About Therapeutic Listening
Therapeutic Listening is a sound therapy home program designed by occupational therapist, Sheila Frick.
- Assists in building core sensory processing systems through targeting the vestibulo-cochlear nerve
- Modulated music for home use, not available over the counter
- Trained and certified providers essential to provide effective outcome
- High intensity and high frequency work completed on a daily basis at home
- Continue seeing therapist once weekly at center while participating in the program
- Frequently recommended for our out of state clients
What is Therapeutic Listening?
Therapeutic Listening was developed by Occupational Therapists Sheila Frick, OTR/L and Colleen Hacker, OTR/L and uses sound training in combination with sensory integrative techniques, which emphasize vestibular stimulation and postural movement strategies and allow therapists to approach the auditory and vestibular system directly. Sound training uses electronically altered music that has been designed to produce specific effects on listening skills when the child follows a prescribed program. Listening skill difficulties are the inability to accurately perceive, process and respond to sounds and are often found to be an integral part of other perceptual, motor, attention and learning difficulties affecting a large number of our children. Therefore, listening becomes a function of our whole body, not just our ear. Hearing, a function of the ear is passive and does not involve the direction of attention to sound. Sound is received by the ear and passed along like a microphone. Listening is active and requires the desire to communicate and the ability to focus the ear on certain sounds selected for discrimination and interpretation.
History of Therapeutic Listening
Therapeutic Listening integrates a number of electronically altered compact disc, based on the ideas and technology created by Alfred Tomatis, Guy Berard and Ingo Steinback, within a sensory integrative frame of reference. Tomatis developed his theory in regard to the development of hearing in utero and the impact of an auditory stimulus on all aspects of development including movement processing. He recognized the sensory integrative value of an auditory stimulus.
Dr. Guy Berard trained and worked with Dr. Tomatis. Berard developed his own device and protocol to reduce the time required to produce results. He emphasized the auditory stimulus impact on behavior and language
Ingo Steinback was influenced by Dr. Tomatis. He developed Samonas sound therapy which is based on the principles of music therapy in accordance with development aspects and natural laws of physics related to sound. He emphasizes the global impact of specific auditory stimulus on physical, emotional, and energetic development.
Who can benefit from Therapeutic Listening?
- Has difficulty understanding speech in noisy situations
- Has trouble hearing in groups
- Has trouble listening
- Becomes anxious or stressed when required to listen
- Is easily distracted
- Has difficulty following directions
- Seems to hear, but not understand what people say
- Has trouble remembering what people say
- Has poor speech or language skills
- Has poor reading or phonics skills
- Has poor spelling skills
- Discrepancy between verbal and performance scores and IQ tests
- Has impulsive behavior
- Is disorganized
- Has poor peer relations
- Has poor self-esteem
How Therapeutic Listening Works
The sound stimulation used in Therapeutic Listening appears to set up the nervous system, preparing ground for emergent skills. The music causes the muscles in the middle ear to contract, helping to discriminate and modulate sound input. In addition, there are tiny bones in the middle ear that vibrate when sound is provided, stimulating the movement (vestibular) and hearing (auditory) sensory receptors in the inner ear. This sensory information is sent throughout the central nervous system causing a multitude of reactions. There are four nerves, which are impacted by sound therapy and travel from the inner ear to the brain and back to other parts of our body. For example, when providing sound therapy you may stimulate the facial nerve. The facial nerve innervates the muscle in the middle ear as well as the muscle of facial expression. Along with this nerve also travels the glossopharyngeal nerve, which controls the motor components of one’s voice. Therefore, the muscles of the ear, which are designed to extract the human voice from a noisy background (listening) are linked with the muscles of facial expression and voice production. When you are talking with someone you rely on the non-verbal facial expressions of the person who is listening to you. So, again these same muscles are necessary for producing clear articulation and for hearing accurately and efficiently. So, through the use of sound therapy, such as Therapeutic Listening, you are stimulating the muscles of the ear as well as the muscles of the mouth, because the nerves that innervate these muscles are the same nerves.
Description of equipment used:
Therapeutic Listening consists of a series of CD’s prescribed specifically for each child over specifically designed headphones and work on a variety of skills. Listening time consists of 2 times a day, each for 30 minutes, with a minimum of 3 hours between listening times. The CD’s are electronically altered or passed through a high-low filter. This means that the frequencies at which the sounds are heard vary. Some CD’s jump from very high frequencies to very low frequencies and back and other CD’s do the same, but the variance is much less and therefore not as intensive for the listener. Here are some examples of CD’s and the skills that are being worked on:
- EASE 1 and 2: hypersensitivity to sound, movement and/or touch or defensive responses to sensory input in general
- Mozart for Modulation: supports organized body movement, attention within the environment, active engagement, language
- Kidz Jamz (Grape): helps with postural organization, sensory modulation and attention difficulties
- Vivaldi for Modulation: supports focus and concentration, supports suck-swallow-breath, heart rate and respiration, improves processing of auditory input in complex auditory environments.
Functional Outcomes of Therapeutic Listening
- Decreased tactile hypersensitivity or defensiveness
- Decreased oral hypersensitivity with increased exploration and acceptance of different foods
- Improved relf-regulatory behaviour such as a more regulated sleep cycle, more regulated hunger-thrist cycle, more regulated such-swallow-breathe pattern, more regulated respiratory control and decreased stress
- Improved balance
- Improved coordination of movement within the environment
- Increased postural organization
- Increased motor skills, both gross and fine
- Improved bilateral motor patterns
- “Emergence” of motor planning
- Improved spatial-temporal organization
- Improved handwriting
- Improved visual-motor skills
- Improved timing of motor execution
- Increased and more elaborate social interactions, with better “timing”
- Discrimination of the dimensionality and directionality of spatial concepts
- Improved components of communication such as greater range of non-verbal communication, improved/clearer articulation, greater emotional and verbal expression and improvements in pragmatic language
>Parts adapted from “Listening with the Whole Body by Sheila M. Frick, OTR/L, and Colleen Hacker, MS. OTR/L.
Hall, L., & Case-Smith, J. (2007). The effect of sound-based intervention on children with sensory processing disorders and visual-motor delays. American Journal of Occupational Therapy, 61, 209–215.
The purpose of this study was to examine the effectiveness of a sensory diet and Therapeutic Listening on a group of children with sensory processing disorder and visual-motor delays. Study participants included a convenience sample of 10 children; ages ranging from 5 years, 8 months to 10 years, 11 months. In the first phase, participants took part in a 4-week sensory diet, followed by an 8-week sensory diet and Therapeutic Listening phase. Each participant was assessed on sensory responsiveness using the Sensory Profile both before, and after, both intervention phases. Participants were assessed on visual-motor performance using the “Draw-A-Person” test, the Developmental Test of Visual-Motor Integration (VMI), and Evaluation Tool of Children’s Handwriting (ETCH) before and after each intervention phase. During the 4-week sensory diet phase, each participant was provided with specific activities to be completed at home with their parents. The activities selected by the occupational therapist were based upon the initial Sensory Profile and the individual needs of the child. In the second 8-week phase, the families again met with the therapist and a Therapeutic Listening protocol was developed to meet the needs of the child.
Participants’ scores on the Sensory Profile indicate a remarkable improvement in sensory processing following the 12-week intervention (scores increased an average of 71 points from pre- to post-test). Following the Therapeutic Listening intervention, participants demonstrated mixed results on the improvement of temporal-spatial skills. Participants demonstrated a significant improvement in scores on the VMI visual subtest and writing lowercase letters (ETCH). Handwriting total legibility improved significantly from initial pre-test to post-test. Parent interviews at the end of the second intervention phase also indicated an improvement in participants’ behavior. Parents reported they observed improvements in their child’s attention, enhanced interaction with peers, improved transitions, greater self-awareness, decreased nightmares, enhanced listening, improved communication, greater regularity following directions, and improved sleep patterns. Overall, the results of this study provide promising support for the use of Therapeutic Listening as an intervention tool to support occupational therapy with sensory integrative treatment approach.
Bazyk, S., Cimino, J., Hayers, K., Goodman, G., & Farrell, P. (2010). The use of Therapeutic Listening with preschoolers with developmental disabilities: a look at the outcomes. Journal of Occupational Therapy, Schools, & Early Intervention, 3(2), 124-138.
The purpose of the study was to further expand the current evidence on Therapeutic Listening by examining the results of listening with a group of preschool children with developmental disabilities. The participants included a group of 15 children, ranging from 3 to 6 years of age, who attended one of four similar preschool classrooms. Each displayed difficulties with sensory processing as demonstrated by their scores on the Sensory Profile. All received occupational therapy services, primarily related to enhancing school performance. Participants engaged in a Therapeutic Listening protocol, which was developed and monitored by an occupational therapist. Assessments were administered pre-intervention at the beginning of the school year (October) and post-intervention at the end (April and May) in the following areas: fine-motor, visual-motor, language, social skills, nonverbal intelligence, and sensory processing. The pretest and posttest assessments included the Peabody Developmental Motor Scales-Second Edition (PMDS-2); Developmental Test of Visual-Motor Integration (VMI); Preschool Language Scale-3 (PLS-3); Draw-A-Person (DAP); Social Skills Rating System (SSRS); and the Sensory Profile. The length of intervention ranged from 6 weeks to 5 months depending on the child’s individual needs. Participants engaged in Therapeutic Listening one to two times a day, for 5 days a week, for duration of 20 to 30 minutes.
The results of this study indicate that participants made statistically significant changes in visual-motor, fine-motor, language, non-verbal, and social skills from pretest to posttest. The mean of each pretest assessment significantly increased at posttest, with the exception of the SSRS problem behavior standard score and the PLS-3 language standard score. Participants did not demonstrate any significant changes on any of the subtests of the Sensory Profile. In addition to improvements in standardized assessments, both teachers and parents noted encouraging changes in their children’s behavior. Parents reported transformations in their children’s execution of activities of daily living. Teachers stated positive improvements in group activity participation, overall attention and processing, increased number of verbalizations, more positive social interactions, and greater ability to attend to and complete directions. The results of this study indicate that for a group of preschool students, Therapeutic Listening in conjunction with traditional occupational therapy services resulted in a statistically significant improvement in a number of critical performance areas (fine-motor, visual-motor, language, non-verbal, and social).
Cipriani, N. (2010). Using evidence-based practice and pilot programming to explore emergent treatment strategies. Unpublished pilot study.
The purpose of this pilot study was to explore the use of Therapeutic Listening in a group of eight elementary-age students. The study participants all had varying degrees of impairment with motor, visual, ocular, and sensory processing skills. Study participants’ caregivers and teachers completed the Sensory Processing Measure (SPM) and the Conners 3 Short Form. Additionally, the Developmental Test of Visual Perception- 2nd edition (DTVP-2) was administered in December and June.
Study participants demonstrated improvements in both behaviors in the classroom and at home. Within two weeks of initiating the Therapeutic Listening protocol, four of the most emotionally labile students were spending more time in the classroom, as compared to previous time spent saddened in the hallway. Teachers noted that participants were more engaged in classroom activities. One parent reported that their child was now sleeping through the night and open to trying new foods. Other parents reported that their children were more regulated, less frustrated, and less anxious. All parents reported an increase in attention and emotional flexibility. All but one teacher, who responded neutral, reported that were likely or very likely to use this program again. The participants’ parents responded positively to the implementation of Therapeutic Listening, and some even requested a continuation of this program for their child. Overall the results of this study support the use of Therapeutic Listening with elementary school students and the use of this tool within a school setting.
Frick, S.., Young, S., Huecker, G. (2007). Therapeutic Listening: listening with the whole body. S.I. Focus Magazine, Autumn, 6-7, 14-18.
This article presents a case study on a 4 ½ year old girl, who had recently been adopted from Russia. Upon referral to occupational therapy, parental primary concerns included poor safety awareness and lack of impulse control. Sara also demonstrated increased activity level, difficulty regulating sleep patterns, postural insecurity, and difficulty with interpersonal interactions. She exhibited adverse responses to light touch, noise, bright lights, and environmental smells. Sara became easily frustrated and had difficulty coping with transitions. In the clinic, Sara presented with poor trunk strength and quickly fatigued while sitting or standing. To compensate for poor trunk strength, Sara would quickly move through all gross-motor activities.
Sara participated in bi-weekly occupational therapy for duration of 60 minutes, for a total of 15 direct treatment sessions over seven months. Sara participated in a Therapeutic Listening program and a sensory diet home program including the TheraPressure Program, How Does your Engine Run?, and postural and muscle coordination activities.
Sara presented with significant behavioral changes within the first few weeks of Therapeutic Listening. She began to tolerate and seek out touch (i.e. hugging her grandmother), and started to notice sounds for the first time (i.e. birds chirping). In the final weeks of Therapeutic Listening, Sara’s teachers reported improvements in overall attention and visual-spatial skills. Parental report indicated that Sara more frequently engaged in a quiet alert state, demonstrated improved eating, and is now able to fall asleep independently. Sara also displayed significant improvements in four subscales on the Sensory Profile. This case study supports the use of Therapeutic Listening with individuals with modulation and self-regulation difficulties in conjunction with other sensory integrative techniques.
Frick, S., Young, Sally. (2009). Listening with the Whole Body: clinical concepts and treatment guidelines for therapeutic listening. Vital Links; Madison, WI.
This book includes a compilation of case studies of individuals who participated in the Therapeutic Listening program. Case study subjects range in age from 10 months to 59 years of age, with a variety of diagnoses, and levels of sensory dysfunction. Individual case studies provide specific detail that pertains to each individual’s detailed occupational therapy program and progression through Therapeutic Listening. While participating in Therapeutic Listening, many individuals also received ongoing occupational therapy services based on a sensory integration treatment perspective and recommendations for home program activities.
Participants in the Therapeutic Listening program demonstrated a range of positive results and improvements in everyday activities. Individuals displayed improvements in overall self-regulation, ability to fall asleep and stay asleep, enhanced ability to engage in social interactions, improvements in ability to perceive and explore space, and increased ability to engage in movement. Younger participants demonstrated improvements in communication, ability to tolerate transitions, enhanced safety awareness, ability to function in noisy environments, and advanced fine- and gross-motor skills. Improvements related to Therapeutic Listening were observed at home as well as in school environments. Participants demonstrated improved academic performance, enhanced attention, and ability to focus on homework. The results of these case studies substantiate the use of Therapeutic Listening, used within a sensory integrative treatment context, with a broad range of individuals, ages, and sensory integration dysfunction.
Over, K. (2011). Effect of Therapeutic Listening on the occupation of play. Unpublished case report.
The purpose of this case report is to describe the impact of Therapeutic Listening on the play skills of a four and half year old boy (“Andrew”) diagnosed with autism. Prior to implementation of Therapeutic Listening intervention, Andrew previously participated in two years of traditional occupational therapy with a sensory integrative treatment approach. However, both Andrew’s parents and occupational therapist felt as though he had not made any progress in his play skills and still did not tolerate change well. Subsequently, his therapist suggested augmenting his current occupational therapy treatment plan with Therapeutic Listening.
Andrew’s play skills were evaluated, using the Revised Knox Preschool Play Scale, prior to and following a 10-week long Therapeutic Listening intervention. Andrew’s play was videotaped over a one-week baseline period at a familiar clinic setting and at a novel playground setting. Following the intervention, play was again videotaped at the clinic and at another novel playground. Videotapes were reviewed by Andrew’s occupational therapist and another occupational therapist blind to the study.
Andrew listened to five albums during his 10-week Therapeutic Listening intervention period: Rhythm and Rhyme, EASe 1, EASe 2, Mozart for Modulaton, and Kidz Jamz: Strawberry- Modified. All albums were selected based upon anecdotal evidence that supports their use for self-regulation.
Following the 10-week intervention, Andrew demonstrated 32 additional play skills according to the Revised Knox Preschool Play Scale. Andrew displayed progress with visual-motor skills, increased attention, awareness and exploration of his environment, began sleeping through the night, and overall improvements in self-regulation and behavior. The results of this case report substantiate the use of Therapeutic Listening, used in conjunction with sensory integration, for young children with autism.
Our son Andrew is diagnosed with mild autism. He also has sensory and motor planning issues. My husband and I decided to try therapeutic listening with Andrew in May, 2004. Andrew was almost 4 years old at the time. Within two weeks we noticed an increase in his verbal communication. Prior to the therapeutic listening, Andrew had trouble using his words to communicate his needs so he would either yell and scream or withdraw. Andrew's vocabulary and articulation was good, but he only used words to label things. He could not put words into phrases and had trouble "finding" the words he wanted to use to express himself. He also had difficulty attending to tasks, following simple directions and was very distracted by even the faintest sounds and noises.
Andrew has been doing therapeutic listening for 6 months now and friends and relatives who do not see him often remark on what progress he has made with his language. He is also able to attend to tasks for much longer periods of time, he is using phrases to express his needs and is much more focused then he used to be. He has become interested in playing with toys in a functional way and he is beginning to be more social with other children. We truly believe that the therapeutic listening, along with the sensory integration and his classroom placement have made a huge difference for him. In February 2004 our developmental pediatrician expressed concern to us because she did not feel that Andrew was making progress at a fast enough rate and today he is like a completely different child. We visited her in September 2004 and her outlook for Andrew is very positive. We tell everyone about our positive experience with therapeutic listening. We know that every child will react differently, but it is definitely worth a try!
A Total Approach Comments
Andrew came to our practice in April 2004 with significant difficulty with sensory integration, sensory modulation, praxis, postural control, bilateral integration, fine motor skills, expressive and receptive language skills, etc. He attends therapy for 1 hour per week. He was highly sensitive to sound and demonstrated a 10 second processing delay. He did not have any interest in playing with toys, had limited social skills, and often wandered the room aimlessly. His praxis skills were significantly impacted including ideation, motor planning, motor sequencing, and feedback loop. Andrew often withdrew when challenged and would just look at you when speaking to him, as he did not understand most of what was said to him.
Andrew started his therapeutic listening program a few weeks after he started at A Total Approach and continued for six straight months. Improvements in his receptive and expressive language skills were noted in the first two weeks and continued to improve throughout the six months he was on the program. His processing time has diminished greatly and Andrew can open and close circles more readily using 4 and 5 word sentences. Although his play skills are somewhat limited his interest in playing with a variety of toys have significantly improved, as well as, his ability to attempt to play with the toys more appropriately. Other improvements are noted in social, attention, sensory regulation, sensory integration, praxis, engagement, and overall interaction. It is important to note that Andrew's family were very faithful in following the therapeutic listening program and incorporating a sensory diet as prescribed by the Occupational Therapist. Andrew responded very well to the Therapeutic Listening program and continues to make overall developmental gains.