Music For Children With Hearing Loss A Resource For Parents and Teachers

Music for Children with Hearing Loss
Music for Children with

Hearing Loss
A Resource for Parents
and Teachers
Lyn E. Schraer-Joiner
1
3
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Library of Congress Cataloging-in-Publication Data

Schraer-Joiner, Lyn E.
Music for children with hearing loss : a resource for parents and teachers / Lyn E. Schraer-Joiner.
pages cm
Includes bibliographical references and index.
ISBN 978–0–19–985581–0 (hardback : alk. paper)—ISBN 978–0–19–985583–4
(paperback : alk. paper) 1. Music for hearing impaired children. 2. Deaf
children—Education. I. Title.
MT17.S37 2014
372.87087'2—dc23
2013045253
9 8 7 6 5 4 3 2 1
Printed in the United States of America
on acid-free paper
To Carmen and Catherine
CON T EN T S
Preface xi
Acknowledgments xv
About the Companion Website xvii
1. Introduction: A Brief Look at the History of Music for the Deaf and
Hard of Hearing 1
The Hearing Process 4
Hearing Loss 11
Music and Hearing Loss: An Overview of Research Past and
Present 26
Conclusions 27
For Your Consideration 28
References 30
2. For Parents: Important Decisions and Considerations 36
Initial Information Gathering 37
Early Identification and Intervention of Hearing Loss 38
Modes of Communication 45
Educational Settings 57
Socialization 65
Making a Difference through Music 68
Conclusions 71
References 76
3. Adapting the Music Classroom: All-Purpose Suggestions and
Approaches 83
Initial Preparation and Fact-Finding 83
Curricular Content: Making Music Accessible 88
Lesson Ideas for the General Music Classroom 93
Conclusions 97
References 102
( vii )
( viii ) Contents
4. M aking the Case: Involving Children with Hearing Loss in General

Music Lessons and Ensembles 104
Music Listening Lessons for the General Music Classroom 104
The Instrumental Music Program 114
The Choral Music Program 123
Conclusions 129
References 136
5. For the Music Education Student: Preparing for a Career in
Teaching 140
Special Education and Disability Rights Laws: A Foundation for
Student Advocacy 141
Making the Most of Methods Coursework and the Student Teaching
Experience 155
Introductory Music Students’ Teaching Experiences at a School for
the Deaf 159
Conclusions 171
References 174
6. Hearing Aids, Assistive Listening Devices (ALD), and Other Sensory
Devices 178
What Are Hearing Aids and How Do They Work? 179
Types of Hearing Aids 181
Monitoring Hearing Aid Devices 190
Assistive Listening Technology for the Home and Classroom 191
Listening to Music through Hearing Aids and Assistive Listening
Devices 195
Musical Sensory Devices for Individuals with Hearing Loss 196
Preventing Noise-Induced Hearing Loss: Protective Gear and
Resources 202
Conclusions 206
References 208
7. An Introduction to the Cochlear Implant 214
An Overview of the Device 214
The History of the Cochlear Implant 218
Pediatric Cochlear Implantation 223
Stimulation Rates and Speech-Processing Strategies: A Brief
Overview 230
One Cochlear Implant User’s Journey: The Story of “C” 232
Adjusting to Life with the Cochlear Implant 235
Contents ( ix )
Controversies Associated with Pediatric Cochlear

Implantation 237
Current Trends in Cochlear Implantation 240
Music and Cochlear Implanted Children: Involvement, Trends, and
Implications for the Music Classroom 245
Conclusions 249
References 257
Appendix 1: Parent/Child Listening Together Journal 265

Appendix 2: Child’s Listening Activity Journal 267
Appendix 3: Beethoven Biography and Listening Guide 269
Appendix 4: Books for Kids 273
Appendix 5: Arts-Related Opportunities for Kids 275
Appendix 6: Sources for Parents and Teachers 279
Appendix 7: Books for Parents and Teachers 281
Notes 283
Glossary 285
Index 307
PR EFACE
THE MOTIVATION BEHIND THIS BOOK
I was motivated to write this book for two reasons. The first was for “C”,
a close friend to whom I promised the continuation of a project we began
in 2001 to develop music materials for the deaf and hard of hearing. The
second reason was to meet the needs of the many parents and teachers
who revealed their desire for more information, support, and collabora-
tion in order to meet the needs of the children with hearing loss in their
lives. Thus, this book is designed to be a comprehensive hands-on resource
for parents and teachers, balancing a technical overview of hearing loss,
including assessment, diagnosis, and intervention, with relevant music
lessons, resources, and research involving children who are deaf and hard
of hearing.
The research studies presented are meant to reinforce both the con-
tinued interest in music for the deaf and hard of hearing as well as the
great support for this population. Any references to “normal” or “hearing
impaired” individuals within these studies are made only within the con-
text of cited articles and resources so as to maintain the integrity of those
published documents. Moreover, I have primarily used “person first lan-
guage,” defined in this book as language which puts the child before his or
her hearing loss. This decision is based upon my philosophy of teaching.
My sincere hope is that parents and teachers alike will read these pages,
either from beginning to end or by researching a specific topic relative to
their current situation, and discover the resources they need.
CHAPTER OVERVIEW
In chapter 1, I lay the foundation for the entire book providing both par-
ents and teachers with the terminology and background they will need to
navigate the remaining chapters. I think this chapter will also stimulate
( xi )
( xii ) Preface
an appreciation for the long history and tradition of music as both a reha-
bilitative and pedagogical tool for children who are deaf or hard of hearing.
Parents are the strongest and most important advocates for their chil-
dren. Therefore, chapter 2 is dedicated to them and to the many decisions
(i.e., modes of communication, educational approaches, academic sup-
ports, and opportunities for socialization) they will face upon receiving
the news that their child has a hearing loss. Such information is also cru-
cial for teachers as it may later help them to provide a learning environ-
ment and experiences that both foster and reinforce the other important
skills the child will need.
Chapters 3 and 4 of this book are devoted to my music colleagues, past
and present. Improvements in hearing technologies will yield increasing
numbers of children who are deaf or hard of hearing in music classrooms.
Ultimately, awareness and preparation are crucial if music teachers are to
successfully include all children into the general music, instrumental, and
choral settings.
In chapter 5, my intent is to encourage music education majors to
make the most of their coursework and embrace every teaching opportu-
nity during their field experience. I have also included my undergraduate
music education students’ teaching experiences to serve as examples for
other young professionals.
Chapters 6 and 7 are technical in nature and are intended to familiarize
both parents and teachers with the various devices that may be recom-
mended for the child who is diagnosed with a hearing loss. Chapter 6 fea-
tures a number of different hearing aids and assistive listening devices.
Music is also a part of this chapter as I discuss listening to music through
these devices. I also highlight a variety of sensory devices and proj-
ects successfully used with children who have hearing loss such as the
Radio Baton, Sound Cradle, Sansula, and the Electro-Acoustic Musically
Interactive Room (EAMIR) technology project. It is also my intention to re-
inforce the many music-making opportunities available to them. Chapter
6 concludes with a discussion of Noise-Induced Hearing Loss, particularly
its impact upon musicians, important protective gear (i.e., musicians’ ear
plugs), strategies, and resources geared towards children and young adults
about the importance of practicing safe listening habits.
Chapter 7 is devoted entirely to the cochlear implant, not only because
of the impact this technological wonder has had upon those who are deaf
or hard of hearing, but also because this device will likely be a part of
the parental decision-making process. Moreover, there are implications
for the public school music teacher who will likely see a greater number of
cochlear implant users in their music classrooms.
Preface ( xiii )
Finally, to spark further musical discussion, I have concluded each

chapter with a section entitled For Your Consideration that offers chapter
questions or discussion points to help guide parents and teachers in their
research. Ideas, activities, and lessons are also presented to promote con-
tinued music-making in home and school.
ACK NOWLEDGMEN T S
This book would not have been possible if not for the support and guid-
ance of so many people. First, I would like to thank my colleagues from the
International Society for Music Education (ISME) Commission on Special
Education, Music Therapy, and Music Medicine: Kimberly McCord, Alice
Ann Darrow, Markku Kaikonnen, Helen Farrell, and Bo Nillson for an-
swering my many questions about international law and for sharing their
creative approaches to music therapy and music education.
Thank you to the Kean University Conservatory of Music faculty who
have always been supportive of my teaching and research efforts and to
Stephanie Young, Maggie, and Darren Breed for their encouragement
throughout this project. Thank you also to the Mount Saint Mary Academy
of Watchung, New Jersey, for the use of their parlor room for the cover
photo.
My studies at the University of North Carolina had a profound impact
upon me. In particular, I wish to express my thanks to Dr. Patti Sink for
the inspiration her class Music for Exceptional Learners provided. I also
wish to express my sincerest gratitude to Dr. Jim Sherbon, my doctoral
advisor, for sharing his interest in music and hearing and for his great
support during my case study research. I would also like to thank my long-
time friends, Dr. Georgiann Toole and Dr. Sandra Teglas, for their guid-
ance and encouragement in both music teaching and research.
My music education students have always been a part of the conver-
sation. Their interest and enthusiasm for music and learning has always
been a source of motivation for me. I would like to thank especially: Chris
Aleixo, Peter Avelar, Manny Carro, Robert Demarco, Kevin Gunther,
Robyn Koenigsberg, Stephen Myers, Christina Quagliato, Charles Reid,
and Katherine Thode for their participation in the Kean University Concert
Series for the Deaf and for sharing their internship experiences with me.
The faculty and student members of the Kean University Concert Series
for the Deaf hold a special place in my heart. From 2007–12, this crew has
traveled to New York, Delaware, and throughout the state of New Jersey to
( xv )
( xvi ) Acknowledgments
bring music to children with hearing loss. I would especially like to thank
Jenna Cipolla, Nicolas Ellis, Beth Lucas, Professor Robert Rocco, and the
Kean University Percussion Ensemble: Dale Alleyne, Rui Arrojado, Manuel
Carro, Josef Ellis, Kenny Medina, Stephen Myers, Steven Plesnarski,
John Reilly, Matthew Savage, and Percussion Ensemble Director, James
Musto, for their dedication to teaching and to their belief that music is
for everyone.
I am indebted to my talented and devoted music education colleagues,
Linda Green, Marguerite Modero, Jenna Cipolla, Jennifer Lorys, and
Jeffrey Stier, for their consistent and sound feedback throughout the
writing process. I am also grateful for the input of Della Thomas, Director
for the Delaware School for the Deaf, and Deborah Solimando, Early
Intervention Program instructor, New Jersey School for the Deaf, spe-
cifically for their incredible dedication to Deaf education and their will-
ingness to read and make insightful recommendations throughout this
project. I wish to also thank my research assistant, Rachel Beleski, for her
tremendous organization as well as her ability to point out fine details,
and Ann Levingston Joiner, for her guidance and support throughout the
revision process. Heartfelt thanks also to music teacher and photogra-
pher, Susan Defurianni, for her artistic contributions to this project.
The enduring spirit of my two greatest mentors and muses, Catherine
and Carmen, cannot go unmentioned for their life stories have guided
my teaching and research. This book represents a promise I made to both
of them.
Finally, I wish to thank my family, in particular, my parents, William
and Beverley Schraer, for their enduring faith in me; and most impor-
tantly, Dave and Jaycie Joiner, my greatest blessings, for their immeasur-
able encouragement and love.
ABOU T T HE COMPANION WEBSI T E
www.oup.com/us/musicforchildrenwithhearingloss
Readers are encouraged to visit the Oxford University Press companion
website for the book, Music for Children with Hearing Loss: A Resource for
Parents and Teachers. Numerous resources, images, and demonstrations
are featured. For example, visitors will enjoy the video titled How the
Cochlear Implant Works, courtesy of Advanced Bionics, as well V. J Manzo’s
EAMIR-based program, Lazy Guy, a wonderful resource for music teachers
everywhere. Additional photos collected during this project are also fea-
tured and consist of the Sound Cradle, the Kean University Concert Series
for the Deaf, and the EAMIR Glove. Various international resources are
also highlighted and include organizations representing many countries
from around the world.
( xvii )
Music for Children with Hearing Loss
CHAP T ER 1
Introduction
A Brief Look at the History of Music for the
Deaf and Hard of Hearing
F or more than two centuries, music has been used to both rehabilitate
and teach the deaf and hard of hearing (Darrow, 1984, 2006; Fahey
& Birkenshaw, 1972; Graham & Beer, 1980; Hagedorn, 1992; Heller &
Livingston, 1994; Mark & Gary, 2007; Nocera, 1979; Shehan-Campbell
& Scott-Kassner, 2006; Solomon, 1980). One of the first documented ac-
counts was that of Jean Marc Gaspard Itard (1806/1962), most recognized
for his work with Victor, the “wild boy of Aveyron.” The boy, thought to
have been abandoned by his parents as a young child, survived alone until
his discovery in 1799, at age eleven. Itard, a physician and teacher of the
deaf, assumed the responsibility of educating Victor to help him integrate
into French society.
Though Victor was not deaf, he was without language. Itard’s work
with Victor was significant because the teaching approaches Itard devel-
oped were used later with children who were deaf or hard of hearing. For
example, Itard used music as a means for developing Victor’s auditory
discrimination skills. One of the first music activities Itard introduced
required that Victor distinguish between different sounds, starting with
instruments such as bells and drums and later instruments that were
“progressively more alike, more complicated, and nearer together” (Itard,
1806, pp. 5, 9; Solomon, 1980, p. 237). As Victor progressed, Itard sought
to create a program that was both enjoyable and structured in order to
develop his individual senses. In one activity, Victor was blindfolded and
raised his finger each time Itard made a sound (Solomon, 1980, p. 237).
( 1 )
( 2 ) Music for Children with Hearing Loss
According to Itard, this was an activity Victor clearly enjoyed (p. 237).
Over the course of several years, Itard documented Victor’s cognitive and
social development that he later published in Rapports sur le Sauvage de
l’Aveyron (Reports on the Wild Boy of Aveyron), considered to be a land-
mark work on human educability. Victor only developed minimal social,
speech, and language skills.1 However, Itard’s work with Victor served as
a model for the approaches Maria Montessori and Edourd Sequin later
developed for children with intellectual disabilities (Braddock & Parish,
2001, p. 30).
William Wolcott Turner and David Ely Bartlett’s (ca. 1848) pioneering
efforts have also had long-lasting effects on current music teaching trends
and curricula for children who are deaf and hard of hearing. Their instruc-
tional approaches emphasized the introduction of musical concepts such
as rhythm, pitch, and form using sight and touch. Turner and Bartlett were
committed to providing all children with opportunities for musical en-
joyment and performance (Abdi, Khalessi, Khorsandi, & Gholami, 2001;
Darrow & Heller, 1985; Solomon, 1980). J. A. Ayers reported the following
about a performance by Augusta Avery, one of Bartlett’s piano students,
who had been totally deaf since the age of eighteen months.
If there be any branch of study in which they would seem necessarily and always
to fail, it would surely be music, for that being directly dependent upon the ear,
being as it were the very soul of sound, would seem surely to be unattainable
by those for whom all sound is dead. Yet it is but a few weeks since we had the
pleasure of listening to a performance upon the piano by a young lady who from
eighteen months of age had been ~ wholly deaf, in which expression, accuracy
and skill were exhibited, fully equal to that commonly attained by other young
1adies. No one hearing it would have dreamed for a moment that the performer
was destitute of the sense of sound, or unable to drink in with a full soul the
harmony that she was, in a measure, unconsciously creating. It is true this was,
to a great extent, only a disp1ay of mechanical skill; yet as an effort, under great
disadvantages, to take one step further in the world of acquisition, it was an
exhibition full of both wonder and interest. (Ayres, 1848, pp. 26–27)
In yet another curricular example, many nineteenth-century deaf schools

incorporated a subject called “rhythms” in order to provide students with
a foundation for speech and language development (Darrow & Heller,
1985; Hummel, 1971; Solomon, 1980). Schools also reported the use of
rhythmic clapping as well as the use of instruments such as pianos, organs,
and drums for the purposes of articulation, speech, language, and audi-
tory skills development (Darrow & Heller, 1985; Sheldon, 1997; Solomon,
I n t r o d u c t i o n ( 3 )
1980). Similarly, a kindergarten and primary school in Washington, DC

(ca. 1883), for children who were deaf and hard of hearing incorporated
music games and imitative singing into their curriculum.
In the early twentieth century, many schools for the deaf, including
those in New York, Tennessee, Kentucky, and Illinois, created respected
brass band programs. Audience members attending concerts of the
Illinois School for the Deaf brass band, active between 1923 and1942,
were said to have been impressed by the boys’ abilities. They described the
musicians’ playing as both perfect and professional in nature. The boys
performed throughout the United States and Canada and were described
as being delighted by their musical achievements. Unfortunately, those
who believed that music for the deaf and hard of hearing was a wasted
effort criticized the program, saying that their time would be better
spent in more meaningful educational endeavors (Sheldon, 1997).
The Mary Hare School, located in Newbury, England, is a recent example
of a deaf school offering its students a music education. In 1975 the school’s
then-deputy principal Bill Fawkes initiated a descant music recorder
group. The early recorder melodies taught included “The Old Grey Goose,”
“Summer Goodbye,” and “London’s Burning” (Fawkes & Ratnanather,
2009). Later, however, the group performed the music of composers such
as François Couperin and John Dowland (Fawkes & Ratnanather, 2009).
Eventually, instrumental opportunities expanded to include flute, clar-
inet, guitar, piano, and trumpet studies. Music was formally introduced
into the school curriculum in 1988. Teachers first exposed students to
rhythm through bodily movement and later with percussion instruments.
Rhythm activities included relaxation and breathing exercises, hand clap-
ping, marching, and singing folk songs such as “Old MacDonald” (Fawkes
& Ratnanather, 2009, p. 8). Eventually, rhythm was taught on pitched
instruments. According to Fawkes, “every child in the Mary Hare pro-
gram was given the opportunity to discover his or her innate musicality”
(p. 8). School reports revealed that some graduates of the program have
performed professionally in top orchestras. One example is flutist Ruth
Montgomery who has performed with the Royal Philharmonic Orchestra
(p. 10). Still other graduates have pursued careers in music education in-
cluding work with the UK Charity Music and the Deaf (p. 10).
Misconceptions Associated with Hearing Loss
Despite a long history of music for children who are deaf and hard of
hearing, the notion of such a practice still confounds many, and this is
only one of many misconceptions. One of the most common is that indi-
viduals with hearing loss cannot perceive any sound, that they are totally
deaf (Marschark, 2009). In actuality, few are without residual hearing,
the hearing that remains after the onset of a loss. Hearing loss cannot be
generalized because no two people are ever alike in terms of their hearing
abilities even if they have identical audiograms, discussed later in this
chapter (Atcherson, 2002). Also, it is naturally assumed that devices such
as hearing aids (chapter 6) and cochlear implants (chapter 7), in particular,
“cure” hearing loss or restore hearing. While such devices can offer ben-
efits such as hearing speech, environmental sounds, and music, variables
such as age, degree, and duration of hearing loss influence the benefits de-
rived by each person. Other misconceptions associated with hearing loss
include the notion that individuals with hearing loss are excellent speech
readers2 or that they only communicate via American Sign Language (ASL)
or other forms. Ultimately, different severities of hearing loss require dif-
ferent modes of communication, technology, teaching approaches, and
classroom modifications.
Unfortunately, misunderstandings about deafness can have a nega-
tive impact on both the educational and musical opportunities offered
to children who are deaf and hard of hearing. This is especially the case
as hearing loss, regardless of severity, is often linked with ability level or
mental acuity (Atcherson, 2002; Higgins, 1980; Marschark, 2009). While
hearing loss can limit musical capacity, it does not mean that responses
to musical stimuli are impossible. Researchers have found that chil-
dren with hearing loss, whether unaided or who use hearing aids and/or
cochlear implants, can experience, respond to, and enjoy musical stim-
uli (Butler, 2004; Darrow, 1979, 1987, 1989, 1992, 1993; Gfeller, 2000;
Gfeller, Witt, Spenser, Stordahl, & Tomblin, 2000; Madsen & Mears,
1965; Schraer-Joiner & Chen-Hafteck, 2009; Solomon, 1980; Stordahl,
2002; Vongpaisal, Trehub, & Schellenberg, 2006; Vongpaisal, Trehub,
Schellenberg, & Papsin, 2004; Yennari, 2010).
THE HEARING PROCESS

The Science behind Sound
Having established that music has been successfully taught and, more im-
portantly, experienced and enjoyed by children with hearing loss, the next
logical question is “what do they actually perceive musically?” To address
this, we must first consider the properties of sound.
When any vibrating source pushes nearby air molecules, those mol-
ecules in turn push against each other and move in regular, wavelike
patterns. These vibrations are sensed by the ear as sound (Lahey, 2001,
p. 106). Sounds, whether environmental or musical in nature, need to
travel through a medium in order for the vibrations of objects to reach
the ear. This medium is typically air, but can also be solid, like a thin wall
between two apartments, or a liquid, like the travel of whale songs in the
water of the ocean. For the purposes of music learning, the medium dis-
cussed will be air.
The frequency of a sound wave is the speed with which the wave vibrates,
measured in terms of the number of vibrations per second, also referred
to as cycles per second or Hertz (Hz) (Darrow, 1990a, p. 25; Lahey, 2001,
p. 106). Human hearing ranges from frequencies as low as 20 Hz and as high
as 20,000 Hz (Lahey, 2001, p. 107). An irregular vibration, a sound without
a regular frequency, is perceived as noise (Radocy & Boyle, 1997, p. 69).
While frequency is a physical property of a sound wave, we call what we
perceive the pitch; although these terms are related there is a difference
between the fundamental physics of vibration of a medium and our per-
ception of that vibration. Psychoacoustics, therefore, is the study of our
sensory responsiveness to the physical stimuli of sound, sensations pro-
duced by various sounds, and speech production (Radocy & Boyle, 1997,
p. 69). Pitch is the psychological phenomenon of sound. Higher frequen-
cies correspond to faster vibration rates and are perceived as being higher
in pitch (Darrow, 1990a, p. 25; Lahey, 2001, p. 107). Conversely, lower fre-
quencies correspond to slower vibration rates and are perceived as being
lower in pitch (Darrow, 1990a, p. 25; Lahey, 2001, p. 107).
Sound waves contain other data, as well. The amplitude of the vibration
refers to how much the air moves as the sound wave travels. The further
the air moves as it vibrates, the greater the intensity of the sound. We per-
ceive the physical property of intensity as the psychoacoustic phenomena
of loudness (Lahey, 2001, p. 107). The intensity of a sound wave, measured
in decibels (dB), is the amount of energy or power that passes through a
square metric area per second. Waves that displace air less produce soft
sounds; those that displace air more produce loud sounds. Our sensation
of loudness or softness is determined by the number of cells stimulated
in the cochlea and the resulting number of impulses sent to the brain.
The more cells stimulated, the louder the sound (Radocy & Boyle, 1997,
p. 73; Schraer & Stoltz, 1999, p. 304). Table 1.1 shows a comparison of
different sounds and their measurements in decibels. Another physical at-
tribute of sound is duration. Duration refers to how long a given pitch lasts.
Table 1.1 A COMPARISON OF DIFFEREN T SOUND SOURCE S AND THEIR

ME A SUREMEN T S IN DECIBEL S
Sound source Decibel Levels
Threshold of Human Hearing 0

Rustling Leaves 10
Quiet Conversation 20
Background music 40
Loud conversation 60
Chamber music, small auditorium 75–85
Traffic 85
Marching Band 100
Symphonic music peak 90
Jazz Concert 91
Rock Concert 104
Chain Saw/Leaf blower 110–115
Pain Threshold 120
Jet Plane (from 100 ft) 130
Fireworks 140
Note: Adapted from Berger, E. H., Neitzel, R., & Kladden, C. A. (2008). Noise navigator ® sound level da-
tabase with over 1700 measurement values. National Hearing Conservation Association. Retrieved from
http://nhca.affiniscape.com/displaycommon.cfm?an=1&subarticlenbr=11Dangerous
Decibels. (2012a). Decibel exposure time guidelines. Retrieved from http://www.dangerousdecibels.org/
education/information-center/decibel-exposure-time-guidelines/
Perception and responses to duration or varying lengths of sound com-

prise the foundation for rhythmic development (Darrow, 1990a, p. 25).
Timbre is a psychoacoustic attribute of sound that combines the pitch,
harmonics, and the attack and release times of the note giving each mu-
sical instrument its “unique colour and character” (Plomp, 1970; Radocy
& Boyle, 2003; Stelmacovich, 2012, “Best and Worst Musical Instruments
for People with Hearing Loss,” para. 6). Timbre enables the listener to
discriminate the sounds produced by different instruments playing in
unison. Timbre may pose some difficulty for those who have hearing loss,
making it more difficult for them to discriminate between instrument
sounds (para. 6).
The Parts of the Ear and Their Role

in the Hearing Process
From birth, the human sense of hearing plays a crucial role in the way the
world is perceived and characterized. Hearing influences our daily inter-
actions as well as our ability to identify and distinguish incoming sound
stimuli (Schraer-Joiner, 2003). Having an understanding of the hearing

process helps us to compare both typical and atypical ear structure and
function.
The Outer Ear
The hearing process begins with the transmission of sound waves from
the environment. These sound waves are gathered by the outer ear and
guided down the ear canal to the eardrum. The pinna, or auricle, is made
of cartilage and soft tissue and has two important roles. First, the pinna
is responsible for collecting sound vibrations from the environment and
guiding them into the ear canal, referred to also as the auditory canal or
external auditory meatus. Second, the structure and shape of the pinna
helps us to determine the direction from which the sound emanates as
well as the source of sound. For example, sounds originating from behind
bounce off the pinna differently than if they originate from a source in
front. This sound reflection alters the pattern of the sound wave that the
brain recognizes. Sound waves cause the eardrum or tympanic membrane,
a thin cone-shaped piece of skin positioned between the ear canal and the
middle ear, to vibrate.
The Middle Ear
The vibration of the ear drum sets the three tiny bones of the middle ear
into motion. These three tiny bones, also referred to as the ossicles, pro-
vide a necessary connection between the eardrum and the inner ear. More
specifically, the sound waves that strike the ear drum cause it to move
back and forth. This movement in turn sets the ossicles into motion. The
ossicles are the smallest bones in the human body and include the malleus
(hammer), incus (anvil), and stapes (stirrup). The malleus is connected to
the center of the eardrum, on the inner side. When the eardrum vibrates,
it moves the malleus from side to side like a lever. The other end of the
malleus connects to the incus, which in turn attaches to the stapes. The
stapes connects to the oval window, one of two membrane-covered open-
ings to the inner ear. The movement of the stapes sets the oval window
into motion.
The middle ear is also connected to the throat via the Eustachian tube.
This tube links the middle-ear cavity with the nasopharynx, the part of the
throat that lies behind the nose and above the soft palate. The Eustachian
tube equalizes atmospheric pressure in the middle ear, therefore enabling
the eardrum to move freely.
The Inner Ear
The vibration of the oval window moves the fluids of the inner ear. These
fluids, the endolymph and perilymph, stimulate the tiny hair cells found
in the cochlea, the bony structure considered to be the hearing portion of
the inner ear. The round window, the other membrane-covered opening
to the inner ear, serves as a pressure valve, bulging outward as fluid pres-
sure rises in the inner ear. Small hair cells, referred to as stereocilia or
nerve fibers, reside within the Organ of Corti. The stereocilia convert
sound vibrations into nerve impulses. The Organ of Corti lies along the
surface of the basilar membrane, a structure that runs through the center
of the cochlea and is divided into an upper and lower chamber (Lahey,
2001, p. 105). When the hair cells are stimulated, nerve impulses are sent
to the brain by way of the auditory nerve, where they are interpreted as
meaningful sound.
The inner ear also contains the semicircular canals that comprise our
balance system. Like the cochlea, the semicircular canals are also filled
with liquid and have thousands of microscopic hairs. As we move, the fluid
in the semicircular canals also moves. This, in turn, moves the hair cells
that send nerve impulses to the brain about the positioning of the head.
The brain responds by sending messages throughout the human body for
the purposes of maintaining balance. The three parts of the ear are illus-
trated in Figure 1.1.
Structure of the Human Ear.

Inner Ear
Anvil
Semicircular Cochlea
Hammer canals
Auditory
Stirrup nerve
Pinna Eustachian
Tympanic Oval tube
Auditory membrane window
canal
Middle Ear
Outer Ear
Figure 1.1: Structure of the Human Ear.

From Schraer, W. D., & Stolze, H. J. (1995). Biology: The study of life. Copyright © 1995
Pearson Education, Inc., or its affiliates. Used by permission. All Rights Reserved.
The Basilar Membrane and Its Role in Hearing

and Pitch Perception
The function of the basilar membrane and its role in our perception of
low- and high-frequency sounds should also be discussed. The Place and
Frequency theories provide some explanation as to how the ear registers
sound frequency. The Place Theory, created by Georg von Bekesy (1960),
suggests that high-frequency sounds register near the oval window or
basal region of the cochlea where the basilar membrane is narrow and
rigid. Low-frequency sounds, alternatively, register at the apical region or
tip of the cochlea, where the basilar membrane is wider and more flexible.
Georg von Bekesy’s work was honored with the Nobel Prize in 1961.
Conversely, the Frequency Theory, also referred to as telephone theory,
suggests that the entire basilar membrane vibrates in response to a sound
and that the resulting nerve impulses mirror the frequency of the sounds
to which we have been exposed. Put another way, each frequency of sound
energy is represented by nerve impulses of the same frequency. Therefore,
the greater the frequency of a sound the greater the number of nerve
impulses transmitted to the brain (Lahey, 2001, p. 110). We now know
that the place and frequency theories each play a role in hearing (Hirsh &
Watson, 1996; Hudspeth, 2000). The Place Theory supports the perception
of high-frequency sounds, while the Frequency Theory better aligns with
perception of low-frequency sounds. Medium-frequency sounds incorpo-
rate both processes.
The Auditory Nerve and the Role of the Brain in Hearing

and Music Perception
The auditory and vestibular nerves carry both sound and balance in-
formation to the brain. Together they comprise the eighth cranial nerve,
or acoustic nerve, and are divided into two pathways, ensuring that the
hemispheres of the brain receive information from both ears.
The temporal lobe resides on both sides of the brain just above the ears
and processes the information sent from both ears. The primary auditory
cortex, located within the temporal lobe, analyzes the frequency (pitch),
intensity (volume), and temporal (rhythm) elements of sound. The primary
auditory cortex detects sound patterns and performs auditory discrimina-
tion, the ability of the listener to distinguish between auditory patterns
of varying lengths and difficulty. Interesting to note is the research of
Shibata (2001) who found that the areas of the brain usually responsible
for hearing showed activity when individuals who were deaf felt vibra-
tions. According to Shibata, these findings suggest that such responses
are similar to those of hearing people perceiving music (University of
Washington, 2001).
Auditory Development and Communication Milestones
Understanding typical auditory skill development will provide a founda-

tion for understanding hearing loss as well as the effects of hearing loss
on typical auditory development. This information can help parents and
teachers alike as the milestones of auditory development can help to iden-
tify the early warning signs of language or learning delays especially as
they may relate to an undiagnosed hearing loss.
The first three years of life, particularly the period between eighteen
months and three years of age, are the most critical for speech and lan-
guage development. While children do not develop at exactly the same
rate, they do, however, follow a similar pattern of skill development
(American Speech-Language-Hearing Association, 2013; Koike, 2006;
Ling & Ling, 1974; Oller, Oller, & Badon, 2006; Turnbull & Justice, 2007).
From birth to four months of age, a hearing child will typically react to
loud sounds with motor responses (physical movement) such as limb ex-
tension or eye widening. The child may also move his or her eyes or head
towards the sound source. Between three and six months of age, the child
will be more consistent about turning and looking for sounds made in the
environment. Also noticeable will be his or her increased vocal experi-
mentation and responsiveness to the sounds of his or her own name. The
child will also respond to the sound and tone (sad, happy, angry) of his
or her parents’ voices (American Speech-Language-Hearing Association,
2013; Koike, 2006; Ling & Ling, 1974; Oller et al., 2006; Turnbull &
Justice, 2007).
The period between six and ten months will see additional milestones
such as the child’s ability to find the sound sources in the environment.
The child will respond to his or her name by turning towards the speaker
and will also begin to pay more attention when his or her parents speak to
them. At this time, the child will be very familiar with sounds found in the
home environment. From ten to fifteen months of age, a hearing child will
babble increasingly over time, this will begin to resemble speech closely.
The child will also continue to experiment with his or her own voices. This
will give way to sound localization between fifteen and eighteen months.
Also, during this time, the child will begin to understand different phrases
and follow simple directions. His or her ability to identify familiar objects
such as toys and body parts will also emerge. By eighteen months, the child
should have an expressive vocabulary of approximately twenty words and
phrases. A vocabulary of several hundred words and the use of two- and
three-word sentences will be evident by twenty-four months. The child
will also be able to name toys and express wants and feelings. Musical
behaviors will include humming and singing. By thirty-six months, the
hearing child will know his or her own name, will use three- to five-word
sentences, and ask short questions. The child will be able to repeat simple
rhymes, name several objects, and assign the appropriate colors to those
objects. Easy household tasks will also be possible at this time (American
Speech-Language-Hearing Association, 2013; Koike, 2006; Ling & Ling,
1974; Oller et al., 2006; Turnbull & Justice, 2007).
HEARING LOSS
Medical and audiological professionals must consider a number of fac-

tors when diagnosing a hearing loss and determining appropriate sup-
port services and programming. These factors include the type of hearing
loss and its location, the age of onset, and the degree of hearing loss in
decibels (Boothroyd & Gatty, 2012; Cole & Flexer, 2011; Nittrouer, 2010;
Northern & Downs, 2002). There are four main types or classifications
of hearing loss. They are conductive, sensorineural, mixed, and central
losses. Hearing loss can be either unilateral (occurring in one ear) or bilat-
eral. Unilateral hearing loss is quite common in children.
Types of Hearing Loss
Conductive Hearing Loss
Conductive hearing loss impacts the outer or middle ear and occurs when
sound is not conducted efficiently through the outer ear canal to the ear
drum and the ossicles of the middle ear. Typically, this loss results in the
reduction of sound levels impacting one’s ability to hear faint sounds.
Conductive hearing loss can be caused by a malformation of the outer- or
middle-ear structures, the result of an infection of the auditory canal, or
a perforated ear drum. Other causes include allergies, benign tumors, or
fluid in the middle ear resulting from colds or impacted earwax (Hoyle,
2010, p. 16). Conductive hearing loss is the most common type of hearing
loss in children typically due to recurring ear infections.
Conductive loss can often be corrected medically or surgically. In

instances where this is not the case, amplification devices such as hearing
aids and other assistive listening devices for classroom use can provide
support. If a child has a conductive hearing loss, he or she might experi-
ence difficulty with auditory reception, the ability of the ear to receive and
transmit sound. The child may also have difficulty in localizing sounds
and understanding speech in the presence of competing noise (i.e., other
classroom discussion, humming from lights, or classroom technology).
Specific difficulties with communication might include the differentiation
of words and sound as well as delays in both receptive (speech perception
and comprehension) and expressive language (speech production). The
child may also have difficulty articulating words, distinguishing between
singular versus plural word forms, and word tense. Academically, conduc-
tive hearing losses may manifest in areas such as reading and spelling
performance. This may require the child’s enrollment in special education
classes for additional support in those academic areas in which he or she is
struggling. A child with this type of loss may also exhibit delays in social
maturity.
Sometimes a child’s hearing sensitivity may fluctuate. This happens
most often with conductive hearing losses. Fluctuation may result from
a buildup of fluid or earwax in the ear, infection, or loud noise exposure.
Fluctuating hearing loss may impact a child’s academic performance be-
cause of his or her reduced and inconsistent ability to hear. The child may
also have difficulty socializing in the academic setting also resulting in
poor self-esteem.
Sensorineural Hearing Loss
Sensorineural hearing loss (SNHL) results from damage to the inner
ear, the pathways leading from the inner ear to the brain, or the central
processing centers of the brain (Tye-Murray, 2004, p. 186). SNHL may be
inherited or result from a malformation of the inner ear. Other causes
may include head trauma, exposure to loud noises, aging, illness, or ex-
posure to drugs that can cause hearing loss. Such losses are typically per-
manent, irreversible, and can range from mild to profound. A child with
SNHL experiences not only a reduction in the ability to hear faint sounds
but also deterioration in the clarity of sound quality. The child may have
difficulty discriminating between different sounds, localizing sounds, and
understanding speech particularly while in a noisy environment. He or
she may also exhibit delays in auditory attention, memory, comprehen-
sion, and language development. Academically, a child with sensorineural
hearing loss will typically exhibit delays or deficits in the areas of lan-
guage arts as well as in vocabulary development, spelling, mathematics,
and problem-solving. The child may also experience a lag in psychosocial
development (i.e., social skills and maturity level in relation to peers of
the same age).
Mixed Hearing Loss
Mixed hearing loss is a combination of both conductive and sensorineural
hearing losses (Gelfand, 2009). A child with mixed hearing loss may have
damage to the outer and/or middle ear as well as to the inner ear, and will
display similar audiological, communication, and academic characteris-
tics as a child with either conductive or sensorineural hearing losses.
Central Hearing Loss
Central hearing losses are rare and result from damage to the central
nervous system specifically, the pathways leading to the brain or the brain
itself (Baloh, 2009; Schaub, 2008). Such damage can be caused by head
trauma, brainstem or right-sided temporal lesions (brain tumors), stroke,
or vascular changes that can suddenly deprive the inner ear of blood
supply (Baloh, 2009). As a result of inconsistent auditory behavior, people
who experience central hearing loss are often misdiagnosed. One example
of such behavior is that a person might respond to environmental stimuli
but not react to sudden loud sounds.
Unilateral Hearing Loss
Unilateral Hearing Loss (UHL) or Single-Sided-Deafness (SSD) warrants
discussion not only because it can largely go undiagnosed but also because
of the difficulties a child may experience as a result of this type of hearing
loss (Northern & Downs, 2002, p. 23). UHL is a hearing loss involving
only one ear. (A loss that involves both ears is termed bilateral hearing
loss.) According to the American Speech-Language-Hearing Association
(2011), approximately one out of every 10,000 children is born with UHL,
and almost 3 percent of school-age children have it as well (Audiology
Information Series, 2011). UHL may be genetic or hereditary, result from
trauma to the ear or head, or from illness. UHL may also result from ex-
cessive exposure to loud noise. Academically, a child with UHL will find
it difficult to understand the teacher’s instruction or direction, particu-
larly in the presence of competing classroom noises (Roesner & Downs,
2004, p. 2). This can be especially challenging if the hearing ear is facing
or close to the competing noise. The child may also experience difficulty in
localizing sounds specifically determining the source and direction of the
sound. He or she will also have difficulty if the teacher moves around the
room during instruction, as the child will not receive a consistent speech
signal. Children with UHL are also at a higher risk for having academic,
speech-language, and social-emotional difficulties than their hearing
peers. As these losses go largely undetected, the child fails to receive the
appropriate interventions and instructional modifications.
Onset of Hearing Loss
The onset of hearing loss is typically categorized as prelingual, perilin-

gual, and postlingual. Prelingual hearing losses occur before the acqui-
sition of spoken language, usually before the child reaches the age of
two (Tye-Murray, 2009, p. 12). Such losses may be present at birth (con-
genital) or may result from “complications associated with the birthing
process” (p. 12). The earlier the onset of hearing loss and longer the child
is deprived of auditory stimulation, the more the loss will interfere with
speech and language development (Gelfand, 2009, p. 157). Some educa-
tors feel that the term prelingual is, overall, misrepresentative of lan-
guage acquisition. They feel that the term discounts the development of
visual communication that begins in early infancy via facial expression
and gesture (Meltzoff & Moore, 1983). The application of the term early
onset deafness is preferred as it is more inclusive of the child who commu-
nicates via sign language (D. Thomas, personal communication, March
20, 2013).
Perilingual hearing loss occurs between two and four years of age, such
that the child acquires a hearing loss as language skills are developing.
Early intervention services, discussed later in this chapter, will aid the
child with congenital and early onset deafness and his or her parents
through the process of testing and diagnosis.
Postlingual hearing losses are those acquired after speech and language
development. Such losses can occur anytime after the age of four. Any
development that has taken place prior to the onset of the hearing loss
will help to offset the impact of the loss and increase the effectiveness of
intervention services (Boothroyd & Gatty, 2012, p. 75; Tye-Murray, 2009,
p. 12).
For those born with hearing, experiencing a hearing loss later in life can
be traumatic, often affecting one’s social and emotional faculties as well
as educational development. A sense of aesthetic loss may also be experi-

enced as music and environmental sounds gradually become undetectable.
Those factors, often affecting the adaptation of late deafened adolescents
or adults, include a lack of accessibility to the environment, increased iso-
lation, loss of independence and interpersonal communication, as well as
perceived negative reactions from others. Postlingually deafened individ-
uals may experience loneliness or depression arising from their inability
to communicate with friends and loved ones or difficulty in adjusting to
their hearing loss.
Degrees of Hearing Loss
The degree of hearing loss indicates a person’s ability to hear those fre-
quencies and intensities most strongly aligned with speech. The degree
of hearing loss is measured in terms of how much stronger or louder a
sound needs to be in order for it to be perceived, expressed in decibels (dB).
Generally, the degrees of hearing loss are described as mild, moderate,
moderately severe, severe, and profound, though there are some varia-
tions of term use and degree range depending on the source (Boothroyd
& Gatty, 2012; Marschark, 2009). Many professionals have varying
opinions about whether such descriptors should be used, as they might
be misleading in terms of the severity of the loss and subsequently the
recommended academic modifications and supports (Northern & Downs,
2002, p. 20).
Mild Hearing Loss
Mild losses range from 25–40 dB. A child with a mild loss will experience
difficulty perceiving soft speech and listening in settings with background
or competing noise. A mild loss is manageable in quiet settings. The child
may also experience problems with clarity since the brain is receiving
some sounds but not all of the information needed for processing speech.
For example, vowel sounds may be heard and voiceless consonants may be
missed (Northern & Downs, 2002, p. 22).
During classroom instruction and discussion, a child can miss
25–40 percent of the speech signal (classroom instruction and discussion)
without the appropriate audiological supports (Cole & Flexer, 2011, p. 41).
Peer discussions will also be missed because the child may be unable to
hear them. A child with a 35–40 dB loss can also miss up to 50 percent of
class discussion, particularly if voices are in another part of the classroom
(Northern & Downs, 2002, p. 41). This might happen if the teacher is
moving around the room because voices will be softer at a distance and
harder for the child to hear.
The energy and extra effort a child needs to focus on the environment
will cause fatigue and result in irritable behavior. Such behavior, coupled
with school reports indicating that the child fails to pay attention or acts
lazy in class, should be brought to the attention of a pediatrician partic-
ularly if the behaviors are atypical (Cole & Flexer, 2011, p. 41). Though
not the only symptom of a hearing loss, these should be addressed with
the classroom teacher and appropriate school personnel. A mild loss that
goes undiagnosed can result in academic delay, thus having an impact on
the child’s self-image (Roesner & Downs, 2004, p. 2; Estabrooks, 2006).
However, with appropriate amplification devices, interventions, and in-
structional supports, the child with mild hearing loss can be successful in
school (Cole & Flexer, 2011, pp. 41–43).
Moderate Hearing Loss
Moderate hearing losses are those ranging from 41–55 dB (Marschark,
2007, p. 34; Waldman & Roush, 2010, p. 17). A child with a moderate loss
will have difficulty hearing conversations in settings with background or
competing noise. In quiet settings he or she will be able to hear at short
distances and understand what teachers or peers are saying in face-to-face
conversation. According to Cole and Flexer (2011), parents and teachers
may, as a result, tend to overestimate the child’s access to auditory stimuli
(p. 42).
A child with a moderate hearing loss will have difficulty hearing con-
sonants, may demonstrate impaired speech production, have a limited
vocabulary for his or her age, and exhibit delayed syntax (Northern &
Downs, 2002, p. 22). There will also be deficits in maturity level, overall
communication, and socialization. A child with moderate hearing loss
may miss between 50 and 75 percent of what is said in a typical classroom
setting, though at the extreme ranges of this hearing loss, much auditory
stimuli will be missed (p. 42). Additionally, if by fourth grade a child is not
identified as having a moderate hearing loss and is subsequently without
the appropriate interventions, there is the potential for the child to fall
two grade levels behind his or her peers (Deconde-Johnson & Seaton,
2012, p. 126). Such an outcome can be prevented if assistive listening
devices and amplification systems are coupled with appropriate auditory
interventions (Cole & Flexer, 2011, p. 42).
Moderately Severe Hearing Loss

Without amplification, spoken communication will need to be very close
and loud in order for the child with a moderately severe (56–70 dB) hearing
loss to have a basic idea of what is being said (Cole & Flexer, 2011, p. 42).
He or she will also have great difficulty in groups.
A child with a moderately severe hearing loss will exhibit delayed
language, an atonal vocal quality, and reduced speech intelligibility
(Deconde-Johnson & Seaton, 2012, p. 126). The child will miss all class-
room instruction and related discussion if they are not appropriately
amplified with a hearing aid and FM system (Cole & Flexer, 2011, p. 42;
Marschark, 2007, p. 34; Waldman & Roush, 2010, p. 17). Social interaction
will be very difficult, as well. Alignment of hearing aids and assistive lis-
tening devices with the appropriate rehabilitative interventions are cru-
cial for the child’s success (Roeser & Downs, 2004, p. 2). Hearing aids and
assistive listening devices are discussed more fully in chapter 6.
Severe Hearing Loss
Severe hearing losses are those ranging from 71–90 dB. Without ampli-
fication, such as a hearing aid coupled with an assistive listening device,
normal conversation will not be audible. Loud speech will also be difficult
to hear or comprehend. With amplification, however, the child will be able
to detect environmental sounds and some speech (Cole & Flexer, 2011,
p. 42; Marschark, 2007, p. 34; Thibodeau, 2006, p. 64; Waldman & Roush,
2010, p. 17).
A child with severe hearing loss may experience as much as a three-year
academic delay without the appropriate amplification (Deconde-Johnson
& Seaton, 2012, p. 126). Early use of amplification devices as well as inter-
ventions, including some additional academic support services, are crit-
ical in the development of speech and language skills, and can make the
difference in terms of the child’s comfort in the classroom.
Profound Hearing Loss
Profound losses are those greater than 91 dB. A child with a profound loss
will have difficulty understanding speech even with the appropriate am-
plification system. Sound vibrations may be perceived and the child will
rely heavily on visual cues as the primary sense for speech recognition
(Tye-Murray, 2004, p. 187). The appropriate educational supports and
intervention services, coupled with a device such as the cochlear implant
(pending family decisions and candidacy), can help the child to be suc-
cessful in the classroom.
In addition to etiology, type, degree, and age of hearing loss onset,
there are still other factors that can affect a student’s “expected per-
formance level,” such as the age at which the child first began wearing
hearing aids and/or cochlear implants; the manner in which the child’s
“hearing loss” has been managed (i.e., rehabilitative and educational sup-
ports); parental support for the child; as well as acumen and personality
(Deconde-Johnson & Seaton, 2012, p. 126).
Reading and Understanding the Audiogram
Parents and teachers can gain a better understanding of what the child
is hearing by reading his or her audiogram. An audiogram illustrates
the type and amount of hearing loss whether it is conductive, sensori-
neural, or mixed, as well as the pattern of hearing loss as illustrated in
Figure 1.2 (Cole & Flexer, 2011, p. 98; Nozza, 2003, p. 193; Tye-Murray,
2004, p. 185). Put another way, the audiogram graph illustrates the
softest sounds that the child is able to hear at different frequencies or
pitches. These sounds are called thresholds or the lowest decibel level
(dB) his or her ears can detect (Waldman & Roush, 2010, p. 16). Typical
thresholds can vary across frequencies and age. One’s ability to hear
the frequencies associated with speech, for example, is not the same as
the ability to hear extremely high pitches, and all of these thresholds
are expected to change over any person’s lifetime. For children consid-
ered to be within the normal range, the hearing threshold is 0–15 dB
(Waldman & Roush, 2010, p. 16). For young adults the normal range is
considered 0–20 dB.
A range of frequencies from 250 Hz to 8000 Hz can be found along the
horizontal axis of the audiogram. Along the vertical axis, a decibel scale
ranges top to bottom from 0 decibels (the softest sound a person can de-
tect) to 120 decibels (a very high intensity sound) (Waldman & Roush,
2010, p. 15). This scale illustrates the amount of hearing loss, typically re-
ferred to as dB HL (decibel hearing level). The greater the decibel level on
the audiogram the louder the threshold of sound required for perception
and subsequently the greater the hearing loss.
The configuration, shape, or slope of the child’s hearing loss refers to
the degree and pattern of hearing loss across frequencies (tones). These
configurations are also illustrated on the audiogram. For example, a
Normal Hearing Conductive hearing loss

Hz 250 500 1000 2000 4000 8000 Hz 250 500 1000 2000 4000 8000
Audiogram key
0 0 Right Left
10 10 A/C
Unmasked
20 20 A/C
30 30 masked
40 B/C
40 Unmasked
50 50 B/C
60 masked
60
B/C
70 70 Forehead
80 Masked
80
90 90
100 100
110 110
120 120
Sensori-neural hearing loss Mixed hearing loss
Hz 250 500 1000 2000 4000 8000 Hz 250 500 1000 2000 4000 8000
0 0
10 10
20 20
30 30
40 40
50 50
60 60
70 70
80 80
90 90
100 100
110 110
120 120
Figure 1.2: Audiograms (and key) illustrating: (a) normal hearing loss; (b) conductive
hearing loss; (c) sensorineural hearing loss; (d) mixed hearing loss. From Figure 3.1(ABCD),
p. 72, in Roland, P., Marple, B., & Meyerhoff, W. (1997). Hearing loss. New York: Thieme.
hearing loss that only affects high tones is a high-frequency loss. Such a
configuration would illustrate that the person is able to hear low tones
but has difficulty with higher tones. If only lower frequencies are im-
pacted, however, the configuration would show the opposite,that the
person has difficulty with lower tones but is able to hear higher tones.
The configuration of hearing loss may also be described by its shape
such as a flat loss, or sloping loss (Gelfand, 2009, p. 144). A flat loss indi-
cates a loss that is relatively even across all frequencies, while sloping
loss indicates an increasing degree of hearing loss as the frequency
increases.
125 250 500 1000 2000 4000 8000
10
20
s lh
Hearing Loss in dB
30 z v
p K
40 j m db i a h g
n o r ch
ng sh
50 θ
u
60
70
80
90
100
110
Frequencies in Cycles Per Second
Figure 1.3: The Speech Banana, as commonly found on audiograms. From p. 34 in

Nittrouer, S. (2010). Early development of children with hearing loss. San Diego, CA: Plural
Publishing, Inc. All rights reserved. Used with permission.
When the sounds necessary for speech are graphed on an audiogram

and a line is drawn around them, the shape resembles that of a banana, as
shown in Figure 1.3. Hence, this region is referred to as the speech banana.
The speech banana consists of most consonants and consonant combina-
tions such as “ch,” “sh,” and “ng.” If the child’s thresholds are located in the
region of the audiogram above the speech banana then this means that
he or she will be able to detect the sounds important for speech (Shipley
& McAfee, 2009, p. 581; Waldman & Roush, 2010, p. 17). If the child falls
below the speech banana, then he or she will not hear the sounds most
important for speech (p. 17). Thresholds within or near the speech banana
indicate that the child will be able to hear some of the sounds important
for speech (p. 17). It is important to note that if the child is able to hear
sounds within the speech banana while wearing hearing aids or cochlear
implant, then he or she will have a better chance of understanding these
sounds and is better able to reproduce them (through speech). Overall,
a child that can hear the sounds of speech will have a much easier time
imitating, understanding, and learning spoken language. The thresholds
for each ear are displayed on the audiogram using a variety of symbols,
which denote how the thresholds were measured. These are also shown
in Figure 1.2.
Appropriate Use and Application of the Terms Related

to Hearing Loss
There are a number of perspectives to consider when using and applying

terms related to hearing loss. Technically, the term “deaf” refers to a loss
of hearing. However, further designations can be made using the degrees
of hearing loss. For example, individuals who have mild to moderately se-
vere hearing loss are considered “hard of hearing” (HH/HOH), while those
with severe to profound hearing losses are considered “deaf.”
From a cultural standpoint, “Deaf,” or “big D Deaf,” refers to individuals
who identify themselves as part of the Deaf community, drawn together
via shared experiences, feelings, and language (Christiansen & Leigh,
2002; Marschark, 2007, 2009). A deaf person who does not have or prefer
to have an association with the Deaf community may also consider him-
or herself to be hard of hearing.
Until 1991, the term “hearing impaired” was used to refer to the Deaf
community until a vote by The World Federation of the Deaf (WFD) and
other organizations led to a very important change (Marschark, 2007,
2009; NAD, 2013). According to the National Association for the Deaf
(2013), “deaf and hard of hearing” people prefer instead to be called “deaf”
or “hard of hearing” and a majority of the organizations for the Deaf
use these terms to describe their constituents (Community and Culture,
para. 8). Moreover, the Deaf community does not support the use of
“person first language” (e.g., “children who are deaf or hard-of-hearing”)
because it is felt that this approach suggests that hearing loss is a dis-
ability or impairment or abnormality. Rather, the Deaf community
prefers Deaf-first language (e.g., “deaf or hard-of-hearing children”) as
“being culturally Deaf is a source of identity and pride” (Mackelprang,
2011, p. 441).
My review of literature on “person first language” has revealed that a
consensus does not exist about what is most appropriate. I have found
rather that there are many arguments both for and against (Lum, 2010;
Schur, Kruse, & Blanck, 2013). I have chosen to implement “person first
language” a decision that stems from my teaching philosophy of putting
my students first regardless of their background or ability. Each child is
unique and full of potential. Thus, it is not my intention to appear resistant
or openly opposed to the position or beliefs of the Deaf community.
The Impact of Hearing Loss on Music Perception
Research examining the musical responsiveness of children who are deaf

or hard of hearing has provided insight as to how hearing loss can impact
a person’s perception of the elements of music. Darrow (1990a) stated that
music is generally more intense than conversational speech and it employs
many more frequencies than normal speech sounds (p. 25). This explains
why children with severe hearing loss, who have difficulty in aurally proc-
essing speech, are still able to listen to and enjoy music (p. 25). The in-
tensity of the music may bring the volume above the listener’s threshold,
while the wider frequency range may utilize hearing ability the listener
has at higher or lower frequencies.
Rhythm
Many early studies exist that examined the abilities of those with hearing
loss to perceive rhythm (Darrow, 1979; Rileigh & Odom, 1972). For ex-
ample, in one study of the rhythmic abilities of children with hearing loss
and normal hearing, those with hearing loss were able to duplicate rhythmic
patterns similar to that of children with normal hearing (Korduba, 1975).
More recent studies have shown that children with hearing loss perform
similar to or better than their hearing peers in the areas of beat identifi-
cation, tempo change, meter discrimination, and rhythmic pattern main-
tenance, but do not perform as well as their hearing peers in the areas of
melodic rhythm duplication and rhythmic pattern duplication (Darrow,
1984). The noted differences between Darrow’s and Korduba’s studies,
particularly in the area of rhythmic pattern duplication, may be the result
of the onset, type, and degree of hearing loss, as well as the assistive lis-
tening device used.
Pitch
Studies have been conducted on the effects of school musical experiences
and age on the ability of children with hearing loss to discriminate pitch
at 250 and 500 Hz. Researchers found that children with hearing losses
do perceive the complex tones of music. Their findings also suggest that
the children, regardless of the type and degree of hearing loss, might also
benefit from appropriate pitch-related activities (Ford, 1988). In another
study, Darrow (1992) examined the effect of vibrotactile stimuli3 (cre-
ated by a SOMATRON vibrotactile device) on the abilities of seventeen
children (aged eight to eleven years) with hearing loss to identify pitch.
The children were tested individually on their use of auditory skills only
and then on their use of auditory skills with the vibrotactile stimuli. The
pitch patterns were created by a Yamaha synthesized PSR-90 keyboard
and recorded for presentation. Results revealed that ten children identi-
fied more pitch changes under the auditory skills coupled with vibrotac-
tile stimuli condition. Four children were able to identify more changes
under the use of auditory skills only condition, while three were able to
identify the same number of changes under both conditions (Darrow,
1992). These findings suggest that children with hearing loss can per-
ceive pitch and that vibration can be a way to enhance what they are
able to perceive (Darrow, 1992). This has important implications for the
approaches music educators use in their classrooms to teach children
with hearing loss.
In another study, Darrow & Cohen (1991) conducted two case studies
to examine the effect of programmed pitch practice on the ability of chil-
dren with hearing loss to reproduce given pitches and pitch patterns vo-
cally. The first case study involved a twelve-year-old child with a severe
hearing loss. As part of this case study, a pitch-practice program and vo-
calization tapes were used in conjunction with a Pitch Master to aid in the
child’s ability to internalize singing as a kinesthetic response (Darrow
& Cohen, 1991). Results revealed a 26 percent improvement pre- and
post-test evaluation in the child’s ability to match a given pitch. The sec-
ond case study involved an eleven-year-old child with a profound hearing
loss. As part of this study, the child participated in private instruction in
order to improve vocal reproduction accuracy. Results revealed a 49 per-
cent improvement pre- and post-test evaluation in the child’s vocal repro-
duction accuracy. Because of the individual programs developed and the
hard work exhibited by these children, both were reported to have been
accepted into their school choirs. Case studies like these serve to reinforce
not only the accomplishments of children with hearing loss to reach their
personal musical goals but additional ideas and approaches for providing
such opportunities. They also reinforce what is possible with individual
practice coupled with music programs developed to aid the children in
the development of their pitch perception and vocal accuracy.
Timbre
Studies examining the abilities of individuals with hearing loss to per-
ceive different timbres in music have also been conducted. One such study
involved thirty-four participants from a state school for the deaf. First, they
were introduced to six instruments from the woodwind, string, and brass
instrument families during a fifteen-minute presentation that involved
an overview of how the instrument was played, the instrument’s name
finger-spelled and written on the board, and the performance of a short
song on each instrument (Darrow, 1991, p. 51). Each participant then had
the opportunity to play the instruments for five minutes. This was done
on an individual basis in an observation room. During the participants’
“play” period, defined for the purposes of this study as the physical ma-
nipulation of the musical instruments, their responses were videotaped.
Data were then analyzed for (a) the order in which the instruments were
selected; (b) the amount of time spent playing each instrument; and (c) a
signed report of preference considered to be the equivalent of verbal report
for children with hearing. Analysis of the data for total playing time across
all participants revealed that the trumpet was most preferred instrument
followed by the clarinet, viola, trombone, violin, and flute. An analysis of
individual participants’ responses revealed that they spent more time with
the violin (p. 52). The signed responses, however, indicated that the most
preferred instruments were the violin and trombone. It was noted that in-
strument timbre and individual instrument features factored into partici-
pants’ responses.
A follow-up study used the Instrument Timbre Preference Test (ITPT)
as a means for examining the timbre preferences for children with hearing
loss. Participants were twenty-one students with severe and profound
hearing loss from a state residential school for the deaf (Darrow, 1991,
p. 53; Gordon, 1984). For the purposes of this study, timbres were intro-
duced without a musical instrument reference. Results revealed that the
group preferred the timbres of the clarinet, saxophone, and French horn,
and substantiated previous studies revealing that factors of preference
may be influenced by cultural bias (p. 57). Chapter 4 further examines the
importance of preference as it relates to the instrument-selection process
for band and orchestra participation.
Collectively, these studies do reveal that there are differences in the
responses of children with hearing loss to various musical elements as
compared to their hearing peers. Rhythm is typically easier for individu-
als with hearing loss to perceive, while the elements of pitch and timbre
are more difficult as a result of the type and degree of hearing loss. Above
all, these studies reveal that children with hearing loss can perceive
and are responsive to musical elements although differently than their
hearing peers.
The Story of “K”: A Flutist with Hearing Loss
I noticed K during concert band rehearsals long before I had the courage
to introduce myself to her. What I remember most is that she removed
her shoes during rehearsals and often leaned towards the flutist sitting
next to her. After several days of friendly nods and waves, my curiosity
and interest finally overwhelmed me. I introduced myself and inquired
about the auditory trainer4 used by the ensemble director. As our friend-
ship developed, K openly shared her early school experiences with me.
Her experiences prior to the formal diagnosis of her hearing loss spoke
directly to the need for teacher and parent education. K’s teachers not
only missed the symptoms she exhibited but also neglected to seek ed-
ucational resources and information about hearing loss once she was
diagnosed. They failed to modify their teaching approaches in order to
meet K’s needs. Her parents soon realized that the “trouble maker” label
often used to describe K during frequent parent-teacher conferences was
the result of her hearing loss rather than the disturbances her teachers
claimed that she caused. K recalled feeling like her teachers had no con-
fidence in her, that she was incapable of learning. She remembered also
being placed in the back of the classroom for most nonmusic lessons.
According to K, they intentionally blocked her view of their lips during
spelling tests because they thought she might be able to “cheat” by speech
reading. Her parents grew increasingly frustrated with the lack of sup-
port for their daughter and the intolerance exhibited, so they sent K to
another school, one that was better able to meet her needs. This proved
to be a positive educational change especially with regard to the musical
opportunities available to her.
The musical experiences of “K” can provide some perspective with re-
gard to the impact of hearing loss on music perception. At age ten, K was
diagnosed with a mild hearing loss (25–40 dB) and later, after contracting
Influenza B, a moderate loss (41–55 dB). K described her relationship with
music as very special. As a young child, K was able to identify notes on
the piano after hearing her father sing them. She also took flute lessons
with her band director the summer before fifth grade. The early lessons
were provided to give K a foundation for correct playing posture, breath
support, and flute fingerings, so that she could participate comfortably in
band rehearsals. She caught on quickly and grew to love her musical expe-
riences. K also discovered that her ability to perceive lower and higher fre-
quencies helped her to use other instruments as entrance cues and as an
aid for keeping track of where she was in the music. Such compensatory
strategies helped K progress to the school’s advanced band. She later per-
formed with the high school band and was also given the opportunity to
play in the marching band. This was accomplished with the help of a friend
who wore the auditory trainer on the field in order to provide K with both
measure and drill numbers.
K’s college playing experiences were exciting and challenging. While
playing in the university concert band, K also depended greatly on com-
pensatory strategies such as visual cues. For example, when music con-
tained long periods of rest, K would often memorize the first few notes
of the flute entrance that freed her to watch either the conductor or first
chair flute player for playing cues. Music with repeated patterns also re-
quired that K lean towards the flutist sitting next to her in order to watch
for helpful cues. Another coping skill for K included removing her shoes
during rehearsals so that she could feel the vibrations made by instru-
ments that produced low sounds and/or strong vibrations. She found that
the auditory trainer microphone picked up instruments with higher fre-
quencies such as the piccolo and E-flat clarinet. As the piccolo player for
the ensemble that semester, I was rather pleased that I could indirectly
help K with the music! Instruments difficult for her to perceive were
B-flat clarinets, oboes, and French horns, due to their frequency range.
According to K, the type of music being performed also had an impact on
her comfort level in rehearsals. Those compositions that were both tech-
nical and loud often made her very uncomfortable. In those instances, K
often adjusted the settings for her hearing aid and in some cases even
removed her hearing aid.
The early educational experiences of my friend “K” reinforce the nega-
tive effects that misconceptions can have on the educational and musical
opportunities offered to children who are deaf and hard of hearing. Her
experiences also highlight the importance of the parents’ role as advo-
cates in both raising and educating a child with hearing loss as well as the
benefits of a music education for all children regardless of background or
ability.
MUSIC AND HEARING LOSS: AN OVERVIEW OF

RESEARCH PAST AND PRESENT
For many years, music researchers have been committed to studying how
music impacts individuals with hearing loss. Musical elements, such as
rhythm, tempo, and accent, can support speech and language develop-
ment (Atterbury, 1990; Darrow, 1989; Darrow & Starmer, 1986; Hash,
2003; Spitzer, 1984). For example, music combined with speech therapy
can aid in the development of good listening habits, auditory skills, au-
ditory figure-ground discrimination, sequential memory, and rhythm of
speech (Darrow, 1985). It has been found that music education can have
some positive effects on the development of the suprasegmental5 ele-
ments of language, voice quality, and on the structuring of simple sen-
tences (Silvestre & Valero, 2005).
Music activity can also promote awareness of both pitch and meter,
can encourage speech-reading, and aid in the development of breath con-
trol. Also, music can dually serve as a motivational tool for positive be-
havior while also relieving the tension and struggle that some children
experience during language training (Hummel, 1971). Musical involve-
ment can help a child to develop a positive self-image with opportunities
for self-expression. Social development can also be improved particu-
larly with opportunities for interactions with hearing students during
music class participation (Darrow, 1989; Darrow & Schunk, 1996, 2002;
Galloway & Bean, 1974; Sandberg, 1954; Zinar, 1987). Children with
hearing loss can also improve body coordination through rhythmic
movement.
CONCLUSIONS
We are in a much better position to understand the hearing mechanism

and the nature of hearing loss, to diagnose, prevent, and provide the ac-
ademic, social, and emotional support necessary for lifelong success. The
dedication and instructional traditions demonstrated by early educators
is continued today. This, coupled with advances in both medicine and
technology, has ensured a continued commitment to education and com-
munication. Parents and teachers alike must be vigilant when it comes to
monitoring auditory milestones, as well the child’s progress in the educa-
tional setting. Most important is that both parents and teachers serve as
role models with regard to the setting of appropriate music listening levels
and work habits.
Finally, a hearing loss does not necessarily mean that the child cannot
learn or that the ability to learn is compromised. This is supported by the
many research studies that have focused on academic success including
music learning as well as speech and language skill development of the
deaf and hard of hearing. With the encouragement and assistance of the
IEP team or a similar support group, a child who is deaf or hard of hearing
can be successful and learn the skills necessary for lifelong success.
FOR YOUR CONSIDERATION

Parents
You know your child better than anyone and it can be scary when you notice that certain
communication milestones are not being met. Auditory development milestones as well as
the signs and symptoms of hearing loss are included here to aid you in evaluating your child
at various ages. If your child does not exhibit most of the behaviors listed below during the
(approximate) age ranges provided, then he or she should be evaluated by the family pedi-
atrician or a pediatric audiologist (American Speech-Language-Hearing Association, 2013;
Koike, 2006; Ling & Ling, 1974; Oller et al., 2006; Turnbull & Justice, 2007).
Checklist: Birth to Age Two
From birth to four months of age, your child should exhibit the following milestones:
1. Awakens, stirs, or startles at loud sounds

2. Is soothed by the sound of your voice
3. Responds to your voice by smiling or cooing
From four to nine months of age, your child should exhibit the following milestones:
1. Turns his or her eyes towards familiar sounds

2. Smiles when spoken to
3. Notices and shows interest in rattles and other sound-making toys
4. Cries differently according to need (hunger, diaper change, tired)
5. Makes babbling sounds
6. Seems to understand simple word/hand motions (i.e., “bye-bye” with a wave)
From nine to fifteen months of age, your child should exhibit the following milestones:
1. Babbles—making different sounds
2. Responds to his/her name
3. Responds to changes in your tone of voice
4. Says “ma-ma” or “da-da”
5. Understands simple requests
6. Repeats some of the sounds you make
7. Uses his/her voice to attract attention
8. Likes the sound of jingles and nursery rhymes
9. Imitate simple words and sounds
From fifteen to twenty-four months of age, your child should exhibit the following
milestones:
1. Points to familiar objects when they are named

2. Listens to stories, songs and rhymes
3. Follows simple directions
4. Uses several different words
5. Points to body parts when asked
6. Name common objects
7. Puts two or more words together
8. Follows simple commands without visual cues
9. Can repeat a phrase
10. Uses short phrases when talking

11. Refers to themselves by name
Checklist: Ages Two and up
From two to three years of age, your child should exhibit the following milestones:
1. Understands spatial concepts such as “in” and “on”

2. Both understands and uses pronouns such as “you,” “me,” and “her”
3. Knows descriptive words such as “big” and “happy”
4. Tells you they need to go to the bathroom
5. Requests items by name
6. Identifies numerous body parts
7. Uses 500 or more expressive words
8. Uses between 500 to 900 or more receptive words
9. Uses the sounds: /p/, /b/, /t/, /d/, /k/, /g/, /f/, /m/, /ng/, /n/, /w/, /h/
10. Answers simple questions
11. Begins to use pronouns such as “you” and “I”
12. Begins to use plurals such as “shoes” or “socks” and regular past tense verbs such as
“jumped”
From three to four years of age, your child should exhibit the following milestones:
1. Groups like objects (animals, food)

2. Identifies colors
3. Uses consonants in the beginning, middle, and end of words
4. Expresses his or her ideas and feelings
5. Uses verbs that end in “ing”
6. Follows simple directions
7. Both asks and answers simple questions
8. Uses five to seven words in a sentence
From four to five years of age, your child should exhibit the following milestones:
1. Understands spatial concepts such as “behind” and “next to”

2. Understands complex questions
3. Defines words
4. Answers questions pertaining to the five Ws (who, what, when, where, why (and how)
5. Recognizes three to four colors
6. Uses sentences comprised of six to eight words
7. Has an expressive vocabulary of 2000 or more words
8. Enjoys rhymes
9. Says most sounds correctly with a few exceptions such as: /l/, /s/, /r/, /v/, /z/, /ch/, /sh/, /th/
From five to six years of age, your child should exhibit the following milestones:
1. Understands time sequences

2. Engages in conversation
3. Uses compound and complex sentences
4. Creates imaginative stories
5. Uses past and future tense correctly
6. Names opposites
Symptoms: Though the following symptoms may not necessarily mean that your child has
hearing loss, they may be the signs of one. If your child exhibits any of the symptoms below,
then you should have your child evaluated by the family pediatrician or a pediatric audi-
ologist (American Speech-Language-Hearing Association, 2013; Koike, 2006; Ling & Ling,
1974; Oller et al., 2006; Turnbull & Justice, 2007). Does your child:
1. Complain of earaches, ear pain, or head noises?

2. Speak unintelligibly?
3. Exhibit noticeable speech and language delays?
4. Respond inconsistently or not at all when called?
5. Respond inappropriately to questions?
6. Often respond with “huh?”
7. Have difficulty understanding what people are saying?
8. Have difficulty following directions?
9. Speak differently than other children of the same age?
10. Struggle academically?
11. Watch others closely in order to imitate what they are doing?
12. Turn up the volume on the television, radio, CD player?
Teachers
You will be responsible for creating a positive learning environment for all of your students.
However, the efforts made to prepare the classroom for the child with hearing loss will en-
sure that he or she becomes acclimated to the learning environment and peers. The more
you know about the student’s hearing loss the better your position to make sure that the
classroom is inclusive. Seek advice and resources from the school audiologist as well as the
school nurse pertaining to the types and degrees of hearing loss.
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CHAP T ER 2
For Parents
Important Decisions and Considerations
F or hearing parents, the discovery that their child has a hearing loss
or any other impairment or disability can be devastating (Gelfand,
Teti, & Fox, 1992; Woolfson, 2004). Initial questions on discovery may
include “How will I communicate with my child?” “Will my child go to
school?” “Will he or she have friends?” “How will my child enjoy the things
in the world around them?” Still other questions will center on the child’s
long-term welfare. “Who will be there for my child when I am gone?” “How
will my child provide for him- or herself?” While parents who are deaf may
be better able to cope with their child’s diagnosis, they are no less con-
cerned about their child’s welfare. A survey conducted by Meadow-Orlans,
Mertens, and Sass-Lehrer (2003) revealed that both deaf and hearing
parents have similar concerns. Deaf parents expressed worry that their
child would experience the same challenges they faced while growing
up (Meadow-Orlans, Mertens, & Sass-Lehrer, 2003, p. 143; Mitchiner &
Sass-Lehrer, 2011, p. 81).
Naturally, parents will want to keep their child safe but this protec-
tiveness must be balanced with opportunities to develop coping skills and
independence (Kentish, 2007; Meadow-Orlans, 1990). Ultimately, beliefs
about deafness will influence parents’ responsiveness toward their child,
providing the foundation for future interaction and communication.
Parents who do not view deafness as a tragedy and remain open-minded
are more likely to parent more effectively (Kentish, 2007, p. 75).
Hearing parents may also experience overwhelming feelings of power-
lessness. For most, there may be some uncertainty about the best place
( 36 )
F o r Pa r e n t s ( 37 )
to start for gathering information. Parents may also feel awkward when
meeting with medical or educational professionals. Viewing these profes-
sionals as a source of information will help parents make the very best, in-
formed decisions for their child (DesJardin, 2006; DesJardin & Eisenberg,
2007; Fewell & Deutscher, 2004).
Parents, you are the most important advocate your child will ever have.
This chapter is devoted to you and to the many decisions you will face upon
receiving the news that your child has a hearing loss; I hope the information
contained herein will empower you to take charge and to advocate for him
or her. These resources will help to guide your research and ultimately the
decisions you make about the communication and educational approaches,
as well as opportunities for socialization. I have also included ideas for cre-
ative activities that you and your families can explore together (DesJardin,
2006; DesJardin & Eisenberg, 2007; Fewell & Deutscher, 2004).
INITIAL INFORMATION GATHERING
Information is power. Becoming familiar with hearing loss can prevent

hearing parents from falling prey to those societal misconceptions pre-
viously mentioned, positively impacting their own perceptions of deaf-
ness, and influencing parenting styles (Kentish, 2007, p. 83). A few words
of caution: the process of research can require both time and patience.
However, the results of persistence and dedication, and of witnessing
the ultimate benefit to their child, will relieve any initial frustration
(DesJardin, 2006; Fewell & Deutscher, 2004; Zapien, 1998). Parents sur-
veyed by Meadow-Orlans et al. (2003) stressed the importance of seeing
the child first, advising parents to treat their child as normally as possible
and not to ignore aspects of childhood that are important for all children,
hearing or deaf (p. 140).
Several years ago, I had the opportunity to observe and conduct research
in an early intervention program. During this time period, I met many
families with varied hearing backgrounds. Their reasons for participation
included the desire to meet and socialize with other families as well as to
experience the program in order to determine if it was the right one for
their child. This program was just as supportive of the parents as it was
of the children. Parents had opportunities to communicate with one an-
other as well as with teachers and paraprofessionals. They were able to
ask questions about hearing loss, communication, available educational
approaches, and, more importantly, how other parents were coping with
the decision-making process.
I found that hearing parents participating in this program had difficulty

deciding which communication approaches and school environments to
pursue. In most cases, they almost always initially wanted their child to
be a part of the “hearing world” and therefore sought those opportuni-
ties that would support such a decision. I discovered that some families
were divided amongst themselves in the decision-making process. One
parent, for instance, believed that the hearing world was the best place
for the child. The other, however, felt that it was better to leave the deci-
sion for the child to make when he was old enough. In the meantime, this
parent wanted social and educational opportunities that included both
the hearing and the Deaf communities. Each set of circumstances posed
its own difficulty, but the ultimate goal of these parents was communi-
cation. They wanted what all parents want, to communicate and interact
with their children.
EARLY IDENTIFICATION AND INTERVENTION

OF HEARING LOSS
Hearing plays a crucial role in the development of speech and language.

The earlier a loss is identified and the appropriate intervention services
are provided, the better chance there is for preventing delays in speech
and language skill development. Upon receiving a diagnosis of hearing
loss, parents should contact the family pediatrician and request referrals
for specialists such as audiologists and speech pathologists.
What Does Early Intervention Entail?
Under the auspices of the Individuals with Disabilities Act (IDEA), chil-
dren with a hearing loss are guaranteed to receive a free and appropriate
public education, ages three to twenty-one. This includes access to and in-
volvement in family-centered early intervention programs for children,
ages birth to three (US Department of Education, 2007). Researchers have
found that speech and language skills develop appropriately when early
identification, as early as six months of age, is combined with early inter-
vention services that actively involve families as part of the habilitation
process (Downs & Yoshinaga-Itano, 1999; Moeller, 2000; Yoshinaga-Itano,
2003; Yoshinaga-Itano, Sedey, Coulter, Mehl, 1998). In addition to helping
the child to develop his or her speech, language, and communication
skills, the educators and hearing specialists should support and guide the
parents. This collaborative effort can help parents to better understand

the early intervention process, specifically including the nature of the
child’s loss, any special communication needs, the documentation which
tracks his or her progress, as well as the decision-making process associ-
ated with intervention and education. The support system that the family,
as a whole, gains from these collaborations is of the most importance.
Early Identification: Hearing Tests
According to the World Health Organization (2011), hearing loss is the

most common cause of moderate and severe disability worldwide and is also
a leading cause of disability in low- and middle-income countries (p. 296).
The introduction of reliable screening techniques such as otoacoustic
emission recordings and automatic auditory brainstem response measures
have allowed for the implementation of hearing screening and early inter-
vention programs in these countries (McPherson, 2012, p. 152). According
to Leigh, Schmulian-Taljaard, and Poulakis (as cited in McPherson, 2012),
in (developed) countries where newborn hearing screening is performed,
there has been a dramatic decrease in the detected average age of hearing
loss. In New South Wales, Australia, for example, the average age of a di-
agnosis for permanent bilateral hearing loss in infants has decreased from
approximately eighteen months to 1.6 months of age (p. 152).
Approximately two to four out of every 1000 infants is born with a
hearing loss in the United States. This statistic reveals hearing loss to
be one of the most common congenital anomalies and as a result, man-
datory hearing screening programs have been implemented throughout
the United States. Each state, including the District of Columbia, has an
Early Hearing Detection and Intervention (EHDI) program that requires
that an infant be evaluated prior to discharge from the hospital. Tests
for newborns may include evoked otoacoustic emissions (EOAE) and au-
ditory brainstem response (ABR) (American Speech-Language-Hearing
Association, 2004).
The age of the child, as well as his or her ability to participate in hearing
test procedures, can determine the type of hearing test to be adminis-
tered. Typically, young children who have been identified as having a
hearing loss should be tested twice a year with the potential for additional
tests particularly if other health concerns have been identified. A child can
acquire a hearing loss after birth, so even if a child passes the hearing test,
parents should carefully monitor their child for auditory milestones ap-
propriate to each age. If a hearing loss is suspected, an appointment with
the child’s pediatrician is recommended so that additional tests can be

administered (Tye-Murray, 2004, p. 554). Older children may be tested
once a year. A description of various hearing tests and conditions for ad-
ministration are provided here to serve as both a point of reference and
discussion.
Testing for Newborns

Infant hearing is measured through a process called Evoked Otoacoustic
Emissions (EOAE) testing. A tiny probe is first inserted into the infant’s
ear canal and sounds are then sent through the probe. A small micro-
phone housed within the probe both measures and records the otoacous-
tic emissions or echos within the infant’s ear. The sounds used during
testing are inaudible. What is measured are the mechanical actions of the
outer hair cells in the cochlea. Infants with hearing will produce emis-
sions, while those with hearing losses of 25–30 dB or greater will not.
This test can be administered quickly and should not cause any discom-
fort. Typically, the test is administered while the infant sleeps (American
Speech-Language-Hearing Association, 2004; Gelfand, 2009; p. 349).
Auditory brainstem response (ABR), typically administered between
birth and five months of age, measures and records infant brain activity
in response to sound (i.e., tone bursts or clicks). Sounds are introduced by
earphones and electrodes that are also attached to the infant’s head. ABR
is typically administered as the infant sleeps to ensure that he or she re-
mains still during testing. Children over six months of age are typically
sedated during testing to ensure the accuracy of the measurements taken.
When sedation is necessary, appropriate medical professionals should be
available to monitor the child’s vital signs throughout the testing process.
ABR is typically administered in cases where the child is unable to give
behavioral responses or when responses are inconsistent. This test is
administered to ascertain degree of hearing loss at different audiometric
frequencies (American Speech-Language-Hearing Association, 2004;
Gelfand, 2009, p. 388).
Testing for Infants and Toddlers

Behavioral Audiometry or Behavioral Observational Audiometry (BOA) is typ-
ically administered to infants through the age of seven months. Hearing
is measured via the infant’s behavioral responses to a variety of acoustical
stimuli such as frequency-specific tones, speech, and music. The behav-
iors measured may include eye-widening, eye-opening, body movement,
startle response, quieting, and even changes in sucking rate after the
stimulus is introduced. The infant typically sits on a parent’s lap during
testing (Gelfand, 2009, p. 363).
Visual Reinforcement Audiometry (VRA) is another form of behavioral au-
diometry typically used for children ranging from six months to two-and-a-
half years of age. This test requires that the child wear earphones so that
each ear can be tested independently. The child typically sits on a parent’s
lap in between two speakers. Sound stimuli similar to that administered
for BOA testing (i.e., frequency-specific tones, speech, and music) are pre-
sented in order to encourage the child to respond by head turning or by
shifting his or her gaze toward the sound source. Such a response results
in visual reinforcement such as a lighted mechanical toy mounted close to
the loudspeaker. A similar test, Conditioned Orientation Reflex Audiometry
(COR or CORA), involves an even greater number of sound sources and
visual reinforcements (American Speech-Language-Hearing Association,
2004; Nozza, 2003).
Conditioned Play Audiometry is the most consistent behavioral tech-
nique to determine ear-specific and frequency-specific hearing thresh-
olds in young children (Gelfand, 2009, p. 367; Northern & Downs, 2002,
p. 184). Typically, it is used to assess children from approximately two to
two-and-a-half years of age. This test is a listening game that uses toys
to maintain the child’s attention and ability to focus on a listening task.
During testing, the child is instructed by the audiologist to perform a re-
sponse task, such as placing a peg into a board or a block in a jar, each time
a sound is presented. Parents may sit in the room with their child but must
remain quiet and still so as not to distract the child or provide cues as to
the presence or absence of sound (Madell, 2008).
Testing for Older Children

Children, ages five and up, may undergo pure tone, bone conduction, im-
pedance, and speech testing (Northern & Downs, 2002, p. 192). Pure Tone
Audiometry measures hearing sensitivity. Each ear is tested individually
at frequencies ranging from 125 to 8000 hertz (Hz). The results indicate
the child’s pure-tone thresholds (PTTs) or the softest sound audible at
least 50 percent of the time. The child’s hearing threshold is measured in
decibels (dB) and the lower the threshold, the better his or her hearing.
There are two components of pure tone audiometry. Air conduction testing
evaluates the functioning of the entire ear (Tye-Murray, 2009, p. 44).
Headphones or earphones are typically required but in cases where this
is not possible, sounds are presented to the child through speakers inside
a sound booth. The child may be asked to respond to the sounds heard by
raising a hand or by pressing a button. Bone-conduction testing bypasses the
outer and middle ear and conducts the sound through the bone directly
to the inner ear (Tye-Murray, 2009, p. 44). A small vibrating element is
placed behind the ear against the skull. The results of pure tone audiom-
etry yield information pertaining to the type and degree of hearing loss as
well as the severity of the loss at different frequencies (p. 44).
Impedance Audiometry, also referred to as acoustic immittance testing, is
a battery of tests including tympanometry, acoustic reflex test, and static
acoustic impedance that measures the function of the middle ear by vary-
ing the pressure within the ear canal and the movement of the ear drum
(Northern & Downs, 2002). Tympanometry is used to detect conductive
hearing loss by measuring the mobility of the eardrum, and consequently
the ability of the middle ear to conduct sound (Cole & Flexer, 2011, p. 97).
Tympanometry can help to identify fluid in the middle ear, determine
if the eardrum has been perforated, and detect the buildup of wax in the
ear canal (Yellin & Roland, 1997, p. 73). A probe fitted into the entrance
of the ear canal emits continuous sound. The amount of sound absorption
or reflection from the middle ear is measured by the probe at normal, pos-
itive, and negative air pressures. A tympanogram provides a graphic of
the acoustic impedance and air pressure testing results of the middle ear
as well as the mobility of the tympanic membrane (Cole & Flexer, 2011,
p. 97). The Acoustic Reflex Test measures the ability of the stapedius mus-
cles to contract in response to loud sound. This test can help to identify
auditory pathway defects. The absence of the acoustic reflex may also in-
dicate lesions of the middle ear, acoustic tumors, or otosclerosis. Static
acoustic impedance testing measures the physical volume of air in the
ear canal and can help to determine whether the ear drum has been per-
forated (Department of Otolaryngology Head and Neck Surgery, 2007,
“Hearing Screening in Children,” para 18).
Speech testing includes the Speech Reception Threshold (SRT) that meas-
ures the faintest speech sounds that can be heard approximately 50 per-
cent of the time. This test helps to reinforce the findings of the pure tone
testing. Other speech tests are also administered that measure speech dis-
crimination. During SRT testing, words are presented either via recording
or by the audiologist. The child is asked to repeat the words that are pre-
sented to them in order to determine his or her ability to hear the word or
sentence. Testing also determines his or her ability to perceive intelligible
speech sounds (Northern & Downs, 2002, p. 183).
Computed Tomography (CT) or Magnetic Resonance Imaging (MRI)
scans may be recommended by the audiologist to determine the cause
of the hearing loss and best treatment options. A CT scan can provide
images of the bony structures of the ear and can alert the audiologist to
any malformations of the cochlea. These malformations could impact a
child’s eligibility for a cochlear implant, a device that will be discussed in
detail in chapter 7. An MRI can provide images of the soft tissues of the
ear and therefore alert the audiologist to tumors or other physical causes
of hearing (California Ear Institute, 2013, “Congenital Hearing Loss and
Infant Hearing screening,” para. 9).
So, What Happens Next?
Following testing, the audiologist will review the results and diagnosis
with the child’s parents or guardians, making recommendations and sug-
gested treatments at that time, and possibly referring parents to an Ear,
Nose, and Throat (ENT) doctor. The audiologist might make additional
suggestions, depending on the nature of the child’s hearing loss, that
could include consideration of amplification devices such as a hearing aid,
BAHA, or cochlear implant. At that time, parents should make inquiries
about parent support groups. According to previous studies, the advice
received from other parents with similar experiences tends to be the most
desired need at the time of diagnosis (Luterman & Kurtzer-White, 1999;
Meadow-Orlans et al., 2003; Tolland, 1995). Both deaf and hearing par-
ents who responded to a survey by Meadow-Orlans et al. (2003) recom-
mended consulting with members of the Deaf community for resources
and educational options (p. 150). Recommendations may also include
speech therapy, an early intervention program with home and school vis-
its, as well as parent/child groups offering opportunities for socialization.
Initially, parents may feel overwhelmed, particularly when in consulta-
tion with the pediatrician, audiologist, or other specialists. It is perfectly
acceptable and expected that these parents will have numerous questions.
They are also strongly encouraged to write down concerns and questions
prior to any consultations with doctors or specialists (Zaidman-Zait &
Young, 2007). Another recommendation that is particularly important
during this initial stage is to keep copies of all records that result from
these appointments. Later records should also include school records and
related reports. These materials should be kept in a binder with plastic
file folders or pocket and be easily accessible (DesJardin, 2006; Fewell &
Deutscher, 2004; Zaidman-Zait & Young, 2007; Zapien, 1998).
Searching databases such as the US Department of Education’s Office
of Special Education Programs (OSEP) and the National Dissemination
Center for Children with Disabilities (NICHCY) can be helpful to parents.

OSEP supports numerous projects to assist the families of children with
disabilities. These projects address topics related to hearing loss as well
as other disabilities such as Autism, Blindness, and Attention Deficit
Disorder; provide information about raising a child with a disability; and
explain parental rights under the Individuals with Disabilities Education
Act (IDEA) described more fully in chapter 5. This information and assis-
tance is provided free to the public.
The type of hearing loss and the age at which a child acquires the hearing
loss will be a determining factor in the selection of listening devices (if
any), as well as the mode of communication and the educational setting
selected. For example, a child born with hearing loss (prelingual) is in a
different position than one whose hearing loss came about after the ac-
quisition of speech and language (postlingual) (Gross, 1970). The child
with postlingual deafness has experienced sound and may have already
begun to read and to develop communication skills prior to the onset of
the hearing loss. In such a case, both the communication and educational
needs of this child will differ greatly from that of a child whose exposure
to sound has been limited or nonexistent (Ertmer, 2002; Gross, 1970;
Zaidman-Zait & Young, 2007).
Family background is yet another consideration that may factor into
decisions of communication, educational approach, and setting. For ex-
ample, children who are deaf or hard of hearing and born to deaf par-
ents have an advantage linguistically over those born to hearing parents
who do not sign (Adamek & Darrow, 2010, p. 244). A number of research
studies have also revealed that they tend to be better readers (Marschark,
2007, p. 169). These children are also reported to attain better emotional
and cognitive outcomes than their peers who have hearing parents (Bailly,
Dechoulydelenclave, & Lauwerier, 2003). Furthermore, they are thought
to have better self-esteem, less difficulty with impulse control, and con-
fidence with regard to their social skills (Meadow-Orlans, 1990). This is
likely because of the early opportunities afforded them in their home en-
vironment as well as the interactions they have had with others in the
Deaf community. Essentially, these children “share a defining character-
istic” with their families that enables them to “share cultural experiences”
together (Meadow-Orlans et al., 2003, p. 144).
Ninety percent of children with hearing loss are born to hearing parents
who are not ASL signers. As a result, hearing parents will have a period
of adjustment and require support and guidance if they are to fulfill the
critical role that parents and other family members provide as language
role models. Early intervention services can provide such support. For
example, research has revealed that early intervention services facilitat-

ing parent engagement in the child’s habilitation/rehabilitation can often
result in improved language acquisition for the child as well as commun-
ications between the child and parents (DesJardin, 2006; Dunst, 2000;
Dunst, Bruder, Trivette, Raab, & McLean, 2001).
MODES OF COMMUNICATION
All children need a working language (Zapien, 1998). According to Gravel

and O’Gara (2003) “a communication option, mode, modality, or method
is the means by which the child and family receive and express language”
(p. 244). This book presents an overview of several communication
modes followed by the educational settings in which they might be used.
Depending on the resource, the terminology associated with communica-
tion can be used interchangeably with educational approaches for the deaf
and hard of hearing. I am not advocating for any one mode in particu-
lar. Rather, I am providing a synopsis to help parents navigate the many
available choices, given the critical nature of such a decision. Each child is
unique and therefore selection must be made based on individual needs.
Let’s not forget, though, that such decisions can promote both open and
effective communications between the parent and child.
American Sign Language (ASL)
American Sign Language has roots in other languages. While the exact
origins of ASL are unknown, ASL can be traced back to the late 1700s,
a time of great European colonization. During that period, there existed
several signed languages including both French and British.
The efforts of Thomas Hopkins Gallaudet, a minister, proved to be the
greatest influence on the development of American Sign Language. His
motivation stemmed from interactions he had with a neighbor, Dr. Mason
Cogswell, whose daughter, Alice, was deaf. Gallaudet was instrumental in
helping Alice to communicate. Initially, he taught her words by writing
them with a stick in the dirt. Because Gallaudet was unfamiliar with the
best ways to educate the deaf, he traveled to Europe in 1816 to study such
methods particularly because there was a history of deaf education in
Europe (Humphries, Padden, & O’Rourke, 1994; Prinz & Strong, 1998).
During his European travels, Gallaudet met Laurent Clerc and Jean
Massieu, former students of Abbe Sicard at the school for the deaf in
Paris, Institution Nationale des Sourds-Muets (National Institute for

Deaf Mutes). Both Clerc and Massieu were teachers at the institute and
it was from them that Gallaudet learned about deaf education meth-
ods and sign language. Gallaudet convinced Clerc to return with him
to America in order to establish a school for the deaf. With help from
Cogswell, Gallaudet and Clerc founded the American School for the Deaf,
in Hartford, Connecticut, in 1817. The American School was the first free
public school for the deaf in the United States. The school quickly ex-
panded as deaf students from around the country enrolled. At that time, a
standard signed language did not exist; however, various signing systems,
now referred to as Old American Sign Language, were created within deaf
communities. As a result, the students who attended the American School
brought the signs from their respective communities. ASL evolved from
these signs, as well as those from French Sign Language. Gallaudet taught
at the school until 1830 and Clerc taught there until the 1850s. The in-
fluence of the American School was evident as other schools for the deaf
were established. Forty-six years later, twenty-two schools for the deaf
had opened in the United States, many of which were founded by Clerc’s
students (Armstrong, 2000; Baker-Shenk & Cokely, 1980; Zapien, 1998).
Thomas Hopkins Gallaudet’s son Edward Miner continued his father’s
teaching traditions. In addition to teaching at the American School,
Edward was also instrumental in the establishment of the first college
for the deaf. His efforts ultimately led to legislation that permitted the
Columbia Institution for the Deaf, Dumb, and Blind in Washington,
DC, to issue college degrees. The institute’s college division, entitled
the National Deaf-Mute College, officially opened in 1864. The college
was renamed Gallaudet College in 1893 to honor the legacy of Thomas
Hopkins Gallaudet and in 1986 was officially titled Gallaudet University
(Armstrong, 2000; Baker-Shenk & Cokely, 1980; Zapien, 1998).
The Second International Congress on Education of the Deaf, often
referred to as the Milan Conference of 1880, had a major impact on the
use of sign language in instruction. Prior to 1880, it should be noted
that members of the Deaf community were very successful, serving as
attorneys, politicians, writers, and teachers. They were also quite active
in the arts. During the conference, however, hearing participants voted
against the use of sign language in deaf education (National Association
for the Deaf, 2010b; Thumann & Simms, 2009; Zapien, 1998). In the end,
oralism was deemed to be superior to that of manual communication and
a resolution was passed that banned the use of sign language in schools.
This landmark decision also resulted in the expulsion of deaf teachers
from classroom settings and sign language was quickly replaced by oral
methods (Gannon, 1981). The quality of life and educational experiences

of the deaf deteriorated significantly. Furthermore, the number of suc-
cessful deaf professionals also declined. The effects are still evident today
as the current number of educators of the deaf and hard of hearing who
are actually deaf themselves is limited. There has also been little input
from the Deaf in deaf education.
Still other impacts of the Milan Conference resulted in a great number
of supporters for the National Association of the Deaf (NAD), those who
sought to maintain Deaf language and culture. Another immediate out-
come of the Milan conference was the decision of Gallaudet College’s pres-
ident to retain sign language on campus. This is considered by many to be
the main reason why ASL has survived (National Association for the Deaf,
2010b; Thumann & Simms, 2009; Zapien, 1998).
In the early 1900s, sign language was reintroduced into deaf education
to “support” speech and language development. This momentum was fur-
ther reinforced in the 1960s and 70s with the research of William Stokoe
who suggested that ASL was a “fully formed human language in the same
sense as spoken languages like English” (Stokoe, 2001, p. 236).
Stokoe is most noted for developing a descriptive system for sign lan-
guage so that demonstrations could be presented to other linguists as
well as the public at large. The culmination of his research led to a mon-
ograph entitled Sign Language Structure, published in 1960. This was
followed in 1965 by A Dictionary of American Sign Language, the first dic-
tionary of its kind, which Stokoe co-authored with Carl Croneberg and
Dorothy Casterline, two colleagues from Gallaudet (Armstrong, 2000;
Baker-Shenk & Cokely, 1980).
American Sign Language (ASL), used in both the United States and
Canada, is considered the language of the North American Deaf com-
munity. ASL, both a visual and gestural language, is composed of manual
gestures (signs) in combination with various types of non-manual
grammar such as mouth morphemes, facial expression, and body move-
ment. The grammatical features of American Sign Language include di-
rectional verbs, classifiers, and rhetorical questions. ASL is not derived
from the English language. Since the English language is linear in struc-
ture, it requires many prepositions to create a mental picture of where
things are in a sentence. ASL, on the other hand, uses the physical space
in front of the signer to create the mental picture and is visually much
easier for a child to comprehend than the other Manual Codes of English
Systems (Armstrong, 2000; Baker-Shenk & Cokely, 1980). Interestingly,
research has revealed a link between persons who are deaf who commu-
nicate via ASL and increased visuospatial ability (Marschark & Spencer,
2003, p. 467). The demographics associated with ASL use in the United
States, however, have been the center of much dispute (Mitchell, Young,
Bellamie, & Karchmer, 2006, p. 25).
Other Forms of Signed Communication
English-based sign systems or manually coded English (MCE) were very

prevalent during the 1960s and 1970s (Easterbrooks & Baker, 2002;
Marschark, 2007). These systems, designed to help children to learn to read
and write, combined both English and sign, and according to Marschark
(2007), presented “English on the hands rather than on the lips” (p. 80).
Some are featured as the signed components of Total and Simultaneous
Communication (Gravel & O’Gara, 2003, p. 247).
English-based sign systems in use today include Signed English, Signing
Exact English (SEEII), and Conceptually Accurate Sign English (CASE)
(Johnson & Seaton, 2011; Mahshie, Moseley, Lee, & Scott, 2006). Seeing
Essential English (SEEI), though no longer in widespread use, is included
herein because some of the signs are still employed today (Nomeland &
Nomeland, 2011, p. 122). Another older manual system, the Rochester
Method, consisting exclusively of finger-spelling, is rarely used (Gravel &
O’Gara, 2003; Paul, 2009).
Signed English
Signed English, developed by Galluadet professor, Harry Bornstein,
parallels the English language by combining English grammar with
the signs of ASL (Nomeland & Nomeland, 2011, p. 122). This system
is based on the premise that “deaf children must depend on what they
see to comprehend what is being said to them” (Mahshie et al., 2006,
p. 65). Signed English includes a set of fourteen markers that are com-
bined with signs in order to communicate English structure (Marschark,
2007, p. 81). The markers refer to important grammatical features of
the English language (p. 81). The signs used in Signed English vary as
some are taken from ASL while others derive from Seeing Essential
English (SEEI) and Signing Exact English (SEEII), both of which are
described below (Mahshie et al., 2006, p. 65). Signed English has been
used to teach deaf children for many years and is still used in parts of
the country; however, it is losing momentum and being replaced by ASL
(Marschark, 2007, p. 81; Nomeland & Nomeland, 2011, p. 122; Trezek,
Wang, & Paul, 2010, p. 212).
Seeing Essential English (SEEI)

Seeing Essential English (SEEI) was invented by deaf educator David
Anthony in the mid-1960s as a way to convey the English language using
the hands (Marschark, 2007; Stewart & Luetke-Stahlman, 1998). In SEEI,
signs are used to represent concepts and the “meaningful parts of words”
(Ogden, 1996, p. 147; Stewart & Luetke-Stahlman, 1998, p. 77). The number
of signs used for a word corresponds to the number of syllables contained
in the word (Ogden, 1996, p. 147; Stewart & Luetke-Stahlman, 1998,
p. 77). Essentially, in SEEI, every English word has an ASL sign and words
are presented in English word order (Marschark, 2007, p. 82). Anthony and
his collaborators were responsible for the development of the “two out of
three” rule that is still very much a part of Signing Exact English system
(Stewart & Luetke-Stahlman, 1998, p. 77). This rule is used to determine
whether a single sign is utilized to represent numerous “similar-sounding
English words” (Ogden, 1996, p. 147). The criteria include similarly spelled
words that sound the same and are similar in meaning (p. 147).
Signing Exact English (SEEII)

Signing Exact English (SEEII) was developed in 1972 by educators
Dr. Gerilee Gustason, Donna Pfetzing, and Esther Zawolkow (Lou, 1988,
p. 92). The signs of SEEII represent English words and affixes according
to English sentence structure (Ogden, 1996, p. 146). This system fol-
lows some of the basic rules for SEEI; however, as the system developed,
Gustason, Pfetzing, and Zawolkow opted to use traditional American
Sign Language, specifically those signs that only have one English trans-
lation (Lou, 1988, p. 92; Nomeland & Nomeland, 2011, p. 122; Trezek
et al., 2010, p. 212). They also created signs for pronouns and affixes
(Nomeland & Nomeland, 2011; Ogden, 1996). The “two out of three
rule” previously mentioned is used with this system as well (Stewart &
Luetke-Stahlman, 1998, p. 77). SEEII is still used in many mainstreamed
school systems today (Nomeland & Nomeland, 2011, p. 122).
Conceptually Accurate Sign English (CASE)

Conceptually Accurate Sign English (CASE), also referred to as sign
English or Pidgen Signed English (PSE), uses the signs from American
Sign Language in English word order (Mahshie et al., 2006, p. 65).
Features of ASL such as facial expression and “use of space” are also incor-
porated (Johnson & Seaton, 2011, p. 454). CASE emphasizes “conceptual
accuracy” as a means for promoting understanding. CASE does not have a

one-to-one relationship with spoken language (p. 454).
Approaches Emphasizing Listening and Spoken Language
The auditory-oral and auditory-verbal therapies are generally considered

to be the oldest “listening and spoken language approaches” used with
the deaf and hard-of-hearing population (Cole & Flexer, 2011; Northern &
Downs, 2002, p. 359; Schirmer, 1994). Both approaches stress hearing over
vision, although the auditory-oral approach also includes speech-reading
and cued speech. Additionally, speech-reading may be encouraged later in
the auditory-verbal approach but only after training has emphasized au-
dition. Articulation is also emphasized in both approaches as a means for
improving speech intelligibility.
Origins of Oralism
The tradition of oralism, the practice of teaching the deaf and hard of
hearing to communicate by means of spoken language, can be attributed
to the early works of educator George Delgarno (1628–87) and physician,
John Amman (1669–1724). Delgarno’s approach combined finger-spelling
and writing. Amman, considered the father of pure oralism, focused on
the mechanics of articulation by teaching the elements of speech first.
This was followed by a blending of these elements into spoken and then
written words (Easterbrooks & Baker, 2002, p. 8).
Superintendent of the Leipsic Institution for the Deaf, Samuel Heinicke
(1729–90), continued the work of Amman. Heinicke, considered to be the
father of the German oral method (oral deaf education), felt that speech
rather than the written word was the only way to ensure a lasting lan-
guage. His approach involved word and syllable study and included an
emphasis on individual sounds and letters (Easterbrooks & Baker, 2002,
p. 8). Interestingly, Heinicke also incorporated the sense of taste into his
method by using different flavors to facilitate students’ mastery of vowel
sounds. His approach was implemented throughout Europe and is still
used in Germany (Easterbrooks & Baker, 2002, p. 8).
Heinicke’s method also influenced deaf education in the United States
(Easterbrooks & Baker, 2002, p. 8). The work of deaf educator Bernhard
Engelsmann is one such example. He opened an oral school in New York
City in March of 1867 that featured the German Oral method (Benderly,
1980, p. 122; Gallaudet, 1886, p. 144). This was followed seven months
later by the Clark Institution, noted for its long-lasting influence with re-
gard to the legacy of oralism (Gallaudet, 1886, p. 144). In fact, many of the
methods and materials developed at the school are still used in oral pro-
grams today. Most prominent in the United States for the promotion of
the oral method was inventor and deaf educator, Alexander Graham Bell
(1847–1922). Bell based much of his teaching on that of Delgarno, and he
also taught a visible method of speech that he implemented at the Boston
School for the Deaf (Benderly, 1980, p. 122; Easterbrooks & Baker, 2002,
p. 9). The increased use of the hearing aid between 1860 and 1870 coupled
with the Milan Conference of 1880 ensured that oralism was a prominent
educational philosophy; it remained so until 1970 (Easterbrooks & Baker,
2002, p. 10).
Auditory-Oral (AO)
Auditory-Oral (AO) therapy is the more traditional of the “listening
and spoken language approaches.” This therapy emphasizes the use of
the child’s residual hearing in conjunction with speech-reading, cued
speech, and other contextual cues (i.e., pictures or manipulatives) to un-
derstand and use spoken language. Consistent use of hearing aids, coch-
lear implants, and FM technology are required for the child’s success
(Goldberg, 1997; Gravel & O’Gara, 2003).
The AO approach facilitates the development of reading and writing
skills that are critical skills for learning in all academic areas. This ap-
proach is best implemented in small self-contained classrooms, and
enhanced by individual instruction, where highly trained teachers pro-
vide spoken language instruction throughout the school day (Cole &
Flexer, 2011; Zapien, 1998).
Speech reading and cued-speech are coping strategies used in conjunction
with Auditory-Oral therapy. Speech reading is often coupled with cued
speech and an amplification device. This coping strategy promotes speech
understanding by using visual clues from a speaker’s lips, throat, cheeks,
tongue, facial expressions, and even body language to decipher spoken
language. Individuals with hearing loss may often rely on speech read-
ing quite heavily for the purposes of communication. While only a small
percentage (30–40 percent) of speech information is visible to the speech
reader, it is still enough to aid them in understanding a discussion or idea.
Some of the issues associated with speech-reading include letters such as
“b,” “m,” and “p” that look the same on the lips. As a result, speech readers
must rely on contextual cues and residual hearing in order to aid them in
differentiating between words such as “bat”, “mat”, and “pat.” Sounds such
as “g” and “k” can also be problematic as they are formed in the back of the
mouth or throat and are therefore less visible to the speech reader. Still
other issues that can arise for speech readers include objects that block or
obstruct the speaker’s face.
Cued Speech is defined by the National Cued Speech Association (NCSA)
(2013) as “a visual mode of communication that uses hand shapes and
placements in combination with the mouth movements of speech to
make the phonemes of a spoken language look different from each other”
(National Cued Speech Association, 2013, “Definition: Cued speech,” para.
1). Eight hand shapes representing different consonant sounds are cou-
pled with four different hand placements, around the mouth, to signify
different vowel sounds. Thus, a hand shape combined with a location can
cue a specific syllable. This combination of oral and manual movements
can make spoken language visible while also conveying important in-
formation such as pronunciation, accent, duration, and the rhythm of
speech. Not only does this help the child to distinguish between the dif-
ferent speech sounds or phonemes but it also aids them in those instances
where sounds look the same on the lips (i.e., “b,” “m,” and “p”) (Marschark,
2007; Tye-Murray, 2004; Zapien, 1998).
Origins of the Aural Traditions
Aural training traditions can be traced back to Dr. Max A. Goldstein
(1870–1941), founder of the Central Institute for the Deaf (1914), though
some reports indicate great interest in aural traditions as early as 1761
(Lim & Simser, 2005, p. 309). Goldstein is most noted for the develop-
ment of the Acoustic Method (ca. 1939). This approach first involved the
isolation of tones and phonemes followed by the production and percep-
tion of syllables, words, and sentences (Chauhan, 1989, p. 224). The sig-
nificance of Goldstein’s method was that it emphasized use of students’
residual hearing (Nittrouer, 2010, p. 236). Goldstein employed amplifica-
tion during training to promote the use of residual hearing as a means
to help his students learn to understand spoken language and to guide
them in the use of their voice for speech production (Irvine, 2004, p. 441).
Goldstein is also credited with establishing the first two-year training
program for teachers of the deaf and he also began the first nursery school
for deaf children (Irvine, 2004, p. 441). During the 1950s, audiologists,
speech pathologists, and educators continued discussions pertaining to
the use of amplification for the purposes of maximizing residual hearing
for aiding deaf and hard-of-hearing children to learn spoken language

(Drous, 2006, p. 175). Dialogue included training the ear as well as the po-
tential impacts on the brain (Drous, 2006, p. 175). Such discussion paved
the way for auditory-verbal therapy.
The oral/aural or natural oral modes of communication are those that tend
to use spoken language as the primary, and often exclusive, means of com-
munication (Gelfand, 2009, p. 474). These modes stress the development
of oral communication skills such as audition via residual hearing for
speech reception, speech reading, and intelligible speech for the purposes
of learning how to communicate with those who speak English (Gelfand,
2009, p. 474; Mahshie et al., 2006, p. 73; Watson, 2012, p. 71). According
to Wells (as cited in Watson, 2012), “the rules and structures associated
with language are assumed to be learned by the child through experi-
ment in use, in much the same way that a young hearing child gradually
learns the rules of “language” (Watson, 2012, p. 71). The oral/aural modes
promote the maximum use of residual hearing by combining auditory
training with amplification devices (i.e., hearing aids, cochlear implants,
and FM systems) in order to provide a foundation for listening, speaking,
and communication. Because manual modes of communication are not
promoted, controversy often arises when oral/aural modes are selected
for children with profound deafness who do not use cochlear implants.
According to Gelfand (2009) the arguments against teaching oral/aural
approaches to deaf children center on the fact that they are visual learners
primarily. Specifically, “visually oriented or manual systems are their nat-
ural primary means of communication, and sign language is the preferred
mode of communication within the Deaf community” (p. 474).
The Auditory-Verbal (AV) Approach

The Auditory-Verbal (AV) approach promotes the use of residual hearing
in conjunction with appropriate amplification devices to aid the child in
developing his or her listening skills, speech, and ability to process verbal
language. This approach has also been referred to as a unisensory ap-
proach due to its great emphasis on a single sense, hearing or audition. It
is stressed so significantly that the child is not permitted to see the lips
or facial expressions of the speaker during speech and language activities
(Goldberg, 1997; Gravel & O’Gara, 2003).
The auditory-verbal therapy requires the early diagnosis of a hearing
loss and early intervention services. Early diagnosis and intervention
of hearing loss are critical because the window for speech and language
development falls between the ages of eighteen months and three years
of age. Amplification must be used at all times while the child is awake.
This is considered essential in order to meet the goals and objectives
of the approach (Goldberg, 1997; Gravel & O’Gara, 2003). Family sup-
port is also a critical component of AV therapy as parents are fully
immersed in the AV therapy with their children. This support includes
partnering with an auditory-verbal therapist and trained teachers who
follow the levels of auditory development and provide consistent diag-
nostic feedback. Such an approach enables parents to become actively
involved in their child’s education while it also ensures that the therapy
becomes an integral part of their daily lives. Children who experience
auditory-verbal therapy are typically mainstreamed, as appropriate,
into a preschool setting rather than in a special self-contained oral pro-
gram. The purpose of this is to create a “typical” learning and living en-
vironment that provides natural language models and encourages young
children to use their residual hearing. The goal is to cultivate indepen-
dent and contributing members of the hearing world. Speech training is
another important component of Auditory-Verbal therapy and requires
intensive one-on-one interaction (Bertram & Pad, 1995; Estabrooks,
1994; Northern & Downs, 2002; Pollack, Goldberg, & Caleffe-Schenck,
1997; Zapien, 1998).
Total Communication (TC)
Total Communication was first introduced in 1967 by deaf educator

and administrator, Dr. Roy Holcomb. Total Communication involves
the simultaneous combination of all methods of spoken language and
speech-reading, amplification, writing, gesture, visual imagery (i.e., pic-
tures), and body language to convey thoughts, ideas, feelings, and emo-
tions for the purposes of conveying manual representations of English
sentence structure and spoken language (Gravel & O’Gara, 2003). In ad-
dition to ASL, many other sign systems are also used including Signing
Exact English (SEEII), Conceptually Accurate Signed English (CASE), and
finger-spelling. Sign systems also make it possible to translate the words
and grammatical morphemes found in spoken English into hand gestures.
This communication philosophy gained much acceptance in the United
States and was reported to be the most widely used approach between
the late 1970s and the mid-1990s (Easterbrooks & Baker, 2002, p. 14).
Proponents thought that the combination of the aforementioned meth-
ods would offer children who were deaf and hard of hearing the opportu-
nity to develop English naturally in a manner similar to that of hearing
children. They also cited the flexibility and freedom of choice offered via
total communication (Marschark, 2007; Mayer, 2012; Zapien, 1998).
Though the ultimate goal of Total Communication was to promote
greater literacy, it failed to produce successful results (Easterbrooks &
Baker, 2002, p. 14). Teachers found that children educated with this phi-
losophy were not able to “read and write English significantly better than
those who were educated orally” (p. 15). More recently, concerns have been
raised by educators about the use of such an approach for teaching lan-
guage to young children who are deaf or hard of hearing, specifically that
they will not receive a solid language model (Mahshie et al., 2006, p. 62).
The reasoning for this is because the message presented via total commu-
nication does not fully represent either ASL or the English language.
More than thirty years have passed since the introduction of the Total
Communication philosophy and in that time technological advances
in cochlear implant and hearing aid technologies have made it possible
for children who are deaf or hard of hearing to access spoken language.
However, Mayer (2012) cautions that there are still learners who will need
the combination of spoken and visual input for language acquisition and
that it is likely that total communication will continue to play an impor-
tant role in deaf education.
Simultaneous Communication
The Total Communication philosophy is often mistaken for “Simultaneous

Communication, also referred to as Sim-Com.” The two are in fact very dif-
ferent (Gravel & O’Gara, 2003, p. 248). Sim-Com is a methodology that
involves the simultaneous use of sign and spoken language (Adams, 1997,
p. 58). Sim-Com follows English word order but does not include function
words and word endings (p. 58). Proponents believe that it is possible to
represent spoken language visually. They also believe that providing the
simultaneous combination of oral and signed approaches better meets the
communication needs of the individual child while also preparing them
for the hearing world (p. 58). Any of the sign systems presented herein can
be used simultaneously with spoken English.
The Bilingual-Bicultural (bi-bi)
The bilingual-bicultural (bi-bi) philosophy to educating children who are

deaf or hard of hearing emphasizes sign language as both the primary
language and method of instruction (Mahshie et al., 2006). The secondary

language, comprised of English, spoken and/or written, is typically ac-
quired at the same time as or even after the primary language. The bi-bi
approach originated from the Deaf community, “those who advocated for
the right to pass on their language and culture to succeeding generations”
(Schirmer, 1994, p. 98). This shift was further reinforced by the disap-
pointing achievement of children who are deaf or hard of hearing (p. 98).
The bi-bi approach not only emphasizes Deaf culture so that children may
develop a better understanding of themselves and others who are deaf,
but also acknowledges the authenticity and importance of the hearing cul-
ture by incorporating elements of both.
Advocates of the bilingual-bicultural approach believe that the Total
Communication and Auditory/Oral approaches fail to meet fully both
the language and cultural needs of children with hearing loss. They also
believe that all children, regardless of the degree of hearing loss, would
benefit from the bi-bi approach that generally tends to be more readily
available within residential school settings. As sign-language is empha-
sized, the feelings of isolation often experienced by children who use sign
as their primary language diminishes. Additionally, it is believed that the
residential school setting promotes opportunities for peer learning.
There are those who feel that the bilingual-bicultural approach would
be better suited to children who are culturally Deaf or whose parents are
also fluent in a sign-language and can therefore serve as strong role mod-
els. Hearing parents who do not sign but opt for this approach will need
to become familiar with and engage in regular interactions with the Deaf
culture (Gravel & O’Gara, 2003). They should also work closely with deaf
educators as part of an early intervention program and later, their child’s
school teachers. A family commitment to learning ASL is crucial as it must
be used routinely at home by everyone (Gravel & O’Gara, 2003; Mahshie,
1995; Marschark, 2007; Zapien, 1998).
American schools that have implemented bilingual-bicultural programs
include the Arizona School for the Deaf (Tucson), the California School for
the Deaf (Fremont), the Delaware School for the Deaf (Newark), Indiana
School for the Deaf (Indianapolis), the New Jersey school for the Deaf
(Ewing Township), the Learning Center in Massachusetts (Framingham),
Texas School for the Deaf (Austin), Maryland School for the Deaf (Columbia
and Frederick), and the Cleary School for the Deaf (Nesconset, New York).
Parents who feel that such an approach is appropriate for their child and
family should contact state residential schools for the deaf.
Internationally, support for and the implementation of bilingual-
bicultural programs arose in Sweden where the grassroots activism of
those impacted by hearing loss led to legislation approved by the Swedish

Parliament in 1981. This legislation served as an acknowledgement that
people who are deaf or hard of hearing need to be bilingual in order to
function successfully at home with their families, in school, and in soci-
ety (Mahshie, 1995; Marschark, 2007; Zapien, 1998). In 1991, Denmark
also recognized sign language as an equivalent to that of Danish language
and promoted sign language as the primary mode of communication in
schools for the deaf. International bilingual-bicultural programs include
the Sign Talk Children’s Center (Winnipeg, Canada), Bjorkasen School for
the Deaf (Norway), Dorcaster School for the Deaf (England), Model School
for the Deaf Project (Ireland), Jorge Otto School for the Deaf (Santiago,
Chile), as well as the Klemzig School (South Australia).
EDUCATIONAL SET TINGS
As the child approaches the age of five, he or she should be enrolled in

school full time. During the school day, the child will work with special
educators, deaf educators, audiologists, and speech-language patholo-
gists who will aid them in developing communication skills. Parents’ or
guardians’ primary role will be to serve as an advocate through every
step of the process, working with school personnel to develop either an
Individualized Education Program (IEP) (United States) or Individual
Education Plan (Australia and United Kingdom) that best meets the
child’s needs both academically and socially in the classroom. The IEP is
discussed in chapters 3 and 5.
School Selection
Initially, parents are strongly encouraged to visit area schools with their
child and talk to teachers and administrators about the school philosophy
and the various approaches used.
They should also determine through discussion with teachers and
administrators whether the school aligns with their child’s strengths and
weaknesses. Several sites should be considered and notes should be taken
regarding the positives and negatives of each; it is particularly important
to make a list of the support services and accommodations the child would
receive. This list must also take into consideration any additional disabili-
ties the child has (i.e., vision loss, developmental delay, physical impair-
ments) (Zapien, 1998). Though parents may receive input and support
from education professionals and family members, they, along with their
child when possible, will ultimately make the final decision.
According to ASHA (2012), approximately two to three of every 1000
children in the United States are born deaf or hard of hearing. Early
identification, including follow-up services such as early intervention
programs, is crucial for language acquisition. Such resources enable the
child to achieve age-appropriate communicative, cognitive, academic,
social, and emotional developmental milestones (Dunst, 2000; Dunst
et al., 2001; Gallaudet University: Laurent-Clerq National Deaf Education
Center, 2011; Mischook & Cole, 1986; Moeller, 2000; National Association
for the Deaf, 2010a). This is reinforced by Kentish (2007), who states that
the early years are critical for the young deaf child with regard to his or
her social and emotional development, in particular the development of
negotiation and communication skills (p. 75).
Children who are deaf or hard of hearing usually participate in an
early intervention or initial program. These programs generally in-
volve children who range in age from birth to age three. The structure
of such programs varies slightly from state to state but ultimately serv-
ices are provided in the home and in the school setting. Sessions in the
home are typically conducted by a certified teacher of the deaf. Topics
addressed in these sessions include hearing loss, its impact on com-
munication, various methods of communication, and developmental
milestones. Parents will also be introduced to the various devices
(e.g., hearing aid, BAHA, and cochlear implant) available and the
maintenance required for each. Services also include individual work
emphasizing exercises and activities for language development. The
importance of family involvement in such processes is also reinforced
(Dunst, 2000; Dunst et al., 2001; Gallaudet University: Laurent-Clerq
National Deaf Education Center, 2011; Mischook & Cole, 1986; Moeller,
2000; NAD, 2010a).
As the child approaches the age of two, such services may expand to in-
clude small group activities for parents and children. The structure of such
programs may include auditory training, communication, language devel-
opment, speech, and production. Such small group activities can provide
the child with further opportunities to develop his or her fine and gross
motor skills. He or she should be introduced and encouraged to complete
developmentally appropriate self-help skills to promote independence,
well-being, cooperation, and responsibility. The child should also develop
readiness skills and expand on his or her cognitive and language abili-
ties via age-appropriate stories, games, and other activities. Socialization,
as well, can be an integral and important part of the early intervention
program, providing opportunities to meet and play with other children

who have similar backgrounds. Parents’ first steps in finding out more
about these early intervention services can begin by contacting their fam-
ily pediatrician or a pediatric audiologist. The online component for this
book provides information pertaining to early intervention services re-
sources by state.
Residential Schools
Residential schools, long considered to be central to the Deaf commu-
nity, have traditionally been an option for children with severe to pro-
found hearing losses who have opted to communicate primarily via sign
language (Marschark, 2007). These boarding schools have had a long his-
tory in the United States and abroad, one that is rich in the traditions
of the Deaf culture. The opportunities for socialization and community
are the essential differences in the education received by children who
attend these schools. Residential schools also provide activities and
programming similar to those found in other school settings including
the arts, sports, and various school clubs. Another benefit of the resi-
dential school is the access that children will have to deaf role models
and teachers. The criteria for the residential school include the type and
degree of hearing loss and the academic needs of the child (LaSasso &
Lollis, 2003; Zapien, 1998). Residential school programs experienced an
increase in enrollment as a result of the Rubella epidemic of the 1960s
(Garvin, 2008, p. 59; Marschark, 2007, p. 144). This was the result of a
significant increase in the number of babies with congenital hearing loss
(Garvin, 2008, p. 59). Residential schools experienced a decline there-
after resulting from the passage of Public Law 94-142 in 1975 (Garvin,
2008, p. 59; Marschark, 2007, p. 144). The passage of PL 94-142 not only
ensured that a greater number of children who were deaf had access to
a public education and appropriate services, but that such an education
could be received in their neighborhood schools as opposed to special-
ized schools.
More recently, technological advances have had an impact on residen-
tial school enrollment. For example, the earlier children with profound
hearing losses are implanted with the cochlear implant, the more likely
they are to be ready for the local public school setting (Archbold & Mayer,
2012). In order to stay open and remain a viable option for those chil-
dren who prefer them, residential programs have alternatively made day
schools available. They have also opened their doors to those children with
hearing loss who also have other special needs.
Day Schools
The day school is an option for families who do not want to send their
children, particularly those who are younger, away to school. While there
are concerns regarding consistency of language and structure for the
child in question, many feel that their children also need to experience
the love, discipline, and nurture that only a family can provide. There are
also concerns about location and isolation. Many parents feel that the
act of sending their child to a residential school isolates them. This also
highlights another issue for hearing parents. In order to prevent “isola-
tion,” it is necessary that they become involved in their child’s educational
experience regardless of comfort level. They need to take the time to be-
come familiar with the community their child has chosen. Ultimately, day
school programs, where available, can offer children with hearing loss
and their families an alternative education option. They provide the child
with opportunities that only specialized programs for the deaf can offer
in terms of communication, socialization, and academic focus while also
allowing the child to live at home (LaSasso & Lollis, 2003; Zapien, 1998).
Public School
While chapter 5 describes the topics of mainstreaming and inclusion,
particularly in terms of their origins and the general philosophy behind
implementation, it is imperative to address them here as possible consider-
ations when making decisions about educational setting. I introduce these
terms here and discuss variations of these models. Addressed also is the
possible impact on academics, socialization, and the emotional well-being
of the child. We must consider that programs vary as do opinions about
their effectiveness. According to Ogden (1996), it is imperative for parents
to stay vigilant by monitoring their child’s schoolwork and overall prog-
ress in the school setting. This includes asking the child about his or her
teacher(s), school, and peers. Ogden also suggests a watch, ask, and mon-
itor approach.
The terms “inclusion” and “mainstreaming” are often used interchange-
ably, but they represent two different philosophies with regard to educat-
ing children with special needs (Angelides & Aravi, 2006). As both terms
are used to describe the educational services a child is receiving in the
general classroom setting and because implementation tends to differ by
school district, it is imperative for parents to understand them as they
consider whether the public school setting is an appropriate fit for their
child. Furthermore, it is common for local educational agencies to provide
several setting options, often including the special education classroom,

resource room, in conjunction with both the mainstreaming and inclusion
models. Such an approach is thought to allow for a placement that best
helps the child achieve his or her individual educational goals. This will
hopefully fuel questions about the child’s placement, the support services
he or she should receive, as well as academic expectations and opportuni-
ties for socialization.
Mainstreaming places the child in the general education classroom for
only a portion of the day (Moores, Cerney, & Garcia, 1990). In the main-
streaming model, the responsibility for the child rests primarily with the
special education teacher. The assumption is that the child will share the
same physical space (i.e., classroom, playground) with his or her peers
when able to do so with minimal modification and little impact on the rest
of the class. The expectation is that the child should be able to adapt to the
general classroom setting (Stinson & Kluwin, 2003).
Inclusion, sometimes referred to as full inclusion, is the practice of edu-
cating the child in the general education setting with his or her peers to the
greatest extent possible with essential support services occurring in that
setting (Adamek & Darrow, 2010; Marschark, 2007; Stinson & Kluwin,
2003). Another variation is partial inclusion. Partial inclusion considers
the necessity of the alternate settings, other than the regular classroom,
when more restrictive environments are deemed to be more appropriate
(Dettmer, Thurston, & Dyck, 2005, p. 39). In some instances, for example,
instruction and essential support services are provided in settings outside
of the general classroom. This is the case when special equipment is nec-
essary for physical or occupational therapy, or if the services required are
disruptive to the rest of the class, as might be the case with speech and
language therapy. This means that the child will leave the general class-
room setting for a smaller and more intensive instructional session, typi-
cally referred to as a resource room (McNamara, 1989). The resource room
allows for more specialized instruction, by a special-education teacher,
than is possible in an inclusive setting while still allowing the child to re-
main in the general education classroom.
While partial inclusion may seem more like mainstreaming than in-
clusion, differences lie in both expectation and commitment. The inclu-
sion model accepts the child and embraces his or her right to participate.
Some of the perceived disadvantages include the perspective that time in
the resource room is time away from the general classroom, specifically
addressing the concern that it not only limits opportunities for socializa-
tion, it also promotes negative responses from peers and contributes to
social stigma (Marschark, 2007, p. 158).
Despite the large body of work indicating the positive results of such a
model, it is important to note that inclusion is not perceived positively by
all educators. Concerns raised include a general lack of support and assis-
tance for teachers, including failure to receive information pertaining
to the disability that would enable the teacher to better meet the child’s
needs. Probably the greatest of these, however, is teacher involvement in
the planning and placement process. According to Dettmer, Thurston, &
Dyck (2005), problems most often arise in inclusionary settings when
children with disabilities are “dumped” into classrooms, a circumstance
that may occur whenever the school faces budget cuts or limited time for
planning and collaboration (Salend & Duhaney, 1999).
Self-contained classes are special education classes within the public
school setting. They are designed to meet the academic, social, and behav-
ioral needs of children with special needs who would otherwise struggle
in the general classroom. Typically, certified special education teachers
are trained to teach in the self-contained classroom. In addition to a lower
student-to-teacher ratio, several teachers’ aides or paraprofessionals often
assist the special education teacher. A child with hearing loss may also re-
ceive support from an itinerant teacher of the deaf and hard of hearing
as well as from an interpreter. These arrangements enable the child to
work in a small, controlled setting with a special education teacher who is
better able to provide a structured educational routine with appropriate
goals and expectations. Although students usually attend classes such as
music, art, or physical education with a general education class, there is
a reduction in opportunities for social interactions with hearing peers
(Zapien, 1998).
Support Services in the School Setting
Services for the child who is deaf or hard of hearing mandated under IDEA
include speech-language pathology and audiological services, as well as
a variety of interpreting services such as sign language transliteration
and interpreting, oral transliteration, and cued language transliteration.
Transcription services such as real-time captioning, also referred to as
communication access real-time translation (CART), are also provided.
Still others include psychological services, physical and occupational
therapy, music therapy, and early identification/assessment of disabilities
in children. Counseling services such as habilitation/rehabilitation coun-
seling, orientation, medical examinations for diagnostic or evaluation
purposes, social work services in schools, as well as parent counseling and
training are also offered. Academic support services critical for the suc-
cess of the deaf and hard-of-hearing child in the public school setting are
described below.
Interpreting and Transliteration Services

Until the Reauthorization of IDEA in 2004, educational interpreters, in-
cluding those individuals involved in sign language interpreting, oral
transliteration, and cued speech transliteration, had little input regarding
the needs of the children with whom they worked (Johnson & Seaton,
2011, p. 19). Educational interpreters are now identified as “related ser-
vice providers,” thus allowing for their involvement in the development
of the child’s IEP (Marschark, 2007, p. 151). This has been a very impor-
tant modification particularly as educational interpreters assist the child
who is deaf or hard of hearing throughout most of the school day and can
therefore address strengths, weaknesses, or difficulties identified during
class time (Marschark, 2007, p. 151). State and nationally certified ed-
ucational interpreters receive extensive training to work with deaf and
hard-of-hearing students in the public school setting (Marschark, 2007,
p. 151).
Sign language interpreters translate between oral and manual forms
of communication (Waldman & Roush, 2010, p. 157). Oral interpreters,
however, are required by those deaf and hard-of-hearing individuals who
do not use sign language (Waldman & Roush, 2010, p. 156). The inter-
preter faces the child who is deaf or hard of hearing, and speaking at a
normal rate of speed, presents on the lips and face the words spoken by
the teacher or other students (p. 156). Though the interpreter will gener-
ally be a few words behind the person speaking, he or she will present a
translation coupled with facial expressions, natural body language, and
gesture that will be understandable by the student (Northcott, 1979,
pp. 135–36; SignOn: A Sign Language Interpreting Resource Inc., 2013,
“Oral Interpreting,” para. 1).
The role of the cued language transliterator (CLT), formerly referred to
as cued speech transliterator (CST), is to provide spoken language access
through Cued Speech. According to the National Cued Speech Association
(2007), the CLT makes sure that individuals “have complete and equal
access to the auditory information found in the environment of the
mainstream including access to linguistic, academic and social develop-
mental information” (NCSA, 2007, “Role and Responsibilities of the Cued
Language Transliterator,” para. 1). The transliterator should be positioned
beside or slightly in front of the teacher providing the primary source of
information to ensure that the child has access to audible information

(Waldman & Roush, 2010, p. 156).
Note Taking
The reauthorization of IDEA has also expanded the definition of educa-
tional interpreting to include note-taking services, CART, C-Print, and
TypeWell (i.e., educational transcription systems) (Johnson & Seaton,
2011; Marschark, Spencer, & Nathan, 2010). At the secondary and
post-secondary levels, support services may include a note taker. A note
taker is literally someone who takes notes for the student who is deaf or
hard of hearing. In most cases, this is another student in the class who has
agreed to share his or her class notes either by providing photocopies of
handwritten notes, or by sending, via email, notes taken on the computer
(Adams, 1997; Marschark, 2007; Waldman & Roush, 2010). Teachers can
also opt to share their lesson notes or presentation materials, such as a
PowerPoint presentation, with the student. As the student who is deaf and
hard of hearing relies heavily on visual cues, having a note taker will allow
them to focus solely on the teacher and other visual and auditory aids
provided in the classroom (Marschark, 2007; Waldman & Roush, 2010).
Real-Time Captioning
Real-time captioning is also referred to as Communication Access
Realtime Translation (CART). This involves a captioner who typically
uses a stenotype machine with a phonetic keyboard to type the spoken
words of the teacher or other students during class. Specialized computer
software translates the phonetic symbols into captions that are then pre-
sented on the student’s personal computer or on a screen at the front of
the class (Johnson & Seaton, 2011; Marschark et al., 2010). This support
enables the student to learn and participate in the lesson alongside his or
her peers (Marschark, 2007; Waldman & Roush, 2010).
Additional Academic Supports

Other academic supports for the student with hearing loss include tutors or
itinerant teachers of the deaf and hard of hearing who can help them with
those concepts with which he or she is having difficulty. Tutors can also
be students who excel in a particular subject, a retired teacher, or another
qualified staff member of the school. School guidance counselors can also
provide additional academic and social supports. Recommendations for

support in the music classroom setting are provided in chapters 3 and 4.
SOCIALIZATION
What is the best way for parents to provide opportunities for their child
that promote communication skill development and help them to learn
how to relate with and develop relationships with others? Understandably,
these are questions that parents will have as their child grows. The proac-
tive steps parents take to search for and secure varied social opportuni-
ties can ultimately help their child to develop self-esteem and confidence
in social settings (Martin, Bat-Chava, Lalwani, & Waltzman, 2011;
Schorr, 2011).
Resources
Primary sources that might provide parents with immediate information

on opportunities and events include the child’s audiologist who may have
information about group meetings and local activities, and the child’s
early intervention teacher as well as others associated with his or her
early intervention program such as speech therapists and ASL instruc-
tors. Parents might also consider reaching out to the deaf educators in
their child’s school district as well as those associated with state or local
programs for the deaf. Local community centers may also provide oppor-
tunities for socialization.
An internet search of hearing loss-related sites may also provide in-
formation. Each state has an association for the deaf as well as a depart-
ment of education. These entities often include sections for children with
hearing loss (Martin et al., 2011; Schorr, 2011). For example, the home
page for the Alexander Graham Bell Association website (www.agbell.org)
includes a link for parents to a calendar of events featuring their various
program offerings. One of particular note is the Parent Advocacy Training
Program, designed to aid parents in advocating for their child particu-
larly when it comes to making connections with local school districts and
service providers. Another example is The Communicator, the quarterly
newspaper of the organization Hands and Voices (www.handsandvoices.
org). Hands and Voices is a national organization that houses chapters
in every state. In addition to articles that focus on topics impacting the
families and professionals who raise and work with children who are deaf
or hard of hearing, the newspaper also advertises various events in com-

munities all over the United States. Individual state organizations may
also have periodicals that occasionally list regional events. For example,
New Jersey’s newsletter, entitled The Monthly Communicator, is a publica-
tion that has served New Jersey’s deaf and hard-of-hearing communities
for over thirty years (http://www.state.nj.us/humanservices/ddhh/news-
letters/communicator/). The Monthly Communicator provides information
pertaining to the various programs, services, and products available to
the members of these communities. On the international front, Voice for
Hearing Impaired Children (http://www.voicefordeafkids.com), a Canadian
organization, includes a kids’ page featuring a yahoo chat option for teen-
agers. With parental permission and supervision, such chat rooms can
offer teenagers with hearing loss opportunities to share his or her experi-
ences with one another.
Playdates
While also acknowledging that all children might appreciate and need
some individual playtime, parents should be proactive in providing their
child with a variety of opportunities. On the home front, parents might
consider arranging for play-dates with children from their early interven-
tion or school program. This one-on-one arrangement is recommended as
it is sometimes more difficult to manage a social experience if there are
many children involved. An opportunity to play with one or even two fa-
vorite friends can be a much more enjoyable experience for all. As a trial
run, consider a play-date that is a little shorter in duration. Times can al-
ways be expanded later once the child is comfortable (Martin et al., 2011;
Schorr, 2011). Some children may also need additional support while
adjusting to social settings (Schorr, 2011). In these instances, parents and
siblings might practice with the child by providing social models such as
how to introduce him- or herself to someone new (i.e., simple introduc-
tions like “Hi, what’s your name?”). This modeling is helpful because such
activities include body language and nonverbal cues unfamiliar to the
child. The child’s speech and language pathologist can serve as a great re-
source in this area by providing guidance on the best ways to introduce
and reinforce such skills (Easterbrooks & Estes, 2007).
Play-dates can and should include musical activity, particularly if the
child is both interested and comfortable. Such activities might be initi-
ated with music listening and sound exploration at home involving, for
example, an investigation of the types of sounds and resulting vibrations
that various objects can make. If the child indicates a real interest in
music, parents can also select music activities that take place in the neigh-
borhood, including public school and community ensembles as well as pro-
grams such as Kindermusik (www.kindermusik.com/), or Music Together
(www.musictogether.com/), both of which families can do together.
Additional opportunities for socialization might include after-school
activities such as sports teams, karate, or arts-related endeavors that both
interest the child and encourage social interaction. Parents must remain
both positive and supportive, especially as some experiences may be more
successful than others. If a child is having difficulty, parents might also
look for social skills groups. These groups can both teach and reinforce a va-
riety of social skills including how to make and keep friends, subsequently
aiding in the development of the child’s self-confidence. Participants are
typically between the ages of six and seventeen and groups are formed
based on age (Schorr, 2011).
Bullying
Children and adolescents who are deaf or hard of hearing and main-
streamed into the public school are not only working to adapt to the au-
ditory environment, but are also concerned about making friends and
fitting in. According to Kent (2003), the fear of “being left out,” “dif-
ferent,” or “undesirable” can often fuel the social relationships that ado-
lescents and children with hearing loss create (p. 316). As a result, they
may choose not to self-identify as having a hearing loss for fear of such
repercussions (p. 315). Research has revealed that children with disabili-
ties are frequently targeted by bullies, and children with observable dis-
abilities are twice as likely to be bullied as those whose disabilities are
not as evident (Sullivan, 2006, p. 236). An earlier survey originating from
the United Kingdom even revealed that children who are deaf or hard of
hearing were found to have the highest rates of victimization by bully-
ing (100 percent) and of bullying others (50 percent) (Whitney, Smith, &
Thompson, 1994).
The impacts of bullying on a child with hearing loss can be numerous,
often manifesting as low self-esteem, failure to adapt to social situa-
tions, psychological distress, cognitive and social cognitive delay, as well
as low academic achievement (Kent, 2003, p. 316). These can also serve
as warning signs for parents, who should also be prepared for the real
possibility that their child may deny being bullied due to feelings of em-
barrassment about being singled out (Edwards & Crocker, 2008, p. 75).
So, what can parents and teachers do? Several resources are available in-
cluding the International Bullying Prevention Association (www.stopbul-
lyingworld.org/), the UK’s Kidscape (www.kidscape.org.uk/), and New
Zealand’s anti-bullying site (www.nobully.org.nz). Other sites include
StopBullying.gov, a website managed by the US Department of Health &
Human Services and the US Department of Education (ed.gov), which pro-
motes awareness about bullying and provides guidelines for its prevention
such as recommendations for parent-child communication, state-by-state
and school anti-bullying laws and policies, and support systems for all
children involved in bullying, including both the victims and bystanders
(Tempkin, 2012).
MAKING A DIFFERENCE THROUGH MUSIC
According the E. Thayer Gaston (1968), we cannot consider music without

man, nor man without music. Music is a form of human behavior, unique
and powerful in its influence (p. 32). Similarly, Barton (2010) emphasizes
that music is a pervasive part of our culture, sustaining us from birth to
death. This is further reinforced by Chen-Hafteck and Schraer-Joiner
(2011) who state that musical ability is innate and that music activities are
naturally engaging to children. Numerous studies have also revealed that
individuals with hearing loss who have been exposed to music training
have benefited in areas such as cognitive and linguistic development,
improved memory, and music perception (Abdi, Khalessi, Khorsandi, &
Gholami, 2001; Bilir, Bal, & Artan, 1995; Chen et al., 2010; Darrow, 2006,
2007; Galvin, Fu, & Nogaki, 2007; Schellenberg, 2004; Schraer-Joiner &
Chen-Hafteck, 2009; Wong, Skoe, Russo, Dees, & Kraus, 2007). Such find-
ings encourage us to reconsider the parameters of what it means to be
musical as musical experience, enjoyment, and expression varies for eve-
ryone regardless of background or ability.
Speech and Language Development
Music can make a difference in the life of a child with hearing loss. For a
long time, speech and language development have been connected with
music, both in transmitting messages including the production of speech
(expressive language) and in receiving or processing speech (receptive
language). This is reinforced by Barton (2010) who states that from an
early age, children need to experience both the music and language of
their own culture. For example, activities that involve singing to a child
with hearing loss can give them pleasure and aid in the development
of listening skills. The act of singing can also help this child to develop
breath control and flow as well as to better help them to focus on vocal
pitch and rhythm. Music activity can also help to reinforce vocabulary
and serve as a memory aid. Overall, music can be motivational in pro-
moting communication. For example, Schraer-Joiner and Chen-Hafteck
(2009) found that the children involved in their study exhibited interest
in communicating with teachers and teachers’ aides. They were also in-
terested in communicating their musical and non-musical thoughts and
ideas with their peers. Musical activity can also provide a child who is
deaf or hard of hearing with early opportunities for self-expression and
creativity, a very powerful tool particularly for a child who is learning
language.
Social and Emotional Development
Music can also break down social barriers and misconceptions in main-
streamed and inclusive settings via activities that emphasize movement
and instrument playing (Kelly, 2007; Martin et al., 2011). For example,
Schraer-Joiner and Chen-Hafteck (2009) found that the children in-
volved in their study demonstrated the social and emotional milestones
of four-year-old children with hearing, suggesting that they were not
delayed as a result of their hearing loss. The researchers also observed
that the children interacted socially with their teachers and teachers’
aides during music activities and gradually interacted with their peers as
lessons progressed. The children expressed empathy for their peers both
verbally and nonverbally and also conveyed a range of emotions during
music activities. Additionally, the children demonstrated their indepen-
dence during music activities. They also exhibited an interest in skill
mastery as evidenced by their desire to show their teachers and teachers’
aides what they could do (Schraer-Joiner & Chen-Hafteck, 2009). Such
findings reinforce what Barton stated about the importance of early ex-
posure to both language and music. Still other factors that contribute
to the social and emotional well-being of a child who is deaf or hard
of hearing include opportunities for “early and effective interactions”
with the family members, peers, and teachers as well as involvement
in early intervention programming (Adamek & Darrow, 2010; Calderon
& Naidu, 1998; Kelly, 2007; Marschark, 1997; Schick, Marschark, &
Spencer, 2006).
Facilitating Participation in Music

and Musical Activities
Advocacy! Parents need to advocate for their child. This means asking
school administrators whether music programs are in place and inquiring
about the level to which their child will be involved in those programs. In
addition to providing early opportunities for exposure, once their child is
in school, parents should be watchful, asking their child about their expe-
riences in music class, comfort level, and musical interests. Parents might
consider having a conversation with the music teacher informing them
of their interest in helping to reinforce musical concepts at home. They
should be prepared for the fact that not every experience is going to be a
positive one and that not every musical experience will be the most enjoy-
able. In some cases, modifications may be necessary to provide the child
with a more fitting experience and in those instances the parent should
take the child’s cue. There is the possibility that the child might not like
music as much as art or the math club. The best that any parent can do is
to provide the opportunity and then let the child decide where his or her
interests lie.
Music Role Models for Children with Hearing Loss
There are numerous music role models for people who are deaf or hard
of hearing. These role models include children, college students, as well
as professional singers and instrumentalists. While each person has
a story, collectively their message is clear that music is an important
part of their lives. Examples of these amazing musicians include opera
singer Janine Roebuck, instrumentalist and rap recording artist Sean
Forbes, and percussionist Dame Evelyn Glennie. Still other role models
are the UK’s charity group Music and the Deaf. This group houses two
musical groups, the Deaf Youth Orchestra and the Hi-Notes that fea-
tures student compositions. Beethoven’s Nightmare, formed in 1971, is
comprised of former Gallaudet University students. The group, founded
on their love of rock-n-roll, released their debut album entitled Turn
It Up Louder in 2006. Also of note is Sean Forbes’ nonprofit organiza-
tion, D-PAN (Deaf Professional Arts Network/ Deaf Performing Arts
Network). Forbes founded this network to show his support for other
deaf artists by finding and promoting creative opportunities for them.
The network also produces American Sign Language videos of popular
songs for everyone to enjoy.
Incorporating Music into Everyday Activities
Barton (2010) strongly encourages song at various times throughout the

day not just during designated music times. For example, singing sim-
ple musical phrases to indicate that it is time to wake-up or go to bed, a
good-morning and goodnight song, is one example. Singing songs to in-
dicate bath time, mealtime, in the car on long trips or to and from school,
as well as to indicate chore-time (i.e., the “Clean-Up Song” from “Campfire
sing-a-long”), are also recommended. As songs become more familiar, they
can be used to comfort a child (at daycare drop off or at the doctor or den-
tist’s office) or aid in transitioning from one activity to another. Some of
the best resources for parents and teachers are included in Estabrooks and
Birkenshaw-Fleming’s Songs for Listening! Songs for Life! (2003) and Hear &
Listen! Talk & Sing! (1994). The musical story and the “Six-Sound Song,” that
aligns with Ling’s Six Sound Test, is another example. This musical story,
written by Warren Estabrooks (2003), has become an important feature in
both individual and group therapy sessions emphasizing either auditory or
oral approaches. A wonderful feature of this book is that the illustrations
were created by a little boy named Hunter who has a cochlear implant.
CONCLUSIONS
The diagnosis of hearing loss can be difficult for both hearing and deaf
parents alike, and many decisions will face them as a result. However,
there are professionals to whom questions and concerns can be addressed.
Initially, this will be the pediatrician and later, the child’s early interven-
tion team comprised of the audiologist, speech pathologist, infant/fam-
ily specialist, and a representative from the school district. As the child
reaches school age, his or her IEP team will also be involved.
Parental advocacy, however, does not focus solely on communication or
academic settings. Parents will also be very involved in their child’s initial
experiences and interactions with others, in particular, with the oppor-
tunities they have to socialize with other children. Initial experiences
should take place within the early intervention group, an experience that
will be beneficial for the entire family. Parents should also have the oppor-
tunity to commune with other parents and families facing the same issues
while their children play and participate in group activities that promote
communication and socialization. Later, play-dates with children from
their preschool may also be added to the list of opportunities for socializa-
tion. Local organizations and publications may also provide information
pertaining to possible community-based activities. The most important

factor is that parents remember that they know their child better than
anyone; therefore, the specifics of such opportunities should be based on
their child’s interests and capabilities at the time (i.e., length and location
of the play-date as well as activity type). Ultimately, these early oppor-
tunities should promote communication skill development and help the
child develop relationships with others.
Throughout this book, I describe some of the developmental delays the
child who is deaf or hard of hearing might experience. Such delays natu-
rally cause parents to wonder about their child’s well-being. These delays,
coupled with mounting research on bullying, cyber-bullying, and state
statistical reports revealing the numbers of children and adolescents vic-
timized each year, can be terrifying. Parents who notice changes in their
child’s behavior, schoolwork, or overall personality should encourage the
child to share his or her experiences. If the child will not, then the parents
need to speak to teachers and other school personnel.
While reviewing materials on bullying for this book, I came across a
blog post from a parent who indicated that her child was being victimized
regularly and that the school administrators took a very passive stance to
the situation. Local law enforcement was approached but indicated that
the issue was the jurisdiction of the local school board. In frustration, the
parent ended the post by stating that no one cares about children who are
bullied. Again, I want to reinforce that parents are the strongest supporter
their child has. If the school board is the administrative body to address,
then parents should go to every board meeting in order to ensure that their
statements become a matter of public record. This should include each in-
stance in which the child has reported an incident of bullying that was not
resolved or acted upon by the teacher and building administrator. Parents
should also seek legal advice if they feel that their child’s well-being is in
danger and if the situation continues to go unresolved. Several states have
anti-bullying campaigns and coalitions for just this reason.
Music has, for a long time, been considered a great equalizer, promoting
understanding and socialization between children who are deaf or hard
of hearing and those who are hearing. Musical involvement has also pos-
itively impacted speech and language development and of course music
skill development. Promoting music through family activities and advo-
cating for the child’s involvement in school-based activities is strongly
encouraged. Following up with the music teacher to ensure that the appro-
priate modifications are made with regard to assistive listening devices is
imperative. Taking the child’s interests to heart as he or she matures is
vital for his or her comfort and well-being.

Teachers and Parents: Music Activities for Home and School
I. Sound Exploration (Home or School Activity)

Source: Based upon activities found in S. D. Nocera (1979). Reaching the special
learner through music. New Jersey: Silver Burdett.
Purpose: To provide the child who is deaf or hard of hearing with opportunities
to explore several items/instruments in the home that produce sound.
Such activities should aid children in developing their detection skills
(i.e., the presence or absence of sound).
Materials: Pots, pans, wooden spoons, metal spoons, dried goods in closed
containers.
Procedures: 1. The parent should first introduce the child to a variety of kitchen/
home items and the sounds they can make. The child will reinforce
the name of each item and explore the various ways to play each.
a. Pots
b. Pans
c. Wooden spoons
d. Metal spoons
e. Dried goods in closed containers
2. Exploration time: Each child can explore each item.
IIa. Auditory Discrimination: Musical Conversations

(Home Activity)
Materials: Pots, pans, wooden sticks (i.e., any solid materials the child wants to
explore!)
Procedures: 1. Using a pot or pan at first, the parent should play a rhythm pattern
or musical question.
2. Encourage the child to answer by creating his or/her own rhythm
pattern or musical answers to a musical question on the pot or pan.
3. The parent should respond with another musical question
and so on.
4. Follow-up activity: Encourage the child to express whether he or
she likes the activity. Encouragement can be achieved through
words, gestures, or drawing pictures.
IIb. Auditory Discrimination: Musical Conversations (School Activity)

Grade level: Kindergarten—4th grade.
Purpose: This activity can encourage children with delayed/speech and lan-
guage skills to use their instrumental voices by creating musical
conversations.
Implementation: These activities should be utilized at the beginning or end of a class or
session.
Materials: Drums, xylophones.
Procedures: 1. Using a drum at first, the teacher should play a pattern.
2. The child should then be encouraged to answer using his or/her
own drum.
3. The teacher should then respond with another musical question
and so on.
Please note: This game can be played with barred instruments
using only the notes that comprise the pentatonic scale C, G,
D, A, and E.
4. Follow-up activity:
Encourage the child to express his or her feelings about the activity
through words, gestures, or drawing pictures.
III. Musical Stories (Home or School Activity)

Grade level: Kindergarten—4th grade.
Purpose: Musical stories are introduced as a means of enhancing literature by
using instrument sounds to reinforce the characters, sounds, and ac-
tion words presented within the story. They can offer young children
opportunities to participate in the music-making process as well as to
express themselves.
Implementation:
Parents: You can apply this activity to the reading you and your child do
at home.
Teachers: Musical stories can be used as a final integrative class activity for a
particular book or poem the students are already reading in class.
Materials: Song sheets, visuals, toy trains, or buses.
Procedures (for
the classroom): 1. Select a story or poem. Teachers, this may be a part of a lesson
unit you are teaching or structured routine you have already
devised.
2. After the child/children are familiar with the story or poem, help
them to identify characters and sound/action words, as well as
major concepts that make up the story.
3. Have the class decide the characters, sound, and/or action words
they want to reinforce and create a list. Parents and Teachers might
start with a single character, idea, concept and instrument at first.
4. Assign instruments to the characters, sounds, and/or action
words list.
5. Read the story playing the selected instrument for approximately
five seconds after the characters, sound, and/or action words are
spoken (Please note that the story should continue after the child
has stopped playing the instrument).
6. Follow-up activity: Encourage the child to express his or her feelings
about the activity. This can be expressed through words, gestures,
or drawing pictures.
7. Parents can display the pictures in their child’s room or on the
refrigerator for everyone to enjoy. For more advanced grade lev-
els, teachers can have the students create a performance key or
story board with symbols for their instruments and performance
directions.
IV. Listening Suggestions, Resources, and Materials

(Home or School Activity)
1. Familiarity: Start with music the child may have listened to before.
2. Simplicity: Start simply with songs limited to one instrument if possible for ten to fif-
teen minutes per day. Remember that everyone is different: some people may be able to
handle more time than others and may likewise be able to add more time sooner than
others. Recorded nursery rhymes and children’s songs can also be used. Parents should
place their child as close to the sound source as possible, of course keeping safety in
mind! Also, parents may want to keep in mind that transmission of vibration works best
on hard wooden surfaces. (Rugs will dampen the vibrations!)
3. Listen daily: Daily listening can provide a review for the child and reinforce concepts/
vocabulary being taught and help to develop the child’s auditory memory.
4. Activities and Approaches for vocabulary reinforcement:
Concepts: Basic vocabulary; expanding the child’s knowledge of his/her environment.
Materials: (i.e., including visuals and manipulatives) Stories; Stuffed animals; Picture
cards for new or old vocabulary words (these can be kept in a special picture box); Songs
such as “Old MacDonald Had a Farm,” “B-I-N-G-O,” “Six Little Ducks,” and “Five Little
Frogs”; Orchestral Works such as Camille St. Saens’s Carnival of the Animals and Sergei
Prokofiev’s Peter and the Wolf.
Procedures:
1. Parents can say and sign the words one at a time and the child will repeat. The words and
related songs are included below and grouped by concept area.
a. Direction
i. Words: Up, Down, Front, Back, In, Out, High, Low
ii. Children’s Songs: “Hokey-Pokey,” “Open Shut Them” (Finger-play), “Bounce
Hi-Bounce-Lo,” “Bounce the Ball to Shiloh”
b. Moving
i. Words: Stop, Go, Jump, Walk, Skip, Open, Shut, Clap, Stomp
ii. General Song: “Walk and Stop,” “Skip to My Lou”
c. Body Parts
i. Words: Shoulders, Knees, Thumbs, Fingers, Head, Hand, Chin, Mouth, Foot,
Nose, Eyes
ii. Children’s Songs: “Head, Shoulders, Knees, and Toes,” “Hokey-Pokey,” “Clap Your
Hands,” “If Your Happy and You Know It!”
d. Transportation
i. Words: Airplane, Bus, Car, Train, Boat
ii. General Song: “I’m Leaving on a Jet Plane,” “Wheels on the Bus,” “I’ve Been Working
on the Railroad,” “Row Row Row Your Boat”
e. Food
i. Words: Muffin, Oats, Peas, Beans, Barley, Spaghetti, Buns, Peanut Butter, Jelly
ii. Children’s Songs: “Muffin Man,” “Oats, Peas, Beans, and Barley,” “On Top of
Spaghetti,” “Hot Cross Buns,” “Peanut Butter Jelly”
f. Animals
i. Words: Spider, Duck, Horse, Cat, Dog, Frog, Cow, Mouse (Rat)
ii. Children’s Songs: “Itsey Bitsey Spider,” “Old MacDonald Had a Farm,” “B-I-N-G-O,”
“Six Little Ducks,” “Five Little Frogs,” “The Farmer in the Dell”
iii. Classical Works: Camille St. Saens’ Carnival of the Animals and Sergei Prokofiev’s
Peter and the Wolf
2. Develop a listening routine: Make sure that the child listens the same way every day!
3. Vocabulary reinforcement sources:
a. Beall, P. C., & Nipp, S. H. (2005). Wee sing nursery rhymes and lullabies. New York,
NY: Price Stern Sloan.
b. Beall, P. C., & Nipp, S. H. (2005). The best of wee sing. New York, NY: Price Stern Sloan.
c. Beall, P. C., Nipp, S. H., & Guida, L. C. (2005). Wee sing childrens’ songs and fingerplays.
New York, NY: Price Stern Sloan.
d. Estabrooks, W., & Birkenshaw-Fleming, L. (1994). Hear & listen! Talk & sing! Toronto,
Canada: Arisa Publishing Group, Inc.
e. Hampson, S., Lillenstein, L., & Morrison, B. (1989). Sharon, lois and bram’s mother
goose: Songs, finger rhymes, tickling verses, games and more. Boston MA: Little Brown & Co.
f. Hampson, S., Lillenstein, L., & Morrison, B. (1989). Sharon, lois and bram’s travellin’
tunes. Boston MA: Little Brown & Co.
g. Prokofiev, S., Saint-Saens, C., & Britten, B. (1991). Bernstein favorites: Children’s classics.
New York, NY: SONY.
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CHAP T ER 3
Adapting the Music Classroom

All-Purpose Suggestions and Approaches
A lthough hearing loss can limit musical capacity, children who are
deaf or hard of hearing should have the same opportunities as their
hearing peers to experience and create music through singing, listening,
playing, and movement (Atkins & Donovan, 1984; Darrow, 1985, 1993;
Darrow & Heller, 1985; Hagedorn, 1994; Marschark, 2009). The music
teacher who has little experience in working with students who are deaf
or hard of hearing will need some guidance (Adamek & Darrow, 2010;
Darrow & Gfeller, 1991; Gilbert & Asmus, 1981).
This chapter explores initial classroom preparations, recommendations
for instructional delivery, as well as multimodal teaching strategies with
specific suggestions for instrumental and both structured and creative
movement activities. In addition, the chapter will also examine music as
a means for teaching speech and auditory training and for promoting ac-
ceptance and understanding. Specific lesson ideas for teaching rhythm,
pitch direction, and melody are also highlighted for the music educator.
The following recommendations represent a wide range of ideas and lesson
approaches that music teachers should feel free to modify in order to meet
their unique classroom situations.
INITIAL PREPARATION AND FACT-FINDING
In order to provide an appropriate learning environment, including the

necessary instructional modifications for students who are deaf or hard of
( 83 )
hearing, the music teacher should first embark on a fact-finding mission.

This should entail communicating with the appropriate school faculty,
staff, and parents. For example, the child’s special education teacher can
provide information pertaining to instructional methods and modifica-
tions currently in place in the student’s regular and/or special education
classes (Shehan-Campbell & Scott-Kassner, 2009). Speech specialists,
as well as the school audiologist, interpreter, and psychologist can pro-
vide background information including, but not limited to, the degree
of hearing loss, primary mode of communication, the type(s) of hearing
devices used, and the child’s level of experience with the device(s).
The music teacher is strongly encouraged to maintain communication
with parents and guardians and should be prepared to ask a variety of
questions in order to find out about the child’s music background. Parents
know their child better than anyone and will therefore be able to provide
a well-rounded picture of the child’s academic and social strengths and
weaknesses, as well as his or her musical interests. Music teachers may
find that parents are enthusiastic about their inquiries and therefore very
willing to describe the musical behaviors that their child has exhibited
at home.
Initially, it may take some time to gather the necessary information.
This can be frustrating particularly if the teacher is given very short no-
tice about having a student who is deaf or hard of hearing in the class-
room. Even on the first day, however, enough data can be collected to help
music teachers to meet the student’s needs. For example, Schraer-Joiner
and Prause-Weber (2009) recommend conducting a Musical Audiogram. To
administer a musical audiogram, the music teacher should select one me-
lodic phrase from a children’s songbook. The melody selected should pref-
erably be one that is familiar to the student. Then, the student should be
informed that the song will be presented differently (i.e., in different reg-
isters and at different dynamic levels) and that he or she is to indicate the
example that sounds the best or the most “comfortable” for them. Such an
activity is particularly important for the student who uses hearing aids
or a cochlear implant as it can provide initial information regarding the
pitches and dynamic ranges most comfortable for the student (Prause,
2003; Schraer-Joiner & Prause-Weber, 2009).
Instructional Delivery
Visibility and Mobility
Some modification to lesson delivery may be required in order to meet the
needs of the student who is deaf or hard of hearing, but any modifications
A d ap t i n g t h e M u s ic C la s s r o o m ( 85 )
made may benefit all of the students in the class. Because the student who
is deaf or hard of hearing depends on gesture, facial expression, and, in
some cases, speech reading, the music teacher should be clearly visible to
the student from any place in the room. This means that positions close to
a window should be avoided as glare from any incoming light will make it
difficult for the student to see the music teacher.
Depending on the music lesson content and plan for delivery, the ap-
propriate position for the student may be in the front row as illustrated
in Figure 3.1. However, if the class is sitting in a half circle configuration
for an instrumental lesson group, for example, place the student in the
center as shown in Figure 3.2. This ensures that the student is able to both
speech read and see the music teacher model musical concepts (Moore,
2000). If a general music classroom setup is one where there are four or
FRONT OF MUSIC CLASSROOM
H H D H H
H H H H H
H H H H H
H H H H H
H H H H H
Key
D=Student with Hearing Loss H=Students with Hearing T=Teacher
Figure 3.1: Front-row position in a general music classroom for a student with

hearing loss.
LESSON GROUP SET-UP
H D H
H H
H H
H H
T
Key
Figure 3.2: Half-circle configuration which positions the student with hearing loss in
the center of the lesson group.
five students sitting at a table or a cluster of desks, the student who is

deaf or hard of hearing should be placed on the outside of the group with
the ability to see the rest of the class. This should make it possible for the
student to see the teacher and his or her classmates. Similarly, the teacher
should also position him- or herself on the outside of each cluster, partic-
ularly when working with each group individually. The teacher should be
able to monitor the entire class while also providing the student who is
deaf or hard of hearing with clear and consistent access to instruction. See
Figure 3.3 for this schematic of appropriate student and teacher positions
in a cluster setup. Ultimately, prepping all materials beforehand, when
possible, and placing them in a central location for all students to see lim-
its any additional and unnecessary movement around the room that can
detract from instruction.
Communication and Presentation

During instruction, the music teacher should speak at a moderate tempo
and articulate each word clearly. He or she should also avoid shouting
or over exaggerating words while speaking. Sitting on the same level as
the student is ideal as this makes it easier for the student to speech read
(Birkenshaw-Fleming, 1993; Moore, 2000). Additionally, while writing
on the board, the teacher is likely facing away from the class. In this in-
stance, the teacher should refrain from continuing to speak as the stu-
dent who is deaf or hard of hearing will be without the necessary visual
cues (Marschark & Hauser, 2011). Instead, the teacher should pause from
writing and turn to readdress the class. Cueing the student before asking
POSITIONING WITHIN STUDENT CLUSTERS
T H H T
D H H D
H H H H
H H H H
H H H H
H H H H
H H H D
H H H T
Key
Figure 3.3: Recommended positions for a student with hearing loss and music teacher
within a cluster setup.
a question can also provide additional support during instruction (Moore,

2000). Furthermore, repeating questions, responses, or comments from
the class can aid in both the comprehension of curricular concepts and
aid the student with class discussion (Moore, 2000). Teachers should also
take care to not speak with a hand or other objects in front of the mouth.
However, if using a manipulative to support instruction, the teacher
should consider holding it near the mouth so that as the word is spoken,
the student can speech read. The goal in this instance is for the student to
associate the word with the object (Birkenshaw-Fleming, 1993).
In cases where an interpreter is present to assist the student, the music
teacher should direct all attention to the student. Furthermore, one to five
seconds of wait time between sentences should be provided for the inter-
preter and note taker. While this may have some impact on instructional
flow, it ensures that the student has access to the information presented.
For after-school music activities, consider inquiring about interpreting
support for the student to insure greater access to such activities with his
or her peers.
Structure and Dependability

In order to provide a structured and dependable music classroom environ-
ment for a student who is deaf or hard of hearing, maintaining routines is
essential. These regular practices should include an auditory routine such
as beginning with certain vocal or instrumental warm-ups or songs, fol-
lowing a consistent rehearsal agenda (i.e., order of music compositions to
be rehearsed), and ending each class with the same music activity such
as a favorite class song or movement activity. The instructional routines
music teachers employ in their classrooms, including taking attendance,
making announcements, writing a rehearsal or class agenda on the board,
reviewing prior music concepts prior to the introduction of new material,
and using consistent transitional statements between musical activities or
compositions, can also provide structure (VanWeelden, 2001, p. 56). The
student will depend on the consistency of such routines in the music class-
room to help them cope in hearing stress situations (Birkenshaw-Fleming,
1993; Darrow, 1985; Schraer-Joiner & Prause-Weber, 2009; Sobol, 2011).
Cross-curricular connections can also contribute to the student’s famil-
iarity with routines and structure. Discussion regarding similarities be-
tween music content and other core curriculum content (i.e., similarities
and/or differences that can be illustrated in a Venn diagram) can help the
student to feel more comfortable, as well as aid the student in remember-
ing the skill or concept.
A structured environment also requires that the music teacher have

the same behavioral expectations for all students. Appropriate and inap-
propriate behavior regardless of student background or ability must be
acknowledged. Students who are deaf or hard of hearing typically experi-
ence some delays in social development. Therefore, the recognition of both
appropriate and inappropriate behavior coupled with the reinforcement of
established rules and consequences can help to reinforce socially accept-
able behaviors and actions (Shehan-Campbell & Scott-Kassner, 2009).
Documenting Student Progress

Follow-up and ongoing documentation are necessary for the welfare of
the student who is deaf or hard of hearing. Though a detailed discussion
of the Individualized Education Program (IEP) is included in chapter 5
it requires some attention here as detailed information pertaining to
the progress of the student throughout the marking period or semester
(i.e., musical strengths and weaknesses, areas of frustration, and peer
interactions) can be very important to the success of the IEP process.
Documenting the student’s responsiveness to the lesson (i.e., student re-
sponsiveness, successful teaching strategies, approaches, and materials)
can also be useful to other members of the IEP team, particularly as the
music teacher may have observed behaviors that other teachers have not
observed. The music teacher may also be able to include recommendations
for classroom modifications that the other teachers and support staff may
find helpful. Collectively, this information can help the music teacher to
make the appropriate instructional modifications for the student.
CURRICULAR CONTENT: MAKING MUSIC ACCESSIBLE
According to Darrow (1990b), a classroom is truly integrated when the

teacher makes an effort to include all students with special needs instead
of just accommodating them. Interestingly, Montgomery (2007), a profes-
sional deaf musician, suggests that the method of teaching does not need
to change significantly to suit the deaf student but rather the individual—
a manner very similar to the way activities are modified to suit differ-
ing abilities in the music classroom for hearing children. So, what does
this mean for you, the music teacher? How can you modify instructional
approaches to meet the needs of all students in the music classroom? Music
is multimodal in nature. In addition to stimulating the mind, it stimulates
the ears, eyes, and the body (Shehan-Campbell & Scott-Kassner, 2009).
This is further supported by Johnson (2009) who states that music is not
just experienced auditorily but visually, kinesthetically, and haptically
(p. 17). Therefore, music concepts should be presented from multiple per-
spectives for the benefit that such an approach will provide for all stu-
dents in the music classroom.
For those students who are deaf or hard of hearing and who rely heavily
on both their vision and residual hearing, this can provide additional rein-
forcement of music concepts. Additionally, a multimodal approach will be
particularly important for the profoundly deafened child who only com-
municates via sign and who does not use devices such as the hearing aid
or cochlear implant yet is included in the general music classroom or in a
self-contained music setting. This child will perceive vibration rather than
sound and will therefore have difficulty in producing melody or harmony
(Graham & Beer, 1980, p. 61). Therefore, a multimodal approach emphasiz-
ing the tactile, kinesthetic, and visual modalities can reinforce musical con-
cepts and thereby enhance their overall musical experience. This does not
mean that the profoundly deaf child should not be included in the general
music classroom or that he or she should not be involved in auditory experi-
ences (p. 61). It does mean that there should be concerted effort on the part
of the child’s teachers (i.e., music, special education, as well as teachers of
the deaf) to support the child in a collaborative manner. Graham and Beer
(1980) also suggest an “extensive use of singing and pitch muscle training”
as the “combination of certain muscle tensions and certain pitch levels pro-
vides a means of teaching even the totally deaf to produce reasonable into-
nation in singing and playing certain musical instruments” (p. 61).
For the Visual Learner
Darrow and Gfeller (1991) affirm that almost any aural concept can be
visually reinforced. For example, much can be learned from watching the
motions of a conductor and responses of the musicians during a perfor-
mance (Johnson, 2009, p. 17). A vocal performance can also convey both
the context and meaning of a composition, attained via facial expression,
gesture, and speech reading (p. 17). Similarly, providing the student who
has a mild to moderate hearing loss with the song lyrics can promote a
better understanding of those words with which he or she is having diffi-
culty (Adamek & Darrow, 2010, p. 243). Displays in the music classroom
such as song page numbers and music vocabulary for the current lesson on
the board, a poster, or PowerPoint presentation can also aid the student
who is deaf or hard of hearing.
Other visuals that might enhance music listening concepts are photos or
illustrations, videos, and listening maps. Visual aids such as song or rhythm
sequencing cards and music with enlarged print can also help to reinforce
the concepts introduced and ensure that the child is able to follow the
lesson. Additionally, visually appealing and reinforcing manipulatives such
as foam stickers as well as visuals with various music symbols reinforced
with raised paint or glitter, uncooked rice or macaroni, felt notation cards,
colorful scarves, and popsicle sticks can provide further reinforcement of
rhythm and pitch (Schraer-Joiner & Prause-Weber, 2009). This is supported
by Darrow and Novak (2007) who examined the role of referential meaning
in music and its influence on the ability of children who are deaf or hard
of hearing to develop communications skills. Their findings revealed that
the visual representations of music helped to clarify what the children per-
ceived (p. 71). Researchers have also recommended using Windows Media
Player visuals because of their colorful representation of music elements
such as rhythm, tempo, and melodic direction (Johnson, 2009, p. 25).
For the Tactile Learner
Teachers can support multimodal learning of musical concepts with vibro-

tactile cues. These are sensory triggers, such as simple rhythmic or melodic
patterns performed on percussion instruments or Orff tone bars, with
the students either touching or sitting near the instrument so that they
can feel the vibration. Other multimodal triggers might include flicking
the classroom lights and movements such as clapping patterns, stamping
feet, or arm waving. Vibrotactile cues, similar in nature to vibrotactile
aids,1 can also help the student with the overall lesson structure by alert-
ing them to the lesson introduction, conclusion, as well as various activity
transitions.
To promote tactile reinforcement, music teachers may also consider
placing stereo speakers on the floor. Students may 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 through the floor
(Shehan-Campbell & Scott-Kassner, 2009). This can best be accomplished
with either wood or tiled floors (Shehan-Campbell & Scott-Kassner,
2009). If this is not possible, the floors of the gymnasium or cafetorium
(i.e., cafeteria and auditorium combined) are alternative suggestions
(Birkenshaw-Fleming, 1993). Music teachers should also consider hav-
ing their students touch and feel the vibration of instruments being used
during the lesson such as the sound board of the piano, the body of the
guitar, frame of the drum, or Orff bass bars. If the class focus is centered
on pitch discrimination or instrument playing activities, music teachers
can provide students who are deaf or hard of hearing with opportunities
to play instruments that have low frequencies or those in the vibration can
be felt through the hand such as rhythm sticks (Graham & Beer, 1980).
Wooden platforms can also increase the resonance potential of certain
sounds from pianos and xylophones. For such activities, instruments with
bright piercing sound should be avoided as they may be uncomfortable for
students who use hearing aids or a cochlear implant. Furthermore, lessons
emphasizing meter and rhythm can be approached by tapping patterns on
desks or other sound conducting surfaces.
For the Kinesthetic Learner
Moving (i.e., running, jumping, or skipping) to drumbeats, adding move-

ments to songs such as “The Wheels on the Bus,” “Old MacDonald,” or
acting out nursery rhymes and stories such as “Mr. Frog Went A ‘Courtin”
and the “Farmer in the Dell” can help students to develop their coordi-
nation skills, build confidence, and can provide opportunities for social-
ization (Fahey & Birkenshaw, 1972). Other activities might include folk
dances. One great resource is the New England Dancing Master’s Chimes of
Dunkirk: Great Dances for Children (2010) that can be modified for use with
young children (Amidon, Davis, & Brass, 2010).
Free or creative movement activities featuring songs with fast tempi
and a strong beat can be used to encourage students to create their
own movements with dolls or stuffed animals. Schraer-Joiner and
Chen-Hafteck (2009) employed such an activity consisting of two con-
trasting pieces “Trepak” (Russian Dance) from Tchaikovsky’s Nutcracker
Suite and “We Got the Beat” written by Charlotte Caffey and performed
by the Go Go’s. Participants were given baby dolls with which they were
supposed to dance. The researchers found that the participants not only
exhibited creativity but also independence. For example, Child B liked
“Trepak,” moving her doll in time to the music. However, she enjoyed
“We Got the Beat” so much more that she also moved her body in time
with the music. “Occasionally she took notice of the movements around
her and when she saw a movement she really liked, she incorporated it as
part of her own dance” (Schraer-Joiner & Chen-Hafteck, 2009, p. 790).
Body rhythms can be implemented to symbolize rhythmic structure.
Pitch can also be illustrated using the body. For example, younger stu-
dents can crouch down for low notes and stand on their tip toes with arms
above their heads for higher notes. If students have limited mobility, they
can be given alternate movements such as raising their arms or hands
to indicate high, extending them outward for middle, and lowering them
down to their sides for lower pitches. These movements can be enhanced
by the use of colorful scarves.
Instrument playing can be a great way to initiate speech and language
activities. One activity involves creating a conversation or musical dialogue
without words using two hand-drums, other like instruments, or house-
hold items including pots and pans. To begin, the teacher should imitate the
patterns that the student plays while experimenting with the instrument.
In this instance, the student becomes the leader thus reinforcing his or her
musical efforts. Such activities also provide a great foundation for expres-
sive language. Later, the teacher might initiate the conversation by playing
patterns and encouraging the student to echo them. In instances where
instrument playing is not possible, a movement activity may serve as a sub-
stitute. Similarly, the teacher should first imitate the movements of the
student and, afterward, encourage the student to imitate the movements
presented by the teacher. In either instance, the student is presented with
the opportunity to express him- or herself through instrument playing or
movement. Important also is that the student gets to be the leader making
creative choices as to the direction of the activity.
Other Benefits of Music-Making
Participation in music not only enriches the lives of students who are deaf
or hard of hearing, but can also be used as a teaching tool in other areas,
including speech and auditory training. According to Darrow (1985), the
perception, interpretation, and performance of sound also serve as the
basis for both speech and music. Both involve the ability to distinguish be-
tween different sounds as well as the characteristics of those sounds such
as pitch, duration, intensity, and timbre. Lessons focused on pitch motion,
articulation, breath, and rhythm can be enhanced by rhythm and melody
instruments as well as visuals.
The music classroom can also play an important role in promoting ac-
ceptance and understanding. Musical activity can aid in breaking down
any social barriers, thus helping to diminish misconceptions and fear re-
lated to hearing loss (Darrow, 1987, 1990a). The opportunity to provide
social interaction can benefit all children involved and can be facilitated
by the incorporation of musical art forms such as sign-interpreted mu-
sical performances and song signing. Instructionally, all children can
be involved in the teaching process via buddy systems and peer tutors
(VanWeelden, 2001, p. 57). This can facilitate a positive social environ-
ment as well as the incorporation of all contributions made by the class
or ensemble (Darrow, 1987, 1990a; Walczyk, 1993). Music is most often
learned in a group setting rather than in one of isolation. Such an ex-
perience can help to promote a feeling of belonging and commitment
(Shehan-Campbell & Scott-Kassner, 2009).
LESSON IDEAS FOR THE GENERAL MUSIC

CLASSROOM
Lesson Suggestion #1: Rhythm
Rhythms can first be introduced and interpreted by playing music that

is appropriate for skipping and walking. These are based on experiences
that children have experienced in play. For example, Schraer-Joiner and
Chen-Hafteck (2009) implemented Estabrooks & Birkenshaw-Fleming’s
(1994) song “Walk and Stop” during their study to introduce and reinforce
the concept of steady beat. This activity also emphasized the first level of
auditory development: detection, defined as the awareness of the presence
or absence of sound (Erber, 1982). The activity was introduced as follows.
1. Auditory: The participants were initially introduced to a recording of

the song.
2. Auditory/Visual: Teacher “A” sang and signed the song. Participants
were instructed to stop on the word “stop” and walk on the word
“walk.”
3. Kinesthetic: Participants marched in a circle as the researcher and
Teacher “A” sang and signed the song.
4. Tactile/Kinesthetic/Social: In later lessons, the “Walk and Stop”
activity was executed with just a drum. Participants did not sing or sign
in these instances; instead, each had the opportunity to serve as soloist
and activity leader. Later variations on this activity included tip-toeing,
hopping, skipping, and mood music (i.e., lullaby, march).
May (1961) recommends an activity similar to the one described above

though involving rhythm. According to May (1961), the students were
most successful when they kept time with their instruments to a march
played fortissimo on the piano. In this instance, the march was played
in the low registers of the piano keyboard in octaves in both hands. The
students were also able to feel the vibrations of the piano from the floor,
which reinforced the low, loud sounds they were able to perceive with their
residual hearing. Some were also able to follow a conductor or a drum beat,
but that was more difficult for many of the students. This activity can be
replicated in the general music classroom as follows (May, 1961, p. 42).
1. Auditory/Tactile: The students place their hands on the piano while the

teacher plays a march.
2. Kinesthetic: Students march around piano as teacher plays.
3. Auditory/Visual/Tactile/Kinesthetic: Rhythm instrument exploration
and selection.
4. Auditory/Visual/Tactile/Kinesthetic: Students keep a steady beat with
their rhythm instruments as the teacher plays a march on the piano.
5. Extension: Opportunities for socialization and leadership.
a. Auditory/Visual/Tactile/Kinesthetic: Following a student conductor,
the students keep a steady beat with their rhythm instruments.
b. Auditory/Visual/Tactile/Kinesthetic: Following a conductor, the stu-
dents keep a steady beat with their rhythm instruments as teacher
plays a march on the piano.
Lesson Suggestion #2: Pitch Discrimination

and Melody
The ability to differentiate between notes or pitches (i.e., pitch discrimi-

nation) is necessary in order to study and learn melodies. These concepts
are usually preceded by the introduction of high and low in kindergarten
or first grade. Often times, the concepts of high and low are difficult even
for hearing students who confuse the terms with loud and soft. So, how do
teachers ensure the success of all students with these foundational con-
cepts? Fahey and Birkenshaw (1972) recommend the following procedures
for pitch discrimination skill development (p. 46):
1. Visual: The teacher places cards with the words high and low on a key-
board or Orff instrument such as a bass xylophone for reinforcement.
Other instruments can also be used to facilitate the understanding of
low and high such as timpani, single Orff tone bars, soprano and bass
xylophones.
2. Auditory/Visual/Tactile: Individual low notes can be played in the
lower range on one of the various instruments suggested above as the
students touch the instruments.
3. Visual: The teacher writes the word low on board for emphasis. When
another low note is played, the teacher assists the student who is deaf
or hard of hearing (as necessary) to place the low card on the keyboard
and then points to the word on the board.
4. Auditory/Visual/Tactile: Individual high notes can be played in the
higher range on one of the instruments previously suggested as the
students touch the instrument.
5. Visual: The teacher writes the word high on the board for emphasis.
When another high note is played, the teacher can then assist the stu-
dent, as necessary, to place the high card on the keyboard and then
points to the word on the board.
6. Kinesthetic: Once high and low notes have been reinforced via aural,
visual, and tactile modes, then body movement can be introduced iso-
lating high and low notes individually at first. For example, the students
can raise arms up and stand on their tip toes reaching for the sky for high
notes. Alternatively, low notes can be represented by having the students
crouch down with their knees bent and arms down touching the ground.
7. Kinesthetic: When the students are comfortable with isolated patterns,
the music teacher can then vary or mix up the notes played. As before,
students can raise their hands when high notes are played and crouch
down when low notes are played. Scarves and crepe streamers can en-
hance movement activities.
Later lessons focusing on melodic direction can be introduced begin-

ning with two- and three-note patterns moving in either an ascending
or descending fashion (Fahey & Birkenshaw, 1972). These patterns can
be played in the lower ranges on one of the instruments previously sug-
gested. The student should have every opportunity to touch the instru-
ment as various patterns are played. Melodic direction can be introduced
as follows (Fahey & Birkenshaw, 1972, p. 47).
1. Visual: The teacher places cards with horizontal, curved, or diagonal

lines to indicate melodic direction on a piano keyboard or bass xylo-
phone. For reinforcement, the teacher then writes the words up or
down on the board.
2. Auditory/Visual/Tactile: As the patterns are played, individual low
notes can be played on one of the various instruments as students
touch the instruments.
3. Auditory/Kinesthetic: As the patterns are played, the teacher can
then assist the student who is deaf or hard of hearing, as necessary, in
pointing to a card with an arrow ascending or descending diagonally.
4. Kinesthetic: Body movements can further reinforce these concepts. For

example, students can begin in a hunched position and gradually stand
up for ascending patterns. For descending patterns, students can begin
on their tip toes reaching with arms raised to the sky and gradually
crouch to the floor.
5. Auditory/Kinesthetic: When the students are comfortable with isolated
patterns, the music teacher can then vary or mix up the patterns played,
asking them to gradually raise their arms when ascending patterns are
played and lowering their arms when descending patterns are played.
Scarves can be added to make the activity more visually stimulating,
as well.
Other examples involve the positioning of the instruments as the

transfer of vibrations through the body can help to reinforce the concept
of pitch. For example, the instrument should be placed on the floor and
the student positioned so that his or her feet and/or legs are making con-
tact with the instrument, thus aiding in the transmission of vibrations
through the lower portion of the body. High pitches can be produced
on instruments such as the glockenspiel, soprano xylophone, or metal-
lophone, and instruments positioned on a table or raised music stand
for closer proximity to the upper portion of the body (i.e., chest cavity
or closer to the neck and head) can further promote the transmission of
these vibrations. The concept of high and low can be expanded to include
the identification of low, middle, and high pitches. In this instance, middle
pitches can be produced via alto xylophones and metallophones. When
the instruments are positioned on a table or stand designed specifically
for the instrument, closer proximity to the middle region of the student’s
body can ensure the transmission of these vibrations.
Lesson Suggestion #3: Dynamics
Dynamic levels can be introduced in a manner similar to that of pitch discrim-

ination activities previously described (Fahey & Birkenshaw, 1972, p. 47).
1. Auditory/Tactile: The teacher can play very loud notes on any or all of

the instruments recommended as students touch the instruments.
2. Auditory/Visual: The teacher writes the word strong/loud on board in
a labored manner (i.e., with heavy strokes) for emphasis. Weak/Softer
notes can then be played; however, when the word weak is written on
the board, it should be done so in a lighter manner.
3. Auditory/Visual/Kinesthetic: The teacher can then vary or mix up the

notes played and have the students differentiate between the two by
softly clapping their hands or by stomping their feet in order to match
the manner in which the notes are presented.
Estabrooks & Birkenshaw-Fleming’s (1994) song “Walk and Stop,” can

also be implemented to reinforce the concept of loud or soft. The students
can walk on tip toes for soft as the song is played softly and march with
strong footsteps as the song is played loudly. Flooring for such activities
can make a big difference in the tactile experience.
CONCLUSIONS
Students who are deaf or hard of hearing should be offered the same mu-
sical opportunities (i.e., singing, listening, playing, moving, and creating
music) as their peers with hearing. This may seem overwhelming for the
music teacher faced with teaching a student who is deaf or hard of hearing
for the first time. The primary role of a music teacher is that of a facilitator
for musical ideas and experiences. The music classroom can provide all
students regardless of background and ability with wonderful opportu-
nities. The music classroom can be the great equalizer, the space where
students who are deaf or hard of hearing engage in many musical expe-
riences along with their hearing peers. Music teachers should consider
reaching out to special educators and the previous music teacher espe-
cially if the student moved up from either an elementary or middle school
within the same school district. Speech and hearing specialists (i.e., audi-
ologist, speech pathologist), the interpreter, and school psychologist can
also be helpful, particularly in understanding the student’s background
information (i.e., degree of hearing loss, primary mode of communication,
the type(s) of hearing devices used, and device experience). Parents and
guardians should also be consulted as they are most familiar with the stu-
dent and therefore better able to provide a well-rounded picture of his or
her academic and social strengths and weaknesses, and interests.
If the music teacher finds him- or herself having to teach the student
while also trying to gather background information, he or she may find
that conducting a musical audiogram provides them with enough in-
formation regarding the tones and dynamic ranges most comfortable for
the student who uses hearing aids or a cochlear implant. Keeping a log of
the student’s successes and areas of weakness during music lessons, in-
cluding those instructional strategies that are most or least successful,
can be equally as useful for the development and modification of his or her
IEP, the foundation for both curriculum and instruction. Such informa-
tion may be beneficial to the other members of the IEP team.
Overview of Instructional Delivery
1. Be visible to the student from any point in the room.

2. Avoid standing close to windows as glare can make it difficult for stu-
dents to see.
3. Pay attention to setting. Lesson content and plan for delivery can im-
pact seating for the student who is deaf or hard of hearing. In a lec-
ture setting, this may mean front row, center. However, if the class is
sitting in a half circle configuration, place the student in the center.
While working in groups, the student should be placed in an outer
position so he or she can gain information from the group while also
having a direct view of the teacher from any place in the room.
4. Speak clearly and at a moderate tempo.
5. Articulate each word rather than over-exaggerating or shouting while
speaking.
6. Sit on the same level as the student while addressing them.
7. Cue the student before asking a direct question.
8. Use repetition. Questions, student responses, or comments from the
class discussion should be repeated by the teacher so that students
who are deaf or hard of hearing have access to all class discussion.
9. Keep your mouth clear of obstruction. The teacher’s mouth should
not be blocked while teaching. However, when using manipulatives
to support teaching they can be held near the mouth so that as the
word is spoken, the student can associate the word with the object
(Birkenshaw-Fleming, 1993).
10. Avoid chewing gum or eating during instruction.
11. Look directly at the student and not the interpreter.
12. Pause and turn to address the class while writing on the board.
Talking while facing the board will put a student who speech reads at
a disadvantage.
13. Allow one to five seconds of wait time between sentences for the in-
terpreter and note taker.
14. Maintain routines to provide both a structured and dependable class-
room environment. This includes both auditory and instructional
routines; as well as instrument cues to indicate activity change.
15. Promote a structured environment. This includes class and lesson rou-

tines, as well as student academic and social expectations. Teachers
should recognize the appropriate and inappropriate behavior of their
students regardless of background or ability.
Overview of Curricular Content
1. Music is multimodal is nature. It stimulates the eyes, ears, and body.

2. Students who are deaf or hard of hearing should be encouraged to use
their residual hearing.
3. Lessons focused on pitch motion, articulation, breath, and rhythm
can be equally beneficial to students who are deaf or hard of hearing.
4. Instrumental and movement activities can promote expressive
language.
5. Movement activities such as folk dances can build coordination skills,
build confidence, and promote socialization.
6. Body rhythms can help to symbolize rhythmic structure.
7. Pitch can be illustrated using the body. For example, younger students
can crouch down for low notes and stand on their tip toes with arms
above their heads for higher notes.
8. Visual aids such as song and rhythm sequencing cards and music with
enlarged print can reinforce musical concepts.
9. Tactile aids such as felt notation cards, colorful scarves, and popsicle
sticks for rhythm building can provide opportunities for hands-on
learning.
10. Social interaction can be promoted via buddy systems, peer teaching,
sign interpreted musical performances, and small group activities re-
sult in a performance of ideas contributed by all group members.
EARLY INTERVENTION (AGES 2–4) MUSIC LESSON SAMPLE

Grade level: Pre-Kindergarten
Duration: 15–30 minute class period
Concepts: Sound, Silence, Steady beat; Skill development: Gross motor skill development
(walking); Readiness skills: attention and following directions, social skills (sharing, leader-
ship), beginning sounds and word recognition
Objectives:
1. The students will sing/sign the song Walk and Stop (Skill objective)2
2. The students will walk to a steady beat during the song Walk and Stop (Skill objective)
3. The students will sing/sign the song Pass the Ball (Skill objective)
4. T he students will patchen their own steady beat while passing the ball to the Pass the
Ball song. (Skill objective)
5. T he students will walk to a steady beat during the Walk and Stop activity (Knowledge
objective)
6. The students will rock their baby dolls to the song Rock-a-by Baby (Affective objective)3
7. The students will create their own movements with their baby dolls to the Tchaikovsky’s
Russian Dance and Caffey’s We got the Beat. (Affective objective)
The National Performance Standards for Music: Prekindergarten

(Ages 2–4)
Content Standard: 3. Responding to music
Achievement Standard: 3b. Children respond through movement to music of var-
ious tempos, meters, dynamics, modes, genres, and styles to
express what they hear and feel in works of music
Achievement Standard: 3c. Children participate freely in music activities
Vocabulary: (Music and non-musical words introduced and reinforced
throughout the lesson) Walk, stop, ball, drum,
Content Standard: 4. Understanding music
Achievement Standard: 4b Children sing, play instruments, move, or verbalize to dem-
onstrate awareness of the elements of music and changes in
their usage
New Jersey State Department of Education: Preschool Teaching and

Learning Standards
Standard 1.2: Children express themselves through and develop an appreciation of music.
Preschool Indicator: Clap or sing songs with repetitive phrases and rhythmic patterns.
Preschool # 1.2.3
Database #1.3.P.B.3
Preschool Indicator: Listen to, imitate, and improvise sounds, patterns, or songs.
Preschool # 1.2.4
Database #1.3.P.B.4
Materials:
Estabrooks, W. & Birkenshaw-Fleming, L. (1994). Hear & Listen! Talk & Sing! Toronto,
Canada: Arisa Publishers.
Warren, J. (1990) Butterflies Everywhere. Everett, Washington: Warren Publishing House.
Additional Items:
Scarves Drum Plastic foam butterflies
Egg shakers Purple/green ball Visuals: Walking, running, and skipping figures
Procedures:
I. General greeting (waving, smiling, saying and signing hello) to the class as they enter
the room
A. Opening: Hello Song
Accommodation: Sing/Sign “hello” to each child and pause to give each child a
chance to respond to the best of their ability (i.e. a wave, smile, signed hello,
spoken hello)
B. Movement/Singing:
1. Review the song “The Wheels on the Bus.”
Accommodation: Sing/Sign the song The Wheels on the Bus

Accommodation: Sing/Sign the song The Wheels on the Bus with scarves
2. Pass the Ball
a. Show the students the ball say and sign the word ball
Accommodation: Encourage the students to respond by saying or signing the word ball
b. Pass the ball around the circle so that they can touch it
Accommodation: Ask the students to describe it (what it is, color, texture) (The
teacher should pause giving each child a chance to respond to the best of their
ability (i.e. sign and/or use spoken language)
Accommodation: Sing/Sign the song Pass the Ball to the children
Accommodation: Sing/Sign as the ball is passing around the circle
3. Review Walk and Stop with drum
Accommodation: Sing/sign the song Walk & Stop

Accommodation: Sing/sign the song while moving with drum
a. Children should then be invited to move in a circle as the drum is played. They should
be encouraged to move similarly to the drum (fast: running; slow: walk; loud: stomp,
soft: tip-toe)
b. The teacher will play a steady walking pattern
c. The teacher will vary the tempo of the drum playing (i. e fast and slow).
d. T he teacher will vary the dynamic level of the drum playing (i.e. fast and slow) For this
step the teacher should exaggerate his or her playing motion
e. Children should be given opportunities to be the drum leader. They should all take turns
as the leader of this activity and be invited to vary the manner in which they play
C. Musical Story/Rhythm: Butterflies Everywhere
1. Introduction: Show the children the butterflies and ask them what they are.
2. Give them a chance to feel and examine the butterflies.
3. Reinforce their answers and also the sign for butterfly.
4. Inform the children that they will be reading a short story about butterflies and
that every time the word is mentioned in the story, they should play the egg shakers.
Accommodation: Read/Sign the story Butterflies Everywhere (teachers)

Accommodation: Read/Sign the story Butterflies Everywhere and add the shaker

after the word butterfly (teachers)
Accommodation: Read story, sign, and shakers (teachers and children)
Accommodation: Sing/sign the song “Butterflies Everywhere.” (Sung to the tune

“Mary Had a Little Lamb”)
Butterflies are Everywhere, Everywhere, Everywhere

Butterflies are Everywhere, Everywhere, Everywhere
Flying All Around
D. Closing: Good bye song
Accommodation: Sing/Sign “goodbye” to each child and pause to give each child

a chance to respond to the best of their ability (i.e. a wave, smile, signed goodbye,
spoken goodbye)

Teachers
Reach out to colleagues at the beginning of the school year and periodically thereafter in
order to get an idea of the student’s successes in other areas. Share instructional ideas
and ask for their feedback on your lessons and teaching strategies. Discuss potential
cross-curricular collaborations.
Provide updates to IEP team members particularly if you begin to notice changes in the
student’s speech and language development, behavior, or concept understanding. Keep
that behavior log updated!
Be sure to remind students to monitor their hearing aid, bone-anchored hearing aid,
and cochlear implant devices as needed for listening and instrument-related activities.
Parents
Inform the music teacher of those music activities (i.e., singing, listening, instrument
playing) in which your child shows an interest.
Inform the music teacher of any music-based activities, routines, or materials used at
home that might help promote a better musical experience for your child in school.
REFERENCES
Amidon, P., Davis, A., & Brass, M. C. (Eds.) (2010). Chimes of Dunkirk: Great dances for
children. Vermont: New England Dancing Masters.
Darrow, A. A., & Novak, J. (2007). The effect of vision and hearing loss on listen-
ers’ perception of referential meaning in music. Journal of Music Therapy,
44(1), 57–73.
Johnson, M. S. (2009). Composing music more accessible to the hearing-impaired.
(Unpublished doctoral dissertation). University of North Carolina at
Greensboro).
the choices, controversies, and decisions faced by parents and educators (2nd ed.).
Marschark, M., & Hauser, P. (2011). How deaf children learn: What parents and teachers
need to know. New York, NY: Oxford University Press.
Montgomery, R. (2007). Music teacher on a mission. Disability Now. Retrieved from
http://www.disabilitynow.org.uk
Schraer-Joiner, L., & Prause-Weber, M. (2009). Strategies for working with children
with cochlear implants. Music Educators Journal, 96(1), 48–55.
Sobol, E. (2011). An attitude and approach for teaching music to special learners. Raleigh,
NC: Pentland Press.
Seminal Works
Atkins, W., & Donovan, M. (1984). A workable music education program for the
hearing impaired. The entity from ERIC acquires the content, including
journal, organization, and conference names, or by means of online submis-
sion from the author. Volta Review, 86(1), 41–44.
Birkenshaw-Fleming, L. (1993). Music for all. Teaching music to people with special
needs. Canada: Gordon V. Thompson Music.
Darrow, A. A. (1987). The arts of sign and song. Music Educators Journal, 74(1), 33–35.
Journal, 77(4), 24–27.
Darrow, A. A. (1990b). Beyond mainstreaming: Dealing with diversity. Music
Educators Journal, 76(8), 36–43.
Darrow, A. A. (1993). The role of music in deaf culture: Implications for music educa-
tors. Journal of Research in Music Education, 41(2), 93–110.
Darrow, A. A., & Gfeller, K. (1991). A study of public school music programs main-
streaming hearing impaired students. Journal of Music Therapy, 28, 22–31.
Darrow, A. A., & Heller, G. N. (1985). Early advocates of music education for the
hearing impaired: William Wolcott Turner and David Ely Bartlett. Journal of
Research in Music Education, 33, 269–279.
Erber, N. (1982). Auditory training. Washington, DC: Alexander Graham Bell
Association for the Deaf.
Estabrooks,W., & Birkenshaw-Fleming, L. (1994). Hear & listen! Talk & sing!
Washington, DC: Alexander Graham Bell Association for the Deaf and Hard
of Hearing.
Fahey, J., & Birkenshaw, L. (1972). Bypassing the ear: The perception of music by
feeling and touch. Music Educators Journal, 58(8), 44–49.
Gilbert, J. P., & Asmus, E. P. (1981). Mainstreaming: Music educators’ participation
and professional needs. Journal of Research in Music Education, 29(1), 31–37.
Graham, R. M., & Beer, A. S. (1980). Teaching music to the exceptional child. Englewood
Cliffs, NJ: Prentice Hall, Inc.
Hagedorn, V. S. (1994). Musical thinking and learning characteristics of the deaf child. In
musical connections: Tradition and change. Auckland: International Society for
Music Education.
May, E. (1961). Music for deaf children. Music Educators Journal, 47(3), 39–40, 42.
Moore, T. (2000). Understanding the hearing-impaired child in your class. In. P.
Benton & T. O’Brian (Eds.), Special needs and the beginning teacher (pp. 88–110).
London, UK: Continuum Books.
Prause, M. (2003). Annaeherung an ein musikerleben mit cochlear im-
plant. Schnecke. Zeitschrift der Deutschen Cochlear Implant Gesellschaft,
41(14), 18–19.
VanWeelden, K. (2001). Choral Mainstreaming: Tips for Success: By focusing in ad-
vance on the special needs of students with disabilities, music teachers can
pave the way for their success in the choral ensemble. Music Educators Journal,
88, 55–60.
Walczyk, E. B. (1993). Music instruction and the hearing impaired. Music Educators’
Journal, 80(1), 42–44.
CHAP T ER 4
Making the Case
Involving Children with Hearing Loss in
General Music Lessons and Ensembles
A ccording to Ford (1985), “the capacity to perceive and assimilate

vibrations in ‘music’ resides in the brain, and although hearing loss
may impose certain limitations upon the extent to which musical poten-
tial is realized, it does not negate the presence of innate musicality” (p. 2).
Students who are deaf or hard of hearing are very capable of perceiving
musical sound and are able to respond to and perform music. Because
of prevailing misconceptions about hearing loss, however, questions
arise from teachers and administrators regarding whether music can be
enjoyed, particularly in singing groups or ensembles such as band or or-
chestra. This chapter examines singing, instrument playing, and listening
activities specifically. The chapter also introduces guidelines for instruc-
tional accommodations, including the selection of music and instruments
and home practice. Music teachers, you are encouraged to use the original
lesson ideas included herein or to adapt them as you see fit to better meet
the individual needs of your students.
MUSIC LISTENING LESSONS FOR THE GENERAL

MUSIC CLASSROOM
Listening and oral communication skills are typically acquired from

daily auditory exposure to the sounds associated with speech and lan-
guage. As hearing loss can delay the development of speech and language
( 104 )
M a k i n g t h e C a s e ( 105 )
skills, teaching students who are deaf or hard of hearing to listen and
interpret sounds is crucial because it can help them to understand and
adapt to the world around them (Nocera, 1979). Music offers a medium
through which listening skills can be cultivated (Darrow, 1985, p. 35).
Students who are deaf or hard of hearing will not naturally attend to
sound-related activities; however, music can be a great incentive for au-
ditory training. Socialization is a natural outgrowth of music listening
activities. Discussions resulting from music activity can encourage the
student with hearing loss to share his or her own music listening experi-
ences and preferences with peers, teachers, and parents (Darrow, 1990c).
Music listening activities can also contribute to musical understanding,
enjoyment, and can increase one’s aesthetic sensitivity (Madsen &
Geringer, 2000/2001).
Music is in some ways more aurally accessible than speech (Darrow,
1989). Music can be more intense than conversational speech and it also
employs a greater number of frequencies. For example, conversational
speech typically takes place between 500 to 2000 Hz in comparison to
that of the piano that ranges from 27.5 to 4186 Hz (Darrow, 1990a).
Furthermore, music is comprised of a greater number of notes that are
longer in duration than those of speech sounds. These comparisons help
to clarify how individuals with severe hearing losses are able to experi-
ence music. They also reinforce the importance of evaluating the audio-
gram prior to the development of listening goals for a student who is deaf
or hard of hearing particularly as the student will have greater access to
music if the frequency of the auditory stimuli is within the comfortable
ranges of his or her audiogram (Darrow, 1990a).
Including Students with Varying Degrees of Hearing Loss

in the Listening Lesson
Levels of Auditory Development
Erber’s levels of auditory development is a listening continuum comprised
of detection, discrimination, identification, and comprehension that can
serve as a guide for the development of music listening goals and objec-
tives (Adamek & Darrow, 2010; Schraer-Joiner, 2003; Schraer-Joiner &
Prause-Weber, 2009). Such an approach, with multimodal emphasis, can
lead to the development of music listening lessons that are both accessible
and enjoyable.
Detection, the most basic level of sound perception, is defined as the
awareness of the presence or absence of sound (Erber 1982; Estabrooks,
1994, 1998; Paul & Whitelaw, 2011). Detection serves as the foundation
for subsequent levels of perception. In the context of music, any melody

can be used to introduce the level of detection. Movement can also be a
key component of this activity. For example, the students can perform a
specified movement to indicate when they perceive the music. The move-
ment subsequently stops when the music ends.
Discrimination, the second level of auditory development, is the ability
to determine if two sounds are the same or different (Erber, 1982;
Estabrooks, 1994, 1998; Paul & Whitelaw, 2011). In order to differentiate
between two sounds, the listener must first be aware of the presence of the
two sounds. In order to determine a student’s level of discrimination, the
music teacher can present students with two rhythmic or pitch patterns
from songs used in detection activities. After the patterns are presented,
students should be invited to describe the similarities or differences they
perceived. As students become more comfortable, they should also be
encouraged to create and contribute their own patterns to the exercise.
Kinesthetic reinforcement may include movements to represent the var-
ious rhythmic or pitch patterns presented. For example, broad strokes of
the arm from one side to the other can indicate longer duration and hand
movements in an upward or downward manner can indicate pitch direc-
tion. For a student with profound hearing loss, listening activities should
also emphasize the sense of touch (i.e., proximity to the sound source,
holding objects that transmit vibration).
The next level, identification, requires that the listener identify or
label the sounds perceived (Erber, 1982; Estabrooks, 1994, 1998; Paul
& Whitelaw, 2011). Such a specific task requires the application of both
detection and discrimination skills. Musically, the students can begin
working to identify individual musical elements (i.e., rhythm, pitch)
within the context of a complete melody. For example, teachers might first
encourage their students to listen to the melody and identify the types of
note durations perceived (i.e., long, short) or the shape of the melody (i.e.,
ascending, descending, undulating). As they become more comfortable
with identification activities, students may also be able to identify specific
melodic intervals or rhythms (Schraer-Joiner, 2003). Later lessons can in-
clude the identification or recognition of tempo, dynamics, phrasing, and
melodic contour. Melodies can be those used for previous levels.
The fourth level is comprehension, the highest and most complicated
level of auditory development. Comprehension employs all levels of au-
ditory development, thus enabling the listener to understand the sound
or message (Erber, 1982; Estabrooks, 1994, 1998; Paul & Whitelaw,
2011). Musically, the students can begin to focus on and identify more
than one element in a melody and discuss their understanding of those
M a k i n g t h e C a s e ( 107 )
Table 4.1 ERBER’S LE VEL S OF AUDITORY DE VELOPMEN T WITH MUSIC AL

APPLIC ATION (ERBER, 1982, PP. 92–94; E S TABROOK S, 1994, 1998)
Levels of Auditory Development Application to music
1. Detection The ability to respond to the presence or ab-

sence of rhythmic and melodic (pitch) stimuli.
2. Discrimination The ability to perceive similarities and dif-
ferences between two or more rhythmic and
melodic (pitch) patterns.
3. Identification The ability to acknowledge verbally rhythmic
and melodic (pitch) stimuli within the context
of a listening exercise or melody. Later lessons
can expand to include expressive qualities
of tempo, dynamics, phrasing, and melodic
contour.
4. Comprehension The ability to demonstrate understanding of
the rhythmic and melodic (pitch) elements
perceived in a listening exercise or melody.
Elements can include those from previous
levels such as tempo, dynamics, phrasing, and
melodic contour. Still further expansion can
include the critical analysis of form, texture
and harmony.
Note: Adapted from Erber, N. (1982). Auditory training. Washington, DC: Alexander Graham Bell
Association for the Deaf; Estabrooks, W. (1994). Auditory-verbal therapy for parents and professionals.
Washington, DC: Alexander Graham Bell Association for the Deaf; Estabrooks, W. (1998). Learning to
listen with a cochlear Implant: A model for children. In W. Estabrooks (Ed.), Cochlear implants for kids
(pp. 72–88). Washington, DC: Alexander Graham Bell Association for the Deaf.
elements. In addition to the elements emphasized in previous levels,

comprehension can be further expanded to include the analysis of form,
texture, and harmony. Table 4.1 illustrates Erber’s hierarchy with mu-
sical application.
These levels of auditory development can and should be worked into
lessons involving larger compositions. Prokofiev’s Peter and the Wolf is
one example (Schraer-Joiner & Prause-Weber, 2009). Peter’s theme, per-
formed by the strings, can be used to introduce the level of detection,
though later lessons can center on the other musical themes from the
composition (i.e., wolf, French horns; grandfather, bassoon; hunters, tim-
pani and bass drum). If necessary, the lesson can be modified to include an
instrument or instruments perceivable by the student with hearing loss.
Such modifications can also be introduced during the “musical heads-up”
activity the student receives prior to the lesson. Preparation for listening
lessons involving a multi-movement work such as Peter and the Wolf might
include support materials such as a simplified score of the piece featur-
ing the main melodies or themes, or listening map. A recording featur-
ing a distinguishable melody or theme should also be considered as this
may provide guidance for the child and his or her parents as they listen
at home together. This is an important consideration as the child will feel
more comfortable in class while listening to the original composition if
he or she is able to identify the melody studied previously. Depending on
the lesson, such materials can be sent home one to two weeks prior to
the class. This step, however, should only be undertaken if parents are on
board and willing to participate. Also, preparing materials for home prac-
tice can take some preparation on the part of the music teacher. Therefore,
it is understood that teachers’ schedules and limited planning time may
impact the implementation of such an idea. Teachers are encouraged to
implement this as they are able. Any steps taken on behalf of the student
can enhance his or her overall musical experience.
The various rhythmic and pitch patterns that make up Peter’s theme
can also be used for the level of discrimination. As before, the students
should then determine and discuss the similarities and differences in
the rhythmic or pitch patterns presented and then discuss them. This
will prepare them for the level of identification, during which the
teacher can encourage the students to identify the same rhythmic and
pitch patterns, individually at first, within the context of Peter’s theme.
A more detailed analysis of the theme including the dynamics, articu-
lations, and tempos might follow in preparation for the transition to
the level of comprehension, where elements can be emphasized equally
during listening. The resulting discussion can include how the combined
elements help to portray Peter’s mood, personality, and various activi-
ties. For example, the punctuated rhythmic and melodic lines help to
convey Peter’s happy walk through the woods. Visuals of the characters
and their instruments can reinforce this lesson series. Movements rep-
resenting each character or the instruments that represent them can
also be added as the story is told.
Other skills, such as auditory figure ground, can also be reinforced by
the comprehension activities detailed above. Auditory figure ground is
defined as one’s ability to focus on one sound without being distracted
by surrounding sounds. This can be achieved musically by teaching the
students to concentrate on the entrance or exit of a particular voice or
instrument in a composition (Darrow, 1985). Another example includes
teaching the student to focus on a particular instrument as his or her
peers perform on a variety of instruments (Darrow, 1985).
M a k i n g t h e C a s e ( 109 )
Hierarchy of Auditory Processing

The hierarchy of auditory processing, a ten-level sequence for processing au-
ditory stimuli, created by Derek Sanders (1977), can also provide a founda-
tion for the development of music listening goals and objectives (Adamek
& Darrow, 2010; Darrow, 1989; Hagedorn, 1992; Sposato, 1982). The
foundational level of this hierarchy is the awareness or the absence of sound
energy (Sanders, 1977, p. 201). According to Sanders (1977), this level is
important because it encourages the active participation of the children in
the changing world around them (p. 202). He also states that “until a child
is aware that a sound has occurred, or changed, he will not be motivated
to search for it” (p. 202). Musically, this level is similar to Erber’s level of
detection, and can therefore also involve music activities such as “Walk
and Stop” (Estabrooks & Birkenshaw-Fleming, 1994).
The second level is localization, defined as the association of a sound
stimulus to the object, event, or person from which it was produced. This is
first accomplished with non-speech stimuli. According to Sanders (1977),
the ability to localize sound facilitates one’s ability to attend to spoken
language (p.202). Therefore, the child must then learn to identify vocal
sounds in a similar manner. Musically, localization can be approached in
two ways. One example is to determine the location of the musical sound
source within the classroom. In this instance, the teacher, and eventu-
ally student volunteers, might sing a pitch pattern, sing a simple melody,
or play an instrument from a certain location in the room to see if the
remainder of the class can determine the sound source location. For ex-
ample, in the game “Musical Marco Polo,” the class should first explore the
instruments. Five students should then be selected to play instruments
while the remainder of the class covers their eyes and indicates the instru-
ments they perceived as well as the direction or location of the sound. This
can be done by taking turns or by assigning small groups to play so as to
allow everyone in the class a chance to be “Marco Polo.” The location of the
instrument sounds can and should also be varied. The second approach
requires that the students identify the musical sound source as a choir,
band, or orchestra. Recordings should also include environmental stimuli
such as transportation, farm, town, and nature sounds. Many of the gen-
eral music basal series such as the MacMillan/McGraw-Hill Spotlight on
Music (2011) and the Pearson Silver Burdett Making Music (2008) include
such sounds for use in general music lessons.
Attention, the third level of this hierarchy, is the ability to direct and
sustain focused attention to sound. This level also includes one’s ability
to select certain relevant stimuli from that of background stimuli (i.e.,
auditory figure-ground) as well as the ability to continuously attend to the

desired stimuli over a period of time (Sanders, 1971, p. 10; Sanders, 1977,
p. 203). The ability of a listener to attend to or pay attention to sound stim-
uli should be developed over time, beginning with short examples that
gradually get longer and more complex. The activities that can be intro-
duced at this level include variations on “Walk and Stop,” such as chang-
ing the way the drum is played or adding song lyrics to reflect the type of
movement performed (i.e., tip-toeing, hopping, skipping). Other sugges-
tions include listening for specific instruments within an example or a
specific rhythmic or melodic motif within an example such as the famous
four note motif of Beethoven’s Symphony No. 5.
The fourth level involves the processing or discrimination of auditory stim-
uli as either speech or non-speech sounds. According to Sanders, this is critical
as it depends on a person’s ability to actually process the signal as speech
(Sanders, 1977, p. 206). Discriminating between musical and non-musical
sounds can include many of the ideas presented for the previous levels. For
example, students can compare music recordings featuring vocalists with
those featuring solo musical instruments. Another example is to com-
pare types of ensembles such as a choir versus either a band or orchestra.
Preliminary activities for this level might also include a comparison of
musical and environmental stimuli. The previous activities ready the lis-
tener for the fifth level, auditory discrimination, the ability of the listener
to distinguish between auditory patterns of varying lengths and diffi-
culty. Success at this stage requires the accurate identification of the time,
frequency, and intensity components of sound. This level also includes the
relationships between these elements in a given example as well as attend-
ing to specified elements or patterns while others are forced into the back-
ground (Hagedorn, 1992, p. 14). Musically, auditory discrimination can
include having the listener make comparisons between rhythmic patterns
and steady beat, unison melodies and harmony, individual instruments
(timbre) and large ensembles, including the entrances and exits of specific
instruments. Still other examples might include listening for specific cues
in a music example such as the canon fire in Tchaikovsky’s 1812 Overture
or the temple blocks in Anderson’s “Sleigh Ride.”
Suprasegmental Discrimination comprises level six of Sander’s audi-
tory processing sequence. Suprasegmentals, or the prosodic properties
of speech, refer to the function of speech sounds or more specifically
the many sound segments that combine to make phrases, clauses, and
sentences. These properties convey information pertaining to voice
length, loudness, pitch, and rate of speech patterns to the listener.
Suprasegmental discrimination involves the ability of the listener to
M a k i n g t h e C a s e ( 111 )
detect differences in these properties. The Suprasegmental or prosodic

qualities of music are the expressive qualities of tempo, dynamics, phras-
ing, intonation, and contour. The discrimination of these elements
within a musical context aligns with Suprasegmental Discrimination.
An infinite number of music examples can be used in this capacity. The
very programmatic Peer Gynt by Edvard Grieg serves as one example, as
the fourth movement “In the Hall of the Mountain King” contains many
tempo and dynamic changes throughout. Another example with very ob-
vious dynamic and tempo change is Tchaikovsky’s “Trepak” or “Russian
Dance” from The Nutcracker Suite.
Segmental discrimination, level seven, involves the detection of differ-
ences in individual speech sounds (phonemes). Segmental discrimination
might specifically target the listener’s ability to make discriminations
about pitch and rhythm. Previous examples provided in association
with Erber’s level of discrimination can also be applied here. Hagedorn
(1992) recommends Copland’s Fanfare for the Common Man due to the as-
cending melodic pattern performed by the brass instruments. According
to Hagedorn (1992), these notes will be perceivable by individuals who
are hard of hearing. Another listening example comes from one of my
professional interns. I observed a kindergarten lesson he taught in the
Fall of 2012 focusing on the concept of duration. The lesson featured
Denmark’s “The 7 Jumps Dance,” a sequence of cumulative movements
that are added one by one through the seven verses or figures. Each addi-
tional action supports the concept of duration and varies with each rep-
etition. This dance has additional benefits as it provides support for the
development of listening and socialization skills, gross motor skills, and
body part identification.
Auditory memory, the eighth level of Sander’s hierarchy, involves the
processing, storage, and retrieval of auditory sound patterns. According to
Sanders (1977), chunking, “the process of segmenting or clustering units
into groups,” is vital for the development of auditory memory because it
allows the listener the time necessary to analyze, understand, and inte-
grate information from the acoustic event. From a music context, auditory
memory can be emphasized with musical memory games whereby the goal
is to have the students recall various elements of a piece of music such
as instruments, rhythms, and melodic patterns (Hagedorn, 1992, p. 14).
Music examples such as Peter and the Wolf can be used in this capacity.
Other musical examples might include Benjamin Britton’s Young Person’s
Guide to the Orchestra because the main theme is presented in each instru-
mental family. Musical stories, described in more detail in chapter 5 can
also be used to develop auditory memory.
Level nine, auditory sequential memory, involves recalling the order in

which auditory stimuli or patterns of sound are perceived. The individual
learns to listen for the arrangement of sounds as well as the temporal and
spatial relationships of patterns (Hagedorn, 1992, p. 14). A musical ap-
proach to auditory sequential memory might then entail having the stu-
dents recall the order in which certain instruments were heard in a music
example (Shank, 2003, p. 6). Britton’s Young Person’s Guide to the Orchestra
may also be used in this instance by having the students recall the order
in which the theme was presented by each instrument.
The tenth level of Sanders’ hierarchy is auditory synthesis. Auditory data
is merged so that the listener transitions from processing small fragments
of sound to chunks, and then finally begins to identify the various patterns
that occur in sound stimuli. From a musical standpoint, auditory synthesis
might involve a critical analysis of the form, texture, and harmony of a music
example (Shank, 2003. p. 6). The listening recommendations made for Peter
in the Wolf, as applied to Erber’s level of comprehension, can also be applied
to auditory synthesis. Another example involves the comparison of texture
and mood in Rossini’s William Tell Overture. After listening to the overture’s
“Prelude” (Dawn), a slow passage with few string instruments, and to the
“Finale” (March of the Swiss Soldiers) that opens energetically with the
trumpets playing a cavalry like galloping melody, the class can use a Venn di-
agram to illustrate the similarities and differences between the two sections.
Sposato (1982) suggests the use of Sander’s hierarchy to maximize the
residual hearing of children who are deaf and hard of hearing as this can
enhance their music listening. Table 4.2 illustrates Sander’s hierarchy of au-
ditory processing with music application. Estabrooks (1998) cautions that
a hierarchy of listening skills and speech language development will only
accommodate the individual child if adaptations are based on specific needs
(p. 80). Ford (1985) also states that the success of any music lesson involving
children who are deaf or hard of hearing demands the music teacher’s aware-
ness of the manner in which the individual child receives and processes
musical sound. Therefore, audiologists, teachers, and parents should be in-
volved in the habilitation process by aiding in the adaptation of such mate-
rials that can promote and support short- and long-term listening goals.
Specific Considerations for the Student with

a Cochlear Implant
When planning music listening lessons, music teachers always need to con-
sider those hearing devices used by the student(s) as well as their experience
M a k i n g t h e C a s e ( 113 )
Table 4.2 SANDER S’ HIER ARCHY OF AUDITORY PROCE SSING WITH

MUSIC AL APPLIC ATION (HAGEDORN, 1992, PP. 14 –15; SANDER S, 1977,
PP. 200 –213; SHANK , 2003, P. 6)
Hierarchy of Auditory Processing Music Application
1. Awareness The listener is aware of the presence or absence

of sound.
2. Localization The listener can determine the location of the
musical sound source within the classroom.
The listener can identify the musical source as
a choir, band, or orchestra.
3. Attention The listener can attend to music stimuli over a
period of time.
4. Discrimination The listener can discriminate between musical
and non-musical sounds.
5. Auditory discrimination The listener can discriminate between dif-
ferent musical patterns (i.e., rhythmic pat-
terns and steady beat; unison melodies and
harmony; individual instruments (timbre) and
large ensembles).
6. Suprasegmental Discrimination The listener can recognize the expressive
qualities of tempo, dynamics, phrasing, into-
nation, and melodic contour within a musical
context.
7. Segmental Discrimination The listener can make discriminations about
pitch and rhythm.
8. Auditory Memory The listener can recall various elements
from a piece of music (i.e., rhythms, pitches,
instruments).
9. Auditory Sequential Memory The listener can recall the order in which
instruments were heard in a musical example.
10. Auditory Synthesis The listener can critically analyze a musical
example for form, texture, and harmony.
Hagedorn, V. S. (1992). Musical learning for hearing impaired children. Research Perspectives in Music
Education, 3, 13–17.
Shank, J. S. (2003). The effect of visual art on music listening. (Doctoral dissertation, University of
Kentucky). Retrieved from http://hdl.handle.net/10225/443.
Note: Sanders, D. A. (1977). Auditory perception of speech: An introduction to principles and problems.
Englewood Cliffs, NJ: Prentice Hall.
level with the device. Students with mild to severe hearing loss, for example,
can listen to recorded activities or even live performances as long as any
hearing devices are adjusted to an appropriate level of loudness. While this
may impact the softer sounds perceived, it will, in the long run, protect the
student from having a loud and therefore painful listening experience.
Still other considerations should be made on behalf of the student

with a cochlear implant. Considering the inclusive general music class-
room, listening lessons are going to feature many compositions, some of
which may or may not feature lyrics, and all with a variety of instruments.
Compositions for large ensembles such as orchestras or bands may be
more difficult for the student to perceive, as such pieces extend beyond
the receptive capacity of modern cochlear implant systems because the
activated electrodes, located along the electrode array inserted into the
cochlea, are related to a specific frequency field. When too many frequen-
cies are produced by one electrode, sound clusters result making the per-
ception of music with the implant difficult. Ultimately, music consisting
of single instruments or chamber music may provide optimum listening
opportunities for the student with a cochlear implant.
When a listening lesson or activity emphasizes a larger composition,
the music teacher should consider giving the cochlear implanted student
a “musical heads-up,” as this can help to prepare the student for the lis-
tening lesson ahead of time. For example, if the focus of an upcoming class
is to learn two new songs for the purposes of teaching melodic contour,
materials might include song lyrics, recordings, as well as an informative
handout that provides an overview of the concepts being taught.
The cochlear implanted student should also be reminded that it may be
necessary for them to adjust the volume control during the lesson. A quiet
reminder at the beginning of class should be sufficient. Such a preventa-
tive measure can ensure the student’s comfort level during the activity
(Schraer-Joiner & Prause-Weber, 2009).
THE INSTRUMENTAL MUSIC PROGRAM
Motivation is a key ingredient for success. Allowing students who are deaf
or hard of hearing to select the instrument they wish to study could be an
important factor in their overall instrumental music experience (Robbins
& Robbins, 1980). Therefore, the ultimate guide for the music teacher or
parent is the student, who should have the opportunity to express his or
her interests, specifically regarding the instrument or instruments that
are the most comfortable and musically satisfying.
Hash (2003) states “considering an ‘average’ profound hearing loss,
the motivated student is capable of learning to play an instrument to at
least an intermediate level” (Instrument Selection, 2003, para. 5). Some
instruments will be easier for the student who is deaf or hard of hearing
to learn but under the right conditions nearly all are audible over most of
M a k i n g t h e C a s e ( 115 )
their ranges (Hash, 2003). Hash is supported by other researchers who

reveal that people who are deaf or hard of hearing are still able to discrim-
inate musical instrument timbres, though somewhat less effectively than
hearing people (Fitz, Burk, & McKinney, 2009). The suggestions included
herein are provided to help music teachers facilitate positive instrumental
music experiences for their students.
Woodwind and Keyboard Instruments
Generally, instruments with fixed pitches, such as the clarinet, saxophone,

flute, piano, and organ, are recommended for students who are deaf or hard of
hearing. These instruments have the most exact fingering systems and large
frequency ranges. They also produce strong vibrations. For example, wood-
wind instruments produce vibrations that can be felt on the lips, and the pia-
no’s soundboard produces strong vibrations that can be felt by those located in
close proximity to or touching the instrument (Anonymous, 1955; Edwards,
1974). The piano has been featured in the program Feel the Music, a partner-
ship between UK’s charity group Music and the Deaf, the Mahler Chamber
Orchestra (MCO), and Norwegian pianist Leif Ove Andsnes (Connolly, 2012,
para. 5). This project, geared towards “opening up the world of music” to chil-
dren who are deaf or hard of hearing, is an outgrowth of the MCO’s concert
series, Beethoven’s Journey, examining his deafness and the impact it had on
his piano playing and music writing (Connolly, 2012, para. 6).
Percussion Instruments
Percussion instruments, particularly the bass drum, are great producers

of vibration and can therefore provide a very tactile experience for a stu-
dent who is deaf or hard of hearing (McCord & Fitzgerald, 2006). Placing
the left hand on the drum head while leaning against it, for example,
allows the student to feel the vibrations produced. Further reinforcement
includes having the student stand on a wooden or tiled floor, when pos-
sible, with no shoes. Such techniques are supported by Hash (2003) who
suggests that students with hearing loss should learn to feel the musical
pulse through sympathetic vibrations such as those Hash (2003) describes
in the following approach (Instrument Selection, 2003, para. 4):
1. The teacher should first play steady beats on a low-pitched drum as the
student touches the instrument.
2. The student should then attempt to count the number of beats felt out
loud or indicate the pulse using the other hand.
3. After counting and subsequently demonstrating the pulse, the exercise
should then be repeated. In this instance, the student should attempt
to feel vibrations indirectly through the table, a music stand, or the
floor where the drum is placed.
4. The student should then attempt to sense vibrations while in close
proximity to the drum.
For those students with severe to profound hearing loss who may have
difficulty with the objectives outlined in the above approach, full contact
with the instrument is recommended. This can be achieved by having stu-
dents wrap their legs around the drum. Bongo or conga drums are perfect
for such an alternative approach due to size and girth. Leaning against
bass drums, as mentioned earlier, can also aid the student in better per-
ceiving vibrations (Birkenshaw-Fleming, 1993; Hash, 2003; Jahns, 2001;
Zinar, 1987). In instances where the student is still having difficulty
sensing sympathetic vibration, instrument selection should include one
that is capable of producing sustaining rather than percussive sounds as
these may be easier to perceive via residual hearing (Birkenshaw-Fleming,
1993; Darrow, 1989; Hash, 2003).
Brass Instruments
Though history has proven otherwise, it is generally thought that

brass instruments may be difficult for the student who is deaf or hard
of hearing to play. This assumption is due to the pitch discrimination
required to discern the partials of these instruments. Specifically, sev-
eral notes can be produced by any number of valve combinations on the
trumpet or position of the slide of the trombone. By pressing the first
valve on the trumpet, for example, one may produce a low B-flat, first
space F in treble clef, or third line B-flat. Therefore, while many brass
instruments may be learned, they may not the not be the best fit for a stu-
dent with severe or profound loss (Hash, 2003; Robbins & Robbins, 1980).
However, reports exist of students learning brass instruments by being
taught to discern the various notes by feel or vibration. This approach,
coupled with instruction on breath support, speed of air for note pro-
duction, and embouchure firmness, can help to support students’ playing
interests (Birkenshaw-Fleming, 1993; McCord & Fitzgerald, 2006). If the
student is involved in a group lesson, skills and concepts can be further
M a k i n g t h e C a s e ( 117 )
reinforced with visual cues as well as the use of assistive listening devices
such as an FM system or loop system.
String Instruments
As with the brass family, string instruments also require a good relative
sense of pitch, due to the precise positioning of the fingers on the strings
required for proper intonation. String players are always required to listen
and adjust their finger placement over the fingerboard in order to address
any intonation issues that may arise. Such exactness and attention to fine
tuning, often difficult for hearing students, will be especially challenging
for the student who is deaf or hard of hearing. However, harp and guitar
may be more viable options because the playing position required for both
brings the instruments close to the ear or head. Additionally, both provide
opportunities for tactile reinforcement via vibration due to the position
of the instruments across the body. When played, these instruments pro-
duce vibrations that can be felt in the chest cavity (Edwards, 1974).
In June 2011, I had the opportunity to attend a performance of the ded-
icated musicians of the Association of Adult Musicians with Hearing Loss
(AAMHL), a group comprised of pianists, guitarists, vocalists, and violists
of varying musical backgrounds. Their performance was both inspiring
and educational, confirming the possibilities of musical enjoyment and
creativity for students of all ages with hearing loss. More importantly,
their performance affirmed that there are always exceptions and that
teachers should consider the interests and motivation of the individual
student before giving in to society’s perceptions of hearing loss.
Including Students with Varying Degrees of Hearing

Loss in the Instrumental Music Program
So, what should music teachers do if they have a student interested in

playing a brass or string instrument? Simply put, they should GO FOR IT!
Remember that the student’s motivation to learn a particular instrument
should serve as the primary guide in the selection process. This can, in the
long run, provide the student with the incentive needed when challenged
or frustrated.
The student who is deaf or hard of hearing should receive instruction
similar to that of his or her hearing peers: all children should have access
to good teachers, receive consistent feedback, and have opportunities for
guided practice, and creative expression (Darrow, 1985; Johnson, 2009;

McPherson & Davidson, 2002; Robbins & Robbins, 1980). Furthermore,
they should be introduced to literature representing a variety of cul-
tures and genres (Darrow & Gfeller, 1991; Darrow & Schunk, 1996;
Shehan-Campbell & Scott-Kassner, 2009; Sheldon, 1997). Careful atten-
tion to literature allows for the exploration of a variety of music concepts
and can also serve to motivate the students. Secondary considerations for
the parent and teacher include the degree and type of hearing loss as well
as the age of onset. With regard to music perception and success with var-
ious music activities, the general music teacher should, having likely had
the student in previous classes, be able to report on his or her strengths,
weaknesses, and interests. Still other considerations are those that in-
strumental music teachers typically make during the recruitment process,
such as the student’s physical characteristics and natural aptitude for an
instrument. For example, is the student physically capable of holding the
instrument? Can the student produce a tone demonstrating a good be-
ginner aperture and embouchure?
Music teachers should consider the following when preparing the in-
strumental classroom for a student with hearing loss:
1. Seat the student in the center of the first or second row in close prox-
imity to instruction. As previously mentioned, this is most beneficial
for those students who speech read. The optimal distance for this is
approximately six feet (Hash, 2003).
2. Position the student who uses devices such as hearing aids or cochlear
implants so that he or she faces the group if ensemble setup requires that
the student be seated at the end of the row (Darrow & Schunk, 1996).
3. Assign a hearing student as a band buddy if the student plays an in-
strument traditionally placed in the back of the ensemble (Hash, 2003;
Zinar, 1987).
4. Focus on small homogeneous instrument groupings. Such groupings
are the best teaching setting for the student who is deaf or hard of
hearing (Robbins & Robbins, 1980). In such settings, arrange the
class in a circle or semicircle, which you will recall is important so
that the child with hearing loss can see everyone’s face (Darrow &
Schunk, 1996).
5. Monitor hearing aid equipment as very loud sounds can be painful to
those students who use such devices. The student will probably be sen-
sitive to such sound levels and as a result will know to adjust his or her
device when participating in group lessons or rehearsals. A gentle re-
minder may only be necessary, at first.
M a k i n g t h e C a s e ( 119 )
6. Seek the input of a qualified audiologist so as to ascertain the optimal

setting when hearing aids are used within the rehearsal setting (Hash,
2003; Zinar, 1987).
From an instructional standpoint, consistent reinforcement of all foun-

dational playing concepts such as hand position, posture, fingerings, em-
bouchure, and aperture via modeling is vital for all students (McPherson
& Davidson, 2002). For the student who is deaf or hard of hearing, visual
reinforcement of these concepts is particularly important. Additional sup-
ports might include placing page numbers and lesson procedures on the
board, class television monitor, or PowerPoint presentation during group
lessons. Rhythms, key concepts, and new fingerings should also be rein-
forced visually. Of the utmost importance is the visual reinforcement of
all concepts presented verbally. During instrumental group lessons and
ensemble rehearsals, seating the student near his or her peers can pro-
vide the necessary visual reinforcement of music concepts and playing
techniques (Atterbury, 1990; Folts, 1977; McCord & Fitzgerald, 2006;
Probasco, 1991; VanWeelden, 2001). As mentioned previously, buddy sys-
tems can also be implemented for this purpose. Hearing aids and assistive
listening devices, a topic developed more fully in chapter 6 should also be
worn and monitored for student’s comfort level so that instruction is con-
sistently reinforced.
Folts (1977) has suggested the following instructional approaches for
students with varying degrees of hearing loss who are in the instrumental
music setting:
1. Modeling the correct fingerings on woodwind instruments for visual

reinforcement.
2. Teaching brass players, particularly trumpet players, to differentiate
those notes that share the same valve combinations by holding the bell
of the trumpet and also by the feel of the vibrations produced.
3. Using physical movement to indicate pitch duration and direction.
Parents and even instrumental music teachers will find themselves very
involved in the child’s practice time, especially at the beginning in order to
help promote good practice habits for fundamental playing skill develop-
ment. As mentioned in the preface, my friend K’s initial success was due
in part to the dedication of her fifth grade band teacher who taught her
privately the summer before she was to begin participating in her school’s
instrumental music program. Such support can make a huge difference in
the experience of a student who is deaf or hard of hearing.
Involving Parents in Instrumental Practice
Instrumental music teachers may find that parents want to be involved in

the practice routine but have a limited musical background. Introducing
the student and his or her parents to a simple practice routine that can be
followed at home may provide the student with hearing loss with a founda-
tion for success. Initially, the instrumental music teacher should introduce
materials during the lesson or rehearsal to provide a musical foundation
and context. To begin, the teacher may implement a whole-part-whole ap-
proach beginning with a general overview of the song including its his-
torical background, significance, and relationships with other concepts
the students might be learning. Similarities or differences from previous
songs studied, such as fingerings, pitch, and rhythm patterns, should
also be addressed. An introduction of new notes, including their position
on the staff, fingerings, what the embouchure looks like, as well as what
the note both sounds and feels like, should be reinforced with modeling.
“Feeling” the note or the vibrations produced when the note is played can
be introduced by having the teacher play the note as the student touches
the instrument, the head joint or mouthpiece in particular. The student
could also touch the teacher’s cheeks. A concluding activity might entail
putting together all of the music components that were studied individu-
ally during the lesson or rehearsal.
When introducing individual lesson songs or exercises from the lesson
book, teachers might consider the following approach as a way to help
the student transfer the information presented at school to practice at
home. This approach is based upon an approach by Phyllis Weikart (1982,
pp. 17–19, 24–27).The first step requires that the teacher and student(s)
read the rhythms of the exercise using a counting system such as Ta,
Ti-Ti, Ti-Ri-Ti-Ri (Kodaly); Du, Du-de, Du-Ta-De-Ta (Gordon); or a mne-
monic approach using familiar words such as Pear, Ap-ple, Boy-sen-ber-ry
(Shehan-Campbell & Scott-Kassner, 2009, p. 179). Teachers might want to
consider reading and clapping the rhythms. In this instance, the teacher
(T) should first speak the rhythms. This should be followed by the teacher
and student (TS) speaking the rhythms together, and finally the student
alone (S). This may need to be repeated several times to ensure that the
student is comfortable and accurate with the rhythm patterns. This step
is particularly important for students with moderate to profound hearing
losses who greatly depend on the rhythmic features of the example. The
next step involves saying the pitch names in rhythm. The pitch names re-
place the counting system from the previous step and should then be fol-
lowed by the modeling approach (T, TS, S) detailed above. This step should
M a k i n g t h e C a s e ( 121 )
also be repeated as necessary. Fingering the pitch names on the instru-

ment while saying them in rhythm throughout each step of the modeling
approach (T, TS, S) follows. The next step also involves practicing the fin-
gerings, although they are not spoken aloud. Instead, the student is to
“think them” throughout each step of the modeling approach (T, TS, S) so
as to internalize the process. Students with moderate to profound hearing
loss will depend upon visual cues during this step, in particular. Therefore,
they should be encouraged to watch their teacher and other students for
cues within the lesson setting during this process. The final step of this
process involves playing the example. Table 4.3 provides a summary of the
practice approach outlined above.
Initial study of an instrument is demanding for any student and
requires the consistent reinforcement of concepts by the teacher, as well
as home practice. The steps outlined above may be modified for the in-
dividual student, taking into consideration fatigue, hearing stress, and
progress. The recommendations for practice can be further enhanced by
video-recordings of both the band lesson in school and of the practice ses-
sions at home. According to Nocera (1979), this can serve as a guide for
parents. Videos taken of the student’s home practice can provide both the
Table 4.3 APPROACH FOR HOME PR AC TICE
Step Description Instructional Notes
Step 1a. Say Read rhythms of the exercise using your Important for students
counting system (i.e., Ta, Ti-Ti, Ti-Ri- with moderate to profound
Ti-Ri (Kodaly); Du, Du-de, Du-Ta-De-Ta hearing losses who will
(Gordon; Word Chant: Pear, Ap-ple, greatly depend upon the
Boy-sen-ber-ry (Shehan-Campbell & rhythmic features of the
Scott Kassner, 2009). example.
Step 1b. Say Say the pitch names in rhythm.
Step 2. Say-Do Finger the pitch names on the Children with moderate to
instrument in rhythm while saying profound hearing loss will
the pitch names in rhythm. depend upon visual cues—
they will most likely watch
other students for cues
within the ensemble setting.
Step 3. Think-Do Think through the example while
fingering the pitch names on the
instrument.
Step 4. Do Play the example!
Note: Adapted from Weikart, P. (1982). Teaching movement and dance: A sequential approach to rhythmic
movement. Ypsilanti, MI: The High Scope Press.
student and teacher with opportunities for further discussion and review
during the lesson. Such approaches can be helpful for students with vary-
ing degrees of hearing loss. As with the practice routine, this may seem to
be a rather demanding approach; however, it is really most crucial during
initial study. Once the student is comfortable with a practice routine and
fundamental playing skills are consistent, the process may not be neces-
sary every week. Furthermore, current technology can make this rather
easy to do, provided that parents and teachers are on board and appro-
priate permissions have been given by school administrators.
Another suggestion, particularly for students with mild to moderate
hearing loss is the SmartMusic interactive software. SmartMusic can be
beneficial particularly if the student is playing in a middle or high school
level ensemble (SmartMusic, 2013). This program enables the music
teacher to create and send assignments to the student that he or she can
complete at home. Students progress can be tracked with recordings col-
lected via the program and presented at IEP or related meetings.
Instruments in the General Music Setting
Band and orchestral instruments can be added to the collection of general

music resources. In addition to using a variety of pitched and unpitched
instruments in the general music classroom, involving band and or-
chestra students in the instructional process can be both reinforcing and
refreshing. In this instance, young instrumentalists can demonstrate
sounds that are low (i.e., double bass, tuba, bassoon), in the middle (i.e.,
cello, French horn, saxophone), and high (i.e., violin, trumpet, flute) as
part of the lesson. During these demonstrations, students who are deaf
or hard of hearing can take turns placing their hands on the instrument
in order to feel the vibrations produced. All instrument families can be
studied in this way. In fact, this would also serve as a great conclusion for
the Peter and the Wolf listening lesson. An extension for this lesson might
also include making replicas of the instruments. Those constructions that
are also playable will yield the greatest pleasure (May, 1961, p. 40).
Specific Considerations for the Child with

a Cochlear Implant
The teacher should make careful considerations when assigning instru-

ment parts for a general music activity. Instruments with clear, short
M a k i n g t h e C a s e ( 123 )
sounds, such as the xylophone, may be easier for the cochlear implanted
child to perceive as opposed to those instruments such as the gong and
metallophone that have broader frequency fields (i.e., those that include
many harmonics). In these instances, the music teacher may want to con-
sider assigning the child to another part such as the xylophone, drum,
rattle, or jingle bells.
THE CHORAL MUSIC PROGRAM
Singing activities are strongly recommended for students who are

deaf or hard of hearing. Although many of the sounds produced may
not be musical sounding, time will be well spent as singing can aid in
the development of breath control, vocal intonation, as well as speech
and language skills. Singing can also reinforce curricular connections
(Birkenshaw-Fleming, 1993).
Darrow and Starmer (1986) examined the effect of vocal training on the
fundamental frequency, frequency range, and speech rate of children who
were deaf. Comparisons were made of the children’s speech performance
before and after receiving eight weeks of vocal music instruction. The
researchers found that vocal training coupled with singing songs in lower
keys helped to modify the fundamental frequency and frequency range of
the children’s voices. This is important because individuals with hearing
loss have difficulty with speech intelligibility. Darrow and Starmer (1986)
concluded that vocal music training should be a part of the education of
children who are deaf or hard of hearing for its benefits to speech and lan-
guage development and training.
Music teachers should consider the following when preparing to in-
troduce singing activities to students who are deaf or hard of hearing.
Students with mild to severe hearing losses should be taught to make
high sounds with their voice as early as possible. Such activities are cru-
cial because if this skill is not developed, the student may not learn the
difference between high and low voice sounds thus impacting his or her
ability to progress to higher registers. The development of this skill can
be reinforced by having the child place his or her fingers on the teach-
er’s throat as the teacher produces high and low sounds. Pitch matching
can later be promoted via bass tone bars or the lower keys on the piano
keyboard as these instruments produce vibrations that can be easily felt
(Birkenshaw-Fleming, 1993). Song ranges should also be considered when
planning singing activities. In general, lower pitches are closer to the stu-
dent’s natural pitch range and may be easier for the student to perceive and
therefore understand. Lower pitches are also best amplified by hearing

aid devices (Zinar, 1987). For this reason, recordings emphasizing either
men’s or women’s voices are optimal because songs sung in lower registers
will be easier for the child with hearing loss to perceive (Darrow, 1987;
Shehan-Campbell & Scott-Kassner, 2009; Sobol, 2001).
Both Darrow (1985) and Birkenshaw-Fleming (1993) caution that
some songs include words that are not set in the child’s natural speaking
rhythm. Therefore, selecting song materials that reflect the natural
pitches and rhythms of speech are particularly helpful for students with
moderate to severe losses. Imitative songs are also strongly recommended
as they can help promote pitch matching. Additionally, songs that are im-
itative in nature and simple in structure can improve auditory memory,
which can be further enhanced by encouraging the student to recall the
words or instruments heard in a song (Darrow, 1985). Songs should also
include those encountered every day, such as patriotic songs, celebratory
songs such as “Happy Birthday,” or holiday music in order to promote fa-
miliarity and functionality for students with mild to severe losses. The
teacher can set aside time during each lesson to define and explain song
words that the students may not understand. Though this will be benefi-
cial to everyone in the class, it can be particularly helpful for those stu-
dents with moderate hearing losses who have a limited vocabulary and
experience difficulty with language use and comprehension (Adamek &
Darrow, 2010, p. 243). Students with severe hearing loss who have im-
paired speech and language skills can also benefit from such approaches.
Word similarities can also pose problems for students with mod-
erate to severe hearing losses, and require the teacher to carefully dif-
ferentiate and isolate those words when introducing them in a song
(Birkenshaw-Fleming, 1993; Darrow, 1985). Examples of such word simi-
larities include: fried eggs and Friday; man, pan, and ban; ice and eyes.
All activities require additional practice and reinforcement. Therefore,
teachers are strongly encouraged to send materials home so that the stu-
dent can practice them with siblings or parents.
Including Students with Varying Degrees of Hearing

Loss in the Singing Lesson
Whether in a general music or choral setting, similar approaches may

be used when introducing song literature to students with hearing loss.
As mentioned in the previous section, the first consideration should al-
ways be given to the singing materials selected (Adamek & Darrow, 2010;
M a k i n g t h e C a s e ( 125 )
Birkenshaw-Fleming, 1993; Zinar, 1987). When introducing song liter-

ature, the choral music teacher should also employ a whole-part-whole
approach beginning with a general overview of the song including its his-
torical background, significance, and relationships with other concepts
the students might be learning. The teacher should also address similari-
ties or differences from previous songs studied. He or she will want to
introduce the rhythms of the piece, followed by the words, and then the
pitches because students with hearing loss will be more responsive ini-
tially to the rhythmic elements of the piece. A concluding activity might
entail putting together all of the music components that were studied in-
dividually during the rehearsal.
While songs both repetitive in nature and with a limited range are best,
most choral music is varied. As a result, the choral music teacher may
begin by introducing small sections of a new composition to the whole
group via SMART Board or PowerPoint. Such an approach ensures that
the ensemble stays together. Body rhythms can help to reinforce rhythmic
study while changes in pitch or pitch direction can be reinforced with
movement. Illustrating new words found in song lyrics with pictures or
actions to reinforce or promote understanding can also be helpful for eve-
ryone in the ensemble during the initial study of a piece. After the whole
composition has been introduced in this manner, students can have their
own music.
Other supports for the choir rehearsal include using a simplified accom-
paniment initially for students with more severe hearing losses until they
are familiar with the music. The reason for this is the more sound with
which they must compete the harder it will be for them to learn the music.
Also, for the purposes of speech reading, consider positioning children
with moderate to profound hearing losses in front of the group during the
rehearsal. Another suggestion is to have the student place his or her hands
on the piano in order to feel the vibration of the different pitches. For
the purposes of speech reading, pitch discrimination, and ear training,
the teacher might consider positioning the student with moderate to pro-
found hearing loss closer to stronger singers. While the musical experi-
ence is of great importance, the social benefits of being in an ensemble are
even greater.
An Approach for Teaching Pitch
Let’s take a closer look at an approach for introducing pitch. The process
outlined below would most likely occur in practice sessions outside of the
regular rehearsal as part of sectional work or even individual or small

group lessons. These sessions, though time-consuming, ensure the stu-
dent’s comfort in the larger ensemble.
When helping students with moderate to profound losses develop their
singing voice or even just a pitch sense, the teacher should introduce pitches
individually, at first progressing to whole measures and then groups of
measures. As previously mentioned, an effective procedure for introducing
pitch is to first sing a pitch, such as middle C, while allowing the student
to feel the music teacher’s face. An alternative to this part of the activity
would be to have the student and teacher touch, but only if they are com-
fortable (Zinar, 1987). The next step would be to have the student place his
or her fingers on the teacher’s neck or throat. Then, encourage the student
to reproduce the pitch. This process should continue with the introduction
of C above middle C (Zinar, 1987). Such an approach allows the child to feel
the rise and fall of pitch as vibration. Over time, the choral music teacher
can vary the pitches and if associated with the learning of a choral piece,
gradually move to larger segments of the work. Adding sections will de-
pend on the comfort level of the student. However, even if the child learns
just the chorus of the song, I would still have them perform!
Specific Considerations for the Child with

a Cochlear Implant
Children with the cochlear implants not only participate in both group and
individual vocal activities including classroom singing and choir but they
also enjoy these experiences (Gfeller, Witt, Spencer, Stordahl, & Tomblin,
2000c; Prause, 2003; Vongpaisal, Trehub, Schellenberg, & Papsin, 2004).
Pitch perception for the cochlear implant user depends on the placement of
the electrode carrier, which differs slightly for each individual. As a result,
the tone perceived by the cochlear implant user differs from that of the ac-
tual tone. Cochlear implanted children can also successfully recognize fa-
miliar songs when words of the songs are provided; however, research has
revealed that they show little recognition when words are not provided
(i.e., piano accompaniment only) (Vongpaisal et al., 2004). 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 ac-
tivity can be both pleasurable and educational for children with cochlear
implants as well as for their typical hearing peers (Darrow, 1987).
Although the implanted child might not match pitch perfectly, sing-
ing activities should be a part of the music curriculum. Providing singing
M a k i n g t h e C a s e ( 127 )
opportunities can aid in refining children’s pitch discrimination skills

as well as their ability to recognize and produce vowels. This has been
substantiated by several research studies. For example, Nakata, Trehub,
Mitani, & Kanda (2006) found that the cochlear implanted children were
able to sing familiar songs from memory even though their vocal pitch
patterns were unrelated to the pitch pattern direction found in the target
songs. Xu et al. (2009), who sought to expand on that work of Nakata et al.
(2006), found that some of the cochlear implanted children were able to
develop certain forms of vocal singing (i.e., songs ranging from ten to
eighty notes in length) though their performance was significantly poorer
than the children with normal hearing on almost all pitch-based assess-
ments of singing. Such findings, coupled with the limited frequency range
of the cochlear implant, suggest that the music educator needs to con-
sider carefully the cochlear implanted child when planning singing activi-
ties. The musical audiogram, in conjunction with information pertaining
to the child’s cochlear implant mapping, can be particularly helpful in
this instance. Some recommendations for the music teacher include pro-
viding the cochlear implanted child with a “musical heads up” consisting
of both a song recording and printed music before 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.
Successful Choral Examples
The examples herein represent two very successful approaches to in-

cluding students who are deaf or hard of hearing into the choral music set-
ting. The first is the Total Communication Choir (Saginaw Public Schools,
MI), that combined the efforts of both the Music and Speech and Hearing
Departments. Implemented in November 1977, the choir, according to
director Ruth Ann Knapp (1980), embodied the school’s philosophy for
educating students with hearing loss through Total Communication.
According to Knapp, the choir combined the efforts of children with
hearing loss and their hearing peers. To begin the process, signs were first
formed and their meaning discussed. The students were then given the
opportunity to practice the signs in the correct rhythm and tempo. Knapp
suggested that left-handed signers be placed on either end of the choir
depending on section assignment so as to prevent them from bumping
into one another. This also ensured that the group looked more unified.
The students all spoke the songs in phrases, with emphasis placed on cor-
rect signs, rhythm, and tempo. The hearing students then sang the song
through while the music teacher played the piano, keeping the accompani-
ment simple to avoid confusion. The teachers of the deaf then signed and
sang the songs, allowing all of the students to see and hear the song in
its entirety. Afterward, the students sang individual phrases or sections,
depending on length, for further reinforcement. The ensemble was con-
stantly reminded to sign what they were singing and not to sign ahead of
their singing.
To provide individual attention as well as to ensure that all signs were
accurate, a music teacher and two teachers of the deaf also provided re-
inforcement for the hearing students who were learning sign language.
During rehearsals, everyone was provided with the music, including both
song lyrics and sign language. According to Knapp (1980), song tempos
often dictated the use and arrangement of signs, particularly as some
signs had two or more motions that needed to fit within the musical time-
frame. As a result, prepositions, articles, tenses, and plurals were most
often removed but circled in the student copies to alert them of the omis-
sion. During concerts, all members of the choir performed by both sing-
ing and signing. Additional signing was also provided for the benefit of
audience members who were deaf or hard of hearing. According to Knapp,
the benefits of The Total Communication Choir were many. Most notice-
able was the improved communication between students who were deaf
and hard of hearing and their hearing peers. Teachers interested in pro-
viding similar opportunities for their students can find many available
resources. Several examples are included in Table 4.4.
A more recent example is that of the White Hands Choir, which launched
in 1995 as part of Venezuela’s El Sistema, the National System of Youth
and Children’s Orchestras. El Sistema is known internationally for its
great efforts in providing children from disadvantaged backgrounds with
musical opportunity. The White Hands Choir, founded by teacher Johnny
Gomez, combines the efforts of both hearing children who sing and chil-
dren with hearing loss who contribute via sign language. Choir members
also include children with various exceptionalities such as visual impair-
ments, developmental delays, cognitive or intellectual impairments,
and autism. This program, which now involves well over 1800 children
throughout Venezuela, including approximately 500 with hearing loss,
has become an international model and considered the banner program
for El Sistema. Members of the program rehearse in the conservatory
along with their hearing peers and many of the teachers for the program
have noted improvements in the self-esteem of all the children involved.
M a k i n g t h e C a s e ( 129 )
Table 4.4 SONGS IN SIGN L ANGUAGE RE SOURCE S
Source Description
Gadling, D. C., Pokorny, D. H., & Riekehof, Illustrated sign language translations of songs
L. L. (1976). Lift up your hands: Inspirational including God Bless America, Let There Be Peace
and patriotic songs in the language of signs on Earth, America the Beautiful, and This Land
Washington, DC: The National Grange. is Your Land.
Jacobson, J. (2004). Sign language for This resource features a book with companion
singers. Indianapolis, IN: Hal Leonard DVD in which ten songs and over 160 signs
Corporation are featured. Gestures are alphabetized and
accompanied by definitions and demonstration
photos. The DVD features John Jacobson who
demonstrates each gesture. Songs include “We
Remember, Child of the World,” “Like a Mighty
Stream,” “Silent Night,” “Kumbaya, and America
the Beautiful.”
Collins, S. H., Kifer, K., & Solar, S. (1995). Six songs in Signed English are featured with
Songs in Sign (Beginning Sign Language simple illustrations. Songs include “If You’re
Series. Eugene, OR: Garlic Press Happy and You Know It;” “Twinkle, Twinkle
Little Star;” “BINGO;” and “Row, Row, Row Your
Boat.”
Harrison, S. J., & Tyree, D. (2000). With A collection of twenty refrains, hymns, and
Heart and Hands and Voices: Songs with songs with sign language. Each song provides
Sign Language for Sunday School, Choir, and teaching suggestions as well as a list of applica-
Worship. Nashville, TN: Abingdon Press. tions for rehearsal (church or school) or class-
room. Songs include “Away in a Manger,” “For
the Beauty of the Earth,” “He’s Got the Whole
World in His Hands,” and “This Little Light of
Mine.”
CONCLUSIONS
The nature of the material in this chapter challenges what many think a
child with hearing loss is capable of accomplishing musically. Lessons that
emphasize listening are possible if enhanced in such a way that the mate-
rials presented are felt, heard, and seen. Listening lessons can promote
musical understanding and enjoyment and can also help in promoting
objectives for speech and language development as well. Likewise, singing
can aid in the development of breath control and vocal intonation as well
as speech and language skills. Singing activities can also reinforce curric-
ular connections while instrumental playing can help to promote listening
goals, reinforce and improve the student’s rhythm skills, and aid in the
development of fine and gross motor skills. As mentioned previously, the

idea of children who are deaf or hard of hearing in choir or band tends
to challenge people’s notion of what is possible. We are reminded also
that there are always exceptions, those students who go above and be-
yond what we think possible. As a result, I urge both instrumental and
vocal music teachers to encourage and include students with hearing loss
in their ensembles, provided it is something the student is interested in
pursuing.
2ND GRADE GENERAL MUSIC LESSON SAMPLE

Duration: 30–45 minute lesson
Concept: Rhythm (steady beat; rhythm notation (review stemmed notation as well as dic-
tation); duration
Objectives:
1. The students will patchen the steady beat on their legs while listening to the song Bingo.
(Skill objective)
2. The students will sing the song BINGO while patchen the steady beat on their legs. (Skill
objective)
3. The students will identify aurally and visually the quarter-quarter-eighth-eighth quarter
in the song BINGO. (Knowledge objective)
4. The students will create physical gestures to express/represent the quarter-
quarter-eighth-eighth quarter rhythm in the song BINGO. (Affective objective)
5. T he students will create their own composition with the utilizing the quarter-
quarter-eighth-eighth quarter. (Affective objective)
6. T he students will first perform their composition and then evaluate the performance
(Skill, Knowledge, Affective objective)
National Performance Standards for Music K-2

Content Standard: 1. Singing, alone and with others, a varied repertoire
of music
Achievement Standard: 1a. Students sing independently, on pitch and in rhythm,
with appropriate timbre, diction, and posture, and
maintain a steady tempo
Content Standard: 2. Performing on instruments, alone and with others, a
varied repertoire of music
Achievement Standard: 2a. Students perform on pitch, in rhythm, with appropriate
dynamics and timbre, and maintain a steady tempo
Content Standard: 4. Composing and arranging music within specified
guidelines
Achievement Standard: 4b. Students create and arrange short songs and instru-
mental pieces within specified guidelines
Content Standard: 5. Reading and notating music
Achievement Standard: 5a. Students read whole, half, dotted half, quarter, and eighth
notes and rests in 2/4, 3/4, and 4/4 meter signatures
M a k i n g t h e C a s e ( 131 )
New Jersey State Visual and Performing Arts Standards

Standard 1.3: All students will synthesize those skills, media, methods, and technologies
appropriate to creating, performing, and/or presenting works of art in dance, music, the-
atre, and visual art.
Strand B. Music
Music content statement: The ability to read music notation correlates with musical flu-
ency and literacy. Notation systems are complex symbolic languages that indicate pitch,
rhythm, dynamics, and tempo.
Cumulative Progress Indicator: Clap, sing, or play on pitch from basic notation in the
treble clef, with consideration of pitch, rhythm, dynamics, and tempo. CPI# 1.3.2.B.1
Materials:
Staton, B. (1988). Grade 1, Music and You Book. New York, NY: MacMillan
Cooper, H. (2005). Pumpkin Soup. New York: Farrar, Straus and Giroux.
Recording/Piano Part for B-I-N-G-O
Paper
Pencils
Powerpoint featuring the lyrics and music
Puppets or stuffed puppies
Ella Jenkins Stop and Go
Procedure:
1. Opening song activity: School Song/Hello song

Accommodation: If student with hearing loss communicates via ASL, sing and sign
the song
Anticipatory Set: How many of you have a pet? How many of you have a dog? What
is your dog’s name? What does he look like? Bring in a picture of your dog to share
with the class next week.
Props: Pictures of dog, puppet or stuffed dog
2. Introduce the song Bingo with rhythm (quarter-quarter-eighth-eighth quarter) embed-
ded (have students keep SB) as the teacher signs and signs the song
Accommodation: Provide song lyrics on paper or presented via powerpoint for the
entire class to follow together
3. Teacher claps rhythm from the song (quarter-quarter-eighth-eighth quarter) that will be
studied. The students should keep a steady beat as the teacher claps the target rhythm.
Accommodation: Provide visual of rhythm (stem notation or standard notation),
rhythm can also be presented to child felt notation card, uncooked rice or macaroni;
reinforce rhythm on drum that child can touch as it is being played
4. As the teacher sings the song, the students should be instructed to listen for the new
rhythm in the song and raise their hands when they hear it.
Accommodation: The teacher can play the melodic rhythm on a drum or piano in
order emphasize the rhythm pattern
5. The students should then listen and identify the word/letters of the song that align
with new rhythm (B-I-N-G-O); Once the students identify the letters, the teacher then
writes the words under the rhythmic pattern that is already written on board for the
class to see
A ccommodation: The student can place his or her fingers (lightly) near the teacher’s
vocal chords or upon his or her cheek to feel the words as they are sung as well as the
rhythm.
6. For further rhythm analysis the teacher and students should:

a. Apply the mnemonic device: dog, dog, barn-yard, dog to the B-I-N-G-O rhythm
b. Review the Gordon syllables (quarter-quarter-eighth-eighth quarter) (du du du-de
du) and apply to the B-I-N-G-O rhythm. Depending upon the students comfort level,
the teacher might see if the students can count the whole song with the Gordon
syllables.
c. Trace/draw the B-I-N-G-O rhythm pattern in the air
d. The teacher should lead the students in making the new rhythm pattern with their
bodies. (i.e. Body rhythms: standing up straight with legs together and hands held
firmly to the sides of the body can represent a single quarter note; hands placed on
bent knees with legs spread apart may represent two eighth notes)
Accommodation: Make sure the student is positioned in the class so that he or
she can see the teacher model both the tracing of the rhythm as well as the body
rhythms. A music buddy can also be assigned to help the student during this activity
7. Using rhythm sticks - have the students each create the new rhythm they have just
learned
8. Point to rhythm stick rhythms while singing the song BINGO
9. Have the students create a four measure pattern incorporating two new patterns (two
should be based upon the pattern learned in an earlier class and the remaining two
should be newly created. They should be encouraged to use rhythm instruments during
their performance.
Accommodation: The class can be assigned to groups for this assignment during
which the child can be assigned to their music buddy to help the student during this
activity. The student might also be asked to create two measures instead of four.
10. Assessment: The students perform their four measure pattern for the class
11. Closing song activity: Elle Jenkins Stop and Go
GRADE: 7–8TH GRADE BAND REHEARSAL SAMPLE

Duration: 30–45 minute band rehearsal
Objectives:
1. The students will play the F Major scale in whole notes, half notes, and in thirds. (Skill
objective)
2. The students will play the d minor scale in whole notes, half notes, and in thirds. (Skill
objective)
3. T he students will analyze the key of Black is the Color if my True Love’s Hair. (Skill/
Knowledge objective)
4. The students will identify aurally and visually the melody Black is the Color of my True
Love’s Hair in the band arrangement Appalachian Suite. (Knowledge objective)
5. T he students will describe the distinguishing musical features of a suite. (Knowledge
objective)
6. T he students will describe the distinguishing musical features of a ballad. (Knowledge
objective)
7. T he students will discuss the ways in which a performance of traditional folk perfor-
mance differs from that of a non-traditional performance (band instruments). (Affective
objective)
M a k i n g t h e C a s e ( 133 )
8. The students will discuss the role of the musician when performing folk music on untra-
ditional instruments. (Affective objective)
National Standards for Music, Grades 5–8

Content Standard: 2. Performing on instruments, alone and with others, a
varied repertoire of music
Achievement Standard: 2a. Students perform on at least one instrument accu-
rately and independently, alone and in small and large
ensembles, with good posture, good playing position,
and good breath, bow, or stick control
Achievement Standard: 2c.
Students perform music representing diverse genres
and cultures, with expression appropriate for the work
being performed
Content Standard: 5. Reading and notating music
Achievement Standard: 5a. Students read whole, half, quarter, eighth, sixteenth,
and dotted notes and rests in 2/4, 3/4, 4/4, 6/8, 3/8,
and alla breve meter signatures
Content Standard: 6. Listening to, analyzing, and describing music
Achievement Standard: 6a. Students describe specific music events in a given aural
example, using appropriate terminology
Achievement Standard: 6b. Students analyze the uses of elements of music in aural
examples representing diverse genres and cultures
Achievement Standard: 6c. Students demonstrate knowledge of the basic princi-
ples of meter, rhythm, tonality, intervals, chords, and
harmonic progressions in their analyses of music

Standard 1.1: The Creative Process: All students will demonstrate an understanding of the
elements and principles that govern the creation of works of art in dance, music, theatre,
and visual art.
Strand B. Music
Music content statement: Common, recognizable musical forms often have character-
istics related to specific cultural traditions.
CPI# 1.1.8.B.1
Cumulative Progress Indicator: Analyze the application of the elements of music in
diverse Western and non-Western musical works from different historical eras using
active listening and by reading and interpreting written scores.
Standard 1.3: Performance: All students will synthesize those skills, media, methods, and
technologies appropriate to creating, performing, and/or presenting works of art in dance,
music, theatre, and visual art.
Strand B. Music
Music content statement: Western, non-Western, and avant-garde notation systems
have distinctly different characteristics.
Cumulative Progress Indicator: Perform instrumental or vocal compositions using
complex standard and non-standard Western, non-Western, and avant-garde nota-
tion. CPI# 1.3.8.B.1
Music content statement: Stylistic considerations vary across genres, cultures, and his-

torical eras.
Cumulative Progress Indicator: Perform independently and in groups with expres-
sive qualities appropriately aligned with the stylistic characteristics of the genre. CPI#
1.3.8.B.2
Music content statement: Understanding of discipline-specific arts terminology (e.g.,
crescendo, diminuendo, pianissimo, forte, etc.) is a component of music literacy.
Cumulative Progress Indicator: Apply theoretical understanding of expressive and dy-
namic music terminology to the performance of written scores in the grand staff. CPI#
1.3.8.B.3
Materials:
Recording: Appalachian Suite
Recording: Black is the color of my true love’s hair
Stereo system
Map of Appalachia
Visuals of traditional folk instruments
Procedures
1. Warm-ups:
a. Students will play the F major scale in whole notes, half notes, and in thirds
b. Students will review the whole and half pattern upon which the scale is built
c. Students will review the idea of relationships specifically that major scales can have
related (relative) minor scales
d. I will inform students that we are discussing this as one of our new pieces is actually
written in a minor key (at first)
e. Students will be introduced to the whole and half step pattern upon which the nat-
ural minor scale is built.
f. Students will find the relative minor of our F major scale (d minor)
g. Students will play the d minor scale in whole notes
h. Students will compare the dotted half and quarter with the Dotted half eight rest and
eighth note because the low brass have the first rhythm while the woodwinds have the
second rhythm within the Appalachian Suite
Accommodation: Visuals of rhythms and scale patterns. Isolate rhythms to be
studied and play them on percussion instruments. Band buddies assigned to the
student to help them through the rehearsal; taking off shoes to feel vibrations
through the floor. Concepts taught should be modeled, reinforced visually
2. Anticipatory set: There are many types of music in our country. However, have we ever
stopped to think about how music got here . . . to our country? We really are a melting
pot and the various types of music did not just pop up! Rather some of the traditions
that we have were established elsewhere . . . were brought over as reminders of heritage
and tradition and actually were changed a bit over time. The piece we are about to begin
is actually an example of this. The piece is called Appalachian Suite.
A Suite is a collection of short instrumental movements or defined as a set of unre-
lated and usually short instrumental pieces, movements or sections played as a group,
and usually in a specific order. In this instance all of the folk songs which make up this
suite are connected as they were found in to be sung in Appalachia which is a mostly
rural, partly urbanized, and partly industrialized region in and around the Appalachian
Mountains in the Eastern United States.
Over twenty million people live in Appalachia, a heavily forested area, roughly the
size of the United Kingdom, covering largely mountainous, often isolated areas from
M a k i n g t h e C a s e ( 135 )
the border of Alabama and Georgia in the south to Pennsylvania and New York in the
north. Between lay large areas of South Carolina, North Carolina, Tennessee, Virginia,
Kentucky, West Virginia, Maryland and Ohio.
Accommodation: Powerpoint of comprehensive lesson—lyrics, instruments, map of
region of Appalachia, When listening to an example, let the student that he or she can
move closer to the sound source
3. Students will listen to traditional performances of each folk song in the piece
(vocal—unaccompanied)
Accommodation: Visual reinforcement can be helpful here. This can include song lyr-
ics and/or a listening map. When listening to an example, let the student move closer
to the sound source (vibration).
4. Introduce the term folk song and provide students with a variety of examples. The pres-
entation should include location, regions, instruments, performance styles
Accommodation: As with the section above, make sure the information presented is
also visible via Powerpoint. This can include new terms introduced, pictures of folk
instruments, a map of the region where certain instruments or songs were found.
When listening to an example, let the student move closer to the sound source (vibra-
tion) and if possible song lyrics and/or a listening map.
5. Play the recording of the first piece, Black Is the Color of My True Love's Hair piece
again
Accommodation: Visual reinforcement can be helpful here. This can include song lyr-
ics and/or a listening map. When listening to an example, let the student move closer
to the sound source (vibration).
6. Ask the students what type of song they think it is. After students provide their responses
explain to them that the song is traditionally considered a ballad. Provide background
on the ballad
7. Have the students play the first folk song in the suite: Black Is the Color of My True
Love's Hair
Accommodation: Band buddies assigned to the student to help them through the re-
hearsal; taking off shoes to feel vibrations through the floor. Concepts taught should
be modeled, reinforced visually
8. We will discuss the differences in timbre (i.e. traditional instrumental or vocal perfor-
mance versus band) and how different instrumentation might impact the performance.
How does the performer play a role?
Accommodation: Visuals to reinforce lyrics, opportunities to experience the vibra-
tions (vocal versus instrumental) produced by the two performances in order to help
them distinguish between the two.
9. Assessment: Have the students’ play Black Is the Color of My True Love's Hair again
Accommodation: Band buddies assigned to the student to help them through the re-
hearsal; taking off shoes to feel vibrations through the floor. Concepts taught should
be modeled, reinforced visually
10. A ssessment: Review the rhythms played in the warm-ups—Have the students review
their parts for rhythms—can they find some of the rhythms we played in our warm-ups
11. Summary of the Rehearsal/Closing
12. Review of the rehearsal- this should include a review of all new musical concepts,
related concepts and terms.
a. Ask for a volunteer to play on their instruments one of the rhythms from our
warm-ups
b. Ask for a volunteer to explain—as a review for the group- the relationship between
major and minor keys
c. Ask for a volunteer to explain—as a review for the group- the whole and half step
patterns for a major scale and a minor scale
d. Ask the students to share some of their thoughts regarding the first attempt at
playing this ballad. Did it sound as if it was a ballad? If not, what can we do differ-
ently during our next rehearsal in order to achieve this?
e. Provide the students with feedback regarding their performance.
Accommodation: All questions asked should be presented visually and any
answers provided by peers should be repeated by the teacher so that the child
with hearing loss (who depends on speech reading can see what is being said.
The student should also be given alternative ways to answer (i.e. sign, writing,
demonstrating)

Teachers
Instrumental music teachers should communicate with the general music teacher to
discuss the student’s progress in music class (i.e., his or her strengths, weaknesses,
and instructional approaches implemented when teaching concepts such as rhythm
and pitch). This communication promotes consistency and familiarity between the
general and instrumental music classroom in terms of the instructional approaches
implemented.
Parents may also be able to provide teachers with information about their child’s instru-
mental music interests. Reach out to them about the selection process as well as their level
of commitment to helping with home practice.
Be sure to monitor the student’s device and to provide the occasional reminder so that
he or she can make the necessary adjustments to their hearing aid or cochlear implant
during lessons. This attention can ensure their comfort level and safety within the band or
orchestral setting.
Parents
Parents, you may be a bit nervous about instrumental music especially if you have never
played an instrument before! If this is the case, request a meeting with the instrumental
music teacher for suggested approaches or resources that can be implemented during
home practice. You should also inquire about private teachers in the community.
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CHAP T ER 5
For the Music Education Student

Preparing for a Career in Teaching
M usic education students are faced with a myriad of requirements as

they prepare for a career in music teaching. During their four or five
years of study, they are stretched to the limit with coursework to hone
their musicianship skills and teaching techniques. The culmination of this
preparation at the undergraduate level leads to the student teaching expe-
rience or internship. For many, this is their final opportunity to work with
a mentor teacher.
Music education studies are intensive and leave little room for addi-
tional coursework. This presents a challenge for the music education stu-
dent, as not all programs are able to provide courses emphasizing music
for children with special needs. Too often, music education majors enter
the field with minimal experience in this area yet are expected to teach
music to all children grades K–12. As such expectations and requirements
can be daunting for even the veteran music teacher, the question becomes,
“how can student teachers and even new teachers prepare themselves for
such experiences?”
While I cannot prepare the student for every possible scenario, I can im-
part a few teaching suggestions including those based on the experiences
of some of my undergraduate music education students who did have the
opportunity to teach children with hearing loss.
Most importantly, this chapter is meant to encourage the music educa-
tion student to embrace every teaching opportunity that presents itself
because as I have found, the most rewarding teaching experiences are al-
most always where you least expect to find them!
( 140 )
F o r t h e M u s ic E d u cat i o n S t u d e n t ( 141 )
SPECIAL EDUCATION AND DISABILIT Y RIGHTS

LAWS: A FOUNDATION FOR STUDENT
ADVOCACY
Music teachers often find themselves in situations that are not in compli-
ance with special education and disability rights laws. Many have reported
not having access to Individualized Education Program (IEP) documents
or any involvement in the placement process while others have described
teaching classes with a disproportionate number of special learners often
times without the assistance of a paraprofessional (i.e., teachers’ aide) (Fett,
2009; Shehan-Campbell & Scott-Kassner, 2009). The music education stu-
dent teacher will be better able to advocate for his or her students if they
have a general understanding of special education and disability rights laws.
Rehabilitation Act of 1973 (Section 504)
The US Rehabilitation Act of 1973 (PL 93-112) was the first “rights”
legislation to prohibit the discrimination toward people with disabili-
ties. This act applies to programs directed by federal agencies, including
those companies or businesses working with federal contractors (US
Department of Justice, 2009, “Rehabilitation Act,” para. 1). For example,
the Rehabilitation Act applies to colleges and universities receiving federal
funds for student loan programs. The Rehabilitation Act was amended in
both 1993 and in 1998 (US Department of Justice, 2009, “Rehabilitation
Act,” para. 1). Standards that determine employment discrimination ac-
cording to the Rehabilitation Act are identical to those found in Title I of
the Americans with Disabilities Act.
Section 504 of the US Rehabilitation Act relates to students with disabil-
ities mandating that schools must make appropriate instructional accom-
modations and modifications to policies and practices in order to allow for
complete access and involvement of the child with special needs (Boston
University Center for Psychiatric Rehabilitation, 2012c, “Rehabilitation
Act: Section 504,” para. 4). Section 504 promotes the development of dis-
ability support services in both colleges and universities (para. 4). The
504 plan, developed by teacher(s), support staff such as the school nurse,
paraprofessionals, speech and language therapist, school administrators,
a parent or legal guardian, and the student when appropriate, is the legal
document that defines the modifications or accommodations necessary
for a child with special needs who is mainstreamed into the public school
(Adamek & Darrow, 2010; Russo & Osborne, 2008; Smith & Patton, 1998).
Accommodations may include facilitated communication for people

with hearing or vision loss, preferential seating in the classroom, length
of testing time as well as the manner in which tests are administered
(orally versus paper and pencil), adaptations to school schedule, behavior
contracts, reward systems, alternative teaching strategies, and precau-
tions for the student’s health and safety (Adamek & Darrow, 2010; Russo
& Osborne, 2008; Smith & Patton, 1998). Accommodations must address
the student’s identified disability in order to ensure access to the activities
available to his or her peers. The 504 plan should also indicate the specifics
of the accommodations: specifically how, where, and by whom they will
be provided (Adamek & Darrow, 2010; Russo & Osborne, 2008; Smith &
Patton, 1998). Programs not in compliance with section 504 can lose their
federal funding.
Americans with Disabilities Act (ADA)
The Americans with Disabilities Act (ADA) (PL 101-336), enacted by the
US Congress in 1990 and signed into law by George H. W. Bush on July
26, 1990, prohibits discrimination toward those with disabilities. As per
the Americans with Disabilities Act, disability is defined as a “physical or
mental impairment that substantially limits a major life activity” (Boston
University Center for Psychiatric Rehabilitation, 2012a, “Definitions
of ADA Terms,” para. 2). This is typically determined on a case-by-case
basis. For those court rulings deemed too restrictive by Congress, the ADA
Amendment Act of 2008 is intended to provide broader protections for
workers with disabilities.
Title II of the Americans with Disabilities Act (ADA) encompasses enti-
ties such as public school systems including those covered by section 504
of the US Rehabilitation Act of 1973. This means that public schools must
comply with ADA in all service programs and activities including those
that are open to parents and the public at large such as graduation cer-
emonies, parent-teacher organizations, meetings, concerts, and plays.
Under Title II, program accessibility must also be assured. Accessibility
includes the availability of appropriate services and auxiliary aids (i.e.,
note takers, interpreters, assistive listening devices) to ensure effective
communication. Such services and aids are required so long as they do
not result in any major modifications in the foundational structure of
the program. Title IV attends to both television and telephone access for
individuals with hearing loss and speech impairments, requiring that tel-
ephone carriers establish interstate and intrastate telecommunications
relay services (TRS) twenty-four hours a day, seven days a week (Boston
University Center for Psychiatric Rehabilitation, 2012b, “Americans with
Disabilities Act: Title IV,” para. 1). TRS services make it possible for callers
with hearing loss and speech impairments who use text (TTYs or TDD) to
communicate with those who use telephones. TRS is conducted through
third-party assistance. Closed captioning of federally funded public ser-
vice announcements is also required under Title IV (Boston University
Center for Psychiatric Rehabilitation, 2012b, “Americans with Disabilities
Act: Title IV,” para. 1).
Individuals with Disabilities Education Act (IDEA)
The Education for All Handicapped Children Act of 1975 (PL-94-142),

later re-authorized in 1990 as the Individuals with Disabilities Education
Act (IDEA), is a federal law providing for the needs of children with dis-
abilities from birth to age twenty-one (i.e., early intervention, special ed-
ucation, and related services). The most recent amendments of IDEA were
passed by Congress in December 2004, with final regulations published
in 2006 and 2011 (National Dissemination Center for Children with
Disabilities, 2012, “Individuals with Disabilities Education Act,” para.
2). Currently, IDEA applies to disabilities including mental retardation,
hearing impairments (including deafness), speech or language impair-
ments, visual impairments (including blindness), emotional disturbance,
orthopedic impairments, autism, and disabilities resulting from trau-
matic brain injury.
Under IDEA, public schools are also required to develop an Individualized
Education Program (IEP) for each eligible student under both federal
and state eligibility standards. The IEP is a written legal document that
describes the special education and related services to be provided for the
child. The top of the IEP document will typically include basic information
such as the student’s name, grade, current class placement, age, and date
of birth. The nature of the student’s hearing loss including mode of com-
munication and the types of hearing devices (i.e., hearing aid, cochlear
implant, FM system, etc.) used will also be indicated. The IEP also includes
a complete description of an appropriate educational setting as well as
specific social and academic goals for the student.
The IEP team members typically include the child’s teacher as well
as another representative of the local school district. Other study team
members might include the school speech pathologist, an interpreter, the
school psychologist, physical therapist, occupational therapist, a parent
or guardian, and when appropriate, the child. The main goal of the IEP
meeting is to discuss the educational needs of the student and to write a
program that identifies goals and objectives and related services for the
year. The IEP may also include a description of the amount of time the stu-
dent is placed into the general education setting. For example, he or she
may be placed in a special education classroom for specific subjects like
reading or math while joining another class for music, art, or physical edu-
cation. Furthermore, IDEA requires that IEP teams document the specific
reasons as to why students may or may not be able to participate in the
general education curriculum, state and local assessments, and also pro-
vides support for the eligibility of a student with a disability for an alter-
native curriculum or setting other than the general classroom. Whenever
a student is placed in a special music class, the IEP document should in-
clude a justification for that placement.
Ideally, plans should help identify the student’s level at the beginning
of the term, including his or her strengths and weaknesses, annual goals
for the class, means for the achievement of these goals, and evaluation
measures for indicating student’s progress. The IEP document should also
include any instructional accommodations for the music classroom as
shown in Figure 5.1. Examples include musical instrument modifications
according to the needs of the child or access to a music therapist for in-
dividual work on development of the singing voice. This document must
be reviewed at least annually and may be modified during the school year
to ensure the student’s success, and if indicated, the student’s placement
may also change to reflect his or her needs.
If not asked to participate in the IEP process, the music teacher should in-
dicate interest by submitting formal requests to IEP team members and the
school administration. At that time, the music teacher should also submit
placement recommendations, appropriate music goals for the student, as
well as copies of assessment records documenting his or her progress in
music class to support the recommendation made. By doing so, the music
teacher has provided evidence that he or she is trying to meet the needs of
the student who is deaf or hard of hearing in the music classroom. Plans
similar to that of the IEP are put into place in other countries, including
the Individualized Education Plan (IEP) of England, Wales, and Australia,
Finland’s Individualized Plan, the Personalized Compensation Plan used
in France, and Sweden’s Development Plan or Action Plan of Provision.
IDEA is comprised of six guiding principles: free and appropriate pub-
lic education (FAPE), zero rejection, appropriate initial identification and
testing procedures, due process, least restrictive environment (LRE), as
well as parental and student involvement.
Figure 5.1: Individualized Education Program (IEP), From Beer & Graham, (1980), Teaching music to the exceptional child: Handbook for
mainstreaming (1st Ed.), (Upper Saddle River, NJ: Pearson Education, Inc.), p. 37. Reprinted by permission.
Free and Appropriate Public Education

Children with special needs are guaranteed a free and appropriate public
education (FAPE). This is defined as “an educational program that is indi-
vidualized to a specific child, designed to meet that child’s unique needs,
and emphasizing a special education with related services, from which the
child receives educational benefit including preparation for further edu-
cation, employment, and independent living” (Adamek & Darrow, 2010,
p. 32; Dettmer, Thurston, & Dyck, 2005, p. 39).
Zero Rejection
FAPE is in alignment with the policy of zero rejection prohibiting the ex-
clusion of a child with disabilities, regardless of how severe, from a public
education (Heward, 2006, pp. 19–21). Moreover, if the child is completely
incapable of benefiting from educational services and all efforts are inef-
fective, the school is still required to provide such educational services
(Adamek & Darrow, 2010, p. 32). This applies to any facility that provides
services for a child with special needs (i.e., public or private schools, hos-
pitals). Educational or support services as we learned in chapter 2, are
crucial for instruction.
Appropriate Initial Identification and Testing Procedures

Children qualifying for special education services may qualify for accom-
modations by Section 504 of the Rehabilitation Act of 1973 and the
Americans with Disabilities Act (ADA) of 1990. In order to determine if
a child has a disability that requires special services, schools are required
to evaluate the child using a variety of standardized testing measures and
procedures (Adamek & Darrow, 2010; Heward, 2006). Such evaluative pro-
cedures can provide Individualized Education Program (IEP) team mem-
bers with necessary functional and developmental information about the
child. Under IDEA, the child is protected during these initial identification
and testing procedures. For example, tests must be non-discriminatory
and resulting identification and placement decisions cannot be made on
the basis of a single test score (Heward, 2006).
Due Process
Under the auspices of due process, parental consent must be obtained prior
to any testing procedures and placement decisions. Parents must have
access to all information pertaining to their children, including scheduled

meetings and the resulting documentation. In cases where disagreement
exists between the parties regarding the results of testing and evaluation,
the parents and children can request an independent evaluation often
conducted at public expense (Heward, 2006, pp. 19–21). Furthermore,
when the school and family fail to see eye to eye on the results of identifi-
cation, testing, and subsequent placement recommendations, the parents
and district may try to come to an agreement through mediation. In some
instances, a due process hearing may result (Heward, 2006, pp. 19–21).
Getty and Summey (2004) state that “due process hearings are a last re-
sort for resolving conflicts or problems between school districts and par-
ents” (p. 40).
Parent and Child Involvement

As previously mentioned, a parent or guardian should be a part of IEP
meetings and, when deemed appropriate, the child should participate as
well. Their presence at these meetings ensures them the opportunity to
weigh in on all aspects of the child’s education, including initial and sub-
sequent evaluations, placement decisions, the design and implementation
of education goals, related services, and any recommended changes made
by team members (Adamek & Darrow, 2010; Heward, 2006).
Least Restrictive Environment (LRE)

The purpose of the least restrictive environment (LRE) is to place chil-
dren with special needs in the most appropriate setting both academ-
ically and socially. More specifically, to the maximum extent possible,
children with disabilities, including those in public or private insti-
tutions, as well as other care facilities, are educated with their peers
in the general classroom environment (US Department of Education,
2013, “Least Restrictive Environment,” para. 1). LRE includes access to
the general education curriculum and extracurricular activities or any
other programs to which their peers would have access. Furthermore,
supplementary aids as well as the support services (i.e., speech and lan-
guage therapy, physical therapy, occupational therapy, music therapy)
deemed necessary to achieve educational goals should also be provided
if a child with special needs is placed in an inclusive setting. Generally,
if the child’s opportunity to interact and learn with those of his or her
peers without disabilities is minimized, a placement is considered to
be overly restrictive. Only when the nature of the child’s disability
prevents the achievement of IEP goals within a regular education set-

ting should the child would be placed in a more restrictive environment
such as a special education classroom within the current school, a spe-
cialized school, or even a hospital program, depending upon the child’s
individual needs.
Other Education Laws
No Child Left Behind and Its Impact on the Child with
Special Needs
The No Child Left Behind Act (NCLB) (Public Law 107-110) was autho-
rized in 2002 under President George W. Bush (Moore, 2011). In addi-
tion to detailing the President’s plans for educational reform, the act also
represents extensive and comprehensive changes to the Elementary and
Secondary Education Act (ESEA), the most ambitious since its approval in
1965 (Moore, 2011). NCLB was enacted in order to improve the academic
achievement of all students regardless of race, ethnicity, socioeconomic
status, language skills, or disability in American public schools. NCLB
requires that states not only administer assessments periodically but en-
sure that all students, in particular, various student subgroups, are achiev-
ing success toward curricular standards (Bender, 2008). Under NCLB,
states are also required to evaluate teacher effectiveness (Bender, 2008).
As the No Child Left Behind Act holds each state more accountable for
student progress and achievement, it is therefore the state’s responsibility
to oversee the development and implementation of academic standards
and benchmarks including annual assessments (Moore, 2011). Yearly
benchmarks have also been implemented on a statewide basis so that profi-
ciency goals like those set for 2014 can be attained. Approximately 95 per-
cent of all students in a given district are assessed under NCLB, including
children with special needs who take part in annual assessments with the
testing adaptations and accommodations detailed in their Individualized
Education Programs (Elliott & Marquart, 2004). Assessment data are typ-
ically reported by the school report card and include a rating of whether
the schools and districts, overall, have successfully met Adequate Yearly
Progress (AYP) benchmarks (Cawthon, 2007).
NCLB legislation has stirred much debate amongst special education
teachers. The primary concern has been that NCLB holds students with
and without disabilities to the same academic standards and benchmarks.
This has led to concerns about the effect of such expectations on the
motivation of students with special needs who may be inappropriately
challenged and discouraged by curricular expectations. Teachers have also

worried about resulting test anxiety and increased high school dropout
rates (Ysseldyke et al., 2004). Also noted has been the increase of students
identified for special education services, the amount of extensive testing
required, as well as the narrowing of curricular emphasis for all students
to include only test-related topics.
The NCLB-mandated Adequate Yearly Progress (AYP) benchmarks have
also been the center of controversy for many school districts as many,
particularly those located in socioeconomically challenged areas, have
struggled to meet these requirements. The teachers in these schools be-
lieve that students from socioeconomically challenged backgrounds have
not been considered in the development AYP goals (Fletcher et al., 2006;
Yell, Katsiyannas, & Shiner, 2006; Ysseldyke et al., 2004). Moreover, many
highly successful schools have failed to meet AYP goals. Teachers and
school administrators believe that this is related to the manner in which
district data has been collected and evaluated, particularly that the “data
for specific groups have been ‘broken out’ for individual aggregation of
scores” (Fletcher et al., 2006; Yell, Katsiyannas, & Shiner, 2006; Ysseldyke,
et al., 2004).
Advocates of No Child Left Behind believe that the NCLB legislation
has offered increased accountability, academic expectations, including
state-wide testing, and curricular standards for children with special
needs (Wilmshurst & Brue, 2005). Also noted by proponents has been the
increased alignment between IEP goals and state curriculum standards,
something that many felt was overdue for this population (Wilmshurst &
Brue, 2005). The availability of varied testing options designed to monitor
each child’s educational progress, alternate standards for the purposes of
evaluation, and the increased number of special needs children in the gen-
eral education classroom setting have served to reinforce the benefits of
this legislation.
Elementary Secondary Education Act (ESEA) Flexibility Plan

The landscaping of NCLB has changed in recent years. While several states
still acknowledge and adhere to the requirements of NCLB, many have in-
stead opted to follow the ESEA Flexibility Package proposed in September
2011 by President Barack Obama to improve student learning by increasing
the quality of instruction and assessment (US Department of Education,
2012, “ESEA Flexibility,” para. 1). Since February 2013, forty-four State
Educational Agencies (SEA), including Puerto Rico and the Bureau of
Indian Education, have submitted requests to the US Department of
Education for flexibility waivers from NCLB, and thirty-four, including

the District of Columbia, have been approved. In exchange, these states
must instead adopt comprehensive state developed plans in order to im-
prove the educational outcomes for their students, close achievement gaps,
increase equity, and improve the quality of instruction (US Department of
Education, 2012, “ESEA Flexibility,” para. 1).
Other Terms Associated with Special Education and

Disability Rights Laws
Student teachers and new teachers will quickly discover the diversity of
their classrooms. A review of student IEP and 504 plans, discussions with
teachers, and documentation left from the previous music teacher will
confirm students’ varying abilities and backgrounds. For this reason, stu-
dent teachers and new teachers should be familiar with the terms main-
streaming and inclusion, particularly the differences between them. These
terms are often used interchangeably but do in fact represent two very dif-
ferent educational philosophies. The fundamental difference between the
two centers on these questions: “Should a student with special needs be in-
tegrated into a general education classroom?” and “When should students
with special needs be integrated into a general education classroom?”
Mainstreaming
Mainstreaming is generally an older term associated with the Regular
Education Initiative of the 1980s, referring to the selective placement
of special education students in one or more “regular” education classes.
This initiative was introduced by Madeline Will, the former Assistant
Secretary of Education. According to Will, a separate approach to ed-
ucation was limiting for both the child’s social and emotional growth
(Gargiulo & Kilgo, 2011, p. 143). Therefore, the intent of this initiative
was to reform approaches to special and general education. For example,
the initiative promoted increased collaboration between special and reg-
ular education teachers. Moreover, regular education teachers had more
opportunities for input and were given more responsibility in planning
and implementing the educational approaches for their students with spe-
cial needs (p. 143).
Ultimately, mainstreaming tended to focus on the disability and special
education needs of the student in question. Emphasis was also placed on
preparing the student for the mainstream (Dettmer et al., 2005, p. 39).
Proponents of mainstreaming generally believed that a student must

adapt to the general classroom setting (Stinson & Kluwin, 2003, p. 53).
Additionally, the student’s level of progress was expected to be close if
not similar to that of his or her peers and non-disruptive behavior was
expected. Such “readiness criteria” meant that only a student with mild
to moderate disabilities might be selected for mainstreaming, leaving stu-
dents with severe disabilities with limited opportunities for accessing the
general curriculum. As a result, parents and educators who believed it to
be too limiting opposed the mainstreaming model indicating that it not
only failed to provide a permanent place in the general education popula-
tion for children with mild to moderate disabilities but entirely neglected
those with severe disabilities. Such beliefs paved the way for the inclusive
education movement of the 1990s, primarily led by parents of children
with severe disabilities.
Inclusion
Inclusion symbolizes the commitment to educate each child to the max-
imum extent appropriate, in the school and classroom he or she would
otherwise attend (Dettmer et al., 2005, p. 39). The inclusion model inher-
ently rejects special schools or classrooms as viable options. Such settings
do not have eligibility criteria and the general education teacher is there-
fore responsible for educating all of the students in the classroom. The
inclusion model expects that support services are brought to the student,
rather than moving the student to the services, and requires only that he
or she benefit from being in the class rather than having to keep up with
peers (Stinson & Kluwin, 2003, p. 53). A student is not removed from the
classroom if he or she is not keeping up; instead, additional supports or
instructional methods and approaches are provided to accommodate the
student within the setting. Also, changes in behavior do not result in the
removal of the student from the setting unless instruction is constantly
disrupted or the students pose a threat to him- or herself or others. Most
typically, inclusion is implemented by school districts serving students
with mild to severe disabilities. Inclusion upholds the student’s right to
participate by embodying a respect for his or her social, civil, and educa-
tional rights,
Despite these historical and philosophical differences, both terms are
still currently used to describe the educational services a student with
special needs is receiving in the general classroom setting. However, im-
plementation varies by state and school district. Therefore, it is imperative
for student teachers and new teachers to have an understanding of both.
The most effective decisions pertaining to a student with special needs in

music result from clear communication and cooperation of the members
of the IEP team.
International Laws and Support Systems
The United Nations Convention on the Rights of Persons with Disabilities

(UNCRPD) was enacted in May 2008, and represents sweeping change re-
garding how the world views disability, specifically that disability is not
just a “social welfare matter but a human rights issue and matter of law”
(European Commission, 2012b, “Justice: United Nations Convention,”
para. 2). “The purpose of the Convention is to promote, protect and en-
sure the full and equal enjoyment of all human rights and fundamental
freedoms by all persons with disabilities” and specifies the civil, cultural,
political, social, and economic rights of people with disabilities (European
Commission, 2012b, “Justice: United Nations Convention,” para. 1).
In conjunction with the UNCRPD, the European Union (EU) adopted
the European Disability Strategy (2010–20) in November 2010. The objec-
tives of this very comprehensive strategy are comprised of eight priority
areas including accessibility, participation, equality, employment, edu-
cation and training, social protection, health, and external action. The
fifth objective pertaining to education and training promotes inclusive
education and lifelong learning for children with disabilities (European
Commission, 2012a, “European Disability Strategy (2010–12),” para. 7).
Several of the laws that have been enacted by individual countries in order
to address the needs of their special populations are included herein for
comparison and perspective.
Australia
Australia has also been a key participant in international laws that have
greatly affected children with special education needs and disabilities.
Examples include The UN Convention on the Rights of the Child (1989)
and The Convention on the Rights of Persons with Disabilities (2008).
Both have influenced the development of a 21st-century curriculum,
the primary goal of which is to provide a foundation for successful, life-
long learning and participation in the Australian community (Australian
Government, 2013, “National Disability Strategy,” para. 1). The imple-
mentation of this curriculum ensures that students with special educa-
tion needs and disabilities receive the appropriate provisions necessary
to ensure their success. The Melbourne Declaration on Educational Goals

for Young Australians (2008), committed to providing “support for all
young Australians to become successful learners, confident and creative
individuals, and active and informed citizens,” has also been foundational
in the development of the national curriculum (Australian Curriculum,
Assessment and Reporting Authority, 2011, “Australian curriculum,”
para. 1).
Older Australian laws including the Disability Discrimination Act of
1992 (DDA), were passed by the Australian Parliament in order to pro-
mote the rights of individuals with disabilities. Notably, this came about
after Australia signed the United Nations’ Declaration supporting the
Rights of Mentally Retarded Persons and the Rights of Disabled Persons
(Equal Opportunity Commission, 2012, “Disability Discrimination Act,”
para. 1). The DDA, similar in nature to disability discrimination laws
of the United States, essentially outlawed discrimination against an-
yone with a disability with regard to education, the provision of goods
and services, and access to housing (Equal Opportunity Commission,
2012, “Disability Discrimination Act,” para. 1). The Disability Standards
for Education 2005, formulated under the DDA, specified the responsi-
bilities and requirements of those who work with students with disabili-
ties. These standards were implemented to ensure that children with
special education needs have equal opportunities to participate in edu-
cational programs in a manner similar to that of their peers (Australian
Government: Department of Education, Employment, and Workplace
Relations, 2013, “Disability Standards,” para 1).
Finland
In Finland, the National Board of Education determines the national core
curriculum and the goals and objectives for core subjects and guidelines
for student assessment, as well as the educational needs of special learn-
ers (Finnish National Board of Education, 2012, “Educational Support,”
para. 4). According to the Finnish National Board of Education (2012),
children of compulsory school age have the right to receive remedial in-
struction or a special education provided primarily through inclusion
into the general education setting (Finnish National Board of Education,
2012, “Educational Support,” para. 5). However, in cases when a child is
unable to cope within the mainstream setting, whether due to disability
or illness, delayed cognitive, social or emotional development, the child
may be enrolled in special education programs (Finnish National Board of
Education, 2012, “Educational Support,” para. 6).
Netherlands
The Going to School Together Project Act (WSNS), was enacted in the
Netherlands in 1994, and placed the responsibility of educating all chil-
dren, regardless of background and ability, on mainstream primary
schools. This was done in order to reduce the number of referrals to spe-
cial schools. A consortium of schools was therefore developed to support
children with special needs in mainstream schools to every extent pos-
sible and in special schools only when necessary (International Review
of Curriculum and Assessment Frameworks: Education Around the World
(INCA), 2012, “Netherlands,” para 3). Their emphasis is placed on the spe-
cific needs and positive capabilities of the child, rather than on his or her
limitations (para. 3).
Scotland
The Education (Additional Support for Learning) Act of Scotland, passed
by Parliament on April 1, 2004, provides for the additional educational
supports of children with special needs. The act also serves as a frame-
work for all local and state education authorities, for related agencies,
and for parents in support of all children regardless of background or
ability (National Archives: Education Act 2004, 2013a, “Main Definition,”
para. 1). Provisions of the law also included the establishment of the
Additional Support Needs Tribunals as well as for procedures to aid in
resolving differences arising between families and authorities (National
Archives: Education Act 2004, 2013b, “Mediation and Dispute Resolution,”
para. 15, 16).
Sweden
As per the Education Act of Sweden (2012), all students “must have ac-
cess to equal quality education, irrespective of gender, their geograph-
ical place of residence, their social and financial situations” (Government
Offices of Sweden, 2012, “Areas of Responsibility,” 2012, para. 9). Sweden
offers a free comprehensive education system comprised of compulsory
schooling at the primary and lower secondary levels. Special schools for
students with impaired vision, hearing loss, speech and language delay,
and learning disabilities are also available. To the extent possible, these
schools provide an education that is equal to that of the compulsory
schools (para. 4–6).
MAKING THE MOST OF METHODS

COURSEWORK AND THE STUDENT TEACHING
EXPERIENCE
Insights and Recommendations from a Music Education
Student Teacher’s Experience
The music education student must advocate for him- or herself by taking
every opportunity that arises during field experiences to work with and
observe students with special needs in the music classroom (Erwin et al.,
2003; Shehan-Campbell, Demorest, & Morrison, 2007). In Spring 2012,
one of my music education student teachers embraced such an opportu-
nity. He had a 6th grade choir student with a cochlear implant who had
recently transferred from a school for the deaf. According to my student
teacher, the student’s transition had been difficult. She was struggling
to make friends and her peers often talked to the music teacher about
her distracting behavior during the choir rehearsal. My student teacher
and his cooperating teacher were working with the student’s classroom
teachers and parents, and they also shared the situation with me and
asked for my input.
During my observations, I noticed that the student was located in the
second row of the ensemble rather far from the piano and not always in
view of her music teachers. I found that she was very attentive and en-
gaged at the beginning of the rehearsal particularly during songs sung in
unison. However, as the rehearsal progressed and song materials became
more difficult, I noticed that her attention began to wane.
The student likely expended much of her energy focusing on the
first part of the rehearsal and was exhausted after about ten to twelve
minutes. The transition to song materials that were more challenging
probably made her feel even more overwhelmed. The student’s overall
performance led me to believe that she wanted to participate with her
peers in the school’s sixth grade chorus, a long standing tradition at the
school. Therefore, I recommended the following solutions that would en-
able the student to participate comfortably and avoid creating distrac-
tions during rehearsal. These included repositioning the student so that
she was in the front of the ensemble, as she would benefit from being in
closer proximity to her music teachers for the purposes of speech read-
ing. Such a position would also place her closer to the group of students
who were singing the main melody in the part songs. I also recommended
that her teachers position her between stronger singers for vocal sup-
port. Song sheets and tapes for all songs, featuring the main melody,
were also recommended for home practice. One other possible solution
that I did not recommend at the time but in retrospect would have sug-
gested, included giving the student a chance to rest for a few minutes
during the rehearsal particularly in instances where the auditory stimuli
was overwhelming. The latter would have worked in this setting as the
sixth grade teachers were always in attendance during the rehearsals
and could have easily taken her into the hall for a break. This approach is
supported by VanWeelden (2001) who suggests adjusting the student’s
time of participation if the student is having difficulty concentrating
and/or participating for the full rehearsal time (p. 57). While this ex-
perience was at times stressful for my student teacher, he embraced the
opportunity to teach and ultimately provided the child with a positive
musical opportunity.
State and National Standards: Resources for the Music

Education Student
Through coursework, the music education student should become fa-

miliar with their state and national standards as they can serve as a
guide for the development of sound education goals. A standards-based
education aligns teaching, learning, and assessment with national,
state, and local (i.e., school district education) standards. Standards
comprise a cumulative body of knowledge, a set of competencies that
determine or define a quality education. Standards can aid teachers in
instructional design, decision-making, assessment, and focus on key
concepts, skills, and behaviors necessary for lifelong learning and suc-
cess. The National Standards for Music Education, for example, are
organized into four sections (Pre-K, K–4, 5–8, and 9–12). Each con-
tent standard specifies what students should know and be able to do
in music. They are accompanied by achievement standards that specify
the understanding and levels of achievement that students are ex-
pected to attain for a specified music competency at the completion of
grades four, eight, and twelve. “These voluntary national standards for
music give the music teacher considerable freedom of choice not only in
selecting learning materials and teaching strategies but also in setting
the performance standards by which student achievement is assessed”
(National Association for Music Education, 2012, “Performance
Standards: Introduction,” para. 1).
Music education students should be familiar with and gain practice in-
tegrating both state and national standards for music education into their
teaching (Erwin et al., 2003; Shehan-Campbell et al.,2007). Integrating

the music standards in this way ensures that all students experience a
high-quality standards-based music curriculum, one that is differentiated
and culturally relevant.
The standards can also serve as guidelines in the development of IEP
music goals and objectives for the student who is deaf or hard of hearing.
Such an approach ensures that he or she has access to the music cur-
riculum as well as the necessary accommodations to engage in music
content-centered learning (Browder, Spooner, & Jimenez, 2011, p. 55;
McLaughlin, Nolet, Rihm, & Henderson, 1999). According to the Council
for Exceptional Children (as cited in Gargiulo & Metcalf, 2011), more
attention has been placed on aligning IEP goals with the content stan-
dards of the general education curriculum. States do differ, however,
in terms of their requirements for and implementation of such an ap-
proach (Ahearn, 2006; Browder, Spooner, & Jimenez, 2011). Research
has revealed that the standards-based IEP places focus on higher aca-
demic expectation, rather than dwelling on “student deficits” (Ahearn,
2006; Thompson, Thurlow, Quenemoen, Esler & Whetstone, 2001).
Such an approach is reported to also promote better collaboration be-
tween both general and special educators (McLaughlin, Nolet, Rihm, &
Henderson, 1999).
Additional Suggestions and Resources for the Music

Education Student
As mentioned earlier, music education studies are intensive, often leav-

ing little room for additional coursework. However, if free electives
comprise some part of the music education degree program, then it is
recommended that the music education student select some courses re-
lated to special education. Students are also encouraged to use their se-
mester breaks and holidays to visit former public school music teachers
and observe their classes. Areas of focus should include the music
teaching methods employed, lesson delivery, student responsiveness,
verbal and nonverbal cues, and approaches to classroom management.
Music education students are again encouraged to ask as many ques-
tions as possible, particularly related to instructional modifications as
they relate to adapting teaching materials like instruments and music
for the child with special needs. He or she should also consider docu-
menting modifications made to classroom setup and lesson planning,
researching the types of exceptionalities students may have, and not-

ing IEP procedures. Teachers’ varied approaches to types of assessment
should also be noted, including formative and summative assessment.
Formative assessment refers to the day-to-day reflective process consid-
ered to be a part of instruction and the instructional sequence. The goal
of formative assessment is to enhance the student’s learning process and
his or her overall attainment of learning goals by providing consistent
feedback regarding student progress. Formative assessment is valuable
for day-to-day teaching as it allows the teacher to monitor student prog-
ress and thus modify the instructional approaches employed to better
meet their needs. Examples include observation, various questioning
strategies, self and peer assessment, progress charting, portfolio assess-
ment, and small group projects. Summative assessment, on the other
hand, refers to chapter tests, end-of-unit or marking period assess-
ments, end-of-term exams, district benchmark or interim assessments,
and state assessments (Danielson, 2007). Consideration should also be
given to collaborating with other teachers in order to develop a network
that will be equally beneficial for the students and teachers, ensuring
that information pertaining to student learning is shared. Dialoguing
with parents is also important; parents are the best advocates for their
children and are often thrilled to find out that arts teachers are inter-
ested in making connections.
The music education student’s peers are a great resource, particularly
upperclassmen who have spent more time in the program. Inquiries can
be made about the courses that they have taken or teaching experiences
involving students who have special needs. Seeking alumni of the music
education program at state or regional music education conferences or
even at university-related events like homecoming to talk about real
world music teaching are still other ideas. Students are also encouraged
to belong to their collegiate National Association for Music Education
(NAfME) professional organization that provides resources and strate-
gies for working with children who have special needs (Erwin et al., 2003;
Shehan-Campbell et al., 2007).
According to the National Association for Music Education (NAfME)
(1994), music educators should be involved in all placement decisions.
The student’s level of musical achievement and social development should
be the primary factor in all placements. Moreover, music placements
should never result in classes that exceed state regulations for class-size
nor should they result in a disproportionate number of students with
special needs in a given class (NAfME, 1994, “Standards for Elementary
School: Curriculum and Scheduling,” para. 16).
INTRODUCTORY MUSIC STUDENTS’ TEACHING

EXPERIENCES AT A SCHOOL FOR THE DEAF
Project Overview
During the Spring 2011 semester, my Introductory Field students were

given the opportunity to teach students at a school for the deaf located in
the mid-Atlantic region of the United States. This opportunity arose from
a major scheduling glitch in the planning of one of our performances for
the Kean University Concert Series for the Deaf. The concert was sched-
uled on a Wednesday, typically the day that I teach this introductory
course. I realized that this concert could serve as part of their coursework
while also fulfilling field experience requirements.
Deaf Concert Series: Background

The impetus for the deaf concert series evolved partially from my work
with an early intervention program from 2005–9. Initially, the children
involved in this early intervention program showed great interest in and
responsiveness to percussion instruments. They consistently sought the
drums during nonmusic activities and always wanted to take multiple
turns during drum-related activities. Considering that such responses
might be an indicator of broader interest for children of various ages at
the school, I brainstormed with the lead teacher of the intervention pro-
gram about the best ways to provide opportunities on a larger scale. With
the combined efforts of the Kean University (KU) music faculty, the con-
cert series was born. In addition to bringing music to children who may
never have experienced musical performance or activity, my colleagues
and I thought the concert series might also aid in raising awareness within
both the deaf and hearing communities about the musical possibilities for
all individuals regardless of background and ability. The inaugural concert
took place during the spring of 2007 and featured the KU percussion en-
semble under the direction of Concert Artist and Professor Jimmy Musto,
shown in Figure 5.2. This was the very first concert for many of the stu-
dents at the school. The principal shared with me the responses of two little
boys that she was sitting next to during the performance. She told me that
one student signed “It feels like dinosaurs are walking across the stage!”
The other boy then signed “the water in my bottle is moving!” The principal
responded excitedly “Yes! The vibrations from the instruments are creating
the movement.” Both of the boys were amazed that the music could have
such an impact on the water!
Figure 5.2: Kean University Percussion Ensemble. Photos by Susan DeFurianni of

DeFurianni Arts.
The concert series has since been expanded to include a performance

on the radio baton, a musical story presented by music education faculty
and students, and instrument “petting zoos.” The petting zoo, featured
in Figure 5.3, allowed the students and teachers from the school for the
deaf opportunities to play the various instruments performed during the
concert.
Student Lesson Plan Preparations

For this concert, my students were charged with leading the musical sto-
ries, the purpose of which is to incorporate instrument sounds, vocal
sounds, and movement to enhance the characters, sounds, and action
words presented within a story. Such an approach can offer young chil-
dren opportunities to participate in the telling of the story and to be part
of the music-making process (Lee, 2010; Schraer-Joiner & Chen-Hafteck,
2009). The stories also made it possible for my students to interact with
the children from the school for the deaf, and to both develop and carry
out a lesson plan.
Figure 5.3: Kean University Concert Series Instrument Petting Zoo. Photos by Susan
DeFurianni of DeFurianni Arts.
Preparations for the Deaf concert began in early February of 2011. My

students and I first discussed the population we would be teaching (i.e.,
preschool children ages two to four with varying degrees of hearing loss).
We also discussed lesson planning as well as the focus for our lesson: mu-
sical stories about reptiles, a concept the students would be working on
at the time of our visit. Preparations included discussion about types
and degrees of hearing loss, the devices the children might use such as
hearing aids, including bone-anchored hearing aids (BAHA) and cochlear
implants, as well as other assistive listening devices such as FM and sound
field technologies. Discussions also included the musical behaviors often
exhibited by children ages two to four, the impact of hearing loss in the
music classroom, and the types of academic and social delays that often
manifest as a result of hearing loss.
As there were two preschool classes, my students were divided into two
team-teaching groups. Each group was assigned to one of the preschool
classes, ensuring that the teaching groups were small and that everyone
was able to contribute to all aspects of the planning, preparation, and
teaching. Because this was the first experience in lesson plan writing for
many of my students, the smaller groups allowed for much discussion and
group support during the writing process.
The classes we were teaching concerned reptiles, therefore each
teaching group was required to select a reptile story to prepare. After
much discussion with the school for the deaf, my students selected two
of Eric Carle’s beloved books, The Foolish Tortoise (1985) and The Mixed-up
Chameleon(1988). The students familiarized themselves with their story,
identifying and listing characters, major concepts as well as the sound and
action words dispersed throughout. Then, they assigned instruments to
the characters and the words identified.
The components of the lesson plan were discussed with much of the
emphasis placed on objective writing and the lesson procedure. We also
reviewed both state and national standards (Pre-K) so that those could
also be appropriately applied to their lessons. Once the foundational
work was complete, the students were able to write a lesson plan around
their story.
One of the biggest hurdles for the music education student is writing
lesson objectives. In order to ensure a well-rounded experience, my stu-
dents were introduced to three types of objectives: skills, knowledge,
and affective objectives. As defined by Patricia O’Toole (2003) in her
book Shaping Sound Musicians, skill objectives or outcomes are defined
as those “outcomes that are a natural part of every music teacher’s goals
for students including such things as technical facility on an instru-
ment and vocal techniques for singers” (p. 25). Knowledge objectives
are defined as an understanding of how music works in terms of its
theory and its historical context. Examples include defining, identify-
ing, or recognizing musical structures, critiquing a performance, or la-
beling the sections of a song (p. 26). Affective objectives address the
human or intrinsic qualities of music. More specifically, they encompass
“the internal and subjective aspects of students’ musical experiences,
their affective responses, attitudes, values, desires, commitments, and
tastes” (p. 27). These objectives ensure that the students are exposed
to a well-rounded musical experience and music education, overall
(O’Toole, 2003).
To make certain that connections were maintained with the curric-
ulum of the school for the deaf, the students prepared an anticipatory set
that would allow not only for an introduction to the musical content upon
which we wanted to focus but also the reptile connection. Once complete,
the teaching groups were responsible for rehearsing their stories and for
directing a formal presentation to the other group, as well as for making
their own costumes.
Experiential Reflections
Participants’ Reflections
A majority of the children involved in the musical stories indicated in
the post-performance surveys that it was their first experience playing
a musical instrument. The children also indicated their excitement about
having the opportunity to play the instruments as part of a story. Some
also revealed their love of playing the instruments but indicated that they
were too loud at times. One student even indicated that the loudness had
a negative impact on his desire to continue playing. The class that par-
ticipated in the presentation of The Mixed-Up Chameleon was especially
excited by the fact that we were presenting a story with which they were
familiar. This was reinforced by the classroom teacher who responded on
her post-concert survey that the “classroom presentation was wonderful
and very appropriate for my students.”
Music Education Students’ Reflections

The first lesson we learned for the day presented itself even before we got
out of the school van! Not everything goes as planned. We arrived at the
school for the deaf over thirty minutes late due to highway traffic. This had
a domino effect on both our timeline and lesson pacing. In retrospect, this
was a good thing for my music education students to experience. Despite
the late arrival, we made it to our first class, a preschool group comprised
of approximately ten eighteen-month-old children. As luck would have it,
this was the class I was to teach, which allowed me to provide my students
with a model for the musical story. See Figure 5.4. One Kean student, “K”
described her observation of the first class as follows:
This was a great way to kick off the day at this school. It was extremely helpful
to see the way Dr. Schraer led The Foolish Tortoise lesson and how she modified it
at the last minute to accommodate the younger participants. The response from
the students was “mind-blowing.” I was so happy to see the excited looks on the
students’ faces when they saw some of us in tortoise costumes, and got to hold
their own bells, and play them too! It was also great to see a handful of students
grasping the concept of word association, and remember what to do every time
the word tortoise was signed. I had no doubt in my mind that the children would
be able to do the task, but actually seeing such a high number of kids able to exe-
cute it was exciting. One little boy showed a great deal of enthusiasm from the mo-
ment we walked into the room. He was jumping up and down, smiling and more
than eager to begin the activity. This first class really set the day up to be a terrific!
Figure 5.4: Musical Story presented by Music Education Students and Faculty. Photos by
Susan DeFurianni of DeFurianni Arts.
Our second class was comprised of eight students ranging in age from two
to four years. Upon entering the room, we found that the teachers had
arranged the students in chairs facing a little stage area that they had
prepared for us. The students’ excitement was evident as we prepared for
our presentation of The Mixed-Up Chameleon, donning our costumes and
arranging the instruments. Their excitement intensified as we passed out
the Chameleon stickers for them to wear and the maracas for them to
play. In this class, we actually had two interpreters, one who was hearing
who conveyed via sign what we were saying to the other interpreter, who
was deaf and responsible for communicating with the deaf students in the
class. This was a new experience for all of us and also required that we ad-
just our lesson pacing, providing us with the second lesson learned for the
day. See Figure 5.5. According to “S,”
When the story finally began, we had to adjust in order to be sure that we were
in-sync with the interpreters we were working with. Initially, our group’s nar-
rator was speaking a little too fast for the interpreters. The students seemed
Figure 5.5: Musical Story presented by Music Education Students. Photos by Susan

DeFurianni of DeFurianni Arts.
very excited to associate the word “chameleon” with shaking the maraca. It was
evident that the objective was achieved.
Of the overall lesson, “S” reflected,
I feel that the lesson was effective, and the main goal of connecting the word to
the sound was achieved. However, I think that some students took their cues
from other students as when to shake the maraca. I think also that the students
in the class did not pay as much attention to the story as they did to shaking
the maraca.
Our third class was postponed until the afternoon due to their late return
from a field trip to the local firehouse. For this class, we were asked to
present The Foolish Tortoise. My students decided to have the children play
three large timpani to represent the tortoise. In retrospect, we should have
modified this lesson, as well. The timpani were overwhelming not only for
the size of the room, but for the students in general. While they were very
excited about playing the instrument, it did not take long for us to realize
that the story would ultimately take a back seat to the instrument(s). “K”
described her experience with this class, as follows:
This class was especially exciting for me because my group was teaching.
I started by welcoming the class and telling them that we would be reading the
story The Foolish Tortoise by Eric Carle. As I was in my tortoise costume, I asked
the students if they could identify the reptile I was dressed as, since the class
had been studying both the story and reptiles. After I asked this, I slowly turned
around so the students could see the entirety of my costume; that included a
green shell on my back and a brown belly. One student instantly said “You’re
a house!” and I said “Not exactly, I am some kind of reptile. I have a shell, and
I walk very slowly,” and almost instantly there were numerous shouts that I was
a turtle! I then asked the class if they wanted to be tortoises with us, I received
a roar of “YES!” So I handed them each a tortoise sticker to wear on their shirts.
I proceeded to explain to the students what the timpani drums were, and asked
them if they wanted to play the timpani with some of my tortoise friends to
help us tell the story. With no hesitation, the class jumped up and wanted to
play the timpani! Once all of the students had a timpani mallet and were with
one of my peers, I told them that every time the word tortoise was signed, they
had to play the timpani. Most of them had already begun to play the timpani
probably because they were excited and interested in this new instrument.
We practiced a few times hitting the drum with the word “tortoise.” Before we
started, I asked the students again what they were going to do when the word
tortoise was signed, and without anyone saying anything, the students all hit
the timpani! As we told the story, some of the students would randomly hit the
timpani. The classroom teachers helped by putting the students’ arms down so
the students understood not to play. One student had a timpani-hitting stance
for almost the entire lesson. It was obvious that he wanted to be ready when it
was his turn to strike the drum! The students hit the timpani every time their
cue word was signed. Once we finished our story, my peers and I thanked the
class and they also thanked us for presenting our story!
Overall, my students found their teaching experiences to be both

eye-opening and positive. This was reinforced by “R” who said of the
overall day at the school:
As a whole I felt that this visit was exciting and beneficial to the students of
the school because we expanded their experiences. I also feel that I’ve benefited
from this experience because I’ve never worked with deaf students or an inter-
preter before, which was a little difficult at first.
STUDENTS’ LESSON PLANS
Lesson Plan I: The Mixed Up Chameleon
1. Grade Level: Preschool
2. Duration: Thirty minutes
3. Concepts: Timbre and Color
4. Objectives:
a. The students will learn about the chameleon. (Knowledge)
b. The students will identify (shape, size, sound of) the maraca. (Knowledge)
c. The students will follow and play the maraca during a guided musical story sequence
(Skill and Knowledge)
d. The students will play their instruments after the word chameleon is presented in the
story. (Knowledge)
e. The students will express the character and instrument that was their favorite in the
story. (Affective)
5. New Jersey Standards:
Content Area Visual and Performing Arts Standard, 1.3 Performance. All students will
synthesize those skills, media, methods, and technologies appropriate to creating, per-
forming, and/or presenting works of art in dance, music, theatre, and visual art.
Strand B. Music
Content Statement: Creating and performing music provides a means of self-expression
for very young learners.
1.3.P.B.4 Listen to, imitate, and improvise sounds, patterns, or songs.
6. Materials
a. Animals
i. Polar bear
1. Instrument: hand drum
2. Costume: Blue shirt and white ears (white feathers attached to a headband);
short white tail (white feathers attached to back of shirt)
ii. Flamingo
1. Instrument: Flute
2. Costume: Pink shirt with pink feathers and wings (white or pink poster
board or fabric and fastened via Velcro dots)
iii. Fox
1. Instrument: High notes on Xylophone
2. Costume: Red tail (made of feathers and attached to back of red shirt) and
red ears (red feathers attached to a headband)
iv. Fish
1. Instrument: Guiro
2. Costume: Blue shirt with cardboard fish attached via velcro dots
v. Deer
1. Instrument: Bells
2. Costume: Brown tee shirt and headband with antlers made of stiff fabric
squares (stir straws were used to help mount the fabric antlers)
vi. Giraffe
1. Instrument: Claves
2. Costume: Yellow tee shirt with brown ovals, yellow ears (yellow feathers at-
tached to a headband)
vii. Turtle
1. Instrument: Low notes on Xylophone

2. Costume: Brown or green shirts with turtle shells (comprised of two panels
(front (brown) and back (green) and held in place with two stripes of brown
fabric that rest on the wearer’s shoulders)
viii. Elephant
1. Instrument: Trumpet
2. Costume: Grey tee shirt, head dress including elephant ears and trunk made
from silver poster board
ix. Seal
1. Instrument: Slap Stick
2. Costume: Grey, blue, or white tee shirt; hands covered with fabric pieces for
flippers
x. People
1. Instrument: Laughing
2. Costume: 1 Umbrella and 1 Top Hat
b. Instruments:
i. 8 Maracas
ii. 3 Timpani
iii. 1 Flute
iv. 1 Xylophone
v. 1 Guiro
vi. Bells
vii. 2 Clave
viii. 1 Trumpet
ix. 1 Slapstick
7. Procedures:
a. We know you have been learning about reptiles, especially one about a mixed-up
chameleon. Today, we are going to read the chameleon story but in a different
and very special way. We are going to add instruments to help us tell the story!
You are going to help us portray the chameleon. When the chameleon is men-
tioned in the story you will all get to play the maracas to help represent him. Let’s
introduce the other instruments and their sounds that will help us with the story,
as well as the characters who will play them!
b. Meet the animals and their instruments!!
c. We will talk about what a chameleon is, what it looks like, where it lives, and how
it survives: Chameleons are reptiles that change colors to blend with the environ-
ment. That is a way that they protect themselves from bigger animals. They have
eyes that can focus on two different things at once. Their tongues are elastic-like
and the tip is sticky so that they could catch and eat flies.
d. We will show the students how to play the maracas the correct way such as explain-
ing how to hold them and how to shake them.
e. The teachers and students will perform the story.
8. A ssessment: We will give the children a chance to play the other instruments from
the story!
9. Conclusion: At the end of the story, we had the students tell us the character that was
their favorite. We had the children play the maracas one last time demonstrating the
technique introduced. At the end, we said to them: “Thank you for letting us make
music with you today! You all did a GREAT job!”
10. Group Evaluation: Overall, we feel that we were fully prepared for the presentation.
One of the only problems was the miscommunication between which class would
hear what story. The children seemed to enjoy the story and enjoyed playing with the
maracas. We found the stickers to be very effective as well. Something that we would
have changed if we could was perhaps practicing having two interpreters or just hav-
ing one interpreter there so that there would be no confusion.
11. Group Follow-up: If we were to visit the school again and plan a follow-up lesson, we
would have the students act out the story. With the help of them knowing the story, as
well as seeing the story acted out for them, we feel that it would be beneficial to have
the students even more involved.
Lesson Plan II: The Foolish Tortoise
1. Grade Level: Preschool
2. Duration: Thirty minutes
3. Concepts: Fast/Slow
4. Objectives:
a. The students will identify (shape, size, sound of) the timpani. (Knowledge)
b. The students will demonstrate through movement how a tortoise moves. (Skill)
c. The students will follow and play the timpani during a guided musical story sequence
(Skill and Knowledge)
d. The students will discuss the instruments they enjoyed listening to and playing the
most. (Affective)
5. New Jersey State Standards:
Content Area Visual and Performing Arts Standard, 1.3 Performance. All students will
synthesize those skills, media, methods, and technologies appropriate to creating, per-
forming, and/or presenting works of art in dance, music, theatre, and visual art.
Strand B. Music
Content Statement: Creating and performing music provides a means of self-expression
for very young learners.
1.3.P.B.4 Listen to, imitate, and improvise sounds, patterns, or songs.
6. Vocabulary: Tortoise, Timpani, Fast, Slow
7. Materials:
a. The book, The Foolish Tortoise by Eric Carle
b. Stuffed Animal Tortoise
c. Animal costumes
i. Tortoises: Brown or green shirts with turtle shells (comprised of two panels
(front (brown) and back (green) and held in place with two stripes of brown
fabric that rest on the wearer’s shoulders)
ii. Wind/Storm—Blue shirt covered with dark blue felt strips and yellow lightening
bolts and move
iii. Tree: Brown shirt with cardboard tree attached in front
iv. Snake: Green shirt; attach snake tongue (made of felt) to chin
v. Bee: Yellow shirt with black felt strips (Bumblebee headband)
d. Instruments:
i. Timpani
ii. Kazoo
iii. Maraca/Egg Shaker
iv. Large Drum
v. Sleigh Bells
vi. Glockenspiel
vii. Cabasa
viii. Slide Whistle

ix. Slapstick
x. Rain stick
xi. Woodblocks
xii. Wooden Xylophone
xiii. Triangle
e. Procedure
i. Anticipatory Set: The teachers will introduce the story, The Foolish Tortoise by
Eric Carle.
ii. The teachers will introduce each sound from the story with its corresponding
instrument.
1. Tortoise: Timpani
2. Hornet: Kazoo
3. Snake: Maracas/Egg Shakers
4. Thunderstorm: All instruments with slapstick
5. Breeze: Rain Stick
6. Slow: Slow hits on a big drum
7. Fast: Low to High on Bells
8. Hooray: Sleigh Bells
9. Tree: Shaker with metal beads
10. Flood: Two high notes on Bells
11. Swooping: High to Low pitch on slide whistle
12. Goggle Eyed: Different pitches on slide whistle
13. Shivered: Wood blocks
14. Bold: Low notes on Wooden Xylophone
15. Roam: Arpeggio on Xylophone
16. Goodnight: Slow hits on a triangle
iii. The teachers will demonstrate for the students how to play the timpani and ex-
plain how it represents the Tortoise. A practice period will follow.
iv. The teachers and students will perform the story.
v. The teachers will ask the students at the end of the story the instrument they
enjoyed listening to and playing the best.
vi. Extended Activity: Invite students to participate in a small Petting Zoo of the
instruments.
8. Group Evaluation: Today, we presented The Foolish Tortoise to the class using timpani and
other percussive instruments to represent various action words/objects and characters
throughout the story. Selecting the timpani to represent the tortoise had positive and
negative results. The timpani’s intense sound enabled the students to feel vibrations
and its large size allowed multiple students to stand around a single drum. However,
because of the nature of the instrument, the activity was harder to control. The students
were so excited that they immediately began playing it before instruction began! Had
we the full time to present our anticipatory set, we could have taught the proper way to
strike the timpani, which would have contributed to a more orderly lesson. The students
had a positive reaction to the various instruments, overall. One student was particularly
interested in the bells. The students satisfied the goal of the lesson, to play the timpani
every time the word tortoise was presented.
9. Group Follow-up: Next time, we will present a lesson that requires even more student
participation. Since the students’ attention went directly to the timpani and away from
us even before the introduction was complete, the anticipatory set will be concluded
before the students receive their instruments.
CONCLUSIONS
“How can music education student teachers as well as new teachers pre-
pare themselves for the diversity of the music classroom?” Having a gen-
eral understanding of both special education and disability rights laws
that provide for the rights of students with special needs can provide a
foundation for success in the music classroom. These laws and related
terms are summarized in Tables 5.1 and 5.2.
Music education students should be familiar with and gain practice
integrating both state and national standards for music education into
Table 5.1 UNITED S TATE S SPECIAL EDUC ATION AND DISABILIT Y

RIGHT S L AWS
Law Overview
The United States Rehabilitation Act Was the first “rights” legislation to prohibit
the discrimination of people with disabilities
specifically in programs conducted by Federal
agencies.
The Americans with Disabilities Prohibits the discrimination of those with
Act (ADA) disabilities. Title II of ADA applies to public
school service programs specifically that all are
to be accessible to children with special needs.
Such activities including those that are open to
parents and the public at large such as gradua-
tion ceremonies, parent-teacher organizations,
meetings, and plays.
The Individuals with Disabilities Governs for the needs (i.e., early intervention,
Education Act (IDEA) special education, and related services) for chil-
dren, ages birth to twenty-one, with disabilities.
IDEA is comprised of six IDEA is comprised of
six guiding principles: free and appropriate pub-
lic education (FAPE), zero rejection, appropriate
initial identification and testing procedures, due
process, least restrictive environment (LRE), as
well as parental and student involvement.
The No Child Left Behind Act (NCLB) Was enacted in order to improve the academic
(Public Law 107-110) achievement of all students regardless of race,
ethnicity, socioeconomic status, language
skills, or disability. It was also ratified to lessen
the consistently pervasive achievement gap in
American public schools.
Table 5.2 OTHER TERMS A SSOCIATED WITH UNITED S TATE S SPECIAL

EDUC ATION AND DISABILIT Y RIGHT S L AWS
Term Definition
FAPE An educational program that is individualized to a specific child,

designed to meet that child’s unique needs, emphasizing a special
education and related services.
Zero Rejection Prohibits the exclusion of a child with disabilities, regardless of how
severe, from a public education.
Initial identification Schools are required to evaluate the child using a variety of
and testing procedures standardized testing measures and procedures. Tests must be
non-discriminatory and resulting decisions cannot be made on the
basis of a single test score.
Due Process Parental consent must be obtained prior to any testing procedures
and placement decisions and parents must have access to all doc-
umentation and scheduled meetings. In cases where there is disa-
greement regarding evaluation results, an independent evaluation
can be requested. Further mediation may result, if necessary.
Least Restrictive One of six principles of IDEA, place children with special needs
Environment (LRE) in a situation in which they can succeed and grow. A placement is
considered to be restrictive if the child’s opportunity to interact and
learn (social and academic) with his or her peers without disabilities
is minimized. Appropriate settings are determined by a team of
professionals and are based upon the students’ needs and interests.
Parental and student Parents and/or guardians should be a part of IEP meetings and
involvement when deemed appropriate, the child should participate, as well.
Under IDEA, they are assured the opportunity to weigh in on all
aspects of the child’s education.
Mainstreaming Refers to the selective placement of special education students in
one or more “regular” education classes. Inclusion is a term that
expresses commitment to educate each child, to the maximum ex-
tent appropriate, in the school and classroom he or she would oth-
erwise attend. It involves bringing the support services to the child
(rather than moving the child to the services) and requires only that
the child will benefit from being in the class (rather than having to
keep up with the other students).
Inclusion Is implemented by school districts who serve students’ with mild to
severe special needs. Ultimately, inclusion is about the child’s right
to participate, an overall respect for his or her social, civil, and ed-
ucational rights; and the school’s responsibility to accept the child.
Inclusion rejects special schools or classrooms as viable options,
essentially any setting which may separate a student with special
needs from those without.
their teaching. These standards describe what students should know and
be able to do in the arts, grades Pre-K–12 and provide educational goals
from which a curriculum and lesson plans may develop. The alignment of
standards and IEP goals ensures that the student who is deaf or hard of
hearing has access to and participates in a high-quality standards-based
music curriculum, one that is differentiated and culturally relevant and
that provides the supports and accommodations they need to engage in
music content-centered learning activities.
In addition to the cooperating teacher, the music education student
teacher should also consider the advice and guidance of special educa-
tion or deaf education colleagues for adapting curricular materials and
teaching techniques to meet the needs of students who are deaf or hard of
hearing. Such dialogue can lead to collaborations centered on integrative
instructional planning, implementation, and various types of evaluation.
A teacher–parent network can be equally as beneficial for all involved.
Parents can be helpful in this regard as they are familiar with their child’s
interests and abilities. They will be their child’s strongest allies and there-
fore supportive of the musical activities in which their child is involved.
Ultimately, music education student teachers must advocate for them-
selves, taking every opportunity to learn as much about the various excep-
tionalities. This extra attention would include using semester breaks and
holidays to visit public school music teachers for the purposes of observa-
tion, and taking special education courses, provided they fit into their pro-
gram of study. Peers can serve as another resource for the music education
student, particularly those who have spent more time in the music edu-
cation program as they can provide advice about coursework, while also
sharing their student teaching experiences. Program alumni can also be
helpful discussing their real world music teaching experiences. Students
are also encouraged to belong to their collegiate professional organiza-
tions (i.e., collegiate NAfME).

Music Education Student Teachers
In Preparation for Student Teaching or Your First Teaching Job:
1. Research special education and disability rights in your state!

2. Are there specific guidelines for children with hearing loss?
3. What is the class size limit for your state?
4. What are state requirements for student-to-teacher ratios particularly with regard to
children with special needs? Are students with hearing loss assigned a paraprofessional
or aid? A note taker and/or interpreter?
Questions for Your Cooperating Teacher:
1. What students have Individual Education Plans?

2. Can I see pages pertaining to recommended modifications for the student?
3. Are there special considerations I need to make as I prepare my lesson plans?
4. What modifications have you/do you implemented for your special needs learners?
5. Can I observe in a special education classroom?
6. Are there opportunities for integrative lessons with other teachers?
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CHAP T ER 6
Hearing Aids, Assistive Listening

Devices (ALD), and Other
Sensory Devices
H earing aids have evolved since ear trumpets, their acoustic predeces-
sors, were used. These early funnel-shaped devices, typically made of
silver, wood, snail shells, or animal horns, collected sound waves from the
environment and led them to the ear. The result was a strengthened and
more focused level of sound energy to the ear drum, resulting in improved
hearing for the individual with hearing loss. According to Dillon (2001),
these older devices reportedly produced between 5 to 10dB of gain at
middle and high frequencies (p. 13). These seventeenth century acoustic
devices were later followed by the carbon hearing aid (ca. 1899) and the
vacuum tube hearing aid introduced in 1920 (Dillon, 2001, p. 14; Paul &
Whitelaw, 2010, p. 78). The application of the vacuum tube led to hearing
aids with greater amplification capabilities to meet the needs of individu-
als with more severe hearing losses (p. 14). Assistive listening devices were
also reportedly in use during this time (ca. 1916) (Dillon, 2001, p. 14).
Still later, hearing aid devices incorporated transistors (ca. 1953),
paving the way for the spectacle and barrette head-mounted hearing aid
devices (Paul & Whitelaw, 2010, p. 78). The spectacle or eyeglass aid com-
bined glasses with one or two hearing aids and contained the hearing aid
circuitry at the temple of the glasses (Dillon, 2001, p. 11; Sweetow, 2009).
Wearers, however, reported that they were heavy and not particularly
fashionable (Tye-Murray, 2004, p. 243). The barrette-head mounted aids,
on the other hand, were more fashionable and could be worn on or under
the hair (Dillon, 2001, p. 11). As hearing aids continued to evolve, the pop-
ularity of the head-mounted devices waned.
( 178 )
H e a r i n g A i d s , A s s i s t i v e L i s t e n i n g D e v ic e s , a n d O t h e r S e n s o r y D e v ic e s ( 179 )
In this chapter I examine a variety of contemporary hearing aids and as-

sistive listening devices (ALD) in order to help parents with the process of
device selection. A variety of music sensory devices available for music in-
struction are also explored. I close with the topic of noise induced hearing
loss (NIHL), placing emphasis on musicians’ earplugs and informational
resources for parents and music teachers stressing NIHL prevention.
WHAT ARE HEARING AIDS AND HOW DO

THEY WORK?
A hearing aid is a medical device that amplifies sound waves as a means

for improving hearing and speech understanding (Punch, 2004, p. 182;
Turkington, 2010, p. 46). Hearing aids are worn either on or in the ear and
are comprised of a microphone, amplifier/receiver with volume control,
a miniature speaker, a low-voltage (1.3 volt) battery, and an acoustically
designed ear mold (Marschark, 2007, p. 42). Acoustic stimuli or envi-
ronmental sounds enter the hearing aid through the microphone and are
transformed into electrical signals. The electrical signal is then enhanced
or increased in intensity through an amplifier and passed through the re-
ceiver, which is responsible for changing the signal back into amplified
acoustic sound. The amplified acoustic sound is delivered to the users’ ear
canal through an ear mold (Hall & Johnston, 2009, p. 121; Marschark,
2007, p. 42; Northern & Downs, 2002, pg. 304; Punch, 2004, p. 182).
Determining if Hearing Aids Are Necessary:

Testing and Early Research
Determining whether or not a child needs a hearing aid will require a thor-
ough medical exam and hearing evaluation (American Speech Language
Hearing Association, 2012). Many states require testing before a hearing
aid can be purchased. After completing these tests, the audiologist will
determine whether the child can benefit from using hearing aids and may
even make some initial device recommendations (Flasher & Fogle, 2011;
Northern & Downs, 2002). The audiologist will also be able to speak with
parents about realistic device expectations. Two hearing aids (binaural)
are typically recommended unless there are “physical or audiological rea-
sons” why the child should only use one hearing aid device (Thibodeau,
2006, p. 65; Waldman & Roush, 2010, p. 54). Using two hearing aids means
that the child has more sounds accessible to them. This can be important
particularly in the classroom setting as sound location may be improved.

Additionally, binaural hearing aids can promote “stereophonic reception,”
as well as “increased amplification of high frequency sounds” (Waldman
& Roush, 2010, p. 54).
Parents need to research hearing aid devices carefully and compare
prices before purchase, as the cost of hearing aids can range from $1000
to $6000 per ear (Christenson, 2012). They should also contact their in-
surance providers to determine the availability of coverage for hearing
aid devices. Some programs such as Medicaid require that states provide
hearing aid coverage for children as part of the Early Periodic Screening,
Diagnosis, and Treatment (EPSDT) Program (Wiles-Higdon & Mustain,
2011, p. 752). Medicare, however, will not likely cover the costs of hearing
assessments or hearing aids. Coverage varies for private insurance pro-
viders (p. 752). According to the American Speech Language Hearing
Association (2013a), only nineteen states require hearing aid coverage by
health care plans (para. 1). These states do require both hearing aid and
cochlear implant coverage for children (para. 1).
Device Selection
The selection of hearing aid devices goes hand in hand with determining the
mode of communication, a topic discussed more fully in chapter 2 (Thibodeau,
2006, p. 57). Since the selection of a hearing aid device, in particular, makes
hearing loss a visible reality, both decisions can be difficult for parents to
make (Hintermair, 2006; Marriage, 2009, p. 146; Meadow-Orlans, Mertens,
& Sass-Lehrer, 2003, p. 46; Waldman & Roush, 2010, p. 51). As arduous as it is
on the parents, hearing aids, if deemed an appropriate solution for the child,
can make a big difference in his or her speech and language skills develop-
ment, promoting also a better understanding of the world (Thibodeau, 2006,
p. 65; Waldman & Roush, 2010, p. 51).
Parents should work closely with their child’s audiologist to ensure that
the right hearing aid devices are selected. As young children and infants
are unable to make the appropriate adjustments to their own hearing
aids, the selection must include a device that can be monitored and main-
tained by parents or guardians (National Institute on Deafness and Other
Communication Disorders, 2012).
Some audiologists sell hearing aids whereas others may only make de-
vice recommendations. In most states, hearing aids must be fitted and sold
by licensed specialists (i.e., hearing aid dispensers or dispensing audiolo-
gists). Parents should be sure to request a list of local competent hearing
H e a r i n g A i d s , A s s i s t i v e L i s t e n i n g D e v ic e s , a n d Ot h e r S e n s o r y D e v ic e s ( 181 )
aid dispensers from their audiologist. In addition to the purchase of the

hearing aid(s), parents should also consider a multi-year warranty for the
hearing aid device (Northern & Downs, 2002, p. 312).
Once it has been determined that a hearing aid is necessary, the
hearing aid specialist will make impressions of the child’s ears using
a putty-like material from which the hearing aid ear mold is created
(Dillon, 2001). Upon returning to the clinic for the device fitting, the
audiologist will also assess the child’s hearing with the aid. The child
and his or her parents should also consider participating in a Hearing
Aid Orientation (HAO) at this time as this will serve as an introduction
to life with the device (Citron, 2008). HAO sessions will be particularly
important for the parents of younger children who initially will require
more assistance and guidance (Tye-Murray, 2009). During these ses-
sions, the audiologist will address device function, control adjustment,
trouble shooting, maintenance, and overall device care. Topics may also
include coping skills, listening tips, the use of assistive listening devices
in conjunction with hearing aids, as well as recommendations for
addressing ear mold sensitivity, and earwax buildup (Palmer, Lindley,
& Mormer, 2008, p. 153; Stach & Ramachandran, 2010, p. 289). During
these sessions, an older child will also practice putting on and taking off
the hearing aid device, and depending on his or her age, will learn how to
replace the batteries (Palmer, Lindley, & Mormer, 2008, p. 153). The child
will also be introduced to a program for daily appropriate use in order
to become acclimated to the device. This program should be followed for
the first few weeks after receiving the device (Citron, 2008; Tye-Murray,
2009).Within a month of receiving the hearing aid, the child should have
a follow-up meeting with his or her audiologist for a hearing evaluation
to determine if the aid is functioning properly (Madell, 1998). Any nec-
essary adjustments to fit or function will be made at this time to en-
sure the child’s comfort with the device. During the return visit, parents
should be prepared to discuss their child’s progress with the device and,
when able, the child should also be part of the conversation. Properly
working hearing aids combined with consistent use of the device will
help a child with hearing loss to use his or her residual hearing and to
develop speech and language skills (Tye-Murray, 2009).
T YPES OF HEARING AIDS
Hearing aids comprise the primary technology for the habilitation and /
or rehabilitation of sensory hearing loss (Harkins & Bakke, 2003, p. 412).
There are more than one thousand different models of hearing aids avail-
able in the United States alone. They come in many styles, all differing
by size, placement on or inside the ear, and the degree to which they am-
plify sound. Hearing aids can be categorized as follows: ear-level aids,
on-the-body aids, and bone-conduction hearing aids (Northern & Downs,
2002, p. 308–9).
Ear-Level Aids
Ear-level aids such as the Behind-the-Ear (BTE) and In-the-Ear (ITE) aids
store all components within a small case in or near the ear (Gelfand, 2009,
p. 430). These devices comprise a majority of the hearing aids dispensed
within the Unites States (p. 430). BTE aids, though most often recom-
mended for children, are not as popular as the ITE models for cosmetic
reasons (Schaub, 2008).
Behind-the-Ear Aids (BTE)
Ear-level aids such as the BTE device, shown in Figure 6.1, are most com-
monly recommended for children with severe to profound hearing loss. If,
however, the child exhibits poor head control due to a physical disability,
Figure 6.1: Behind-the-Ear (BTE) Hearing Aid, Copyright 2012. Courtesy of Phonak LLC.

he or she may experience consistent feedback with an ear-level aid

(Northern & Downs, 2002, p. 312). In these instances, other hearing aid
recommendations such as the body-worn aid may be made (Dillon, 2001).
BTE hearing aids consist of a customized ear mold and a small curved
plastic case containing the microphone, amplifier, and receiver. The two
are connected by a small piece of plastic tubing. The case is worn behind
the pinna and rests against the mastoid surface, and the ear mold fits into
the ear canal. This device is much less conspicuous than the other hearing
aid models yet it provides the wearer with powerful sound amplification
(and quality). Also, hearing reception is at a more natural position on the
head. BTE aids are reliable, simple to maintain, and easily interchangeable
when service is necessary (Mueller & Bentler, 2012). An added benefit of
this device is that only the ear mold needs to be recast when the child
outgrows the one he or she is wearing (Lewis & Eiten, 2008, p. 97; Mueller
& Bentler, 2012). Therefore, the process of remodeling is much less ex-
pensive for the BTE device than for smaller hearing aids such as the ITE
models. Other adjustments that are typically made to accommodate the
child’s growth and development include frequency response, amount of
amplification, and maximum limits of amplification (Cole & Flexer, 2011;
Northern & Downs, 2002). BTE devices are also easy to clean because the
ear mold is both detachable and washable, which is important for chil-
dren who might experience a buildup of earwax or who may perspire
during recess or gym class. The soft ear mold is also a safer option than
the in-the-ear models during such activities.
The recommended hearing aid should have those features that would en-
able the child to benefit from Assistive Listening Devices (ALD). The BTE
aid, for example, can be fitted with powerful telecoil circuits to allow for
a connection to a classroom FM system (Cole & Flexer, 2011; Tye-Murray,
2004). The telecoil is a small magnetic coil that allows the hearing aid user
to receive sound through the circuitry of the hearing aid as opposed to
its microphone. This makes it easier to hear telephone conversations. The
telecoil also helps people to better hear in public venues particularly those
that have audio frequency induction loop systems. Parents and teachers
should be aware that there is the potential for acoustic feedback due to
close proximity of the microphone and receiver to the ear-mold (Northern
& Downs, 2002, p. 308).
Other features to consider include direct audio input (DAI) coupled with
a telecoil microphone and microphone/telephone option (Dillon, 2012;
Northern & Downs, 2002, p. 312; Palmer & Mueller, 2000, p. 347). This
feature, typically found with Behind-the-Ear (BTE) devices, allows for a
direct connection between the hearing aid and another assistive listening
device. Parents should also inquire about safety features for their very
young child’s device such as childproof battery doors and volume control
covers.
The Over-the-Ear Aids (OTE)

The Over-the-Ear (OTE), or Open-Fit-Style, hearing aid is another type
of BTE device. Typically recommended for adults with mild to moderately
severe hearing loss, this lightweight hearing aid consists of a casement
that rests behind the ear and a tube that runs into the ear canal (Hall &
Johnston, 2009). The tubing for the OTE device ends in a small, soft sili-
cone dome with a highly vented tip that allows for a more natural sound.
The smaller case and thinner tubing make this a more cosmetically ap-
pealing option for hearing aid wearers. This style tends to reduce the oc-
clusion effect though there is an increased risk for feedback.
In-the-Ear Aids (ITE)
The ITE hearing aids as shown in Figure 6.2 are considered to be the most
contemporary and cosmetically appealing of devices (Schaub, 2008).
Typically recommended for adults with mild to severe hearing losses, this
aid is lightweight and fits in the outer ear bowl or the concha1 of the outer
ear (Hall & Johnston, 2009, p. 123). They are not suggested for young
children due to the frequent changes required to the hearing aid in order
Figure 6.2: In-the-Ear (ITE) Hearing Aid, Copyright 2012. Courtesy of Phonak LLC.

to accommodate skull growth. However, this does not mean that older
children and teenagers cannot use these devices (Dillon, 2001). In fact,
as a child reaches adolescence, it is likely that the cosmetic appearance
of the hearing aid device will become a concern. As a result, he or she
may request the smaller, less visible ear-level aids such as the ITE device
(Hodgson, 2001, p. 105). Older children and teenagers can also make color
and style selections for their hearing aids and ear-molds (Lewis & Eiten,
2008, p. 113; Northern & Downs, 2002, p. 312). According to Northern
and Downs (2002) “it is better to fit the growing pediatric patient with a
hearing aid that will be worn willingly and used daily than to force the use
of an unwanted hearing aid that will not be worn” (p. 308).
The ITE case containing the electronic equipment is made of hard
plastic and the fit is more secure. However, device components are report-
edly harder to insert and remove as compared to that of other models.
Additionally, the small battery door size and volume control may also
make adjustments difficult. Still other concerns related to this device in-
clude feedback resulting from the proximity of the microphone and the
receiver, as well as damage due to earwax and moisture buildup.
Parents should consider the practicality of the ITE device (as well as
the others) as part of the selection process. For instance, the smaller
size of the device will make it more difficult for parents and teachers to
determine if the device is on or off or whether the volume control is set
appropriately (Dillon, 2012). Another consideration is that if the thin
shell of the ITE device is broken, it could cause damage to the wearer’s
ear (Dillon, 2012). There is only a slight risk for such damage but the
wearer should be careful during sports activities. Care and mainte-
nance are also factors to be considered when purchasing a hearing aid
for your child.
There are smaller ITE aids that fill only a small portion of the concha.
These include the In-the-Canal (ITC) aids and Completely-in-Canal (CIC)
aids. Both are designed to fit deeper into the auditory canal and so that
they are less visible to others (Hall & Johnston, 2009, p. 123). The ITC and
CIC devices are shown in Figures 6.3 and 6.4, respectively. Specific ben-
efits of the ITC aids include the position of the microphone that enhances
the amplification of higher frequency sounds (Hall & Johnston, 2009,
p. 123). Also, the proximity of the ITC receiver to the ear drum means
that less volume or gain is required to provide the wearer with appro-
priate amplification (Hall & Johnston, 2009, p. 123; Tye-Murray, 2004,
p. 246). Specific advantages of the CIC aid include better sound quality and
improved telephone use. CIC wearers are also less likely to need assistive
listening devices (p. 247).
Figure 6.3: In the Canal Aid (ITC) Hearing Aid, Copyright 2012. Reproduced with the
permission of Starkey Hearing Technologies (2012). Copyright 2012 Starkey Hearing
Technologies. All Rights Reserved.
Figure 6.4: Completely in the Canal Aid (CIC) Hearing Aid. Reproduced with the per-
mission of Starkey Hearing Technologies (2012). Copyright 2012 Starkey Hearing
Technologies. All Rights Reserved.
On-the-Body Aids
On-the-body or body-worn aids are approximately the size of a deck of

cards. They can be worn on the torso, contained either in a shirt pocket
or attached directly to a shirt (Dillon, 2001, p. 10). The casement houses
the circuitry of the device and is connected to the ear mold by a cord
(Tye-Murray, 2004, p. 242). These represent a very small percentage of the
aids used today; however, they do have many benefits (Mueller & Bentler,
2012; Sweetow, 2009). For example, the body-aid provides powerful am-
plification, due to the size of the battery, and can be worn by those with
severe to profound deafness (Sweetow, 2009). These devices are durable
and have large controls that can be managed by those with limited dex-
terity (Tye-Murray, 2004, p. 242). Damage to the device or loss is mini-
mized as the body-aid is affixed to the child via a harness (Northern &
Downs, 2002, p. 309). Despite these benefits, many wearers cite disad-
vantages including both physical and emotional discomfort because of
the size and visibility of the body-aid (Tye-Murray, 2004). The cords have
also been described as cumbersome and some wearers have reported that
they are easily tangled in clothing. Also, if the power supply is worn under
clothing, noise can result when fabric rubs against the microphone. The
microphone for the body-worn devices is not at ear level so it does not
provide natural sound reception at the ear (Lokanadha-Reddy, Ramar, &
Kusuma, 2010, p. 111).
Bone-Conduction Hearing Aids
Bone-conduction hearing aids bypass the outer and middle ears. These aids
boost natural bone transmission and use it as a pathway through which
sound can travel to the inner ear. The traditional bone-conduction hearing
aid consists of a body-worn aid and a vibrating bone conductor that is
affixed to a headband (Dillon, 2001, p. 442). The headband secures the
vibrating component tightly to the skull directly behind the ear. Sounds
are perceived when the resulting vibrations are transmitted directly from
the bone conductor of the hearing aid through the skull to the cochlea.
These devices are suitable for those with conductive hearing losses who
cannot wear conventional hearing aids due, for example, to continuous
ear infections or malformation of the outer or middle ear (Dillon, 2001,
p. 442). Some of the disadvantages of this device include visibility of the
device, headaches, and sore skin resulting from the pressure of the head-
band (Dillon, 2001, p. 447).
Bone-Anchored Hearing Aid (BAHA)

A more recent type of bone-conduction device is the bone-anchored hearing
aid (BAHA) shown in Figure 6.5. The BAHA consists of three parts, a ti-
tanium implant, external abutment, and sound processor (National
Institute on Deafness and Other Communication Disorders, 2012;
University of Maryland Medical Center, 2012). This device also conducts
sound through bone rather than through the outer and middle ears. The
sound processor transmits sound vibration through the external abut-
ment to the implant. The implant that is surgically placed in the skull
bone behind the ear sets up vibrations within the skull and inner ear and
then stimulates the hair cells of the inner ear (Dillon, 2001; University of
Maryland Medical Center, 2012). Candidates for the BAHA include indi-
viduals with conductive, mixed, or unilateral hearing losses. In particu-
lar, the device is well suited to those who experience chronic ear infection
or who have a malformation of the outer ear and are therefore unable
to wear conventional hearing aids (National Institute on Deafness and
Other Communication Disorders, 2012; University of Maryland Medical
Center, 2012).
Sound Processor
Coupling
Abutment
Implant
Vibrations
Inner ear
Figure 6.5: Bone-Anchored Hearing Aid System: Cross section of ear showing BAHA
components in place. Courtesy of Oticon.
Middle-Ear Implant (MEI)
Another alternative to the traditional hearing aid is the middle-ear implant
(MEI), also referred to as a fully or partially implanted hearing aid. This
device stimulates the bones of the middle ear and is used to treat indi-
viduals with sensorineural, conductive, and mixed hearing losses (Dillon,
2001, p. 449; Zenner & Rodriguez, 2010, p. 72). The MEI is comprised of an
externally worn component referred to as the audio processor, an internal
receiver (vibrating ossicular prosthesis) and floating mass transducer. The
audio processor that supplies the power for the implant system consists of
a battery, a microphone, and the electronics responsible for digital signal
processing. The processor, positioned behind the ear and held in place by
a magnet implanted underneath the skin, converts sounds from the envi-
ronment into mechanical vibrations that are then transferred across the
skin electromagnetically to the implanted receiver. The receiver transmits
this information to the floating mass transducer that directly stimulates
the ossicles of the middle ear thus impacting the inner ear (Snik, 2011,
p. 86). The MEI reduces issues of occlusion and feedback and also has
improved sound quality. However, it does tend to be expensive, and has
some associated surgical risks and technical issues (p. 86).
Analog versus Digital Hearing Aids
Hearing aid technology has changed drastically since the mid-1990s.

Hearing aids no longer function using an analog system. Instead these are
digital devices with electronic processors (DiGiovanni, 2010; Gargiulo &
Kilgo, 2010, p. 267; Schaub, 2008, p. xi).
Older analog hearing aids amplified all sounds equally including those
that the hearing aid user is actually trying to hear (i.e., a class discussion/
instruction, music). The design of the older conventional analog hearing
aids centered on a particular frequency response. Such devices contained
a microchip that allowed them to be programmed for different types of
listening environments including noisy settings such as the school cafe-
teria, gymnasium, or auditorium, and quieter settings such as the school
resource room for one-on-one or small group instruction. The settings
were determined by the child’s hearing loss profile, his or her ability to
comprehend speech, and tolerance for louder sounds.
Digital aids are designed to amplify only those frequencies that cor-
respond to the child’s hearing loss so that only the signal and not the
noise is amplified (Marschark, 2007, p. 42). The current availability of pro-
grammable and digital-based devices has proven to be especially useful in
fitting children with the appropriate amplification (Northern & Downs,

2002, p. 305).
Digitally programmable hearing aids have exceptional sound qual-
ity. These hearing aids not only contain the features of analog pro-
grammable aids but also utilize digitized sound processing (DSP) so as
to convert sound waves into digital signals. A computer chip housed
within the aid analyzes the signals for the purposes of determining
whether the sound is noise or speech. The chip self-adjusts appropri-
ately so that the wearer receives a clear, amplified, distortion-free
signal. Digital processing allows for more programming flexibility so
that the sound to be transmitted aligns with the child’s specific hearing
loss. Typically, the digital aids represent the most expensive of hearing
aid equipment. However, they provide the wearer with numerous ben-
efits including a longer device life span, improved programming, noise
reduction, greater control of acoustic feedback and loudness levels,
as well as a better overall fit. Digital aids have multiple memories for
storing different prescriptive programs, enabling the wearer to make
adjustments that accommodate the listening environment (Northern
& Downs, 2002, p. 307; Thibodeau, 2006, p. 69). The controls for such
adjustments are located in the device.
MONITORING HEARING AID DEVICES
Parents and guardians should take the following steps each day to en-
sure that their child’s device is functioning properly. First, a parent
should conduct a visual examination of the device to make sure that all
external controls (i.e., volume) are working properly. Ear-mold tubing
should be checked to ensure that it is free of fissures, holes, or twisting.
Parents should also inspect the ear mold daily for any signs of moisture
and earwax buildup. Soft clothes and the appropriate wax removal tool
can be helpful in maintaining the device and are typically obtainable from
the audiologist (Children’s Hearing Aid of Pittsburgh, 2010, “Caring for
Hearing Aids and Earmolds,” para. 2; Wayner, 1990, p. 14).
It is vital that parents and guardians test hearing aid function
each day prior to wear, listening in particular for static or crackling.
Additionally, the Ling Six Sound Test is another simple way to monitor
the functioning of hearing aids and cochlear implant devices (Ling,
1978, 1988, 2002). One of the great benefits of this test is that it is
easily usable by parents, teachers, audiologists, and speech language
pathologists (Children’s Hearing Aid of Pittsburgh, 2010, “Caring for
Hearing Aids and Earmolds,” para. 3; Smiley, Martin, & Lance, 2004;
Wayner, 1990, p. 14).
The Ling Six test is comprised of familiar speech sounds that broadly
represent the speech spectrum (250–8000 Hz) (Smiley et al., 2004). The
spectral range incorporated in the Ling test mirrors standard audiometry.
The test is comprised of isolated phonemes, specifically [m]‌, [ah], [oo], [ee],
[sh], and [s], to target low-, middle-, and high-frequency sounds (Smiley
et al., 2004.) According to Ling, one’s ability to hear all six of the sounds
implies one’s ability to hear or detect all other speech sounds (1978). The
test may even be administered daily to monitor changes in a child’s ability
to hear.
To administer the Ling Six test, the parent, guardian, or educator
should first begin by vocalizing the test sounds, with his or her mouth
hidden from the child’s view. When a sound is perceived, the child is
to respond by clapping, dropping a toy, or raising his or her hand. The
response should also be determined prior to testing. If the child is sud-
denly unable to detect sounds that were perceivable by them previously,
then the device may be malfunctioning (Tye-Murray, 2004, p. 751).
When a problem with the device has been identified then a call to an
audiologist is imperative.
Parents and guardians should also inspect the battery to determine if it
has a full charge or if a change is necessary prior to use. This process is typ-
ically introduced during the hearing aid orientation. Storage is also very
important. When the device is not in use, wipe it clean and turn it off with
the battery compartment door left open. The storage area should be dry
and cool during the day and at night in a dry-aid or dehumidifier (Children’s
Hearing Aid of Pittsburgh, 2010, “Caring for Hearing Aids and Earmolds,”
para. 5). On a weekly basis, remove the ear mold and tubing for cleaning
in warm water and mild soap. These components should be dried over-
night and reattached the next day. An ear mold aid blower is also available
from the audiologist and will assist the parent or guardian in removing
any moisture from the tubing (Children’s Hearing Aid of Pittsburgh, 2010,
“Caring for Hearing Aids and Earmolds,” para. 6; Wayner, 1990, p. 14).
ASSISTIVE LISTENING TECHNOLOGY FOR THE

HOME AND CLASSROOM
Children and teenagers can benefit greatly from Assistive Listening Devices
(ALD), also referred to as Assistive Listening Systems (ALS) or Hearing
Assistive Technology (HAT), whether used in the school or home setting.
The most significant factor limiting the benefit of hearing aids tends to
be environmental noise (Cole & Flexer, 2011, p. 140; Northern & Downs,
2002, p. 327). Such devices depend on their proximity to the speaker in
order to achieve high signal-to-noise effect. Proximity is hard to control in
the classroom or other school environments such as the cafeteria or gym-
nasium because as the teacher moves away from the child, the increase in
distance contributes to a breakdown or weakening of signal amplification.
The hearing aid user is then faced with a weak sound signal that he or she
tends to modify by increasing the gain of their hearing aid device. The
outcome is both an increase in background noise and a masking effect that
occurs when one sound is masked or covered by a louder sound.
The development of oral expressive language is dependent on the clarity
and completeness of the speech signal. Therefore, it is vital to improve
the speech-to-noise ratio for all learning environments (Cole & Flexer,
2011, p. 140; Estabrooks, 2006; Ling, 2002). Coupling hearing aids with
assistive listening devices addresses this issue. Assistive listening devices
contain a microphone, transmission technology, and a device for both re-
ceiving the signal and for bringing the sound to the ear, making it possible
for the person using the device to focus solely upon speech sounds (Flexer,
Smaldino, & Crandell, 2005). Assistive listening devices include FM sys-
tems, sound field amplification systems, audio frequency induction loop
systems, and infrared systems (Marschark, 2007, p. 43).
Assistive listening devices enable the child to separate speech sounds
from other sounds typically found in the classroom or rehearsal setting
(Bess & Humes, 2009). They help to minimize background noise and re-
duce the effect of distance between the child and the sound source.
These devices also minimize the effects of poor room acoustics (i.e., re-
verberation) by improving what is referred to as the signal-to-noise-ratio
(Boothroyd, 2002; Cole & Flexer, 2011; Marschark, 2007). The signal-to-
noise-ratio (S/N) is the relationship between the primary speech signal
and background noise. According to Flexer, Smaldino, and Crandell
(2005), an S/N ratio of approximately +20 dB is needed for children with
a hearing loss. Frequency modulation (FM) and sound-field systems can
boost the S/N ratio for a typical classroom in which the ratio averages
about +4 dB leaving a deficit of 16 dB.
FM Systems
Personal FM systems are imperative for a child with hearing loss who
is a part of an inclusive classroom setting (Bess & Humes, 2009). FM
systems offer a direct line of communication between the teacher and

student in any communication situation by providing a positive and con-
sistent S/N ratio (Cole & Flexer, 2011, p. 142). Teachers wear a microphone
that is attached to an FM transmitter and the child will have an FM re-
ceiver attached to his or her hearing aid. These components are shown in
Figures 6.6a and 6.6b. The child can be at a maximum distance of 50 feet
of the person who is speaking (i.e., teacher, peer, and teacher’s aide) as the
system is not hampered by wires between child and teacher. Essentially,
the device is an FM radio that transmits and receives a single frequency.
(a)
(b)
Figure 6.6 (a, b): Amigo FM system including the educational transmitter (a) and the
multi-channel receiver (b). Courtesy of Oticon.
There are two different FM system models. The first device incorpo-
rates the FM system into the ear-level hearing aid case. The other con-
sists of a small FM receiver boot that is attached directly to the bottom
of the ear-level hearing aid or to the speech processor of the cochlear
implant, introduced in chapter 7. According to Marschark (2007), these
smaller devices provide a cleaner sound and are able to bypass issues of
background noise and masking, therefore providing the child with more
sound information (p. 44). Overall, FM systems offer mobility and flex-
ibility for both the teacher and student without impacting the sound
signal. It is important to note that there is a growing body of research that
has also revealed the benefits of FM systems for infants and toddlers in
the home (Bess & Humes, 2009; Moeller, Donaghy, Beauchaine, Lewis, &
Stelmachowicz, 1996).
Sound Field Amplification Systems
Sound field amplification systems are educational tools that allow for
the control of the classroom environment by facilitating the acoustic
accessibility of teacher instruction for all children (Flexer, Smaldino,
& Crandell, 2005). As with the FM system, the teacher wears a wire-
less microphone transmitter. The teacher’s voice is then sent via radio
waves (FM) or light waves (infrared) to an amplifier that is connected
to a number of ceiling mounted loudspeakers. This allows the teacher
to move freely throughout the classroom (Cole & Flexer, 2011, p. 148).
These devices are designed to ensure that the entire speech signal, in-
cluding weak high-frequency consonants, reach all children in the class-
room (Bess & Humes, 2009).
Audio Frequency Induction Loop and Infrared Systems
Audio frequency induction loop systems, also referred to as loop, loop sys-
tem, or hearing loop, are comprised of an electronic telecoil located in the
hearing aid. The telecoil picks up the magnetic signals generated by a tel-
ephone handset or closed circuit loop system and sends that information
directly to the hearing aid receiver. Sound signals are generated by a loop
that is either located on the ceiling or the floor. Another type of assistive
listening device is Infrared Technology (IR) that utilizes light-based tech-
nology. Such devices are frequently installed in places of entertainment
and are also designed for home use.
LISTENING TO MUSIC THROUGH HEARING AIDS

AND ASSISTIVE LISTENING DEVICES
Experienced hearing aid users have reported that music does not sound
the same with their digital hearing aids as compared to their older analog
devices (Chasin, 2011; Healthy Hearing, 2008; Hearing Link, 2013). The
distortion occurs because hearing aids are traditionally programmed to
make the most of the high frequencies found in speech rather than the
lower frequencies of music (Hearing Link, 2013). The tendency of current
devices to filter these lower frequencies makes the music sound unnat-
ural or even distorted as they pass through the hearing aid (Chasin, 2011,
2012; Healthy Hearing, 2008; Hearing Link, 2013; Ross, 2009).
Advances in hearing aid technology have led to improved music lis-
tening. Hearing aid programs specific to music switch off or deactivate
optimal speech settings so that the quality of the music is maintained.
These music-specific features can be discussed with your child’s audiolo-
gist (Healthy Hearing, 2008, “How Do Hearing Aids Affect the Enjoyment
of Music,” para. 2).
Your child’s audiologist may be able to apply settings that replicate ex-
isting programs if his or her hearing aid does not have a specific music pro-
gram (Hearing Link, 2013, “Music and Hearing Loss,” para. 3). Examples
include extending the hearing aid’s low-frequency range and disabling
the feedback manager, and/ or reducing the noise reduction settings
(Hearing Link, 2013, “Music and Hearing Loss,” para. 3). Chasin (2012)
recommends four strategies to help improve the “fidelity of music” for the
hearing aid user (para. 2). The first suggestion involves turning down the
input or stereo while turning up the volume of the hearing aid (Chasin,
2012, “Four Strategies to Improve Music Listening through Hearing
Aids,” para. 2). The second strategy involves having the hearing aid user
remove his or her device for the purposes of music listening (para. 2). The
third suggestion is the easiest to implement and involves using Scotch
tape as a microphone covering (para. 3). This has the same effect as using
a microphone with less sensitivity because the tape “shifts its ability to
transduce sound downwards by about 10 dB for three or four layers of
the tape” (para. 3). As a result, “A/D converter is then presented with a
signal that is 10 dB less intense” and therefore more likely to be “within
its optimal operating range” (para. 3). Chasin cautions that there is some
trial and error involved and suggests also that the hearing aid user exper-
iment with up to three pieces of tape over the device’s microphones. The
fourth and final recommendation is to change the musical instrument.
This successful strategy, frequently implemented by musicians, has to do
with the selection of an instrument that is more perceivable by the indi-

vidual or more specifically one that “has more of its energy in an audio-
metric region of better hearing” (para. 3). Since the above suggestions are
geared towards older hearing aid users, parents should help their child
to adjust his or her hearing aid settings for music listening. Also, as their
children begin to express more of an interest in music or as music class
involvement increases, parents are encouraged to discuss music listening
options with their child’s audiologist.
Researchers are now trying to identify and isolate the problems that
hearing aid wearers experience when listening to music. They are also
trying to determine if certain types of genres are of particular diffi-
culty. Other research focuses include determining the benefits of current
hearing aids for music listening and whether the benefit relates to the
hearing aid wearers degree and type of hearing loss.
Advances in technology have also led to improvements in the effec-
tiveness of assistive listening devices (ALD). These devices can now do
a better job of bringing higher-quality sounds from your child’s music
player, phone, and computer, for example, to his or her ear (Hearing &
Balance Institute of the Rockies, 2013, “Assistive Listening Devices,”
para. 2). Hearing aids with BlueTooth® technology, coupled with contem-
porary ALD devices, allow for an even easier connection to MP3 player
devices. Additionally, your child can also enjoy listening to music wire-
lessly through his or her hearing aids from an MP3 player (para. 3).
MUSICAL SENSORY DEVICES FOR INDIVIDUALS

WITH HEARING LOSS
There are a number of music sensory devices and computer programs that
have been used with the deaf and hard of hearing as well as with other
special needs populations. Those included herein are particularly notable
for their effective results and because they are both user-friendly and ac-
cessible to parents, teachers, and children.
Radio Baton
The radio baton was invented by Max Mathews (1926–2011) and built by
Tom Oberheim (Grimes, 2011). Mathews has long been considered the
“Father of Computer Music.” The radio baton, as shown in Figure 6.7, con-
sists of two batons, an antenna board, and an electronics box. The batons,
Figure 6.7: The Radio Baton. Courtesy of Susan DeFurianni of DeFurianni Arts.
comparable to timpani mallets, house antennas that when moved over the
antenna board, allow the performer to spatially manipulate the tempo,
dynamics, and balance of a digitized orchestral composition stored on a
computer. The performer moves the batons in a manner similar to the way
a conductor leads an orchestra. Only ten wireless radio batons are in exist-
ence today (Grimes, 2011). The radio baton controls sounds that are much
lower and higher than many acoustic musical instruments and it creates
more intense vibrations. This device has been a featured part of the Kean
University Concert Series for the Deaf that is described in more detail in
chapter 5. The responsiveness of the children who have both enjoyed radio
baton performances and have had the opportunity to play this unique
instrument is palpable.
The Sound Cradle and Sansula
While doing research for this project, I came across the sound cradle, a
very interesting instrument most typically aligned with sound therapy.
To quote sound therapist, U. Muckenhumer (personal communication,
December 10, 2012), “the sound cradle has a trance-inducing effect. The
richness of the sound cradle’s natural tones embraces both the listener
and the performer, guiding each into deeper planes of consciousness.”
The sound cradle originates from the Monochord and is long and
rounded similar to the interior part of a cradle though the wood is not
quite as thick. The sides of the instrument are equipped with numerous
strings extending the length of the instrument. Strings on one side are
tuned to A while those on the opposite side are tuned a perfect fifth higher
(E). Additional strings, easily discernible from the others because they
are white, produce the same pitches though an octave lower. Together,
these strings offer a sonorous sound spectrum that is easy to harmonize
(Gandharva Loka: World Music Store, 2012b). The most impressive and
important aspect of this instrument is the resulting vibrations that can
be felt from head to toe as the strings are plucked. The sound cradle is
illustrated in Figures 6.8 and 6.9.
The sound cradle, wildly popular in Europe and Canada, is now
beginning to make itself known in the United States. This instrument has
been used in many educational and therapeutic settings with both chil-
dren and adults. In particular, the sound cradle has been used to soothe
individuals undergoing cancer treatment and to aid in the rehabilitation
of those who have experienced trauma induced syndromes (Gandharva
Loka: World Music Store, 2012b). The benefits of using such an instrument
Figure 6.8: The Sound Cradle, Front View, Photos by Susan DeFurianni of DeFurianni
Arts; Courtesy of Allton & Gandharva Loka World Music, 1650 Johnston Street,
Vancouver, British Columbia, Canada, www.gandharvaloka.com
Figure 6.9: The Sound Cradle, Side View, Photos by Susan DeFurianni of DeFurianni Arts;
Courtesy of Allton & Gandharva Loka World Music, 1650 Johnston Street, Vancouver,
British Columbia, Canada, www.gandharvaloka.com
with a child who has hearing loss lie in the design of the instrument. The
hollowed portion of the sound cradle serves as a resonating chamber and
it is within this hollow portion that a child can sit or lie down. The result
is intense vibrations from the strings that can be felt throughout his or
her whole body.
A smaller version of this instrument, often referred to as the little sister
of the sound cradle, is the Sansula, created by Peter Hokema (Gandharva
Loka: World Music Store, 2012a). Similar to the African kalimba or mbira,
this instrument produces wonderful melodies when the tines are plucked
by the thumbs. The sansula is tuned in the key of a-minor and additional
tines produce the pitches, b and f (Gandharva Loka: World Music Store,
2012a). The melodies produced are pleasing and when placed on the body
or a drum head, the vibrations of the instrument can be intensified.
A similar effect may result when the performer alternatively raises and
lowers the instrument while playing (Gandharva Loka: World Music Store,
2012a). The greatest advantage of the Sansula is its easy use. Everyone
can play it without learning a specific playing technique first and produce
intuitive melodies and free rhythms. Infants have even enjoyed it for its
soothing effect.
Figure 6.10: The Remo Synthetic Sansula, mounted (left) and unmounted (right). Photos by
Susan DeFurianni of DeFurianni Arts; Courtesy of Hokema & Gandharva Loka World Music,
1650 Johnston Street, Vancouver, British Columbia, Canada, www.gandharvaloka.com
There are three types of sansula and each differs based on the type of
material used for the drum head. The sansula with the goat skin drum head
is considered to be the most durable of the three. The Renaissance sansula,
illustrated in Figure 6.10, has a synthetic drum head, is natural looking
in appearance, and is humidity proof. Either of these two sturdier sansu-
las are strong enough for use with younger students, however the sansula
with the drumhead constructed with thin parchment is more delicate and
requires more careful maintenance, and as such it would be suited only
for older students (C. E. Barrineau, personal communication, October 26,
2012; U. Muckenhumer, personal communication, December 10, 2012).
Both the sound cradle and the sansula can be used in therapeutic settings
or in the general music classroom to promote spontaneous music-making
and improvisation. They can also be included in Orff ensembles and as
part of multicultural music lessons.
The Electro-Acoustic Musically Interactive Room (EAMIR)
The Electro-Acoustic Musically Interactive Room (EAMIR) was created

by VJ Manzo, author of Max/MSP/Jitter for Music: A Practical Guide to
Developing Interactive Music Systems for Education and More (2011). EAMIR
is an open-source music technology project developed for teachers, par-
ents, and music therapists who can download the application to their Mac
or PC for classroom, therapy session, or personal use. EAMIR software
applications have been used in a variety of classroom settings and is in-
cluded herein for its use and subsequent benefits for special needs popula-
tions (Manzo, 2007a).
EAMIR incorporates alternate controllers, sensors, and adaptive
instruments to facilitate music instruction, performance, and composi-
tion all through a collection of interactive music systems. EAMIR floor
tiles are featured in Figure 6.11. Controllers can be played with minimal
body movement. For example, one program, called Lazy Guy, requires the
student to wave a laser pointer in the air in order to create and perform
music. The color of the laser pointer is tracked by the EAMIR software
and, depending on the horizontal orientation of the pointer, a wide range
of notes can be produced (Manzo, 2007b). As with all EAMIR programs,
practical use and demonstration videos are available for teachers and
therapists. Another program that can be used for lessons emphasizing
the creation of song melodies and accompaniment is the EAMIR Smart
IWB as shown in Figure 6.12. This program enables users to play chords
by clicking on the screen. Teachers can modify settings for chords such
as the number of chord tones played, tempo, and timbre to accommodate
the students. The program can be operated by the music teacher and stu-
dents via computer mouse, touch-screen computer, or interactive (smart)
whiteboard (Manzo, 2009). EAMIR essentially bypasses the physical and
Figure 6.11: EAMIR Floor Tiles. Courtesy of VJ Manzo at vjmanzo.com

Figure 6.12: EAMIR Smart Board. Courtesy of VJ Manzo at vjmanzo.com
technical limitations sometimes found with acoustic instruments thus

ensuring that music is accessible to all children. Additionally, teachers and
therapists can control for a variety of musical variables such as key sig-
natures, chords, and dynamics in order to promote creative activity. The
tactile nature of this device, coupled with its accessibility, makes this an
outstanding educational and therapeutic tool for music teachers, parents,
and children with hearing loss.
Still other devices and resources include The Vibrato System designed
by graduate student Shane Kerwin in 2005. This device, connected to a
speaker, transmits the vibrations from the instruments being performed
via five different finger pads so as to allow the wearer to feel the difference
between rhythms, pitches, and timbres. Kerwin’s Vibrato System makes it
possible for people who are hard-of-hearing or deaf to experience musical
performance in a “more dramatic and sophisticated way” (CNN, 2005).
PREVENTING NOISE-INDUCED HEARING

LOSS: PROTECTIVE GEAR AND RESOURCES
We have looked at devices that not only amplify sound but bring sound di-
rectly to the listener. It seems appropriate to also address another device—
one that helps to protect hearing and prevent noise-induced hearing loss
(NIHL). Musicians both young and old and music teachers K–12 need to be
aware of NIHL, a permanent type of hearing loss resulting from prolonged
exposure to high levels of noise (American Hearing Research Foundation,
2012, “Noise Induced Hearing Loss,” para. 1). Approximately 5.2 million
children and adolescents, ages six to nineteen years, and twenty-six

million adults, ages twenty to sixty-nine, have experienced permanent
hearing loss. These rates are progressively increasing among various age
groups because of exposure to loud music and the popularity of devices
such as the iPod or MP3 Player.
Reports specifically related to the loss of hearing amongst musicians
have reinforced the idea that repeated exposure to loud music can lead to
hearing damage, in ensembles, practice rooms, lesson studios, as well as
K–12 music classrooms (Ostri, Eller, Dahlin, & Skylv, 1989). While there
is no known cure for NIHL, it is preventable. For example, risk-factors
that contribute to NIHL include playing music at a continuously loud level,
playing loud music containing higher-frequency levels, long exposure
times, as well as poor acoustic design of rehearsal and performance spaces
(Axelsson, Jerson, & Lindgren, 1981; Chesky & Henoch, 2000; Hart,
Geltman, Schupbach, & Santucci, 1987; Kähäri, Axelsson, Hellström, &
Zachau, 2001; Kähäri, Zachau, Eklöf, & Möller, 2004; Kähäri, Zachau,
Eklöf, Sandsjö, & Möller, 2003). Musicians, young and old, who often
spend much of their time practicing, performing, and teaching should
take the necessary precautions in order to conserve their hearing. This
means using the appropriate hearing protective gear, described in the
next section, and resting after long periods of exposure to environmental
sound or music (Bray, Szymanski, & Mills, 2004; DeLay et al., 1991). This
is particularly critical as musicians’ ears need several hours to recover
after such exposure (Bray, Szymanski, & Mills, 2004; Chesky, 2008; DeLay
et al., 1991; Fearn 1993).
Protective Gear for Musicians
Protective gear such as musicians’ earplugs can help to reduce the sound
levels to which musicians are exposed. Earplugs can be purchased with
filters that attenuate at 9, 15, and 25 decibels (dB), respectively (Etymotic,
2013, “Musicians Earplugs,” para. 3). This means that the ear plugs reduce
sound levels evenly across frequencies so that both music and speech are
clear and natural (Etymotic, 2013, “Musicians Earplugs,” para. 3). Filters
are selected based upon the musician’s average daily dose (i.e., the amount
of sound to which the musician is exposed on a daily basis). These earplugs
also allow musicians to hear their own instrument as well as others for the
purposes of blend and intonation (para. 3). The filters for the musicians’
earplugs are designed to reduce all frequencies evenly and can be changed
depending upon the musical setting. Though musicians’ earplugs can be
purchased over the counter, those custom molded by an audiologist en-

sure a secure fit for the wearer.
While the protective gear described above is most appropriate for the
more active musician, it does not mean that hearing protection should
not be made available to a younger child. In fact, there are companies
that manufacture earplugs for children as young as the age of three that
are promoted for use during swimming as well as protection from loud
noise exposure. The National Institute for Occupational Safety and Health
(NIOSH) (2012) recommends an exposure limit of 85 dBA for eight hours
per day (Centers for Disease Control and Prevention: National Institute
for Occupational Safety and Health, 2012). According to these standards,
the National Institute on Deafness and Other Communication Disorders
(NIDCD) therefore recommends hearing protection for anyone experienc-
ing this level of noise exposure. Your child’s activities as well as his or her
comfort level can help to determine whether hearing protectors are nec-
essary. For example, your preteen should wear protective earplugs if he or
she has begun to attend music concerts, particularly if they are in stadi-
ums, gymnasiums, other concert venues. If he or she performs regularly
in band or orchestra, hearing protection is necessary. Sporting activities
like hunting or shooting demand that hearing protection be a part of their
safety gear (It’s a Noisy Planet Protect Their Hearing, 2013, “Sound Advice
for Young Ears,” para. 4). Your child’s body language will also indicate
noise levels that make him or her uncomfortable (i.e., covering ears). In
these instances the NIDCD, in conjunction with the National Institutes of
Health (NIH), recommends having hearing protectors on hand for those
unexpected times when sound levels are too loud (para. 4).
Guidelines for occupational noise exposure have been established by
the Occupational Safety and Health Administration (OSHA). These can be
found at https://www.osha.gov/law-regs.html (United States Department
of Labor: Occupational Safety and Health Administration, 2012).
Resources
Several programs committed to preventing noise-induced hearing loss are

available. For example, The National Hearing Conservation Association
(NHCA) seeks to prevent hearing loss resulting from noise and other en-
vironmental causes as well as to provide opportunities for professional
development and education (Berger, Neitzel, & Kladden, 2008). The NHCA
also aims to serve as a resource for the prevention of noise-induced hearing
loss by promoting the development of effective occupational hearing
conservation programs. Their Hearing Resources for Kids provides parents

and teachers with activities and informational materials for protecting
children’s hearing and Crank It Down, a hearing conservation program
meant to encourage local communities and schools to educate children
and adolescents about the risks of hazardous noise exposures (American
Speech-Language-Hearing Association, 2013b, “Hearing Conservation
for Children,” para. 6; National Hearing Conservation Association, 2013,
“Children’s Hearing Conservation Programs,” para. 1).
The American Speech-Language-Hearing Association (ASHA) developed
the Listen to Your Buds Campaign in order to raise awareness about hearing
health. The campaign targets very young audiences, educating them about
the importance of “practicing safe listening habits,” which include turning
down the volume and taking listening breaks while using their iPods and
MP3 players in order to avoid the lifelong impact of hearing loss (ASHA,
2013c, “About Listen to Your Buds,” para 1).
Dangerous Decibels, a public health educational campaign, was intro-
duced in 1999 with the sole purpose of significantly reducing incidences of
NIHL and tinnitus2 through education, research, and exhibits (Dangerous
Decibels, 2012). This informational campaign represented the collabora-
tive efforts of scientific researchers, clinicians, museum educators, health
communication experts, civic leaders, teachers, and public health profes-
sionals. Partners in this educational venture included Oregon Health &
Science University (OHSU) Hearing Research Center, The Department of
Health Communications at Portland State University, and University of
Northern Colorado. Goals of the Dangerous Decibels campaign included
raising public awareness about the hearing process and hearing loss, edu-
cating people about the sources of loud noise as well as the effects of ex-
posure, and most importantly, protection (Dangerous Decibels, 2012).
Although the museum exhibit closed in May 2011, classroom curricula
and activities for school-age children, international teacher training
opportunities and materials, epidemiological and educational research
components are still available at http://www.dangerousdecibels.org.
The WISE EARS!® campaign was introduced in 1999 by the National
Institute on Deafness and Other Communicative Disorders (NIDCD)
(NIDCD, 2011b). Comprised of a very thorough hearing conservation
curriculum with components for children and their parents, educators,
and the public at large, this campaign includes lesson plans and activi-
ties for grades three through six, questions and answers about hearing,
an interactive sound ruler, and three videos (Folmer, Griest, & Martin,
2002). The NIDCD has since increased its NIHL prevention efforts by
launching It’s a Noisy Planet: Protect Their Hearing, available at www.
noisyplanet.nidcd.nih.gov (NIDCD, 2011a). The Noisy Planet campaign

is geared towards children between the ages of eight and twelve as well
as their parents.
Yet another campaign is Hearing Education and Awareness for Rockers
(H.E.A.R.). Founded in 1988, H.E.A.R is a nonprofit volunteer organiza-
tion committed to raising awareness about the dangers of repeated or
excessive exposure to loud music and environmental sound that can ulti-
mately lead to permanent hearing loss and debilitating tinnitus (H.E.A.R.,
2012). H.E.A.R. has been recognized internationally not only for efforts
to educate the public on the dangers of excessive noise, but for providing
adequate hearing protection for musicians and music fans. Notable pro-
grams include Listen Smart, a “rockumentary” featuring popular musi-
cians such as Ozzy Osbourne and Wyclef Jean who discuss noise-induced
hearing loss. H.E.A.R. also features listening exhibits such as the “It’s Hip
to H.E.A.R.” program, “a national cause-related initiative designed to edu-
cate baby boomers about the importance of hearing health awareness, pre-
vention and treatment” (H.E.A.R., 2012). School programs and workshops
are also available for music schools, conferences, and the music industry.
CONCLUSIONS
Today’s hearing aids, regardless of make, model, or brand, are comprised

of a microphone, amplifier/receiver, speaker, battery, and ear mold. More
than one thousand models of hearing aids are available in the United
States alone, all differing in size, placement, and the degree to which they
amplify sound. They can be categorized as ear-level aids, on-the-body aids,
and bone-conduction hearing aids. Ear-level aids consist of behind-the-ear
(BTE) and in-the-ear aids (ITE). ITEs include the in-the-canal (ITC) and
completely in-canal (CIC) devices, as well. The on-the-body and eyeglass
aids are considered older devices by today’s standards and are rarely
selected over the much-preferred in-the-ear and behind-the-ear aids. Yet
another hearing aid is the bone-anchored hearing aid (BAHA) that uses
direct bone conduction as a pathway through which sound can travel to
the inner ear. The middle-ear implant (MEI) is yet another alternative to
the traditional hearing aid.
Hearing aids can also be distinguished by their technology or cir-
cuitry. In particular, the programmable and digital-based devices have
had a positive impact on ensuring that the appropriate amplification is
selected for a child. Regardless of the device, parents will play an inte-
gral role in helping their child adjust to his or her hearing aid. This vital
role includes monitoring device function, maintenance, and care. The

Ling Six Sound Test is one way to ensure that the device is functioning
properly. This test can be administered daily to monitor changes in the
child’s ability to hear.
Classroom success with hearing aids is an important consideration.
Factors that can limit hearing aid benefits include competing noise in the
classroom and proximity of the hearing aid user to the person speaking.
Using assistive listening devices such as FM systems, sound field ampli-
fication systems, audioloop, and infrared systems in conjunction with
hearing aids can ensure that the child is able to focus solely on speech
sounds. ALDs improve what is referred to as the signal-to-noise ratio
and can be particularly helpful in noisy classroom settings with poor
acoustic conditions (reverberation). Music sensory devices such as the
radio baton (digital), Sound Cradle, Sansula (acoustic), EAMIR (digital),
and the Vibrato System can provide opportunities for an enhanced mu-
sical experience for all children. Still other important devices are those
that help musicians to protect their hearing from noise-induced hearing
loss (NIHL), a permanent type of hearing loss resulting from prolonged
exposure to high levels of noise.

Teachers and Parents
Assistive listening devices such as FM systems and sound field amplification systems are
imperative for the classroom because they can aid students in focusing their attention on
classroom instruction and related discussion. Use of such devices may be specified in the
child’s IEP or educational plan. The effective use of the microphone is crucial, and teachers
must be instructed as to how to use the microphones effectively. Cole and Flexer (2011)
also recommend that the teacher introduce the devices to all children in the classroom as
an educational tool. This brief instruction will also assuage their curiosity and any distrac-
tions that may result. Parents are a great resource for teachers as they can provide an over-
view of the child’s device (Gargiulo & Kilgo, 2010, p. 267).
If ALDs are being used in the home or school setting, considerations should be given to
the following:
1. Microphone Placement: The microphone can dramatically impact the output speech spec-
trum. A collar microphone, worn around the neck of either the teacher or parent allows
for control of microphone distance. Lapel or lavaliere microphones should be worn mid-
line on the chest about six inches from the mouth (Cole & Flexer, 2011, p. 152).
2. Device Function: Be sure to check the batteries if any malfunctions occur with the assistive
listening device. A weak battery charge can cause interference, static, and provide only
an intermittent signal in FM and IR technologies (Cole & Flexer, 2011, p. 152).
3. Audiological Support: Audiologists can be quite helpful in making recommendations for
teachers and parents regarding appropriate ALD devices (Roush & Kamo, 2008, p. 275).
This assistance includes a rationale for the type or types of S/N ratio enhancing tech-
nology needed for the home or classroom. In addition, the audiologist can provide
other information including equipment characteristics, suggestions for parent/teacher
in-services, and follow-up visits (Cole & Flexer, 2011, p. 152).
Protecting the Hearing Mechanism
1. Wear hearing protectors when exposed to any loud noise (i.e., music, loud machinery).
Ear plugs can either be purchased over the counter or custom made (molded) (Northern
& Downs, 2002, p. 100).
2. Monitor volume levels of music particularly when using ear buds, while in the car, or in
small spaces such as practice rooms (Northern & Downs, 2002, p. 100). If everyone else
can hear the music you are listening to through ear buds or headphones, then the music
is too loud. Ear buds or headphones are dangerous as they deliver sound directly to the
ear canal.
3. Avoid children’s toys that produce high noise levels, particularly those that are 85dB or
above (Rawool, 2012). Noise ratings should be provided on toys, household, and recre-
ational devices. In cases where this information is not readily available, parents should
contact the manufacturer. Audiologists recommend that masking tape be placed over
the speaker of a toy to reduce the noise level (Northern & Downs, 2002, p. 100).
4. Avoid sitting directly in front of the speakers when attending a concert or sporting event
(Chasin, 2009, p. 32).
5. Avoid sudden loud sounds (when possible) such as those created by firecrackers or guns
(Northern & Downs, 2002, p. 100).
6. It is essential that musicians, regardless of age and experience, develop a habit of
wearing ear protection such as musicians’ earplugs for individual practice, rehearsals,
and performances purpose (Chasin, 2009, p. 32).
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CHAP T ER 7
An Introduction to the
Cochlear Implant
AN OVERVIEW OF THE DEVICE
This chapter is devoted entirely to the cochlear implant because par-

ents should be familiar with the device as it will play a large role in the
decision-making process when choosing the best means for maximizing
residual hearing for their young child. Teachers should also be familiar
with the device, as they will likely see a greater number of cochlear im-
plant users in their music classrooms due to evolving technology.
The cochlear implant is a biomedical electronic device containing elec-
trodes positioned within the cochlea to stimulate remaining hair cells.
The device transmits those elements of acoustical signals that are believed
to be the most important for speech, aiding in the aural rehabilitation
of children and adults diagnosed with severe or profound hearing losses
who are unable to hear or comprehend speech with conventional hearing
aids (Beiter & Brimacombe, 1993). This chapter will also explore the devel-
opment of the cochlear implant device, pediatric cochlear implantation,
current research trends, and controversies associated with the device.
Music research studies highlighting the musical involvement of children
with the device as well as implications for the music classroom are also
included herein.
Cochlear Implant Components
All cochlear implants, regardless of make, model, or manufacturer, are

comprised of an internal receiver-stimulator package with electrode array,
( 214 )
A n I n t r o d u c t i o n t o t h e Co chl e a r I mpla n t ( 215 )
an external microphone with radio frequency transmitter, and a sound proc-

essor. Differences do exist, however, in the types of sound-processing
strategies used (i.e., transmission of sound information and electrode
stimulation) as well as in the types of electrode arrays (i.e., shapes and
number of electrodes) (Grayden & Clark, 2006; Wilson & Dorman, 2009).
The internal receiver-stimulator package is placed behind the ear, under-
neath the skin. Connected to the receiver is the electrode array, a tapered
piece of flexible tubing that is lined with electrodes. The array, shown
in Figure 7.1, is implanted into the cochlea’s scala tympani through a
cochleostomy, a surgically created opening just lateral to the round win-
dow of the inner ear (Grayden & Clark, 2006). The externally worn mi-
crophone and radio-frequency transmitter are held in place by a magnet,
placed directly above the receiver-stimulator package. The sound proc-
essor is typically worn behind the ear. Both the speech processor and
radio-frequency transmitter are illustrated in Figure 7.2. A more com-
fortable option for younger children involves fastening the speech proc-
essor to a shirt collar. The body-worn processor, shown in Figure 7.3, can
be worn on a belt or even housed in a shirt or jacket pocket, although this
is not as common today.
Figure 7.1: The HiRes 90K™ implant and electrode array (coiled, left), Images courtesy
of Advanced Bionics.
Figure 7.2: Harmony Sound Processor with radio-frequency transmitter (foreground),

Image courtesy of Advanced Bionics.
Figure 7.3: Nucleus Freedom Body-worn Sound Processor, including processing unit,
transmitter, and controller (left to right). Image courtesy of Cochlear 2012.
Cochlear Implant Function
The cochlear implant microphone and radio frequency transmitter col-

lects sounds from the environment. These sounds are sent through the
implant system via cable to the sound processor that analyzes and con-
verts the stimuli into a digital format for the electrodes (Grayden & Clark,
Figure 7.4: Cross section of ear showing cochlear implant external and internal ear com-
ponents in place. Courtesy of MED-EL Corporation.
2006; Paul & Whitelaw, 2011). The resulting signal travels back through
the same cable to the transmitter and then through the skin via radio
waves to the internal receiver-stimulator package. The receiver-stimulator
package not only decodes the signal but controls the electrical current
sent to each electrode along the array thus stimulating remaining hair
cells or auditory nerve fibers. The ensuing electrical discharge of the audi-
tory (afferent) neurons advances through the central auditory system to
the auditory cortex and is interpreted as meaningful sound. This process
is illustrated in Figure 7.4.
Comparing Cochlear Implants and Hearing Aids
Hearing aids differ from cochlear implants in both design and function.
They are externally worn devices that send amplified sounds through the
outer and middle ears to the hair cells of the inner ear where they are
converted from sound energy into the electro-chemical signals recognized
by the auditory nerve. Alternatively, the cochlear implant converts sound
into electrical energy and altogether bypasses the outer and middle ear,
as well as the damaged hair cells of the inner ear to directly stimulate re-
maining auditory hair cells.
Both devices are most successful when viable hair cells remain so that
signals can reach the auditory nerve. This is impossible in cases where
the hair cells are severely damaged or dead. Additionally, hearing aids
also tend to work best if the hair cells in the cochlea are evenly distrib-
uted. Advances in cochlear implant technology, coupled with researchers’
attempts at preserving residual hearing, have resulted in a hybrid device
combining both hearing aid and cochlear implant technologies.
THE HISTORY OF THE COCHLEAR IMPLANT

Preliminary Research and Experimentation Leading to
Cochlear Implantation
The first attempts to electrically stimulate the auditory system were

those of Italian physicist, Alessandro Volta, ca. 1800 (Tyler & Tye-Murray,
1991). Soon after developing the battery, Volta conducted an experiment
in which he inserted two metal rods, producing approximately fifty volts,
into his own ears (Blume, 2010). Volta described the results as “a disa-
greeable sensation” and a “boom within the head” (Blume, 2010; House &
Berliner, 1991; Tye-Murray, 2004).
Volta’s attempts were followed, in 1855, by Guillaume Duchenne, a
French neurologist, who was noted for stimulating the ear with alter-
nating currents. Duchenne created the alternating currents by inserting
a vibrating object into a circuit containing a condenser (capacitor) and in-
duction coil. The resulting auditory experience was described as sounding
similar to “the beating of a fly’s wings between a pane of glass and curtain”
(Clark, 2003). Yet another example was that of Brenner (1868) known for
researching the effects of polarity, rate, and intensity variation of stimuli
(Clark, 2003). He was also known for studying the impact of electrode
placement on hearing sensation. Brenner accomplished this by placing
one electrode in saline within the auditory canal and the other on another
location on the body (Clark, 2003; Clark, Tong, & Patrick, 1990). Brenner
found that electrical stimulation that produced negative polarity in the
ear yielded improved hearing. Participants in Brenner’s studies described
the resulting sounds as metallic in nature. Additionally, when the Brenner
Electrode, as it is currently referred, was placed correctly, all side effects
(i.e., pain, vertigo, and facial nerve stimulation) previously experienced by
participants reportedly diminished (Clark, 2003). Such experimentation
paved the way for future researchers who were also interested in providing
opportunities for sound perception and communication for individuals
with hearing loss.
Research and Development: Now We Are Getting

Somewhere!
Research interests in the reproduction of hearing via electrical stimula-

tion lost momentum until the 1930s when investigators began to study
the role of the inner ear. At that time, it was speculated that electrical
current could be converted into sound vibration before reaching the
inner ear, a process termed electrophonic hearing. Research conducted in
the 1940s and 50s focused on the mechanisms involved in electrophonic
hearing and led to the importance and necessity of residual cochlear func-
tion. Investigators also established that a more localized stimulation of
the remaining hair cells of the inner ear was required for the correction of
total perception deafness.
Developments of the 1950s and 60s
One of the first recorded attempts to directly stimulate the auditory nerve
with a sinusoidal current was performed by Lundberg in 1950 (Clark
et al., 1978). This was followed, in 1957, by French otologist Charles Eyries
and his colleague André Djourno, whose work yielded the first detailed
description and model for the direct stimulation of the auditory nerve
(House & Berliner, 1991). Eyries and Djourno implanted a man, who
was eager to perceive even a minimal sensation of sound, with an elec-
trode. In this instance, the electrode was placed on the bony wall sepa-
rating the middle ear and the cochlea. The man reported hearing a few
sounds and some common words; however, the effect was not sustainable
and the implanted electrode was eventually removed (Nevins & Chute,
1996; Spencer, 2002). Prior to 1957, all attempts to electrically stimu-
late the hearing mechanism involved participants who had at least a par-
tially functioning cochlea (Eisen, 2006, p. 2). The findings of this earlier
research were attributed to electrophonic hearing as opposed to the direct
stimulation of the auditory nerve (p. 2).
In 1961 Dr. William House, the creator of the cochlear implant,
along with his colleagues Drs. James and John Doyle, developed a
single-channeled device. The electrodes of this device all received the
same signal and were inserted via the round window into the scala tym-
pani. House and his colleagues implanted several adult volunteers with a
single-channeled device while one participant received a multi-channeled
device. The purpose of the early multi-channeled device was to provide
some speech discrimination. The device was noted for having “stimulated
the cochlea at five different positions along its length, each sensitive to
a different range of frequencies” (Blume, 1999; Spencer, 2002). Overall,
the early work of House and his colleagues yielded satisfactory results as
patients were able to perceive and repeat phrases. After repeated trials,
however, House decided to focus on the single-channel implant because
he and other researchers believed that both single and multiple-channel
devices could be equally successful (House, 1987). Yet another outcome of
these findings was the removal of all earlier implant devices due to issues
related to the insulating material (House & Berliner, 1991).
Dr. Blair Simmons and Dr. Robin Michelson also began to work on the
multi-channel device in an attempt to mimic the normal cochlea (Nevins &
Chute, 1996, p. 26). In 1964 Simmons attempted to stimulate nerve fibers
representing different frequencies by implanting six electrodes along the
central portion of the cochlea. Results revealed patients’ ability to “de-
tect pitch change of up to a frequency of 300 pulses per second.” Simmons
also found that a single stimulus produced a pitch sensation that varied
according to the position of the stimulating electrode (Dorman, 1998;
Grayden & Clark, 2006; Simmons, 1964). Participants were able to distin-
guish the duration of the signal and, in some cases, a degree of tonality
(Simmons, 1964). In a later study, Simmons (1967) found that electrodes
could be inserted through the round window of the cochlea without caus-
ing it to deteriorate.
Developments of the 1970s
Throughout the 1970s, many single- and multiple-channel devices were

developed in Europe, Australia, and the United States. According to
Hochmair and Hochmair-Desoyer (as cited in Grayden & Clark, 2006),
Austrian researchers developed a device with “eight intracochlear elec-
trodes in four stimulating pairs of electrodes plus a pair of extracochlear
electrodes” ( p. 4). “This particular device utilized a single electrode sound
processing strategy” (p. 4). Participants were reportedly capable of open
speech recognition. Another device, the single-channel implant, was devel-
oped in London and used extracochlear stimulation of the auditory nerve.
In this instance, the electrical currents corresponded to glottal vibrations
received from a microphone placed beside the larynx. Those who used this
device were reported to have improved vocalizations and speech-reading
skills. During the 1970s, researchers at California’s House Ear Institute
focused on a single-electrode schema for stimulating the scala tympani.
These trials revealed that participants experienced increased perception
of some speech features, environmental sound, and improved vocal mod-

ulations (p. 4). The Australian ten-channel device was also introduced in
the 1970s. This device, developed at the University of Melbourne, resulted
in increased speech-reading ability as well as open-set speech recognition
for those participants using electrical stimulation alone (p. 5). The decade
also saw the development of the first sound processor that was designed
to interface with the single-channel implant (p. 5). Furthermore, research
involving electrode placement revealed that electrodes could be inserted
along the scala tympani with little trauma. This was found to be possible
as long as the basilar membrane and spiral lamina, the bony shelf extend-
ing from the modiolus across the spiral canal of the cochlea, were undam-
aged (Grayden & Clark, 2006, p. 5; Spencer, 2002, p. 23).
Developments of the 1980s
The 1980s saw further development of both single- and multi-channel

devices as well as extensive clinical trials involving both children and
adults. For example, the House/3M single-channel device was tested in
children in 1980 (Drennan & Rubenstein, 2006, p. 40; Grayden & Clark,
2006, p. 6). Findings revealed that the participants were able to recognize
environmental sound and discriminate between different speech sounds
(Grayden & Clark, 2006; Thielemeir, Tonokawa, Peterson, & Eisenberg,
1985). Some of the children were reported as having obtained some
open-set speech recognition (i.e., understanding speech without visual
clues) (Berliner, Tonokawa, Dye, & House, 1989; Grayden & Clark, 2006).
The 3M/House single-channel device and the multi-channel Nucleus 22
device were the primary devices available internationally during the 1980s
(Spencer, 2002, p. 26). In 1984 the 3M/House Institute single-channel
device became the first cochlear implant approved by the FDA for post-
lingually deafened adults (Eisen, 2009; Spencer, 2002; Zeng, 2004). The
next year, the Australian-developed Nucleus 22 multiple-channel device
was implanted in a fourteen-year-old child. Trial results revealed that the
implant helped the child to speech-read (Clark, 1987; Grayden & Clark,
2006). The FDA approval of this cochlear implant system followed in 1985
(Spencer, 2002). The success of the Nucleus 22 device coupled with the
small market for the cochlear implant led to the 3M Corporation’s deci-
sion to remove itself from cochlear implant research and development
(Chute & Nevins, 2002; Spencer, 2002). The Cochlear Corporation later
purchased 3M in order to provide continued services for those adults and
children implanted with those devices.
A significant contribution to cochlear implant technology during

the 1980s was the earth magnet. Developed by Dr. Jack Hough, the
earth magnet could be implanted without interfering with the internal
receiver-stimulator package (Valente, Hosford-Dunn, & Roeser, 2000,
p. 513). Hough’s magnet changed the direction of cochlear implant tech-
nology because it made transmission across the skin more exact and
less variable between and within participants (p. 513). With one magnet
implanted internally and another externally as part of the transmitter,
implant users were able to obtain a more direct and stable connection
between the two components of the device. This development had a di-
rect impact on the eligibility of children for cochlear implantation as
the introduction of the new magnet subsequently eliminated the issues
raised regarding signal consistency for the child (Nevins & Chute, 1996;
Spencer, 2002). The new modification eliminated the need for the head-
bands and glasses previously required to hold the transmitter in place
(Nevins & Chute, 1996, p. 28). A smaller and better-aligned device was
also developed by Cochlear Corporation and the University of Melbourne
(Grayden & Clark, 2006, p. 6). Trial results for this much smaller device,
also featuring a similar magnet promoting better alignment between the
receiver-stimulator package and transmitter, suggested that children
implanted at a young age could achieve speech-recognition ability similar
to that of postlingually deafened adults (Dawson et al., 1989; Eisen, 2009).
In the 1980s, researchers from North Carolina’s Research Triangle and
the University of Melbourne also focused on improving both the sound
processor and processing strategies. The additional research was neces-
sary for the continued development of the implant system particularly
due to the narrow range of electrical stimulation available in cochlear im-
plant systems. North Carolina Research Triangle scientists’ investigations
resulted in the Continuous Interleavered Sampler (CIS) speech-processing
strategy.
Developments of the 1990s to the Present
The 1990s saw an expansion of the numbers and types of cochlear implants
available. In addition to an increase in the number of FDA-approved
devices, the decade was also noted for the FDA’s approval of the devices for
implantation in children. In 1990, for example, the Nucleus 22-channel
implant system earned FDA approval for children ranging from two to
eighteen years of age (Chute & Nevins, 2002; Eisen, 2009; Grayden &
Clark, 2006; Spencer, 2002). At that time, it was the only device to have
received pre-market approval for use in both adults and children. As the
decade progressed, devices for even younger children gained approval.
For example, in 1998, devices were approved for children ranging from
eighteen months to eighteen years of age and in 2002 for children as
young as twelve months of age. Technological advances in the electrode
array (i.e., stimulation rate, number of electrodes, placement of the array),
processing strategies, the structure and design of the device as well as
related implant software have continued well into the new millennium
(Eisen, 2009; Grayden & Clark, 2006; Spencer, 2002).
PEDIATRIC COCHLEAR IMPLANTATION
The National Institute on Deafness and Other Communication Disorders

(2010), reports that the device has now been implanted in 188,000 indi-
viduals worldwide. In the United States alone, approximately 30,000 chil-
dren now have implants. This figure includes children as young as twelve
months of age.
Vocabulary and language acquisition, in conjunction with both cog-
nitive and motor skill development, progresses rapidly for children be-
tween the ages of eighteen months and three years. By four years of age,
children should have a large vocabulary and speak fluently (Ramsden &
Axon, 2009, p. 355). For the child with prelingual deafness, early inter-
vention is imperative as they often have little or no access to the speech
and language cues important for the development of communication
skills (Schorr, Roth, & Fox, 2008). Without the appropriate interven-
tion services, they will likely experience a delay of speech and language
skills development that can later manifest both academically and so-
cially (Malcolm, 2002). Because the window of opportunity for speech
and language acquisition is temporary, attention to the auditory mile-
stones associated with speech and language are critical, particularly
with regard to pediatric cochlear implantation. In order to provide the
child who has prelingual deafness with every opportunity to learn how
to assign meaning to incoming auditory stimuli through the device and
ultimately develop his or her speech and language skills, implantation
should occur before the window of opportunity closes. The child with
postlingual deafness, on the other hand, acquires a hearing loss after
speech and language skills have developed. According to Ramsden and
Axon (2009), the postlingually deafened child or adolescent is “in lin-
guistic terms” not very different from that of a postlingually deafened
adult with regard to the rehabilitation approaches employed following

surgery (p. 355).
Early Cochlear Implantation and Speech

and Language Development
Early implantation and advances in cochlear implant technology have

had a significant impact on the speech and language development skills
of children with prelingual deafness. As a result, it is now very common
to implant children between the ages of twelve and eighteen months.
Research has revealed that the earlier a child is implanted, the greater
the benefits he or she will receive from the device (Osberger, Robbins &
Trautwein, 2006; Tye-Murray, 2004; Tye-Murray & Kirk, 1993). A study
by Kirk, Miyamoto, Ying, Perdew, and Zuganelis (2002) suggests also that
a greater number of children developed age-appropriate language skills
as a result of early implantation. Still other studies have found that chil-
dren implanted prior to eighteen months of age have demonstrated typ-
ical and, in some cases, an accelerated growth of their language skills
(Hammes, Novak, Rotz, Willis, & Edmondson, 2002; Novak et al., 2000).
Additionally, Yoshinaga-Itano, Sedey, Coulter, & Mehl (1998) found that
children implanted earlier than eighteen months of age are also better
able to transition from manual to oral modes of communication whereas
children implanted after two-and-a-half years of age have found this tran-
sition more difficult.
Music and Early Cochlear Implantation
As with speech, children with prelingual deafness differ from post-

lingually deafened children and adults who have had a chance to expe-
rience and enjoy music prior to the onset of their hearing loss (Gfeller,
Witt, Spencer, Stordahl, & Tomblin, 2000; Schraer-Joiner, 2003; Stordahl,
2002). That previous experience in postlingually deafened children can
be advantageous, especially post implantation, when it serves as a foun-
dation for trying to comprehend the sounds perceived with the cochlear
implant. Children with prelingual deafness, on the other hand, have had
minimal exposure to the pitch and timbral characteristics of music. As a
result, their musical experiences are limited to what they know of music
with the implant (Gfeller et al., 2000; Stordahl, 2002).
Early cochlear implantation has had an impact on the musical involve-

ment of young children. Mitani et al. (2007), for example, investigated
the ability of children implant users with congenital deafness, ages four
to eight, to recognize and appraise music from their favorite television
programs. Successful recognition resulted when listening examples in-
cluded all of the features of the original music, specifically the instru-
ments, timing, and vocals. Participants were not successful, however,
when listening examples did not include vocals or when they included
only a synthesized flute sound. According to the researchers, the partici-
pants had a positive music experience, overall. The researchers attributed
these positive experiences to the participants’ young age (Mitani et al.,
2007, p. 32).
Candidacy: Initial Testing and Evaluation
To ensure the safety of the child and to determine that the implant is the
best option, an extensive testing protocol initiates the cochlear implanta-
tion process. A team of specialists consisting of an otologist, audiologist,
speech-language pathologist, educational consultant, social worker, and
psychologist typically determine cochlear implant candidacy (Osberger
et al., 2006). Initial evaluative procedures to determine eligibility include
audiological testing to verify auditory nerve function and hearing levels
both with and without hearing aids. These levels will depend greatly on
the child’s age and maturity level (Tye-Murray, 2004, p. 730). An otolog-
ical evaluation of the outer and middle ears is also conducted to ascertain
whether infection or other irregularities having to do with the forma-
tion or function of the ear(s) exists. The child should not have a history of
chronic ear disease, an obstructed cochlea, or have recently experienced a
middle-ear infection or inflammation (otitus media) (Tye-Murray, 2004).
Magnetic resonance imaging (MRI) and computerized tomography
(CT) are also administered to evaluate the inner ear, facial and cochleo-
vestibular nerves, the brain, and brainstem. Such testing is conducted to
determine whether the child’s hearing loss resulted from lesions of the
auditory nerve, the central auditory pathway, or from auditory neurop-
athy, a condition that affects the neural processing of auditory stimuli
(Columbia University: Department of Otolaryngology Head and Neck
Surgery, 2007, “Hearing Loss,” para. 18). CT scans can also help to de-
termine the existence of structural abnormalities of the inner ear that
would prevent the surgical implantation of the cochlear implant device
(University of Maryland Medical Center, 2011, “Can Every Patient with
Severe to Profound Sensorineural Hearing Loss Benefit from a Cochlear

Implant?,” para. 11).
So parents, what are some of the general criteria that will determine
your child’s eligibility for the cochlear implant? Generally, your child is a
pediatric candidate if he or she is between the ages of twelve months and
seventeen years and has an audiological evaluation revealing a severe to
profound sensorineural hearing loss in both ears. The benefits your child
receives from his or her hearing aids also determine pediatric candidacy.
This criterion is particularly important because as your child advances in
school, there will be increasing demands on his or her listening abilities in
the academic setting. Whether your child has a history of communicating
primarily by listening and speaking will also help to determine his or her
eligibility. Older children who have experienced a sudden-onset hearing
loss or progressive hearing loss who communicate by oral language are
also candidates (House Research Institute, 2013, “With the Emphasis on
Very Early Implantation, Are Older Children Ever Candidates for Cochlear
Implantation?” para. 10). Your strong family commitment is a major factor
in terms of candidacy criteria as is having a solid educational plan in place
that emphasizes auditory skill development (The Children’s Hospital of
Philadelphia, 2013, “Pediatric Candidacy Criteria,” para. 1).
Reasons that your child might not be a candidate for a cochlear im-
plant include but are not limited to an audiological evaluation that reveals
damage to or the absence of the cochlea or a hearing loss that involves
the outer or middle ears rather than the inner ear. If your child has had
a profound loss for a long period of time, he or she may not be consid-
ered a candidate since “. . . older children who do not already communicate
through listening and speaking will be less likely to learn to understand
spoken language or learn to communicate primarily through listening
and speaking” (House Research Institute, 2013, “With the Emphasis on
Very Early Implantation, Are Older Children Ever Candidates for Cochlear
Implantation?,” para. 10).
Considering cochlear implantation is a huge responsibility for any
parent. When a child is very young, parents are solely responsible for all
decisions regarding the implantation process including post-implantation
follow-ups and aural habilitation/rehabilitation (Chute & Nevins, 2002;
Tye-Murray, 2004). Older children are strongly encouraged to participate
in the informed consent process if they are able. In either instance, it is
imperative for all family members to participate in all aspects of the im-
plantation process. Participation includes both counseling and psycholog-
ical testing, as part of a child’s initial evaluation, so as to ensure that the
expectations of all involved are realistic and healthy. It is more important
that the child has the support of his or her family and therefore a sense
of security.
It is also important to acknowledge that there are parents who de-
cide against cochlear implantation regardless of their child’s eligibility.
Parents who have made these decisions indicate the importance of a bi-
lingual education rather than a mainstreamed education that emphasizes
spoken language. These parents also express concerns over financial costs
and the availability of services in neighborhood or area schools as their
reasons (Li, Bain, and Steinberg, 2004). Conversely, there are also many
deaf parents who do choose cochlear implants for their deaf children as
well as for themselves (Ouellette, 2011, p. 1259). The award-winning film
Sound and Fury, released in 2000 and nominated for an academy award,
detailed the decision-making process of one deaf family to implant their
children (p. 1259). The follow-up film Sound and Fury: 6 Years Later docu-
ments several family members’ “change of heart” about cochlear implan-
tation as well as their subsequent decision to become implant recipients
themselves.
The Implantation Process

Surgical Procedures for Implantation
Once a child’s candidacy has been determined and the family decides to
pursue this option, the procedure is scheduled. Sometimes an overnight
stay in the hospital is required if deemed appropriate by the surgeon; how-
ever, the procedure is typically completed on an outpatient basis. A gen-
eral anesthetic is given so the child will sleep during surgery. The child’s
hair is shaved both above and behind the ear being implanted and the
skin is washed with an antiseptic solution. For the purposes of accuracy,
the surgeon, an ENT, places a mark on the scalp exacting the position of
the cochlear implant incision spaces (Cohen, 1998; Tucci & Pilkington,
2009). After the incision is made, the scalp is separated from the bone
above and behind the ear and a depression is created in the bone to ac-
commodate the implant receiver-stimulator package (Cohen, 1998; Tucci
& Pilkington, 2009). Small holes are then drilled above and below the
depression to allow for the sutures that will aid in holding the device in
place. The mastoid bone is hollowed out so that a channel can be created
for the receiver-stimulator package that will be housed between the mas-
toid cavity and depression. The facial nerve is then located and an opening,
called a cochleostomy, is created in front of and into the middle ear expos-
ing the round window, the location for the entrance into the scala tym-
pani. The electrode is then implanted. After all components are secured,
the device is typically checked to determine if it is functioning effectively.

Finally, the device is packed with tissue in order to secure it and also to
prevent fluid leakage and the incision is then closed using either sutures
or staples (Cohen, 1998; Tucci & Pilkington, 2009).
Surgical Follow-up
The staples or sutures are taken out approximately ten to twelve days fol-
lowing surgery but the recovery period typically lasts four to six weeks.
During this time period, the child needs to avoid prolonged immersion
in water and intensive physical activity so as to prevent trauma to the
surgical site. Even after the recovery period, the child needs to wear pro-
tective gear, especially for sports such as horseback riding, soccer, field
hockey, and softball.
Activation of the Implant and Mapping
Activating the implant, a process referred to as initial stimulation or

hook-up, follows the recovery period. For children younger than the age of
seven, the process typically requires two audiologists who administer all of
the procedures. These audiologists place the external implant components
of the device on the child’s head over the implanted internal-stimulator
package. They then connect the child’s sound processor to both a com-
puter and clinical programming unit. (Craddock, 2006; Nevins & Chute,
1996). During initial stimulation, the child responds to electrical signals
delivered to individual electrodes along the array. As the process contin-
ues, babies or toddlers may cry out in surprise as a result of sudden sound
whereas older children may express anxiety or concern as a result of their
first experiences with sound. The electrode array is designed so that it is
similar to that of the functioning cochlea because the electrodes along
the array are assigned to specific frequency bands (i.e., apical responses to
lower frequencies; basal responses to higher frequencies) (Backus, 1977;
Nevins & Chute, 1996). Initial stimulation most often begins with the
low-frequency electrodes as they are easier for the child with profound
deafness to perceive. Threshold levels (T-levels), the lowest level at which a
child consistently identifies a sound, are first determined for each electrode
as electrical pulses are delivered to a designated electrode at a particular
current. While initial mapping procedures are overseen by an audiologist,
older children may be able to set the level themselves using a control knob
that regulates the delivery of pulses (Craddock, 2006). Responses for very
young children include an orienting response or reflex while the responses

of older children include behavioral observational methods or play audi-
ometry (Northern & Downs, 2001). Comfort levels (C-levels), the loudest
sound that can be listened to comfortably for a sustained period of time,
are also determined for each electrode (Craddock, 2006; Shapiro, 2006).
C-levels are often difficult to obtain for young children as their concepts
of sound are often times undeveloped (Craddock, 2006).
The setting of the T- and C-levels for each electrode on the cochlear
implant’s internal electrode array comprises a program or MAP. Each
MAP is developed specifically for the individual cochlear implant user
and includes information pertaining to the rates and type of electrode
stimulation, dynamic levels, and volume settings, as well as special
locks and controls for children (Chute & Nevins, 2002). Mapping is typ-
ically completed over a two-day period with follow-up appointments
occurring one week and then one month following device activation.
Thereafter, the child should return every three months (Wolfe & Shafer,
2010, p. 98). For children seven years or older or with at least two years
of experience, the child should return every six months for a check-up
(p. 99).
Over time, the MAP may become weak, producing a signal that is less
clear or even soft. This happens most often because the cochlear implant
user has adapted to the mapping strategy. In these instances, the cochlear
implant will be reprogrammed. Indicators that remapping may be neces-
sary, particularly when children are too young to provide information per-
taining to their experiences with the device, include changes in the child’s
speech production and a decrease in vocalization (Chute & Nevins, 2008,
p. 352). Ongoing communication is important between parents, teachers,
and the cochlear implant center. The implanted child should visit his or
her audiologist every few months initially to ensure that his or her MAP
is working effectively. A mapping report is often provided for parents
describing map parameters, threshold, and comfort-level settings.
Device Failures
According to Waltzman and Shapiro (2008), percentages of device failures,

though small, are increasing (p. 367). Device failures may be quite “sudden
and total” or gradual. Some of the symptoms that precede device failure
may include reduced speech recognition, buzzing, or even pain (p. 367). In
order to accurately diagnose a device failure, it is imperative that regularly
scheduled device check-ups are maintained, particularly if the individual’s
speech recognition test performance continues to diminish and if remap-

ping yields no improvement (p. 367).
STIMULATION RATES AND SPEECH-PROCESSING

STRATEGIES: A BRIEF OVERVIEW
Stimulation rate, designated as pulses per second (pps), refers to the

number of biphasic pulses delivered to an individual electrode within one
second (Wolfe & Schafer, 2010, p. 30). Current implant systems feature
much higher stimulation rates that can result in changes to pitch and
loudness perception for the cochlear implant user (p. 31).
Continuous Interleaved Sampling (CIS) Strategy
The CIS processing strategy makes use of the full spectrum of incoming
acoustic waveforms without negatively impacting temporal information.
All CIS-related strategies stimulate active electrode contacts with biphasic
pulses in either a sequential or partially simultaneous manner (Rouiha,
Bachir, & Ali, 2008; Tye-Murray, 2004; Wolfe & Schafer, 2010). According
to Wilson (1993) and Loizou, Poroy, and Dorman (2000), pulsation rate is
an important factor in CIS strategy performance as a higher rate of stim-
ulation results in better speech intelligibility. This strategy has served as
the forerunner for a majority of the current strategies, and is available in
the devices manufactured by all three cochlear implant companies (i.e.,
Advanced Bionics, Cochlear Corp, Med-El) (Wilson & Dorman, 2009;
Wolfe & Schafer, 2010). Strategies include Advanced Bionics’ Multiple
Pulsatile Sampler (MPS) and Hi-Resolution Fidelity 120 as well as Med-El’s
CIS+ and High Definition CIS (Wilson & Dorman, 2009, p. 100.) Med El has
also released a CIS-related strategy called Fine Structure Processing (FSP)
that is purported to improve speech recognition, sound quality, music
appreciation, and recognition (Wilson & Dorman, 2009, p. 101;Wolfe &
Schafer, 2010, p. 45).
The “n-of-m” Strategy
The “n-of-m” strategy stimulates a fixed number of channels at a high rate.

Specifically, “the signal is processed through ‘m’ bandpass filters from which
only the maximum envelope amplitudes are selected for stimulation” (Hu &
Loizou, 2008, p. 498). This strategy is used in Med El devices and allows for
a faster stimulation rate, reduction in channel interaction, and increases in
battery life (Wilson & Dorman, 2009, p. 101). The Spectral Peak Extraction
(SPEAK) strategy, used with Cochlear Corporation’s Nucleus devices, was
one of the first clinically available signal coding strategies that used the
n-of-m approach (Wolfe & Schafer, 2010, p. 42). The SPEAK strategy first
analyzes incoming sound to identify those filters with the greatest amount
of energy. A subset of filters is then selected followed by the stimulation of
the corresponding electrodes (Koch, 2000).
The Advanced Combination Encoder (ACE) is yet another n-of-m proc-
essing strategy and is available for Nucleus cochlear implant devices. This
strategy is similar to SPEAK but merges higher stimulation rates with the
SPEAK strategy’s “spectral maxima detection,” ultimately providing fine
temporal structure (Koch, 2000; Wolfe & Schafer, 2010). ACE is currently
a default signal coding strategy used with cochlear implants. A more re-
cent version of this is Cochlear Corporation’s ACE (RE) or High ACE that
operates exactly like ACE but with still greater stimulation rates (Wolfe &
Schafer, 2010, p. 43).
MP 3000 is another variation of the ACE strategy developed by Cochlear
Corporation (Drennan & Rubenstein, 2008, p. 8). According to Drennan
and Rubenstein (2008), this strategy “uses psychophysical masking to
limit the information transfer” of masked acoustical information (p. 8).
Masking allows only the most “perceptually salient components of the
stimulus” to be delivered (p. 8). MP 3000 is similar to the approach used
in the modern MP3 recreational audio players that remove unimportant
sound information from the signal. Overall, the signal is conveyed in a
more efficient manner and without a significant compromise in quality
and clarity. A primary advantage of MP 3000 is improvement in signal ef-
ficiency thus allowing for longer battery life, reduction in battery size, and
smaller sound processors. Research also suggests that MP 3000 may yield
better music perception (Drennan & Rubenstein, 2008, p. 8).
Simultaneous Analog Stimulation (SAS) Strategy
An earlier signal coding strategy, Simultaneous Analog Stimulation (SAS),

stimulates electrode contacts simultaneously on each cycle with contin-
uous electrical waveforms rather than biphasic pulses (Wolfe & Schafer,
2010, p. 45). SAS has only been used in devices manufactured by the
Advanced Bionics Corporation, in particular those implanted prior to
2002 (Tye-Murray, 2004; Wolfe & Schafer, 2010, p. 45). The advantage of
this strategy was that it preserved most of the cues present in the original
input signal. Additionally, proponents suggest that this form of stimu-
lation enables the nervous system to organize and make meaning of the
information contained in the presented wave forms. One of the primary
disadvantages of this strategy has been channel interaction. Although SAS
is no longer available in current Advanced Bionics devices, the company
has developed and implemented a partially simultaneous stimulation
processing strategy involving the simultaneous presentation of biphasic
electrical pulses to two different electrode contacts that are separated “by
a large physical distance” (Wolfe & Schafer, 2010, p. 35).
Telemetry
Current implant systems employ a technology called telemetry used to

monitor the reliability and effectiveness of the intracochlear electrodes
post-implantation (Chute & Nevins, 2008, p. 352). Telemetry is vital as
device malfunctions are hard to detect and diagnose in young children
who have limited experience with the cochlear implant and auditory
stimulus. Additionally, cochlear implant devices also contain software
that evaluates device function during the remapping process (p. 352).
Telemetry is also used during the mapping process particularly during the
setting of T-levels (Wolfe & Schafer, 2010, p. 37). The current telemetry
technology includes Cochlear Corporation’s Neural Response Telemetry
(NRT), Advanced Bionics’s Neural Response Imagery (NRI), and Med-El’s
Auditory Nerve Response (ART) (Chute & Nevins, 2008, p. 367).
ONE COCHLEAR IMPLANT USER’S JOURNEY:

THE STORY OF “C”
The experiences of my friend “C,” an adult cochlear implant user, may

add some perspective to the procedures previously described. I first met
C in the Fall of 2001 through a faculty member at the University of North
Carolina at Greensboro. C had a profound hearing loss that resulted from
the gradual deterioration of the hair cells of her inner ear. For C, a coch-
lear implant was the only remaining solution. She was implanted with
the Advanced Bionics CLARION S-Series cochlear implant in July 1998.
Though C was not a child at the time she was implanted, her story provides
some insight into postlingual deafness, the implantation process, as well
her return to music post implantation.
C’s Pre-Implant Experiences
C became acutely aware of her hearing loss when she was a senior in
high school. She told me, however, that it was likely present during her
childhood as she recalled several instances where she missed the verbal
instructions for class assignments (Schraer-Joiner, 2003; Schraer-Joiner
& Prause-Weber, 2009). She also recalled being startled by people’s en-
trance into a room because she had not perceived their footsteps or other
sounds associated with their approach.
C loved music. She told me that music was an integral part of her child-
hood and adolescence. She took piano lessons at the age of eight and had
many musical listening opportunities including the music-making of her
mother and father, who played quite often for C and her brother. The mu-
sical styles C loved the most included big band, classical, and church hymns.
While in her teens, C’s musical tastes evolved to include groups such as
Peter, Paul, and Mary; The Kingston Trio; The Beatles; The Supremes; and
Smoky Robinson. According to C, her music memories faded after the
1960s, a change she attributed to musical taste rather than her hearing
loss (Schraer-Joiner, 2003; Schraer-Joiner & Prause-Weber, 2009).
Decisions, Decisions
C had her first formal hearing test at the age of twenty-four. At that time,
she was diagnosed with a mild loss and was informed that the loss would
likely not progress. However, after a span of many years, her hearing loss
did advance to the point that traditional hearing aids were no longer ben-
eficial to her. She told me that “it took every fiber tactile sense” she had
to comprehend her surroundings and that she was often exhausted as a
result. C’s audiologist introduced the cochlear implant as an alternative
means for improving her hearing ability but at the time C was not ready to
pursue such an invasive option. In 1996, when C was diagnosed with a pro-
found loss in her left ear and a severe to profound loss in her right ear, she
reconsidered and began to research cochlear implantation. According to C,
the decision-making process was agonizing for her family (Schraer-Joiner,
C’s Experiences Following the Implantation Process
Immediately following surgery, C experienced tinnitus, though it subsided

within a week. While recovering, she relied heavily on the residual hearing
of her right ear coupled with a hearing aid. In August 1998, C was fitted
with the external components of the implant system (i.e., the microphone
and sound processor). She also experienced her first mapping. Within
six weeks, C reported that she had begun to use the telephone. Although
she was using it only sparingly, she was very excited because it had been
decades since she had been able to hear over the phone! Six months fol-
lowing her implantation and mapping, sounds and voices that had been
familiar to C many years before were again recognizable to her. She also
told me that getting to hear her mother’s voice again was an amazing gift.
C’s word comprehension was also gradually improving (Schraer-Joiner,
Musical Listening after Implantation
The successful implantation of the Clarion device enabled C to regain

her independence and to again enjoy group activities. C also told me that
she felt like herself again. Additionally, she experienced some musical
listening success and was interested in further musical involvement, a
common interest of many postlingually deafened cochlear implant users
(Schraer-Joiner, 2003; Stainsby, McDermott, McKay, & Clark, 1997).
After meeting, she and I began working towards her new musical goals.
Her musical abilities, specifically rhythm and melody recognition,
were assessed via activities emphasizing Erber’s (1982) levels of auditory
development, addressed in chapter 4 (Birkenshaw 1982; Erber, 1982;
Estabrooks, 1994, 1998). Goals for lessons were based on C’s previous
music experiences, interests, and future music goals. The flute was uti-
lized in all music activities primarily due to the pureness of the tone
produced, and melodies for the lessons were selected based on their
frequency in elementary basal music series and generic children’s song
books. Those initially introduced to C included “Jingle Bells,” “Happy
Birthday,” “Yankee Doodle,” “Mary Had a Little Lamb,” “Frere Jacques,”
“The Star Spangled Banner,” “America,” and “Jolly Old St. Nicholas” due
to her interest in them prior to the onset of her hearing loss. These early
activities evolved into a nineteen-week music training program that
I developed specifically for C. The results of our work together revealed
that C was able to perceive and respond to the elements of rhythm and
pitch, and it was clear that she enjoyed the music listening experience.
Together, we also identified and developed listening strategies she could
employ while listening to music (Schraer-Joiner, 2003; Schraer-Joiner &
Prause-Weber, 2009).
ADJUSTING TO LIFE WITH THE COCHLEAR

IMPLANT
Audiological Training and Speech Therapy
Following implantation, children receive extensive habilitation1/re-

habilitation services from audiologists, speech-language pathologists,
teachers, and counselors as they learn to listen and develop their speech
and language skills. For children with little or no experience, sounds
heard through the device will seem strange. As a result, training and
therapy are necessary to aid them in learning to identify and characterize
sound as well as to respond appropriately. Habilitation for the child with
prelingual deafness will involve developing an awareness of the sound
and its many contexts and developing speech and voice production as
well as age-appropriate expressive and receptive language (Clark, 2003,
p. 654). The process of habilitation should also involve family members,
particularly to aid in promoting their acceptance and understanding of
both the capabilities and limitations of the device (p. 654). Yet another
goal of habilitation involves the alignment of auditory communication
skills with the overall development of the child (p. 655). With time, the
child will learn to listen and to develop his or her speech and language
skills.
For older children or adolescents with previous listening experience,
sounds through the cochlear implant may seem unnatural and incom-
prehensible at first and require a period of adjustment. Older children or
adolescents must be involved in the habilitation/rehabilitation process,
one that is both meaningful and motivating for their age. Robbins (2009)
suggests that the materials used during habilitation/rehabilitation
should emphasize facets of their life, specifically the music, video games,
books, favorite sports, or other relevant icons of the time most impor-
tant to them (p. 305). Speech therapy will likely focus on intelligibility of
words, phrases, and sentences as well as social language skills and social
etiquette. The social activities are particularly important for those who
have not previously experienced such cues and who, as a result, exhibit
poor socialization skills with their hearing peers and teachers (Robbins,
2009, p. 305).
Support and guidance for the implanted child are crucial if his or her
aural habilitation/rehabilitation is to be maintained. The helpfulness
of this support hinges on the communication of the audiologist, reha-
bilitative clinicians, therapists, teachers, and family members, essen-
tially those individuals who work closest with the child. Parents are also
strongly encouraged to take part in their child’s intensive program. The
parents’ involvement will better help them to understand what their child
is experiencing and enable them to be part of the cohesive unit that will
aid the child in becoming acclimated to the device (Incesulu, Vural, &
Erkam, 2003).
The music teacher can also provide support and guidance for the child
with a cochlear implant, so he or she should become familiar with the par-
ticular cochlear implant the child is using (i.e., make, model, and brand).
The music teacher should also insist on being a part of any parent-teacher
meetings so as to remain updated on the functioning of the device and the
particular MAP being used, as well as any changes to the MAP, and educa-
tional modifications implemented in the child’s others classes. Similarly,
the music teacher should be consistent in his or her observation of the
cochlear implanted child. Daily evaluations of the child should include his
or her musical successes during class, as well as noticed changes in the
child’s perceptions or musical responsiveness.
Monitoring the Cochlear Implant Device
Post-surgical responsibilities for parents entail making sure that their

child is using the cochlear implant consistently and that he or she is
attending all appointments related to the device including all program-
ming appointments and rehabilitative sessions. Care and maintenance
including repair is vital for successful use of the device. One simple sug-
gestion for monitoring the device includes administering a listening check
with the Ling Six Sound Test (Ling, 1978, 1988, 2002).
Some Thoughts on Electrostatic Discharge
Electrostatic discharge (ESD), defined as the accumulation of an electric

charge on a person or object resulting from friction between two materi-
als, is another possible effect that needs to be considered. Though risk for
ESD is minimal, ESD can cause damage to the programs or maps stored in
the sound processor. Therefore, parents and teachers should take precau-
tions to ensure the safety and comfort of the cochlear implanted child.
Precautions can include the use of humidifiers for very dry areas, anti-
static mats and shields for electronic equipment such as computers, and
the application of anti-static spray to materials and surfaces (i.e., com-
puters, televisions, plastic toys, carpeting, or mats) that the child will be
using. Other options include the removal of the sound processor during
play (Cohen, 1998; Nevins & Chute, 1996; Paul & Whitelaw, 2011). Parents
and teachers might also consider grounding themselves first by touching
a conductive surface such as a metal desk or table prior to handling the
sound processor.
CONTROVERSIES ASSOCIATED WITH PEDIATRIC

COCHLEAR IMPLANTATION
Cochlear Implantation and Meningitis
Meningitis is an infection of the membranes (meninges) and fluids sur-

rounding the brain and spinal cord. Understandably, parents have been
fearful about the incidences of meningitis associated with cochlear im-
plantation; however, cases have significantly diminished as a result of pa-
tient vaccination, observance of rigorous surgical principles such as the
packing of the cochleostomy, and the elimination of potentially harmful
electrode arrays (Cohen, Roland, & Marrinan, 2004; Cole & Flexer, 2011).
In 2002, ninety-one cases of postimplantation meningitis were re-
ported by the Food and Drug Administration (FDA) and by September of
2003, 118 cases had been reported worldwide, including fifty-five from
the United States and sixty-three from other parts of the world (Wei,
Robins-Browne, Shepherd, Clark, & O’Leary, 2008, p. 1). Parental con-
cern grew during the summer of 2003 after the New England Journal of
Medicine published findings from a study conducted by the Food and Drug
Administration, the Centers for Disease Control, and other health-related
organizations, revealing that children with cochlear implants were at
greater risk of developing bacterial meningitis than those in the general
population. This study as well as numerous health announcements re-
ceived considerable media attention. Parents of pediatric cochlear im-
plant candidates were distressed by these research findings (Marschark,
2007, p. 55).
In the last decade, clinical and laboratory researchers have identified
several contributing risk factors associated with the contraction of men-
ingitis amongst cochlear implant users. Such factors have included age at
the time of implantation as well as conditions of the cochlea and temporal
bone. Children implanted at a younger age and those who had a malforma-
tion of the cochlear or temporal bone were particularly at risk. Children
whose device included a positioner, a small plastic wedge inserted along-
side the implanted electrode array to ensure a secure fit within the spiral
of the cochlea and proximity to the auditory nerve, were also at risk.
Vaccinations to protect against pneumococcal meningitis are strongly

recommended before and after cochlear implantation (Childrens’ Hospital
of St. Louis, 2013, “Precautions,” para. 10). These include the four-part
Prevnar 7-valent vaccination which should be administered before a child
reaches the age of two and the Pneumovax 23-valent vaccination for chil-
dren over the age of two. Medical experts further recommend that chil-
dren receive a second Pneumovax 23-valent vaccination five years after
the first administration (para. 10).
Deaf Community and Hearing Parents:

Different Perspectives
The Perspective of the Deaf Community
Cochlear implantation, particularly involving the very young pediatric
patient, has sparked opposition resulting in troubled relations between
some members of the Deaf community and the parents of children either
implanted with the device or considering implantation (Christensen &
Leigh, 2002, p. 264.)
Initially, the National Association of the Deaf (NAD) believed that the
cochlear implantation of children was too experimental and that signif-
icant support for the long-term benefits of implantation was unavailable
(Cherney, 1999). Later concerns of the Deaf community included the
cases of meningitis contracted by children following implantation. The
reported instances of facial paralysis, scarring, and severe headaches
also added to their apprehension and resistance to accept cochlear im-
plantation as a viable option for children (Paludneviciene & Leigh, 2011,
p. 7). Deaf adults and stakeholders in deaf education also expressed
their unease regarding an overemphasis on both auditory training and
spoken language at the expense of an accessible visual language (p. 7).
Some members of the Deaf community questioned whether hearing
parents should make such lasting decisions on behalf of their children.
Such decisions were said to have been based on hearing parents’ ideas
of deafness and not their knowledge or understanding of the benefits of
belonging to the Deaf community. Yet another concern raised by the Deaf
community has been that hearing parents would prevent their child from
learning a sign language or from becoming a member of the Deaf commu-
nity, which could lead to the child finding it difficult to fit into either the
hearing world or Deaf community (Biderman, 1998; Blume, 2010; Cherney,
1999; Paludneviciene & Leigh, 2011; Samson-Fang, Simons-McCandless,
& Shelton, 2000; Wrigley, 1997).
Feelings about the device stem partially from the experiences of many
members of the Deaf community who have had negative experiences
when required to participate in oral programs without regard for their
ability to perceive spoken language via residual hearing (Paludneviciene
& Leigh, 2011, p. 6). In some cases this was coupled with hearing aids and
assistive listening devices that were not paired to their physical hearing
ability, thus further limiting their access to communication. The inability
of these approaches to fully include the Deaf community in the past is a
large part of why that community viewed cochlear implants and the pro-
motion of oral approaches to communication as a “return to a dark era in
deaf history” (p. 6).
Perceptions of the cochlear implant have changed. The implant’s im-
pact upon the Deaf community, benefits to wearers, and even viewpoints
regarding the implantation of young children are being reconsidered
(Paludneviciene & Leigh, 2011, p. 3). For example, in 2000 the NAD
released a statement advocating for the preservation of the “psychosocial
integrity of the deaf” (Dillehay, 2011, p. 20). Based on the “wellness model,”
the NAD recognized “the rights of parents to make informed choices for
the deaf and hard of hearing children” (NAD, 2000, “Cochlear Implants,”
para. 6). The NAD strongly encouraged physicians, audiologists, and allied
professionals to refer parents to qualified experts in deafness as well as
other relevant resources. The intent was to help parents to make fully in-
formed medical/surgical decisions as well as those pertaining to language
models, to educational settings and training opportunities, psychological
and social development, and to the use of technological devices and aids
(NAD, 2000, “Cochlear Implants,” para. 11).
Technological advances in the area of cochlear implantation coupled
with available research and information on the device, as well as con-
tinued improvements in surgical procedure information has led to
growing numbers of deaf children with deaf parents and/or caregiv-
ers who are receiving implants (Mitchiner & Sass-Lehrer, 2011, p. 72).
Another indicator of changing perceptions is the growing number of
cochlear implant users who have maintained their ties to the Deaf com-
munity (p. 80). Christiansen and Leigh (2002) report that “young people
with the cochlear implant are a part of the inclusive Deaf community, that
they are still deaf” (p. 322). This is based upon the recognition that coch-
lear implants do not automatically entail a “repudiation of Deaf commu-
nity values” (p. 322). Additionally, this change represents their transition
from the cultural to the bicultural community (p. 322). From an educa-
tional standpoint, the changing views about the implant also serve as an
acknowledgement that “both visual and aural input” can enhance the ed-
ucation of deaf children (Cooper, 2009; Rhoades, 2011, p. 144).
The Parents’ Perspective

Despite advances in cochlear implant technology, parents have reported
that the decision to implant is an agonizing one (Hintermair, 2004,
2006; Incesulu et al., 2003; Lederberg & Golbach, 2001; Meadow-Orlans,
Spencer, & Koester, 2004; Pipp-Siegel, Sedey, & Yoshinaga-Itano, 2002;
Spahn, Richter, Zschocke, Löhle, & Wirsching, 2001). Parents are prima-
rily driven by their desire to communicate and so they maintain that they
alone should make decisions in their child’s stead and not others who are
unaware of their family dynamic. Medical professionals remain in full
support of parents’ rights and responsibilities to decide on behalf of their
children (Blume, 2010).
Ultimately, the perspectives presented in this book are based on dif-
ferent life experiences and circumstances. There are differing degrees of
effectiveness and success with the device and parents should be aware of
the controversies surrounding pediatric cochlear implantation as part
of the decision-making process. Parents should also make themselves
fully aware of all processes involving cochlear implantation including
the possible outcomes as well as the social, emotional, and educational
implications (Nevins & Chute, 1996, p. 9). Stringent candidacy criteria,
testing and evaluation, as well as counseling are in place to ensure that
the decision-making process is thorough, that the pros and cons are con-
sidered, and that the families facing such decisions have the necessary
support.
CURRENT TRENDS IN COCHLEAR IMPLANTATION
Cochlear implant research has evolved as a scientific field of study (Zeng,

2004). For example, researchers are working to improve the electrode
development in order to restore “normal pitch sensation” to cochlear im-
plant users (p. 9). Processors are also under continuous development. Due
to the advances of silicon chip technology in the last decade, the external
components of the cochlear implant are now much smaller. This modifi-
cation has made it possible for the device’s circuitry to be contained in
an ear-level package rather than on the body (Ramsden & Axon, 2009,
p. 355; Smullen, Eshraghi, & Balkany, 2006, p. 371). This reduction in size
has therefore required higher-powered batteries with lower power con-

sumption (Clark, 2003, p. 483).
Hybrid Cochlear Implant Devices
Another area of research is the hybrid implant device, as shown in Figure

7.5. Hybrids or “short electrode” cochlear implants were developed for
patients with severe to profound hearing losses in higher frequencies
(Woodson, Reiss, Turner, Gfeller, & Ganz, 2010). The device was also de-
veloped with the intention of preserving low residual frequency hearing.
Essentially, the electrode of the hybrid device is implanted into the base
of the cochlea, and combines the technologies of both the hearing aid that
acoustically amplifies low frequencies, and the cochlear implant that elec-
trically amplifies high frequencies (Goldstein, 2009). The device ultimately
provides an alternative solution for those who “hear too well to receive a
cochlear implant but who cannot use conventional hearing aids” (Hear-it
Press, 2013, “Hybrid Hearing Aid/Cochlear Implant,” para. 1).
Yao, Turner, and Gantz (2006) investigated the stability of low-frequency
auditory thresholds to determine whether short-electrode cochlear implan-
tation could be a long-term solution for adults and children diagnosed with
Figure 7.5: Combined Electric Acoustic Stimulation (EAS) (Hybrid Device). Courtesy of

MED-EL Corporation.
high-frequency severe-to-profound hearing loss (p. 1085). These investiga-

tors examined the long-term rate of decline of acoustic hearing for patients
with a preexisting hearing loss who had not yet been implanted with a
cochlear implant. To calculate the rate of change of threshold over time,
the investigators reviewed the audiograms for those patients who met
candidacy criteria for the short-electrode device. Results provided sup-
port for short-electrode cochlear implantation in adult candidates because
the researchers found that participants’ low-frequency acoustic hearing
remained fairly stable over time. The findings for the pediatric patients
were highly variable because only some of the participants’ thresholds
remained stable. While the hybrid device is an option for those pediatric
patients with stable low-frequency hearing, the researchers stress that
clinicians would need “reliable indictors” to determine those pediatric
patients that would be best suited for the device (Yao et al., 2006, p. 1089).
Research involving music perception with hybrid devices has also
gained momentum. Gfeller, Olszewski, Turner, Gantz, and Oleson (2006),
for example, sought to examine the music perception abilities of coch-
lear implant users implanted with the Cochlear Nucleus Hybrid device.
Researchers were also interested in comparing the hybrid users’ per-
formance with that of hearing adults and with cochlear implant users
implanted with conventional long-electrode devices (i.e., Advanced
Bionics: 90K, Clarion, CIIHF; Cochlear Corporation: C124M, C122,
Contour; Ineraid). Data revealed that both hybrid recipients and hearing
participants were significantly more accurate than long-electrode device
users in the real-world song recognition measures that were presented
without lyrics. Researchers also found that the hybrid and hearing par-
ticipants were significantly more accurate on the instrument recognition
measures for low- and high-frequency ranges than were the participants
implanted with the conventional long-electrode device. Overall, these
findings suggest that perception of real-world music is dependent on the
preservation of low-frequency acoustic hearing and that the hybrid device
may be beneficial for such listening (Gfeller et al., 2006).
Bilateral Cochlear Implantation
Having a cochlear implant in both ears, termed bilateral cochlear implan-

tation, is another growing rehabilitation trend. For example, Litovsky
et al. (2004) examined sound localization and speech intelligibility in
noise for adults and children with bilateral cochlear implants. Their find-
ings revealed that bilateral implantation led to better performances on
the localization and speech tasks for the adults when the noise was closer
to their weaker ears. For children, localization and discrimination results
were only slightly better under the bilateral conditions. Researchers also
found that one of the children did not benefit from bilateral hearing on
the speech perception measures while two other children did exhibit con-
sistent improvement with bilateral hearing when the noise was presented
nearest to the ear first implanted.
Another study by Litovsky, Johnstone, and Godar (2006) examined
the functional benefits of bilateral stimulation. Participants for the study
were twenty children, ages four to fourteen. Ten of the participants used
bilateral cochlear implants and the other ten used a cochlear implant in
one ear and a hearing aid in the contralateral ear. The researchers found
that both groups performed similarly when speech reception thresholds
were evaluated. Findings also revealed significant benefits for the chil-
dren with bilateral implants in the areas of sound localization, acuity, and
speech intelligibility as compared to the participants using both a coch-
lear implant and hearing aid.
In addition to sound localization and improved speech perception, other
benefits of bilateral cochlear implantation include a greater sensitivity to
softer sounds, sound source differentiation, improved spatial awareness,
and the ability to perceive sound equally across two ears. Having the sec-
ond device to serve as a backup also protects implant users in terms of
device malfunction or failure (Tyler, Dunn, Witt, & Noble, 2007).
A study by Kuhn-Inacker, Shehata-Dieler, Muller, and Helms (2004),
involving thirty-nine children with bilateral cochlear implants, revealed
that bilateral implantation did improve the children’s communicative be-
havior, especially within complex listening situations. Children examined
with the speech-in-noise test scored significantly better in the bilateral
condition as compared to those in the unilateral condition. Findings also
revealed that participants were better able to integrate the sound informa-
tion received with the second implant when the second cochlear implant
surgery closely followed that of the first.
Concerns associated with bilateral cochlear implantation do exist
and include reduced acoustical residual hearing. While this is also true
for monaural implantation, greater concern arises when considering bi-
lateral implants. Another concern is that of electrode insertion and the
destruction of cochlear tissue in both ears because this can impact the
individual’s opportunities for taking advantage of future cochlear im-
plant technologies. Surgical risks associated with bilateral implants are
the same or slightly greater than for single implantation and include in-
fection, anesthesia, and potential blood loss.
Bimodal Stimulation
Several researchers have conducted studies that compare bilateral coch-

lear implantation with bimodal stimulation, which involves the electrical
stimulation with a cochlear implant in one ear and acoustic stimulation
with a hearing aid in the contralateral ear. For example, Mok, Galvin,
Dowell, and McKay (2009) examined the speech perception benefits of
children using either bimodal or bilateral stimulation. The research-
ers found that most of their participants had a significant advantage in
speech perception in at least one noise condition (p. 45). Results also re-
vealed that the bimodal participants had an advantage over those who
were bilaterally implanted in the noise front condition, although findings
also suggest that the second implant may provide an advantage in real-life
settings (p. 45). Overall, this study provides support for bimodal stimu-
lation and bilateral implantation for children and is consistent with pre-
vious studies that have supported binaural/bimodal fittings for children
and adults, which also highlight both the individual nature of and differ-
ences in bimodal stimulation and bilateral implantation (Ching, Incerti,
Hill, & van Wanrooy, 2006; Looi, 2008).
Schafer and Thibodeau (2006) examined the speech recognition per-
formance in noise as it occurred in children who used bilateral cochlear
implants or a hearing aid in the contralateral ear. This was done in con-
junction with a frequency modulation (FM) system on one or both sides.
Their findings revealed that the participants’ speech-in-noise thresholds
did not improve as a result of either a second cochlear implant or a hearing
aid on the contralateral ear. The participants with cochlear implants, how-
ever, did have better speech recognition in noise when using an FM sys-
tem on one or both sides.
Sucher and McDermott (2009) examined the effect of bimodal stim-
ulation on music perception and perceived sound quality. Nine postlin-
gually deafened adult cochlear implant users served as the participants
for this study, which has been included due to the limited number of
studies in this research area involving children. Participants were
examined in three conditions: implant alone, hearing aid alone, and bi-
modal stimulation. The researchers discovered that bimodal stimula-
tion provided optimal results for music perception and perceived sound
quality as compared to the results obtained with electrical stimulation
alone (cochlear implant only). According to the researchers, bimodal
stimulation may be advantageous when listening to music and other
non-speech sounds for cochlear implant users with usable acoustic
hearing.
MUSIC AND COCHLEAR IMPLANTED

CHILDREN: INVOLVEMENT, TRENDS, AND
IMPLICATIONS FOR THE MUSIC CLASSROOM
Musical Involvement
An early study by Gfeller, Witt, Spencer, Stordahl, and Tomblin (2000)

examined the musical involvement and enjoyment of children who use
cochlear implants. The participants’ responses to the music included
motor responsiveness such as clapping and swaying, singing, and smil-
ing. Parents also reported that their children seemed to enjoy music. The
researchers noted too that the apparent pleasure of the children was de-
pendent on the volume of the music. One participant showed no respon-
siveness to the music. According to the researchers, this was likely due
to the child’s limited experience (one month) with the implant. These
findings have been substantiated by Yennari (2010) who observed that
very young cochlear implanted children are actively involved in singing
in their everyday lives (p. 293). Yennari found that children also partici-
pated in song routines, indicated song preferences, and responded emo-
tionally to songs. Schraer-Joiner and Chen-Hafteck (2009) found that
familiarity with song material increased young children’s involvement
in singing activities. They also observed that participants were also hap-
pier and more excited when involved in activities featuring familiar song
materials (Schraer-Joiner & Chen-Hafteck, 2009). Still other studies have
found that older children with the cochlear implant, ages six to nineteen,
enjoy being involved in musical activities regardless of the limitations
(i.e., poor pitch differentiation) imposed by the device (Cooper, Tobey,
& Loizou, 2008; Fujita & Ito, 1999; Galvin, Fu, & Nogaki, 2007; Gfeller,
2000; Gfeller, Christ, Knutson, Witt, Murray, & Tyler, 2000; Gfeller, Witt,
Spencer, Stordahl, & Tomblin, 2000; Gfeller, Woodworth, Robin, Witt,
& Knutson, 1997; Kong, Cruz, Jones, & Zeng, 2004; Leal et al., 2003;
Linsenmeier, 1999; Masia, Rogers, Olszewski, & Gfeller, 2001; Stordahl,
2002; Vongpaisal, Trehub, & Schellenberg, 2006; Vongpaisal, Trehub,
Schellenberg, & Papsin, 2004).
Current Music Research Trends
Continued advances in cochlear implant technology are due, in part, to the

findings of researchers who have chronicled the experiences of children
with cochlear implants. This cochlear implant research, spanning more
than two decades, has implications for the planning and implementation
of music lessons involving children with cochlear implants. Several studies

have revealed that these children have been successful in identifying fa-
miliar songs though not at the same level as their hearing peers (Stordahl,
2002; Vongpaisal, Trehub, Schellenberg, & Papsin, 2004; Vongpaisal
et al., 2006).
Vongpaisal, Trehub, and Schellenberg (2009) examined the ability of
children with cochlear implants to recognize their favorite television
tunes on the basis of incidental exposure. The songs were presented in
three conditions: a flute rendition of the main (sung) melody, a full in-
strumental version without lyrics, and the music in its original form
(Vongpaisal et al., 2009, p. 17). The researchers found that the children
with implants were less accurate than the hearing children who partici-
pated in the study. However, the implanted children were able to success-
fully identify all versions of the songs presented at “above chance levels”
which the researchers attributed to timing cues that matched the original
music (p. 17). In a related study, Hsiao (2008) investigated the ability of
cochlear implanted children who spoke Mandarin Chinese to recognize
familiar melodies. According to Hsiao (2008), participants performed
with greater accuracy when lyrics were presented and were much less suc-
cessful when melodies were presented without rhythmic patterns and lyr-
ics. Furthermore, Hsiao (2008) found that the presentation of rhythmic
patterns helped the participants to identify the target melodies; however,
they were still less successful than when the lyrics were also presented.
Still other studies have revealed that cochlear implant users are able
to perceive both tempo and rhythm, though not to the same extent as
hearing persons (Cooper et al., 2008; Kong et al., 2004; McDermott, 2004).
Additionally, timbre recognition has been found to be difficult for cochlear
implant users due to the “degradation of spectral shape” (Vongpaisal et al,
2009, p. 17). Such findings suggest that implanted children will be more
successful with music listening when provided with rhythmic cues and
song lyrics. Simple familiar melodies presented on single instruments will
also serve as a solid starting point for music exploration. The music studies
included herein have important implications for parents and teachers spe-
cifically regarding implant users’ perception of musical stimuli as well as
those factors that have had an impact on music perception.
Implications for Music Education
Music educators will likely see more children with cochlear implants
in their classrooms as technology improves and devices become more
commonplace. Therefore, many teachers will require support and guid-

ance in order to adequately meet the specific aural and communica-
tive needs of these students (Marschark & Hauser, 2011). This also has
implications for music teacher training programs. According to McCord
(2007), music education students often feel anxious and unsure of the
ways in which to teach students with hearing loss. However, following a
semester-long collaboration with deaf educators, McCord’s students felt
empowered and secure. Her students also shared their observations par-
ticularly that the deaf students they worked with valued music and were
capable of participating in classes and ensembles (McCord, 2007). In re-
lated studies, preservice teachers felt significantly more positive about
using music in the education of students with special needs after their
field experiences emphasized such teaching opportunities (VanWeelden &
Whipple, 2005, 2007). With the appropriate resources and strategies for
the inclusion of their students with hearing loss, teachers, veteran and ne-
ophyte, can enhance the education received by all of the children in their
music classroom.
Applications for Music Lessons
There are some factors particular to the child with a cochlear implant that
should be considered in preparation and planning. For example, consider
the cochlear implanted child’s social characteristics and background. If
the implanted student is socialized within deaf culture or has a bilin-
gual background, he or she may be familiar with manual communication.
Therefore, emphasis in the music classroom can be placed on musical art
forms such as sign-interpreted musical performances and song signing.
If the implanted child originates from a strictly aural-oral environment,
having never been exposed to manual communication, musical activi-
ties involving song signing need not be as emphasized (Schraer-Joiner
& Prause-Weber, 2009). Another factor to consider in lesson planning
is familiarity, particularly as the cochlear implanted child is constantly
grappling to orientate to his or her auditory surroundings. Hearing-stress
situations2 can be reduced simply by maintaining predictable class struc-
tures and routines (Sobol, 2001). Such an approach can ensure a safe, fa-
miliar, and dependable learning environment for all children in the music
classroom.
Music educators should be aware that the implanted child may have
difficulty with multiple element focuses (i.e., listening that involves their
focus on both rhythm and pitch or rhythm and tempo). Depending on the
cochlear implanted child’s experience and success with the implant, the
music teacher may want to consider having them focus on one element
during a music listening activity (i.e., rhythm at first followed then by
pitch, for example). Single-element focuses can be reinforced and enhanced
with a listening map, a graphic representation of the music, and move-
ment activities that emphasize the element. For example, specified arm
movements may be used to represent either the melodic or harmonic line.
Body rhythms can also be implemented to symbolize rhythmic structure
(Schraer-Joiner & Prause-Weber, 2009). Furthermore, a whole-part-whole
approach may be employed during a listening lesson. For example, the
music teacher might consider introducing the entire piece first, including
the history and background, main themes and instruments; followed by
an emphasis on individual musical elements for more in depth study; and
then conclude with a reiteration of the entire piece. Such an approach
would be beneficial for the entire class and particularly helpful to the
implanted child who is developing his or her listening skills with the de-
vice (Schraer-Joiner & Prause-Weber, 2009). Sending home a “musical
heads-up” in the form of materials that can help the child to prepare for
upcoming music classes can provide further academic support. As I men-
tioned in chapter 4, this approach involves a collaborative effort between
parents and teachers and should only be initiated if everyone is onboard.
Additionally, such an approach may seem daunting due to the additional
planning time required. Therefore, music teachers are encouraged to adapt
and implement the ideas presented herein to better align with their own
teaching approaches and classroom needs.
The external components (microphone and sound 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 com-
ponents. Children who feel uneasy about doing so should be carefully
monitored throughout the activity. An alternate activity or modified
movements can be planned for the child as a precaution. If the micro-
phone is dislodged from the magnet that holds it in place, in most cases
the child will be able to replace it him- or herself.
In some cases, children with cochlear implants may not have an indi-
vidualized education program. Such a decision is made by the parent or
guardian of a child whose implant surgery and subsequent habilitation
were successful and, therefore, do not want to have their child identi-
fied or labeled as having a hearing loss. In such a situation, the music
teacher should speak with the child’s other teachers, in addition to the
school nurse, to determine whether the district has been informed by
the child’s parents. Music teachers should also feel comfortable contact-
ing the parents directly so they can answer questions about their child’s
cochlear implant. One of the first questions that should be asked by the
music teacher is “What are the child’s spectral capacities?,” referring to
those frequencies available to the child with his or her implant system.
Furthermore, the music teacher should review the child’s audiogram. If
unfamiliar with such information, questions or concerns may be also
directed to the school’s audiologist, speech-language pathologist, or
school nurse. The music teacher may also want to consider contacting the
child’s other teachers to find out about the instructional modifications
implemented in those classes. All of this information will better help the
music teacher to safely and successfully modify the curriculum in order
to accommodate the cochlear implanted child in the music classroom
(Schraer-Joiner & Prause-Weber, 2009). Finally, as the gathering and un-
derstanding of such information may take some time, the music teacher
may want to conduct a musical audiogram. As described in chapter 3, this
is an aural perception activity that can provide the music teacher with
some initial information regarding those tones and dynamic ranges most
comfortable for the child (Prause, 2003). Ultimately, all children have the
potential to develop musically. Therefore, it is important for parents and
teachers to realize that differences exist for the cochlear implanted child
due to the very individual nature of the device.
CONCLUSIONS
Approximately 188,000 people from around the world have received coch-
lear implants, a biomedical electronic device that bypasses the outer and
middle ear to directly stimulate the remaining auditory nerve fibers of the
inner ear. Since the late 1700s researchers have been interested in finding
ways to restore hearing to those with hearing loss. The early investigations
of Volta, Duchenne, and Brenner paved the way for later researchers such
as Eyries and Djourno whose work yielded the first detailed description
and model for the direct stimulation of the auditory nerve. Such research
led to the development of the first single- and multi-channeled implant
devices in the 1960s and 70s with results for individuals ranging from
improved vocalizations and speech reading to increased perception of en-
vironmental sound and open-set speech recognition. The 1980s saw great
advances in cochlear implant technology as well as clinical trials involv-
ing child participants. Devices also began earning FDA approval. With the
1990s came an expansion in the types and numbers of devices available to
the public, including technological advances in the electrode array, proc-

essing strategies, and implant software. By 2002, several devices were
approved for children as young as twelve months of age.
Parents considering cochlear implantation for their child feel the
weight and responsibility of making this decision. Parents are not alone,
however, as they work together with a team of specialists who help to
ensure that the procedure is the best option for their child. Extensive
habilitation/rehabilitation and counseling services follow implantation
procedures to aid the child as he or she adjusts to life and sound with
the device. Support and guidance are crucial for the child to ensure that
his or her auditory training program is maintained. This support often
depends on the communication of all team members who work closest
with the child.
Both early implantation and technological advances in design and ef-
ficiency have significantly influenced the speech and language develop-
ment skills of children with early onset deafness. Research has revealed
that the earlier a child is implanted, the greater the benefits he or she may
receive from the cochlear implant. Early implantation, for those families
who make the choice together, can provide opportunities for sound identi-
fication as well as speech and language development. Despite advances in
cochlear implantation and an extensive body of supportive research, pe-
diatric cochlear implantation has sparked much opposition between the
parents of young cochlear implant users and the Deaf community. While a
majority of professionals associated with pediatric cochlear implantation
would agree that decisions ultimately reside with the child’s parents, the
concerns of the Deaf community reinforce the importance of gathering in-
formation pertaining to the variety of options available to children with
hearing loss. Parents should also make themselves fully aware of all pro-
cesses involving cochlear implantation including the possible outcomes
and social, emotional, and educational implications, including the con-
troversies surrounding pediatric cochlear implantation (Archbold, Sach,
O’Neill, Lutman, & Gregory, 2006).
Cochlear implant research has evolved as a scientific field of study.
Areas of continuous development include components of the device
such as the electrode array and sound processors to ensure device ef-
ficiency. Silicon chip technology has also resulted in a reduction in the
size of the external components of the cochlear implant. Still other
areas of research and development include the hybrid or “short elec-
trode” cochlear implant, bilateral cochlear implantation, and bimodal
stimulation.
Research studies investigating the musical responsiveness and enjoy-

ment of children with cochlear implants provide support for their in-
volvement in music activities. Findings have also revealed those musical
elements perceivable with the device (rhythm, tempo) as well as those that
are more difficult (pitch, timbre). Several studies have revealed, however,
that older children involve themselves in musical activities regardless of
the limitations imposed by the device. The aforementioned research has
implications for the music classroom. The cochlear implanted child is con-
stantly faced with numerous auditory demands and auditory learning
often resulting in hearing-stress situations. With guidance, the music
teacher can meet the needs of the growing number of implanted children
in the music classroom, thus ensuring that they have the same opportuni-
ties for musical learning as their peers.
1ST GRADE GENERAL MUSIC LESSON PLAN SAMPLE

Duration: 1 class period
Concepts: steady beat/ rhythm
Objectives:
1. The students will add instruments to help portray the characters of the duck (woodblocks),
cat (bells), and squirrel (drums) in the story Pumpkin Soup by Helen Cooper (Affective and
Skill objective).
2. The students will define the term steady beat. (Knowledge objective)
3. The students will identify aurally the steady beat of the song Pumpkin Stew. (Knowledge
objective)
4. The students will patchen the steady beat on their legs while listening to the song
Pumpkin Stew. (Skill objective)
5. The students will create their own musical Pumpkin Stew by playing an Orff accompani-
ment. (Affective Objective)
The National Performance Standards for Music K-2:

Content Standard: 2: Performing on instruments, alone and with others, a
varied repertoire of music.
Achievement Standard: 2b: Perform easy rhythmic, melodic, and chordal patterns
accurately and independently on rhythmic, melodic,
and harmonic classroom instruments.
Content Standard: 8: Understanding relationships between music, the other
arts, and disciplines outside of the arts.
Achievement Standard: 8b:
Identify ways in which the principles and subject
matter of other disciplines taught in the school are
interrelated with those of music.

Standard1.1: The Creative Process: All students will demonstrate an understanding of the
elements and principles that govern the creation of works of art in dance, music, theatre,
and visual art.
Strand B. Music
Music content statement: The elements of music are foundational to basic music
literacy.
Cumulative Progress Indicator: Identify musical elements in response to diverse aural
prompts, such as rhythm, timbre, dynamics, form, and melody. CPI#: 1.1.2.B.2
Music content statement: Music is often defined as organized sound that is dependent
on predictable properties of tone and pitch. Musical notation captures tonality, dy-
namic range, and rhythm.
Cumulative Progress Indicator: Identify and categorize sound sources by common
traits (e.g., scales, rhythmic patterns, and/or other musical elements), and identify
rhythmic notation up to eighth notes and rests CPI#: 1.1.2.B.3
Music content statement: Musical instruments have unique qualities of tonality and res-
onance. Conventional instruments are divided into musical families according to shared
properties.
Cumulative Progress Indicator: Categorize families of instruments and identify their
associated musical properties. CPI#: 1.1.2.B.4
Standard 1.3 Performance: All students will synthesize those skills, media, methods, and
technologies appropriate to creating, performing, and/or presenting works of art in dance,
music, theatre, and visual art.
Stand B. Music
Music content statement: Playing techniques for Orff instruments develop founda-
tional skills used for hand percussion and melodic percussion instruments.
Cumulative Progress Indicator: Demonstrate correct playing techniques for Orff
instruments or equivalent homemade instruments. CPI#: 1.3.2.B.3
Materials:
Staton, B. (1988). Grade 1, Music and You Book. New York, NY: MacMillan
Cooper, H. (2005). Pumpkin Soup. New York: Farrar, Straus and Giroux.
Additional Items:
Triangle D and A tone bars Tambourine
Drums Woodblock Bells (jingle)
Preliminary Preparations for the child with a cochlear implant

For the Teacher: 1. Provide the cochlear implanted child with the lyrics, listening map,
and recording of the song Pumpkin Stew.
2. Provide information pertaining to the story Pumpkin Soup by Helen
Cooper (ISBN-10: 0374361649) so that the child’s parents can ei-
ther purchase it or find it at the library in order to review for the
upcoming lesson.
3. Pre-assess the child’s comfort level with instruments such as the trian-
gle, bells, and tambourine to be sure that they do not cause the child
any discomfort. Please note that the instruments for this lesson have
narrower frequency fields (fewer harmonics) and therefore should be
easier for the cochlear implanted child to perceive. Since variations
due exist in terms of perception and comfort level, you may still want
to pre-assess. In instances where the instrument does have an impact,
consider modifying instrument for the assignment or find an alternate
part for the child to play!
For the Parent: 1. Listen to the recording of the song Pumpkin Stew with your child and
sing it after listening. The more familiar they are with the song, the
easier it will be for them to keep up in class - ultimately, the more
comfortable they will be!
2. Read the story Pumpkin Soup to your child so that he/she can be fa-
miliar with it for the upcoming lesson.
Procedure: 1. Anticipatory set: The students and teacher will discuss the upcoming
Halloween holiday including symbols and/or environmental cues
we see in the Fall (October and November) including pumpkins and
Jack-o-Lanterns, scary costumes, Scarecrows, colorful leaves, and
colder temperatures!
2. We will read the story Pumpkin Soup by Helen Cooper adding
instruments to help portray the duck (woodblocks), cat (bells), and
squirrel (drums). I will ask the students for ideas as to how to
play the instruments so as to best represent each animal in the
story.
Accommodation: The child with a cochlear implant should be posi-
tioned so that he or she can see the teacher’s face and the book as
the story is being read.
3. We will then talk about the moral of the story (compromise,
sharing, giving) in the story and then I will tell them we are going to
sing a song about pumpkins called Pumpkin Stew.
4. First, however, we will add ingredients to our own Pumpkin Stew.
5. As a class we will think about the things that go into a pumpkin
stew (I will ask the student to indicate that they have an idea by
putting their hands on their heads)
Accommodation: Restate the ingredients offered by each student
as a reinforcement for the child
6. When everyone has had the chance to contribute an idea, I will
sing the song to model first as the students go to in small groups to
our cauldron, which will be placed in the middle of the classroom,
to add their ingredients.
a. Students will then listen while I model the song four times both
singing and playing the bordun on the tone bars. As they listen,
the students will keep a steady beat by patchen their legs so as to
mimic the way we play the tone bars.
b. The students and I will sing the song line by line as a group while
keeping the steady beat. If any additional help with the words is
needed, I will break the song down again, line by line, having the
students sing after I have modeled the line in question. Once
they are comfortable, we will sing the song together from the
beginning.
Accommodation: During this step, the child should free to focus
upon the singing only at first and then add the steady beat as
they are comfortable with the lyrics; a listening map can help the
child follow the song.
c. Students will then take turns cooking the stew (in this instance
cooking will be an accompaniment on the following instru-
ments: Triangle, D and A wooden Tone bars, and Tambourine.)
Accommodation: Position the child close to the instruments to
reinforce transmission of vibration
d. Once finished, the class will then set the cauldron aside to let
it simmer!
6. Assessment: As students “cook the stew,” the teacher will assess
how each student is doing with steady beat while playing the tone
bars (bordun), and other accompaniment parts (i.e. Triangle (to be
played on the word stew); Tambourine (to be played on the word
pumpkin.), as well as with pitch matching as they sing the song.
The rest of the class will help their peers by keeping the beat by
patchen their legs. (Each student will have the opportunity to play
each part). (This will help to reinforce the concept of steady beat
for the child with a cochlear implant)
7. Assessment (Question and Answer) about the musical experiences
the children had in class:
a. What instruments did we play today during our story?
b. What ingredients did we add to our pumpkin stew?
c. What Orff instruments did we play today for our song
Pumpkin Stew?
Accommodation: Restate each answer provided by the class.
The student should also be given alternative ways to answer (i.e.
sign, writing, demonstrating)
8. Assessment/Conclusion: The students will perform Pumpkin Stew
for their classroom teacher
Pumpkin Stew
Music by Randy DeLelles; Words by Sue Snyder

Boyer-White. R., Campbelle-duGard, M., Robert de Frece, R., Goodkin, D., Henderson,
B. M., Jothen, M., King, C., Miller, N.L. T., Rawkins, I. (2006). Share The Music, Grade
1. New York: McGraw-Hill.
St. Clair, T. (2010). Kindergarten Song Sheet. Retrieved from: http://www.kirkwood.k12.
mo.us/parent_student/ke/stclait/Letter%20PDFs/Kindergarten%20Song%20Sheet%20
%233.pdf
Verse 1:
Pumpkin stew,
Pumpkin stew,
What shall we put in the pumpkin stew?
Verse 2:
Pumpkin stew,
Pumpkin stew,
Verse 3: (Additional Lyrics are optional)
Chop Chop Chop
Drop Drop Drop
Stir it up, Stir it up,
Sip sip stop!
Verse 4:
Pumpkin stew,
Pumpkin stew,
PUMPKIN STEW LISTENING MAP
Listening Map Citations

Pumpkin Question M. (2010). Retrieved from http://powet.tv/
(100) Cauldron. (2010). Retrieved from http://www.holidaycutouts.ne

Parents
1. As your child begins to make the transition to public school, he or she may have many
questions including “Will I fit in?” “Will I make friends?” “Will I be able to keep up with
everyone?” In order to help your child make as smooth a move as possible, you might
want to consider requesting a preliminary meeting with your child’s classroom teachers
including those teachers who provide art, music, and physical education instruction.
This discussion can provide you with the opportunity to make teachers aware of your
child’s cochlear implant and allow them the chance to ask questions. Topics might in-
clude the make and model of the device, resource materials pertaining to your child’s
particular device, spectral capacity, as well as precautions associated with electrostatic
discharge. Parents might also consider providing a simple demonstration of the ways to
monitor the child’s device. Remember, information is power! Taking such preliminary
measures ensure your child’s comfort level in a new situation.
2. Encourage your child to discuss his or her listening experiences with you (i.e., interesting,
new, and/or exciting sounds from school, songs he or she is learning in music class,
changes in what he or she is able to perceive in general as this may mean that a visit to
the audiologist to evaluate the effectiveness of the map is necessary.) Possible topics for
discussion include:
a. What type of music do you like? What musical sounds are the most comfortable for
you? Uncomfortable?
b. Who are your favorite musicians?
Shared listening experiences can be especially helpful for the young child who is
becoming acclimated to the cochlear implant device. See Appendix 1 for the Parent/
Child Listening Together Journal. Such experiences encourage communication as well
as a way for all to share in new listening experiences. Older children or adolescents
should be encouraged to maintain their own listening journal as a way to keep track
of any listening changes that should be brought to the attention of the audiologist.
See Appendix 2 for the Child Listening Activity Journal.
3. Update your child’s teacher as to any changes in the functioning of his or her cochlear
implant including mapping strategy. Changes in mapping strategy, for example, can sig-
nificantly impact your child’s perception of pitch. Additionally, if the external compo-
nents of your child’s device are in need of repair, he or she may be attending music class
without a fully functioning implant. The music teacher should be notified of such a sit-
uation in order to make any necessary modifications to the lesson to ensure your child’s
comfort and success.
Teachers
1. Consider sharing your music curriculum, teaching approaches, and strategies with the
student’s parents as well as school colleagues. Ask colleagues to share their lesson mate-
rials with you, as well. As a group, you are a support system for the student with a coch-
lear implant and for each other.
2. Consider collaborative lesson plan development. Such an approach can encourage the
integration of concepts across subject areas as well as a reinforcement of important
curricular concepts for all of the students in your classes.
3. Maintain open communication with the student’s parents by providing a “musical heads-up”
regarding upcoming music lessons, especially those that involve instrument playing,
listening, and movement. This requires some special consideration and monitoring of the
device. A musical heads-up can give the student a chance to prepare adequately.
4. Keep detailed notes on the student’s progress, updating his or her parents, other
teachers, and specialists working with the student. This is especially important as the
student’s responses indicate that modifications to his or her mapping strategy may be
necessary. Share the student’s musical success with everyone.
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APPENDIX 1
Parent/Child Listening
Together Journal
1. Today we: (describe here the musical activities you did together in-
cluding singing, listening, moving, finger plays, etc.)
2. Today we heard some new sounds!
a. They were:
b. The new sounds we liked were:
c. We liked them because:
d. The new sounds we did not like were:
e. We did not like them because:
NOTABLES: INFORMATION TO NOTE FOR THE

AUDIOLOGIST
1. While we were making music, my child responded by: (For example,

mimicking the words of the song, humming the melody with me, or
singing with the words and melody. This led me to believe that he/she
both recognized it and remembered it)
2. Today my child’s musical behavior was:
a. The same as the last time we made music at home together because:
b. Different because:
c. Inconsistent because:
( 265 )
( 266 ) Appendix 1
QUESTIONS TO KEEP IN MIND:
3. I think my child’s language skills have been influenced by the following

music activities:
4. Additional information I would like to contribute regarding my child’s
musical behavior:
APPENDIX 2
Child’s Listening Activity Journal
I. Today I: (describe here the musical activities you did today including
singing, listening, moving, instrument playing, etc.)
II. Today I encountered many sounds that were especially pleasant.
They were:
III. Today I encountered many sounds that were unpleasant. They were:
IV. The following personal or environmental factors (i.e., not feeling well,
tired, bored, excited about something, room, noise, etc.) may have
influenced my musical experiences today. They were:
V. Reflecting over the last few days (and weeks), I have noticed changes
in the sounds (environmental and/or musical). I am perceiving:
( 267 )
APPENDIX 3
Beethoven Biography and

Listening Guide
This listening guide was used for one of the Kean University Concert
Series for the Deaf programs. I have included it herein for parents and
teachers to use as they wish.
LUDWIG VAN BEETHOVEN

(Dec. 17, 1770–March 26, 1827)
Beethoven was widely regarded by many to be the greatest composer who

ever lived. As a young boy, he was very shy and only attended elementary
school because he lived during a time when only a few children went on
to Gymnasium (high school). His first music teacher was his father who
taught him to play the violin, viola, and harpsichord (a predecessor of the
piano).
During his adolescence, Beethoven was the assistant to German opera
composer and conductor, Christian Gottlob Neefe. He performed a great
deal during this time while also studying compositional technique with
Neefe. At the age of seventeen, Beethoven had the opportunity to travel
to Vienna. While there, he met Wolfgang Amadeus Mozart, another com-
poser of the time period, whom Beethoven greatly respected. He also had
the opportunity to study composition with Mozart.
While in his mid-twenties, Beethoven studied with another well-known
composer, Franz Joseph Haydn. As time passed, Beethoven gained promi-
nence as a composer and was favored by many music publishers who often
competed for his new compositions. In his late twenties, Beethoven began
to lose his hearing though he was still able to compose and experience
( 269 )
( 270 ) Appendix 3
music employing compensatory strategies to better help him to perceive

sound. One example of this involved a wooden pole which was connected
to the piano soundboard. Beethoven clenched the pole in his teeth which
enabled him to hear/feel the notes vibrate in his head. His compositional
efforts continued and were so successful that he was the first musician
to receive a salary with no duties required of him other than to compose.
Beethoven wrote a total of nine symphonies and, unlike many composers,
was famous throughout Europe during his lifetime. When he died 20,000
people were reported to have attended his funeral.
Listening Map for Beethoven’s Symphony No. 5
The Symphony No. 5 in C minor was written by Ludwig van Beethoven

between 1804 and 1808.
The first movement of this symphony, Allegro con brio (fast, with vigor
and spirit), contains a distinctive short-short-short-long pattern (fol-
lowed by a short period of silence). This four note theme is the basis for
the entire movement.
Below you will find two pictures which represent the pattern for
the motif:
1. Iconic representation:
● ● ● ▬ (silence)
2. Actual pattern: Symbolic representation
This short pattern or motif was described by Beethoven as fate knock-

ing on the door. Historians have also reported that Beethoven’s idea for
this motif actually came from bird calls specifically the Yellowhammer’s
song which he heard one day while taking a walk. (He often took long
walks in the afternoons and would always take a sketchbook in order to
write down his musical ideas.) Other descriptions for this motif include
that of a “thunderbolt,” and a “fist held high.”
Beethoven used percussion instruments more frequently than compos-
ers before him—possibly to create loud bursts in his music. Some histo-
rians think this may have been to help him find his place in the music.
Beethoven was creative in many ways, and perhaps the most important
way was how he managed to be a musician with profound hearing loss.
Appendix 3 ( 271 )
REFERENCES
Biography.com. (2011). Ludwig Van Beethoven [On-line]. Retrieved from http://www.

biography.com/articles/Ludwig-van-Beethoven-9204862
Classical Net. (2011). Ludwig Van Beethoven [On-line]. Retrieved from http://www.
classical.net/music/comp.lst/beethoven.php
Kerman, J., Tyson A., Johnson, D., & Drabkin, W. (1980). Beethoven, Ludwig van.
In Grove Music Online. Oxford Music Online. Retrieved from http://www.oxfordmusi-
conline.com/subscriber/article/grove/music/40026
APPENDIX 4
Books for Kids
Addabbo, C. (2005). Dina the deaf dinosaur. Stamford, CT: Hannacroix Creek
Books, Inc.
Anderson, J.F. (2004). My hearing loss and me: We get long most of the time. Bloomington,
IN: Trafford.
Aseltine, L., Mueller, E. & Tait, N. I’m deaf and it’s okay. Morton Grove, IL: Albert
Whitman & Company.
Brownlie, S. (2011). Samantha’s Fun FM and Hearing Aid Book! CreateSpace Independent
Publishing Platform. Retrieved from www.createspace.com/
Burk, C. (2005). Prudence Parker and a sign of friendship. Austin, TX: Dandy Lion
Publishing.
Carey, K., Guevremont, K., & Marsh, N. (2007). The smart princess and other deaf tales.
Toronto, ON: Second Story Press.
Clemente, G. (1994). Cosmo gets an ear. Los Alamitos, CA: Modern Signs Press.
Dussling, S. (2010). Sunny and her cochlear implants. Bloomington, IN: Author House.
Ernst-Schneider, E. & Dineen, T. (2004). Taking hearing impairment to school.
Woodbury, NY: JayJo Books.
Gaynor, K. (2009). A birthday for Ben. Children with hearing difficulty. Dublin,
Ireland: Special Stories Publishing.
Heelan, J. R. (2002). Can you hear a Rainbow?: The story of a deaf boy named Chris.
Chicago, IL: Rehabilitation Institute of Chicago Learning Books.
Klakow, N. & Riski, M. C. (1994). Patrick gets hearing aids. Warrenville, IL: Phonak, Inc.
Kelley, W. P. (2004). Hearing loss: An alphabet book. Austin, TX: Buto Ltd Co
Kelley, W. P. (2003). Deaf culture: A to Z. Austin, TX: Buto Ltd Co.
Kelley, W. P. (2004). The “I love you” story. Austin, TX: Buto Ltd Co.
Lakin, P. & Steele, R. G. (1994). Dad and me in the morning. Park Ridge, IL: Albert
Whitman & Company.
Litchfield. A. B. & Mill, E. (1976). A button in her ear. Park Ridge, IL: Albert Whitman
& Company.
Matlin, M. (2004). Deaf child crossing. New York, NY: Simon & Schuster.
Millman, I. (2000). Moses goes to school. Canada: Douglas & McIntyre.
Millman, I. (2002). Moses goes to a concert. Canada: Douglas & McIntyre.
Millman, I. (2004). Moses sees a play. Canada: Douglas & McIntyre.
Moore-Mallinos, J. & Fabrega, M. (2009). I am deaf. Hauppauge, NY: Barron’s
Educational Series.
( 273 )
( 274 ) Appendix 4
Nijssen, E. (2010). Laurie. New York, NY: Clavis Publishing.

Powell, J. (2009). Jordan has a hearing loss. (Like Me Like You). New York, NY: M. Evans
and Company.
Riski, M. C. (2008). Abby gets a cochlear implant. Kent, UK: Cassidy Publishing.
Schaefer, L. M. (2008). Some kids are deaf. Mankato, MN: Capstone Press.
Spradley T. S. & Spradley, J. P. (1985). Deaf like me. Washington, DC: Gallaudet
University Press.
Thomas, P. (2005). Don’t call me special: A first look at disability. Hauppauge, NY: Barron’s
Educational Series.
Willis, J. & Ross, T. Susan laughs. New York, NY: Henry Holt and Company.
APPENDIX 5
Arts-Related Opportunities
for Kids
Organization: The Little Theatre of the Deaf (LTD)

Purpose: The Little Theatre of the Deaf (LTD) is the children’s division of
the National Theatre of the Deaf. Active since 1968, LTD is committed
to reaching out to youngsters and their families. LTD performs original
works, classic stories, fables, and poems and gives live performances each
year to thousands of children and adults in both schools and theatres
throughout the United States. LTD has also toured internationally and
has been active on television. Examples include the PBS program Sesame
Street (1975) and the Disney Channel series “Out of the Box” in 2001.
Main Website: http://www.ntd.org/lil_theatre.php
Contact:
a. National Theatre of the Deaf
Monte Cristo Cottage
325 Pequot Avenue
New London, CT 06320
Email: Info@NTD.org
b. National Theatre of the Deaf
139 North Main Street
West Hartford, CT 06107
Telephone & Fax
Monte Cristo Cottage (voice): 860-574-9063
c. West Hartford Office (voice): 860-236-4193
Video Phone (VP): 860-607-1334
Fax: 860-574-9107
( 275 )
( 276 ) Appendix 5
Reference
The Little Theater of the Deaf. (2013). About the little theater of the deaf.
Retrieved from http://www.ntd.org/lil_theatre.php
Organization: National Theater for the Deaf
Mission:
The mission of the National Theater for the Deaf is to produce theatrically
challenging work of the highest quality and to perform original works in a
manner which links American Sign Language and spoken language. They
also seek to train and employ Deaf artists and to provide community out-
reach activities that will educate the general public.
Main Website: http://www.ntd.org/
Contact:
National Theatre of the Deaf
Monte Cristo Cottage
325 Pequot Avenue
New London, CT 06320
National Theatre of the Deaf
139 North Main Street
West Hartford, CT 06107
Telephone & Fax
Monte Cristo Cottage (voice): 860-574-9063
West Hartford Office (voice): 860-236-4193
Video Phone (VP): 860-607-1334
Fax: 860-574-9107
Email: Info@NTD.org
Reference
National Theater for the Deaf (2013). About us. Retrieved from http://
www.ntd.org/about.php
Organization: International Center on Deafness and the Arts through
Education
Purpose: The International Center on Deafness and the Arts through
Education (ICODA) is dedicated to educating, enriching, and empower-
ing Deaf, Hard of Hearing, Hearing children and adults through quality
artistic and educational experiences. ICODA has continuously demon-
strated the relationship of arts and learning through its many program
offerings while also encouraging the development of the individual.
ICODA also promotes public awareness of Deaf Culture and the creation of
Appendix 5 ( 277 )
an environment that promotes and seeks to strengthen the bonds among

diverse populations. Some of the programs available to children, adoles-
cents, and adults include Continuing Education, dedicated to the profes-
sionals who work with the children with hearing loss; The Traveling Hands
Troupe, comprised of Deaf, Hard-of-Hearing, and Hearing members be-
tween the ages of seven and eighteen, who perform poems, interpreted
songs and dances for various service organizations, schools, and sporting
events; the Story-n-Sign Touring Theater, featuring programs for children
and teenagers; as well as ICODance, featuring dancers who are Deaf, Hard
of Hearing, as well as Hearing.
Main Website: http://www.icodaarts.com/index.html
Contact:
International Center on Deafness and the Arts through Education
(ICODA)
614 Anthony Trail
Northbrook, IL 60062
Phone: 847-509-8260
Fax: 847-509-8157
TTY: 847-509-8257
Email: info@icodaarts.org
Reference
International Center on Deafness and the Arts through Education (ICODA)
(2013). About ICODA. Retrieved from http://www.icodaarts.com/index.html
Organization: Music and the Deaf
Mission and purpose: Founded in 1988 by Paul Whittaker, Music and the
Deaf helps those who are deaf and hard of hearing as well as those who live
and work with them, to access and enjoy music.
Main Website: http://matd.org.uk/
Contact:
Music and the Deaf
7 Northumberland Street
Huddersfield
HD1 1RL
UK
Voice: 01484 483115
Fax: 01484 483116
Textphone: 01484 483117
( 278 ) Appendix 5
SMS: 07831 270479
Email: info@matd.org.uk
Reference
Music and the Deaf (2010). Who we are. Retrieved from http://matd.org.
uk/
Organization: Deaf West Theatre (DWT)
Mission and purpose: Deaf West Theatre (DWT) productions feature deaf
and hearing actors joining onstage to tell stories in a seamless ballet of
movement, American Sign Language (ASL), and spoken or sung English.
Deaf West Theatre, Inc.
The mission of DWT is to directly improve and enrich the cultural lives
of individuals with hearing loss who live in the Los Angeles area by pro-
viding exposure and access to professional theater. They also serve as an
institution for the discovery and exploration of artists’ identities and
stature; and also wish to create, share, and preserve a legacy of deaf cul-
ture through the medium of Sign Language.
Main Website: http://www.deafwest.org/
Contact:
5114 Lankershim Boulevard
North Hollywood, CA 91601
Voice: 818-762-2998
VP: 866-954-2986
Email: info@deafwest.org
Reference
Deaf west theater (2013). About DWT. Retrieved from http://www.deafwest.org/
APPENDIX 6
Sources for Parents and Teachers
Organization: No Limits for deaf-and-hard of hearing children

Mission: The mission of No Limits is to meet the auditory, speech, and lan-
guage needs of deaf children; to enhance their confidence through expe-
riences in the theatre arts and individual therapy; and to provide family
support and community awareness about the needs and talents of deaf
children who are learning to speak.
Main Website: http://nolimitsfordeafchildren.org/
Contact:
9801 Washington Blvd, Second Floor
Culver City, CA 90232
Phone/Fax:
Phone: 310.280.0878
Fax: 310.280.0872
Email:
Michelle Christie-Adams, Founder and Executive Director
Michelle@KidswithNoLimits.org
Reference
No Limits for deaf and hard-of-hearing children (2014). About us. Retrieved
from http://nolimitsfordeafchildren.org/about-us
Organization: DEAF Media, Inc.
Purpose: DEAF Media, Inc., is dedicated to supporting Deaf arts as well as
for the development of cultural, educational, and professional opportu-
nities for the Deaf community. Each program involves outreach to both
the Deaf and hearing communities, and promotes the visual, performing,
and media arts. DEAF Media, a nonprofit corporation, was established in
( 279 )
( 280 ) Appendix 6
1974, and though it provides supports and services primarily in northern

California, it has had both a national and international impact. Examples
include The Deaf Artists at the Oakland Museum of California that affords
meaningful museum access for artists and non-artists. Specifically, the
project offers Deaf adults, Deaf children, and their families hands-on ex-
perience in the arts, and provides them with opportunities to meet, ac-
knowledge, and work with Deaf artists. Another program, Feast for the
Eyes, is an annual storytelling event for the Deaf community with the
Office of Continuing Education at the California School for the Deaf,
Fremont. The Deaf Education and Arts Network (D.E.A.N.) involves Deaf
storytellers and artists who participate in school and community pro-
grams primarily serving Deaf children. D.E.AN. provides arts and cultural
enrichment while also serving as both social and linguistic role models
for the Deaf child. Yet another program is the Broadcast Television and
Media Distribution Rainbow’s End, DEAF Media’s Emmy Award-winning
PBS series for Deaf children. Rainbow’s End is dedicated to introducing
children to the humanities and to employing positive Deaf role models
using American Sign Language (ASL).
Main Website: http://www.deafmedia.org/
Contact:
DEAF Media, Inc.
1700 Parker St.
Berkeley, CA 94703
510.841.0163 (voice)
510.841.0165 (TTY)
510.845.6319 (fax)
Email: info@deafmedia.org
Reference
DEAF Media (2012). About us. Retrieved from http://www.deafmedia.org/about/
about.htm
APPENDIX 7
Books for Parents and Teachers
Bahan, B. & Dannis, J. (1990). Signs for me: Basic sign vocabulary for children, parents &
teachers. San Diego, CA: Dawn Sign Press.
Candlish, P. A. M. Not deaf enough: Raising a child who is hard of hearing with hugs and
humor. Washington, DC: Alexander Graham Bell Association for Deaf.
Casey, T. (2010). Inclusive play: Practical strategies for children from birth to eight.
London: Sage Publications Ltd.
Chute, P. M. & Nevins, M. E. (2002). The parents’ guide to cochlear implants. Washington,
Clark, M. (2006). A practical guide to quality interaction with children who have a hearing
loss. San Diego, CA: Plural Publishing Inc.
Cook, R. E. & Sparks, S. N. (2008). The art and practice of home visiting: Early inter-
vention for children with special needs and their families. Baltimore, MD: Paul H
Brookes Pub Co.
Cook-Meats, L. (2012). Speech to print: Language essentials for teachers. Baltimore,
MD: Paul H Brookes Publishing Co.
Easterbrook, S., & Estes, E. L. (2007). Helping deaf and hard of hearing students
to use spoken language: A guide for educators and families. Thousand Oaks,
CA: Corwin Press.
English, K. (2002). Counseling children with hearing impairment and their families.
Boston, MA: Allyn & Bacon.
Frost, J. L., Wortham, S. C., & Reifel, S. (2012). Play and child development.
Boston: Pearson.
Marschark, M. & Hauser, P. C. (2012). How deaf children learn: What parents and
teachers need to know. New York, NY: Oxford University Press.
the choices, controversies, and decisions faced by parents and educators (2nd ed.).
Medwid, D. & Weston, D. (1995). Kid-friendly parenting with deaf and hard of hearing
children. Washington, DC: Gallaudet University Press.
Nevins, M. E. & Chute, P. M. (2006). School professionals working with children with
cochlear implants. San Diego, CA: Plural Publishing.
Postance, J. (2009). Breaking the sound barriers: 9 deaf success stories. Australia: Deaf
Children Australia.
( 281 )
( 282 ) Appendix 7
Schwartz, S. (2007). Choices in deafness: A parent’s guide to communication options.

Bethesda, MD: Woodbine House, Inc.
Seeger, P. & Jacobs, P. D. (2006). The deaf musicians. New York, NY: G.P. Putnum’s Sons.
Stewart, D. A. & Clarke, B. R. (2003). Literacy and your deaf child: What every parent
should know. Washington, DC: Gallaudet University Press.
Uhlberg, M. (2009). Hands of my father: a hearing boy, his deaf parents, and the language
of love. New York, NY: Bantam Books.
Waldman, D. & Roush, J. (2005). Your child’s hearing loss: what parents need to know.
New York, NY: The Berkeley Publishing Group.
Walker, L. (1986). A loss for words: The story of deafness in a family. New York,
NY: Harper & Row Publishers, Inc.
Wright, J. D. (1915). What the mother of a deaf child ought to know. New York,
NY: Frederick Stokes Company. (digital copy available via Amazon Digital
Services, Inc.)
NOT E S
CHAPTER 1
1. According to Blum and Baron (1997), “speech is the motor act of communicat-
ing by articulating verbal expression, whereas, language is the knowledge of a
symbol system used for interpersonal communication” (pp. 845–849).
2. This is a reference to speech reading (formerly called lip-reading) involving
the analysis and understanding of spoken language through movement of the
mouth and face.
3. Vibrotactile stimuli allow a person to feel sensations through the pressure
receptors in their skin and body.
4. A wireless FM system comprised of a microphone that picks up a speaker’s voice
and transmits them, via radio waves, to the person wearing a corresponding FM
receiver.
5. Stress, tone, or word juncture that either accompanies or is added over conso-
nants or vowels.
CHAPTER 3
1. Vibrotactile aids help individuals who are deaf or hard of hearing detect and in-
terpret sound through the sense of touch.
2. A reference to the three types of objectives (Skill, Knowledge, Affective) ac-
cording to Patricia O’Toole (2003). (See Lesson Plan Sample for this chapter.)
3. The affective designation for this lesson objective refers primarily to the social
and emotional response elicited. (See Lesson Plan Sample for this chapter.)
CHAPTER 6
1. The concha is the hollow of the ear nearest the auditory canal of the outer ear
(Hall & Johnson, 2009).
2. Tinnitus is a noise or ringing in the ears.
CHAPTER 7
1. “Habilitation refers to the development of new communication skills for the

first time in children who are born deaf or deafened early in life” (Clark, 2003,
p. 654).
2. Hearing-stress situations refer to environments in which there is a great deal of
competing auditory stimuli.
( 283 )
GLOS SARY
Accent: Refers to the stress or emphasis placed upon the notes in a musical
composition.
Acoustic Nerve/Auditory Nerve/Cochlear nerve: The eighth cranial nerve is
responsible for the transmission of sound and balance information from
the inner ear to the brain.
Acoustic Reflex Test: The Acoustic reflex test measures the ability of the sta-
pedius muscles to contract in response to loud sound. This test can help to
identify auditory pathway defects.
Acoustic Tumor: A tumor of the nerve that connects the ear to the brain.
Advanced Combination Encoder (ACE) Strategy: A speech-processing
strategy for Nucleus devices similar to the “n-of-m” strategy.
Affective Objective: A type of instructional objective that addresses the
human qualities of music, the intrinsic qualities—more specifically, the
internal and subjective aspects of students’ musical experiences, their af-
fective responses, attitudes, values, desires, commitments, and tastes.
Air Conduction: Air conduction tests evaluate the sensitivity of the ear.
Testing is conducted with earphones that are placed over the ears or
inserted into the ear canal. Single frequencies or pure tones are presented
via a calibrated audiometer.
American Sign Language (ASL): The predominant sign language for cultur-
ally deaf individuals in North America.
American Speech-Language-Hearing Association (ASHA): An association
for audiologists, speech-language pathologists, and speech, language, and
hearing scientists.
Americans with Disabilities Act (ADA): Prohibits the discrimination of
those with disabilities. Title II of ADA applies to public school service pro-
grams, specifically that all are to be accessible to children with special
needs. Activities include those open to parents and the public at large,
such as graduation ceremonies, parent-teacher organizations, meetings,
and plays.
( 285 )
( 286 ) Glossary
Amplify: To increase the amplitude of an electrical signal or other oscilla-

tion. (The increase in the volume of sound.)
Amplitude: The amplitude of a vibration refers to how much the air is dis-
placed as the sound wave travels.
Analog Hearing Aid: A type of hearing aid that amplifies all sounds equally.
Such a device amplifies the sound wave by making it larger using transis-
tors and circuitry to amplify and modify the incoming sound stimuli.
Aperture: The center of the lip or embouchure.
Apical: Refers to the apical end of the cochlea—the portion of the cochlea
that responds to lower-frequency sounds.
Assistive Listening Devices (ALD): A term applied to personal devices, also
referred to as Assistive Listening Systems (ALS) and Hearing Assistive
Technology (HAT), that aid in the transmission, processing, or amplifica-
tion of sound. This term may also refer to alerting devices but is not used
to refer to hearing aids.
Association of Adult Musicians with Hearing Loss (AAMHL): An organi-
zation dedicated to providing a forum for adult musicians with hearing
loss so that they can discuss their musical experiences and challenges. The
association also creates opportunities for a variety of public performances
and other educational endeavors, and provides information for hearing
professional researchers and educators.
Attention: The ability to direct and sustain focused attention to sound.
Audio Loop/Audio Frequency Induction Loop Systems: Transmits sound
by a loop of wire that is placed around the classroom. Sound signals are
then received and amplified by the hearing aid.
Audio Processor (used in conjunction with the middle-ear implant): The
audio processor supplies the power for the implant system. The processor
consists of the battery, a microphone, and electronics responsible for digi-
tal signal processing.
Audiogram: A graph that represents a person’s responses to auditory stim-
uli, particularly the softest sounds that a person can hear 50 percent of
the time.
Audiologist: An Audiologist is a licensed healthcare professional who diagno-
ses, evaluates, and treats hearing disorders and communication problems.
Audiometer: An instrument fused to measure the hearing thresholds for
pure tones of frequencies generally varying from 200 to 8000 Hz and re-
corded in decibels.
Audiometry: Refers to the testing of a person’s ability to hear a variety of
frequencies presented at various intensity levels.
Glossary ( 287 )
Auditory Brainstem Response (ABR): A test that measures and records in-
fant brain activity in response to sound. This test administered to infants
between birth and five months of age.
Auditory Cortex: The part of the brain that processes sound.
Auditory Discrimination: The ability of the listener to distinguish between
auditory patterns of varying lengths and difficulty.
Auditory Figure Ground: The ability of a listener to focus upon one sound
without being distracted by surrounding sounds.
Auditory Memory: Involves the detection of differences in individual speech
sounds (phonemes), storage, and retrieval of auditory sound patterns.
Auditory Neuron: Refers to the afferent neurons or sensory neurons that
bring the stimuli from the inner ear to the central nervous system.
Auditory Neuropathy: A condition that affects the neural processing of au-
ditory stimuli.
Auditory Reception: The ability of the ear to receive and transmit sound.
More specifically, the process in the ear when sound is converted from an
air signal to that of a fluid signal.
Auditory Sequential Memory: Involves recalling the order in which audi-
tory stimuli or patterns of sound are perceived.
Auditory Synthesis: Auditory data is merged so that the listener transi-
tions from processing small fragments of sound to chunks, and then
finally begins to identify the various patterns that occur in sound
stimuli.
Auditory/Oral Approach: A method that involves the use of residual hearing
in conjunction with speech-reading and contextual cues in order to under-
stand and use spoken language.
Auditory/Verbal: Also referred to as unisensory, a method that involves the
use of residual hearing in conjunction with devices such as hearing aids,
FM devices, and cochlear implants.
Aural/Oral: Stresses the development of oral communication skills such as
audition via residual hearing for speech reception, speech reading, and
intelligible speech for the purposes of learning how to communicate with
those who speak English.
Awareness: The listener is aware of acoustic sound stimuli.
Basal: Refers to the basal end of the cochlea—the portion of the cochlea that
responds to higher-frequency sounds.
Basilar Membrane: A membrane located within the cochlea that supports
the Organ of Corti. The basilar membrane plays a crucial role in the per-
ception of pitch.
( 288 ) Glossary
Behavioral Observational Audiometry (BOA): A test that measures the

infant’s hearing via behavioral responses to a variety of acoustical stimuli
such as frequency-specific tones, speech, and music. This test is adminis-
tered to infants through the age of seven months.
Behind-the-Ear Hearing Aids (BTE): A type of hearing aid in which all com-
ponents are contained in a small plastic case that rests behind the ear; the
case is connected to an ear mold by a piece of clear tubing.
Bilateral Cochlear Implantation: The implantation of the cochlear pros-
thesis in both ears.
Bilateral Hearing Loss: Hearing loss that impacts both ears.
Bilingual-Bicultural (bi-bi) Approach: Acknowledges both the authenticity
and importance of hearing and Deaf cultures. Bi-bi programs employ sign
language as both the primary language and the method of instruction for
children who are deaf or hard of hearing. The secondary language is typi-
cally acquired at the same time as or even after the primary language and
is comprised of spoken and/or written English.
Bimodal Stimulation: Involves the electrical stimulation by cochlear implant
in one ear and acoustic stimulation by hearing aid in the contralateral ear.
Binaural: Relating to two ears; the perception of sound with both ears.
Bone-Anchored Hearing Aids (BAHA): A type of hearing aid that works by
bone conduction.
Bone-Conduction Hearing Aid: These hearing aids boost natural bone
transmission and use it as a pathway through which sound can travel to
the inner ear. The bone-conduction hearing aid consists of a body-worn
aid and a bone conductor or vibrator that is affixed to a headband. The
headband secures the vibrating component tightly to the skull directly
behind the ear.
Bone-Conduction Tests: Tests that bypass the outer and middle ear, and con-
duct sound through the skull directly to the inner ear. Testing is done via
a small vibrating element that is placed behind the ear against the skull.
Brainstem: The region at the base of the brain that connects the cerebrum
to the spinal cord. The brainstem is divided into three sections—the
midbrain, medulla oblongata, and pons—and is responsible for coordi-
nating the motor control signals sent from the brain to the various parts
of the body.
C-Print: A speech-to-text system developed at the National Technical
Institute for the Deaf (NTID).
Centers for Disease Control (CDC): A Federal Agency in the United States
under the Department of Health and Human Services. The CDC works to
both protect and promote public health and safety by raising awareness
Glossary ( 289 )
regarding disease prevention and control by providing data that will en-
sure informed health decisions. This agency also works with state and
local health organizations.
Central Auditory Pathway: A pathway that begins where the auditory nerve
enters the brainstem. The pathway ascends to the cerebral cortex, specifi-
cally the temporal lobe(s) of the brain.
Central Auditory System: The central auditory system begins with the coch-
lear or auditory nerve and ascends from the cochlea to the brainstem and
serves to process information from the Organ of Corti.
Child Study Team (CST): A multidisciplinary team trained to study and eval-
uate a child’s present level of performance and to recommend strategies
and interventions to improve the child’s progress in school.
Chord: A group of two or more notes played simultaneously. Most chords
are based upon triads (three notes) and contain the interval of a major or
minor third between each of the notes. The two most common chords are
the major and minor chords.
Cochlea: The snail-shaped structure located in the inner ear. It is divided
into three fluid-filled sections. Two are comprised of canals allowing for
the transmission of pressure while the third section contains the Organ
of Corti.
Cochlear Implant: A biomedical electronic device that converts sound into
electrical currents and directly stimulates the remaining auditory nerve
fibers of the inner ear.
Cochleostomy: A surgically created opening just lateral to the round window
of the inner ear.
Cochleovestibular Nerves: The nerves of the cochlea and the vestibule.
Comfort Levels (C-levels): C-levels are the loudest sound that can be lis-
tened to comfortably for a sustained period of time and are determined
for each electrode along the cochlear implant’s electrode array as part of
the mapping process.
Communication Access Realtime Translation CART: Go to Real-time
Captioning.
Completely-in-the-Canal (CIC): The smallest size of hearing aid that fits
deeply within the ear canal.
Comprehension: Understanding the meaning of the sound or message.
Computerized Tomography (CT scan): A combination of X-rays that are
taken from several different angles coupled with computer processing
that allows for the creation of cross-sectional images of the tissues and
bones of the body.
( 290 ) Glossary
Concha: A part of the outer ear, specifically the bowl-shaped portion of the
pinna nearest to the ear or auditory canal.
Condenser: A capacitor, a circuit element typically involving two separated
metal sheets. (Capacitors are used to store charge in a circuit similar to a
battery.)
Conditioned Orientation Reflex (COR) Audiometry: A test similar to Visual
Reinforcement Audiometry (VRA) but that uses more sound sources and
visual reinforcements.
Conditioned Play Audiometry: A behavioral technique most often used
to determine ear-specific and frequency-specific hearing thresholds
in young children. Administered to children who are approximately
two to two-and-a-half years of age, the test is a listening game that
uses toys to maintain the child’s attention and focus upon a listening
task.
Conductive Hearing Loss: A type of hearing loss that involves the outer and
middle ear.
Congenital Deafness: Deafness that is present at birth.
Continuous Interleaved Sampling (CIS) strategy: A strategy in speech
processing for cochlear implants in which brief pulses are presented
to each electrode in a non-overlapping sequence. The continuous inter-
leaved sampling strategy filters the incoming speech into eight bands
and then obtains the speech envelope and compresses the signal for
each channel. (Available for the devices manufactured by Cochlear Corp,
MED-EL, and Advanced Bionics.)
Cued Language Transliterator (CLT): Provides spoken language access
through Cued Speech.
Cued Speech Transliterator (CST). (See Cued Language Transliterator.)
Cued Speech: A system of hand shapes used around the face to show dif-
ferent sounds of spoken language.
Dangerous Decibels: A public health educational campaign introduced in
1999 with the goal of significantly reducing incidences of NIHL and tin-
nitus through education, research, and exhibits.
Day School: A program that can provide opportunities for a child with
hearing loss, similar to specialized programs for the deaf in terms of com-
munication, socialization, and academic focus while also allowing the
child to live at home.
deaf: Refers of an individual with little or no hearing.
Deaf: (Big “D” Deaf) Refers to those who are a part of the Deaf culture/
community.
Glossary ( 291 )
Deafness: Defined by IDEA as “a hearing impairment that is so severe that

the child is impaired in processing linguistic information through hearing,
with or without amplification” (US Department of Education, 2007).
Decibels (dB): A logorhythmic unit used to measure sound intensity or power.
Descant: A high-pitched member of a number of instrument families such as
the recorder; a high ornamental line that is placed above the melody part
(Randel, 1999, p. 183).
Detection: The awareness of the presence or absence of sound.
Digital Hearing Aid: A hearing aid device that uses digitized sound
processing.
Digitized Sound Processing (DSP): The decomposition of sound into in-
dividual frequency components that can be processed in small discrete
units prior to amplification.
Direct Audio Input (DAI): A feature of some behind-the-ear hearing aids
that allows an external source to be directly connected as an input, thus
bypassing the microphone component.
Discrimination: The ability to determine if two sounds are the same or
different.
Due process: Under IDEA, a hearing designed to resolve any disputes that
arise between parents and school districts regarding the education of stu-
dents with special needs.
Dynamics: Degrees of loudness in music.
Ear Canal (Auditory Canal, External Auditory Meatus): The passageway of
the outer ear through which sound travels from the pinna (auricle) to the
ear drum or tympanic membrane.
Ear-Level Aids: A group of hearing aids consisting of In-the-Ear (ITE) and
Behind-the-Ear (BTE) aids.
Ear Mold: A piece of plastic, acrylic, or other soft material that is molded to
fit the ear and to deliver the sound from a hearing aid device.
Ear, Nose, and Throat (ENT) Doctor (Otolaryngologist): A doctor who can
diagnose and treat diseases and disorders of the ear, nose, and throat.
Eardrum (Tympanic Membrane): A thin cone-shaped piece of skin posi-
tioned between the ear canal and the middle ear, to vibrate.
Early Hearing Detection and Intervention (EHDI): The process of screening
newborns for hearing loss prior to their discharge from the hospital.
Early Intervention Programs: Services provided to very young children
with special needs from birth to age three, including speech therapy, oc-
cupational, and physical therapy, provided in either the home or in an
office setting.
( 292 ) Glossary
Eighth Notes: One of many symbols of music notation representing the du-
ration of sound (Randel, 1999, p. 456).
Electro-Acoustic-Musically-Interactive-Room (EAMIR): is an open-source
music technology project developed for teachers, parents, and music ther-
apists. EAMIR incorporates alternate controllers, sensors, and adaptive
instruments to facilitate music instruction, performance, and composi-
tion—all through a collection of interactive music systems for classroom,
therapy session, or personal use.
Electro-Chemical Signals: Signals that are transmitted via neurons to the
brain and nervous system.
Electrode Array: The array, connected to the internal receiver-stimulator
package component of the cochlear implant, is a tapered piece of flexible
tubing lined with electrodes and inserted into the cochlea of the inner ear.
Electrophonic Hearing: Early research that examined the potential con-
version of electrical current into sound vibration before reaching the
inner ear.
Electrostatic Discharge (ESD): The accumulation of an electric charge on a
person or object resulting from friction between two materials.
Elementary and Secondary Education Act (ESEA): A law passed in 1965 as
a means for fighting poverty. Emphasized equal access to education and
the establishment of high standards and accountability. The law autho-
rized federally funded education programs to be administered by the
states. In 2002 the ESEA was amended and reauthorized as the No Child
Left Behind Act (NCLB).
Embouchure: The shape of the lips as applied to the mouthpiece (or head-
joint) of woodwind and brass instruments for tone production.
Endolymph: One of the fluids found in the inner ear.
English-Based Sign Systems or Manually Coded English (MCE): Combined
both English and sign and were designed to help children to learn to
read and write. English-based sign systems in use today include Signed
English, Signing Exact English (SEEII), and Conceptually Accurate Sign
English (CASE). It is a form of signing that uses ASL vocabulary in English
word order.
Eustachian Tube: A tube that links the middle-ear cavity with the naso-
pharynx (the nasal part of the pharynx that lies behind the nose and
above the soft palate) that helps the air pressure on both sides of the ear-
drum to remain equal and also ensures that the eardrum is able to move
freely.
Evoked Otoacoustic Emissions (EOAE): A test administered to infants in
order to measure the mechanical actions of the outer hair cells in the
Glossary ( 293 )
cochlea. This is accomplished via a vibration that produces a sound that

echoes back into the middle ear.
Expressive Language: Speech production.
External Abutment: The external cone-shaped component of the
bone-anchored hearing aid (BAHA) to which the sound processor connects.
Extracochlear: Outside of the cochlea.
Eyeglass Hearing Aid: A popular hearing aid between 1950 and 1970. This
device houses all circuitry at the temple of the glasses. The microphone is
near the ear and the receiver sends sound through tubing to the ear mold
that is located in the concha.
Feedback: A whistling sound that occurs with hearing aids. There are three main
types of feedback that can occur. Acoustical feedback occurs when amplified
sound produced by the hearing aid speaker is received again by the aid’s mi-
crophone, thus creating a sound loop. Mechanical feedback occurs when phys-
ical vibrations are created due to contact between the hearing aid speaker
and casing. The vibrations are subsequently transferred from the casing back
to the microphone. Electronic feedback results due to a malfunction of the
hearing aid circuitry. Such feedback often requires professional repair.
Figure-Ground Discrimination: The ability to pick out important or fore-
ground sounds from a noisy background.
Fine Structure Processing (FSP): A CIS-related strategy released by Med El.
Finger-Spelling: Hand shapes and motions that represent the letters of the
alphabet.
Flat Loss: A hearing loss that is relatively even across all frequencies.
FM Systems/Auditory Trainers: Allow educators to talk directly into a micro-
phone that transmits the sound of their voice directly to the hearing aid.
Form: Refers to the structure or plan of a musical composition.
Formative Assessment: Refers to a day-to-day reflective process that is con-
sidered to be a part of instruction and the instructional sequence. The goal
of formative assessment is to enhance student learning and overall attain-
ment of learning goals by providing consistent feedback regarding student
progress. It is more valuable for day-to-day teaching as it allows the teacher
to monitor student progress and thus modify the instructional approaches
employed to better meet their needs.
Fortissimo: Very loud.
Free and Appropriate Public Education (FAPE): Under IDEA, FAPE is the
provision of “a free and appropriate public education” and related serv-
ices, at public expense and in conjunction with an IEP document that is
designed to meet the child’s academic and social needs.
( 294 ) Glossary
Frequency Response: A curve representing the output-to-input ratio of a

transducer as a function of frequency. The ability of a hearing aid device
to detect sounds at different frequencies.
Frequency Theory (Telephone Theory): A theory suggesting that the entire
basilar membrane vibrates in response to a sound and that the resulting
nerve impulses mirror the frequency of the sounds to which we have been
exposed.
Frequency: The number of occurrences of a repeating event per unit time.
Full Inclusion: The practice of educating a child with hearing loss in the gen-
eral education setting for a majority of the school day with essential sup-
port services occurring in that setting.
Gain: Amplification.
Glottal Vibrations: Vibrations of the glottis or the vocal folds (vocal cords)
and the spaces in between the folds.
Habilitation: “Habilitation refers to the development of new communica-
tion skills for the first time in children who are born deaf or deafened
early in life” (Clark, 2003, p. 654).
Hair Cells: The sensory receptors located within the Organ of Corti upon
which tiny hair-like strands called cilia are located.
Haptic: Relating to the sense of touch
Hard of Hearing (HH/HOH): Refers to individuals who have mild, mod-
erate, or moderate-to-severe hearing loss. Deaf individuals who do not
wish to belong to the Deaf community may also refer to themselves as
hard of hearing.
Harmonize: To play or sing in harmony, which is defined as a combination of
notes sounding simultaneously to produce chords and chord progressions
with a pleasing effect.
Hearing Aid Orientation (HAO): Sessions or meetings designed for indi-
viduals with hearing loss and their families. These sessions include top-
ics such as hearing aid function and use as well as care and maintenance
of hearing aid equipment. Sessions may also address audiogram reading,
coping skills, assistive listening devices, and listening tips.
Hearing Aid: An electronic device that amplifies sound for individuals with
hearing loss.
Hearing Education and Awareness for Rockers (H.E.A.R.): A nonprofit vol-
unteer organization committed to raising awareness about the dangers of
repeated exposure to excessively loud music and environmental sound that
can ultimately lead to permanent hearing loss and debilitating tinnitus.
Glossary ( 295 )
Hearing Impairment: Defined by IDEA as “an impairment in hearing,

whether permanent or fluctuating, that adversely affects a child’s educa-
tional performance” (US Department of Education, 2007).
Hertz (Hz): A standard measure of frequency.
Hierarchy of Auditory Processing: A ten-level sequence for processing audi-
tory stimuli, created by Derek Sanders (1977). The levels are Awareness,
Localization, Attention, Discrimination, Auditory Discrimination,
Segmental Discrimination, Suprasegmental Discrimination, Auditory
Memory, Auditory Sequential Memory, Auditory Synthesis.
Hybrid/“Short Electrode” cochlear implant: A cochlear implant device that
combines the technologies of both the hearing aid that acoustically ampli-
fies low frequencies, and the cochlear implant that electrically amplifies
high frequencies.
Identification: The identification and labeling of the sounds perceived.
Impedance Audiometry (Acoustic Immittance Testing): A battery of tests
including tympanometry, acoustic reflex test, and static acoustic imped-
ance that measures the function of the middle ear by varying the pressure
within the ear canal and the movement of the ear drum.
In-the-Canal (ITC) Hearing Aids: Aids contained in a tiny case fitting partly
or completely into the ear canal.
In-the-Ear Hearing Aids (ITE): Parts of this aid are contained in a shell that
fills the entire portion of the outer ear.
Inclusion: A term that expresses commitment to educate each child, to
the maximum extent appropriate, in the school and classroom he or
she would otherwise attend. It involves bringing the support serv-
ices to the child (rather than moving the child to the services) and
requires only that the child will benefit from being in the class (rather
than having to keep up with the other students). Inclusion is about
the child’s right to participate, an overall respect for their social,
civil, and educational rights, and the school’s responsibility to accept
the child.
Inclusive Classroom: A reference to inclusion, a term that expresses com-
mitment to educate each child, to the maximum extent appropriate, in
the school and classroom he or she would otherwise attend. Support serv-
ices are brought to the child (rather than moving the child to the services)
and requires only that the child will benefit from being in the class (rather
than having to keep up with the other students).
Incus: The anvil-shaped bone in the middle ear that connects the malleus to
the stapes.
( 296 ) Glossary
Individualized Education Plan (IEP): A written, legal document used in the

United Kingdom and Australia that describes the special education and
related services to be provided for individuals who need special services.
Individualized Education Program (IEP): A written, legal document used in
the United States that describes the special education and related services
to be provided for individuals who need special services.
Individuals with Disabilities Education Act (IDEA) (PL-94-142): Is the
United States’ special education law. Originally enacted in 1975 as the
Education of All Handicapped Children Act (PL 94-142), it was a response
to increased awareness of the need to educate children with disabilities.
PL 9-142 later evolved to become IDEA that requires each state to pro-
vide a free appropriate public education (FAPE) in the least restrictive
environment (LRE).
Individuals with Disabilities Education Act (IDEA): Governs for the needs
(i.e., early intervention, special education, and related services) for chil-
dren, ages birth to twenty-one, with disabilities.
Induction Coil: A circuit element typically designed as a coil of wire capable
of storing electromagnetic energy. The induction coil was used by French
neurologist, Guillaume Duchenne. The induction coils of Duchenne’s era
were designed to modify voltage.
Infrared Systems: Transmit sound to students’ in the classroom via invisible
infrared light waves.
Initial Stimulation (or hook-up): The activation process of the cochlear im-
plant. During initial stimulation, the child responds to electrical signals
delivered to individual electrodes along the array. Also see MAP.
Inner Ear: The part of the human hearing system that contains the organs
for hearing (cochlea) and balance (semicircular canals).
Intensity: The intensity of a sound wave, measured in decibels (dB), is the
amount of energy or power that passes through a square metric area per
second.
Internal Receiver-Stimulator Package: The component of the cochlear im-
plant that is placed behind the ear and underneath the skin. It is con-
nected to the electrode array and decodes the signal while also controlling
the electrical current sent to each electrode along the array thus stimu-
lating remaining hair cells or auditory nerve fibers.
Intracochlear: Within the cochlea.
Key Signature: Identifies the key or “principal pitches” used in a composition.
Knowledge Objectives: A type of instructional objective that addresses the
understanding of how music works in terms of its theory and its historical
Glossary ( 297 )
context. Examples include defining, identifying, or recognizing musical

structures, critiquing a performance, or labeling the sections of a song.
Kodaly: A music education method for children created by Hungarian com-
poser, Zoltán Kodály (1882–1967). The purpose of the method was to pro-
mote music literacy through the use of Hungarian folk songs and a solfège
system emphasizing moveable do (Randel, 1999, p. 352).
Larynx: Also referred to as the voice box, the larynx is comprised of both
cartilage and muscle and is a part of the respiratory tract that is located
between the trachea and pharynx.
Lease Restrictive Environment (LRE): The placement of children with
special needs in a situation that will facilitate both academic and social
growth. Such placement decisions should be based upon factors specified
within the IEP process.
Least Restrictive Environment (LRE): The placement of exceptional learn-
ers within a setting that will enable them to succeed both socially and
academically.
Levels of Auditory Development: A four-level sequence for the processing of
auditory sound created by Norman Erber (1982). The levels are Detection,
Discrimination, Identification, and Comprehension.
Ling Six Sound Test: A listening test developed by Daniel Ling to both quickly
and easily test hearing and hearing aids of a child across the speech spec-
trum. The test uses six sounds, specifically [m]‌, [ah], [oo], [ee], [sh], and [s],
to target low-, middle-, and high-frequency sounds.
Localization: The listener can identify the location of a sound source.
Magnetic Resonance Imaging (MRI scan): A test that uses a magnetic field
and radio waves to create comprehensive images of the tissues and organs
of the body.
Mainstreaming: A term that has been used to refer to the selective placement
of special education students in one or more “regular” education classes.
Those in support of mainstreaming generally believe that a student must
“earn” his or her place in regular classes by demonstrating an ability to
“keep up” with the work assigned by the regular classroom teacher.
Malleus: The hammer-shaped bone in the middle ear that is connected to the
inner side of the eardrum as well as to the incus.
Manually Coded English (MCE): See English-based sign systems.
MAP: The setting of the T and C levels for each electrode on the cochlear
implant’s internal electrode array comprises a program or MAP. Each
MAP is developed specifically for the individual cochlear implant user
and includes information pertaining to the type of electrode stimulation.
( 298 ) Glossary
Mapping: The setting of the Threshold and Comfort levels for each electrode
on the cochlear implant’s internal electrode array.
Mastoid: Refers to the mastoid bone or process of the temporal bone behind
the ear at the base of the skull.
Meningitis: An infection of the membranes (meninges) and fluids sur-
rounding the brain and spinal cord.
Meter: The pattern in which a steady succession of rhythmic pulses is organ-
ized (Randel, 1999, p. 415).
Microphone: An external component of the cochlear implant that collects
sounds from the environment and then sends them to the speech proc-
essor for analysis.
Middle-Ear Implant (MEI): Also referred to as fully or partially implanted
hearing aid, the MEI stimulates the bones of the middle ear. It is com-
prised of an externally worn component referred to as the audio proc-
essor, an internal receiver (vibrating ossicular prosthesis), and floating
mass transducer.
Middle Ear: The part of the human hearing system that transmits the vibra-
tions of the tympanic membrane to the inner ear. Also contained in the
middle ear is the Eustachian tube.
Mild Hearing Loss: Typically classified as a hearing loss of around 26 to 40
decibels.
Mixed Hearing Loss: A combination of both conductive and sensorineural
hearing loss that involves both the middle and inner ear.
Moderate Hearing Loss: Typically classified as a hearing loss of around 41
to 55 decibels.
Moderately Severe Hearing Loss: A hearing loss ranging from 55–70
decibels.
Modiolus: The bony conical-shaped core of the cochlea.
Monaural: Relating to one ear; the perception of sound with one ear.
Morphemes: The smallest grammatical unit of speech.
MP 3000: A variation of the ACE strategy developed by Cochlear Corporation.
This strategy “uses psychophysical masking to limit the information
transfer” of masked acoustical information.
Multi-Channeled Device: A cochlear implant device that presents different
channels of electrical signals to different sites along the cochlea.
Multimodal: Having or involving more than one mode or modality (i.e., au-
ditory, visual, tactile, kinesthetic).
Music Therapist: Music therapy is the utilization of music to accomplish
therapeutic goals (i.e., the restoration, maintenance, and improvement
Glossary ( 299 )
of mental, physical, and spiritual health). Music therapy represents a sci-

entific application of music to bring about positive changes so that the
individual can develop to his or her full potential and achieve a more sat-
isfying adjustment to society.
Musical Audiogram: An aural perception activity that will provide the music
teacher with some initial information regarding that tones and dynamic
ranges most comfortable for the child.
“n-of-m” strategy: A speech processing strategy for MED-EL cochlear im-
plant devices that stimulates a fixed number of channels at a high rate.
This strategy analyzes the incoming sound to first identify those filters
with the greatest amount of energy. A subset of filters is selected followed
by the stimulation of corresponding electrodes.
National Association for Music Education (NAfME): The primary organiza-
tion for American music educators dedicated to advancing and preserving
music education and its curriculum.
National Association of the Deaf (NAD): An organization that advocates
for the needs and civil rights of the deaf and hard of hearing.
National Cued Speech Association (NCSA): An advocacy organization
formed in 1982 to provide support to parents and educators working with
children who are deaf and hard of hearing.
National Hearing Conservation Association (NHCA): An association whose
mission is to prevent hearing loss resulting from noise and other environ-
mental causes, and to provide opportunities for professional development
and education.
National Institute on Deafness and Other Communicative Disorders
(NIDCD): An organization established in 1988 to conduct and support
biomedical and behavioral research and training in the normal and dis-
ordered processes of hearing, balance, taste, smell, voice, speech, and
language.
Neurologist: A physician who specializes in the study and treatment of dis-
orders of the nervous system.
No Child Left Behind Act (NCLB): Enacted in order to improve the academic
achievement of all students regardless of race, ethnicity, socioeconomic
status, language skills, or disability. It was also ratified to lessen the con-
sistently pervasive achievement gap in American public schools.
Noise-Induced Hearing Loss (NIHL): NIHL is defined as the loss that
results from a singular or few loud impulse sound(s) or repeated exposure
to sounds over 90 decibels over an extended period of time that damage
sensitive structures of the inner ear.
Occlusion Effect: Occurs when bone-conducted vibrations reverberate off an
object that fills the auditory canal.
( 300 ) Glossary
Octave: An interval in music embracing eight diatonic degrees.

On-the-Body Aids: A device featuring a larger microphone, amplifier, and
power supply typically carried inside a case within the pocket or on the
clothing of the hearing aid user.
Open-Set Speech Recognition: Assesses one’s ability to perceive large sets of
monosyllabic or bisyllabic words.
Oral Interpreters: Are required by those deaf and hard-of-hearing individu-
als who do not use sign language. They present on the lips and face the
words spoken by another person (i.e., teacher, another child).
Oralism: The practice of teaching the deaf and hard of hearing to communi-
cate by means of spoken language.
Orff Instruments: Instruments used as part of Orff Schulwerk that is based
upon the educational philosophy and pedagogy of composer Carl Orff
and his music colleague Gunhild Keetman. Orff Instruments (tone bars,
xylophones, glockenspiels, metallophones, drums, and records) comprise
a large part of an entire learning approach that promotes music explo-
ration and learning through improvisation, movement, speech, singing,
and instrument playing, all in the child’s natural play environment. These
instruments coupled with improvisation, movement, speech, singing help
to develop the child physically, emotionally, socially, and musically.
Organ of Corti: Detects pressure impulses responding subsequently with
electrical impulses that travel the length of the auditory nerve to the brain.
Ossicles: The smallest bones of the human body comprising the middle ear.
They are the malleus, incus, and stapes.
Otitus Media: An inflammation of the middle ear; a middle-ear infection.
Otologist: A physician who specializes in diseases and disorders of the ear.
Otosclerosis: A disease of the bones of the middle and inner ear.
Outer Ear: The external portion of the ear that consists of the pinnacle and
auditory canal.
“Over-the-Ear” (OTE) or Open-fit-style hearing aids: These devices consist
of a casement that rests behind the ear and a tube that runs into the ear
canal. The tubing ends in a small, soft silicone dome with a highly vented
tip that allows for a more natural sound.
Partial Inclusion: A type of inclusion that does include alternate settings
when more restrictive environments are deemed to be more appropriate.
In this instance, instruction and essential support services are provided
in settings outside of the general classroom particularly when special
equipment (physical or occupational therapy) is necessary or if services
might be disruptive to the rest of the class (speech and language therapy).
Glossary ( 301 )
Perilingual Deafness: The onset of hearing loss during speech and language
skills development.
Perilymph: The fluids found in the scala tympani of the inner ear.
Phonemes: The perceptually distinct units of sound in a specified language
that distinguish one word from another.
Physiological: Pertaining to the normal functioning of a living organism.
Pinna or Auricle: Responsible for collecting sound vibrations from the envi-
ronment and guiding them into the ear canal.
Pitch: The psychological phenomenon of sound.
Pitched Instruments: Those instruments that produce a variety of pitches.
Place Theory: A theory of Georg von Bekesy that states that high-frequency
sounds register near the oval window or basal region of the cochlea where
the basilar membrane is narrow and rigid. Low-frequency sounds, alter-
natively, register at the apical region or tip of the cochlea, where the bas-
ilar membrane is wider and more flexible.
Positioner: A small plastic wedge inserted alongside the implanted electrode
array of the cochlear implant to ensure both a secure fit within the spiral
of the cochlea and proximity to the auditory nerve within the center of
the cochlea.
Postlingual Deafness: The onset of hearing loss after speech and language
skill development.
Prelingual Hearing Loss: The onset of hearing loss prior to speech and lan-
guage development.
Profound Hearing Loss: Hearing losses greater than 90 dB.
Psychoacoustics: The study of our sensory responses to physical stimuli.
Psychological: Pertaining to, dealing with, or affecting the mind, especially
as a function of awareness, feeling, or motivation.
Psychosocial: A child’s social skills and maturity level in relation to peers of
the same age.
Pure Tone Audiometry: A test that measures hearing sensitivity. Each ear
is tested individually at frequencies ranging from 125 to 8000 hertz (Hz).
The results indicate an individual’s pure-tone thresholds (PTTs).
Pure-Tone Thresholds (PTT): The softest sound audible to them at least
50 percent of the time.
Quarter Note: One of many symbols of music notation representing the du-
ration of sound (Randel, 1999, p. 456).
Radio Baton: A device consisting of two batons, an antenna board, and an
electronics box. The batons house antennas that, when moved over the
( 302 ) Glossary
antenna board, allow the performer to spatially manipulate the tempo,

dynamics, and balance of a digitized orchestral composition stored on a
computer.
Real-Time Captioning: Also referred to as Communication Access Realtime
Translation (CART) involves a captioner who typically uses a stenotype
machine with a phonetic keyboard to type the spoken words of the teacher
or other students during the class lesson.
Receptive Language: The perception and comprehension of speech.
Residential Schools: Have traditionally been an option for children with se-
vere to profound hearing losses who have opted to communicate prima-
rily via sign language.
Residual Hearing: The hearing that remains after the onset of a hearing loss.
Rhythm: The duration of sounds and silence in music.
Sansula: An instrument belonging to the kalimba family. The kalimba is a
modern version of the African mbira that is made up of a sound box with
metal keys or lamellas attached on the top. Sound is produced when the
tongues are plucked by the thumbs or fingers.
Scala Tympani: A perilymph-filled cavity of the cochlea.
Segmental Discrimination: Involves the detection of differences in indi-
vidual speech sounds (phonemes).
Self-Contained Classes: Special education classes within the public school
setting that are designed to meet the academic, social, and behavioral
needs of children with special needs who would otherwise struggle in the
general classroom.
Sensorineural Hearing Losses: Also referred to as nerve deafness, a form
of hearing loss that involves the structures of the inner ear and/or
auditory nerve.
Severe Hearing Loss: Hearing losses ranging from 71–90 decibels.
Sign Language: A form of communication that combines movement of the
hands, arms, body, as well as facial expression as a means of expressing a
speaker’s thoughts and ideas.
Signal-to-Noise Ratio: The relationship between the primary speech signal
and background noise.
Signed Exact English (SEE): A manual code that represents spoken English
by following the rules of English grammar and uses modified signs to rep-
resent English vocabulary. SEE was developed to improve Deaf students’
English language skills.
Simultaneous Analog Stimulation (SAS) Strategy: Stimulates elec-
trode contacts simultaneously on each cycle with continuous electrical
Glossary ( 303 )
waveforms (rather than biphasic pulses. SAS has only been used in devices
manufactured by the Advanced Bionics Corporation.
Simultaneous Communication (Sim-Com): Often mistaken for the Total
Communication philosophy. Sim-Com is a methodology that involves the
simultaneous use of sign and spoken language. It follows English word
order but does not include function words and word endings.
Single-Channeled Device: An early implant device inserted via the round
window into the scala tympani, and that transmitted all sound frequen-
cies as a single signal to the inner ear.
Sinusoidal Current: An oscillating current.
Skills Objectives: A type of instructional objective that addresses the skills
associated with the development of technical facility on an instrument
and vocal techniques for singers.
Sloping Loss: Indicates an increasing degree of hearing loss as the frequency
increases.
Smart Board: Interactive whiteboards for use in the classroom.
SmartMusic: Interactive computer software that allows for the development
of customized instrumental music assignments that students can prac-
tice at home. The program provides feedback regarding music-reading
skills and musicality.
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.
Sound Cradle: An instrument with origins from the Monochord and is long
and rounded similar to the interior part of a cradle though the wood is
not quite as thick. The sides of the instrument are equipped with nu-
merous strings extending the length of the instrument. Strings on one
side are tuned to A while those on the opposite side are tuned a perfect
fifth higher (E´).
Sound Field Amplification Systems: Educational tools involving a wire-
less microphone transmitter whereby a speaker’s voice is sent via radio
waves (FM) or light waves (infrared) to an amplifier that is connected to a
number of ceiling-mounted loudspeakers.
Sound Processor: The part of the BAHA that transmits sound vibration
through the external abutment to the implant.
Sound Therapy: A range of therapies that use sound to treat physical and
mental conditions.
Spectral Peak Extraction (SPEAK) Strategy: Analyzes incoming sound by
first identifying those filters with the greatest amount of energy. A subset of
filters is selected followed by the stimulation of corresponding electrodes.
( 304 ) Glossary
Speech Banana: The banana-shaped configuration on an audiogram that

comprises the frequencies and decibel levels necessary to understand
speech.
Speech Processor: The external component of the cochlear implant that can
either be worn behind the ear or fastened to a shirt collar. The speech
processor analyzes and converts sound stimuli into a digital format for
the electrodes along the electrode array.
Speech Reader/Speech Reading: Formerly referred to as “lip reading,”
involves an analysis and understanding of spoken language through
movement of the mouth and face.
Speech Reception Threshold (SRT): Testing that measures the faintest
speech sounds that can he heard approximately 50 percent of the time.
Speech Therapy: The treatment of speech and communication disorders.
Speech-Language Pathologist: A professional who diagnoses, treats, and
aids in the prevention of a variety of disorders including but not limited
to communication, cognitive, voice, swallowing, fluency, and other related
disorders.
Spiral Lamina: The bony shelf extending from the modiolus across to the
spiral canal of the cochlea.
Staccato: A type of music articulation indicating detached; a note of short-
ened duration.
Stapedius Muscle: A small muscle of the middle ear that acts reflexively in
response to loud sounds in order to reduce excessive vibrations that could
injure the inner ear.
Stapes: The stirrup-shaped bone in the middle ear that is connected to the
incus and the oval window of the inner ear.
Static Acoustic Impedance: Static acoustic impedance testing measures the
physical volume of air in the ear canal and can help to determine whether
the ear drum has been perforated.
Steady Beat: Underlying pulse of a piece of music.
Student Teacher: Refers to the undergraduate (music) education major who is
completing a full-time field experience in the public school setting.
Student Teaching: Refers to the field experiences typically required during
an undergraduate (music) education program.
Summative Assessment: A type of assessment typically administered at the
end of instruction (a unit, marking period, academic year). These can include
chapter tests, end-of-unit or marking period assessments, end-of-term
exams, district benchmark or interim assessments, and state assessments.
Suprasegmental Discrimination: Involves the ability of the listener to de-
tect differences in the Suprasegmental or prosadic qualities of speech.
Glossary ( 305 )
Suprasegmental: Stress, tone, or word juncture that either accompanies or is

added over consonants or vowels.
Sympathetic Vibrations: The vibrations that result from vibrations from a
nearby object.
Telecoil: A small magnetic coil that allows the hearing aid user to receive sound
through the circuitry of the hearing aid as opposed to its microphone.
Telemetry: A technology used to monitor the reliability and effectiveness of
the intracochlear electrodes of the cochlear implant post-implantation.
Tempo: The speed or pace of a musical composition.
Temporal Bones: Bones located on the sides and base of the skull. These
bones are lateral to the temporal lobes of the cerebrum, for which they
serve as a protection.
Temporal Lobe: The temporal lobe resides on both sides of the brain just
above the ears and is the part of the brain that processes the information
sent from both ears. Within the temporal lobe resides the primary audi-
tory cortex that is responsible for analyzing the frequency (pitch), inten-
sity (volume), and temporal (rhythm) elements of sound.
Threshold Levels (T-levels): Are determined for each electrode along the
cochlear implant’s electrode array as part of the mapping process. T-levels
are the lowest level at which a person consistently identifies a sound. This
is achieved by electrical pulses that are delivered to a designated electrode
at a particular current.
Timbre/Tone Color: The distinguishable attributes or characteristics of a
tone that enable a listener to identify identical pitches produced by dif-
ferent instruments.
Tinnitus: The perception of sound or noise in the ear in the absence of a cor-
responding external sound. (A noise or ringing in the ears.)
Tonality: The organized relationships of tones around a tonal center or tonic
(Randel, 1999, p. 674).
Total Communication (TC): The simultaneous combination of all methods
of communication, specifically American sign language, speech reading,
Signed Exact English, Finger-spelling, CASE, and body language in order
to convey thoughts, ideas, feelings, and emotions.
Tympanic Membrane (ear drum): A thin cone-shaped piece of skin posi-
tioned between the ear canal and the middle ear, to vibrate.
Tympanogram: Provides a graphic representation of the acoustic impedance
and air pressure testing results of the middle ear as well as the mobility of
the tympanic membrane.
Tympanometry: Detects conductive hearing loss by measuring the mobility
of the eardrum, and consequently the ability of the middle ear to conduct
( 306 ) Glossary
sound. It can help to identify fluid in the middle ear, a perforated ear-
drum, the buildup of wax in the ear canal, or in the anatomic localization
of facial nerve paralysis.
TypeWell: A speech-to-text transcription service for deaf and hard-of-hearing
students.
US Food and Drug Administration (FDA): A Federal Agency in the United
States under the Department of Health and Human Services. The FDA
works to both protect and promote public health and safety through the
regulation and supervision of food safety, prescription drugs, as well as
over-the-counter medications, tobacco products, medical devices, and
vaccines.
Unilateral Hearing Losses (UHL): Referred to also as single-sided-deafness
(SSD), UHL is a form of hearing loss in which an individual experiences
normal hearing in one ear and a loss in the other ear.
Unisensory: Also referred to as Auditory-Verbal, an emphasis placed upon a
single sense, hearing or audition.
United States Rehabilitation Act of 1973: The first “rights” legislation to
prohibit the discrimination of people with disabilities specifically in pro-
grams conducted by Federal agencies.
Venn Diagram: A graphic organizer employing overlapping circles to repre-
sent the relationships amongst small sets of data by their inclusion, exclu-
sion, or intersection of the curves.
Vestibular Nerve: The part of the auditory nerve that transmits sensory in-
formation related to balance to the brain.
Vibrotactile Cues: Sensory triggers that indicate an impending activity or
event within the context of an activity. Such cues help individuals who
are deaf or hard of hearing detect and interpret sound through the sense
of touch, can also aid the student with the overall lesson structure that
is alerting them to the lesson introduction, conclusion, as well as various
activity transitions.
Visual Reinforcement Audiometry (VRA): A form of behavioral audiometry
typically used for children ranging from six months to two-and-a-half
years of age. Sound stimuli are presented to encourage the child to re-
spond by turning their head or shifting their gaze toward a sound source.
Such a response results in visual reinforcement such as lighted mechan-
ical toy mounted close to the loudspeaker.
Waveforms: A graphic representation of a wave indicating characteristics
such as frequency and amplitude.
Zero Rejection: One of the principles of IDEA that states that a child with
disabilities, regardless of how severe, may not be excluded from a public
education.
INDE X
Page numbers in italics refer to figures and tables
504 Plan, 141–42, 150 FM systems, 192, 193, 194

1812 Overture, 110 Infrared, 194
7 Jumps Dance, 111 Sound Field Amplification Systems,
3M Corporation, 221 194
3M/House single-channel device, 221 Assistive Listening Systems. See
AAMHL. See Association of Adult Assistive Listening Devices
Musicians with Hearing Loss Association of Adult Musicians with
ADA. See Americans with Disabilities Hearing Loss, 117
Act audiogram, 18–21, 105
adapting the music classroom, 83. See configuration, shape, slope of, 18–19
also instructional delivery definition of, 18
Advanced Bionics, 215, 216, 230, 231, speech banana, 20
232, 242 thresholds, 18, 20–21, 41
advocating for students with hearing auditory development milestones,
loss, 26, 37, 57, 70, 141, 158 28. See also communication
ALD. See Assistive Listening Device milestones
American School for the Deaf, 46 auditory nerve, 8
Americans with Disabilities Act, role in hearing and music percep-
142–43, 146, 171 tion, 9
Title II, 142 Auditory-Oral Therapy (AO), 51
American Sign Language. See Modes of coping strategies, and. See speech
Communication reading, cued speech
Anderson, Leroy Auditory-Verbal Approach (AV), 53–54
Sleigh Ride, 110 aural traditions, origins of, 52–53
Arts-related opportunities, for kids, 275
ASL. See Communication, Modes of BAHA. See hearing aids
Assistive Listening Devices, 178, 181 band buddy/band buddies, 118, 134,
benefits of, 191–92, 207–8 135
how they work, 192 Bartlett, David Ely, 2
music listening with, 195–96 basilar membrane, role in hearing and
parts of, 192 pitch perception, 9
recommendations for use, 192, 207–8 Beethoven, Ludwig van
types of, 192 biography of, 269–70
Audio Frequency Induction Loop, listening guide for Symphony No. 5 in
183, 194 C minor, 270
( 307 )
( 308 ) I n d e x
Beethoven’s Nightmare, 70 cochlear implant,

Bell, Alexander Graham, 51 audiological training and speech
bi-bi. See bilingual-bicultural therapy, and, 235–36
big “D” Deaf. See Deaf candidacy criteria for, 225–27
bilingual-bicultural, 55–57 components of, 214, 215, 216
American schools emphasizing, 56 current trends
definition of, 55–56 bilateral cochlear implantation,
differing positions on, 56 242–44
international support and programs bimodal stimulation, 244
for, 56–57 hybrid devices, 241-42
origins, 56 Deaf community, perspectives on,
Birkenshaw-Fleming, Lois, 71, 93, 97, 238–40
124 definition of, 214
Songs for Listening! Songs for Life!, device failures, 229–30
71 early implantation
body rhythms, 91, 125, 132, 248 music, and, 224–25
books, speech and language development,
kids, for, 273–74 and, 224
parents and teachers, for, 281–82 Electrostatic discharge, 236–7, 256
Brenner electrode, 218 function of, 216–17
Britton, Benjamin hearing aid, comparing with, 217–18
Young Person’s Guide to the hearing parents, perspectives on
Orchestra, 111 cochlear implants, 240
bullying. See socialization history and development of, 218–23
implantation process
Carle, Eric activation and mapping, 228–29
Foolish Tortoise, The (1985), 162, surgical procedures, 227–28
163, 165, 166, 169–70 monitoring the device, 236. See also
Mixed-Up Chameleon, The (1988), Six Sound Test
162, 163, 164, 168–69 multi-channeled device, 219
CART. (Communication Access music and children with
Real-Time Translation). See applications for music lessons,
support services 247–49
Casterline, Dorothy, 47 classroom implications, 246–47
Child’s Listening Activity Journal, 267 current music research trends,
choral music program, the, 123 245–46
benefits of, 123, 125 Nucleus 22, multi-channeled device,
cochlear implanted child, consider- 221, 222
ations for, 126–27 parents and
considerations for introduction of preliminary meetings with class-
singing activities, 123–24 room teachers, 256
including students with varying role in decision making process,
degrees of hearing loss in the 214, 226, 227, 240
singing lesson, 124–25 shared listening experiences with
pitch, teaching approaches for, child as approach to device
125–26 acclimation, 256
research in support of, 123 pediatric, cochlear implantation,
chunking, 111 223–30, 237–40
CI. See cochlear implant single-channeled devices, 219, 220, 221
Cochlear Corporation, 221, 222, 231, speech processing strategies
232, 242 Advanced Combination Encoder, 231
I n d e x ( 3 0 9 )
Continuous Interleaved Sampling Copland, Aaron

(CIS), 230 Fanfare for the Common Man, 111
Fine Structure Processing (FSP), 230 Council for Exceptional Children, 157
High Definition CIS, 230 Croneberg, Carl, 47
Hi-Resolution Fidelity, 230 Cued speech, 50, 51, 52, 63
MP 3000, 230
Multiple Pulsatile Sampler, 230 D-Pan. See Deaf Professional Arts
n-of-m strategy, 230–31 Network/ Deaf Performing
Simultaneous Analog Stimulation Arts Network
(SAS), 231–32 deaf
Spectral Peak Extraction (SPEAK), appropriate use and application of
231 term, 21
stimulation rates, 230, 231, 232 definition of, 21
teachers and Deaf
collaborative lesson plan develop- appropriate use and application of
ment, 256 term, 21
detailing student progress, 257 definition of, 21
maintaining open communication Deaf Professional Arts Network/ Deaf
with parents, 256 Performing Arts Network,
shared music curriculum, 256 70. See also Sean Forbes
telemetry, 232 Deaf Youth Orchestra, 21
communication milestones. See also due process. See Individuals with
auditory development mile- Disabilities Education Act
stones, 28
Communication, Modes of EAMIR. See Electro-Acoustic-Musically-
American Sign Language, 45–48, 49, Interactive-Room
70, 276, 278, 280 ear, the. 6–8
Dictionary of, 47 Ear, Nose, and Throat doctors, 43
ASL. See American Sign Language early intervention. See hearing loss,
Conceptually Accurate Sign English, early intervention and identi-
49, 54 fication of
English-based sign systems, 48 earth magnet , 222
Manually coded English. See educational settings, 57–62, 143, 239
English-based sign systems School selection and options,
Pidgen Signed English. See 57–59
Conceptually Accurate Sign residential schools, 59
English day schools, 60
Rochester Method, 48 public schools, 60–62
Seeing Essential English, 48, 49 Elementary and Secondary Education
sign English. See Conceptually Act (1965), 148
Accurate Sign English Elementary and Secondary Education
Signed English, 48 Act Flexibility plan (2011),
Signing Exact English, 48, 49, 54 149
Concert Series for the Deaf, Kean Electro-Acoustic-Musically-Interactive-
University, 159, 160, 269 Room, 201, 202
background, 159 benefits of, 201–2
components of. See percussion en- components of, 201
semble, radio baton, musical function, 201
story, instrument petting zoo Lazy Guy, 201
Congress on Education of the Smart IWB, 201–2
Deaf, 46 El Sistema, 128
( 310 ) I n d e x
ENT. See Ear, Nose and Throat doctors selection of, 180–81
ESEA. See Elementary and Secondary types of, 181–88
Education Act, 1965, 2011 bone conduction hearing aids, 187
Estabrooks, Warren, 71, 93, 97, 107, 112 BAHA (bone-anchored hearing
Six-Sound Song, 71 aid), 188
Songs for Listening! Songs for Life!, ear level aids, 182–86
71 on-the-body aids, 187
Eyries, Charles, 219 Hearing Assistive Technology. See
Assistive Listening Device
FAPE (Free and Appropriate Education). hearing impaired, earlier uses of, 21
See Individuals with hearing loss
Disabilities Education Act degrees of, 15–18, 21, 30, 105, 117,
finger spelling, 48, 50, 54 124, 161
Forbes, Sean, 70 mild, 15–16
formative assessment, 158 moderate, 16
Free and Appropriate Education. See moderately severe, 17
Individuals with Disabilities profound, 17–18
Education Act severe, 17
early identification and intervention
Gallaudet, Thomas Hopkins, 45–46 of
Gallaudet University, 46, 70 early detection and intervention
general music classroom, lesson ideas program, 39
for hearing tests
dynamics, 96–97 newborns, for
pitch discrimination and melody, Auditory Brainstem Response,
94–96 40
rhythm, 93–94 Evoked Otoacoustic Emissions
Glennie, Dame Evelyn, 70 (EOAE), 40
Gordon Approach, The, 120, 121, 132 older children, for
Grieg, Edvard air conduction testing, 41
Peer Gynt, In the Hall of the bone conduction testing, 41
Mountain King, 111 Computed Tomography,
42–43, 225
hard-of-hearing impedance audiometry, 42
appropriate use and application of acoustic reflex test, 42
term, 21 tympanometry, 42
definition of, 21 Magnetic Resonance Imaging,
Hear & Listen! Talk & Sing (1994), 71, 42–43, 225
76, 100 pure tone audiometry, 41–42
hearing aids speech reception threshold, 42
analog versus digital, 189–90 otoacoustic emission recording, 39
cost, 180 toddlers, for
definition of, 179 behavioral audiometry. See
hearing aid orientation, 181 Behavioral Observational
history of, 178–79 Audiometry
how they work, 179 Behavioral Observational
monitoring or maintenance of, 190– Audiometry, 40–41
91. See also Six Sound Test Conditioned Play Audiometry, 41
need for, 179–80 Conditioned Orientation Reflex
parts of, 179 Audiometry, 41
I n d e x ( 311 )
Visual Reinforcement initial identification and testing

Audiometry, 41 procedures, appropriate, 146
misconceptions of, 3–4 due process, 146–47
music research, and, 26–27 free and appropriate public educa-
music perception, impact on tion, 146
pitch, 22–23 least restrictive environment,
rhythm, 22 147–48
timbre, 23–24 parental and student involvement,
onset of, 14–15 147
early onset, use of instead of term zero rejection, 144, 146, 171, 172
prelingual, 14 Individualized Education Program, 88,
perilingual, 14 141, 145, 146
postlingual, 14–15, 44, 223, 224 alternative curriculum or setting, 144
prelingual, 14, 44, 223, 224 annual goals, 143, 144
symptoms of, 30 child’s involvement in, 144
types of defined, 143
central, 13 instructional accommodations for,
conductive, 11–12 144
mixed hearing loss, 13 meeting goals of, 144
sensorineural, 12–13 music teacher access to and involve-
single-sided-deafness. See unilat- ment in, 88, 144
eral deafness parent involvement in, 147
unilateral deafness, 13–14 team members, 143
Hi-Notes, 70 initial identification and test proce-
Home activities dures. See Individuals with
sound exploration, 66, 73 Disabilities Education Act
auditory discrimination. See also Institution Nationale des Sourds-Muets
musical conversations 73 (National Institute for Deaf
House Ear Institute of California, Mutes), 46
220 instructional delivery
House, Dr. William, 219 visibility and mobility, 84, 85, 86
communication and presentation,
IDEA. See Individuals with Disabilities 86-87
Education Act structure and dependability, 87–88
inclusion, 60–62, 151 documenting student progress, 88
behavior changes, addressing, 151 instrumental music program, the
concerns raised, 62 Brass, 116–17
definition of, 61 including students with varying
general education classroom, and, degrees of hearing loss, in,
61, 151 117–19
in Least Restrictive Environment, classroom preparation, 118–19
147 instructional approaches, 119
origins of, 151 Keyboard, 115
support services, and, 61, 151 Percussion, 115–16
IEP. See Individualized Education Strings, 117
Program Woodwinds, 115
Individuals with Disabilities Education instruments, in the general music pro-
Act, 143–48, 171 gram, 122
definition of, 143 cochlear implanted child, consider-
guiding principles of, 144, 146–48 ations for, 122–23
( 312 ) I n d e x
instrument petting zoo, 160, 161, 170 Matthews, Max, 196. See also Radio
international laws and support systems, Baton
152–56 Max/MSP/Jitter for Music: A Practical
interpreting services. See support Guide to Developing
services Interactive Music Systems for
Itard, Marc Gaspard, 1–2 Education and More (2011),
200
K, flutist with hearing loss, 25–26 Med-El, 230, 231
Kindermuzik, 67 Middle Ear Implant, 189
Knapp, Ruth Ann. See Total Milan Conference. See also Congress on
Communication Choir Education of the Deaf, 46–47,
Kodaly Method, The, 120, 121 51
Montessori, Maria, 2
late deafened adolescents or adult. See multimodal teaching approaches
hearing loss, postlingual kinesthetic learners, for, 89, 91–92,
Least Restrictive Environment. See 93, 94, 95, 96, 97, 106
Individuals with Disabilities tactile learners, for, 89, 90–91, 93,
Education Act 94, 95, 96, 97, 115, 117, 202
Lesson plan samples, music visual learners, for, 89–90, 93, 94, 95,
Early intervention classroom, for, 96, 97, 99, 108, 119, 121
99–101 musical audiogram, 84, 97, 127, 249
1st grade general music classroom, musical conversations, 73
for, 251–55 musical heads-up, 107, 114, 248, 256,
2nd grade general music classroom, 257
for, 130–32 musical story, 71, 101, 160, 163, 164,
7 th and 8th grade instrumental music 165, 167, 169
setting, for, 132–36 Music and the Deaf, UK Charity Group,
Listening suggestions, resources, and 3, 70, 115, 277–78
materials, 75–76 music education students
LRE (Least Restrictive Environment). cooperating teacher, questions for,
See Individuals with 174
Disabilities Education Act field teaching experiences at School
for the Deaf, 159–70
Mainstreaming preparing for student teaching or
definition of, 60, 61, 150–51 first teaching job experience,
general education classroom, and, recommendations for, 173
61 insights from music education stu-
history and intent of, 150 dent teacher, 155–56
inclusive education movement, role in making most of coursework and
promoting, 151 student teaching, 155–56,
proponents of, 151 157–58
“readiness criteria,” as promoted by state and national standards, as
child with mild to moderate dis- resources and guides for,
abilities, implications for the, 156–57
151 music for the deaf and hard of hearing
child with severe disabilities, impli- benefits of, 26–27, 92–93
cations for the, 151 speech and language development,
Mary Hare School. See also music for for, 68–69
the deaf and hard of hearing, social and emotional development,
history of, 3 for, 69
I n d e x ( 313 )
facilitating participation in, 70 as reauthorization of Elementary

history of, 1–3 and Secondary Education Act
in every day activities, 71 (ESEA), 148
role models, 27, 44, 70 state accountability, 148, 149
music listening lessons for the general students with special needs, impact
music classroom, 104–14, 122 upon, 148–49
auditory processing, hierarchy of Noise Induced Hearing Loss, 202–6
(Sanders), 109–13 definition of, 202
cochlear implanted child, consider- precautions for, 202–3
ations for, 112–14 protective gear for musician, 203–4
including students with varying resources for prevention of, 204–6
degrees of hearing loss in, 105 risk factors, 203
levels of auditory development note-taking. See support services
(Erber), as the guide for, 105,
106, 107, 108 Oral/aural. See natural oral modes
music teachers Oralism, origins of, 50–51
instrumental and vocal music, com- OSEP. See United States Department of
munication between, 136 Education, Office of Special
reaching out to classroom and special Education Programs
education teachers, 84 O’Toole, Patricia
reaching out to parents, 84 Shaping Sound Musicians (2003), 162
updates for other IEP team members,
102 Parent/Child Listening Together
Music Together, 67 Journal, 265
parental and student involvement. See
NAD. See National Association of the Individuals with Disabilities
Deaf Education Act
NAfME. See National Association for Parents
Music Education advocacy for child, 65, 70
National Association for Music changes in cochlear implant MAP,
Education, 158 hearing aid, or assistive
Criteria for placement of children listening device, informing
with special needs in music music teachers and other IEP
classroom, 158 team members of, 72, 229
National Association of the Deaf, 21, 47, child’s musical interests, routines,
238, 239 informing music teachers of,
National Dissemination Center for Children 70, 84
with Disabilities, 43–44 important decisions and consider-
National Standards for Music ations for, 36
Education, 156–57 initial information gathering, 37–38
natural oral modes, 53 involvement in instrumental prac-
NCLB. See No Child Left Behind tice, 120–22
NICHCY. See National Dissemination Parent/Child Listening Together
Center for Children with Journal, 265–66
Disabilities partial inclusion, 61–62
NIHL. See Noise Induced Hearing Loss definition of, 61
No Child Left Behind, 148–50 perceived disadvantages of, 61–62
adequate yearly progress (AYP) percussion ensemble, Kean University,
benchmarks for, 148–49 159, 160
advocates for, 149 person first language, 21
( 314 ) I n d e x
Personalized Compensation Plan duration, 4, 5–6

(France), 144 frequency, 5, 9
PL-94-142. See also Individuals with intensity, 5, 9
Disabilities Education Act, 143 vibration, 5, 7, 8, 10
reauthorization of, 143 sources, for parents and teachers,
play-dates. See socialization 279–80
Prokofiev, Sergei speech reading, 25, 51, 53, 85, 89, 125,
Peter and the Wolf, 75, 107 155
Psychoacoustics, 5 standards-based IEP, 157
pure tone thresholds, 41 Stokoe, William, 47
summative assessments, 158
Radio Baton, 196–97 support services
Rapports sur le Sauvage del’ Aveyron. additional academic supports, 64
See Wild boy of Aveyron Communication Access Real-Time
Regular Education Initiative. See translation, 62, 64. See also
Mainstreaming real-time captioning
Rehabilitation Act of 1973, the United interpreting and transliteration serv-
States, 141–42, 146 ices, 62, 63
Accommodations, 141–42, 146 note taking, 64
Section 504, 141–42, 146 real-time captioning, 62, 64
Research Triangle, of North Carolina, 222
residual hearing, 51–54 Tchaikovsky, Pyotr Ilyich,
Roebuck, Janine, 70 Nutcracker Suite, Trepak (Russian
Rossini, Gioachino Dance), 91, 111
William Tell Overture, 112 Tinnitus, 205, 206, 233
Total Communication, 54–55, 56
Sansula, 199–200 Total Communication Choir, 127, 128
self-contained classes, 62 transliteration services. See support
Sim Com. See simultaneous communication services
simultaneous communication, 55 tympanogram, 42
Six Sound Song, 71
Six Sound test, 71, 190–91, 236 United States Department of Education,
SmartMusic, 122 Office of Special Education
socialization, 65, 67, 91, 105 Programs, 43, 44
bullying, 67–68
playdates, 66 Vibrato System, 202
resources, opportunities providing Volta, Alessandro, 218
for, 65–66
Songs for Listening! Songs for Life!, 71 Weikart, Phyllis, 120, 121
sound, 4–5. See also sound wave WFD. See World Federation of the Deaf
sound cradle, 197, 198, 199 White Hands Choir, 128
Sound and Fury, 227 WHO. See World Health Organization
sound wave, 5, 7, 178, 179, 190 Wild Boy of Aveyron, 1, 2
amplitude, 5 whole-part-whole approach, 120, 125,
decibel, 5, 6, 11, 15, 18, 41, 203 248
frequency, 5, 9 World Federation of the Deaf, 21
Hertz, 5 World Health Organization, 39
irregular vibration, 5
noise, 5 Zero Rejection. See Individuals with
physical properties of Disabilities Education Act

Music For Children With Hearing Loss A Resource For Parents and Teachers

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Music for Children with Hearing Loss

Music for Children with

Oxford is a registered trademark of Oxford University Press

Published in the United States of America by

© Oxford University Press 2014

All rights reserved. No part of this publication may be reproduced, stored in

You must not circulate this work in any other form

Library of Congress Cataloging-in-Publication Data

4. M aking the Case: Involving Children with Hearing Loss in General

Controversies Associated with Pediatric Cochlear

Appendix 1: Parent/Child Listening Together Journal 265

THE MOTIVATION BEHIND THIS BOOK

Finally, to spark further musical discussion, I have concluded each

In yet another curricular example, many nineteenth-century deaf schools

1980). Similarly, a kindergarten and primary school in Washington, DC

Misconceptions Associated with Hearing Loss

THE HEARING PROCESS

Table 1.1 A COMPARISON OF DIFFEREN T SOUND SOURCE S AND THEIR

Sound source Decibel Levels

Threshold of Human Hearing 0

Perception and responses to duration or varying lengths of sound com-

The Parts of the Ear and Their Role

stimuli (Schraer-Joiner, 2003). Having an understanding of the hearing

Structure of the Human Ear.

Figure 1.1: Structure of the Human Ear.

The Basilar Membrane and Its Role in Hearing

The Auditory Nerve and the Role of the Brain in Hearing

Auditory Development and Communication Milestones

Understanding typical auditory skill development will provide a founda-

Medical and audiological professionals must consider a number of fac-

Conductive loss can often be corrected medically or surgically. In

The onset of hearing loss is typically categorized as prelingual, perilin-

as educational development. A sense of aesthetic loss may also be experi-

Moderately Severe Hearing Loss

Reading and Understanding the Audiogram

Normal Hearing Conductive hearing loss

125 250 500 1000 2000 4000 8000

Figure 1.3: The Speech Banana, as commonly found on audiograms. From p. 34 in

When the sounds necessary for speech are graphed on an audiogram

Appropriate Use and Application of the Terms Related

There are a number of perspectives to consider when using and applying

The Impact of Hearing Loss on Music Perception

Research examining the musical responsiveness of children who are deaf

The Story of “K”: A Flutist with Hearing Loss

MUSIC AND HEARING LOSS: AN OVERVIEW OF

We are in a much better position to understand the hearing mechanism

FOR YOUR CONSIDERATION

1. Awakens, stirs, or startles at loud sounds

1. Turns his or her eyes towards familiar sounds

1. Points to familiar objects when they are named

10. Uses short phrases when talking

1. Understands spatial concepts such as “in” and “on”

1. Groups like objects (animals, food)

1. Understands spatial concepts such as “behind” and “next to”

1. Understands time sequences

1. Complain of earaches, ear pain, or head noises?

American Speech-Language-Hearing Association. (2013). How does your child hear

Gelfand, S. A. (2009). Essentials of audiology. New York, NY: Thieme Medical

Darrow, A. A. (1992). The effect of vibrotactile stimuli on the recognition of pitch

University of Washington. (2001, November 28). Brains of deaf people rewire to

INITIAL INFORMATION GATHERING

Information is power. Becoming familiar with hearing loss can prevent

I found that hearing parents participating in this program had difficulty

4. M aking the Case: Involving Children with Hearing Loss in General