Therapeutic Listening & Severe Hearing Impairment
Belle
Belle was a bright four-year-old with a severe hearing impairment. She communicated primarily through sign language, and this was an ongoing struggle for her. Often, in frustration, she would act aggressively towards herself or others by biting, pinching, kicking, hitting, or pilling hair. Belle also struggled with regulation of her sleep-wake cycle and experienced frequent night waking, up to four times a night. Belle was frequently on-the-go and strongly preferred movement activities over stationary ones. She also constantly sought oral input by mouthing, biting, or chewing objects.
At the start of her OT evaluation, Belle was quite shy and needed support and reassurance from her mother to participate in activities. Initially, she only referenced her mother and did not make direct eye contact with the therapist. Belle moved quickly from one activity to another. The longest she stayed with a single activity was 20 seconds, and most ranged between five and ten seconds before she was eager to transition to something new. She abandoned any activity as soon as it became challenging, and once she was ready to quit an activity it to ok extended coaxing to get her to repeat it. Vestibular input triggered Belle’s attention, so her therapist attempted to engage her with a variety of swings and suspended Lycra activities. However, these did not settle or calm her in any way. Although she frequently hung upside down from the ropes in the clinic, Belle startled when she was bounced backwards in the suspended Lycra and immediately tried to flee.
Belle had poor balance between flexion and extension on the scooter board and had difficulty maintaining an upright posture on the tire swing; she hugged the swing, keeping her trunk in full contact with it and her head in extension. In addition, her overall movement patterns were dominated by symmetry. For example, when she was maneuvering herself out of large pillows on the floor, there was a complete lack of rotation through her trunk. Relying solely on symmetrical movement patterns meant she could only orient to those people or objects directly within her line of sight and in “near space” (within three to five feet of her).
Belle’s startle to backwards movement suggested that she was insecure, not with gravity, but with backwards space. She was comfortable having her feet leave the ground and her head moving in all places, except backwards. These things, in addition to her drive to hang upside down, suggest a picture of “spatial insecurity” rather than a true gravitational insecurity.
After Listening
When a spatially-enhanced CD was played over open speakers, Belle’s posture immediately became more upright in the tire swing. Soon she was fully erect with her arms extending from her body to hang onto the swing. She began playing with different postural movements on the swing. For the first time, she oriented to people and things in “far space” (i.e., beyond five feet). She began making eye contact with all people in the clinic, waving to them as she swung around. She also demonstrated more trunk rotation as she oriented to people and objects outside of her visual field. In addition, Belle appeared to be calmer and had improved attention.
When putting headphones on for the first time, Belle immediately oriented to the music. Her entire body stilled and her eyes moved back and forth from right to left as she listened intently. While listening, Belle was able to sustain attention to activities for much longer periods of time and no longer quickly moved from one activity to another. This was observed in the tire swing where she remained for 12 minutes compared to the initial 5-20 duration. During listening, Belle made several attempts at language, using intonation and longer strings of words. She also attempted to coordinate pushing and pulling to propel a platform swing. She even used trunk rotation on the swing to notice the therapist sitting behind her.
After listening, Belle began a more organized process of selecting activities. She relayed her interest to the therapist, searched for the needed equipment, and helped set up the space for the activity. She appeared more aware of the space around her. At one point she cleared a number of therapy balls out of the way that would have impeded her on the scooter board.
Therapeutic Listening ignited Belle’s postural muscles, and she began to show an internal drive for mastering skilled activities such as the scooter board and climbing in the Lycra. She remained prone on the scooter board for 11 seconds and supine for 15 seconds at a time. Although she continued to have difficulty with head/neck flexion and repeatedly fell off, Belle clearly wanted to master this activity, and she persevered with it for a total of four minutes. In the Lycra, Belle was able to climb from layer to layer, with assistance, all the way to the top. She remained in the top layer and bounced for a while before climbing down. She clearly enjoyed the challenge of climbing and was no longer bothered by backwards head movement.