Music, music therapy, and children/adolescents with hearing

of the speech signal due to the variety of frequencies and intensities of which music consists. Due to its flexibility, music can be modified according to the person's hearing level as well as to the language level, maturity and music preferences. Only a small percentage of persons with HI do not hear at all (Darrow, 1989).

The topic of music and music therapy for children with HI has been extensively covered in the researcher’s master’s dissertation (Amir, 1982). Therefore, only research and/or anecdotal literature from 1983 onward to 2004 will be presented in this section according to the following sub-topics, i.e., auditory training through music, rhythm, pitch, vocal and speech production, etc. However, to avoid redundancy, there will be no elaboration on the importance of each sub-topic for persons with HI.

The subjects' level of hearing loss is not always given in the following studies presented here. However, all these studies focused on children with moderate to profound prelingual hearing losses.

Auditory training through music: Darrow (1985, 1995) states that the goal of auditory training is to teach the complex task of listening, a much more involved task than the physical act of hearing. She indicates that children with HI must learn to interpret sounds and attach meaning to them. In her article from 1989, she refers to the commonalities between the music parameters and speech, which allow music and music therapy to provide an alternative and pleasurable tool to enhance traditional auditory techniques. In an article based on the researcher’s master’s dissertation (Amir & Schuchman, 1985), the effect of auditory training within a musical context on the use of residual hearing as well as on social, emotional and task-oriented behaviors of preschool children with severe to profound HI, was investigated. Two groups of six children in each, aged 3.5-4.5, were matched on variables related to biography, socioeconomic status, hearing impairment, and cognitive functioning. The experimental group received 24 sessions (twice a week, 30 minutes per session) of

19 The literature review on music and cochlear implants was updated until 2004; therefore, any studies that emerged later will be considered in the discussion chapter.

auditory training through music and demonstrated a significant increase in the use of residual hearing on the levels of discrimination and recognition as well as more effective use of their intellectual potential, compared with the control group.

Regarding the social, emotional and task-oriented behavior, a marked difference on the assessment of the children's pictorial creation was detected in favor of the experimental group. The study implies that auditory training though music, conducted in groups, is effective and may serve as a useful adjunct to other techniques for maximizing the use of residual hearing, and thus, provides experimental support for what is already known about the value of music for children with HI.

Rhythm: Darrow (1985) cites David Ely Bartlett, a pioneer and an advocate of music education for persons with HI, who, in 1848 wrote the following statement, which holds true today as well:

In estimating the pleasure that is derived from music, it must not be forgotten that the sensation or perception of sound is not the whole of the pleasure produced by music. A considerable part of this pleasure results from the underlying rhythmic character of the movement which can be perceived by the sense of sight alone to a considerable extent, and yet more perfectly by sight and feeling together... (unknown page number).

Darrow (1984) compared the rhythmic responsiveness of 62 public school students with NH and with HI (from severe to profound hearing loss), ages 9-16, with a mean age of 12. The students with HI performed as well or better than those with NH regarding beat identification, tempo change, accent as a factor in meter discrimination, and rhythm pattern maintenance (i.e., maintain a given rhythm as in an ostinato). However, there was a significant difference between the two groups with regards to melodic rhythm duplication and rhythm pattern duplication. Age and gender did not yield significant differences. In addition, the degree of hearing loss was not related to the performance level on the tests, with the exception of the students with profound hearing loss. Darrow also investigated the relationship of rhythmic responsiveness to the suprasegmental (i.e., nonlinguistic) aspects of speech perception that involve rhythm discrimination in students with HI. Results revealed significant correlations between the rhythmic responsiveness subtests that measured beat identification, melodic rhythm duplication and rhythm pattern maintenance

performance with the two suprasegmental speech perception tests. This study supports the position that hearing impairment does not vitiate innate rhythm responsiveness.

In another study of Darrow and Goll (1989), 29 students, from severe to profound hearing loss, identified rhythmic change by using (a) auditory skills only, and (b) auditory skills supported by vibrotactile stimuli. The latter condition yielded better performance. The authors therefore recommend using vibrotactile stimuli in teaching rhythmic concepts to children with HI.

Another study which examined the feasibility of using a commercially-available computer program ("Toney listens to music") in testing differences in the discrimination skills of children with HI and children with NH on listening tasks involving changes in tempo, rhythm patterns, intervals and simple melodies (Coffman, Gfeller, Darrow, & Coffman, 1992). Significant differences between the two groups were found only in the pitch perception tasks- interval and melody discrimination. Though the appropriateness of the computer program as an assessment tool was not definitive, this study does indicate the value of exposure and access to music experiences for these children.

Darrow (1995) indicates that in the studies where subjects with HI were asked to reproduce a given rhythm or beat, their performance was dependent on their perception of the stimuli. Thus, in an attempt to control this variable, Darrow and Bolton (as cited in Darrow, 1995) tested the ability of mainstreamed children with HI to read and perform selected rhythms. No significant differences were found between the rhythmic performances of children with HI when compared with children with NH.

Pitch: Ford (1988) investigated (a) the effect of musical experience and age on the ability of 39 children with HI, from two age groups (ages 6 to 9 and 11 to 12) to discriminate pitch, and (b) the relationship between pitch discrimination and hearing levels, academic achievement levels in reading and mathematics, and gender. No differences were found for pitch discrimination due to age or music training, but at 250 Hz the subjects performed more accurately than in 500 Hz. Ford recommends listening activities for these children that are in an optimal pitch range (which is approximately around 'B' below middle 'C' to an interval of a twelfth above middle

'C') as well as starting with gross pitch discrimination, and gradually introducing smaller intervals.

Darrow (1992) examined whether pitch changes in patterns of different intervals of vibrotactile stimuli (via Somatron, a manufactured vibratory platform mattress) could be identified by 17 children with HI (severe to profound hearing loss). Results revealed that more pitch changes were identified under the use of auditory skills supported by the vibrotactile stimuli than under the use of auditory skills only. Thus, the tactile sense is a valuable channel through which these children can process selected tonal stimuli in addition to the use of their auditory skills.

Two case studies are described by Darrow and Cohen (1991) that examined the effect of programmed pitch practice on pitch matching skills of two girls with HI. The programmed pitch practice was done via the Pitch Master- (an electronic device which measures a single and/or a melodic vocal response against a pre-recorded reference) For the 12- year-old girl who had a severe hearing loss, results revealed a significant improvement (p < .05) in her ability to match a given pitch between the pre- and the posttest evaluation. Daily recorded data showed similar vocal performance accuracy scores across all sessions. There was improvement in vocal accuracy also for the second subject, 11-year-old girl with a profound hearing loss.

Suggestions for procedures which can be utilized with other children with HI are given for improving vocal quality and increasing vocal repertoire.

See also the study by Coffman, Gfeller, Darrow, & Coffman, 1992, in the previous sub-section on rhythm.

Timbre: Darrow (1991) carried out two studies to find preferences for timbre and musical instruments of children with HI (severe to profound). In the first study, videotapes of the children's playing behaviors were analyzed for instrument preferences by three measures: the order in which the instruments were chosen, the amount of time spent playing each instrument, and a report of preference given to the experimenter in sign language. Signed responses of 34 children (grades 1 through 4), showed that the violin and trombone were the most preferred instruments. It seemed as if novelty and aural feedback were two factors related to the children's interest in specific instrument. The agreement among the three measures was not significant.

Twenty one children (grades 2 through 4) participated in the second study. No strong preference or dislike was found for a specific timbre among the younger children.

Although preferences were more apparent in older children, Darrow indicates that these preferences may have a cultural bias. She recommends assessing individual preference for timbre, synthesized sounds or actual instruments and using it in auditory training exercises as well as in music therapy.

Vocal and speech production: Since speech prosody (rhythm, intonation, rate and stress) conveys important contextual information, Darrow and Starmer (1986) investigated the effect of vocal training on the fundamental frequency, frequency range and speech rate on the speech of children with HI (severe to profound) since they tend to have a higher fundamental frequency and vary pitch less, and thus, produce problems in speech intelligibility. Results showed that vocal training (i.e., free vocalizations, vocal imitation, rhythmic vocalizations, and vocal phrasing and dynamics) and singing songs in lower keys may help modify the fundamental frequency and frequency range of the children's speech.

In a preliminary study on the efficacy of musical speech rhythm training, Gfeller (1986) employed such a training program for nine children with HI and analyzed pre and post speech samples on intelligibility, speech rate, prosodic features and number of utterances per second. Five out of nine children improved their intelligibility and speech rate, six improved prosodic features and seven had increased number of utterances. Two children declined in most speech intelligibility factors, a finding which indicated that this approach is not appropriate in all cases and further research is needed.

Staum (1987) used a 40 days treatment program (daily sessions) of visual notation system in an attempt to improve speech prosody of 35 children with HI (ages 3-12), by practicing words of with progressive complexity with the appropriate rhythmic and inflectional structure. Speech prosody improved significantly as well as significant generalization and transfer of learning. The youngsters capable of reading made the greatest gains in transferring their skill to novel verbal material.

Darrow (1990) examined whether frequency adjustments of auditory stimuli to accommodate the individual audiological curves of children with HI (moderate to severe hearing losses) can assist them with pitch discrimination tasks and consequently, with their vocal production. The data provided an adequate useful start according to the author, but she concludes that these data should be viewed with

caution and that further development of special techniques is needed to assist this population.

Regarding singing of children with HI (sever to profound hearing loss), Darrow (as cited in Darrow, 1995)) found that the mean range of their singing is significantly smaller and the midpoint is significantly lower. She indicates that this is in contrast with the fact that common tonal characteristics of deaf speech generally include higher fundamental frequency than in normal speech and frequently no variations in pitch.

Bang (1998) has done a research project on the use of tone bars for improving the voice of children with profound hearing loss, aged 5-15. Bang indicates that these tone bars have a frequency range of 64 to 380 Hz, where the greatest part of the deaf has some residual hearing, a fact that enable activating and utilizing the residual hearing through work with these bars. Analysis of the effect of musical speech therapy with the bars on the qualities of the subjects' voices and vocal function included parameters such as tone, intensity, frequencies, intonation, reduction of nasality, etc. The analyzed material served as a basis for developing two mathematical models in order to qualitatively evaluate the vocal improvement of the responding and the spontaneous voices before and after the training with the tone bars. The analyses as well as the models are not presented in this article.

Dynamics: No research was found by the researcher concerning the area of dynamics and children with HI during the years covered in this section (1983-2004).

Language development: Campbell (2000) stated that “the systems the brain uses to process music are either identical to or fundamentally entwined with the systems used in perception, memory, and language” (p. 22). Gfeller and Darrow (1987) suggest that singing or signing self-composed songs allows persons with HI to express or illustrate thoughts and feelings that may be too difficult to produce in written form. They write: "The use of songwriting and song-signing not only provides variety of method and reinforcement of other language training, it emphasizes emotional and social components as well as syntactic elements- both important for effective and meaningful communication" (p. 234). Gray-Thompson (1988) examined whether visual aids such as picture song books can be used as a tool to teach sight vocabulary to children with HI who used American Sign Language as their primary

mode of communication. Thirty words from songs were selected by classroom teachers as appropriate to the vocabulary needs of their students and pictures depicted these "key words". Sight vocabulary was divided into word recognition and concept recognition. Following six weeks of intervention, all three groups scored significantly higher on the post-test for word recognition and concept recognition. The author concluded that picture song books are an effective tool for teaching selected components of sight vocabulary.

Gfeller and Baumann (1988) describe assessment procedures appropriate for language development goals in music therapy with clients with HI. The authors review language problems of children with severe hearing loss as well as major treatment goals and approaches in speech pathology and music therapy.

The effects of music therapy on the wholesome development of children with HI: Van Deventer (as cited by Darrow and Gfeller, 1996) employed a 12 session music therapy program to examine its effect on the self-concept of a group of children with HI (grade one). The program focused on rhythm and body image. The statistical results confirmed the therapists and teachers' observations of improvement in self-concept of these children. Staum (1987) refers to the positive results in speech prosody (see previous sub-section on speech), generalization and music learning, and claims that all these areas enhance the self-esteem of children with HI.

General implications for music educators: Darrow and Gfeller (1991) examined the status of public school music instruction for students with HI as well as factors contributing to their successful mainstreaming in the regular music classroom. Results from questionnaires revealed that more than half of all these students attend music classes. Lack of suitable curricula in music for such students was found as well as appropriate methodologies, materials, and activities that were identified as helpful in integrating these students into the regular music classroom (see also Ford & Shroyer, 1987; Gfeller, Darrow, & Hedden, 1990; Shroyer & Ford, 1986; Spitzer, 1984). Some of the findings in a study by Darrow (1993) on the role of music in the deaf culture, showed that the students with HI are involved in music, enjoy most singing/signing songs, listening to music, and moving/dancing to music. Darrow (1985) recommends music experiences even for children with severe HI, since they can receive sensory satisfaction and valuable auditory training from these experiences.

Birkenshaw-Fleming (1993) refers to four main ways that persons with HI can use music: for relaxation, developing listening skills, encouraging language acquisition, and when combined with movement- it can foster good posture and a graceful way of walking and moving.

Implications for music therapy: Darrow (1995) indicates that although the areas of music perception and performance of persons with HI have been more investigated than the area of music therapy, some of the findings are relevant to music therapists who work with these clients, such as:

• Participation in music activities may result in musical as well as non-musical benefits, e.g., speech production, listening, language and academic skills.

• Rhythmic aspects of music increase responsiveness of persons with HI more than the tonal ones.

• To meet therapeutic goals, greater exposure to musical stimuli, both in duration and intensity, is required than in the case of persons with NH.

• Aural feedback is provided more usefully by sustaining instruments than by percussive ones.

• Use of moderate tempi may assist in greater rhythm performance accuracy.

• Verbal rhythmic and intonational accuracy may be increased by reading standard music notation than by relying on the ear to imitate or learn by rote.

• Vocal intonation in singing and speaking can be improved by participating in vocal activities; however, the vocal range of song literature should be taken into consideration with singers with HI.

• Vibrotactile stimuli may serve as a supplemental tool in music instruction of persons with HI.

• Persons with HI are capable of improvements in ear training and may develop a more sensitive ear over time as do persons with NH.

• Persons with HI demonstrate certain musical preferences regarding sound source, intensity, and listening conditions.

• When instructing persons with HI, particular attention should be given to amplification and sound quality.

For further background information on the above topic and for more material, the

reader may refer to Darrow, 1989, 1995; Darrow & Gfeller, 1996, and annotated bibliography in-

http://people.uwec.edu/rasarla/research/litandgoals/Hearing/mutx.hearingimpaired.htm No additional research was found by the researcher during the years 1999-2004 on this topic. It seems as if research moved towards investigating the topic of music and cochlear implants.