Archive for Therapeutic Listening

Therapeutic Listening: It’s Not Just About Sound

May 3, 2009 Rachel Dyspraxia, Hearing, Occupational Therapy, Sensory Processing Disorder (SPD), Sensory Processing Issues, Therapeutic Listening, Vestibular System, Visual/Spatial Skills

Last week, my OT gave me some written information explaining how neuro-typical people process sound and why Therapeutic Listening might be helpful to people with sensory processing issues. One of the articles, A Brief Introduction to Therapeutic Listening, Vital Links 2006, was especially helpful. I’ll do my best to summarize the information from that article and to share my responses. 

Listening: It’s Not Easy
Reading about how neuro-typical people take in and interpret sound gave me a profound sense of the difficulties that Aspies have with auditory stimuli.

Both consciously and unconsciously, human beings constantly monitor the auditory environment. It’s a basic survival skill. For a neuro-typical person, the process of locating and selecting which sounds merit investigation is largely unconscious. Therefore, other pathways in the brain are free to perform other functions. On a conscious level, a neuro-typical person takes the auditory information the brain has unconsciously selected, listens to it, makes choices about which sounds have priority, and interprets these sounds accordingly.

This basic neuro-typical process feels quite foreign to me. I’m not sure how much unconscious locating and selecting I do with sound. Very little, it seems. No wonder I get so tired! Some of the other pathways in my brain can’t attend to other things because my unconscious doesn’t give them a break. Almost all my processing is conscious. It feels like the only unconscious responses I give to sound are to defend against it or to become very unnerved by it.

For me, all sounds come in at a very similar volume (and thus seem to have a similar level of importance), and when I attempt to locate sound, I often look in the wrong place. For instance, this morning, two guys were on our roof fixing our chimney, and they were having a conversation. I was outside, on the other side of the house, and I could hear some of the words. For about a half hour, I was sure that the sound was coming from the apartment on my right, when it was actually coming from my house on my left!

As for consciously attending to some sounds, but not to others—under most circumstances, I can’t. I just give my attention to all of them. Sometimes, when I listen to many people talking at once, I hear a jumble of words in which I can glean different phrases, but I can’t put the meanings together. At other times, the sound of many people talking just comes into my brain as undifferentiated noise.

I can prioritize and select sounds only in very structured environments. The purpose and the organization of the group have to be clear. For example, at my karate dojo, I gave most of my attention to my sensei, since she was my teacher and kept the group focused. In well-facilitated business meetings, with clear agendas, I was able set priorities about where to put my attention. At the store where I work, I was once able to attend to one conversation rather than another, but only because the space was very big and otherwise quiet.

Even in the most structured situation, however, I find that listening and keeping up with the flow of the conversation is very hard work.

How Our Ears Work: The Cochlear and Vestibular Systems
Remember in high school, when we learned about the inner ear? I remember the cochlea, which looks like a snail shell and controls hearing. But there is more to the story. The inner ear also consists of three semicircular canals, plus the utricle and the saccule, all of which constitute the vestibular system—the system that controls movement, balance, and spatial orientation. Not surprisingly, the cochlear and vestibular systems are intimately connected. Our bodies use the same (amazingly tiny) osseous labyrinth for both systems. In fact, the cochlear and vestibular systems use the same cranial nerve for sending information to the brain, and they exchange information all along their neurological pathways.

During my sensory assessment, it became clear that in addition to my difficulties filtering auditory input, I have deficits in each facet of my vestibular system: movement, balance, and spatial orientation. I have moderate dyspraxia when performing tasks that involve balance and moving my body through space. For instance, I had a lot of difficulty learning different forms in karate. I would have to draw them out visually and then memorize the pattern. My sensei would keep urging me to just feel each form in my body, but it was very difficult. Sometimes, she would even have us do katas with our eyes closed, just to help us feel the forms inside us. Unfortunately, these exercises generally resulted in my becoming frustrated and rooted to the floor. It was either that or become completely dizzy and fall down.

As for spatial orientation…What spatial orientation? If you need directions to anywhere in the world, just send me an email. If I tell you to go left, you should go right. If I tell you to head due east (wherever that is), you should head due west. It works like a charm (except for those random, statistically insignificant moments in which I am correct).

In the final analysis, the cochlear system, which allows us to hear, is also involved with spatial orientation. Hearing allows us to become oriented to the world around us, while the vestibular system gives us information about where we are on the ground. Since both hearing and spatial orientation are basic survival skills, it should come as no surprise that those of us with auditory and vestibular deficits feel pretty anxious and disoriented. A lot.

Isn’t it a relief to know that these feelings have their origins in our neurology, rather than in some deep, dark, psychological abyss? It is for me.

How Does Therapeutic Listening Work?
Since I have problems with my auditory and vestibular systems, I was very happy to learn that Therapeutic Listening works by engaging both.

At the moment, I am listening to the “modulated” CDs. I loved the Mozart for Modulation CD, and I’m currently working with a modulated Vivaldi CD. The people who create these CDs pass the music through a filter. Sometimes the higher frequencies are allowed to come through; sometimes the lower frequencies are allowed to come through. This type of modulation exercises both the auditory and vestibular portions of the inner ear. It also works the middle ear muscles that help control our ability to attend to our auditory environment and to organize sensory data. In general, these benefits should result in better overall sensory processing and self-modulation.

At present, I’m listening to my CD for 20-30 minutes, twice a day. I’ll do so for a minimum of 10-12 weeks. Some people continue the therapy for six months or more, and others make the therapy an ongoing part of their sensory diet. I hope that the therapy is effective for me, and that I’ll be able to include it in my sensory diet. I thrive on consistency, and besides, I really love the music.

Ultimately, the purposes of Therapeutic Listening are to help me use more than one sense at a time, to reduce auditory overload, and to improve the deficits in my vestibular system. To get used to multitasking, I engage in movement while listening to the CD. Generally, while I listen, I wash dishes, fold laundry, do my artwork, or work in the garden. When I’m not listening to the CD, I do activities that engage both my auditory system (such as singing) and my vestibular system (such as rocking, walking, or bicycling).

Walking, biking, and gardening also provide joint compression and reduce stress. I’ve even noticed myself toe-walking lately. Because Therapeutic Listening is hard work for my body, it’s important to have these kind of grounding activities.

Is There a Down Side to Therapeutic Listening?
At the moment, for me, there seems to be one. I’ve been getting a lot of migraines. Fortunately, I’ve figured out why. I’m resisting using more than one sense at a time. When I’m listening to the CD and making my lunch, the combination annoys me.

Okay, it doesn’t just annoy me. It makes me irritable. Being an Aspie, I’m just not wired to multitask. Using one sense at a time allows me to focus on a project and to enjoy the process. I get so much accomplished that way. I love it. And I’m beginning to love that part of myself that keeps working, and working, and won’t let go until something beautiful comes out of it.

But I also want to be in the world. Being at home gives me much needed solitude and respite, but I lose perspective when I’m alone for too many days on end. Besides, I find people very interesting, and I like them, and I like helping them. And then, of course, I would also like to re-engage basic survival skills, like buying my food at the grocery store, without it wiping me out for the rest of the day.

To be able to do these things, I have to learn to use more than one sense at a time. So, instead of long, measured strides, I’m taking baby steps. Baby steps! At my age. With my education. And my work experience. And my talents. And all those other things I’ve used to mask my utter confusion in life.

Baby steps. Okay. I’ll try it.

© 2009 by Rachel Cohen-Rottenberg

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Music and My Fifth OT Visit

April 27, 2009 Rachel Occupational Therapy, Sensory Processing Disorder (SPD), Sensory Processing Issues, Therapeutic Listening

Note: For posts about previous visits, including my sensory assessment, see the Occupational Therapy category, to the right of this post.

My OT rocks! I am so lucky.

I drove down to my OT appointment this afternoon on about 4 1/2 hours of sleep. I had gone to bed reasonably early, but then woke up at 3:45 am and couldn’t get back to sleep. Instead of fretting about it, I meditated awhile, thought about what I’d like to do with the day, and tried to relax till daybreak. Then, I got my daughter up for school and, once she was on her way, decided to do some joint compressions by going out into my front yard at 7 am and digging up what’s left of the grass. Very therapeutic. An hour and a half later, I had breakfast and then worked out on my bike. Also very therapeutic.

Then, just before I left for my appointment, I had a nice talk with a neighbor about the work I was doing in the garden. The talk didn’t last for more than 10 minutes, so I actually succeeded in keeping track of the entire conversation. I like it when that happens.

Finally, I got in the car and drove for an hour to my appointment. I was really looking forward to going. Why? Because my OT rocks!

Oh, right, I already said that. Well, here’s why she rocks:

1. She is friendly in a genuine way.
2. She has a great sense of humor.
3. She is sensitive to my sensory needs.
4. She knows how hard I work just to get through the day.
5. She wants to know how I’m doing.
6. She is very practical.

This list is not exhaustive, but hey, I don’t have all the time in the world here, and I’m trying to learn brevity. (How am I doing so far?)

It seems like nearly everything we did today involved music, which was wondrous.

But first things first: When I got there, she asked me what I needed in order to ground, and before she even got the words out of her mouth, I said, “Thumper!” (Quirky Mom, you might want to skip the rest of this paragraph.) She used that divinely inspired machine on my back, and this time, I could feel the vibrations in my nasal cavities and in my lips. Pure heaven.

Then, she asked me how the Therapeutic Listening was going. I really love the Mozart for Modulation CD, but found that I’ve been getting a lot of migraines lately. She thought it might have to do with the fact that I sometimes listen for more than a half hour at a time. When I’m out gardening, I lose track of time and have probably listened to the CD for 45 minutes to an hour in one session. The music is really working my ears, so even though I don’t feel like I’m working hard, I am. She said that for the next two weeks, I should start by listening to the CD for 20 minutes, twice a day, once while resting and once while being active (doing chores, having dinner, and so forth). I’m supposed to increase my listening time by 2-3 minutes every 1-2 days.

That sounded good. Then, I got to choose a new CD. I started by listening to one that had children’s songs on it. It was kind of sweet and appealed to the childlike Aspie aspects of my soul, but when the alphabet song started, my brain got really hooked on the letters. The whole point of the exercise is to listen to the CD without fully concentrating on it. In other words, the point is to multi-task. If I get hooked on the letters, I’m giving the music too much attention.

So she gave me another CD, one with water and dolphin sounds, along with some sort of music in the background. It drove me nuts. The music had no center. I don’t know why some people find that relaxing, because it makes me want to cry.

My OT said we didn’t have a lot more choices for this stage in my Therapeutic Listening life, but perhaps I’d like a Vivaldi for Modulation CD? OMG! Heaven. Absolute heaven. I love Vivaldi with a passion. So I was a happy camper. I listened to Vivaldi while my OT asked me a lot of questions about other parts of my sensory diet. I’ll share a little about that.

I love working out on my bike and singing with the Annie Lennox Medusa CD. It’s a 45-minute CD, and I listen to it twice. I’m noticing that my singing voice is getting much stronger and clearer, and that I’m singing with more of my body. It feels great. My husband loves the CD too, so sometimes, he’ll come in and do paperwork and sing with me. It’s way fun.

I’ve also relearned Torah cantillation, and have been choosing random portions of Torah to chant every couple of days. It makes me feel really great to know that I can just pick up any passage and follow the cantillation marks without much trouble. When my husband and I were leading services, I would prepare a Torah portion, and it always felt like a lot of pressure. Now that I’m doing things for my own enjoyment, they’re much more fun. I’m not chanting Torah in preparation for any kind of public gathering. I’m just chanting because I love it. In Jewish tradition, it’s customary to rock back and forth when you’re chanting or praying, so I get to do movement that feels very natural to me.

A few weeks back, I xeroxed some lines from Torah and put them on a door in the kitchen. There are three groups of words. I have to look up to see one, I have to look directly in front of me to see another, and I have to look down to see the last one. My task is to start from 10 feet away, chanting from the top, while walking forward and backward. Kind of like walking and chewing gum, except harder. I had been practicing this exercise a few weeks ago, and the OT said to reinstate it. I enjoyed the exercise before, so that will be fun as well.

So, there you have it. I left the appointment feeling very relaxed and focused. On my way home, I even had the energy to stop at a store that sells perennials. I bought a few (okay, eight) to bring home and plant. When I got home, I was quite tired, but lying down didn’t help, so I went back out and attacked the remaining grass in my front yard. It is now gone. Time to start planting the garden!

© 2009 by Rachel Cohen-Rottenberg

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Therapeutic Monday

April 20, 2009 Rachel Hearing, Occupational Therapy, Sensory Processing Disorder (SPD), Sensory Processing Issues, Therapeutic Brushing, Therapeutic Listening

The Therapeutic Listening program is going very well for me, and I’ll share some experiences below. At the end of my post, I’ll also have some information about a possible alternative to Therapeutic Brushing.

But first, today’s visual.

To explain the difference between how neuro-typical people and Aspies handle sensory input, Tony Attwood employs the images of a bucket and a cup. Our neuro-typical friends, he says, have a sensory bucket, capable of holding a great deal of sensory information. Those of us on the spectrum, however, have a much smaller vessel—a cup, which gets filled a teensy-bit more quickly.


Just before Passover, my husband made an offhand comment about my sensory vessel being a thimble. At work the next day, I just happened to run across a very nice ceramic thimble. I put it on our seder table as a reminder. So here is my sensory vessel, photographed next to a very small bottle cap for scale.

And now, onto the therapeutic ways I am attempting to replace a thimble with a cup.

Therapeutic Listening
So far, I am able to listen to the CD for 30 minutes/day while lying under my weighted blanket. I generally fall into a deep sleep after a half hour of listening, and I wake up an hour later wondering what day it is. I don’t think that’s the primary purpose of the exercise, but I appreciate it nonetheless.

In terms of intended effect, I am seeing some small progress already. For example, at work the other day, I was looking at some clothing. To my left, a staff person was talking excitedly with a friend she hadn’t seen for awhile. To my right, a man was laughing loudly over an outfit that two women wanted him to put on. I had the following reactions:

1. I was not jarred or annoyed by the man laughing loudly, even though he was only about 6 feet away from me. In fact, I smiled to myself. Weird, but true.

2. I did not experience both conversations in stereo. I tuned out the first conversation because I was enjoying the laughter in the second conversation.

These responses are highly unusual. I generally get very irritated by loud people. And it’s almost always impossible for me to tune out one conversation in the service of another. I was able to do so at the store because only two conversations were going on in an uncrowded space. With more people, in closer quarters, all talking at once, I still hear everything at the same volume—the one marked “Very High, and Why Do You Look So Alarmed?”

I also noticed that I was able to pick out a line from song that I’d been listening to for weeks. I have a terrible time hearing song lyrics, but all of a sudden, this one line just sounded loud and clear. Kinda cool.

In general, I’m becoming more aware of the effect of sound on my nervous system. Usually, I’m so fascinated by visuals that I don’t really notice my body’s response to sound until I’m overloaded. But yesterday, when my husband and I were going out shopping, something changed. As we were walking down the street, four guys driving VERY LOUD Harleys drove past us and gunned their engines as they were idling. (Don’t you hate that?) My first response was to feel very angry, as though they were gunning their engines just to piss me off. Then, I noticed that my ears and head felt assaulted, and that my stomach was churning. After the motorcycles were gone, I stumbled over to the nearest wall and tried to catch my breath. When we got into the sneaker store (which was pretty quiet and calm), the stomach churning stopped.

So, some small (but welcome) progress on the auditory front.

An Alternative to Therapeutic Brushing
A friend in Minneapolis, who is an OT, wrote to tell me about an alternative to Therapeutic Brushing. It’s called “hand hugs,” and consists of someone using their hands to apply pressure to the arms and lower legs. I’m told that it’s a powerful technique, so do not try it without an OT showing you how to go about it. Apparently, Therapeutic Brushing does not work for many people, so if you’re having difficulties with it, hand hugs might be an alternative. I am going to ask my OT about it the next time I see her.

And now, I’m going to go take a nap…I mean, listen to my Therapeutic Listening CD. :-)


© 2009 by Rachel Cohen-Rottenberg


 

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Sleeping, Listening, and My Fourth OT Visit

April 15, 2009 Rachel Anxiety, Hearing, Occupational Therapy, Sensory Processing Disorder (SPD), Sensory Processing Issues, Sleep, Therapeutic Listening, Vestibular System, Weighted Blankets

Note: For posts about previous visits, including my sensory assessment, see the Occupational Therapy category, to the right of this post.

After receiving so many wonderful ideas from all of you about my sleep resistance dilemma, I went to see my OT on Monday. The first thing she had me do was to write out a list of objectives for the therapy. A list! I was so happy.

Objectives

  • To stop resisting sleep by eating and watching TV.
  • To reduce auditory overload. (Auditory overload seems to be the most intense for me, followed very closely by visual and vestibular overload.)
  • To do the grocery shopping one day per week, every week. (My husband does most of the grocery shopping these days.)
  • To deal better with changes to my routine. (I don’t get upset with people anymore when plans change, but I still get very stuck and have difficulty adapting.)
  • To keep up with OT tasks, such as exercise, singing, and drumming.

We began working on the top two issues on the list: sleep resistance and auditory overload.

Sleep Resistance
We talked about my sleep issues from a sensory point of view. My OT feels very strongly that I need to reframe the way I see winding down, ending the day, going to bed, and sleeping. Right now, I resist all of those things. She said that I need to frame all of them as being very positive. Sleep is the time that our bodies regenerate cells. Sleep provides rest for the immune system and for the nervous system. Both systems are key to the health of the body and to the enjoyment of the daytime hours.

We then discussed ways to take care of my sensory needs so that I don’t try to calm myself by watching TV and eating too much. It’s clear to me that what calms my nervous system is a lot of physical, tactile pressure, like the pressure of a weighted blanket or the vibrations of the Thumper. On Passover, I fell asleep under two weighted blankets—30 pounds of pressure. Since I’d like to start going to sleep earlier, my OT suggested that in the evening, when I imagine the best possible place in the world to be, I imagine lying underneath 30 pounds of weighted blankets at 10:15 pm! Talk about reframing. Given that lying under weighted blankets feels a little bit like heaven, I think I can do it.

As we talked about the process of replacing one routine with another, my OT was very adamant that I not completely ditch the old way of doing things until I add something more powerful to it. My tendency is to try to jettison an entire routine before I’ve started on a new one. The results are usually not good. So this time, for example, I will not take away chocolate without giving myself something that works better. In other words, I need to respect that I am in a transition. Transitions are difficult, but I’m willing to put some energy into this one.

I’ve decided to make some changes. Over the past couple of days, I’ve taken a look at my daily list and given more attention to the times for my late afternoon and evening tasks. According to the list, I have different self-care tasks and chores to start by 4 pm, by 6 pm, and by 8 pm. Up to now, I’ve been getting the tasks done, somehow, but I’ve paid virtually no attention to the time at which I get started. For example, sometimes the dishes get done at midnight, even though according to the list, they should get done by around 8 o’clock.

In addition to keeping better track of my present tasks, I added a new task, which is to make myself a very weird but useful concoction of mashed bananas, soy powder, and tahini at 10 pm. I used to eat this little concoction when I was on an elimination diet to weed out food allergies and sensitivities. It always helped me to feel full so that I could fall asleep. So, on Monday night and Tuesday night, I had this lovely dish and also allowed myself a small piece of dark chocolate. On Monday night, I feel asleep at 10:30 pm, woke at 4:20 am, and then meditated myself back to sleep until 6 am, when my alarm went off. On Tuesday night, I fell asleep a bit later, around 11:15 pm, woke up again at 4:20 am (not sure why, except that perhaps the heating system was coming back on), and then fell back to sleep until about 7 am. Not too bad at all. I didn’t watch TV either night.

I can see that this whole transition is going to be a one-day-at-a-time proposition.

Therapeutic Listening
After our conversation about sleep, my OT and I went into the gym and began the Therapeutic Listening program. The goal of the program is to help me filter out sounds in my environment so that they don’t feel like they are all rushing in at one high volume. It involves using a special headset and a series of CDs.

While lying under a heavy weighted blanket, while standing up on a swing and rocking laterally, and while rocking laterally on a peanut-shaped physioball, I listened to part of a CD called Mozart for Modulation. The makers of the Therapeutic Listening program take pieces of music and change them in ways that work the muscles in your ears. The music is supposed to be in the “background” to make your ears reach for some of the sounds, so I heard it at a low volume (from 2-4 on a CD player, without any bass boost), and I could still talk to the OT without needing to speak loudly. I was supposed to listen to the music while not actually concentrating on it (not so easy for an Aspie), so my OT had me swinging and rocking while I talked to her about, well, whatever—my daughter as a baby, what her sleep patterns were like back then, and a lot of other stuff I don’t remember.

Listening, talking, and moving were a lot to do at once, and I felt pretty tired and disoriented by the end of the session. My system really resists that amount of multitasking. But the OT said that the point of the therapy is to ask my brain to attend to several things at once without getting overloaded. I overloaded this time, but the goal is to begin to reduce the overload, so I’m willing to commit to this program and see whether it helps.

I brought home the CD and special headphones. I don’t have a portable CD player, and my OT said it was okay to listen to the CD on my computer, as long as I wasn’t watching the screen. (She said that, under no circumstances, should I listen to the CD while driving or watching anything on a screen. I don’t know what happens exactly, but it doesn’t sound good.) I was supposed to combine movement with listening to the CD, but right now, the only way to move and listen at the same time is to put the computer at the foot of my bike while I’m working out. I really don’t want to do that, because I love the routine of biking and singing my favorite songs. My OT agrees that I shouldn’t interrupt that routine.

So yesterday, after work, I came home, got myself organized, lay down under my weighted blanket, and listened to 20-30 minutes of Mozart for Modulation until I fell asleep! I really enjoyed lying under my weighted blanket in the late afternoon and listening to the CD. It was the first time that resting felt like a good thing, because my mind was occupied with something other than my own constant thinking. Since it feels so nice to me, my OT said that once a day, I should listen to the whole CD while resting, and then listen to it again at some other point, while I’m moving around. Moving around can include walking, eating a meal, knitting, making mobiles, or doing the dishes. The goal is to activate and integrate the visual, auditory, and vestibular systems. The CD is nearly 75 minutes long, so I’ll need to work up to listening to the full CD twice a day.

[Correction: I just heard from my OT, who reads my blog. She said that I only need to listen to the CD for 30 minutes, twice a day, with at least three hours between listening sessions. She said that the beginner CDs are 30 minutes long, and that she had forgotten how much more music was on the one she gave me.]

Of course, I finished off the OT visit with the Thumper, and this time, I could feel the vibrations in my teeth! Very cool.

© 2009 by Rachel Cohen-Rottenberg

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