1. Be an objective sceptic - give things a try.

2. Attend a structured and comprehensive training programme.

3. Prime the system by activating repressed or undeveloped listening abilities.
4. Use the self-voice as a platform for improving other learning skills.
5. Enhance outcomes by working closely with other professionals.
6. Do not underestimate the power of therapeutic listening!
Practical points: therapeutic listening
l use
therapeutc
stenng
vhat do we do when cents are
makng sow or no progress'
vhen they have a varety o
dcutes whch nterere wth ther
earnng, communcaton and soca
sks' vhen t can be hard to put
your nger on where thngs are
gong wrong'
There s unortunatey no magc
wand n speech and anguage
therapy, but s our understandabe
suspcon o therapeutc stenng
programmes - whch do thngs very
derenty - makng us dea to ther
potenta benets'
So sten up, and hear why our three
contrbutors woudnt be wthout
ther Ds and headphones.
Dilys Treharne is a speech and
language therapist at the
Department of Human
Communication, University of
Sheffield. She is a trainer for
The Listening Program,
www.advancedbrain.com.
Dr Colin Lane, the founder of
A.R.R.O.W., is based at The
A.R.R.O.W. Centre, Bridgwater
College Campus, College Way,
Bridgwater, Somerset TA6 4PZ,
e-mail
arrowcentre@bridgwater.ac.uk,
tel / fax 01278 441249.
Karen OConnor is a speech and
language therapist who runs
her own private practice in
Galway, Ireland. Karen also
co-trains with Sheila Frick
internationally in Therapeutic
Listening, www.vitallinks.net.
you
beeve stenng has a
major mpact on anguage
and earnng
ee some cents are
underachevng
want evdence or therapy
approaches
Read ths
how l...
SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 2002 (
the programme). Nature sounds are added and the whole is presented
dichotically. This has the effect of the sound appearing to move around
the room and to be near or distant.
I purchased the CDs but ask parents to provide the CD player and high
quality headphones if possible. The childrens pleased expressions at
being expected to sit down and listen to CDs twice a day fade a little
when told it is based on classical music. Some have grown to like it
while others still only like the duck bits.
I discuss the listening diary by telephone and the parents collect and
return CDs to the clinic each week, so several children can work with a
single set. I am also able to lend a full or half set for eight or four weeks
to children who live further away.
Beyond expectations
In the evaluation study the children were reassessed at the end of the
programme and then left for eight weeks before being reassessed once
more. The results were beyond my expectations: all showed an
improvement greater than one would expect from maturation.
The pattern of change was interesting. Parents noticed an improve-
ment in general attention and attention to sounds within three weeks.
All reported a greater responsiveness to conversation. One child who
did not initiate conversation even at home began offering opinions and
became quite a chatterbox; another noticed the church bells for the first
time in his eight years. Awareness of sound and attention span had not
been assessed in the pre-trial period so I was unable to objectively mea-
sure the amount of improvement in these areas. In the sixth or seventh
week of the programme many children exhibited a deterioration in
behaviour, becoming disagreeable or aggressive. Fortunately this lasted
only a few days to a week, and settled as they moved on to the next CD.
This occurred at a point where the gating (acoustic modification) is
markedly increased and I believe this, together with the childs increased
sensitivity to sounds in the environment, was the cause and a sign that
the programme was being effective.
The greatest change was in selective attention (auditory figure-
ground). All made an appreciable improvement and the overall change
for the group was significant. Those with the severest difficulties made
the greatest improvement. In some this change was dramatic moving
from below the first centile to the 7th, 9th and in one case 16th centile
in just eight weeks. Remember, these childrens scores had remained sta-
tic for the previous eight weeks.
Many also showed change in auditory memory but perhaps this was
due to their improved attention levels. The measured changes were
small immediately after the programme and in many cases the greatest
change occurred within two months after completion.
These improvements were good in themselves but more importantly
they were maintained and opened the door for other activities such as
Earobics to become effective. Progress did not stop after two months,
and even those without direct intervention continued to make gains.
The length of this extended progress period varied. When progress
stopped or a slight regression was noticed the child took another course
of The Listening Program. Progress was also evident in fields not direct-
ly targeted. Joe, who had been very slow to make any progress in
SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 2002
how l
work with children and young people
with auditory processing difficulties.
Usually between 6 and 17 years of age
when referred, they are underachieving
or complain of not being able to hear prop-
erly in school but on pure tone testing have
no significant hearing loss. Some have had a
dyslexia assessment but only show a borderline pattern. Others have
had a significant amount of speech and language therapy focusing pri-
marily on phonology and comprehension with some expressive work,
and have made limited progress. Many have a history of poor attention
and in some cases have had a diagnosis of attention deficit disorder or
mild autism. Referrals come from audiology departments, speech and
language therapists, teachers and parents.
After an in-depth assessment a pattern of difficulty emerges with
selective attention or auditory figure-ground tasks (hearing speech in
background noise which most people are not aware of, such as the hiss
of a gas fire or a clock ticking), maintaining attention, auditory sequen-
tial memory, sequencing, dichotic listening tasks, temporal pattern pro-
cessing, pitch perception, processing language at normal speed, motor
coordination, and motor coordination with speaking. Not all the chil-
dren have all the problems. Some have a clear auditory processing dis-
order and some will be borderline or at the lower end of the normal
range. However, if they are having problems functioning in the class-
room they are offered a programme of therapy.
Initially I used Earobics to improve listening skills, together with tasks
tailored to the individual to teach tolerance of background noise, audi-
tory memory, and phonological awareness. I used the relative visual
strength to support comprehension of read and spoken sequences
through visualising and verbalising. Brain Gym style activities (see
Dennison & Dennison, 1989) were used to improve coordination and
concentration. Progress was slow and used a great deal of clinical time.
Worth a try
I was then introduced to The Listening Program (Advanced Brain, 1999),
a type of sound therapy programme based on the work of Tomatis and
Samonas (Leeds, 2001). It was different in that it was home-based and
required the relatively short two fifteen minute periods each day for
five days a week over eight weeks. I was objectively sceptical, but any-
thing was worth a try, and it came with good reports.
I evaluated it with a limited number of children, selecting the prime
problem areas for assessment (Treharne, 2001). In this first cohort were
10 children between the ages of 8 and 16 years with non-verbal intelli-
gence scores ranging from the 3rd to the 95th centile. They all had
problems with auditory figure-ground and most with auditory sequen-
tial memory and attention. Temporal pattern perception, phonological
awareness, reading and spelling were also common problems but at a
higher stage of processing. Baseline assessments were repeated on the
prime areas of auditory figure-ground using the Goldman Fristoe
Woodcock (1976) Auditory Skills Selective Attention test, and auditory
sequential memory using Gardners (1996) Test of Auditory Perceptual
Skills (TAPS-R). Temporal pattern perception was tested using my own
TraCoL (in preparation). Children who had made no progress over the
previous eight weeks were selected.
The Listening Program is contained on eight CDs, one for each week.
Each contains 12 tracks, three to be used at a 15-minute listening peri-
od of which there are two each day. The music is classical, specially
recorded and then acoustically treated by filtering out certain frequen-
cies (this varies from track to track and increases as you move through
l

lrom sceptc to convert,

the objectve way
Resuts rom her research were so
encouragng that Dys Treharne now uses
The lstenng Program as the rst step or
young peope wth audtory processng
dcutes , prmng the system or more
specc therapy programmes.
ing skills. Students aiming to improve their
reading/spelling skills are averaging eight months
improvement in reading and seven months improve-
ment in spelling after an eight hour A.R.R.O.W. pro-
gramme. Whilst the improvement of listening, speech
and cognitive skills is a central feature of the system,
many tutors also report an improvement in a learners self-esteem after under-
taking it.
Initially I developed A.R.R.O.W. as a listen read copy compare model for hear-
ing impaired children to improve their speech and listening skills. They were
expected to improve by comparing the original teacher recording with their
own recorded version played back to them on specially developed equipment.
Conventional modelling techniques were used for speech or language
improvements before self-voice replay. Tutor and child listened to the master
track recording, the child repeated the phrase and had both voices played back
as confirmation of progress. It quickly became apparent that severely hearing
impaired students could operate the recorders themselves. Students of all ages
and abilities maintain attention for up to 30 minutes when working alone on
A.R.R.O.W. During practice sessions I noticed many of the original group of stu-
dents preferred to turn down the tutor voice and only listen to their own
replayed voices. I observed them smiling when listening to the self-voice and,
in some cases, silently mouthing the replayed speech material. These effects
have since been noted elsewhere by other tutors. My later Ph.D. research into
the self-voice showed that children preferred their own voices far more than
any other voice delivering either a sentence, list of words or single vowel.
An early effect of A.R.R.O.W. was a marked improvement in listening skills of
the hearing impaired students at my unit. Parents and mainstream teachers
commented upon the improvements, including Shirley Manley, the parent of
a nine-year-old severely hearing impaired student: ...his speech has improved
enormously but also his listening. Before I would call him from upstairs and he
couldnt hear me, now I call him from upstairs and he responds.
Marked and sustained
I undertook higher degree research with children in special schools for
those with moderate or severe learning difficulty and in hearing impaired
units in Somerset. The research showed that 15 minutes daily A.R.R.O.W.
speech and language and at eight years was still almost unintelligible
with really low self-esteem, became much more relaxed and confident
and, two thirds of the way through the second course, his phonological
system had improved dramatically without further intervention.
We have also tried The Listening Program with students who were
finding lectures difficult to follow and some have noticed a change. The
results are being analysed.
Originally designed as a home programme, it can also be used in
school. Four children have completed it at two schools with a special
needs classroom assistant. The children listen in a group while the assis-
tant does paperwork. They discuss what they have heard and the lis-
tening record is written up. The schools are amazed at the results and
consider it time well spent.
The effect of The Listening Program has prompted me to explore other
sound therapy techniques - such as the sound health CDs, also from
Advanced Brain - to support and maintain attention and concentration
levels after the programme at home and in schools.
The Listening Program is now my first step in auditory training as it
seems to activate listening skills that have been repressed or never
developed, thus priming the system for more specifically targeted
therapy programmes.
References
Dennison, P.E. & Dennison, G.E. (1989) Brain Gym. Edu-Kinesthetics Inc.
Leeds, J. (2001) The power of sound. Healing Arts Press.
Treharne, D. (2001) Efficacy of TLP with children with auditory process-
ing problems. Paper presented at TLP conference November 2001 (full
version to be posted on www.advancedbrain.com).
Resources
Earobics: Cognitive Concepts www.cogcon.com.
Gardner, M.F. (1996) Test of Auditory perceptual Skills - Revised. Ann
Arbour Publishers Ltd.
Goldman, R., Fristoe, M. & Woodcock, R.W (1976) Auditory Skills
Battery Selective Attention Test. American Guidance Service.
Treharne, D. (in preparation) Test of Rhythm and Comprehension of Language.
The Listening Program (1999) Advanced Brain www.advancedbrain.com.
UK contact: F. Mitchell-Roberts, e-mail: twi@pobox.com.
SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 2002
how l

A.R.R.O.v. hts the

bus-ear
Dr on lane stresses the mportance o the se-voce
to the A.R.R.O.v. technque or mprovng stenng,
speech and teracy sks. Orgnay deveoped or
chdren wth hearng mparment, ts use has extended
across the communty to ncude aduts wth aphasa,
bran njury and earnng dsabty.
A.R.R.O.W. is a multisensory learning programme I first developed in 1975.
It is based on the use of the students own recorded voice which I termed
the self-voice. A.R.R.O.W. has since been under continuous refinement
with students of all ages and abilities including those with reading and
spelling problems, dyslexia, hearing impairment, speech and language dis-
orders, communication difficulties and visual impairment. Some 800 tutors
have been trained and an estimated 30,000 children and adults have been
helped. A.R.R.O.W. requires the use of special high fidelity two-track
recording equipment either in CD-ROM or audiocassette formats in which
tutor and students wear appropriate headsets.
A.R.R.O.W. is an acronym for:
Aural - The student listens to speech through headsets (either a tutors
spontaneous speech or pre-recorded speech through CD-ROM or audio
cassette facility).
Read - The student reads associated text whilst listening to speech.
Respond - The student is required to make a response.
Oral - The student repeats the text.
Write - The student writes down or types the text while
listening to the self-voice recording.
Whilst any or all of the above components may be stressed during training,
the role of the self-voice is essential to A.R.R.O.W.s effectiveness. Many stu-
dents, particularly those of preschool age or those with severe learning/com-
munication problems, may not be able to undertake the reading or writing
components. However, virtually all students can benefit enormously from the
use of the self-voice as a platform for improving other learning skills includ-
ing those of listening, cognitive processing and speech.
Since its inception, research and practical application of the programme has
taken place in schools, colleges and the community. It has been demonstrably
proved by A.R.R.O.W. trained tutors that it is possible to make rapid and sus-
tained improvements in reading, spelling, short term memory, speech and listen-
initial test averaged 60.6 words correct from 20 sentences containing 100
words. Re-test scores averaged 65.2, an improvement of 9 per cent. A sixth
student was tested but was then given A.R.R.O.W. listening training. On
re-test his score rose from a pre-training 51 to 81 correct after A.R.R.O.W.
- an improvement of 58.8 per cent. He comments, After completing the
A.R.R.O.W. Listening Enhancement Programme that took approximately
25 minutes I experienced a mental clarity, I had a feeling of heightened
awareness, found it easier to focus on the voice and differentiate and
exclude background noise... (Gallagher, 2002).
A.R.R.O.W. self-voice methods hold considerable application for children
and adults within the community. Through the auspices of Bridgwater
College, a community-based initiative featuring the self-voice has been
most successfully implemented. Members on the A.R.R.O.W. community
course include adults with aphasia as a result of stroke, adults with brain
injury as a result of accidents or surgery, and adults with learning problems
for whom Further Education at Colleges is not a realistic option.
Note
It is essential that practitioners receive a structured training programme to
competently assess and deliver A.R.R.O.W. Costs are currently set at 426.00
plus VAT for a four day Advanced BTEC Award for A.R.R.O.W. Tutors. These
courses cover both the CD-ROM and audio cassette format - equipment
costs p.o.a. and are organised on a regional basis according to demand.
References
Bellamy, H. & Long, L. (1994) In: Lane, C.H. A.R.R.O.W. Links 2, 1 (3); 5-9.
Crewdson, D. (1996) The Sound of Ones Voice. Bulletin, Royal College of
Speech and Language Therapists 533; 8-9.
Gallagher, J. (2002) Personal Comunication.
Harvey, B.M. (1995) An Arrow Experience. Dyslexia Contact 14; 2.
Lane, C.H. (1997) With One Voice. Special Children, May; 17-20.
SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 2002 ;
how l
s a speech and language
therapist with a keen
interest and growing
knowledge in the area of
sensory integration, I was fascinated
to hear of a three day course
Listening with the whole body,
given by Sheila Frick. This well-known American occupational therapist lec-
tures worldwide in the area of sensory integration, on topics such as clini-
cal neurology, respiration, the vestibular-auditory system and auditory
intervention techniques such as therapeutic listening. Occupational thera-
pists, physiotherapists, speech and language therapists, audiologists, psy-
chologists and other educators were there.
I returned with a new found enthusiasm in my heart, knowledge in my
head and a set of headphones in each hand! Parents also hoped this
technique could help their children where more traditional therapy had
not succeeded. Those same parents, having seen some very encouraging
results, urged me to write this article so others can benefit. From my per-
spective, it has opened up a new world where clients can now achieve
their potential in a more functional and effective way.
Therapeutic Listening uses sound stimulation in combination with
sensory integrative techniques to stimulate brain processing. It combines
a variety of electronically altered compact discs based on the ideas and
technology created by Alfred Tomatis, Guy Berard and Ingo Steinbach,
within a sensory integrative framework, (Frick, 2001.) This approach
highlights the importance of close collaboration and joint work
between therapists, as activities are often based on postural activation,
organisation, oral motor and respiratory strategies (Frick, 1991).
CDs vary in level of musical complexity and enhancement.
Individualised programme
Each client is assessed with the view to developing an individualised
therapeutic listening programme, which can be school and/or home
rather than clinic-based. Each programme should be supported by a
strong sensory-diet of activities (Wilbarger & Wilbarger, 1991). Sensory-
diet is a concept which proposes that each individual requires a certain
amount of activity and sensation to be at their most alert, adaptable
and skilful. These activities are tailored to the individuals needs and
scheduled throughout their day.
The development of listening techniques began with the work of
Alfred Tomatis - a French Ear, Nose and Throat Consultant - in the 1940s.
He researched the role of the ear and its profound effect on listening,
language and learning... he seeks to explain how humans function
through the focal point of the auditory system, (Madaule, 1994.)
Tomatis is renowned for developing the first auditory training device,
using progressively filtered sounds - Mozarts music, Gregorian chant
and mothers voice - to cause change.

A
Enthusasm, knowedge -
and a set o headphones
vth oo satsed cents, Karen Oonnor needs no urther
convncng o the benets o occupatona therapst Shea
lrcks Therapeutc lstenng n hepng chdren acheve
ther potenta.
training for five weeks caused marked and sustained improvements in lis-
tening and speech tasks. These improvements were statistically superior to
those being achieved from non-A.R.R.O.W. work being undertaken at each
site. The improvements covered identifying sounds of the environment,
sentence understanding, working short term memory for digits and words,
consonant discrimination and vocalisation skills.
After extensive use in Somerset schools, the A.R.R.O.W. programme was
tried with adults. A teacher of lip-reading, herself severely hearing impaired,
agreed to undertake A.R.R.O.W. training at home. She practised using the
special recorder linked to a neck loop attachment. Material was based on
various pre-recorded poems. After two weeks practice for a maximum of
15 minutes each day, she reported a considerable improvement in her abili-
ty to distinguish sounds of the environment and to hold conversation in less
than ideal acoustic conditions.
We have since developed an A.R.R.O.W. Accelerated Concentration
Programme. I had the idea of asking students to listen to their voice against
varying levels of background noise using the two-track facility available on
the A.R.R.O.W. recorder. Using carefully graded stages of listening, including
easily attainable and extremely difficult tasks, I found it was possible to min-
imise the time taken to train listening skills to a period of 40 minutes or in
some cases even less. I initially used the system with hearing impaired adults
and found marked improvements on pre-post test measures. Adults also
reported improvements in environmental listening and ability to hold con-
versations. Work with children followed and we showed it is possible to
improve listening skills with hearing impaired children inside a total of one
hours training. We have since found that the training is appropriate for
both normally hearing and hearing-impaired children / adults whilst the CD-
ROM format offers exciting new possibilities for self-help attention training.
In late August 2002 a small group of normally hearing students (n=6) were
given a background noise listening test. Five of the students were re-tested
without receiving any A.R.R.O.W. listening training. Mean scores on the
A French doctor, Guy Berard, felt the Tomatis method was too lengthy
and developed his own method of filtering sound. This Auditory
Integration Training (modulating sound frequencies at random intervals
for random periods of time) was developed to treat people with audi-
tory processing problems.
Ingo Steinbach, a German sound engineer, developed the Samonas
method. He found that by heightening his attention to the structural
elements contained in all natural sounds, and capturing them in his
recordings, immediate listening was achieved, even in unfiltered music.
He developed special technology to capture music as sound in space and
combined his spectral activation process with Tomatis method of filter-
ing (Frick et al, 1997).
The benefits of a therapeutic listening programme are extensive and
varied. When I introduce the areas in which families should expect to
see change, they are understandably surprised. Having used therapeutic
listening programmes with approximately three hundred children, I
have witnessed and recorded change in all the areas in figure 1.
The case studies in figure 2 give some indication as to how therapeu-
tic listening can be used with quite different client groups. I now use
this technique with most of my clients, in combination with other
approaches, and I endeavour to work closely with occupational thera-
pists and physiotherapists to
enhance the benefits.
Listening with the
Whole Body - courses
Karen OConnor (Ireland) e-mail
speechtherapyservices1@eircom.net.
Sandra deWet (UK), tel. 01892
513659 (also supplies the
Listening with the whole body
book in the UK for 37 inc p+p).
Further information
www.vitallinks.net - includes
case studies
www.samonas.com - Samonas
CDs, developed by Ingo
Steinbach.
References
Ayres, A.J. (1979) Sensory
Integration and the Child. Los
Angeles: Western Psychological
Services.
Ayres, A.J., & Mailloux, Z. (1981)
Influences of sensory integration
procedures on language develop-
ment. American Journal of
Occupational Therapy 35 (6); 383-
390.
Frick, S. & Hacker, C. (2001)
Listening with the Whole Body.
Vital Links, Madison, WI.
Madaule, P. (1994) When listening
comes alive. Norval, ONT., Canada:
Moulin Publishing.
Semel, E., Wiig, E.H. & Secord, W.
(2000) Clinical Evaluation of
Language Fundamentals - Third
Edition (UK). The Psychological
Corporation.
Tomatis, A.A. (1996) The Ear and
Language. Norval, ONT., Canada; Moulin Publishing.
Stark, R.E. & Tallal, P. (1981) Selection of children with specific language
deficits. Journal of Speech and Hearing Disorders 46 (2); 114 -122.
SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 2002 8
how l

Figure 2 Case studies

Eoin has Aspergers Syndrome. I worked with his family three years ago when the primary concerns were
concentration, auditory processing and pragmatics, in particular topic maintenance. We had utilised many
approaches with limited generalisation.
Mum was eager for me to reassess Eoin as she felt his auditory processing difficulties were directly related to his
auditory distractibility. He became my first client to use Therapeutic Listening - and he loved it!
We started Eoin on EASE 1 and blended in a Samonas CD within a fortnight. Mum reported he would lie down
on a chair and listen attentively to the music. She noticed improvements in his ability to concentrate within the
first three weeks. Over the past year we have focused on his ability to filter out important auditory information
from background noise, auditory processing skills, sentence formulation and pragmatic language.
Eoins standard scores on the Clinical Evaluation of Language Fundamentals (Semel et al, 2000) have increased by
approximately three standard deviations in both receptive and expressive language. More importantly, Eoin is
doing better at school and making more friends.
Peter, a twin whose general milestones were achieved as expected, was referred aged 3;4 years by his local GP.
Mum became worried when Peter was much slower than his twin to put words together. He had a significant
history of ear infections and grommets were inserted following his initial assessment.
Peter was constantly moving from one activity to another and generally did not respond to questions, but
chatted away to himself. He tended not to look at you when asked a question.
Peter attended regularly for eight months with the focus on:
* attention and listening skills
* auditory processing skills
* auditory memory
* sentence formulation skills
* vocabulary-building
* phonological development.
Limited improvements were noted and mum agreed to try Therapeutic Listening.
We started Peter on Disc EASE and gradually introduced Carulli (Classic Quality Version) on week 3. Within the
first three weeks mum noticed Peter was much calmer, less active and generally listening more attentively.
Improvements continue to be seen in the areas of expressive language and vocabulary building. Peter is also
following a language programme, which consolidates and enhances development of the emerging linguistic
skills. His skills are approaching age appropriate in all targeted areas.
Nigel (10), who has spina bifida, had been attending regularly for eighteen months. Formal and informal
assessments indicated attention and listening difficulties, auditory processing and sentence formulation deficits.
His teacher reported he was quite distracted in class, finding it difficult to concentrate and he was functioning
approximately three years behind the rest of his class. Rigorous direct and indirect work showed limited
improvement so we introduced Therapeutic Listening.
After three weeks, Mum reported Nigel seemed much more tuned-in, able to become involved in
conversations and beginning to follow and talk about story-lines from television programmes, which he hadnt
done previously. Nigel continues on a listening programme and is responding more effectively to other
language programmes to further develop and consolidate his skills.
Figure 1 Areas potentially affected by therapeutic listening
Arousal, attention and focus
Receptive and expressive language
Increased speed of motor and language processing
Balance and coordination
Praxic skill - ideation, planning and execution
Affect; facial expression and responsiveness
Motivation
Awareness of the environment
Gravitational security
Modulation of ability to stay calm while receiving sensations
Organisation
Self-initiation of play and work behaviors, and verbal instruction
Social and emotional development
Eye contact and tracking
Decrease in self-stimulating behaviours
Independence
Feeding skills
Eating and sleeping patterns
Improved awareness and regulation of hunger and thirst patterns
(Frick et al, 1997)