Child With Headphones

Therapeutic Listening® is an evidence based protocol developed by Vital Links that can be implemented by therapists who have been specifically trained in utilization of the program.  Therapists can evaluate a child’s sensory processing needs, develop a child specific program, then implement Therapeutic Listening® in the clinic setting while advising families on how to carry over the program in their home environment.  Therapeutic Listening® combines a sound based intervention which utilizes electronically altered music on compact discs with traditional sensory integration treatment strategies.

Therapeutic Listening® in conjunction with sensory integration techniques tends to speed the emergence of some of the following:

  • Attention
  • Organized behavior
  • Self regulation
  • Fine motor control
  • Postural control
  • Oral motor/articulation
  • Visual motor integration
  • Social skills/communication
  • Praxis
  • Bilateral integration

The equipment required for listening therapy are headphones that meet specific requirements, a CD player with special features, and CDs that are electronically altered, based on the ideas and the technology created by Alfred Tomatis, Guy Beard, and Ingo Steinbach. Depending on the child’s treatment goals, the therapist will determine which music, modulation, and activities best suit the child and a program will be developed to specifically target the child’s unique needs.

Frequently Asked Questions about Therapeutic Listening®

Protocol:

What activities should be discouraged while listening to music selections?

Generally, any activities that make the child seem unavailable are not recommended during listening. TV, videos, computer use, and video games are all discouraged except as activities of last resort. Additionally, while it is usually fine for a child to play with cars or other favorite toys, the child should be using these toys in a constructive or creative manner. Lining up toys or other objects would be an activity to discourage during listening.

Does it have to be a full 3 hours in between listening times? 

In order for the body to completely integrate the program & based on the way the body’s internal rhythms works, yes at least 3 hours is recommended to separate listening times. On occasion we will recommend clients complete only one Therapeutic Listening session per day if listening two times a day separated by three hours is impossible.  However, only listening one time per day may not result in as immediate changes as listening two times per day.

Are there contraindications for listening longer than 2x 30 minutes?

We do not recommend listening more than the protocol of 2x/day for 30 minutes with 3 hours in between, based on the body’s internal rhythms and to allow the body to completely integrate the program.

At what volume should listening occur?

The volume should be set at a normal conversation level. For exactness, a decibel reader can be used. A volume of 45-55 dB for listening is well within OSHA standards. However, a general rule of thumb is that the listener should not be speaking in a louder than typical voice for carrying on a conversation. If he/she does seem to be speaking loudly, the volume is probably too high and should be decreased. Volume may have to be adjusted over the life of the batteries used.

Can a child listen to the albums over the car speakers or loudspeakers if they won’t leave the headphones on?

Once car speakers or loudspeakers are used, the listening program is being delivered is radically different. Sound travels as waves through space. The greater the space through which the sound waves must travel, the less the sound waves impact the listener. The modified albums are NOT configured for speaker use. They should only be used over headphones.

Rarely, when headphones are not appropriate for use because of the child’s age (under 2 years of age), the modified albums may be used over speakers. If this is the case, the speakers should be of good quality, the child should be relatively stationary with respect to the speakers and should be positioned in the apex of the triangle formed between the speakers and the child, and the room in which listening occurs should be fairly small. A bathroom might be a good choice.

Equipment:

Why do I need to use the Sennheiser headphones?

The Sennheiser 500A headphones (or Pro-50) were specifically designed for the Therapeutic Listening program. The headphones have the specifications of being circumaural open air headphones capable of capturing 18 Hz- 30,000 Hz and have an impedance of 150 ohms. The Sennheiser 500A are well-engineered headphones which offer a 2-year warranty. Experimenting with lower quality headphones could potentially impact the child’s treatment & affect their listening times. An individual can not be considered to be using Therapeutic Listening program if lesser quality headphones are used, as the program has been altered.

What will I lose if I use a pair of headphones with a lower rating of 150 ohms?

Ohms refer to the energy needed to push sound through the electrical wiring. The higher the impedance, or ohms, the greater the quality of sound.  Lower impedance produces a lesser quality of sound, affects clarity, & drops off power in the high range. Experimenting with lower quality headphones could potentially impact the child’s treatment & affect their listening times. An individual can not be considered to be using Therapeutic Listening program if lesser quality headphones are used, as the program has been altered.

Will wireless headphones work?

No. Wireless headphones have a low dynamic frequency (range of response). The quality, especially of the upper frequencies in which the important discriminative information is carried, is lost. Wireless headphones also pick up unwanted higher frequencies from any other electronic appliances that are being used within a nearby space.

Can we burn the albums to save costs?  What exactly does this do to the quality of the music?

No. Besides being illegal, we do not recommend burning the albums because it works by first compressing and then expanding frequencies. With this process, you will be losing some of the higher frequencies and only get about 80% of the frequencies of the modulated music. These higher frequencies are the important part of the music that the ear “tunes into” and are crucial to Therapeutic Listening. Burning an album can also create subtle gaps in the music. If you do this, you are no longer doing “Therapeutic Listening”, as you have altered the music. Thus, to maintain the highest level of quality and professional use we do not recommend burning Therapeutic Listening music for personal or in clinic use.

Changes in Behaviors and Concerns after starting TL:

We started listening and my child seems to have increased negative behaviors and emotionality. What does this mean?

What we sometimes can see, is what we like to refer to as a “period of disorganization followed by reorganization”, as the nervous system reorganizes itself. This happens in typical development as well, as a child gains a new skill, they may regress in another for a short period of time. Often when children become more integrated and connected to their emotions and communicative abilities we can see that struggle for independence emerge. Emotionality is typical as a child’s modulation becomes more regulated. The child may be trying to communicate wants/needs, but does not currently have the means to do so.   If this child is coming into his own in a bigger way at this time his arguing could be a response to his new found sense of self. We encourage the parents to set limits where needed, but not to get caught in a power struggle with him as he gains this new skill. If on the other hand the arguing is coming from a place of disorganization or irritability that is more than the family can handle or is making his life difficult in other environments, then I would look to make a change in his listening program.

We started listening and my child seems to have increased auditory sensitivity. What does this mean?

The most primitive defensive response is to shut off sensation. Often times, when these children begin a Therapeutic Listening, they cover their ears; begin to complain of noise, etc. These are all higher level of adaptive behavior than shutting off. It is important to look at the context of what you are observing. For example, is the increase in auditory sensitivity also coupled with an increased attention, increased vocalizations, behavioral changes, or improved postural control? Observing progress in other areas is a key that the music selection is on the right tract. Children will typically progress through the increased sensitivity phase to an even more advanced level of processing auditory input. In this phase you will see increased attentiveness & connectedness. Again, increased auditory sensitivity is usually a positive adaptive response. However, if auditory sensitivity persists for more than 1-2 weeks, consider modifying listening times, albums, or overall sensory diet strategies.

Since starting Therapeutic Listening, my child has demonstrated an increase in stimming behaviors—any suggestions?

To decrease self-stimulatory behaviors, it is helpful to increase proprioceptive input in their sensory diet.

We started Therapeutic Listening and now my child starting have increased bowel/bladder issues.  Specifically, they have started wetting their pants during the day and have accidents at night.  Why is this? 

If the child has poor vagal tone, there sphincter will be less relaxed. As the music works on the vagal system, you can see relaxing of the sphincter whereas before it was controlled in a narrow range. Now the range of control is broadening. As the child begins to integrate the new range of bowel/bladder control, you will see a decrease in the enuresis and soiling.

Hearing Loss: 

Is it appropriate to put a child with a hearing loss on a Therapeutic Listening program?

Yes, kids with hearing loss benefit from a Therapeutic Listening program. The hearing loss is not a reason to not do Therapeutic Listening. Hearing aides must be removed prior to placing the headphones on the child, if they create any feedback. Be careful to keep the volume at a regular level – do NOT increase the volume while listening. The Therapeutic Listening will not change hearing for an individual with a known loss, but we have seen attention to sound improve as well as vestibular-based and regulatory issues.

Insurance and Billing: 

Can my insurance company be billed for Therapeutic Listening? 

As Therapeutic Listening is a program used as part of a comprehensive sensory integration treatment approach it is NOT appropriate to bill insurance companies.  Insurance companies primarily reimburse for the direct treatment time an occupational therapist spends with a client.  Thus, an occupational therapist would not bill an insurance company for the specific use of the Therapeutic Listening as a tool in their therapy session, only for the time they spent engaging in occupational therapy with their client.

Is Therapeutic Listening equipment considered “medical equipment”? 

The equipment and music albums are NOT considered necessary medical equipment and should not be billed to insurance companies.  On occasion, social services may find an outside organization to cover partial costs of Therapeutic Listening.