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From the Hearing Journal, June, 2007
Cochlear implants can help patient enjoy listening to and making music Manuela Prause-Weber and Lyn Schraer-Joiner June 2007 The Hearing Journal
Cochlear implants can help patients enjoy listening to and making music
By Manuela Prause-Weber and Lyn Schraer-Joiner
It is well documented that cochlear implants do not prevent users from appreciating music and that many wearers enjoy listening to music.1-4
To cite a specific example, Victor Senn, a post-lingually deafened adult, reported the following in his cochlear implant diary: "Yesterday, I bought a CD of George Gershwin.
I listened to his Rhapsody in Blue, Lullaby, An American in Paris, and Cuban Overture. These are wonderful music pieces!... At the moment, I am listening to the Beatles...
Music definitely prepares my listening... [and] broadens my awareness."5
In addition to the growing body of research studies and anecdotal accounts from cochlear implant users, there are also case studies that support the use and esthetic gain for these individuals from listening to music. For example, Hapel and Pahlke described a systematic music listening program consisting of six steps that aided in the listening
process of a post-lingually deafened adult implant recipient during the post-surgical rehabilitation phase.6
A SIX-STEP MUSIC LISTENING PROGRAM
During the first phase, the implant wearer was asked to say which of two notes played by the auditory therapist seemed higher and which lower. At the beginning of Phase I, the subject found this no easy task.
Phase II of rehabilitation required the implant user to report on her ability to recognize easy children's songs played on the piano without accompaniment, and in Phase III, the subject tried to sing the aforementioned songs herself. The latter stage revealed that, although the subject was able to sing the whole song with some accuracy, she often began on a different note from the one presented.
According to the researchers, there seemed to be a difference between the tone as she perceived it and the sound produced on the piano.
Phase IV of rehabilitation required the subject to report her ability to recognize well-known songs in Germany such as Hänschen klein, Fuchs, Du hast die Gans gestohlen, and Happy Birthday performed by the researchers. Interestingly, the subject can still easily recognize these melodies today after listening to only a few notes.
During Phase V, intervals composed of octaves and
fifths played throughout the entire range of the piano were presented so the subject could become used to listening to certain intervals with her new implant. Phase VI materials consisted of triads presented in succession. The subject, who was required to identify the tones she perceived, was
sometimes able to tell whether the triads presented were minor or major. The subject of the study finally concluded: "My cochlear implant, which has been constructed for understanding speech, allows me the joy of getting involved in musical activities. This makes me very happy."6
A CASE STUDY
A case study by the second author of this article revealed that musical listening experience and enjoyment with a cochlear implant was possible for the subject.7 "C," a post-lingually deafened adult, was implanted with the Clarion ® S-Series Multi-Strategy cochlear prosthesis (Advanced Bionics Corporation) more than 25 years after the onset
of her hearing loss. The successful implantation of the prosthesis enabled C to regain her social and environmental independence and to resume group activities that she had given up. Her musical listening interests were also rekindled.
7
Initially, C's musical abilities, specifically her skill at recognizing rhythms and melodies, were assessed through musical activities that focused on the stages of auditory development. For example, these included auditory awareness (detecting the presence or absence of sound) auditory discrimination (determining the similarities and differences among sounds); and auditory sequencing, involving the recognition and sequence of musical elements as suggested
in Birkenshaw's Music for Fun, Music for Learning.8
Schraer-Joiner played the flute for the melody-recognition activities because of the sinusoidal stimuli that C had experienced during audiometric testing and the comparable lack of harmonics in the flute tone. The melodies were selected based on the frequency range input of 250 to 6800 Hz available to C with her cochlear implant and the tonalrange
frequency of the songs. The melodies used were gathered from elementary basal music series such as Share the Music9 and generic children's songbooks such as The Reader's Digest Children's Songbook.
10 Melodies including Jingle Bells, Happy Birthday,Yankee Doodle, Mary Had a Little Lamb, Frere Jacques, The Star Spangled Banner, America, and Jolly Old St. Nicholas were selected based on the subject's previous exposure to and familiarity
with these pieces.
The data gathered during these preliminary sessions revealed that C was strong rhythmically, and could recognize some songs based on their rhythmic makeup, and, in some instances, their
melodic patterns.7 C described the flute timbre as "high-pitched." Comments on some of the flute pieces, either recorded songs or those Schraer-Joiner performed live, included "lots of notes" and were "very melodious." She indicated also that
it seemed as though there was "a lot of music for one instrument!"
C could perceive other musical instruments involved in preliminary activities as well. For example, she recognized the woodblock, rhythm sticks, finger cymbals, and triangle. In discrimination activities,
C was able to determine without seeing the instruments that each of them sounded different from the others. Her descriptions of the finger cymbals included "tinny," and she described the triangle as "lower than the finger cymbals and tinny."
The literature on musical skills and involvement with cochlear implantation has revealed that implant recipients do have abilities in the areas of frequency related and rhythm-related discrimination, 2 timbre recognition, and music
appreciation.3,4
Although most of the research focuses on adults, data for children do exist. Gfeller et al. investigated the quality of musical experiences, types of involvement with music, and general attitudes of children implanted with cochlear prostheses.4 The
researchers found that many children who use implants take part in formal music activities. For example, 46% of the children attended general music classes and 29% were involved in school musicals.
Researchers also found that the children participated in informal music activities such as listening to music at home or in a community setting, dancing to music, and watching music videos.4 They also discovered factors that either enhanced or detracted from music appreciation. Listening to music in a quiet environment, using direct plug-in equipment, being able to control the volume of the music (with quiet to moderate being preferred), and incorporating visual cues for help in the interpretation of the sound were all found to enhance the enjoyment of music.4 The researchers found that 78% of children showed greater interest in music following implantation, while 5% indicated a dislike of music. Only 8% reported having no interest in music either before or after implantation and 6% said their interest in music did not change from pre- to post-implantation.
Results of this study reveal that implanted children are engaging in musical activity regardless of the limitations imposed by current implant devices.4
IMPLANT WEARERS
MAKING MUSIC
Studies have documented that, in addition to developing music listening skills, cochlear implant users can become involved in singing and playing musical instruments. For example, Gfeller et al. found that implanted children are often enrolled in choirs and bands.4 Additionally, Senn et al. have reported on the ability of cochlear implantees to learn to play the piano.1,5,6
In a case study, Linsenmeier described how an 8-year-old boy with a cochlear prosthesis learned to play the violin via the Suzuki method.11 Approaches employed included visual reinforcement (such as imitation, but without music sheets) and much repetition. The author explained the positive results, the high instrumental skills of the child through the achieved auditory listening skills, and the supplementary vibrotactile information
transmitted via bone conduction.
Ruth Fox, a former music teacher and professional violinist with a university degree in performance, described her postimplantation experiences in an article entitled "Music, the language of our souls:
How we can hear it with cochlear implants."12 Interestingly, Fox found her initial listening experiences disappointing.
Anticipating a positive experience, she brought her college senior recital tape and several books on tape for listening to after her implant was in place and functioning.
However, she was unable to determine if the sounds she was listening to were speech or music. As a result, Fox began listening to children's songs and stories due to their simple composition. With
practice, the speech and music became more distinctive and Fox also began to perceive different tones. She reported that larger intervals and pitches played in the context of a familiar melody were the easiest to perceive. Although redefined by
the cochlear prosthesis, Fox considered her music-making efforts worthwhile because of the melodies she was able to perceive.
STATEMENTS AND CONCLUSIONS
Existing research findings and reported experiences allow us to make some general statements and draw some practical conclusions:
v Active participation in and enjoyment and appreciation of music are possible with a cochlear implant, regardless of how wearers' perceptions of music may differ from those of non-impaired listeners.
v Music can support the hearing process in the post-surgical rehabilitation phase.
v The value of music lies not only in the benefits gleaned from it as part of a rehabilitative program but also for the esthetic enjoyment that results. Music is a creative process fundamental to the human experience.13 In conclusion, as Laufer states, "Music in an esthetic approach is a field of encounter that lives on the sensitivity, activity,
and behavior within each listener."
Music "is much more than an evolutionary luxury or a nice accessory to our functional life." There is an innate need within all of us to be musical, "an
evolutionary need for esthetics arising in the personal will for esthetics."14
In conclusion, cochlear implant users who wish to do so should get involved with music, regardless of the quality or quantity of the musical experiences that result. Although doing this may require an effort from everyone involved, e.g., the rehabilitation staff, parents, educators, hearing therapists, and, above all, the implanted person him or herself, we hope this article will serve as a habilitative or rehabilitative starting point. We also hope that the accounts cited herein will encourage
cochlear implant users to pursue their musical listening interests while also encouraging the hearing healthcare professionals who will guide them.
Manuela Prause-Weber, PhD, is Lecturer at the
Department of Music in Special Education/Music Therapy at
the University of Cologne and Clinical Music Therapist at the University Hospital Munich.Lyn Schraer-Joiner, PhD,
is Music Education Coordinator and Assistant Professor at Kean University. Readers may contact Dr. Prause-Weber at Manuela.Prause@t-online.de or at Heilpaedagogik, Universität zu Koeln, Frangenheimstrasse 4, 50931 Cologne, Germany. Dr. Schraer-Joiner can be contacted at lschraer@kean.edu or at Music Department, 1000 Morris Avenue, Kean University, Union, NJ 07083.
Cochlear implants can help patient enjoy listening to and making music Manuela Prause-Weber and Lyn Schraer-Joiner June 2007 The Hearing Journal
Cochlear implants can help patients enjoy listening to and making music
By Manuela Prause-Weber and Lyn Schraer-Joiner
It is well documented that cochlear implants do not prevent users from appreciating music and that many wearers enjoy listening to music.1-4
To cite a specific example, Victor Senn, a post-lingually deafened adult, reported the following in his cochlear implant diary: "Yesterday, I bought a CD of George Gershwin.
I listened to his Rhapsody in Blue, Lullaby, An American in Paris, and Cuban Overture. These are wonderful music pieces!... At the moment, I am listening to the Beatles...
Music definitely prepares my listening... [and] broadens my awareness."5
In addition to the growing body of research studies and anecdotal accounts from cochlear implant users, there are also case studies that support the use and esthetic gain for these individuals from listening to music. For example, Hapel and Pahlke described a systematic music listening program consisting of six steps that aided in the listening
process of a post-lingually deafened adult implant recipient during the post-surgical rehabilitation phase.6
A SIX-STEP MUSIC LISTENING PROGRAM
During the first phase, the implant wearer was asked to say which of two notes played by the auditory therapist seemed higher and which lower. At the beginning of Phase I, the subject found this no easy task.
Phase II of rehabilitation required the implant user to report on her ability to recognize easy children's songs played on the piano without accompaniment, and in Phase III, the subject tried to sing the aforementioned songs herself. The latter stage revealed that, although the subject was able to sing the whole song with some accuracy, she often began on a different note from the one presented.
According to the researchers, there seemed to be a difference between the tone as she perceived it and the sound produced on the piano.
Phase IV of rehabilitation required the subject to report her ability to recognize well-known songs in Germany such as Hänschen klein, Fuchs, Du hast die Gans gestohlen, and Happy Birthday performed by the researchers. Interestingly, the subject can still easily recognize these melodies today after listening to only a few notes.
During Phase V, intervals composed of octaves and
fifths played throughout the entire range of the piano were presented so the subject could become used to listening to certain intervals with her new implant. Phase VI materials consisted of triads presented in succession. The subject, who was required to identify the tones she perceived, was
sometimes able to tell whether the triads presented were minor or major. The subject of the study finally concluded: "My cochlear implant, which has been constructed for understanding speech, allows me the joy of getting involved in musical activities. This makes me very happy."6
A CASE STUDY
A case study by the second author of this article revealed that musical listening experience and enjoyment with a cochlear implant was possible for the subject.7 "C," a post-lingually deafened adult, was implanted with the Clarion ® S-Series Multi-Strategy cochlear prosthesis (Advanced Bionics Corporation) more than 25 years after the onset
of her hearing loss. The successful implantation of the prosthesis enabled C to regain her social and environmental independence and to resume group activities that she had given up. Her musical listening interests were also rekindled.
7
Initially, C's musical abilities, specifically her skill at recognizing rhythms and melodies, were assessed through musical activities that focused on the stages of auditory development. For example, these included auditory awareness (detecting the presence or absence of sound) auditory discrimination (determining the similarities and differences among sounds); and auditory sequencing, involving the recognition and sequence of musical elements as suggested
in Birkenshaw's Music for Fun, Music for Learning.8
Schraer-Joiner played the flute for the melody-recognition activities because of the sinusoidal stimuli that C had experienced during audiometric testing and the comparable lack of harmonics in the flute tone. The melodies were selected based on the frequency range input of 250 to 6800 Hz available to C with her cochlear implant and the tonalrange
frequency of the songs. The melodies used were gathered from elementary basal music series such as Share the Music9 and generic children's songbooks such as The Reader's Digest Children's Songbook.
10 Melodies including Jingle Bells, Happy Birthday,Yankee Doodle, Mary Had a Little Lamb, Frere Jacques, The Star Spangled Banner, America, and Jolly Old St. Nicholas were selected based on the subject's previous exposure to and familiarity
with these pieces.
The data gathered during these preliminary sessions revealed that C was strong rhythmically, and could recognize some songs based on their rhythmic makeup, and, in some instances, their
melodic patterns.7 C described the flute timbre as "high-pitched." Comments on some of the flute pieces, either recorded songs or those Schraer-Joiner performed live, included "lots of notes" and were "very melodious." She indicated also that
it seemed as though there was "a lot of music for one instrument!"
C could perceive other musical instruments involved in preliminary activities as well. For example, she recognized the woodblock, rhythm sticks, finger cymbals, and triangle. In discrimination activities,
C was able to determine without seeing the instruments that each of them sounded different from the others. Her descriptions of the finger cymbals included "tinny," and she described the triangle as "lower than the finger cymbals and tinny."
The literature on musical skills and involvement with cochlear implantation has revealed that implant recipients do have abilities in the areas of frequency related and rhythm-related discrimination, 2 timbre recognition, and music
appreciation.3,4
Although most of the research focuses on adults, data for children do exist. Gfeller et al. investigated the quality of musical experiences, types of involvement with music, and general attitudes of children implanted with cochlear prostheses.4 The
researchers found that many children who use implants take part in formal music activities. For example, 46% of the children attended general music classes and 29% were involved in school musicals.
Researchers also found that the children participated in informal music activities such as listening to music at home or in a community setting, dancing to music, and watching music videos.4 They also discovered factors that either enhanced or detracted from music appreciation. Listening to music in a quiet environment, using direct plug-in equipment, being able to control the volume of the music (with quiet to moderate being preferred), and incorporating visual cues for help in the interpretation of the sound were all found to enhance the enjoyment of music.4 The researchers found that 78% of children showed greater interest in music following implantation, while 5% indicated a dislike of music. Only 8% reported having no interest in music either before or after implantation and 6% said their interest in music did not change from pre- to post-implantation.
Results of this study reveal that implanted children are engaging in musical activity regardless of the limitations imposed by current implant devices.4
IMPLANT WEARERS
MAKING MUSIC
Studies have documented that, in addition to developing music listening skills, cochlear implant users can become involved in singing and playing musical instruments. For example, Gfeller et al. found that implanted children are often enrolled in choirs and bands.4 Additionally, Senn et al. have reported on the ability of cochlear implantees to learn to play the piano.1,5,6
In a case study, Linsenmeier described how an 8-year-old boy with a cochlear prosthesis learned to play the violin via the Suzuki method.11 Approaches employed included visual reinforcement (such as imitation, but without music sheets) and much repetition. The author explained the positive results, the high instrumental skills of the child through the achieved auditory listening skills, and the supplementary vibrotactile information
transmitted via bone conduction.
Ruth Fox, a former music teacher and professional violinist with a university degree in performance, described her postimplantation experiences in an article entitled "Music, the language of our souls:
How we can hear it with cochlear implants."12 Interestingly, Fox found her initial listening experiences disappointing.
Anticipating a positive experience, she brought her college senior recital tape and several books on tape for listening to after her implant was in place and functioning.
However, she was unable to determine if the sounds she was listening to were speech or music. As a result, Fox began listening to children's songs and stories due to their simple composition. With
practice, the speech and music became more distinctive and Fox also began to perceive different tones. She reported that larger intervals and pitches played in the context of a familiar melody were the easiest to perceive. Although redefined by
the cochlear prosthesis, Fox considered her music-making efforts worthwhile because of the melodies she was able to perceive.
STATEMENTS AND CONCLUSIONS
Existing research findings and reported experiences allow us to make some general statements and draw some practical conclusions:
v Active participation in and enjoyment and appreciation of music are possible with a cochlear implant, regardless of how wearers' perceptions of music may differ from those of non-impaired listeners.
v Music can support the hearing process in the post-surgical rehabilitation phase.
v The value of music lies not only in the benefits gleaned from it as part of a rehabilitative program but also for the esthetic enjoyment that results. Music is a creative process fundamental to the human experience.13 In conclusion, as Laufer states, "Music in an esthetic approach is a field of encounter that lives on the sensitivity, activity,
and behavior within each listener."
Music "is much more than an evolutionary luxury or a nice accessory to our functional life." There is an innate need within all of us to be musical, "an
evolutionary need for esthetics arising in the personal will for esthetics."14
In conclusion, cochlear implant users who wish to do so should get involved with music, regardless of the quality or quantity of the musical experiences that result. Although doing this may require an effort from everyone involved, e.g., the rehabilitation staff, parents, educators, hearing therapists, and, above all, the implanted person him or herself, we hope this article will serve as a habilitative or rehabilitative starting point. We also hope that the accounts cited herein will encourage
cochlear implant users to pursue their musical listening interests while also encouraging the hearing healthcare professionals who will guide them.
Manuela Prause-Weber, PhD, is Lecturer at the
Department of Music in Special Education/Music Therapy at
the University of Cologne and Clinical Music Therapist at the University Hospital Munich.Lyn Schraer-Joiner, PhD,
is Music Education Coordinator and Assistant Professor at Kean University. Readers may contact Dr. Prause-Weber at Manuela.Prause@t-online.de or at Heilpaedagogik, Universität zu Koeln, Frangenheimstrasse 4, 50931 Cologne, Germany. Dr. Schraer-Joiner can be contacted at lschraer@kean.edu or at Music Department, 1000 Morris Avenue, Kean University, Union, NJ 07083.
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