The Magical Mystery Cure Revisited

“Revisiting The Magical Mystery Cure:”
Does Therapeutic Listening ® make a difference as an
addition to
therapy for children with sensory integration issues?
Melinda L. Richards, Ph.D., Lynne Burgess, M.A.,
Kathy Boling, OTR/L, and Velvet Buehler, M.A.
Presented to the 22nd Annual Convention of
The Tennessee Association of Audiologists & Speech-Language Pathologists
3 October 2014
What is “The Magical
Mystery Cure?
• Auditory Integration Therapy (AIT)
• Background
• What it does
• What it does not do
• Recent incarnations of AIT
• Integrated Listening Systems (iLs)
• Vital Links’ Therapeutic Listening ®
(TL®)
• Other programs
Citing the ASHA Code of Ethics requirement
that holders of the CCC “provide high quality
service by voluntarily meeting rigorous
academic and professional standards, going
beyond the minimum requirements for state
licensure, and actively engaging in ongoing
professional development . . .”
“Therefore . . .
. . . a CCC holder who uses AIT is at
potential risk for being brought before the
(Ethics) Board and, therefore, could be
sanctioned, and, in extreme cases, could
possibly lose their CCCs.”
• The concern for patient safety was heightened by the
Practice Policy issued by ASHA in 1994, and adopted by
the Legislative Council in 2003. ASHA typically does not
take positions on treatment methods/techniques/
programs; however, in the instance of AIT an exception
was made and ASHA came out with a policy paper on AIT
stating that: "after reviewing empirical research in the
area to date, concludes that AIT has not met scientific
standards for efficacy that would justify its practice by
audiologists and speech-language pathologists. However,
well-designed, institutionally approved, research
protocols designed to assess the efficacy of AIT are
encouraged. It is recommended that this position be
reexamined should scientific, controlled studies
supporting AIT’s effectiveness and safety become
available. The AIT policy paper continues to be reviewed
by ASHA. As late as August 2013, ASHA's position
remained unchanged. The links to the documents may
be found on the www.asha.org. The Position Statement
outlining the possibility of these sanctions may be found
at: http://www.asha.org/docs/html/PS2004-00218.html
(Deussing, Personal Communication, 2013).
Our present study . . .
• A Pilot Study, designed to determine the efficacy of TL® as an add-on
therapy to traditional Occupational Therapy (OT)
• The Subjects:
• Three groups, six children each group
• Qualifications for inclusion in the study
• Group assignment was double-blind:
• Group 1 received OT only
• Group 2 received unmodified music, together with OT
• Group 3 received modified music, together with OT
Our present study . . .
• Test selection for pre- and post-therapy results: The Battery
•
•
•
•
Sensory Processing Measure
Degangi-Berk Test of Sensory Integration
Fisher Test
Audiological Battery:
•
•
•
•
•
•
•
•
Acoustic Reflexes, contralateral
Tympanometry
Pure-tone Thresholds
Otoacoustic Emissions (OAEs)
First half, SSW test; first half of Competing Environmental Sounds
CID-W22 Speech-in-Noise test
Pitch-Pattern Perception Test
Visual inspection of peripheral hearing mechanism using an otoscope.
Our present study . . . The Method
• Pre- and Post-test battery administered by TL®-certified OTR/L:
• Parents completed the Functional Listening Questionnaire (required by Vital Links®)
• Sensory Processing Measure (Preschool Home Form)
• To profile the child’s sensory processing skills:
•
•
•
•
•
•
•
•
Social
Vision
Hearing
Touch
Body Awareness
Balance
Planning/Ideas
Total Test Score
• DeGangi-Berk Test of Sensory Integration
• To assess the three components of vestibular processing;
• postural control
• bilateral motor coordination
• reflex integration
The Occupational Therapy Assessments
• Sensory Processing Measure- Preschool Home Form
• Designed to assess children ages 2-5
• Covers a wide range of behaviors and characteristics related to sensory
processing, social participation, and praxis
• Rated in terms of frequency of the behavior on a 4 point scale
• Areas tested include: social participation, vision, hearing, touch, body
awareness, balance, planning and ideas, and total sensory systems
• Yields standard scores into one of three interpretive ranges: typical, some
problems, or definite dysfunction
I. The Occupational Therapy Assessments
• B. DeGangi-Berk Test of Sensory Integration
• A 36 item test for preschool children ages 3-5
• Assesses three vestibular based functions to include: postural control, bilateral motor
integration, and reflex integration
• The primary purposes of the vestibular system are:
• 1- detect motion
• 2- detect and respond to gravity
• 3- detect motion within the visual field
• 4- detect muscle tone and motor coordination
• 5- develop and maintain body scheme
• This assessment was chosen for the study because of the close connection between
the vestibular and auditory systems. These two systems develop as a unit and appear
to be connected from both structural and functional points of view. They share the
bony labyrinth and membranes of the inner ear and their receptors respond to
vibration with common fluids. The auditory and vestibular systems have their own
branch of the eighth cranial nerve; however, upon stimulation, there is crossover
from one to the other.
Test items for postural control
1. Monkey Task- ability to assume and maintain anti-gravity posture of flexion
Test items for postural control
• 2. Side-sit cocontraction- cocontraction of upper extremities and trunk
Test items for postural control
• 3. Prone on elbows- Neck cocontraction in the prone position
Test items for postural control
• 4. Wheelbarrow walk- Stability of the neck, trunk, and upper extremity extensors
Test items for postural control
• 5. Airplane- Ability to assume and maintain an antigravity posture of extension
Test items for postural control
• 6. Scooter board cocontraction- cocontraction of the upper extremteies
Test items for bilateral motor integration
1.Rolling pin activity- bilateral motor coordination, trunk rotation, crossing the midline
2.Jump and turn- BMC of the lower extremities, trunk rotation
3.Diadokenesis- complete forearm rotation
4.Drumming- BMC
1.Upper extremity control- motor speed, disassociation of the trunk and arm, crossing the
midline
Test items for reflex integration
• 1. Asymmetrical Tonic Neck Reflex (ATNR)
• 2. Symmetrical Tonic Neck Reflex (STNR)
• 3. Diadokokenesis
II. Additional tools/documentation used in the
study
A. Functional listening questionnaire (Vital Links) 15 pg child history form
B. Clinical observations of listening (Vital Links) 3 pg checklist of orienting and attending patterns,
respiratory patterns, and movement patterns
II. Additional tools/documentation used in the
study
• C. Home program “Ease” disc/modulated music (Vital Links)
II. Additional tools/documentation used in the
study
• D. Parent log (PCSG)
II. Additional tools/documentation used in the
study
• E. Therapist log (PCSG)
Our Present Study . . . Method
The Therapy Protocol
• Group A: Received 10 weeks of prescribed and appropriately profiled
OT with no listening component.
• Group B: Received 10 weeks of prescribed and appropriately profiled
OT and listened unmodified music, stylistically matched to TL®
through Sennheiser HD-500A headphones during therapy.
• Group C: Received 10 weeks of prescribed and appropriately profiled
OT and listened Modified TL® music through Sennheiser HD-500A
headphones during therapy.
III. The therapy sessions
A.Selecting a profile and choosing CDs
 Within TL® there is a wide variety of musical styles and 4 different programming
series, each with its own type of electronic modification. These include:
The Modulated Series *
The Fine Tuning Series
The Spatial Enhancement Series
The Gearshifters
 * used in this present study
III. The therapy sessions
A.Selecting a profile and choosing CDs
 Our study only used the Modulated Series. A filter was used that alternates
between high pass and low pass, with the pivot point set at 1000 Hz, which
has been shown to be the best range for eliciting an orienting response.
 Play sample of Modulated Music
III. The therapy sessions
A. Selecting a profile and choosing CDs

There are 3 categories in the modulated series.
 Engagement (sensory modulation and space)- The ability to modulate
sensation and understand space
 Interaction (core, praxis, and ability to motorically respond with the
environment)
 Discrimination (higher levels of attention and perceptions)
III. The therapy sessions
A. Selecting a profile and choosing CDs





Start with engagement then move to interaction then discrimination
Move from top to bottom of CD list (musical complexity listed from less to more)
How long you stay in each area depends on severity
There are 3 profiles (severe, moderate, mild)
Our study had 3 severe (2 modified, 1 unmodified), 7 moderate (4 modified, 3
unmodified), and 1 mild (unmodified)
III. The therapy sessions
• B. Power tools of sensory integration
•
1. DPPT
•
2. Astronaut Training
•
3. Sensory Diet
•
4. Therapeutic Listening (group A and B)
•
III. The therapy sessions
• C. Video clip of treatment session
III. The therapy sessions
• D. Parent Testimonial
Audiologic Test Battery
Katz Central Test Battery
Jack Katz, 1997,2001
Our present study . . . The Method:
Audiological Measures
• Pre- and Post-test battery administered by ASHA-certified Audiologist:
•
•
•
•
•
•
•
•
Hearing screening
Tympanometry
Acoustic Reflexes
Staggered Spondaic Word Test
Competing Environmental Sounds Test
CID-W22 Speech-In-Noise Test
Phonemic Synthesis Picture Test
Fisher’s Auditory Problems Checklist (scored by audiologist)
Audiologic Assessment
• Otoscopy
• Tympanometry
• Acoustic Reflexes
• Hearing Screening
Fisher’s Auditory Problems Checklist
Normed to age five
•
•
•
•
•
•
•
•
•
•
Association
Attention
Attention span
Auditory visual integration
Closure
Comprehension
Discrimination
Figure-ground
Identification
Localization
25 statements to mark as a
concern
•
•
•
•
•
•
•
•
Long term memory
Motivation
Performance
Recognition
Sensitivity
Sequential memory
Short term memory
Speech language problems
Fishers Auditory Problems Checklist
Staggered Spondaic Word Test (SSW)
• Normed down to age 5 years
• Assesses dichotic listening
• Requires the auditory process of binaural integration when
linguistic cues are present
• Binaural Integration: the ability to understand and
process two different messages presented
simultaneously
Example: up
RNC
stairs
down town
RC
LC
LNC
Staggered Spondaic Word Test (SSW)
CID-W22 Speech In Noise Test
• Normed down to age five
• Assesses the auditory process of auditory figure ground
• Auditory figure ground: the ability to understand
messages in the presence of background noise (+5db
S/N ratio)
Example: Repeat these words (25 RE, then 25 LE)
Listen to the man and ignore the noise
Compare difference in ears
Compare difference in quiet and in noise
CID Auditory Test W-22 in Noise
Phonemic Synthesis Picture Test
• Preschool to First Grade (4-7 years of age)
• Listen, sequence and remember sounds discreetly presented and
blend to make word
• Example: m- i- l- k = milk
25 words increasing in number of sounds
Percent correct and analysis of types of errors
Phonemic Synthesis Picture Test
Competing Environmental Sounds
• Normed down to age 6 years
• Dichotic task assessing Binaural Integration
• Example: hear two environmental sounds presented
simultaneously to each ear and point to pictures representing
the two sounds
• Car horn (RE) and sneezing (LE)
get total percent correct, and percent correct in each ear
Competing Environmental Sounds Test
Competing Environmental Sounds Test
Results of Pre and Post Testing
Fisher’s Auditory Problems Checklist
Control Group
A1
A2
A3
A4
A5
Fisher's Test Ave. Percent
Pre
Post
Gain/Loss
76
76
0
-9
84
89
64
80
20
-9
96
91
48
44
-8
OT w/Modified TL®
C1
C2
C3
C4
C5
C6
OT w/Music
B1
B2
B3
B4
B5
Fisher's Test Ave.
Percent
Pre
Post
Gain/Loss
100
100
0
40
52
30
48
44
-8
64
80
25
80
68
-15
60
60
0
Fisher's
Pre
Test Ave.
Post
80
52
64
84
64
Percent
Gain/Loss
84
5
72
38
80
25
88
5
68
6
Our present study . . . The Results
• Findings must be considered preliminary
• Pilot Study with small N indicates the need for further study
• Between Groups GainScore statistic showed no statistical significance
• (p > .303; F = 1.310 with 2 df)
• Alternatively, we will consider the percent-change for each individual and
group. (see next slide)
Results: Percent change for Pre- and Post Administrations of
Sensory Processing Measure – OT only (Control Group)
Sensory Processing Measure
Pre-test
SOC
A1
( t-score)
A2
( t-score)
A3
( t-score)
A4
( t-score)
A5
(t-score)
Post-test
VIS
HEA
TOU
BOD
BAL
PLA
TOT
Percent
SOC
Percent
Gain/Loss
VIS
Percent
Gain/Loss
HEA
Percent
Gain/Loss
Percent
Gain/Los
s
TOU
Percent
Gain/Los
s
BOD
Percent
Gain/Los
s
BAL
Percent
Gain/Los
s
PLA
Gain/Los
s
TOT
20
16
11
22
19
11
14
85
17
-15
20
25
10
-9
27
23
15
-21
13
18
15
7
91
7
68
56
52
62
69
42
61
60
63
-7
64
14
47
-10
67
8
62
-10
55
31
64
5
64
7
14
21
21
19
15
17
14
99
16
14
21
0
20
-5
29
53
21
40
24
41
19
36
121
22
54
66
71
55
62
67
61
67
59
9
66
0
70
-1
69
25
72
16
76
13
71
16
72
7
28
14
16
10
16
10
15
72
14
-50
21
50
21
31
31
210
16
0
18
80
14
-7
115
60
69
58
65
42
63
44
58
57
54
-22
66
14
71
9
71
69
65
3
67
52
61
5
70
23
16
30
19
36
24
20
16
135
13
-19
19
-37
15
-21
29
-19
17
-29
18
-10
11
-31
102
-24
59
75
69
80
77
70
65
72
52
-12
62
-17
63
-9
69
-14
66
-14
67
-4
52
-20
67
-7
19
16
23
37
15
20
10
119
20
5
20
25
24
4
35
-5
18
20
24
20
20
100
129
8
67
56
72
80
62
70
48
72
68
1
64
14
73
1
77
-4
68
10
75
7
72
50
72
0
Results: Percent change for Pre- and Post Administrations of
Sensory Processing Measure – OT w/Music
Sensory
Processing Measure
Pre-test
SOC
B1
( t-score)
B2
( t-score)
B3
(t-score)
B4
(t-score)
B5
Post-test
VIS
HEA
TOU
BOD
BAL
PLA
TOT
SOC
VIS
HEA
TOU
BOD
BAL
PLA
TOT
22
27
22
28
23
28
16
136
19
-14
18
-33
16
-43
27
-4
19
-86
21
11
20
11
109
581
70
72
72
68
76
76
65
72
27
-61
60
-17
65
-4
67
-12
69
-4
71
163
72
20
69
6
22
27
22
28
23
28
16
136
19
-14
18
-33
16
-43
27
-4
19
-86
21
11
20
11
109
581
70
72
72
68
76
76
65
72
67
-4
60
-17
65
-4
67
-12
69
-4
71
6
72
20
69
6
15
17
19
23
13
20
14
98
14
-7
19
12
17
-26
21
5
15
-85
22
57
13
-32
99
482
56
58
69
63
57
70
61
66
54
-4
62
7
66
5
60
-14
62
-6
72
33
58
-6
67
2
23
25
18
41
23
19
24
131
19
-17
26
4
13
-68
34
79
22
-83
24
26
23
-12
126
869
71
71
67
80
76
68
75
72
67
-6
72
1
58
-28
76
12
74
3
75
12
75
4
72
24
13
19
10
23
16
12
11
89
17
31
20
5
10
-57
28
133
18
-80
18
6
10
-50
104
940
Results: Percent change for Pre- and Post Administrations of
Sensory Processing Measure – OT w/Modulated TL®
Sensory Processing
Measure
Pre-test
SOC
Post-test
VIS
HEA
TOU
BOD
BAL
PLA
TOT
SOC
VIS
Pre-test
C1
( t-score)
C2
( t-score)
C3
( t-score)
C4
( t-score)
C5
(t-score)
C6
(t-score)
HEA
% change
TOU
% change
BOD
BAL
% change
% change
PLA
% change
TOT
% change
Total
% change
% change
21
16
26
22
12
17
9
97
17
-19
12
-25
16
-38
19
-14
9
-25
14
-18
9
0
74
-24
69
56
76
62
54
67
40
66
63
-9
43
-23
64
-16
55
-11
40
-26
58
-13
40
0
53
-20
20
23
14
33
12
15
25
104
18
-10
20
-13
17
21
35
6
18
50
16
7
22
-12
112
8
68
69
60
74
54
62
76
68
66
-3
64
-7
66
10
77
4
68
26
64
3
74
-3
70
3
23
29
14
32
21
19
23
123
22
-4
25
-14
10
-29
24
-25
16
-24
16
-16
17
-26
96
-22
71
74
60
72
72
68
75
72
70
-1
71
-4
47
-22
64
-11
65
-10
64
-6
67
-11
66
-8
19
32
20
33
28
22
18
143
21
11
23
-28
21
5
17
-48
39
39
18
-18
14
-22
127
-11
67
76
70
75
80
72
69
76
58
-13
74
-3
73
4
66
-12
80
0
73
1
56
-19
75
-1
14
23
19
21
9
12
20
89
10
-29
16
-30
12
-37
15
-29
12
33
12
0
16
-20
72
-19
54
69
69
60
40
50
72
63
44
-19
56
-19
55
-20
43
-28
54
35
50
0
65
-10
52
-17
25
54
13
21
10
18
24
89
18
-28
26 ??
14
8
30
43
15
50
12
-33
19
-21
106
19
73
69
57
58
43
69
77
60
66
-10
26 ??
60
5
70
21
62
44
50
-28
71
-8
69
15
Results: Percent change for Pre- and Post Administrations of
DeGangi-Berk Test of Sensory Integration– OT only (Controls)
Degangi- Berk Test
of Sensory
Integration
Pre-test
Post-test
Pos Cont Bi-Lateral
Reflexes
Total
Pos Cont
Bi-Lateral
Motor Integ
Reflexes
Total
Motor Integ
Percent
Percent
Percent
Gain/loss
Gain/loss
Gain/loss
Percent
Gain/loss
A1
28
30
12
70
29
4
33
10
16
33
78
11
A2
25
27
4
56
28
12
33
22
12
200
73
30
A3
25
36
15
76
27
8
30
-17
16
7
73
-4
A4
25
23
12
60
27
8
35
52
16
33
78
30
A5
18
24
13
55
24
33
33
38
15
15
72
31
Results: Percent change for Pre- and Post Administrations of
DeGangi-Berk Test of Sensory Integration– OT w/Music
Degangi- Berk Test
of Sensory Integration
Pre-test
Post-test
Pos Cont
Bi-Lateral
Reflexes
Total
Pos Cont
Bi-Lateral
Percent Motor Integ
Motor Integ
Gain/Loss
Reflexes
Percent
Total
Percent
Gain/Loss
Percent
Gain/Loss
Gain/Loss
B1
18
23
12
53
21
17
24
4
10
-17
55
4
B2
18
23
12
53
21
17
24
4
10
-17
55
4
B3
26
29
14
69
29
12
39
34
16
14
84
22
B4
19
26
6
51
27
42
31
19
14
133
72
41
B5
6
2
8
11
83
10
400
9
0
30
275
Results: Percent change for Pre- and Post Administrations of
DeGangi-Berk Test of Sensory Integration– OT w/ Modulated TL ®
Degangi- Berk Test
of Sensory Integration
Pre-test
Post-test
Pos Cont
Bi-Lateral
Reflexes
Total
Bi-Lateral
Pos Cont
Motor
% change Integ
Motor Integ
Reflexes
% change
Total
% change
% change
C1
25
36
9
70
25
0
33
-8
13
44
71
1
C2
17
24
10
51
20
18
25
4
11
10
56
10
C3
-9
-9
-9
-9
-9
0
-9
0
-9
0
-9
0
C4
27
24
10
61
26
-4
28
17
12
20
66
8
C5
17
10
10
37
20
18
19
90
12
20
51
38
C6
14
12
12
38
21
50
20
67
14
17
55
45
Our present study . . . The Results
• The primary limitations:
• Lack of adequate funding severely limited the N
• Severity level of the subjects may have been a factor
• (Was testing done on “good day/bad day?”)
• Recommendations for further study and analysis
• Re-analyze these data, using the Bootstrap Method (explain)
• Use the results of this study to apply for increased funding (external v.
internal funding sources)
• Replicate the study, using multiple sites to increase the N
Our present study . . . Discussion
• Recommendations
References
“Koo-Koo-Kah-Choo, Koo-Koo-Kah-Choo-Kah-Choo
I am the Walrus”