ONLINE JOURNAL OF MISSOURI SPEECH-LANGUAGE-HEARING ASSOCIATION 2017, VOLUME 3, NUMBER 1 1
Online Journal of Missouri Speech- Language-Hearing Association Volume 3; Number 1; 2017 (OJMSHA)
© Missouri Speech-Language- 2017 Hearing Association
Ray, Jayanti
Annual Publication of the Missouri Speech-Language-Hearing Association
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Scope of OJMSHA
The Online Journal of Missouri Speech-Language-Hearing Association is a peer-reviewed, interprofessional journal publishing articles that make clinical and research contributions to current practices in the fields of Speech-Language Pathology and Audiology. The journal is also intended to provide updates on various professional issues faced by our members while bringing them the latest and most significant findings in the field of communication disorders.
The journal welcomes academicians, clinicians, graduate and undergraduate students, and other allied health professionals who are interested or engaged in research in the field of communication disorders. The interested contributors are highly encouraged to submit their manuscripts/papers to [email protected]. An inquiry regarding specific information about a submission may be emailed to Jayanti Ray ([email protected]).
Upon acceptance of the manuscripts, a PDF version of the journal will be posted online during August or September. This publication is open to both members and nonmembers. Readers can freely access or cite the articles.
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Table of Contents
Research
Effective teaming in AAC: A qualitative case study 8 Pamela Hart and Julie Scherz
Auditory Benefits of Computer-based Music Training 21 Susan Fulton, Amanda Peluso, and Jennifer L. O’Brien
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Editorial Board (Peer Reviewers)
Carol Koch, EdD, CCC-SLP, has been a practicing Elaine Beussink conducts diagnostic/treatment pediatric speech language pathologist for the past 28 services for individuals at Southeast Missouri State years. She has also taught at the undergraduate and University Autism Center. Earning her Master’s graduate levels for the past 11 years. Her areas of degree in Speech Language Pathology in 1989, clinical expertise, teaching and research interests Elaine holds her ASHA Certificate of Clinical include early intervention, childhood apraxia of Competence and is a Licensed Speech Language speech, autism spectrum disorders, early Pathologist in the state of Missouri. She has been phonological acquisition, assessment and intervention working with individuals with developmental delays of speech sound disorders, family and sibling across settings since 1989, specializing in autism experiences, and clinical education. Carol was a spectrum disorders since 2002. Elaine has served recent participant in the ASHA Leadership the southeast region as Adjunct Faculty (SEMO), an Development in Health Care Program. She currently In-District Autism Consultant and a Social Cognition has a publishing contract to write a textbook on the therapist. She directs Camp SOCIAL, provides topic of speech sound disorders. Carol has also been professional development for area service providers serving on the Board of Directors for Children's TLC and presents at State and National conferences. for the past 6 years.
Kevin Squibb, PhD, CCC-A is an associate
Janet L. Gooch, Ph.D., CCC-SLP is Full Professor professor in the Department of Communication and Dean of the School of Health Sciences and Disorders at Southeast Missouri State University. He Education at Truman State University and a certified holds a Master of Science in Audiology from East and Missouri licensed speech-language pathologist Tennessee State University and a Doctor of with successful clinical, teaching and administrative Philosophy degree from Bowling Green State experience. She obtained her Bachelor of Arts in University. He is a clinical audiologist with primary Speech Pathology from the University of Kansas, interest in speech science and diagnostic audiology Master of Arts in Speech Pathology from Kent State with a focused interest in auditory processing. Dr. University, and her Ph.D. from Case Western Squibb has been teaching at Southeast for 27 years Reserve University in Cleveland, Ohio. Dr. Gooch’s and maintains an intense interest in his students and academic and research interests lie in the areas of the pedagogy of teaching. Child Phonology, early reading abilities, and cleft lip and palate.
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Martha J. Cook, PhD, CCC-SLP is an assistant Shirley A. (Blanchard) Brummett is a professor in the Department of Communication speech/language pathologist and Secondary SLP Disorders at Southeast Missouri State University. Coordinator for Raytown Quality Schools. Mrs. She is a graduate of the University of Mississippi, Brummett is a Southeast Missouri State University Southeast Missouri State University and Southern alumnus where she obtained her Bachelor of Arts Illinois University-Carbondale, where she earned and Master of Science degrees in Speech her doctorate in Rehabilitation with an emphasis in Pathology. Additionally, she holds a Master of Communication Disorders and Sciences. Her areas Science in Special Education from the University of interest in research and teaching are in fluency of Kansas where she specialized in autism. Mrs. disorders (stuttering) and professional issues and Brummett’s professional areas of interest include pedagogy in communication disorders. Dr. Cook is phonological and sound system disorders, child the Coordinator of the Center for Speech and language development and disorders and Hearing and the co-advisor for the Southeast multicultural issues. When not engaged in Chapter of the National Student Speech-Language- professional pursuits, she enjoys hiking, cycling Hearing Association. and kayaking with her husband, children, extended family and friends.
Jennifer Kerr is a clinical assistant professor at Missouri State University (MSU). She has over 16 Lisa Bell, M.A., CCC-SLP, is a clinical assistant years of clinical experience working with adult professor in the CSD department at MSU. She has populations as a medical speech-language over 27 years of clinical and instructional pathologist (SLP) and 7.5 years of teaching and experience as a public school therapist, per diem supervisory experience at the university level. Her clinician in a multitude of medical settings, and as primary clinical interest areas are aphasia, motor a member of the graduate faculty at MSU. Lisa speech disorders, cognitive-linguistic provides clinical instruction to graduate student communication, and working with caregivers. clinicians and teaches the undergraduate Jennifer has given professional presentations “Observation II” course and a workshop for SLP regarding aphasia treatment, counseling, Assistants. supervision, and how evaluation and treatment of communication disorders should be integrated into the WHO model of service delivery. Her primary focus as an educator includes teaching undergraduate communication sciences and disorders majors and mentoring and supervising SLP graduate students. Prior to joining the faculty at MSU, Jennifer was a clinical instructor at the University of Washington, which is where she also Susan Fulton, Ph.D. CCC-A is an assistant earned her master of science in speech-language professor in the Department of Communication pathology. She also holds a bachelor of science in Disorders at Southeast Missouri State University. communication studies from the Florida State She holds a Master of Science degree in University. Communicology (Audiology) from the University of South Florida, Tampa, FL and a Doctor of Philosophy degree in Communication Sciences and Disorders with a concentration in Hearing Science from the University of South Florida, Tampa, FL.
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Dr. Fulton has worked clinically as a pediatric Arizona’s National Center for Neurogenic audiologist for 31 years and in academia for 13 Communication Disorders where she studied years. She primary interests are auditory acquired language disorders in children. She has processing, psychoacoustics, and neural processes. published in the areas of assessment and treatment Her current research focuses on the benefit of of Hispanic children with communication disorders music training on auditory processing. and has written 3 books on these topics. Her specialization has been the preschool Hispanic child who is learning English. She has served at Texas Christian University, New Mexico State University (NMSU), and Saint Louis University (SLU). Dr. Kayser was a full professor at NMSU and SLU. She is a Fellow of ASHA and received the Award for Special Contributions for Multicultural Populations. Shatonda Jones, PhD, CCC-SLP is an Assistant Professor of Communication Sciences and Disorders at Rockhurst University. She has worked in adult neurogenic rehabilitation for 10 years. Dr. Jones received her Bachelor of Science in Speech Language Pathology and Audiology from the University of Tulsa, Master of Arts in Speech Language Pathology from the University of Iowa, and Doctor of Philosophy in Therapeutic Sciences from the University of Kansas Medical Center. Victoria Carlson-Casaregola, MA, CCC-SLP, is a school-based Speech-Language Pathologist and university adjunct instructor of advanced writing in St. Louis. She holds a Master’s degree in English/ Expository Writing from The University of Iowa and a Master of Arts in Communication Sciences and Disorders from Saint Louis University. In collaboration with SLP colleagues at St. Joseph Institute for the Deaf, she co-wrote GOALS: A Anne Bedwinek, PhD, CCC-SLP has alternated Listening and Spoken Language Guide. She won between full-time university teaching and medical First Place in the ASHA 2006 Student Ethics Essay speech pathology. She is an Adjunct Associate competition. Professor at the University of Missouri and taught at Washington University, St. Louis University, and the University of Tennessee. She has served on four cleft palate-craniofacial teams, including St. Louis Children’s Hospital and Mercy Children’s Hospital. She is an active member of ASHA’s SIG 5, the American Cleft Palate-Craniofacial Association, and the advisory board of RSF- Earthspeak. She holds a BA from the University of Michigan-Ann Arbor, and MA from Northwestern University, and a PhD from Union University. Grace McConnell, PhD, CCC-SLP, is an assistant professor at Rockhurst University. She received both her PhD in Communication Sciences and Disorders from Kansas University. After receiving her M.A. in CSD from KU, she worked as a clinician in the schools for a decade before returning for doctoral studies. Her interests include language development, language disorders of school age children, and multicultural issues in CSD, including the effects of poverty on language development. Hortencia Kayser is a graduate of the University of Arizona and received her doctorate from New Mexico State University. Dr. Kayser completed a post-doctoral fellowship with the University of
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Coordinator/Editorial Board Production/Editorial Associate Jayanti Ray, PhD, CCC-SLP is a professor in the Melissa Klaybor is a clinical fellow speech- Department of Communication Disorders at language pathologist at ABC Pediatric Therapy in Southeast Missouri State University. She teaches O’Fallon, Illinois. Melissa obtained her Bachelor of undergraduate and graduate courses, and her Science and Master of Arts degrees from Southeast research interests are dysarthria, AAC, and quality Missouri State University. Some of her interests of life in older adults. OJMSHA is her dream come include the remediation of child and adult language true! disorders and quality of life in children and adults with communication disorders.
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Effective Teaming in AAC: A Qualitative Case Study
Pamela Hart, Ph.D., CCC-SLP Rockhurst University
Julie Scherz, Ph.D., CCC-SLP Wichita State University
The purpose of this research was to explore factors that contributed to challenges experienced by an AAC team working to implement an AAC device for a child with Down syndrome. Data methods in this study included ethnographic interviews with team members, observations of the child in multiple environments, and review of relevant educational documents. Following the AAC evaluation, team members believed they had chosen a communication device that would allow the child to become an effective communicator. After three months of working to integrate the AAC device into the child’s daily school routine, however, the child was displaying avoidance behaviors toward the AAC device. Four themes were identified that described the team’s challenges (a) team member roles and responsibilities, (b) team member relationships, (c) Jason’s frustrations with AAC, and (d) team member perseverance. An important implication of this study was the finding that through participation in the study, specifically the ethnographic interviews, team members reached a deeper level of reflection regarding how their own perceptions, values, and beliefs influenced the outcome. As they reflected on these challenges, team members were ultimately able to develop a more cohesive and collaborative plan to support the child’s continued development in using the AAC device.
Key Words: AAC; Case Study; Qualitative; Team; Outcomes
Individuals with complex communication these complexities, it is important to needs (CCNs) may require assistive involve a variety of professionals in the technology including augmentative and AAC assessment and intervention process alternative communication (AAC) from disciplines such as special education, strategies to become effective speech-language pathology, occupational communicators. AAC is defined as an area therapy, physical therapy, and assistive of multidisciplinary research and practice technology. To be effective, these that involves finding ways to compensate professionals must have two strong skill for severe difficulties with spoken and/or sets across knowledge of AAC and the written modes of communication ability to function as part of an (American Speech-Language-Hearing interprofessional team. Both have been Association, 2005). Etiologies of CCNs noted as equally important when working include clients with developmental or toward the goal of improving acquired disorders such as autism communication skills for individuals who spectrum disorder, cerebral vascular use AAC (Hunt, Soto, Maier, Muller, & accidents, Down syndrome, cerebral palsy, Goetz, 2002; Light & McNaughton, 2015; traumatic brain injury, and Soto, Muller, Hunt, & Goetz 2001; Stoner, neurodegenerative diseases to name a few Angell, & Bailey 2010). (Beukelman & Mirenda, 2013). In addition to the spoken language difficulties of these Teamwork and AAC individuals, physical, linguistic, and/or Building collaborative AAC teams cognitive limitations may co-occur. Due to is critical to achieving positive outcomes.
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While not a new concept, the idea of Specific to interprofessional AAC interprofessional education and teams, Soto et al. (2001) examined collaboration has received strengthened perceptions of effective AAC teams in attention in recent years (Fulmer, 2016; inclusive settings by conducting focus Zorek & Raehl, 2013). Professional groups with five teams of professionals organizations across healthcare and who had implemented AAC in inclusive education have embraced the importance settings for at least three years. A positive of interprofessional development of environment with recognition that practitioners with knowledge that in most successful AAC implementation is feasible instances, education and healthcare and appropriate in inclusive settings was professionals work as teams toward shared cited as an important shared goal of team goals of improving client or student members. Additionally, the ability to work outcomes. Researchers have identified cohesively and collaboratively, along with several factors supportive of effective adequate training and knowledge of AAC interprofessional teamwork in healthcare strategies were also identified as important and educational settings that include (a) a components. Similarly, Hunt et al. (2002) shared vision focused on the wellbeing of investigated the use of an AAC teaming the client, (b) clear understanding of each process to promote the academic and team member’s role, (c) trust and respect social development of three students who among team members, (d) strong used AAC. Collaborative support plans interprofessional communication skills, (e) were developed for each student that physical structure that supports specified the curricular, communication, collaboration, (f) a clear process to guide and social supports necessary to enable the the work of the team, and (g) knowledge three students who used AAC to of one’s own values, beliefs, and potential participate more fully in their educational biases (Al-sayah et al., 2014; Baxter, programs. Team meetings were held each Enderby, Evans, & Judge, 2012; Fulmer, month to discuss progress and develop or 2016). refine specific responsibilities of team In addition to skilled professionals members. These regular team meetings in from a variety of disciplines, the client and which team members were allowed to his or her family, along with other key share expertise, goals, and determine stakeholders should also be involved as responsibilities along with team member equal team members in all aspects of the flexibility around professional boundaries AAC assessment and intervention process. were identified by the teams as important Families, however, have expressed feeling toward the development of a collaborative varying levels of value and involvement in AAC process. Knowledge of AAC healthcare and education teams, dependent strategies and devices along with strong on factors related to the culture of the team leadership were identified as team. In some instances, families and particularly important to successful caregivers have deemed their input was implementation of AAC. The importance not valued. Specifically, the structure of of similar team dynamics was also team meetings across (a) the amount of identified by Stoner et al. (2010) who professional jargon used by team members investigated implementation of AAC for a and (b) the respect shown by team 16-year-old with cerebral palsy. In this members toward each other has been instance, the team was struggling to find found to determine whether families felt ways to effectively implement the AAC included as equal members of the team device in inclusive settings. They noted (Bailey, Stoner, Parette, & Angell, 2006; lack of team leadership and unclear Briggs, 1997). delineation of team roles negatively
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impacted the successful implementation of complex relationship between team culture AAC for this student. and AAC outcomes. While there is general consensus among researchers and practitioners about Methodology the benefits of collaborative, A qualitative, ethnomethodological interprofessional teams in AAC case study design was chosen because the assessment and intervention, it continues goal was to gain insight into the factors to be the case that sometimes teams that affected successful outcomes from the struggle to achieve a collaborative, perspectives of the team members. Case effective AAC process. As a result, studies as explained by Stake (1995) achievement of positive outcomes for the include the study of a program, event, client may suffer. The purpose of the process, or an individual. In this study, the current study was to examine how the case was the AAC intervention process for perceptions, beliefs, and values of an AAC a young child with Down syndrome. team influenced the ability of the team to Ethical guidelines for human participants function in an effective, interprofessional were followed. The researchers contacted manner. What happens when an AAC the special education director of an area team is not able to achieve an effective school district to inquire about the outcome? How does such a team refocus possibility of studying the AAC teaming and begin to build collaborative process. The special education director relationships in a situation where tension referred the researchers to Jason’s team and frustration are prevalent? The current and subsequent contacts were made to research study examined such a case. In obtain informed consent from all this instance, an AAC device was chosen participants. Jason is a pseudo name to and obtained for a child with Down protect the identity of the participants. syndrome. After three months of intervention, however, the child had not Participants developed more effective communication The participants in this study skills than prior to the device, and was included Jason and his (a) mother, (b) developing avoidance behaviors toward speech-language pathologist (SLP), (c) the device. A variety of qualitative data special education teacher, (d) regular collection methods allowed the researchers education teacher, (e) occupational to analyze the factors that contributed to therapist (OT), and (g) assistive the challenges and how these were technology consultant. All team members ultimately overcome. Interestingly, had been in their roles for at least 8 years participation in this study was cited by the and with the exception of the regular participants as a turning point for education teacher, had prior experience beginning to achieve more positive working with children who used AAC. outcomes for the client. As will be Table 1 provides additional demographic demonstrated by this case, there exists a information about the team members.
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Table 1 Education Professional Team Demographics
Staff Member Experience with AAC Services Provided to Jason SLP 14 years of experience as a SLP; 4 First year providing services previous clients with AAC to Jason – provided 30 minutes of therapy in the special or regular education classroom, two times per week. Special Education 10 years of experience as a special Second year providing Teacher education teacher; Experienced services to Jason – Jason with a variety of low-tech AAC spent approximately ¾ of strategies each day in the special education room. OT 8 years of experience as an OT; 12 Second year providing previous clients with AAC services to Jason – provided 30 minutes of therapy to Jason, one time per week in the special education classroom. Regular Education 12 years of experience as a First year working with Jason Teacher classroom teacher; No previous – Jason spent approximately experience with children who used ¼ of each day in the regular AAC education classroom. AT Specialist 18 years of experience with First experience working with assistive technology; Previously Jason – collaborated with the worked with more than 50 team as a consultant. individuals with AAC needs
Jason. At the time of this study, several communicative functions such as Jason was 7 years old with a diagnosis of requests, questions, and protests through Down syndrome. He lived at home with body language, gestures, and facial both parents and a younger sibling. Jason expressions. Jason had acquired the attended his neighborhood school where functional use of several signs and his he received a combination of self- team believed his potential for expressive contained and general education services. language exceeded his ability to use sign He was included in the regular first grade language due to some fine motor classroom for circle time, music, physical difficulties. Jason’s team also felt that sign education, art, and some additional language limited Jason to communication activities such as class parties. Within the partners who also knew sign language and self-contained classroom Jason received they wanted him to have a means to special education services for academics communicate with his peers and along with SLP and OT services. Jason’s individuals in the community. Jason also speech skills included the ability to used a picture-based communication book vocalize some sounds but he was not yet to request highly preferred items and able to produce intelligible words. Specific activities. While Jason had been judged by to language, Jason was able to follow one the district educational psychologist to step directions, identify common objects in exhibit a moderate intellectual disability, his environment by pointing, and express his ability to use some signs and picture-
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based communication showed good conducting one ethnographic interview development of symbolic representation with each participant, (b) second, and potential for new learning. At the time conducting one school and one home of this study, Jason was in the emergent observation of Jason, (c) third, completion stage of literacy development, able to a second ethnographic interview with each recognize some of the letters of his name. participant, (d) fourth, conducting another Jason had recently completed the school and home observation of Jason, (e) school district’s comprehensive re- conducting three more school observations evaluation process, and this had included across a nine-week timespan, and (f) evaluation for AAC needs. The current completing the third ethnographic study was initiated approximately three interviews as needed. During observations, months after Jason had received his new the researcher did not interact with team AAC device. The device chosen by the members nor Jason. Detailed field notes team was a static display device with 24 were taken for later analysis. Ethnographic cells and multiple levels. The team’s interviews were conducted at locations determination of this particular device had convenient to the participants and included been made following a trial period with the Jason’s house and the elementary school. device and two team meetings to discuss All participants completed at least two Jason’s progress. When asked to ethnographic interviews each lasting participate in this study, all team members approximately 60-min each. If after the expressed realization of challenges that second interview, questions remained seemed to be impeding successful about the experiences, perceptions, or implementation of the AAC device. While beliefs of the participant, a third interview not directly related to the goal of the study, was conducted. Jason’s mother, assistive all team members conveyed an eagerness technology specialist, and SLP all to participate in the study with hopes of completed three ethnographic interviews. potentially determining a more successful The interviews were audiotaped and later future plan for implementation of AAC transcribed verbatim. Documents were with Jason. This eagerness and dedication reviewed as they were made available to was evident in all interactions with the the researcher and occurred prior to the team members. The obvious commitment final ethnographic interviews. and perseverance of the team through challenging situations was clear and Ethnographic Interviews. The should be commended. ethnographic interviews were a key aspect of this project. Ethnographic interviewing Data Collection involves asking open ended questions in Data were collected over a 12- an attempt to understand another’s month period and included (a) experiences from his or her own ethnographic interviews with the SLP, perspective. The goal is “to grasp the special education teacher, regular native’s point of view” (Malinowski, 1922 education teacher, OT, assistive p. 25). This method of inquiry originated technology specialist, and Jason’s mother in cultural anthropology. Participants in (b) observations of Jason across home and this study were asked open ended educational settings, and (c) review of questions to encourage them to tell their relevant educational documents including own story. Spradley’s (1979) Jason’s Individualized Education Plan recommendations for obtaining (IEP) and the assistive technology AAC meaningful information were followed. evaluation report written by the assistive According to Spradley, the most important technology specialist. The sequence of initial step is “to get informants talking” data collection consisted of (a) first (p. 46). Interviews were open ended to
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allow participants to direct the interview process allowed the participants conversation to what they felt was most to reflect on their participation as a important and included both descriptive member of Jason’s AAC team. and structural questions. Descriptive questions prompted participants to Triangulation describe their experiences and as Reliability and validity of this recommended by Westby, Burda, and qualitative study were partly established Mehta (2003), began with broad topics through a process of triangulation. such as Tell me about a typical day with Triangulation denotes the cross checking Jason followed by more specific of information and conclusions through the descriptive questions such as, You use of multiple research procedures, mentioned he doesn’t like his AAC device. methods, and sources. When the different What would I see if I was to watch Jason procedures or sources are in agreement try to use his AAC device? Structural this is known as corroboration which questions included asking the participant increases the trustworthiness of the to reflect on the rationale for particular information (Hwa-Froelich & Westby, decisions along the way in addition to each 2003). Trustworthiness of this case was participant’s thoughts about what might facilitated by triangulating data sources, have caused the AAC implementation data methods, and data analysis. Data challenges. In each instance, the sources were triangulated by using participant’s own words were used by the multiple respondents in the interviews. interviewer to provide reflection Data methods were triangulated using opportunities for the participant and to interviews, observations across multiple further develop the researchers’ own environments, and review of educational understanding of the relationships between documents. Triangulation of data analysis people and events. Summation comments was accomplished by reviewing transcripts on the part of the interviewer such as That multiple times to identify themes and the must have been so difficult were avoided to use of the NVivo 10 (2012) qualitative decrease the likelihood of introducing coding software program to assist with the ideas that would bias the participant to identification and organization of themes. comment in a particular way. Instead, Additionally, participant feedback was hearing the participant describe a difficult sought throughout the process to determine situation, the interviewer would be more whether the story was being told in a way likely to ask, Can you give me another that was consistent with their experiences. example of a difficult decision for the team? In this way, the interviewer was Data Analysis able to better understand how the Data were analyzed with an participant perceived various situations inductive approach to allow themes to and events and was eventually able to emerge rather than trying to fit information identify repeated phrases and patterns as into predetermined categories. Transcripts the individual discussed the events from the ethnographic interviews surrounding the AAC team, Jason, and the comprised the majority of the data used for evaluation and intervention process. this project. The information collected Additionally, Spradley’s (1979) from observations and document review recommendations for rapport building was used to triangulate findings and were followed which included explaining provide additional verification of the purpose of the interview, re-stating in identified themes. The data were reviewed the interviewee’s own words, and asking multiple times by both researchers and meaning-based questions rather than codes generated to summarize the content. “why” questions. In this case, the Through careful review, codes were
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collapsed into broad themes encompassing Document Review. The assistive the main areas of difficulty encountered by technology report and Jason’s IEP were the team. Additionally, participants were reviewed and information related to asked to review the codes and themes to Jason’s strengths, needs, and team make sure the information accurately recommendations was pulled from the reflected their thoughts and perceptions. documents for comparison to interview and observation data. Throughout the data Ethnographic interviews. analysis process, different methods were Ethnographic interviews were transcribed used to substantiate information obtained verbatim which resulted in 163 pages of from the various sources. This systematic transcribed interviews. Principles of open process of data analysis allowed the thematic coding were followed in which researchers to compare and contrast line by line coding identified frequently information across contexts, activities, and occurring words and phrases for participants. comparison at a semantic level across Results transcripts (Braun & Clark, 2006). To be considered a theme, the number of Identification of Themes speakers who indicated the idea as well as Once the initial coding was the number of occurrences of the idea were complete, the researchers reviewed the taken into account. Qualitative coding codes and synthesized these into four software, QSR International NVivo 10 themes that encompassed similarities (2012) was used to assist with data across ethnographic interviews, reduction and identification of themes. For observations, and documents. The four example, if an interviewee said, The themes were as follows (a) team member process of finding the AAC device was roles and responsibilities, (b) team frustrating, a code was created for AAC member relationships, (c) Jason’s Frustrations and as additional interviewees frustrations with AAC, and (d) team discussed similar ideas, these utterances member perseverance. were also coded as AAC Frustrations. Once the initial coding was complete, the Team member roles and researchers reviewed the codes and responsibilities. The IEP and assistive synthesized these into themes that technology report delineated some of the summarized similar ideas, thoughts, and expected roles of team members. The IEP perceptions of the participants. listed academic, communication, and physical developmental goals and Observations. Jason was observed specified the responsible professional for seven times in a variety of contexts and each area. The assistive technology AAC activities for a total of 10 observation hrs. report included recommended tasks such Five of the observations took place in the as data collection by the SLP and special school setting and two were conducted at education teacher regarding Jason’s use of Jason’s home. Field notes were taken to the device across the school day. All team describe the activities, conversations, and members agreed, however, that additional contexts that occurred. In total, 56 pages of clarification of team member roles and field notes were reviewed by the responsibilities was needed once the AAC researchers multiple times and organized device was received. Specifically, team to reflect patterns of behavior on the part members did not indicate a clear of Jason and his caregivers with regard to understanding of (a) Who was the team his communication skills and use of the leader? and (b) Who would develop the AAC device. specific plans and strategies to integrate the device across Jason’s day? Jason’s
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mother expressed frustration the device determined to get this specific was not consistently used at school and felt device but she didn’t really stay as it was the responsibility of the SLP to keep involved once we received it. her updated regarding Jason’s use of the (Special Education Teacher) AAC device. The SLP, however, All of the professional team explained that she only worked with Jason members expressed confusion regarding two times a week for 30 minutes and the role of Jason’s mom with the AAC assumed the special education teacher was device once it was received because it did updating the parent on a more regular not seem to be used at home. Jason’s mom basis. The special education teacher felt explained during interviews, however, that like she needed more training by the SLP she had many other ways to communicate because Jason was demonstrating with Jason at home that were more avoidance behaviors when she attempted efficient than using the device. She to have him use the device. Participants believed it was the role of the observed and commented about many professionals to determine ways to instances indicative of insufficient role and incorporate the device at school so that responsibility clarification. Jason would be able to use it when Our roles weren’t clearly defined. I communicating with less familiar could have really used more input communication partners. The two home from the rest of the team for ways observations conducted for this project to coordinate use of the device supported this finding. Jason was observed across home and school but we to mostly communicate using unaided have not met on a regular basis gestures during these times at home. since the device was obtained. Gestures included putting his hand on his (Speech-Language Pathologist) mouth to indicate he was hungry, animated Additional role clarification was facial expressions to indicate agreement or also needed to determine who would disagreement with choices offered, and maintain and program the device on a pointing or pulling his mother toward regular basis. The special education and preferred items or activities. During the regular education teachers felt it was the first home observation, Jason used role of the parent to make sure the device pointing to indicate he wanted to play a was charged and ready at the start of each board game. During the game he interacted school day. Jason’s mother, however, with his mother and sibling by using rarely used the device at home and excited vocalizations that seemed to assumed maintenance was taken care of at indicate he was having fun. Jason’s mother school. and sibling understood all of his attempts Nobody really said much right after to communicate without needing the AAC the device was received. I assumed device. Additionally, Jason’s mother said they were using it at school and all that she believed her role as Jason’s mom was going well. I didn’t realize was to educate others about children with until a few months later that the special needs. device stayed in his locker most of the time. (Jason’s mother) Team member relationships. After spending so much time While team members were cooperative working to provide Jason a device, with each other, they struggled to find I wish his mom would have ways to truly collaborate. Information charged the device at home and gathered through the ethnographic used it to reinforce what we were interviews indicated some team members working on at school. It was had difficulty trusting the motives of other confusing because she seemed team members. For example, before Jason
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entered kindergarten, Jason’s mother had enjoyment working with Jason and insisted that Jason be included in the appreciation for the opportunity to know regular education classroom to a greater him. With regard to Jason’s use of AAC, extent than the school district professionals however, things became more challenging recommended. This conflict created a for the team members. All team members feeling of distrust that carried over into talked at length about Jason’s frustrations many of Jason’s mother’s interactions with with the AAC device and observations of school district personnel. She expressed Jason using the device supported these during the ethnographic interviews that she frustrations. During the first observation at was always worried the school district Jason’s school, Jason was observed in the would try to do the least amount possible special education classroom. He was for Jason. Unknown to her, the special working with his paraprofessional in a education director had already told the one-on-one activity that involved picture school-based team members that the matching. He was not attending to the task district would buy whatever device the and was playing with some dirt on the team recommended. Additional insights table and on the floor during the into team member relationships were observation. At this point, the conveyed by interview comments such as paraprofessional took Jason’s AAC device the following: out of his locker and placed it on the table, I just kind of went along with what asking him, Tell me what is wrong? Jason everybody else wanted because I immediately dove under the table and the didn’t want to create conflict. I paraprofessional looked at the researcher was mostly worried about the and said, That is what he usually does potential disruption of any AAC anymore when I get the device out. He device on my classroom either runs away or hides from it. The environment but did not feel like I session continued with Jason’s could say that in our meetings. paraprofessional trying to coax Jason out (Regular education teacher) from under the table and Jason refusing There seemed to be a lot of tension until the special education teacher came between some team members and over and physically assisted him. Jason the parent. This made it difficult to continued to refuse to engage with the openly discuss the child’s strengths device by shaking his head ‘no’ repeatedly and needs because there was a fear as the paraprofessional prompted him to of offending somebody. (Special Tell me what is wrong? and What do you education teacher) want? Eventually Jason was receptive to I might have come off a little too some hand over hand assistance to guide strong and made it difficult for his selection to the icon that represented some to express their opinions. I I’M DONE. During another observation, was just so worried they would when the special education teacher took brush off his needs and he the AAC device out of Jason’s locker, wouldn’t have a way to Jason bolted out of the classroom and communicate. (Jason’s mother) down the hall to avoid having to work with the device. The paraprofessional brought Jason’s frustrations with AAC. Jason back to the room and he sat at a All team members expressed many table refusing to look at the device. Jason’s positive aspects related to working with mother preferred the device be used for Jason. They explained he was usually a Jason to communicate his knowledge of very happy child who enjoyed coming to classroom academic content while the SLP school and liked most of the school day advocated for use of the device to help activities. All the team members expressed Jason interact socially with peers.
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The device was initially described their participation in the programmed by his mom and contained assessment and intervention process, things that did not motivate him to including challenges, they began to communicate. describe additional insight gained relative He didn’t really care about telling to the perspective of each team member me something was a triangle and so and how their own biases and fears may I had a hard time getting him have affected the outcome. interested in using the device and I’m sure Jason’s mom was scared ultimately, he avoided it. We need he would not receive a device. We to reprogram the device with more need to work harder to come motivating messages, but we need together as a team and solve these to all sit down and discuss the need problems. I know Jason has more to change this first (Speech- potential than we are seeing now. Language Pathologist) (Special education teacher) The school professionals explained The classroom teacher and various the purpose of the assessment had been to paraprofessionals worked to encourage “find a device” while Jason’s mother Jason to interact with the device, but he explained the purpose was to “not let the was never observed to use the device school district brush off Jason’s need for spontaneously. All team members noted it this device.” was challenging to integrate the device It was such a stressful transition throughout Jason’s day in meaningful and from the early education center to reinforcing ways. the regular school… It is hard for I was really hoping he would be parents to get used to a whole new able to use the device to tell us team of people to work with again. some important things like when he And, there is the general idea needs to use the bathroom. (Special among parents that the school will education teacher) try to spend as little money as The teachers are hoping he can tell possible, so you go into the them when he needs to use the situation already defensive. bathroom but there is so much that (Jason’s mother) goes into his ability to do that. He Toward the end of each would have to be able to anticipate participant’s series of ethnographic needing to use the bathroom before interviews, comments began to emerge it gets to a point where it is an that demonstrated a realization that the immediate need and he just hasn’t purpose of the evaluation should have shown us he can do that yet. It isn’t been to enable Jason to become a more as easy as just giving him a button effective communicator. to push. (Occupational Therapist) We got off on the wrong foot with each other and Jason’s mom. This Team Member Perseverance. Of is a good team though and now that notable importance in this study, even we’ve had time to think and talk though there were frustrations along the about what went wrong, I know we way, was the determination of the team to will be able to come up with a achieve a successful outcome. As such, better plan and Jason will become a perhaps the most interesting and important good communicator. (Occupational theme that emerged from the data was the therapist) perseverance of team members to find Final observations in the school better answers and better ways of using the setting indicated that school professionals device with Jason. As team members had developed a more specific plan of
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implementation with increased qualitative study. As such, this accountability of team members. This demonstration of the value of qualitative included improved methods of methodologies toward shaping and communication between team members improving team performance is an and better strategies for increasing the interesting and important finding. As team appeal of the device for Jason. members stepped back from their day to Specifically, the team initiated (a) monthly day roles and reflected on their meetings to discuss Jason’s progress perceptions, thoughts, and beliefs about toward goals and team member questions, Jason’s AAC evaluation and intervention, (b) use of a notebook in the classroom for they were able to identify solutions to therapists and educators to write notes to problems that had hindered successful each other regarding how implementation outcomes. The researchers of this study of the device was going, and (c) use of fun believe that the process of ethnographic messages on the device to increase interviewing in which open ended collaboration between home and school questions were asked and the participant’s such as “Last night at home we….” and own words were restated to achieve deeper another for Jason’s teacher, “Today at levels of reflection, was an important school we…” to encourage use of the contribution to the eventual more device in both environments. While Jason successful outcome. had initially avoided using the device to As demonstrated in this instance, express academic content earlier in the one of the benefits of qualitative research study, he was observed to respond design is the opportunity for participants to favorably to these new phrases and proved reflect on their experiences and begin to to be very forgiving of his initial solve their own problems. While avoidance of AAC. unfortunate that issues related to roles, responsibilities and frustrations were not Discussion initially discussed openly in team In current study, a meetings, it is reassuring to find the team multidisciplinary team completed an AAC was able to refocus around these issues evaluation and chose an AAC device they and develop common threads of thought would enable Jason to become a understanding. Particularly identified by more effective communicator. When after participants as disruptive to the team three months Jason had developed process was Jason’s mother’s feeling that aversion behaviors toward the device, this the district was trying to avoid paying for research project was initiated. Consistent an AAC device. In comparison, school with the findings of previous researchers, team members expressed the special areas identified as important to effective education director had already approved team functioning in this study included (a) funding for whatever device ended up clear delineation of roles and being recommended by the team. It is responsibilities, (b) a team culture of trust reasonable is to assume that if this where all members are able to share information been conveyed to Jason’s information, and (c) knowledge of mother, conflict and distrust might have effective AAC implementation strategies been lessened or avoided. (Bailey, Stoner, Parette, & Angell, 2006; Another important clinical Briggs, 1997; Soto et al., 2001; Stoner et implication of this study is the need to al., 2010). Unique to the current study, widely disseminate and share available however, was the finding that team resources for AAC device assessment and perseverance and ability to refocus during intervention so that teams have access to a difficult situation, was largely achieved these tools. One such resource that would through the team’s participation in this have been potentially helpful to team
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members in this instance is the professional training required for Collaborative Teaming for Students Using successful AAC assessment and AAC in Inclusion, Roles and intervention. As demonstrated by this case, Responsibilities document. This checklist time spent in developing collaborative, provides a framework for AAC teams to trusting relationships at the outset, may establish shared and individual save a great deal of time later in the professional responsibilities during AAC process. implementation across classroom integration, programming and vocabulary References support, peer interaction facilitation, maintenance, and documentation Al-sayih, F., Szafran, O., Robertson, S., (www.bridgeschool.org/transition/docs/col Bell, N., & Williams, B. (2014). lab_teaming.pdf). Nursing perspectives on factors influencing interdisciplinary team Directions for Future Research work in Canadian primary care This was an in-depth case study of setting. Journal of Clinical one team and one client. Additional studies Nursing, 23, 2968-2979. on a larger scale are needed to identify American Speech-Language-Hearing differences in experiences across teams Association. (2005). Roles and and the ways that team culture and responsibilities of speech-language knowledge affect outcomes along with pathologists with respect to strategies to overcome these difficulties. augmentative and alternative One limitation of this study was that data communication: position statement collection was initiated during the device [Position Statement]. Available implementation phase rather than during from www.asha.org/policy. the evaluation phase. The participants Bailey, R., Stoner, J., Parette, H., & provided their reflections and Angell, M. (2006). AAC team interpretations after the evaluation phase perceptions: Augmentative and was completed. It would be useful for alternative communication device future researchers to study the AAC use. Education and Training in teaming process during the initial meetings Developmental Disabilities, 41, and device trial period with a similar in 139-154. depth qualitative methodology. Baxter, S., Enderby, P., Evans, P., & AAC is a challenging but Judge, S. (2012). Barriers and rewarding area of research and facilitators to the use of high- professional practice. Research is needed technology augmentative and that expands our current understanding of alternative communication devices: the components of successful AAC A systematic review and teaming strategies with clear qualitative synthesis. International recommendations for professionals. It is Journal of Language and the belief of the researchers of the current Communication Disorders, 47, study that all individuals working to 115-129. become competent AAC communicators Beukelman, D., & Mirenda, P. (2013). will experience success, however, the Augmentative and alternative speed at which progress is experienced communication: Management of depends on multiple individual and team severe communication disorders in factors as demonstrated by this case. As children and adults. Baltimore, practitioners of AAC research and clinical MD: Paul H. Brookes Publishing practice, we must continue to advocate for Co. the necessary time, support, and
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Braun, V. and Clarke, V. (2006) Using Soto, G., Müller, E., Hunt, P., & Goetz, L. thematic analysis in psychology. (2001). Critical issues in the Qualitative Research in inclusion of students who use Psychology, 3, 77-101. augmentative and alternative Briggs, M. (1997). Building early communication: An educational intervention teams: Working team perspective. Augmentative together for children and families. and Alternative Communication, Gaithersburg, MD: Aspen. 17, 62-72. Fulmer, T. (2016). Effective Spradley, J. P. (1979). The Ethnographic interdisciplinary teams: Do we Interview. New York: Holt, really know how to build them? Rinehart & Winston. Generations, 40, 64-70. Stake, R. E. (1995), The Art of Case Study Hunt, P., Soto, G., Maier, J., Muller, E., Research. Thousand Oaks, CA: and Goetz, L. (2002). Collaborative Sage Publications teaming to support students with Stoner, J., Angell, M., & Bailey, R. augmentative and alternative (2010). Implementing communication needs in general augmentative and alternative education classrooms. communication in inclusive Augmentative and Alternative educational settings: A case study. Communication, 18, 20-35. Augmentative and Alternative Hunt-Berg, M. (2005). The bridge school: Communication, 26, 122-135. Educational inclusion outcomes Westby, C., Burda, A., & Mehta, Z. over 15 years. Augmentative and (2003). Asking the right questions Alternative Communication, 21, in the right ways, strategies for 116-131. ethnographic interviewing. The Hwa-Froelich, D. A., & Westby, C. E. ASHA Leader, 8, 4-17. (2003). A Vietnamese Interpreter’s Zorek, J., & Raehl C., (2013). Story: A Case Study. Interprofessional education Communication Disorders accreditation standards in the USA: Quarterly, 24, 86-98. A comparative analysis. Journal of Light, J., & McNaughton, D. (2013). Interprofessional Care, 27, 123- Putting people first: Re-thinking 130. the role of technology in augmentative and alternative communication intervention. Contact: Augmentative and Alternative Communication, 29, 299-309. Pam Hart, PhD, CCC-SLP Rockhurst University Light, J., & McNaughton, D. (2015). Communication Sciences and Disorders Designing AAC research and Associate Professor intervention to improve outcomes 1100 Rockhurst Road for individuals with complex Kansas City, MO 64110 communication Phone: (816) 501-4223 needs. Augmentative and Alternative Communication, 31, Note: The authors do not have any financial or 85-96. nonfinancial disclosures. NVivo qualitative data analysis Software; QSR International Pty Ltd. Version 10, 2012.
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Auditory Benefits of Computer-based Music Training
Susan E. Fulton, Ph.D., CCC-A Southeast Missouri State University
Amanda Peluso, BA University of South Florida, Tampa
Jennifer L. O’Brien, Ph.D. University of South Florida, St. Petersburg
Current research shows that musical training enhances neural and behavioral auditory skills, even in as little as 20 minutes to 5 weeks of instruction (Barrett, Ashley, Strait, & Kraus, 2013; Pantev & Herholz, 2011). A computer-based music training program may be an innovative tool for improving auditory perception and listening skills. The purpose of the current study was to examine the effects of a computer-based music training program on auditory processing abilities. Participants included 20 young adults with hearing within normal limits and no history of musical training, defined as private lessons or band/orchestra/chorus class for two years or more. Participants were randomized into either a training group or a no-train control group. The training group completed a computer-based music training program, Quaver’s Marvelous World of Music™ (www.QuaverMusic.com), for 30 minutes, 6 days a week, for four weeks. Significant improvement in scores on the Dichotic Digits Free-Recall (triple-pair test) and Adaptive Test of Temporal Resolution (across-channel condition) were found for the training group. No improvement in scores on either test was found for the no-train control group. Results suggest benefits of music training on auditory skills.
Key Words: Auditory training; Music training; Auditory perception; Listening skills
Introduction
Central Auditory Processing Disorder, or listening environments (ASHA, 2005). (C)APD, is defined by the American Individuals with (C)APD often struggle Speech and Hearing Association (ASHA) with tasks such as remembering the as a deficit in the neural processing of content of auditory instructions, processing auditory stimuli that is not due to higher- the timing of auditory stimuli, order language, cognitive, or related discriminating auditory signals from factors (ASHA, 2005). (C)APD is competing signals, and understanding characterized by problems in one or more speech presented in noise or reverberant of the following skill areas: sound acoustic environments (American localization and lateralization, auditory Academy of Audiology [AAA], 2010). pattern recognition, temporal processing, Programs for treatment following and poor auditory performance in difficult diagnosis of an auditory processing deficit are limited. Emanuel, Ficca, and Korczak (2011) surveyed 195 audiologists with expertise in (C)APD diagnosis and treatment. Environmental modifications
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(e.g., preferential seating, gaining recalling sentences, receptive language attention, and repeating or rephrasing) skills, and core language skills. were recommended most often, followed Currently, computer-based auditory by remediation tools (e.g., computer training programs provide a viable training programs, auditory closure intervention for auditory processing skills activities, and phoneme training), and remediation. Commonly used computer- finally compensatory strategies (e.g., based training programs include Listening active listening training, metamemory skill and Communication Enhancement (LACE; training, self-advocacy, organizational Sweetow & Sabes, 2006) and Brain HQ management, and context derived (Posit Science: www.BrainHQ.com). vocabulary building). Among remediation These linguistically-based programs use tools, auditory closure activities and the acoustic stimuli that range from phonemes linguistically-based computer training and single words to sentences and small program, Earobics®, were recommended paragraphs, often presented in challenging 70% of the time. Additional remediation listening situations. A need exists for non- tools recommended by (C)APD linguistic-based programs, which may be professionals include phonemic training, useful treatments for individuals with temporal training, Fast ForWord® auditory processing problems, in addition software, and prosody training. While to, or in place of, commonly utilized many management styles are available, linguistic-based training methods. many are linguistically-based and address Successful auditory training reading and phonetic skills. The selected programs must be intensive and graduated therapeutic strategy should be based on the in difficulty, with time dedicated on a individual’s unique profile of auditory consistent basis over the course of several processing strengths and weaknesses, weeks at minimum (Weihing, Chermak, & which may involve non-linguistic listening Musiek, 2015). Compliance using and skills such as prosody, temporal completing these programs varies from processing, and auditory memory. 30% (Sweetow & Sabes, 2010) to 84% The guidelines for (C)APD (Chisolm et al., 2013). Low compliance intervention (ASHA, 2005; AAA, 2010) may be due to loss of motivation (AAA, recommend that interventions include both 2010). Other critical considerations linguistic and non-linguistic activities. include the success-to-failure ratio and Linguistic activities include phoneme opportunity for immediate reinforcement. discrimination and processing target Alternative non-linguistic activities are signals in noise, while non-linguistic needed to enhance auditory function. One activities include intensity, frequency, and engaging non-traditional remediation duration discrimination, as well as activity that shows promise is music temporal gap discrimination. Non- training. linguistic remediation activities such as Research indicates that musical temporal and prosodic training are not training enhances auditory memory, commonly recommended. Sharma, Purdy, auditory discrimination, speech and Kelly (2012) used a randomized trial understanding in noise, and pitch control method to examine the effects of perception (Schon, Magne, & Besson, language-oriented, linguistic based 2004; Strait, Parbery-Clark, Hittner, & training and non-linguistic based training. Kraus, 2012). Barrett, Ashley, Strait, and Those exposed to non-linguistic training Kraus (2013) suggested that musicians showed improvement with frequency have more precise neural timing to speech discrimination and temporal pattern in quiet and noise. More robust responses perception, concepts and directions, with increased wave component amplitudes are evident, when controlling
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for attention (Pantev & Herholz, 2011). Pantev, 2008). Bangert and Altenmuller Musicians have a larger corpus callosum (2003) found adaptation in the auditory structurally, reflecting more and motor cortices of non-musicians after interhemispheric communication (Schlaug, just 20 minutes of active music playing. Jäncke, Huang, Staiger, Steinmetz, 1995a). Even passive exposure to music can There is greater connectivity with the activate attention and memory systems frontal and motor cortices, as well as (Moreno et al., 2011). training-related plasticity in the Musical training enhances skills in hippocampus, resulting in improved many of the same areas of difficulty for attention and memory (Pantev & Heholz, those with auditory processing deficits. 2011). These enhancements may be due, Given the importance of auditory in part, to the fact that music performance decoding, prosody, and integration for the requires a combination of different sensory development and maintenance of systems including auditory perception language-related skills, musical training, (hearing and accurately tuning one’s even in the short term, may be beneficial. instrument), visual perception (reading a Musical training is readily available in score), and kinesthetic control (postural schools and communities and may be an control and manual dexterity), which are untapped, engaging, inexpensive resource integrated and coordinated at a high degree to help develop auditory skills in listeners. of synchrony and accuracy. In regard to Olakunbi, Bamiou, Steward, and Luxon prosody, musicians demonstrate more (2010) suggested that musical skills may refined pitch processing (Magne, Schon, & be reflective of auditory processing Besson, 2006; Moreno & Bidelman, difficulties. Indeed, music training may be 2014). This is likely due to melody and a powerful resource to help enhance speech sharing similar acoustic auditory deficits. No studies have used a parameters, fundamental frequency/pitch randomized control method to examine the contours, and spectral characteristics. benefit of online music training on Musicians, compared to non-musicians, auditory processing skills. also have improved rhythm and pattern The auditory benefits of music detection as well as timbre specialization training, even in the short-term, are well (Barrett, Ashley, Strait, & Kraus, 2013; documented. Computer-based training Pantev & Herholz, 2011). Fortunately, programs have yielded significant musical auditory benefits are possible at outcomes. However, the effect of a any age. Enhanced processing following computer-based music program on music training programs has been auditory processing has not been observed/reported in children (Moreno, investigated. The purpose of the current 2011), young adults (Bidelman, Weiss, study was to examine how short-term Moreno, & Alain, 2014; George & Coch, training on musical themes (including 2011) and older adults (O’Brien, Nikjeh, pitch recognition, rhythm, and tempo) & Lister, 2015). affects performance on behavioral auditory Most of the literature has focused tasks in a typical hearing population. The on effects of long-term musicianship; study hypothesized that participants who however, short-term training benefits are trained with the computer-based also evident. Moreno et al. (2011) showed curriculum, Quaver’s Marvelous World of improvement in vocabulary and language Music™, would demonstrate significant abilities for participants following 20 days improvements on behavioral auditory of music training. Electrophysiologic measures (e.g., dichotic listening, temporal changes have been observed following as processing) commonly used for diagnosis little as two weeks of intense musical of auditory processing deficits. training (Lappe, Herholz, Trainor, &
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Method listener’s ability to attend to different signals presented simultaneously to each Participants ear. Testing was presented in a Whisper Twenty young adults between the Room sound-attenuated booth at a ages of 19 and 30 years (M = 23.31, SD = comfortable listening level via an 3.69) were recruited for the current study. Interacoustics Equinox audiometer using Individuals with prior musical training, ER-3A insert headphones. Two free-recall defined as private music lessons or formal conditions were tested – double pair and band/orchestra/chorus class of 2 years or triple pair digits. In the double pair more, were excluded. Additionally, condition, two single-syllable numbers are participants had no history of hearing loss, presented simultaneously to each ear, severe speech/language delays or followed directly by a second pair. In the neurological disorders. triple pair condition, a third pair is All individuals were recruited from presented directly thereafter. The listener undergraduate classes at the University of is asked to repeat, in any order, all four or South Florida (USF) Tampa and St. six numbers heard after each trial. A set is Petersburg campuses. During recruitment, scored as correct only when the listener participants were contacted by e-mail and can repeat every number correctly. Each phone, or through an online participant list consists of 25 sets of numbers. The pool. All participants signed an informed total score represents the percent correct consent in accordance with the University repeated trials. Higher scores suggest of South Florida Institutional Review better ability to process competing Board. auditory input presented simultaneously to both ears. Study Design The ATTR (Lister et al., 2006) The study was conducted on USF assesses an individual’s ability to resolve Tampa and St. Petersburg, FL campuses. acoustic changes over time. It is a During the initial testing session, a hearing computer-based test that determines the screening (15 dB at 250-8000 Hz smallest detectible silent interval between bilaterally) and baseline behavioral and two sounds, or a gap detection threshold electrophysiological data was gathered for (GDT). Pairs of narrow bands of noise are all participants. Half of the participants presented monaurally at a comfortable were assigned to the training group and listening level simultaneously with visual completed a computer-based music boxes or pictures appearing on a computer program for the four weeks, while the screen. Three sets of stimuli are presented remaining 10 participants were assigned consecutively. The first set of narrowband control no-train group for the same noises are separated by a silent interval of duration. Measures were repeated at 1 ms and serves as the reference or follow-up. Behavioral test measures standard. The following two sets each included the Dichotic Digits Free Recall contain a gap of 1 ms or a gap that (Strouse & Wilson, 1999) and the adaptively varies in size. The last two sets Adaptive Tests of Temporal Resolution vary randomly in presentation order. The (ATTR; Lister, Roberts, Shackelford, & listener must select the box on the screen Rogers, 2006). Measures were selected that represents the different set or the one based on AAA guidelines, significant containing the larger gap. There are two findings from the literature, and pilot test conditions: Within-channel and cross- research conducted by the principal channel. For the within-channel condition, investigator. both stimuli are ¼ octave noise bursts, The Dichotic Digits Free-Recall each with a 2000 Hz center frequency. test (Strouse & Wilson, 1999) assesses a
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Figure 1. Example study timeline. Behavioral measures were completed for all participants at initial and final timepoints.
dedicated to music theory, composition, The across-channel is similar in and music appreciation, as well as auditory presentation; however, the noise bursts skills training. Activities are highly have different center frequencies (2000 Hz interactive and adapt to users’ skill level before the gap and 1000 Hz following the through scaffolding. With correct gap). The test utilizes a standard adaptive responses, tasks increase in difficulty and two-alternative forced choice paradigm, with incorrect responses, tasks are made where the duration of the silent gap easier. The program provides listeners between noise bursts is varied, increasing with auditory training through use of when the selected interval is incorrect and musical games, videos, and creative increasing in size when the selected activities. Participants in the training interval is correct. The psychophysical group were instructed to visit the website procedure targets a 70.0% correct gap six days a week for four weeks. The detection threshold. principal investigator assigned specific at- home assignments, which lasted Music Training approximately 30 minutes each day – 15 Participants were randomly minutes in listening activities and games assigned to a training group or a no- and 15 minutes composition for keyboard, training control. The training group was guitar, and percussion. Listening given access to an interactive computer- assignments included interval comparison, based music program through Quaver’s chord imitation, and pitch comparison Marvelous World of Music™ exercises as well as instrument (www.QuaverMusic.com). Quaver Music identification and rhythm, genre, timbre, meets standards for music education and tempo training videos. Assignments through the National Association for were logged through QuaverMusic.com Music Education as well as the National and monitored by the principal investigator Coalition for Core Arts Standards. It has a to ensure all training was completed as customizable curriculum geared toward instructed. The control group did not children in kindergarten through grade complete the training during the four-week eight. The program consists of modules wait period, but received the same pre- and post-testing.
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Results revealed no significant difference Behavioral test scores and average in pre-test scores. Pre-test scores (above) were determined for pre- and post-training and post-test scores (No-train: M = 51.20, sessions. All data was analyzed in IBM SD = 14.94, Train: M = 77.00, SD = 14.64) SPSS Statistics Version 24 (IBM, 2016). were analyzed using a 2-factor repeated An alpha level of 0.05 was used. Behavioral measures ANOVA with one within- test scores and average were determined for subjects variable (time) and one between- pre- and post-training sessions. All data subjects variable (group). Results showed was analyzed in IBM SPSS Statistics a significant effect of time [F(1,18)=5.40, Version 24 (IBM, 2016). An alpha level of p=0.032] and a significant interaction 0.05 was used. between testing time and group [F(1,18)=19.07, p=0.001]. Follow-up Dichotic Digits paired samples t-tests revealed that while Pre-test Dichotic Digits (double- the control group did not change between pair) test scores (No-train control M = pre- and post- testing, the musically 86.60, SD = 9.807; Train: M = 87.60, SD = trained group improved significantly 11.47) were analyzed using an [t(8)=4.41, p=0.002], suggesting the independent t-test. Results revealed no intervention for the music group significant difference between groups at contributed to task performance (Fig. 2). baseline, indicating similar group performance before the intervention. Pre- test scores (above) and post-test scores (No-Train control M = 87.60, SD = 9.69; Train M = 94.00, SD = 6.39) were analyzed using a 2-factor repeated measures ANOVA with one within- subjects variable (time) and at one between-subjects variable (group). Results showed no significant effects of time or group or interaction between the two, indicating no music training effect. Pre-test Dichotic Digits (triple- pair) test scores (No-train control M = 56.00, SD = 12.78, Train: M = 59.50, SD = 16.06) were also analyzed using an independent samples t-test. Again, results
Figure 2. Results from the dichotic digits, triple pair task. Performance in percent correct is displayed as a function of group membership. Error bars denote standard errors of the mean. Asterisks denote significant improvement (p<0.01).
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Table 1. Pre-test ATTR scores for within- and across-channel conditions. Within-Channel Across Channel Group RE LE RE LE No-Train 5.7 ms 5.8 ms 32.2 ms 31.0 ms (SD = 3.2) (SD = 3.9) (SD = 15.6) (SD = 11.1) Train 4.6 ms 5.3 ms 39.1 ms 37.0 ms (SD = 1.9) (SD = 4.0) (SD = 17.9) (SD = 13.6)
Table 2. Post-test ATTR scores for within- and across-channel conditions. Within-Channel Across Channel Group RE LE RE LE No-Train 5.3 ms 5.6 ms 32.4 ms 29.0 ms (SD = 3.0) (SD = 5.1) (SD = 17.0) (SD = 11.2) Train 3.5 ms 3.5 ms 30.5 ms 27.8 ms (SD = 3.4) (SD = 1.9) (SD = 21.8) (SD = 13.7)
Figure 3. Gap detection threshold (in milliseconds) for the across-channel condition of the ATTR. Separate ear data is displayed by group membership. Lower gap detection threshold scores indicate better performance. Error bars denote standard errors of the mean. Asterisks denote significant improvement (p<0.05).
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Adaptive Test of Temporal Resolution Dichotic Digits task and across-channel (ATTR) ATTR. As a reminder, lower scores on the Although no training effect was ATTR indicate smaller gap detection observed for the Dichotic Digits double-pair thresholds and overall better performance. In task, performance at baseline approached addition, gap detection thresholds are typically ceiling levels and would not permit a much smaller for within-channel conditions significant change after the intervention. compared to across-channel conditions (Lister, Baseline scores for the triple-pair test for both Roberts, Krause, DeBiase, & Carlson, 2011). groups were worse overall when compared to A Multivariate Analysis of Variance the double-pair condition, indicating increased (MANOVA) was completed to assess pre-test difficulty of the task. While the control and scores for both within-channel and across- music groups did not statistically differ at channel ATTR conditions. No significant baseline, recall performance increased for the results were found for either condition, train group after the computer-based musical indicating similar performance across and training. This was statistically significant, within groups (No-Train, Train) and across indicating that the music training group had and within ears (RE, LE) before music improved binaural integration abilities. As training. See Table 1 for all pre-test scores. such, musical training impacted participant’s A repeated measures MANOVA was performance and enhanced their ability to completed for the within-channel condition integrate and remember triple-pair digits. scores (see Table 2), with one within-subjects Gap detection thresholds in the ATTR variable (time) and two between-subjects are typically smaller for within-channel than variables (group and ear). No significant across-channel conditions and are often not differences were found, indicating no music well correlated (Lister et al., 2006). Data from training effect pre- versus post-test for either this study are in agreement. It is suspected that group (No-train, Train) or ear (right, left). the two gap detection conditions are processed The same analysis was completed for the by different channels (Lister et al., 2011). across-channel condition scores (see Table 2). Although no significant results were observed The time by group interaction approached for the within-channel condition pre-versus significance, F(1,18)=4.05, p=0.059, and a post-training, there was a statistically significant effect of time was found significant finding for the more difficult cross- [F(1,18)=4.76, p=0.043]. Data were further channel condition. For the left ear, the analyzed, separating ears for comparison. musically-trained group showed a significant Paired samples t-tests revealed only one reduction in gap detection threshold size statistically significant finding: A reduction in following intervention, suggesting that short- gap detection thresholds was observed for the term online music training may improve left ear after the intervention, t(8)=3.45, temporal resolution. p=0.009, but not for the right ear (p=0.380) The findings are promising in showing (Figure 3). that music may be a valuable resource for improving specific auditory processing skills, Discussion however more research is needed. Many different Central Auditory Processing Disorder This study sought to bring together test batteries exist and are used to diagnose two lines of research: auditory processing auditory processing abilities within the interventions and the benefits of music American Speech and Language Association’s training. It was hypothesized that typical- definition of (C)APD. The benefit of online hearing listeners who complete a computer- music training for other common behavioral based training on musical themes would auditory processing measures needs to be perform better on auditory listening tasks examined. In addition, it would be valuable to typically used in diagnosis of (C)APD. use other test paradigms such as the complex Results suggest that a computer-based musical Auditory Brainstem Response (c-ABR; training program has the potential to improve Rocha-Muniz, Befi-Lopes, & Schochat, 2012; auditory processing abilities, as evidenced by Skoe & Kraus, 2014; Tierney, Krizman, Skoe, the significant findings for the triple-pair Johnston, & Kraus, 2013), or mismatch negativity response (MMN; Moreno &
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Bidelman, 2014; Putkinen, Tervaniemi, References Saarikivi, Ojala, & Huotilainen, 2014) to determine if neural changes with an online American Academy of Audiology. (2010). music intervention are possible and repeatable. Clinical practice guidelines for the Quaver Music.com™ was designed for diagnosis, treatment, and management elementary and middle school-aged children, of children and adults with central while the study sample was composed of auditory processing disorder. college-aged students. Despite positive Available from feedback regarding the music training program www.audiology.org/resources/docume and subjective reports that the ntlibrary/Pages/CentralAuditoryProces creatives/composition section was interactive singDisorder.aspx and enjoyable, the intervention was likely too American Speech-Language-Hearing easy for the participants’ age range. This Association. (2005). (Central) auditory study should be completed with younger processing disorders [technical participants to target the intended population report]. Available from of the Quaver Music curriculum. Also, www.asha.org/policy training parameters could be redefined for Bangert, M. & Altenmuller, E.O. (2003). better results. Future research could Mapping perception to action in piano investigate the benefits of different session practice: a longitudinal DC-EEG lengths and identify the ideal number of weeks study. BMC Neuroscience, 4(26), 1- and total number of hours trained. The current 14. study design included 12 hours of training Barrett, K.C., Ashley, R., Strait,D.L., & Kraus, over the course of 4 weeks. Overall, the N. (2013). Art and science: How literature suggests that larger improvements musical training shapes the brain. occur when musical training takes place over a Frontiers in Psychology, 4(713), 1-13. longer period (Bidelman et al., 2014). Bellis, T. J. & Anzalone, A.M. (2008). Inclusion of a subjective outcome measure Intervention approaches for may assist in tailoring the administration of individuals with (central) auditory training. Finally, future test sessions should processing disorders. Contemporary employ experimenter blinding to group Issues in Communication Sciences and membership. This could reduce bias and Disorders, 35, 143-153. prevent a possible Rosenthal Effect where the Bellis, T.J. (2003) Assessment and experimenter unintentionally influences management of Central Auditory results. Processing Disorders in the The literature has demonstrated that educational setting. Science to nd music training enhances skills in many of the Practice, 2 Edition. New York: same areas in which people with (C)APD Delmar Learning. struggle. Given the importance of auditory Bellis, T.J. (2002) When the brain can’t hear: attention for the development and maintenance Unraveling the mystery of Auditory of language-related skills, musical training Processing Disorder. New York: may aid in the prevention, habilitation, and Pocket Books. remediation of individuals with a wide range Bidelman, G.M., Weiss, M.W., Moreno, S. & of auditory processing deficits. However, Alain, C. (2014). Coordinated further research is necessary to determine if a plasticity in brainstem and auditory music intervention such as Quaver’s cortex contributes to enhanced Marvelous World of Music is effective in categorical speech perception in treating this population. Further research is musicians. European Journal of needed to determine if an effective computer- Neuroscience, 40(4), 2662-2673. based music training program can be doi:10.1111/enj.12627 recommended as a management strategy in the Brainhq.com/Retrieved December 25, 2017, clinical setting for patients diagnosed with from https://www.brainhq.com/ auditory processing difficulties. Chisolm, T. H., Saunders, G.H., Frederick, M.T., McArdle, R.A., Smith, S.L. & Wilson R.H. (2013) Learning to listen again: The role of compliance in
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auditory training for adults with better than nonmusician children: hearing loss. American Journal of Behavioral and electrophysiological Audiology, 22(2), 339-342. approaches. Journal of Cognitive Earobics: Auditory development and phonics Neuroscience, 18(2), 199-211. program [Computer software]. (1997). Moreno, S. & Besson, M. (2006). Musical Cambridge, MA: Cognitive Concepts. training and language-related brain Emanuel, D.C., Ficca, K.N. & Korczak, P. electrical activity in children. (2011). Survey of the diagnosis and Psychophysiology, 43(3), 287-291. management of auditory processing doi:10.1111/j1469-8986.2006.00401 disorder. American Journal of Moreno, S., Bialystok, E., Barac, R., Audiology, 20(1):48-60. Schellenberg, E.G., Cepeda, N.J., & doi:10.1044/1059-0889 Chau, T. (2011). Short-term music Fast ForWard: Reading and Language training enhances verbal intelligence Intervention Program (2017). and executive function. Psychological Oakland, CA: Scientific Learning Science, 22(11), 1425-1433. Corporation. doi:10.1177/0956797611416999 George, E.M. & Koch, D. (2011). Music Moreno, S. & Bidelman, G.M. (2014). training and working memory: An Examining neural plasticity and ERP study. Neuropsychologia, 49(5). cognitive benefit through the unique 1083-1094. lens of musical training. Hearing doi:10.1016/j.neuropsychologia.2011. Research, 308(2014), 84-97. 02.001 doi:10.1016/jheares.2013.09.012 IBM Corp. Released 2016. IBM SPSS O’Brien, J.L. Nikjeh, D.A. & Lister, J.J. Statistics for Windows, Version 24.0. (2015). Interaction of musicianship Armonk, NY: IBM Corp. and aging: A comparison of cortical Katz, J. (1993). Central Auditory auditory evoked potentials. Processing: The Audiologic Behavioural Neurology, 2015, 1-12. Contribution. Seminars in Hearing, Olaknubi, D. Bamious, D.E., Steward, L. & 14(2), 191-199. Luxon, L.M. (2010). Evaluation of musical skills in children with a Lappe, C., Herholz, S.C., Trainor, L.J. & diagnosis of auditory processing Pantev, C. (2008). Cortical disorder. International Journal of plasticity induced by short-term Pediatric Otorhinolaryngology, 74(6), unimodal and multimodal musical 633-636. training. Journal of Neuroscience. doi:10.1016/j.ijporl.2010.03.008 Pantev, C., & Herholz, S.C. (2011). Plasticity 28(39): 9632-9639. of the human auditory cortex related doi:10.1523/JNEUROSCI.2254- to musical training. Neuroscience & 08.2008 Biobehavioral Reviews, 35, 2140- Lister, J.J, Roberts, R.A., Krause, J.C., 2154. DeBiase, D. & Carlson, H. (2011). An doi:10.1016/j.neubiorev.2011.06.010 adaptive clinical test of temporal Putkinen, V., Tervaniemi, M., Saarikivi, K., resolution: Within-channel and across- Ojala, P., & Huotilainen, M. (2014). channel gap detection. International Enhanced development of auditory Journal of Audiology, 50(6): 375-384 change detection in musically trained doi: 10.3109/14992027.2010.551217 school-aged children: A longitudinal Lister, J.J., Roberts, R.A., Shackelford, J., event-related potential study. Rogers, C.L. (2006). An adaptive Developmental science. 17(2), 282- clinical test of temporal resolution. 297 American Journal of Audiology, 15(2), Quaver's Marvelous World of Music. 133-140. doi:1059.0889/06/1502-0133 Retrieved December 27, 2017, from Magne, C., Schon, D., & Besson, M. (2006). http://www.quavermusic.com Musician children detect pitch Rocha-Muniz, C.N, Befi-Lopes, D.M., & violations in both music and language Schochat E. (2012). Investigation of auditory processing disorder and
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language impairment using the Strouse, A., & Wilson, R. H. (1999). speech-evoked auditory brainstem Recognition of one-, two-, and three- response. Hearing Research. 294, pair dichotic digits under free and 143-152. directed recall. Journal of the doi:10.1016/jhears.2012.08.008 American Academy of Audiology, Schlaug, G., Jäncke, L., Huang, Y., Staiger, 10(10), 557-571. J.F., & Steinmetz, H. (1995a). Sweetow, R.W. & Henderson Sabes, J. (2010). Increased corpus Auditory training and challenges callosum size in musicians. associated with participation and Neuropsychologia 33, 1047–1055 compliance. Journal of the American Schon, D., Magne, C., & Besson, M. (2004). Academy of Audiology, 21(9), 586- The music of speech: Music training 593. doi:10.3766/jaaa.21.9.4 facilitates pitch processing in both Sweetow, R. W., & Sabes, J. H. (2006). The music and language. need for and development of an Psychophysiology, 41, 341-349. adaptive Listening and doi:10.1111/1469- Communication Enhancement 8986.00172.(Sharma, Purdy, & Kelly, (LACE) Program. Journal of the 2012) American Academy of Audiology, 17, Sharma, M., Purdy, S. C., & Kelly, A. S. 538–558. (2012). A randomized control trial Tierney, A., Krizman, J., Skoe, E., Johnston, of interventions in school-aged K., & Kraus, N. (2013). High school children with auditory processing music classes enhance the neural disorders. International Journal of processing of speech. Frontiers in psychology, 4(855), 1-7. Audiologyl, 51(7), 506-518. doi:10.3389/fpsych.2013.00855 doi:10.3109/14992027.2012.67027 Weihing, J., Chermak, G.D., & Musiek, F.E. 2 (2015). Auditory training for Central Skoe, E. & Kraus, N. (2014). Musical training Auditory Processing Disorder. heightens auditory brainstem function Seminars in Hearing, 36(04), 199-215. during sensitive periods in doi:10.1055/s-003501564458 development. Frontiers in psychology. 4(622), 1-15. doi:10.3389/fpsyg.2013.00622 Contact: Strait, D.L. & Kraus, N. (2011). Can you hear Susan Fulton, Ph.D., CCC-A me now? Musical training shapes Southeast Missouri State University functional brain networks for selective 1 University Plaza auditory attention and hearing speech Mailstop 2600 in noise. Frontiers in Psychology. Cape Girardeau, Mo. 63701 2(113), 1-10. [email protected] doi:10.3389/fpsyg.2011.00113 Strait, D.L. & Kraus, N. (2013). Biological impact of auditory expertise across the Disclosures: This article was based on an life span: Musicians as a model of Audiology Doctoral Project by the second author auditory learning. Hearing Research, in the Department of Communication Sciences and 308(2014), 109-121. Disorders at the University of South Florida. doi:10.1016/j.heares.2013.08.004 Research was sponsored by a USF Internal Awards Strait, D.L., Parbery-Clark, A., O’Connell, S., Program, New Research Grant. Quaver Music allowed full access to their educational website for & Kraus, N. (2013). Biological impact training used in the study. None of the authors have of preschool music classes on intellectual or financial associations with Quaver processing speech in noise. Music. Developmental cognitive neuroscience 6, 51-60. doi:10.1016/j.dcn.2013.06.003
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Research
Effective teaming in AAC: A qualitative case study 8 Pamela Hart and Julie Scherz
Auditory Benefits of Computer-based Music Training 21 Susan Fulton, Amanda Peluso, and Jennifer L. O’Brien