Life is Bliss - Lily's Cochlear Implant Journey

Local lecture by Dr Charles Limb - Building the Musical Muscle

Great local lecture called "Building the Musical Muscle" by Dr Charles Limb who is a CI surgeon from John Hopkins School of Medicine and a music professor in the Peabody Conservatory of Music.  His goal is to use music to help recreate perfect hearing. 

Go to http://client.stretchinternet.com/client/nwuadmin.portal# and search "Limb." Then press "Watch."

Music perception - What can Lily hear?

I had a wonderful discussion with one of our blog readers about how Lily might hear the different notes on the piano.  I'm appreciative of her expert explanation and feedback.  
 
Lily, depending on where you play the notes on the keyboard, may be able to tell the difference of 1-4 semitones. In some areas, she’ll be able to tell you that C-C# sound different (when not looking) but may not always be able to tell you which direction they are going. In other areas of the keyboard, she may have to have C-E or larger to tell a difference. In addition, most implants are programmed for speech at around 250Hz, which is the F# below middle C. This usually knocks out the rest of the notes below there, but not always. Her larger challenge would be telling major from minor chords (and honestly, as a trained musician, it can be challenging).
 
Regarding music you have ‘The Good, The Bad and the Ugly.’  The good is rhythm, the bad is timbre and the ugly is pitch. Mainly that is  because rhythm is a significant part of speech and helps us so it’s conveyed very well. Timbre, the ability to detect different tone qualities is harder, but can be learned.   It is hard because of its complex spectral quality. Think about how similar a clarinet and saxophone sound, for instance, now add in the complexity of a cochlear implant’s processing strategy.  Finally,pitch is the hardest, simply because you and I have 30,000 hair cells (each of which responds to one frequency) and Lily now has 18 electrodes to represent those same 30,000 hairs cells. That’s not to say she won’t be amazing (she clearly already is), but that she may have a “sweet spot” for certain types of music perception and production (ie., singing on key in a specific range).

Then Lily's fabulous music teacher, who shows so much interest in this topic (thank you), told us the following:

Semitone is another word for a half step, which would be the difference between one note next to another one on the piano, like B-C, E-F, or B flat-B. Lily was able to sing descending Major triads starting on Eb (E flat) and ending on G below middle C (which is pretty low for a kindergartner) So she sang descending triads in the Major keys of Eb, D, Db, C, B, Bb, A, Ab, and G. I'm convinced she can hear the difference between 1 semitone.

Amazing!

TEDMed Talk by CI Surgeon - CIs and Music

Very interesting TEDMed talk (16 mins) by cochlear implant (CI) surgeon and musician Charles Limb, associate professor, Otolaryngology, Head & Neck Surgery, at Johns Hopkins.  He explains the challenges of CI patients hearing music and the brain research that is being done to help restore the full range of human hearing abilities.  The talk even shows a video of a cat with a CI responding to a trumpet. 

Lily loves music and has recently figured out the phrase "That song is stuck in my head."  Her newest trick is dancing around the house singing "I got the mooooooooooooves like Jager" over and over again.  More focus and attention on music therapy would be an incredible addition to the speech therapy that now helps kids with CIs learn langauge. 

 

Music changes our brains

Excellent article on how music changes our brains.   We've long been a believer in incorporating "music therapy" in all forms in Lily's auditory rehab, as there is growing evidence in its impact for listening and language.    

I'm often reminded of the person who told me "there was no proof, I was wrong in believing this, and that they wouldn't even consider this as a part of LIly's therapy."   Glad we didn't listen to this advice.  

Music - Resources and Innovation

One of the most frequent inquiries we get to this blog are those from Music Therapists in all corners of the world.  Most of the emails ask for resource ideas to work with kids with Cochlear Implants.  I think this is a growing indication of the language and listening value and benefit that kids can receive from good music therapy.

One of the best music therapy resource is Christine Barton - Check out her 2010 publcation of Music, Spoken Language, and Children with Hearing Loss: Using Music to Develop Spoken Language, as well as all her other publications.  Also Advanced Bionic's Listening Room is an excellent resource for interactive and uniquely designed practice activities for hearing rehabilitation. 

Also check out this interesting story about a music performance designed specifically for Cochlear Implant users.  

 

Music Therapy Research - CI Rehab for Toddlers

We receive emails and comments from people all over the world on our blog.  The most common topic people have thoughts or questions about is Music Therapy. 

A few weeks ago we received a note from Felicia, a music therapist from Australia, who is interested in working with children who are deaf and hard of hearing.

She found this great article supporting our argument for including Music Therapy in rehabilitation. The article discusses that a Music Therapist in Israel, working with children with CIs, found that spontaneous communication was more frequent and prolonged when music was used.  This is a rapidly growing field of study and one which should be immediately implemented in rehabilitation strategies.  

We didn't know what to do with Lily and music.  Our approach was a gradual one.  According to this research, that seems to be the right approach.   Now Lily demands music in the car, in the house and pretty much anytime she can get someone to turn it on.  She's had a music therapist, been to Kindermusik and now she has music in preschool.  She sings, she twirls, she makes up songs, she picks up words and says "don't turn it off yet.  I want to listen to the whole song."  

Music is critically important to language learning. 

CI Theory

I've posted this CI Theory website before but just went back and found some incredible updates about this guy who has a AB CI and has been using it to work on a next generation CI speech and music strategy.   Check out My Biography and Background and Info about Speech Processor and Work.  

Music Therapy for Kids with CIs

A new doctoral study (video) conducted in Israel and led by Professor Tony Wigram, Head of PhD Studies in Music at the University of Aalborg in Denmark, once again highlights the incredible qualities of music....These sounds and others were played by Dr. Dikla Kerem to two and three-year-olds who have an elaborate hearing aid called a "cochlear implant" surgically placed in their ears. Dr. Kerem examined the value of music therapy in the post-surgery rehabilitation process.... One of the things Dr. Kerem discovered is that music therapy significantly enhances the toddlers' spontaneous communicative interactions, compared to play-based communication.

Music Therapy should be incorporated into the standard practice of therapy for kids with CIs. 

Music 'Tones The Brain'

An article in LiveScience quotes a new study published in the journal Nature Reviews Neuroscience suggesting that learning music can have an impact on other brain functions and abilities such as better hearing in noise, better vocabularies and better reading abilities. Click for full article.

Lullaby

Tonight my daughter asked me to sing her to sleep with a lullaby. Nuff said.

Music Benefits

Another study looking at the benefits of music for cochlear implant users. Lily loves her Kinder Music classes.

Lily Sings Her ABC's

Lily made a quick recording on my iPhone of her singing the ABC song. American Idol here we come.

Download Lily Sings ABCs

Online Music Therapy Courses and other CI Experts

Last week, I watched a free online session with Chris Barton, board certified music therapist, hosted by Advanced Bionics. Chris  is an award-winning composer, performer and music therapy guru.  I think I've raved about her before, but this online session reminded me of how well she understands kids with CIs and how music therapy/music training is a must for kids who are learning to listen and talk.

The session I attended was primarily a Q and A, but there are at least seven other free online courses with Chris Barton in Advanced Bionics's Listening Room. 

There are also lots of other sessions in their eLearning Library by some of my favorite CI experts like Dave Sindrey, Mary Koch and Amy Robbins. Specially look at Amy Robbin's intervention Activities for ITSIs (Infants and Toddlers with Cochlear Implants).  Check it out!

Music and the Cochlear Implant

Hearing Health Magazine recently released a variety of articles on Music and the Cochlear Implant. 

In the first article, Ward Drennan, PH.D. writes, "The primary weakness of CIs is their inability to deliver pitch information. There has been a long-standing controversy regarding what acoustic information normally hearing people use to allow them to perceive pitch." 

He continues later in the article, "The CI encodes frequencies according to place. Unfortunately, however, most of the fine timing information that could contribute to pitch is lost. The implant divides incoming acoustic information into 12, 16 or 22 channels, whereas normal hearing gleans information from 30 to 40 channels. Even in the best scenario, place information is already degraded relative to normal hearing. The degenerated condition of the auditory nerves of implant recipients further limits the end result to eight or nine functional channels. Additionally, CI-users lack information that hair cells normally “gather.” Groups of hair cells and their associated nerves, working in tandem, have the ability to capture the detailed pitch timing of each wax and wane of the acoustic wave up to 3,000 to 4,000 hertz. This ability is almost completely lost in the implant-user, who rarely gets such information greater than 300 hertz. Thus, the refined pitch, chords and melodies in music that normally hearing people enjoy often become a garbled, blurred mess when heard via a CI. For the CI-user then, the ability to perceive both place and timing information about pitch is marginalized.  Despite these unfortunate limitations, rhythm perception, an essential element of music, is nearly normal in CI-users. "

He goes on to say, "The brain is the CI-user’s greatest asset. With training and effort, the CI-user can utilize the garbled mess they hear, perhaps finding cues in the implant stimuli, and make the best use of music based on memory. Also, in the vein of Charles Ives, in which any sound might be considered music, the CI-user can learn to find aesthetic value in the “new” sound. Perceiving art, and art in sound, is primarily a state of mind." 

Finally he discusses Cochlear Implant company strategies to improve music listening including those of Advanced Bionics and Cochlear.

Great articles!!!

Pretending and Singing Mr Sun

We're having lots of fun as summer draws to a close.  It was a beautiful weekend to play outside and do all those summer kid activities like bubbles, chalk on the sidewalk and play dough on the porch. 

One funny interaction this evening was when were pretending with the play dough that we were having a picnic.  I told Lily we were pretending to eat.  Then asked, "What am I eating?"  She finally decided I was eating a strawberry.  Then I tried to change it and said, "Now I am eating an enchilada."  Lily said, "No Mommy.  It's not enchilada, it's strawberry.  Pretend strawberry." 

Lily has also been growing her singing ability.  Tonight she told me to "Stop singing Mommy.  Shoe singing."  She was playing with her pink sandal and apparently it wanted to sing.  (We don't stifle creativity here.)   Then she started into "Mr Sun, Sun, Mr Ol' (Golden) Sun, Please shine down me."  Totally amazing.  We cheered. 

Check out this article called Bringing Music to Their Bionic Ears: Nurturing Music Development in Children With Cochlear Implants.  By Christine Barton - A music therapist who we adore!

A few more fun pictures to enjoy.

Music Therapy and Its Link to Listening and Reading

New research on music therapy and its effectiveness at teaching listening skills, especially in noise. 

Incorporating a music therapist for kids in early intervention, for a range of issues, seems like an increasingly good public policy idea. 

"The findings strongly support the potential therapeutic and rehabilitation use of musical training to address auditory processing and communication disorders throughout the life span.....Better perception in noise was linked with better working memory and tone discrimination ability. The results imply that musical training enhances the ability to hear speech in challenging listening environments by strengthening auditory memory and the representation of important acoustic features."

The researchers have also looked at the link between music and reading.

"The Auditory Neuroscience Lab at Northwestern has helped establish the relationship between sound encoding in the brain and linguistic abilities by showing that the very neural sound transcription processes that are deficient in children with dyslexia are enhanced in people with musical experience. Based on this collective work, poor readers may show greater benefits from training programs that include music as well as speech sounds."

AB Hearing Journey for Babies and Toddlers

A new section on Advanced Bionics Hearing Journey website, targeting babies and toddlers, has just been   launched.  This is an excellent site for free activities and resources to support the development of speech, language and listening skills.  The site features works from Dave Sindrey, AVT and Chris Barton, Music Therapist. 

Kindermusik Class

Lily and I have started a Kindermusik class, thanks to a scholarship by G-pa, to both expose her to more music and increase her socialization opportunities with kids her age.   There were 10 or so kids from 18 months to 3 years all singing, dancing and playing instruments.  Every kid looked, behaved and dressed exactly like their Mom.  Too funny.  The class moved right along and Lily didn't miss a beat.  We sang songs that involved lots of movement and language.  "Shake your feet, spin around, march and stop."   When the kids got the bells out of the bag, Lily was right there grabbing with the rest of them.  She even sat on the blanket for story time, at least for a little while.  We always sit close for books, so Lily was soon up on her feet in front of the other kids pointing something out in the book, then she sat on the teacher's lap.  I don't think she is shy at all.  Ahhh those powerful genetics. 

Music Therapy Lesson Plan

We've just had our sixth session of Music Therapy.  Every other week, our MT Nicole comes to our house with her guitar, drums and bag of instruments such as shakers, sticks and tambourines.  I think Lily has gotten a lot out of it.  She loves listening, especially to the drums and the guitar.  Nicole has started putting lesson plans together and I thought I'd share a sample of the latest one.

Interventions:
1)    Hello song
Goals: a) introduce music as daily activity b) functional speech and language

2) Guitar strings: B & X (E, Eflat, D, Dflat, C)
Goal: Pitch Perception

3)    Twinkle & The Wheels on the Bus (or other known action songs)
Goal: Melodic Recognition

4)    Rhythm instruments
Goal:  Sound localization
(Lily turned the right way immediately every time.  The challenge came when the lower notes on the guitar were played OR Lily was tired of the game.)

5)    Rhythm instruments
Goal:  Moving Sound localization

6)  Goodbye song
Goals: a) transition from music time  b) functional speech and language

Music Therapist

We've started having Nicole, a certified music therapist, come to our house and work with Lily every other week.  The first two weeks have been pretty interesting to watch Lily's reactions and engagement with the music and instruments.   

Nicole brings a guitar, lots of drums (my favorite is the buffalo drum), shakers, egg chimes, sticks, and tambourines.   She starts the session by singing the Hello song and then invites Lily to touch and "play" the guitar, along with the other instruments.  There are lots of language opportunities woven in to this play, as well as listening to various pitches and rhythms.  Nicole has a beautiful voice and knows all the words to songs, which I am finding I typically only know the first verse or have made up words  and now believe that is how they are supposed to be sung.  For example, who knew there were five plus verses of You are My Sunshine. 

Nicole is also helping me build the research case for providing Music Therapy as a service LPS offers kids in the Early Intervention program.  I have found 10 plus research studies so far that make the case of the effectiveness of music therapy with kids with hearing loss/CIs.  There is lot of other research about the benefits for kids with other disabilities. 

Check out this excellent  Early Childhood Music Therapy newsletter for more information.   Download earlychild.pdf

 

Music Therapy Researcher at Iowa

As a graduate of University of Iowa, I think I missed my calling in the audiology arena.  Seems that one of the best schools in the country for audiology is U of I and now I find they have a Music Therapist on their Cochlear Implant team. So cool.  I gave tours at Iowa and all I said about the Audiology building was that it was shaped like an ear.  Hmmmm.  I think I undersold it. 

Kate Gfeller is director of Graduate Studies in the Music Therapy Program in the School of Music, and holds a secondary appointment in the Department of Speech Pathology and Audiology. Dr. Gfeller is a member of the Iowa Cochlear Implant Team at the University of Iowa Hospitals and Clinics, Department of Otolaryngology. As Principal Investigator for the Music Perception Project, she investigates musical perception and enjoyment by deafened adults who use a bionic inner ear called the cochlear implant, a project which is funded by the National Institutes of Health. Dr. Gfeller has also been involved in applied research and clinical protocols for aural rehabilitation of children and adults who are deaf or hard of hearing, and her work has been funded by the Office of Special Education and Rehabilitation. Other research investigating music therapy practices for adults with Alzheimer's Disease has been funded by the Federal Administration on Aging.

Music Therapy

Yesterday, I had a meeting with our public school administrators.  While advocating for an Oral preschool and more Oral training for EI staff, I mentioned Music Therapy and how I thought this should be incorporated into speech and language learning for HI kids. 

I was told that there is no proof behind music therapy, but if there was they would think about adding it to the curriculum.   Ohhh i love a challenge.  I made two calls to local music therapists and they said there are stack of research on the validity and success of the therapy and that there are at least two researchers who focus specifically on music therapy and kids with Cochlear Impants (Alice-Ann Darrow and Mary Adamic).  Love it!!  Not only that, but the American Music Therapy Association (301-589-3300) was developed to provide this type of information to people and school districts.  And Omaha has had Music Therapy in their schools for 10 years.   

We also purchased the Tune Ups CD by Christine Barton (Music Therapist) and Amy McConkey Robbins (speech therapist).  It is very well done and has lots of ideas on ideas to foster communication development.  So I'm off to do some Music Therapy research to see what I can find.