving a lesson but a child is also tapping a pencil nearby, they cannot filter out this background noise and attend to the teacher. These instances can lead to “behaviors” and can leave a child feeling out of place in an environment where their participation is crucial to development. When you begin to think about listening in this way, listening becomes more than just listening and instead a key to overall sensory processing.
The music in the program is “electronically modified to highlight the parts of the sound spectrum that naturally capture attention and activate body movement, synchronizing it with the environment. Therapeutic Listening uses electronic modifications, along with organized, rhythmical sound patterns inherent in music to trigger the self-organizing capacities of the nervous system”. That is a lot of words, that make sense as you read them but can be hard to explain and understand in everyday terms. So, let’s break it down a bit more. In the paragraph above we defined what is known as an orienting response, or turning to hear the leaves. This response is when you hear a sound, orient to it and then choose to attend to this sound over others around you [listening to your friend talk versus eavesdropping to the next table over]. The first step in understanding this is breaking down what a sound is. “Sound waves are created from rhythmic back and forth motion, or vibration of an object.” If you think about an old school stereo or large speakers at a wedding, you can almost see them vibrating with sound. As sound reaches our inner ear, they cause the ear drum to vibrate and this is how we perceive sound. In a previous post [see here] we discussed the vestibular system. This system is also housed in the inner ear. The auditory and vestibular system share a single cranial nerve and anatomically there is no clear boundary between the two systems. Therefore, Therapeutic Listening can impact a child’s postural control, mood/self-regulation and motor coordination. When we stimulate the inner ear through the music we are also stimulating the vestibular system and receiving all of the benefits that working on the vestibular system brings.
There are 3 properties of sounds waves: frequency, amplitude and complexity. Frequency is the rate of vibration and is measured in Hertz and can occur in high and low tones. Low tones are processed by the vestibular system whereas high tones are processed by the cochlea [for hearing]. Amplitude is what we think of as loudness. Complexity is how many sound waves are coming together for us to perceive as a single sound. A simple sound wave would be the vibration of a tuning fork, but most natural sounds are many sound waves coming together. The environment in which we hear a sound also changes how we perceive it. As sound waves move through the air they can bounce off different surfaces and even be absorbed by materials in the environment. Yelling in a small room sounds very different than it does in a hallway. Speaking to your friend in an empty gymnasium versus during a full gymnasium during an assembly will sound and feel different. People with auditory processing difficulties may have more difficulty in certain environments based on the acoustics of the room or space. Similarly, someone with difficulty sensing their body in space [vestibular system] may use sound to help them feel more comfortable in a new space. When walking in a hallway a child may always yell or make noises, which can seem like a behavior, but instead they maybe are trying to perceive the new space/environment around them. Similarly, children may have difficulty modulating their voice volume and you find yourself constantly saying “use your inside voice” or “no yelling”. The child may change their voice volume momentarily and then seconds later they are back to speaking too loudly for the environment. This is likely related to sensory processing and maybe even related to their ability to process how loud their voice is in a particular space.
Now we know that all sound involves vibration, which we process in our ear and this is closely related to the structures of our vestibular system. On to music, music is “compromised of vibrations that have an underlying structure and are organized into patterns”. We already know this without thinking about it. When you listen to heavy metal you feel different than when you listen to classical music in comparison to rap/hip-hop in comparison to pop music in comparison to jazz. Each person’s response to a certain type of music is determined by their make-up and past experiences. In the simplest definition, Therapeutic Listening is capturing this response and using it to help its participants function optimally. All the music used in Therapeutic Listening has been electronically modified, therefore it is required that you use specialized headphones. This means that you cannot copy a CD or download it to a your computer, iPhone, etc. and play. Doing so will alter the modifications of the music and limit the therapeutic benefits. [Vital Links does now offer the music to be purchased directly from your iPhone, if this is something you are interested in please speak to your therapist.] This is also why you must listen to the music on the Seinheiser headphones, they were specifically designed for the program and it’s music.
The CDs that your therapist send home are “modulated music”. Modulated music alternates between high and low frequency sounds, this activates the organs inside of our ears and trains them to focus on something nearby and then relax and monitor the environment around them. The music literally helps your child practice hearing a sound and orienting to it and then knowing when to let sound fade into the background because it isn’t pertinent. As has already been mentioned, at the same time this music is impacting your child’s vestibular system and both systems are communicating with the rest of the brain and nervous system. This is how this program has impacts on such a large scale. Each CD has a different clinical application based on playing with the elements of music described above. Some CDs are meant to encourage an upright posture, improvements in speech, biological rhythms [sleeping, going to the bathroom], coordination, or motor planning. Every program and musical sequence is picked based on the specific child and no two programs look the same.
There are a few logistics involved in listening to the music. Typically, a child will listen twice a day for 30 minute sessions with a 3-hour break in between sessions. [There are some specific circumstances where this could change, but as always speak with your therapist]. While they are listening no other background music can be on, no watching television, looking at the computer or electronic devices. This is because these other inputs could also impact the brain, lessening the effects of the program. Many families will listen during mealtime, playtime [you can use the Tune Belt, which is basically a fanny pack that holds a CD player so your child can play at the tabletop or be moving around] or in the car. The car is a suitable option; however, no other music can be playing in the background and you can’t be speaking on the phone through your Bluetooth. The headphones are open ended, meaning while listening to the music your child can also hear the environment around them. For this reason, they can listen during a lesson or while doing homework, some children become too distracted by listening to the music so this is not the best option for them. At Positive Steps, we will lend you the CD player and headphone to start the program off [after trialing this in our session]. Once it is determined that the program is a good match for your child and family, we ask that you order your own set of headphones, CD player and Tune Belt [if you wish]. We will lend you new CD approximately every 2 weeks [we may change a CD sooner if the response is negative or leave one longer if it is working well]. Your therapist is also an available resource to answer questions and help you navigate the program. As a therapist, any observations you see at home are helpful in guiding our music selections and determining the success of the program. How long a child stays on program varies greatly, sometimes we will stop the program and start it back up again in a couple of months.
Hopefully this post cleared up any confusion you may have had regarding this wonderful sensory tool. As always ask us if you have further questions!
Frick, S. & Young, S. [2009]. Listening with the Whole Body: Clinical Concepts and Treatment Guidelines for Therapeutic Listening. Madison, Wisconsin: Vital Links.