Download Peter – aged 4

Difficulties with listening,
discrimination and rhythm
contribute to stress:
The role of auditory stimulation
programmes in remediation
Camilla Leslie
Specialist Speech and Language Therapist
Edinburgh UK
© Clear Listening LLP 2014
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The Plan
• What are the links between listening, auditory
processing, rhythm, stress, composure, behaviour and
learning?
• How can a music based auditory stimulation programme
help to make life easier?
• What are the specific features of Johansen
Individualised Auditory Stimulation?
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Stress
• Studies in the US and the UK confirm our impression that stress is
increasing in the modern world
• The average level of anxiety found in children and young people at
the end of the 1990s was equivalent to clinical levels in the 1950s
• Further studies have confirmed an ongoing increase between the
1980s and 2011
• People who are stressed:
– are in a state of permanent high alert
– feel overtired and irritable
– are unable to sustain attention to complete tasks
• Anyone with a learning delay or difference is likely to find their social
and learning environment continually stressful
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Hearing
• HEARING is a sense
• HEARING is the physical ability of the ear and brain to receive sound
• The potential to HEAR is innate provided the physical structures are
intact
• Hearing is the only sense that is fully functioning before we are born
and is believed to be the last sense to go before we die
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Listening
• LISTENING is a behaviour
• LISTENING is paying attention to sound
• LISTENING is a learnt skill. Children learn to listen
• LISTENING enables our brain to interpret the sounds we hear so that
we can understand
• LISTENING implies an active process while HEARING implies a
more passive process
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Auditory Processing
• AUDITORY PROCESSING is the medical term for LISTENING
• It is the processing of sound before it takes meaning
• AUDITORY PROCESSING describes noticing and interpreting the
sounds we hear. This involves both the pathways from the ear to the
brain (afferent) and ‘top-down’ processing (efferent) which
influences how information is processed
• AUDITORY PROCESSING is a vital component of understanding
speech and language
• There are many interactive links including cerebral dominance,
language processing, attention, memory, emotion, vision, movement,
balance and spatial awareness
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The Development of Hearing and
Auditory Processing
• Sound travels along afferent pathways from the ear to the cortex
where complex links are made for perception:
• Attention
• Emotion
• Language
• Vision
• Movement
• Information then travels back to the auditory cortex and down efferent
pathways to the muscles in the middle ear
• They adapt to filter sound and modulate how we respond
• The impact of the downward efferent pathways on listening can be
more complex than the upward afferent pathways
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Functions of Auditory Processing
• Language Patterns (the bigger picture)
– Rhythm, Intonation, Emotional content
• Discrimination
– Recognising sounds and sound patterns
– Discriminating between similar sounds
– Selecting target sounds in competing noise
– Noticing the order in which sounds are made
• Integrating discrimination and the bigger picture
– What and where are the sounds around us
– Using experience, memory and imagination to understand the
full meaning
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Speech Perception
• Efficient Auditory Processing supports the higher order functions
of language, learning and communication:
–
–
–
–
–
Attention to auditory information
Memory for auditory information
Auditory comprehension
Phonological awareness
The emotional and implied aspects of language
• The more easily we process auditory information in social and
learning contexts, the more likely we are to manage the stresses of
daily life while remaining calm, happy and available for learning
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General Information about
Auditory Stimulation
• Musical Auditory Stimulation programmes give extra, focused
listening practice. They have been shown to improve listening and
associated skills, including:
– General composure
– Attention and concentration
– Understanding spoken language
– Clear speech
– Social communication
– Noticing letter-sounds for reading and spelling
– Confidence and self esteem
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Johansen Individualised
Auditory Stimulation
(Johansen IAS)
• Has been developed by Dr. Kjeld Johansen, a Danish teacher and
psychologist
• Johansen IAS is now used in more than 25 countries world wide
• Uses specially composed synthesised music
• The music has been arranged to encourage better awareness of the
detail in what we hear
• It involves listening through good quality stereo headphones at
home or school
• It involves listening to an individually planned programme for 10
minutes per day
• An overall programme lasts from 6-18 months – most children listen
for 9-10 months
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Rhythm
• We often associate rhythm with music
• Rhythm (from Greek word rhythmos, "any regular recurring motion,
symmetry”)
• Rhythm generally means a regular recurring pattern in time, from
longer patterns over days or years to microseconds
• Regular rhythms underpin the pattern of:
– night and day
– school time table
– a wide range of gross and fine motor skills
– bodily rhythms including respiration and the cardiac rhythm of
the heart beat
– sound waves
– the intonation patterns and ‘tune’ in music and speech
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Rhythm
• Noticing the rhythms of life helps us to become aware of sequences
of events
• This in turn enables us to reflect on, monitor and plan our behaviour
• Rhythm helps us to know what is expected of us, and what to expect
• When we notice a rhythm our motor cortex highlights the activity
patterns used to move to the rhythm
• This underpins controlled and synchronised input and output which
regulates the accuracy, speed and fluency of our actions and
speech
• This supports calm, confident and stress-free engagement with new
tasks, the people around us and learning opportunities
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Rhythm
• Without a sense of rhythm events and experiences constantly take
us by surprise
• We may respond by being over focussed, for example, on
background sounds or loud sounds
• We may respond to the overload by shutting down and not hearing
when spoken to
• We may be unable to settle in a learning context
• We may be a different person one-to-one where we are able to
interact calmly, to when we are in a busy classroom
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Rhythm, Music and Language
• There is now a significant body of research reporting changes in the
wider neural processing networks involved in language as a result of
musical training
• Imaging studies of the neural networks involved in music processing
have recorded the areas responding to unexpected musical changes
• Activated areas included Broca’s, Wernicke’s, the Superior
Temporal Sulcus and Heschl’s Gyrus
• The network comprising all these structures was previously thought
to be specific for language
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Rhythm, Music and Language
• The rhythms in music, language and movement are often shared in
emotional connection and comforting situations
• It has been proposed that the emotions induced by shared music
and dance had a major role in supporting social cohesion and group
cooperation in early societies
• We are still at risk of not fitting in if we mess up the rhythms of turn
taking, appropriate tone of voice and being on time
• Music based interventions can support the development of
language, communication and wider attention skills
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Music and Language
• Listening to and engaging with music also benefits children suffering
from Post Traumatic Stress Disorder in conflict zones
• Known symptoms of PTSD have been found to regularise in
response to music
– Raised heart rate
– Breathlessness
– Vagal deregulation
– Attention deficits
– Emotional deregulation
Youtube - Nigel Osborne talking about children in Mostar, Bosnia
Nigel Osborne (2012) Neuroscience and “real world” practice: music as a
therapeutic resource for children in zones of conflict. Annals of the New
York Academy of Science, Boston, Blackwell
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Listening Supports Doing
• Research studies with diverse groups from infants to adults post
stroke or with dementia show positive changes in response to music
based listening programmes
• Whilst there is a substantial body of evidence for the benefits of
engaging in rhythmic movement and music making, many clients
need to learn to focus on and notice sound before dividing their
attention between input and output
• The best benefits of rhythmic movements and music making are
seen for those people who show the best focused and sustained
attention to sound
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Johansen IAS and Rhythm
• Johansen IAS is a music based auditory stimulation programme
• The client listens to the same simple, calming recording everyday for
an average of 6 to 8 weeks
• The recordings are chosen by a Registered Johansen IAS Provider
to match the client’s profile of difficulties
• They can also be enhanced by the addition of either regular or
bilateral beats which emphasise basic rhythms
• The calm listening protocols promote uncluttered awareness of
rhythm in sound and stimulate associated brain activity supporting
rhythm in movement
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Johansen IAS and Rhythm
• Explicit rhythms can be added to the basic Johansen IAS music
where background information and assessment show the need for
emphasis
• Let’s listen
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Sound Discrimination
• In order to have the mental space to think about the meaning of
what we hear we need to process the basic detail easily
• In order to be motivated to continue to pay attention when we are
spoken to in conversation and in the classroom we need to process
the basic detail easily
• This involves sound discrimination:
– Recognising sounds and sound patterns
– Discriminating between similar sounds
– Selecting target sounds in competing noise
– Noticing the order in which sounds are made
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Sound Discrimination Difficulties
• If discrimination is hard our ability to understand and remember
what we have heard and learned is reduced
• Additional time and effort is required in
– Conversation
– Learning
– Reading
– Spelling
– Etc
• We miss out on the satisfaction of doing things easily
• The time and effort devoted to completing our work becomes
disproportionate in our lives and increases stress
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Sound Discrimination Difficulties
• The detail of what we hear may be unclear because:
– physical and emotional issues have affected the development of
our listening attention or
– early glue ear has removed some sounds from our early
learning experience
• Conversation and school learning get harder as we get older. There
is more spoken instruction and it is more complex, there are fewer
visual clues and there is more discussion
• Being constantly unsure what is going on is stressful and can lead
to:
– shutting down because of overload or
– compensating with inappropriate talk or actions
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Johansen IAS and Discrimination
• The rhythmic components of a Johansen IAS programme help these
children’s composure and readiness to listen
• In addition, individual recordings can be customised by raising or
lowering the intensity of stimulation at each frequency
• This is done to match the pattern of hyper- and hypo- sensitivity
identified in a listening audiogram
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A Listening Audiogram
dB (Decibels) – Measure of Pressure
When threshold responses are lower than 20dB, despite good
attention, referral to a member of an Audiology Team is recommended
125
250
Hz (Hertz) – Measure of Frequency
500 750 1000 1500 2000 3000 4000 6000 8000
125
250
500
-10
- 5
0
5
10
15
20
25
30
35
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750
1000 1500 2000 3000 4000 6000 8000
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Bilateral Integration
• Accurate, fast and fluent understanding of language increasingly
demands mature bilateral integration
• When we listen we identify the detail in speech mainly through the
route from the right ear to the left hemisphere
• We identify the rhythm of sentence structure and the emotional
content of the speech mainly through the route from the left ear to
the right hemisphere
• The two components are combined through the highway of the
Corpus Callosum
• Additional information is quickly added through links to knowledge,
experience and imagination
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Kimura D (1961)
Cerebral dominance and the perception of verbal stimuli
in: Canadian Journal of Psychology 15, 166-171
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Johansen IAS and
Bilateral Integration
• A Johansen IAS programme allows the flexibility to balance the
stimulation between the right ear/ left hemisphere route and the left
ear/ right hemisphere route
• This encourages processing in each route to achieve maximum
efficiency
• Developmentally, this promotes bilateral integration
• Additional musical effects can also promote faster and more
consistent integration
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The Johansen Music
• Seven 10 minute pieces (Waves), divided into 2 sections of 5
minutes each
• Each 10 minute piece is written in a different major key, reflecting a
different mood
• The number indicates the frequency of the lowest C note in that
octave e.g. Waves 3 E512 (512Hz is frequency of lowest C in that
range)
• All individualised programmes use this music, in various
combinations and with hemisphere and frequency specific
modifications
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Johansen IAS Programmes have
been used successfully with:
• Children, including premature babies and infants, with a wide variety
of presenting difficulties
• Groups of children in school needing a simple programme to support
early development
• Children with identified profiles of neurodevelopmental delay,
autistic spectrum difficulties, speech and language difficulties,
dyslexia, dyspraxia and attention deficit disorders
• Adults with developmental and acquired processing difficulties
including acquired brain injury, tinnitus
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Waves 1
C 128
100Hz to 250Hz
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Waves 2
D 256
200Hz to 500Hz
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Waves 3
E 512
400Hz to 1000Hz
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Waves 4
F 1024
800Hz to 2000Hz
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Waves 5
G 2048
1600Hz to 4000Hz
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Waves 6
A 4096
3200Hz to 8000Hz
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Waves 7
B 8192
6400Hz to 16000Hz
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Listening and Discrimination
Difficulties cause Stress
• There are many of you in this audience today for whom neither
English nor German is your first language
• For you listening is harder than for those of us who speak English or
German every day
• You are working harder, you have less mental space to think around
what you are hearing, and you are likely to be especially tired by the
end of the day, however easy it has (hopefully) been easy to follow
my talk
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Listening and Discrimination
Difficulties cause Stress
As the Queen of Denmark once said:
•‘I have to listen to a lot of boring speeches but I have discovered there
is nothing more boring than not listening to a boring speech’
•Thank you for listening
[email protected]
www.camilla-leslie.com www.johansenias.com
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