Music Educators Journal

http://mej.sagepub.com Strategies for Working with Children with Cochlear Implants

Lyn Schraer-Joiner and Manuela Prause-Weber Music Educators Journal 2009; 96; 48 DOI: 10.1177/0027432109341274 The online version of this article can be found at: http://mej.sagepub.com

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MENC: The National Association for Music Education

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by Lyn Schraer-Joiner and Manuela Prause-Weber

Strategies for Working with Children with Cochlear Implants

A
Is there a student in your music class who uses a prosthetic device to better help them to perceive sound? The techniques described here might assist both of you.

ccording to the National Institute on Deafness and Other Communication Disorders, 23,000 individuals in the United States, including 10,000 children, have a cochlear implant.1 This biomedical electronic device has been a breakthrough in the auditory rehabilitation of individuals diagnosed with severe or profound sensorineural hearing losses who are unable to hear and/or comprehend speech with conventional hearing aids.2 While the cochlear implant can convey a sense of sound to individuals with hearing loss, it is not a cure. Cochlear implants differ from hearing aids, which only amplify sound. The cochlear implant converts incoming sound signals into electrical impulses that directly stimulate the remaining auditory nerve fibers in the inner ear.3 All cochlear implants are comprised of a receiver (shown in Figure 1) placed subcutaneously behind the ear and three external components, specifically, the transmitter system, the microphone, and the speech processor (shown in Figure 2). The acoustical signals gathered by the microphone are electrically transduced, traveling via cable to the speech processor. These signals are transformed into electrical impulses that travel back to the transmitter. The signals are then sent through the skin via radio waves to the receiver and subsequently to the electrodes implanted within the cochlea of the inner ear. The electrical discharge of the auditory neurons advancing

through the central auditory system to the auditory cortex are then interpreted as meaningful sound.4 An implanted cochlear prosthesis is shown in Figure 3. Because of advances in cochlear implant technology, music educators will see more children with cochlear implants in their classrooms. As a result, many will require support and guidance to adequately meet the specific aural and communicative needs of these students. Educator Kimberly McCords research involving collaboration between deaf education and music education students revealed a series of strategies for working with deaf students, including those with cochlear implants.5 According to McCord, music education students reported feeling anxious and unsure of how to teach these students.6 Following their semester-long collaboration with deaf educators, the music education students felt empowered and secure, sharing also their observations that the deaf students valued music and were capable of participating in classes and ensembles.7 With the appropriate resources and strategies for the inclusion of deaf and hard-of-hearing students, teachers can enhance the education received by all of the children in their music classroom. All children, regardless of background and ability, should experience the different facets of their musical heritage and have opportunities to develop their aural, artistic, expressive, and musical sensibilities. Musi-

Copyright 2009 MENC: The National Association for Music Education DOI: 10.1177/0027432109341274 http://mej.sagepub.com

Lyn Schraer-Joiner is the music education coordinator and an assistant professor in the music department at Kean University, Union, New Jersey. Manuela Prause-Weber is a lecturer in the department of music and special education/music therapy at the University of Cologne, Germany, and a clinical music therapist at University Hospital Munich. They can be contacted at lschraer@ kean.edu and Manuela.Prause@t-online.de, respectively.

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Music Educators Journal September 2009

FIGURE 1
Implant (internal component) and electrode array.

cal activity can promote both acceptance and understanding. It can eliminate social barriers and help to diminish the misconceptions and fear often associated with impairments or disabilities. The following recommendations reach across all backgrounds and abilities.

General Considerations
Approaching topics from a multisensory perspective can enhance student participation in musical activities. Vibrotactile cues, defined for the purposes of this article as sensory triggers that indicate an impending activity or event in the context of an activity, can be provided by instruments such as xylophones, marimbas, or drums. Teachers may also consider placing stereo speakers on the floor. In such situations, children can either sit on the floor in close but safe proximity to the stereo system or in their chairs with their shoes off so that they can feel the vibrations.8 The latter can best be accomplished with wood or tiled floors.9 If this is not possible, the gymnasium or cafetorium floor are alternatives. Visual aids, such as sequencing cards and music with enlarged print, can help to reinforce the concepts introduced and ensure that the child is able to follow the lesson. Additionally, manipulatives, such as foam stickers, felt notation cards, colorful scarves, or Popsicle stickswhich are useful for building rhythms and can provide further opportunities for hands-on learning. Manual communication can greatly enhance music instruction for all. Manual communication refers to physical messages received by the eyes.10 Such messages, produced by the hands, arms, and face, for example, can be presented via body gesture, finger spelling, and sign.11 Manual communication modes include song-signing, an art form originating from the deaf community in which one or more children sign while singing or sign while listening to music.12 Such an

Note. Nucleus Freedom Cochlear Implant component, courtesy of Cochlear Americas.

FIGURE 2
Microphone and sound processor.

Note. Auria Harmony Sound Processor, courtesy of Advanced Bionics, a Boston Scientific Company.

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FIGURE 3
How a cochlear implant works.

Note. Implanted PULSARCI100 Cochlear prosthesis and Tempo+ Speech Processor, courtesy of MED-EL Corporation.

approach will reinforce music concepts both visually and kinesthetically and will promote a greater appreciation for this form of communication. Several studies have revealed that using visual cues in music activities increases the success of cochlearimplanted children.13 Visual prompts and models may also help to reinforce both movement and instrumental activities. Furthermore, seating the cochlearimplanted child at either the front or side of the demonstration area will ensure that he or she has a clear view of the activity and is able to speech-read (formerly called lip reading). Lessons presented in a clear and concise manner will also ensure the integrity of prosodic speech elements such as rhythm and melody.14

Information about the cochlear-implanted childs social characteristics and background can be beneficial for the music teachers instructional planning. For instance, if the cochlear-implanted student is socialized within deaf culture or has a bilingual background, he or she may be familiar with manual communication. Therefore, emphasis in the music classroom can be placed on such musical art forms as sign-interpreted musical performances and song signing. If the child has experienced a strictly aural-oral environment and has never been exposed to manual communication, music activities involving song-signing need not be as emphasized. Familiarity is fundamental. Children with cochlear implants are constantly

grappling to orient themselves in their auditory surroundings. By maintaining predictable class structures and routines, the music educator can reduce hearingstress situations the cochlear-implanted child faces daily when interacting with others.15 This approach will ensure a safe, familiar, and dependable learning environment for all children in the music classroom.

Special Musical Considerations

Children implanted with the cochlear prosthesis can perceive musical elements. The assumption is often made that musical enjoyment and the development of music skills are impossibilities for hardof-hearing/deaf students. Rhythm, pitch, harmony, and timbre are all viable topics.

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Music Educators Journal September 2009

Additionally, research has revealed that the cochlear implant does not hinder the user from the perception of these musical elements.16 Music educators should be aware that the child may at first have difficulty with multiple element focuses. Depending upon the cochlear-implanted childs experience and success with the implant, the music teacher may want to consider having the child focus on one element during a listening activity. Single elements can be reinforced and enhanced with listening maps as well as movement activities that emphasize the element. For example, specified arm movements may be used to represent either the melodic or the harmonic line. Body rhythms can be implemented to symbolize rhythmic structure. For example, standing up straight with legs together and hands held firmly to the sides of the body can represent a single quarter note, while hands placed on bent knees with legs spread apart may represent two eighth notes. A whole-part-whole approach can be used during a listening lesson. For instance, the music teacher might consider introducing the entire piece first, followed by an emphasis on individual musical elements for more in-depth study, and conclude with a reiteration of the entire piece. Such an approach would be beneficial for the entire class and particularly helpful to the child who is developing his or her listening skills with the device. Music activities reinforcing the levels of auditory development can help all students to develop their listening and communication skills.17 The levels of auditory development can be modified to align with music objectives in the following manner:18 1. Detection: The ability to respond to the presence or absence of rhythmic and melodic stimuli. Stop and Go is an example.19 During this activity, students move when they hear the music and stop when the music stops. 2. Discrimination: The ability to perceive similarities and differences between two or more rhythmic and melodic patterns. Activities can be expanded

to include various dynamic levels, tempos, and timbres.20 In this instance, teachers can present students with two different rhythm patterns and/ or two different pitch patterns, timbres, dynamics, or tempos. Students are then asked to respond regarding the similarities and differences of the structural patterns or timbres. Eventually, patterns can be student composed and performed. 3. Identification: The ability to acknowledge verbally rhythmic and melodic stimuli. For instance, in listening to specific childrens songs, students might be asked to identify particular elemental attributes, such as the rhythm patterns employed or the direction of the melodic line. Students may also describe, using accurate terminology, the dynamics, tempos, and timbres perceived.21 4. Comprehension: The ability to demonstrate understanding of the rhythmic and melodic elements perceived in a listening exercise or melody. This level is an extension of level 3, identification. Instead of focusing on one musical element, students would be asked to identify and describe all of the elements they have perceived. For instance, if using Prokofievs Peter and the Wolf, the teacher might consider first aiding the children with their identification of the violin and its relationship to Peter, and subsequently relating the clarinet to the cat, and the bassoon to the grandfather, and so on. At first, this might be reinforced visually with pictures of both the instruments and the animals. Kinesthetic reinforcement may include movements representing each character as well as movements with the music as the story is being told. Further study at this level might entail a more in-depth examination of the music, specifically, the rhythms, pitch patterns, dynamics, and articulations that help to portray the individual characters, such as the staccato articulations in the flute part that help convey the birds whistle or the punctuated rhythm and melodic

lines that reflect Peters walk through the woods. The cochlear-implanted child may not have an Individualized Education Program (IEP). This may be the decision of a parent whose childs implant surgery and subsequent habilitation were successful. In this instance, the music educator should converse with the childs other teachers, in addition to the school nurse, to determine whether the district has been informed by the childs parents. Music teachers should also feel comfortable contacting the parents directly so they can answer questions about their childs cochlear implant. Of particular interest to music teachers are the childs spectral capacitiesfrequencies available to the child with his or her implant system. Such information will enable teachers to safely and successfully accommodate the child in the music classroom. If the cochlear-implanted child does have an IEP, the music teacher should review their audiogram (a visual representation of hearing sensitivity at various frequencies) as well as the childs spectral capacities with the implant. Any questions or concerns may also be directed to the schools audiologist, speech-language pathologist, or school nurse. The music teacher may also want to consider contacting the childs other teachers to find out about the instructional modifications implemented in those classes for the purposes of consistency. The music teacher may want to conduct a musical audiogram to understand and meet the cochlear-implanted students spectral capabilities. To administer a musical audiogram, the music teacher should first select one melodic phrase from a childrens songbookspecifically, one that the child is familiar with. Second, the teacher should inform the child that the tune will be performed in three different ways, each in a different register and at a different dynamic level. The child should indicate which example sounded the best or was the most comfortable to listen to. This activity will provide the teacher with some initial information about which tones and dynamic ranges are most comfortable for the child.22
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A Music Educators Guide to the Cochlear Implant

Music teachers should be acquainted with the functional aspects of the cochlear implant, including support materials and resources. Such information will not only influence the teaching approaches employed by music educators but will also aid them in successfully including cochlear-implanted students in their music classes.

Resources
To address the needs of both the public school teacher and the young cochlear implant user, various manufacturers of the device have developed special troubleshooting manuals. Examples include Advanced Bionics Tools for Schools Helping Children with Cochlear Implants Succeed in the Classroom (Advanced Bionics Corporation, http://www.bionicear.com), Med-Els Handbook for Educators: Teaching Children Who Listen with a Cochlear Implant (Med-El Corporation, http://www.medel.com), and Cochlear Americass The Nucleus Troubleshooting Kit for Educators (Cochlear Americas, http://www.cochlearamericas.com).1 The primary purpose of these manuals is to aid educators in both recognizing and attending to problems that may arise with the sound processor to lessen the time a child is without auditory stimulation.2 For the music educator, the manuals serve as excellent informational resources when working with cochlear-implanted students. Of particular benefit to the music educator is the information pertaining to the types and degrees of hearing loss, treatment options, audiogram interpretation, candidacy criteria for cochlear implantation, pre- and postimplantation procedures, as well as classroom suggestions and instructional strategies. Additional topics include step-bystep troubleshooting guides for both the body-worn components and the behind-the-ear transmitter systems as well as maintenance suggestions (e.g., verification of optimal equipment function for the battery, cable, coil, and microphone and procedures for daily listening checks.) Music educators need not feel intimidated by cochlear implant technology, as they also have available to them many school resource persons, such as the nurse, audiologist, speech-language pathologist, occupational therapist, and the childs classroom teachers. The most valuable resources for the music teacher are the childs parents or guardians. They have garnered great experience and insight throughout the implantation process as advocates for their childs health, well-being, and education.

children would respond by walking in a circle when the drum, which was placed in the center of the circle (and subsequently visible to them), was played and would stop when the drum stopped. They later responded to the instrument in conjunction with the song. For example, the children would move when they heard the song and would stop when the song stopped. A variation of this activity, which reinforced the concepts of fast, slow, loud, and soft, offered the children opportunities to serve as the leader by providing the sound for this activity. The child whose turn it was to play the drum could vary both the tempo and dynamic levels of their drum pattern, which would then result in a variety of movements by the group members. For example, a child striking the drum at both a fast tempo and loud dynamic level resulted in the groups running in a circle with heavy foot stomps. When a child played at a very slow tempo and soft dynamic level, the children would walk slowly on their tiptoes.7

Some Final Thoughts

As educators, it is our responsibility to educate all our students, providing them with chances to explore, experience, and create music. Children with cochlear implants can be successfully included in music class, especially if the activities take into consideration their unique needs. The most important finding of our research has been that music listening experiences can be both educational and pleasurable for the cochlear implant user even if his or her perception of music differs from that of typical-hearing or aided individuals.

Notes
1. Advanced Bionics Corporation, Advanced Bionics Tools for Schools Helping Children with Cochlear Implants Succeed in the Classroom, http://www.bionicear.com/professionals/tools.asp; Med-El Corporation, Med-Els Handbook for Educators: Teaching Children Who Listen with a Cochlear Implant, http://www.medel.com/ENG/US/50_Resources/40_ Educational_Resources/000_ed_resources.asp; and Cochlear Americas, The Nucleus Troubleshooting Kit for Educators, http://www. cochlearamericas.com/Support/40.asp. 2. Med-El Corporation, Med-Els Handbook for Educators. 3. Manuela Prause, Music for the Deaf and Hard of Hearing (Including Cochlear Implant Users), in Music as a Human Resource: Conference Book of the Seminar for Music Education, Music Therapy, and Music Medicine, ed. Daniela Laufer and Janet Montgomery (Nedlands, Western Australia: International Society for Music Education, 2000); Lynann Schraer-Joiner, The Effects of Training on a Cochlear Implant Users Musical Listening Skills and Hearing Behaviors: A Case Study (PhD diss., University of North Carolina at Greensboro, 2003); Lyn Schraer-Joiner, The Musical Interactions and Experiences of Young Children Implanted with the Cochlear Prosthesis (poster presented at the MENC Eastern Division Biennial In-Service Conference, Hartford, CT, March 2007); and Lyn Schraer-Joiner and Lily ChenHafteck, Music Teaching Approaches for Preschool Cochlear Implant Users: A Multiple Case Study (poster presented at MENC: The National Association for Music Education National Biennial In-Service Conference, Milwaukee, WI, April 2008). 4. Kate Gfeller, Shelley Witt, Linda Spencer, Julie Stordahl, and Bruce Tomblin, Musical Involvement and Enjoyment of Children Who Use Cochlear Implants, Volta Review 100, no. 4 (1998): 21333; and Kate Gfeller and John Knutson, Music to the Impaired or Implanted Ear Psychosocial Implications for Aural Rehabilitation, ASHA Leader Online (April 2003): http://www.asha.org/about/publications/leader -online/archives/2003/q2/f030429a.htm (accessed October 6, 2006). 5. Schraer-Joiner, The Effects of Training; and Schraer-Joiner, The Musical Interactions and Experiences. 6. Lois Birkenshaw, Music for Fun, Music for Learning (St. Louis, MO: MMB Music, 1982). 7. Schraer-Joiner, The Musical Interactions and Experiences.

Childrens Musical Experiences

Data from Schraer-Joiner and Prause-Webers experiential research with children who are hard-of-hearing/deaf, either implanted with a cochlear prosthesis or fitted with hearing aids, has revealed that familiarity and repetitious listening are key.3 Simple, short, repetitive songs and rhythm activities incorporating instruments have been the most successful. Such recommendations are substantiated by researchers Kate Gfeller, Shelley Witt, Linda Spencer, Julie Stordahl, and Bruce Tomblin.4 Songs emphasizing concepts such as transportation and directions such as stop, go, up, and down introduced in the students other classes have not only provided students with a review of vocabulary but have also helped reinforce similarities and differences across subject areas. The observable music behaviors exhibited by the children consisted of steady beat and the vocalization of vowels, such as oo, ah, and bu, introduced in various songs. Over time, children seemed more interested and confident in their responses to the activities, possibly due to their familiarity of music class procedures and activities. Children displayed a general interest in classroom instruments. For example, one profoundly deafened child demonstrated his interest by seeking out and even playing drums and bells prior to the music lesson. Activities introduced were described as predetection, as the children involved were not yet ready for detection, the first level of auditory development, defined in this research as the ability to respond to the presence or absence of rhythmic and melodic stimuli.5 One particular activity, Walk and Stop, was of special interest to the children.6 Sound sources were visible and available for children to freely explore. At first, their involvement 52 of responding to just the instrument (sound versus no sound). For example, the consisted

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Recordings emphasizing large ensembles may extend beyond the capacity of the modern cochlear implant system. Compositions for large ensembles, such as orchestras or bands, may be more difficult for the child implanted with the

cochlear prosthesis to perceive, as such pieces extend beyond the receptive capacity of modern cochlear implant systems. This is because the activated electrodes, located along the electrode array inserted into the cochlea, are related

Additional Resources
Adamek, Mary, and Alice-Ann Darrow. Music in Special Education (Silver Spring, MD: American Music Therapy Association, 2005). Atterbury, Betty. Mainstreaming Exceptional Children (Englewood Cliffs, NJ: Prentice Hall, 1990). Cooper, Nancy A. A Survey of Current Music Inclusion Practices and Issues in New Jersey. Contributions to Music Education 26, no. 2 (1999): 937. Darrow, Alice-Ann. Beyond Mainstreaming: Dealing with Diversity. Music Educators Journal 76, no. 8 (1990): 3643. Darrow, Alice-Ann. Music for the Deaf. Music Educators Journal 71, no. 6 (1985): 3335. Darrow, Alice-Ann. Music Therapy in the Treatment of the Hearing Impaired. Music Therapy Perspectives 6 (1989): 6170. Darrow, Alice-Ann. The Role of Hearing in Understanding Music. Music Educators Journal 77, no. 4 (1990): 2427. Darrow, Alice-Ann, and Kate Gfeller. A Study of Public School Music Programs Mainstreaming Hearing Impaired Students. Journal of Music Therapy 28 (1991): 2231. Frisque, James, Loretta Niebur, and Jere Humphreys, Music Mainstreaming: Practices in Arizona. Journal of Research in Music Education 42 no. 2 (Summer 1994): 94104. Gfeller, Kate, and Charissa Lansing. Musical Perception of Cochlear Implant Users as Measured by the Primary Measures of Music Audiation: An Item Analysis. Journal of Music Therapy 29, no. 1 (1992): 1839. Johnson, Christopher, and Alice-Ann Darrow. The Effect of Positive Models on Band Students Attitudinal Statements Regarding the Inclusion of Students with Disabilities. Journal of Research in Music Education 45, no. 2 (Summer 1997): 17384. McCord, Kimberly, and Emily Watts. Collaboration and Access for Our Children: Music Educators and Special Educators Together. Music Educators Journal 92, no. 4 (2006): 2633. Prause, Manuela. Musik und Gehoerlosigkeit. Therapeutische und paedagogische Aspekte der Verwendung von Musik bei gehoerlosen Menschen unter besonderer Beruecksichtigung des anglo-amerikanischen Forschungsgebietes (Cologne, Germany: Dohr, 2001). Prause, Manuela. Annaeherung an ein Musikerleben mit Cochlear Implant. Schnecke. Zeitschrift der Deutschen Cochlear Implant Gesellschaft 41, no.14 (2003): 1819.

to a specific frequency field. When too many frequencies are produced by one electrode, sound clusters result that make perception of music with the implant difficult. Ultimately, music consisting of single instruments or chamber music will provide optimum listening opportunities for the cochlear-implanted child. In instances when a particular listening lesson or activity emphasizes a larger work, the music teacher might consider giving the cochlear-implanted child a musical heads-up to help him or her prepare for that lesson. Providing the child with a recording ahead of time may be very helpful. Depending on the childs experience with the implant, a modified version of the piece emphasizing the main melody would be optimal. Listening maps can also help the cochlear-implanted child to follow the listening example. The spectral capacities of the cochlear implant should be considered when planning music lessons. Research has indicated not only that children implanted with the cochlear prosthesis participate in both group and individual vocal activities, including classroom singing and choir, but that they enjoy these experiences as well.23 Pitch perception, for the cochlear implant user, depends on the placement of the electrode carrier. This placement differs slightly for each individual. Therefore, the tone perceived by the cochlear implant user differs from the actual tone. Research has also revealed that cochlear-implanted children can successfully recognize familiar songs when words of the songs are provided but show little recognition when no words are provided, such as with piano accompaniment only.24 Song reviews can therefore be very helpful to the cochlear-implanted child. Reinforcing song lyrics via song-signing is one way that this can be done. Such an activity can be both pleasurable and educational for children with cochlear implants as well as for their typical-hearing peers.25 Although the child may not match pitch perfectly, singing activities should not be avoided. Providing singing opportunities can aid in refining childrens pitch discrimination skills as well as their ability to recognize and produce vow53

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els. Because the frequency range of the cochlear implant does not expand beyond that of an octave and a third, the music educator will need to carefully consider the cochlear-implanted child when planning singing activities. The findings of the aforementioned musical audiogram in conjunction with the childs spectral capacity will be particularly helpful in this instance. A musical heads-up would also be appropriate for this lesson, as research has revealed that repetition and familiarity are key components to the musical success of children implanted with the cochlear prosthesis. Some recommendations for the music teacher include providing the cochlear-implanted child with a recording of the song before the lesson. Recordings emphasizing mens and womens voices are optimal.26 The latter can be particularly reinforcing, since songs sung in lower registers will be easier for the cochlear-implanted child to perceive. During the lesson, the music teacher should consider surrounding the child with good vocal models. Also suggested is simplifying vocal parts so that the child can participate. If the child cannot partake in a planned singing activity, the music teacher might add an instrumental accompaniment for them to perform. Careful consideration should also be given when assigning instrument parts for a music activity. In general, instruments with clear, short sounds, such as the xylophone, will be easier for the cochlearimplanted child to perceive. Instruments such as the gong and metallophone have a broader frequency field (include many harmonics). As a result, these instruments may be difficult for the cochlear-implanted child to play. Therefore, the music teacher may want to consider assigning them another part to play, such as the xylophone, drum, rattle, or jingle bells. The external components (microphone and speech processor) of the implant system should be monitored during music lessons. Activities emphasizing movement and/or dance are of particular concern. In such instances, children should, if comfortable, remove the external components. Children who feel uneasy about doing so should be carefully monitored throughout
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the activity. An alternate activity or modified movements can be planned for the child as a precaution. If the microphone is dislodged from the magnet that holds it in place, in most cases, the child will be able to replace it without assistance. When listening activities are planned for a music lesson, the music teacher should remind the cochlear-implanted child that they may need to adjust his or her volume control. A quiet reminder at the beginning of class will serve as a preventative measure against any difficulties the child may experience, subsequently ensuring his or her comfort level.

4. Ibid. 5. Kimberly McCord, Pre-service Special Educators and Music Educators Collaborating in Teaching Music to Children who are Hard of Hearing or Deaf, in Proceedings of the ISME Commission Seminar on Music in Special Education, Music Therapy, and Music Medicine, ed. Manuela Prause-Weber (Nedlands, Western Australia: International Society for Music Education, 2007). 6. Ibid. 7. Ibid. 8. Carol Scott-Kassner and Patricia Shehan Campbell, Music in Childhood: From Preschool through the Elementary Grades (Belmont, CA: Wadsworth, 1995), 348. 9. Ibid. 10. Mark Marschark, Raising and Educating a Deaf Child (New York: Oxford University Press, 1997). 11. Alice-Ann Darrow, The Arts of Sign and Song, Music Educators Journal 74, no. 1 (1987): 3335. 12. Mary Adamek and Alice-Ann Darrow, Music in Special Education (Silver Spring, MD: American Music Therapy Association, 2005); and Darrow, The Arts of Sign and Song. 13. Kate Gfeller, Shelley Witt, Linda Spencer, Julie Stordahl, and Bruce Tomblin, Musical Involvement and Enjoyment of Children Who Use Cochlear Implants, Volta Review 100, no. 4 (1998): 21333; Carol Linsenmeier, Violin Instruction for a Child with Profound Deafness: A Descriptive Case Study (PhD diss., Kent State University, Kent, Ohio, 1999); and Manuela Prause, Annaeherung an ein Musikerleben mit Cochlear Implant, Schnecke. Zeitschrift der Deutschen Cochlear Implant Gesellschaft 41, no. 14 (2003): 1819. 14. Michael Studdert-Kennedy, Speech Perception, Language and Speech 23, no. 1 (1980): 4565. 15. Elise Sobol, An Attitude and Approach for Teaching Music to Special Learners (Raleigh, NC: Pentland, 2001.) 16. S. Abdi, M. H. Khalessi, M. Khorsandi, and B. Gholami, Introducing Music as a Means of Habilitation for Children with Cochlear Implants, International Journal of Pediatric Otorhinolaryngology 59, no. 2 (2001): 10513; Kate Gfeller and Charissa Lansing, Musical Perception of Cochlear Implant Users as Measured by the Primary Measures of Music Audiation: An Item Analysis, Journal of Music Therapy, 29, no. 1 (1992):1839; and Gfeller et al., Musical Involvement and Enjoyment.

Music for All

Music can be attainable by all children if given the opportunity. The child implanted with the cochlear prosthesis, like any hard-of-hearing or deaf child, is constantly faced with numerous auditory demands and auditory learning, often resulting in hearing stress. Musical involvement will offer the cochlear-implanted child the same opportunities for musical learning as their typical-hearing peers and will provide sensory experiences that are both pleasurable and educational. Music teachers responsible for educating a child with a cochlear prosthesis should consider adapting lessons to meet the special needs and aural demands of the student. The recommendations offered here can serve as a foundation for music educators in providing pleasurable musical experiences for many children with this hearing prosthesis.

Notes
1. National Institute on Deafness and Other Communication Disorders, Statistics about Hearing Disorders, Ear Infections, and Deafness, http://www.nidcd.nih.gov/ health/statistics/hearing.asp. 2. Anne Beiter and Judith Brimacombe, Cochlear Implants, in Rehabilitative Audiology: Children and Adults, ed. Jerome Alpiner and Patricia McCarthy (Baltimore: Williams and Wilkins, 1993), 41744. 3. Michael Dorman, An Overview of Cochlear Implants, in Cochlear Implants: A Handbook, ed. Bonnie Tucker (Jefferson, NC: McFarland, 1998), 528.

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17. Adamek and Darrow, Music in Special Education; and Darrow, The Arts of Sign and Song. 18. Lynann Schraer-Joiner, The Effects of Training on a Cochlear Implant Users Musical Listening Skills and Hearing Behaviors: A Case Study (PhD diss., University of North Carolina at Greensboro, 2003); and Lynann Schraer-Joiner, An Adult Cochlear Implant Users Musical Listening Skills (paper presented at the 27th International Society for Music Education World Conference, Kuala Lumpur, Malaysia, January 2007). 19. Lois Birkenshaw, Music for Fun, Music for Learning (St. Louis, MO: MMB Music, 1982). 20. Alice-Ann Darrow, Music Therapy for Hearing Impaired Clients, in The Art and Science of Music Therapy: A Handbook, ed. Tony Wigran, Bruce Saperston, and Robert West (Florence, KY: Routledge, 1995), 36384. 21. Ibid. 22. Prause, Annaeherung an ein Musikerleben. 23. Gfeller et al., Musical Involvement and Enjoyment; Tara Vongpaisal, Sandra E. Trehub, E. Glenn Schellenberg, and Blake Papsin, Music Recognition by Children with Cochlear Implants, International Congress Series 1273 (2004): 19396; and Prause, Annaeherung an ein Musikerleben. 24. Vongpaisal et al., Music Recognition. 25. Darrow, The Arts of Sign and Song. 26. Adamek and Darrow, Music in Special Education; Darrow, The Arts of Sign and Song; Sobol, An Attitude and Approach; and Scott-Kassner and Campbell, Music in Childhood, 348.

June 2329, 2010

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