© clear listening llp 20141 camilla leslie specialist speech and language therapist edinburgh uk...

© Clear Listening LLP 2014 1

Camilla LeslieSpecialist Speech and Language Therapist

Edinburgh UK

Difficulties with listening, discrimination and rhythm

contribute to stress: The role of auditory stimulation

programmes in remediation

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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?



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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• 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

The Development of Hearing and Auditory Processing

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© Clear Listening LLP 2014

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


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


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


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


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


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


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


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


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


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


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


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


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



125 250 500 750 1000 1500 2000 3000 4000 6000 8000

Hz (Hertz) – Measure of Frequency

dB

(D

ecib

els)

– M

easu

re o

f P

ress

ure

125 250 500 750 1000 1500 2000 3000 4000 6000 8000

A Listening AudiogramWhen threshold responses are lower than 20dB, despite good

attention, referral to a member of an Audiology Team is recommended

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- 5

0

5

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15

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25

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35

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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



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


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


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


Waves 1

100Hz to 250HzC 128


Waves 2

200Hz to 500HzD 256


Waves 3

400Hz to 1000HzE 512


Waves 4

800Hz to 2000HzF 1024


Waves 5

1600Hz to 4000HzG 2048


Waves 6

3200Hz to 8000HzA 4096


Waves 7

6400Hz to 16000HzB 8192


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


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


mailto:[email protected]

http://www.camilla-leslie.com/

http://www.johansenias.com/

© clear listening llp 20141 camilla leslie specialist speech and language therapist edinburgh uk...

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