Musical stimulation proposal for hearing impaired children: case reports

Pacheco, Letícia do Rosário Amado; Miguel, Juliana Habiro de Souza; Gil, Daniela

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Original Article • CoDAS 32 (5) • 2020 • https://doi.org/10.1590/2317-1782/20202019139 copy

Musical stimulation proposal for hearing impaired children: case reports

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

To develop and to apply a musical stimulation program for children using Cochlear Implant.

Method:

The research was conducted at the Educational Audiology Outpatient Clinic, UNIFESP, and was carried out in two stages - conception of the musical stimulation activities and its application in five children using Cochlear Implant, aged between 2 and 5 years, who had been under speech therapy for at least 12 months. The study group was submitted to six sessions of musical stimulation. We used three instruments to quantify the evolution of the child: Children’s Musical Identification, Musical Skills Development and Musical Aptitude Test - all of them were designed by one of the authors.

Results:

Musical stimulation had a positive effect, thereby improving the rhythm and the melody skills of the participants. The children showed a performance over 50% in the tasks undertaken. Musical stimulation had a positive effect, thereby improving the rhythm (p=0.0267) and the melody (p=0.0445) skills of the participants.

Conclusion:

We conclude that it is possible to develop a musical stimulation program that can be applied to children using Cochlear Implant inserted in aurioral rehabilitation, who benefit from the activities.

Keywords
Hearing Loss; Cochlear Implantation; Music; Auditory Perception; Acoustic Stimulation

Session	Activity developed during the session	Activity proposed for home
1º Rhythm	The therapist sang and performed the percussion (on the timba) of the song "Marcha Soldado" (beating the hand only in the first time of each compass, which coincides with the tonic syllable) while the child should remain with the hand on the timba with the palm open, feeling the sound and the vibration of the rhythm of the song. Subsequently, the child should beat the drum along with the therapist.	The person responsible for the child should sing and clap in the rhythm of the song "Marcha Soldado" along with the child. If the person in charge did not have the skills to perform the task, she should put the audio of the song and to explain what the child should do; in this case, to ask his/her to clap simultaneously with the song.
2º Rhythm	As in the previous session, the therapist sang and performed the percussion of the song "Marcha Soldado" on the timba according to her pulse (heartbeat), and not just beating her hand on the timba in the first time. The child felt the vibration and the sound of the musical pulsation through the contact with the timba, and then should play along with the therapist.	The person responsible for the child should sing and beat in a pot/drum or the utensil that is available in the rhythm of the song "Marcha Soldado" along with the child. If the person in charge did not have the skills to perform the task, she should put the audio of the song and to explain what the child should do; in this case, to ask his/her to drum simultaneously with the song.
3º Rhythm	The child should march according to the rhythm of the song. Firstly, the therapist set an example, and then the task was performed along with the child.	The person responsible for the child should sing and march in the rhythm of the song "Marcha Soldado" along with the child. If the person in charge did not have the skills to perform the task, she should put the audio of the song and to explain what the child should do; in this case, to ask his/her to march simultaneously with the song.
4º Rhythm	The song "Brilha, Brilha Estrelinha" was introduced to the child and played on the keyboard. The child was stimulated to hum along with the therapist after being introduced to the song.	The person responsible for the child should sing the song "Brilha, Brilha Estrelinha" along with the child. If the person in charge did not have the skills to perform the task, she should put the audio of the song and to explain what the child should do; in this case, to ask his/her to sing simultaneously with the song.
5º Rhythm	The therapist worked on the notions of bass and treble. For this purpose, she played like live or dead (dead, the child should stay down, but alive the child should get up) with musical notes (lower and higher), i.e., when the therapist played a bass note, the child should get down, but when playing a treble note, should get up. Subsequently, she played and sang the song along with the child on the keyboard, holding his/her finger one octave down and one octave above, thereby enabling the child, besides listening to the difference in tones, to perceive that the same melody is played in different heights (pitches) on the keyboard. In order to help with the perception, the therapist pasted colored stickers on the keyboard buttons: blue for the low tones and orange for the high tones.	The person responsible for the child should sing the song "Brilha, Brilha Estrelinha" making a lower voice and a higher voice, asking the child to try to sing along with her. If the person in charge did not have the skills to perform the task, she should put the audio of the song on the bass/shrill versions and to explain what the child should do; in this case, to ask his/her to sing simultaneously with the audio of the song.
6º Rhythm	The therapist played the song along with the child on the keyboard, holding his/her finger, one octave below and one octave above, still with the stickers. Subsequently, the therapist played the music alone in two different heights (pitches) and asked the child to speak the color of the keyboard buttons that the therapist played, orange - treble (high) and blue - bass (low).

	Chronological Age	Auditory Age
P1	2.7	1.4
P2	5.0	3.0
P3	3.6	1.6
P4	4.8	1.0
P5	4.9	1.8
Average	4.2	1.8
Median	4.8	1.6
Variance	1.1	0.6
SD	1.0	0.8
VC	25%	43%
Min	2.7	1.0
Max	5.0	3.0

Session	Objective	P1	P2	P3	P4	P5	Consolidated
1ª Session	O1	Yes	No	Yes	Yes	No	60%
1ª Session	O2	Yes	Yes	Yes	Yes	Yes	100%
2ª Session	O3	Yes	Yes	Yes	Yes	Yes	100%
2ª Session	O4	Yes	Yes	Yes	Yes	No	80%
3ª Session	O5	Yes	Yes	Yes	Yes	Yes	100%
3ª Session	O6	Yes	Yes	Yes	Yes	Yes	100%
4ª Session	O7	Yes	No	No	Yes	No	40%
4ª Session	O8	Yes	No	No	No	No	20%
5ª Session	O9	Yes	Yes	Yes	Yes	No	80%
5ª Session	O10	No	No	No	No	No	0%
6ª Session	O11	Yes	Yes	Yes	Yes	No	80%
Performance		91%	64%	73%	82%	36%

Question	Description	Positive Responses	Sample %
Q1	Do you or does anyone in your family who is close to your child play any kind of instrument or sing (whether professional or amateur)?	2	40%
Q2	Do you or does anyone in your family who is close to your child listen to music regularly?	5	100%
Q3	Does your child often sing/dance and/or drum?	4	80%
Q4	Does your child often sing/dance and/or drum while watching a DVD or a television program or when there is some music playing?	4	80%
Q5	Do you or does anyone in your family often take (s) your child to music shows/concerts/theatrical performances?	2	40%
Q6	Does your child often watch cartoons or television programs that contain music?	4	80%
Q7	Does the school that your child attends have musical activities and/or lessons?	3	60%
Q8	Do you often sing children's songs with your child?	2	40%
Q9	Does your child have any favorite music?	2	40%
Q10	Would you encourage your child to play some musical instrument and/or sing?	5	100%

Question	Description	Positive Responses	Sample %
Q1	Did you or anyone in your family who is close to your child start listening to music regularly after the beginning of the musical training?	4	80%
Q2	Did your child start singing/dancing and/or drumming after training?	5	100%
Q3	Is your child singing/dancing and/or beginning to drum while watching a DVD or television program or when there is some music playing after training?	5	100%
Q4	Did your child become more interested in watching cartoons or television programs that contain music?	3	60%
Q5	Do you sing children's songs along with your child more often after training?	4	80%
Q6	Will you encourage your child to play a musical instrument and/or to sing after this experience with musical training?	5	100%
Q7	Do you think your child has improved his/her musical skills after training?	4	80%
Q8	Do you think your child has improved his/her communication skills after training?	5	100%
Q9	Did you perceive that your child felt more excited during musical activities?	4	80%
Q10	Would you recommend this musical training to other children?	5	100%

Musical Aptitude Test	P-value
Rhythm (Before vs. After)	0,02667*
Melody (Before vs. After)	0.02667*
Wilcoxon Signed-rank Test
Statistical significance = 5%

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[1] Correspondence address: Daniela Gil. Universidade Federal de São Paulo - UNIFESP, Departamento de Fonoaudiologia. Rua Botucatu, 802, Vila Clementino, São Paulo (SP), Brasil. CEP 04.037-030. Tel.: (11) 55764531. Fax: (11) 55497500. E-mail: danielagil@hotmail.com

Scale	Description - Rhythm
1	The child did not react or take an interest in or understand the song
2	The child understood that he/she was playing a song and that he/she should clap, but he/she did not
3	The child understood and tried to clap with the song, but in only a few parts of the track and out of rhythm
4	The child managed to get the rhythm right at some moments of the song, but he/she did not keep it during all the song
5	The child managed to clap within the rhythm and kept it throughout the song
Scale	Description - Rhythm
1	The child did not react or take an interest in or understand the song
2	The child understood that he/she was playing a song and that he/she should hum it, but he/she did not
3	The child tried to hum the song, but could not get the melody right
4	The child was able to hum the melody during some moments of the song
5	The child was able to hum the melody throughout the song