Music therapy in the rehabilitation of children - World Federation of ...
Music therapy in the rehabilitation of children - World Federation of ...
Music therapy in the rehabilitation of children - World Federation of ...
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Radbruch, K. (2001) <strong>Music</strong> <strong><strong>the</strong>rapy</strong> <strong>in</strong> <strong>the</strong> <strong>rehabilitation</strong> <strong>of</strong> <strong>children</strong> with<br />
cochlear implant (CI). <strong>Music</strong> Therapy Today (onl<strong>in</strong>e), November, available at<br />
www.music<strong><strong>the</strong>rapy</strong>world.<strong>in</strong>fo<br />
<strong>Music</strong> <strong><strong>the</strong>rapy</strong> <strong>in</strong> <strong>the</strong> <strong>rehabilitation</strong> <strong>of</strong> <strong>children</strong><br />
with cochlea implant (CI)<br />
Karen Radbruch<br />
When I speak about music <strong><strong>the</strong>rapy</strong> <strong>in</strong> <strong>rehabilitation</strong> for <strong>children</strong> with cochlea<br />
implant it is necessary to characterise <strong>the</strong> context first <strong>of</strong> all.<br />
After <strong>the</strong> operation with a cochlea implant deaf or ra<strong>the</strong>r high grade hear<strong>in</strong>g<br />
impaired <strong>children</strong> ga<strong>in</strong> at least some physiological hear<strong>in</strong>g abilities and <strong>the</strong><br />
condition <strong>of</strong> learn<strong>in</strong>g to hear is created. Some <strong>children</strong> have for <strong>the</strong> first time<br />
a hear<strong>in</strong>g experience. Rehabilitation <strong>in</strong> this context means to company and to<br />
support <strong>the</strong> slow grow<strong>in</strong>g <strong>in</strong>to <strong>the</strong> world <strong>of</strong> sounds and voices. They have to<br />
make up <strong>the</strong> same steps <strong>of</strong> development as <strong>children</strong> do without a hear<strong>in</strong>g<br />
loss - just a few years later. Our job is to bear <strong>in</strong> m<strong>in</strong>d this natural<br />
development and to create conditions to help <strong>the</strong>se <strong>children</strong> to make <strong>the</strong><br />
essential experiences on <strong>the</strong>ir way. An <strong>in</strong>terdiscipl<strong>in</strong>ary team works toge<strong>the</strong>r,<br />
and what is <strong>in</strong>terest<strong>in</strong>g is that a music <strong>the</strong>rapist is seldom part <strong>of</strong> this<br />
<strong>rehabilitation</strong> team <strong>in</strong> Germany. But never<strong>the</strong>less we f<strong>in</strong>d several fields <strong>of</strong><br />
work with<strong>in</strong> this process, <strong>in</strong> which music plays a major role: musical speech<br />
<strong><strong>the</strong>rapy</strong>, listen<strong>in</strong>g tra<strong>in</strong><strong>in</strong>g with music <strong>in</strong>struments, musical rhythmic education<br />
and last but not least music <strong><strong>the</strong>rapy</strong>. In practical work it is not always possible<br />
to draw a clear divid<strong>in</strong>g l<strong>in</strong>e between all <strong>the</strong>se work<strong>in</strong>g fields and it is even<br />
not possible to def<strong>in</strong>e a general, standardised concept for music <strong><strong>the</strong>rapy</strong>.<br />
When work<strong>in</strong>g with <strong>children</strong> my <strong>in</strong>tention is to get <strong>in</strong> contact and to<br />
communicate with <strong>the</strong>m via <strong>the</strong> medium <strong>of</strong> music. This k<strong>in</strong>d <strong>of</strong> communication<br />
happens <strong>in</strong> a very playful way. At <strong>the</strong> beg<strong>in</strong>n<strong>in</strong>g <strong>the</strong>re are no specials rules or<br />
exercises. The <strong>children</strong> might try whatever <strong>the</strong>y like to and what comes to<br />
<strong>the</strong>ir m<strong>in</strong>d. Thus, <strong>children</strong> have <strong>the</strong> opportunity to discover <strong>the</strong>ir personal<br />
1
Radbruch, K. (2001) <strong>Music</strong> <strong><strong>the</strong>rapy</strong> <strong>in</strong> <strong>the</strong> <strong>rehabilitation</strong> <strong>of</strong> <strong>children</strong> with<br />
cochlear implant (CI). <strong>Music</strong> Therapy Today (onl<strong>in</strong>e), November, available at<br />
www.music<strong><strong>the</strong>rapy</strong>world.<strong>in</strong>fo<br />
creative skills. Dur<strong>in</strong>g this period, I try to take up <strong>the</strong>ir musical <strong>of</strong>fers, to reply<br />
<strong>the</strong>m or to cont<strong>in</strong>ue <strong>the</strong>m and to built up a first contact. It is important to<br />
emphasise <strong>the</strong> concept <strong>of</strong> musical activity as a jo<strong>in</strong>t activity. I am just ano<strong>the</strong>r<br />
player with equal rights, I am not <strong>the</strong> leader, who <strong>in</strong> knows <strong>in</strong> advance what<br />
will happen next.<br />
I would like to characterise <strong>the</strong> situation as a sort <strong>of</strong> “musical playground”.<br />
Hear<strong>in</strong>g impaired <strong>children</strong> are <strong>in</strong>volved <strong>in</strong> tra<strong>in</strong>ee programs quite <strong>of</strong>ten, do<strong>in</strong>g<br />
a lot <strong>of</strong> exercises to improve <strong>the</strong>ir hear<strong>in</strong>g and speak<strong>in</strong>g abilities. I th<strong>in</strong>k that<br />
<strong>the</strong> play<strong>in</strong>g character <strong>of</strong> music <strong><strong>the</strong>rapy</strong> can be a nice contrast. Learn<strong>in</strong>g and<br />
discover<strong>in</strong>g by play<strong>in</strong>g is a natural way <strong>of</strong> learn<strong>in</strong>g <strong>in</strong> <strong>the</strong> development <strong>of</strong><br />
<strong>children</strong> and we must pay attention, that <strong>the</strong>se <strong>children</strong> don’t forget to play.<br />
When I started work<strong>in</strong>g with cochlea implanted <strong>children</strong> I <strong>of</strong>ten began with a<br />
welcome song with piano accompaniment or I added wonderful harmony<br />
chords to <strong>the</strong> first musical activities <strong>of</strong> <strong>the</strong> <strong>children</strong>. But <strong>the</strong>se <strong>children</strong> were<br />
not really enthusiastic! Some looked somehow afraid, o<strong>the</strong>rs looked just<br />
bored. These activities already make great demands on <strong>the</strong> <strong>children</strong>’s ability<br />
to hear. For <strong>children</strong> who stand at <strong>the</strong> beg<strong>in</strong>n<strong>in</strong>g <strong>of</strong> a hear<strong>in</strong>g process and<br />
who get <strong>in</strong> contact with music probably <strong>the</strong> first time this might ask too much<br />
<strong>of</strong> <strong>the</strong>m and a welcome song with piano accompaniment might be<br />
characterised as “language with disturb<strong>in</strong>g factors and <strong>in</strong>terference”.<br />
Therefore, I prefer a more basic first contact with music: music that is simply<br />
and clearly built and does not frighten <strong>the</strong> <strong>children</strong>. From this start<strong>in</strong>g po<strong>in</strong>t<br />
<strong>the</strong> musical activity can become more complex and be developed toge<strong>the</strong>r<br />
with <strong>the</strong> <strong>children</strong>.<br />
To f<strong>in</strong>d out <strong>the</strong>ir <strong>in</strong>dividual hear<strong>in</strong>g needs we have to watch <strong>the</strong> <strong>children</strong> and<br />
<strong>the</strong>ir reactions attentively. They <strong>of</strong>ten show <strong>the</strong>ir needs quite clearly!<br />
For me it is important <strong>in</strong> music <strong><strong>the</strong>rapy</strong> that <strong>children</strong> have <strong>the</strong> opportunity to<br />
discover <strong>in</strong>struments and sounds <strong>the</strong>mselves (– even if it is not always easy<br />
for a music <strong>the</strong>rapist to keep out <strong>of</strong> <strong>the</strong> process <strong>in</strong> <strong>the</strong> beg<strong>in</strong>n<strong>in</strong>g!). However,<br />
2
Radbruch, K. (2001) <strong>Music</strong> <strong><strong>the</strong>rapy</strong> <strong>in</strong> <strong>the</strong> <strong>rehabilitation</strong> <strong>of</strong> <strong>children</strong> with<br />
cochlear implant (CI). <strong>Music</strong> Therapy Today (onl<strong>in</strong>e), November, available at<br />
www.music<strong><strong>the</strong>rapy</strong>world.<strong>in</strong>fo<br />
to start music dialogue and communication, <strong>children</strong> need to perceive<br />
<strong>the</strong>mselves as creators <strong>of</strong> sounds and must get used to hear<strong>in</strong>g all <strong>the</strong>se<br />
different sounds <strong>of</strong> <strong>the</strong> <strong>in</strong>struments.<br />
Goals <strong>of</strong> music <strong><strong>the</strong>rapy</strong> when work<strong>in</strong>g with <strong>children</strong> with cochlear<br />
implant<br />
• For cochlea implanted <strong>children</strong> <strong>the</strong> first goal <strong>of</strong> music <strong><strong>the</strong>rapy</strong> on <strong>the</strong>ir way<br />
to <strong>the</strong> world <strong>of</strong> sounds and voices might be to awaken an <strong>in</strong>terest <strong>in</strong><br />
musical <strong>in</strong>struments and to explore <strong>the</strong> <strong>in</strong>struments as sound-<strong>in</strong>struments.<br />
I have met several <strong>children</strong>, <strong>of</strong>ten short time after <strong>the</strong> CI-implantation, who<br />
were quite <strong>in</strong>terested at <strong>the</strong> <strong>in</strong>struments – but <strong>the</strong>y were fasc<strong>in</strong>ated by all<br />
<strong>the</strong> screws <strong>of</strong> <strong>the</strong> drums, <strong>the</strong>y discovered <strong>the</strong> letters written on <strong>the</strong><br />
xylophone and arranged <strong>the</strong> same letters toge<strong>the</strong>r or <strong>the</strong>y reflected <strong>the</strong>ir<br />
faces <strong>in</strong> <strong>the</strong> metal <strong>of</strong> <strong>the</strong> trumpets. But <strong>the</strong>y were not really <strong>in</strong>terested <strong>in</strong><br />
play<strong>in</strong>g <strong>the</strong>se <strong>in</strong>struments <strong>in</strong> <strong>the</strong> way we used to do it....<br />
• If we succeed to develop an <strong>in</strong>terest at <strong>the</strong> sounds <strong>of</strong> <strong>the</strong> <strong>in</strong>struments <strong>the</strong><br />
<strong>children</strong> can discover a great variety <strong>of</strong> sounds and timbres. The high<br />
<strong>in</strong>tensity and <strong>the</strong> huge frequency <strong>of</strong> music makes <strong>the</strong> perception <strong>of</strong> music<br />
somehow easier than <strong>the</strong> perception <strong>of</strong> language; hear<strong>in</strong>g impaired<br />
people are more easily reached by musical sounds.<br />
• Follow<strong>in</strong>g this idea, a fur<strong>the</strong>r aim <strong>of</strong> music <strong><strong>the</strong>rapy</strong> is that <strong>the</strong> process <strong>of</strong><br />
learn<strong>in</strong>g to hear is supported and encouraged not only by discover<strong>in</strong>g, but<br />
also by dist<strong>in</strong>guish<strong>in</strong>g, identify<strong>in</strong>g and understand<strong>in</strong>g.<br />
Focused listen<strong>in</strong>g as a first step, focused listen<strong>in</strong>g to ano<strong>the</strong>r person as a<br />
second step are preconditions <strong>of</strong> effective mutual communication and we<br />
should not forget that <strong>the</strong> <strong>children</strong> have to make <strong>the</strong>se basic experiences<br />
after an cochlea implantation.<br />
3
Radbruch, K. (2001) <strong>Music</strong> <strong><strong>the</strong>rapy</strong> <strong>in</strong> <strong>the</strong> <strong>rehabilitation</strong> <strong>of</strong> <strong>children</strong> with<br />
cochlear implant (CI). <strong>Music</strong> Therapy Today (onl<strong>in</strong>e), November, available at<br />
www.music<strong><strong>the</strong>rapy</strong>world.<strong>in</strong>fo<br />
The ability to hear can’t be conveyed <strong>in</strong> an isolated surround<strong>in</strong>g – it is only<br />
<strong>in</strong> a stimulat<strong>in</strong>g environment where a child is actively listen<strong>in</strong>g.<br />
• An important fact is, that <strong>the</strong> auditory perception <strong>in</strong> this case is closely<br />
l<strong>in</strong>ked to <strong>the</strong>ir actions - <strong>children</strong> can search actively and are not just<br />
passive consumers.<br />
• Ano<strong>the</strong>r goal for <strong>the</strong> <strong>children</strong> with CI is to discover <strong>the</strong>ir <strong>in</strong>dividual voice <strong>in</strong><br />
a new way. They can play and experiment with <strong>the</strong>ir voice, without <strong>the</strong><br />
demands <strong>of</strong> speech and articulation.<br />
“A baby with hear<strong>in</strong>g impairment does not hear his own voice. It doesn t<br />
play with its voice like it plays with its feet and its hands” (HILDMANN,<br />
1999, S.30). After <strong>the</strong> implantation <strong>the</strong> <strong>children</strong> have to catch up on this<br />
experience: play<strong>in</strong>g with <strong>the</strong>ir voice, scream<strong>in</strong>g, squeak<strong>in</strong>g, howl<strong>in</strong>g. And<br />
we can work with all <strong>the</strong>se sounds <strong>in</strong> a musical way: every voice has its<br />
pitch, its dynamic, probably its rhythm. So we accept it as a musical <strong>of</strong>fer<br />
and work and play with it <strong>in</strong> a musical way.<br />
• What is also worth mention<strong>in</strong>g is <strong>the</strong> fact that <strong>children</strong> f<strong>in</strong>d a new way to<br />
br<strong>in</strong>g emotions <strong>in</strong>to a form <strong>of</strong> expression – <strong>children</strong> who are <strong>in</strong> majority <strong>of</strong><br />
cases limited <strong>in</strong> <strong>the</strong>ir development <strong>of</strong> speech and sometimes hardly f<strong>in</strong>d a<br />
way to express emotions. <strong>Music</strong> can have <strong>the</strong> function <strong>of</strong> a emotional<br />
“outlet”.<br />
• Moreover, <strong>children</strong> might experience music as someth<strong>in</strong>g positive and<br />
stimulat<strong>in</strong>g that enriches <strong>the</strong>ir way <strong>of</strong> perception. The promotion <strong>of</strong><br />
personal musical abilities can be supported. A new self-confidence <strong>in</strong><br />
musical abilities can be established and fears might be overcome.<br />
• I personally th<strong>in</strong>k, that <strong>the</strong> most important aim is <strong>the</strong> communicative<br />
aspect <strong>of</strong> music <strong><strong>the</strong>rapy</strong> with cochlea implanted <strong>children</strong>, which is<br />
communication that is not l<strong>in</strong>ked to normal speech communication and<br />
4
Radbruch, K. (2001) <strong>Music</strong> <strong><strong>the</strong>rapy</strong> <strong>in</strong> <strong>the</strong> <strong>rehabilitation</strong> <strong>of</strong> <strong>children</strong> with<br />
cochlear implant (CI). <strong>Music</strong> Therapy Today (onl<strong>in</strong>e), November, available at<br />
www.music<strong><strong>the</strong>rapy</strong>world.<strong>in</strong>fo<br />
can be orientated at <strong>the</strong> age and <strong>the</strong> developmental abilities <strong>of</strong> each<br />
<strong>children</strong>.<br />
S<strong>in</strong>ce <strong>the</strong> last po<strong>in</strong>t mentioned is <strong>the</strong> central aspect <strong>of</strong> my research I am<br />
work<strong>in</strong>g on, I would like to focus on <strong>the</strong> topic <strong>of</strong> communication.<br />
Communicative development<br />
The communicative development <strong>in</strong> <strong>children</strong>, with regard to <strong>children</strong> who can<br />
hear as well as those who suffer hear<strong>in</strong>g deficits, starts very early <strong>in</strong> <strong>the</strong>ir<br />
lives. Already <strong>in</strong> <strong>the</strong> preverbal phase, a small child ga<strong>in</strong>s important<br />
communicative skills while <strong>in</strong>teract<strong>in</strong>g with <strong>the</strong> person to whom <strong>the</strong> small<br />
child relates most closely. Not only is <strong>the</strong> child's day <strong>of</strong>ten structured by <strong>the</strong><br />
parents but also <strong>in</strong>teraction and communication, which, later on, leads to <strong>the</strong><br />
acquisition <strong>of</strong> language.<br />
If a child is hear<strong>in</strong>g impaired, <strong>in</strong>teraction between <strong>the</strong> child and parent is<br />
made more difficult. It is not <strong>the</strong> hear<strong>in</strong>g impaired person who is h<strong>in</strong>dered to<br />
communicate with <strong>the</strong> outer world, but ra<strong>the</strong>r his way <strong>of</strong> <strong>in</strong>teract<strong>in</strong>g with <strong>the</strong><br />
hear<strong>in</strong>g world. Verbal and non-verbal communication between <strong>the</strong> hear<strong>in</strong>g<br />
impaired child and its hear<strong>in</strong>g environment can not succeed completely and<br />
<strong>of</strong>ten much more effort is needed.<br />
A large amount <strong>of</strong> psychological research has been done on <strong>the</strong> topic <strong>of</strong> <strong>the</strong><br />
communicative development and behaviour <strong>of</strong> hear<strong>in</strong>g impaired <strong>children</strong> (for<br />
example NICHOLAS, GEERS an KOZAK, 1994: “Development <strong>of</strong><br />
Communication Function <strong>in</strong> Young Hear<strong>in</strong>g-Impaired and Normally Hear<strong>in</strong>g<br />
Children”. LEDERBERG EVERHARDT, 1998: “Communication between<br />
Deaf Children and <strong>the</strong>ir Hear<strong>in</strong>g Mo<strong>the</strong>rs: <strong>the</strong> Role <strong>of</strong> Language, Gesture and<br />
Vocalisation”).<br />
Those <strong>in</strong>vestigations mostly come to <strong>the</strong> conclusion that <strong>the</strong> communicative<br />
development <strong>of</strong> hear<strong>in</strong>g impaired <strong>children</strong> progresses slowly concern<strong>in</strong>g <strong>the</strong><br />
5
Radbruch, K. (2001) <strong>Music</strong> <strong><strong>the</strong>rapy</strong> <strong>in</strong> <strong>the</strong> <strong>rehabilitation</strong> <strong>of</strong> <strong>children</strong> with<br />
cochlear implant (CI). <strong>Music</strong> Therapy Today (onl<strong>in</strong>e), November, available at<br />
www.music<strong><strong>the</strong>rapy</strong>world.<strong>in</strong>fo<br />
quality and quantity aspect <strong>of</strong> development (with <strong>the</strong> exception <strong>of</strong> deaf<br />
<strong>children</strong> <strong>of</strong> deaf parents). In my assessment it seems to be important <strong>in</strong> this<br />
context that verbal communication is always based on non-verbal<br />
communication. The research mentioned above also support this fact.<br />
When work<strong>in</strong>g with <strong>children</strong> after <strong>the</strong> CI-Implantation, <strong>the</strong> learn<strong>in</strong>g <strong>of</strong> speech<br />
is central – but it should aga<strong>in</strong> be mentioned that non-verbal communication<br />
is <strong>the</strong> basic issue. The dependence <strong>of</strong> verbal communication upon nonverbal<br />
communication is always present.<br />
“Several contemporary <strong>the</strong>ories <strong>of</strong> language acquisition hold that <strong>the</strong><br />
functional aspect <strong>of</strong> communication is <strong>the</strong> driv<strong>in</strong>g force <strong>in</strong> <strong>the</strong> acquisition <strong>of</strong> a<br />
formal language.”(NICHOLAS, GEERS, KOZAK 1994, S. 39)<br />
The development <strong>of</strong> communicative skills is also fundamental for <strong>the</strong> social<br />
development <strong>of</strong> <strong>the</strong> child and is a key role for social <strong>in</strong>tegration. I am still not<br />
talk<strong>in</strong>g about <strong>the</strong> acquisition <strong>of</strong> speech but ra<strong>the</strong>r <strong>the</strong> acquisition <strong>of</strong><br />
communicative skills.<br />
To support and stimulate communicative development, it is necessary, as<br />
already mentioned, to focus on playful communication and dialogue, both<br />
meet<strong>in</strong>g <strong>the</strong> needs <strong>of</strong> hear<strong>in</strong>g impaired <strong>children</strong>. While do<strong>in</strong>g so, <strong>the</strong> child’s<br />
personal stage <strong>of</strong> development, its hear<strong>in</strong>g abilities and age <strong>of</strong> hear<strong>in</strong>g<br />
should always be taken <strong>in</strong>to consideration.<br />
Through experienc<strong>in</strong>g a positive and relaxed communicative situation,<br />
<strong>children</strong> ga<strong>in</strong> personal strength and develop a sense <strong>of</strong> curiosity and joy for<br />
<strong>in</strong>teraction and last but not least a motivation.<br />
Improvised music <strong>of</strong>fers possibilities for extremely varied communication, not<br />
merely l<strong>in</strong>ked to language components ( s.a. ALDRIDGE, 1996, S.51ff).<br />
S<strong>in</strong>ce 1999 I have been do<strong>in</strong>g research on exactly this topic, namely to<br />
exam<strong>in</strong>e <strong>the</strong> components <strong>of</strong> communication development with<strong>in</strong> <strong>the</strong> work <strong>of</strong><br />
6
Radbruch, K. (2001) <strong>Music</strong> <strong><strong>the</strong>rapy</strong> <strong>in</strong> <strong>the</strong> <strong>rehabilitation</strong> <strong>of</strong> <strong>children</strong> with<br />
cochlear implant (CI). <strong>Music</strong> Therapy Today (onl<strong>in</strong>e), November, available at<br />
www.music<strong><strong>the</strong>rapy</strong>world.<strong>in</strong>fo<br />
music <strong><strong>the</strong>rapy</strong> with hear<strong>in</strong>g impaired <strong>children</strong>. I would like to thank Andreas-<br />
Tobias-foundation, placed <strong>in</strong> Hamburg, which f<strong>in</strong>ancially supports this<br />
research.<br />
<strong>Music</strong> <strong><strong>the</strong>rapy</strong> with hear<strong>in</strong>g impaired <strong>children</strong> with a particular<br />
emphasis on communicative development<br />
The <strong>in</strong>tention <strong>of</strong> my study is to f<strong>in</strong>d out whe<strong>the</strong>r communicative behaviour <strong>of</strong><br />
<strong>children</strong> significantly changes with<strong>in</strong> 10 sessions <strong>of</strong> music <strong><strong>the</strong>rapy</strong>. The<br />
follow<strong>in</strong>g questions are always present:<br />
• Does <strong>the</strong> length <strong>of</strong> <strong>the</strong> <strong>in</strong>teractive phase between child and <strong>the</strong>rapist<br />
change?<br />
• What is <strong>the</strong> relationship between <strong>the</strong> communicative modes “alternation”<br />
and “co-activity” <strong>in</strong> <strong>the</strong> <strong>in</strong>teractive phases?<br />
This differentiation and division <strong>of</strong> those two communication modes is<br />
based on <strong>the</strong> <strong>the</strong>ories <strong>of</strong> DANIEL STERN. In 1975 he found <strong>in</strong> <strong>the</strong> nonverbal<br />
communication between mo<strong>the</strong>r and child two parallel modes <strong>of</strong><br />
communication:<br />
- <strong>the</strong> co-activity, where mo<strong>the</strong>r and child vocalise at <strong>the</strong> same time. It is<br />
<strong>in</strong>dicative <strong>of</strong> emotional tone and promotes mutual experience.<br />
- <strong>the</strong> alternation, which has a dialogical structure and which is important<br />
for <strong>the</strong> exchange <strong>of</strong> symbolic <strong>in</strong>formation.<br />
We can f<strong>in</strong>d both modes <strong>of</strong> communication <strong>in</strong> improvised music.<br />
• At least <strong>the</strong> focus on <strong>the</strong> “<strong>in</strong>itiatives for communication”, which means <strong>the</strong><br />
vary<strong>in</strong>g <strong>of</strong>fer<strong>in</strong>gs made by both players <strong>in</strong> <strong>the</strong> <strong>in</strong>teractive phases that<br />
br<strong>in</strong>gs <strong>the</strong> o<strong>the</strong>r partner <strong>in</strong>to communication. Does <strong>the</strong> number <strong>of</strong> <strong>the</strong><br />
<strong>in</strong>itiatives changes and does <strong>the</strong> relationship between <strong>the</strong> <strong>in</strong>itiatives <strong>of</strong> <strong>the</strong><br />
child and <strong>the</strong> <strong>the</strong>rapist change?<br />
It would be tak<strong>in</strong>g th<strong>in</strong>gs to far <strong>in</strong> this research to evaluate all sessions<br />
accord<strong>in</strong>g to those questions; <strong>the</strong>refore I will only focus on 2 episodes <strong>in</strong> <strong>the</strong><br />
7
Radbruch, K. (2001) <strong>Music</strong> <strong><strong>the</strong>rapy</strong> <strong>in</strong> <strong>the</strong> <strong>rehabilitation</strong> <strong>of</strong> <strong>children</strong> with<br />
cochlear implant (CI). <strong>Music</strong> Therapy Today (onl<strong>in</strong>e), November, available at<br />
www.music<strong><strong>the</strong>rapy</strong>world.<strong>in</strong>fo<br />
first, fifth and tenth session. Each episode is about two m<strong>in</strong>utes and conta<strong>in</strong>s<br />
two examples <strong>of</strong> <strong>the</strong> longest phases <strong>of</strong> <strong>in</strong>teraction between child and<br />
<strong>the</strong>rapist <strong>in</strong> each session.<br />
In co-operation with a special education development program for hear<strong>in</strong>g<br />
impaired <strong>children</strong> up to <strong>the</strong> age <strong>of</strong> 6 years <strong>in</strong> Bochum and <strong>the</strong> k<strong>in</strong>dergarten<br />
for hear<strong>in</strong>g-impaired <strong>children</strong> <strong>in</strong> Bochum as well I have been work<strong>in</strong>g with 24<br />
<strong>children</strong> between <strong>the</strong> age <strong>of</strong> 3 and 6. 11 <strong>of</strong> <strong>the</strong>m have a cochlea implant, <strong>the</strong><br />
o<strong>the</strong>rs normal hear<strong>in</strong>g aids. These <strong>children</strong> are part <strong>of</strong> a special program but<br />
previously have never had experience with music <strong><strong>the</strong>rapy</strong> before. Children<br />
with additional impairments were excluded from my research.<br />
I would like to present to you two little boys and take concrete examples from<br />
<strong>the</strong>ir <strong>the</strong>rapies to expla<strong>in</strong> <strong>the</strong> results:<br />
Marv<strong>in</strong> is four-year-old boy, very friendly and calm, a little dreamer, who likes<br />
to be by himself. He is untir<strong>in</strong>g <strong>in</strong> his actions if left alone.<br />
When Marv<strong>in</strong> was one year old, a severe hear<strong>in</strong>g impairment border<strong>in</strong>g<br />
deafness was diagnosed <strong>in</strong> both ears. When he was three and a half years<br />
old, he got a CI. Three months later I got to know him <strong>in</strong> music <strong><strong>the</strong>rapy</strong>.<br />
The follow<strong>in</strong>g sentences are taken from his file: “Marv<strong>in</strong> shows a passive<br />
communicative behaviour with<strong>in</strong> <strong>the</strong> verbal level... Changes <strong>in</strong> play were only<br />
noticed sporadically .”<br />
In <strong>the</strong> first music <strong><strong>the</strong>rapy</strong> sessions he was <strong>in</strong>terested at <strong>the</strong> music<br />
<strong>in</strong>struments <strong>in</strong> his own way: he touches and exam<strong>in</strong>es <strong>the</strong>m, especially <strong>the</strong><br />
screws and fiddled around with <strong>the</strong> drumsticks. There is only some play<br />
activity and little <strong>in</strong>terest for me. Moreover, <strong>the</strong>re seems to be no <strong>in</strong>terest <strong>in</strong><br />
<strong>the</strong> <strong>in</strong>struments concern<strong>in</strong>g sound. The first <strong>in</strong>strument he uses a little bit<br />
longer <strong>in</strong> <strong>the</strong> first session was <strong>the</strong> triangle.<br />
Lets have a look at <strong>the</strong> beg<strong>in</strong>n<strong>in</strong>g if this improvisation:<br />
Marv<strong>in</strong> has chosen <strong>the</strong> triangle. He plays <strong>the</strong> triangle and observes how <strong>the</strong><br />
<strong>in</strong>strument moves – he is fully concentrated and thrilled.<br />
8
Radbruch, K. (2001) <strong>Music</strong> <strong><strong>the</strong>rapy</strong> <strong>in</strong> <strong>the</strong> <strong>rehabilitation</strong> <strong>of</strong> <strong>children</strong> with<br />
cochlear implant (CI). <strong>Music</strong> Therapy Today (onl<strong>in</strong>e), November, available at<br />
www.music<strong><strong>the</strong>rapy</strong>world.<strong>in</strong>fo<br />
I play <strong>the</strong> piano – like him with high pitch. I try to follow his play<strong>in</strong>g, I try to<br />
imitate it.<br />
A focused listen<strong>in</strong>g to his own <strong>in</strong>strumental activity starts – a focused<br />
listen<strong>in</strong>g to me is one step too far and so <strong>the</strong>re is nearly no place for musical<br />
<strong>in</strong>teraction for <strong>the</strong> moment.<br />
In <strong>the</strong> 10 th session we start sitt<strong>in</strong>g <strong>the</strong>re with <strong>the</strong> congas; an <strong>in</strong>terplay<br />
develops and <strong>the</strong>re are long moments <strong>in</strong> which I have his full attention.<br />
Marv<strong>in</strong> realises my musical <strong>of</strong>fers and he is able to response appropriately. In<br />
addition to that he br<strong>in</strong>gs his own ideas <strong>in</strong>to <strong>the</strong> common play. Such a phase<br />
<strong>of</strong> directed concentration is someth<strong>in</strong>g special for Marv<strong>in</strong> at this time.<br />
Marv<strong>in</strong> is one <strong>of</strong> <strong>the</strong> <strong>children</strong> <strong>in</strong> <strong>the</strong> research whose phases <strong>of</strong> <strong>in</strong>teraction<br />
have become much longer. In a chart this change <strong>of</strong> behaviour looks like this:<br />
Transparency 1<br />
Seconds<br />
200<br />
150<br />
100<br />
50<br />
0<br />
Marv<strong>in</strong>: "Interaction"<br />
Interaktion f<strong>in</strong>det statt Interaktion f<strong>in</strong>det nicht statt<br />
11<br />
172<br />
9<br />
55<br />
166<br />
1 2 3<br />
79 54<br />
Episodes 1 from Session 1, 2 from Session 5, 3<br />
from Session 10.<br />
This result explicitly proves that dur<strong>in</strong>g <strong>the</strong>se musical activities Marv<strong>in</strong> has<br />
discovered and enlarged his way <strong>of</strong> <strong>in</strong>teract<strong>in</strong>g and has made basically<br />
experiences concern<strong>in</strong>g his communicative development: as we f<strong>in</strong>d <strong>the</strong>
Radbruch, K. (2001) <strong>Music</strong> <strong><strong>the</strong>rapy</strong> <strong>in</strong> <strong>the</strong> <strong>rehabilitation</strong> <strong>of</strong> <strong>children</strong> with<br />
cochlear implant (CI). <strong>Music</strong> Therapy Today (onl<strong>in</strong>e), November, available at<br />
www.music<strong><strong>the</strong>rapy</strong>world.<strong>in</strong>fo<br />
ability to listen and respond appropriately to sound, which is a vital aspect <strong>of</strong><br />
communication.<br />
Until now I have done this evaluation with <strong>the</strong> videos <strong>of</strong> 9 <strong>children</strong> with<br />
cochlear implants and regard<strong>in</strong>g this group we f<strong>in</strong>d 6 o<strong>the</strong>r <strong>children</strong> with <strong>the</strong><br />
same tendency concern<strong>in</strong>g <strong>the</strong> phases <strong>of</strong> <strong>in</strong>teraction. All <strong>the</strong>se 6 <strong>children</strong> I<br />
met <strong>in</strong> <strong>the</strong>ir first 18 months after <strong>the</strong> operation <strong>of</strong> <strong>the</strong> CI.<br />
A second result <strong>of</strong> this evaluation is <strong>the</strong> structure <strong>in</strong> which Marv<strong>in</strong> plays with<strong>in</strong><br />
<strong>the</strong> <strong>in</strong>teractive sessions:<br />
Transparency 2<br />
Seconds<br />
Marv<strong>in</strong>: "Interaction/Structured play"<br />
Co-Aktivität Alternation<br />
150<br />
100<br />
50<br />
0<br />
5 6<br />
10<br />
25 14<br />
24<br />
1 2 3<br />
134<br />
Episodes 1 from Session 1, 2 from Session 5, 3 from<br />
Session 10.<br />
This <strong>in</strong>teraction bases on <strong>the</strong> structure <strong>of</strong> alternation which seems to be<br />
plausible consider<strong>in</strong>g Marv<strong>in</strong>’s hear<strong>in</strong>g age.<br />
All <strong>the</strong> 6 <strong>children</strong>, where we f<strong>in</strong>d an <strong>in</strong>crease <strong>of</strong> phases <strong>of</strong> <strong>in</strong>teraction, started<br />
musical <strong>in</strong>teraction <strong>in</strong> a dialogical structure, although this mode <strong>of</strong>
Radbruch, K. (2001) <strong>Music</strong> <strong><strong>the</strong>rapy</strong> <strong>in</strong> <strong>the</strong> <strong>rehabilitation</strong> <strong>of</strong> <strong>children</strong> with<br />
cochlear implant (CI). <strong>Music</strong> Therapy Today (onl<strong>in</strong>e), November, available at<br />
www.music<strong><strong>the</strong>rapy</strong>world.<strong>in</strong>fo<br />
communication is not always as dom<strong>in</strong>ant as we f<strong>in</strong>d is <strong>in</strong> <strong>the</strong> development <strong>of</strong><br />
Marv<strong>in</strong>.<br />
“...<strong>the</strong> establishment <strong>of</strong> dialogical structure, that <strong>in</strong> itself enables mean<strong>in</strong>g to<br />
be negotiated, is <strong>the</strong> first important step <strong>in</strong> communication”. (ALDRIDGE<br />
1996, S. 36)<br />
Completely different are <strong>the</strong> results <strong>of</strong> <strong>the</strong> second child I will show to you<br />
now:<br />
Niklas is a 6-year-old boy. He is tall, full <strong>of</strong> energy and has broken three<br />
drumsticks dur<strong>in</strong>g those 10 sessions while play<strong>in</strong>g <strong>the</strong> drums ...<br />
Niklas’ high grade severe hear<strong>in</strong>g impairment was diagnosed when he was<br />
four months old. At <strong>the</strong> age <strong>of</strong> three he got a CI, which he didn’t accept at <strong>the</strong><br />
beg<strong>in</strong>n<strong>in</strong>g, but f<strong>in</strong>ally did half a year later. When I got to know Niklas he had<br />
already had <strong>the</strong> CI for two and a half years. From his file I get <strong>the</strong> follow<strong>in</strong>g<br />
<strong>in</strong>formation: “Niklas knows about <strong>the</strong> communicative character <strong>of</strong> language<br />
and tries more and more to use this language.”<br />
Let’s have a look at <strong>the</strong> graph show<strong>in</strong>g Niklas' length <strong>of</strong> <strong>in</strong>teractive phases:<br />
Transparency 3<br />
Seconds<br />
200<br />
150<br />
100<br />
50<br />
0<br />
Niklas: "Interaction"<br />
Interaktion f<strong>in</strong>det statt Interaktion f<strong>in</strong>det nicht statt<br />
180<br />
51<br />
182<br />
11<br />
56<br />
168<br />
1 2 3<br />
65<br />
Episodes 1 from Session 1, 2 from Session 5, 3 from<br />
Session 10.
Radbruch, K. (2001) <strong>Music</strong> <strong><strong>the</strong>rapy</strong> <strong>in</strong> <strong>the</strong> <strong>rehabilitation</strong> <strong>of</strong> <strong>children</strong> with<br />
cochlear implant (CI). <strong>Music</strong> Therapy Today (onl<strong>in</strong>e), November, available at<br />
www.music<strong><strong>the</strong>rapy</strong>world.<strong>in</strong>fo<br />
A leng<strong>the</strong>n<strong>in</strong>g <strong>of</strong> <strong>the</strong> <strong>in</strong>teractive phases can’t be observed – <strong>the</strong> tendency is<br />
even contrary. 3 <strong>children</strong> <strong>of</strong> <strong>the</strong> study show no clear change concern<strong>in</strong>g <strong>the</strong><br />
length <strong>of</strong> <strong>the</strong> phases <strong>of</strong> <strong>in</strong>teraction. All <strong>of</strong> <strong>the</strong>m had <strong>the</strong> CI for one and a half<br />
year or more. There is only one child where <strong>the</strong> <strong>in</strong>teractive phases are<br />
def<strong>in</strong>itely shorter <strong>in</strong> <strong>the</strong> end.<br />
However, <strong>the</strong>re is a change <strong>in</strong> Niklas’ communicative behaviour. I would like<br />
to illustrate this by referr<strong>in</strong>g two examples from <strong>the</strong> first and tenth session:<br />
Niklas starts play<strong>in</strong>g <strong>the</strong> drum very loudly and powerfully, I sit at <strong>the</strong> piano.<br />
He makes short breaks and waits for my entries. He gives <strong>the</strong> <strong>in</strong>itiatives, I<br />
imitate his <strong>in</strong>structions. Twice I make him an <strong>of</strong>fer, but he doesn t seem to<br />
notice it. He seems to be quite astonished when I go on play<strong>in</strong>g <strong>the</strong> piano<br />
without mak<strong>in</strong>g a break. He waits till I f<strong>in</strong>ally make a break to go on with his<br />
drumm<strong>in</strong>g.<br />
The next example belongs to <strong>the</strong> 10 th session:<br />
I play 2 congas <strong>in</strong> a regular, slow metre. Niklas sits down at <strong>the</strong> piano and<br />
starts to play <strong>in</strong> my tempo – we play toge<strong>the</strong>r for a while. Then I start play<strong>in</strong>g<br />
very s<strong>of</strong>t and he does <strong>the</strong> same. He imitates my way <strong>of</strong> play<strong>in</strong>g and f<strong>in</strong>ds out<br />
alternative ways <strong>of</strong> play<strong>in</strong>g <strong>the</strong> piano. At <strong>the</strong> end <strong>the</strong> communicative mode<br />
changes aga<strong>in</strong> an we play toge<strong>the</strong>r strongly – <strong>in</strong>terrupted by jo<strong>in</strong>t breaks by a<br />
show <strong>of</strong> hands.<br />
I th<strong>in</strong>k it is very pla<strong>in</strong>, that <strong>the</strong> quality <strong>of</strong> <strong>in</strong>teraction has changed <strong>in</strong> between<br />
<strong>the</strong> first and <strong>the</strong> second example and <strong>in</strong> addition Niklas has found a <strong>in</strong>dividual<br />
way <strong>of</strong> creation and expression <strong>in</strong> musical activity. In <strong>the</strong> first session it was<br />
Niklas who determ<strong>in</strong>ates <strong>the</strong> <strong>in</strong>teraction and <strong>the</strong> mode <strong>of</strong> communication was<br />
exclusive <strong>the</strong> alternation.<br />
In <strong>the</strong> 10 th session we f<strong>in</strong>d both modes <strong>of</strong> <strong>in</strong>teraction, co-activity and<br />
alternation. This leads me to <strong>the</strong> assumption, that <strong>the</strong> quality <strong>of</strong> partnership<br />
has changed.<br />
12
Radbruch, K. (2001) <strong>Music</strong> <strong><strong>the</strong>rapy</strong> <strong>in</strong> <strong>the</strong> <strong>rehabilitation</strong> <strong>of</strong> <strong>children</strong> with<br />
cochlear implant (CI). <strong>Music</strong> Therapy Today (onl<strong>in</strong>e), November, available at<br />
www.music<strong><strong>the</strong>rapy</strong>world.<strong>in</strong>fo<br />
Interaction is not only <strong>the</strong> imitation <strong>of</strong> a special number, <strong>of</strong> a special dynamic<br />
or tempo. Interaction has become more and more flexible and free. It is not<br />
so static as it was <strong>in</strong> <strong>the</strong> beg<strong>in</strong>n<strong>in</strong>g.<br />
Fur<strong>the</strong>rmore <strong>the</strong> mode <strong>of</strong> co-activity makes higher demands on <strong>the</strong> ability <strong>of</strong><br />
hear<strong>in</strong>g. Niklas has to follow <strong>the</strong> sounds <strong>of</strong> two different <strong>in</strong>struments<br />
simultaneously.<br />
In a chart this change looks like this:<br />
Transparency 4<br />
Niklas: "Interaktion/Structured play"<br />
Seconds<br />
200<br />
150<br />
100<br />
50<br />
0<br />
Co-Aktivität Alternation<br />
0<br />
180<br />
63<br />
119<br />
1 2 3<br />
13<br />
81 86<br />
Episodes 1 from Session 1, 2 from Session 5, 3 from Session 10.<br />
7 <strong>of</strong> <strong>the</strong> 9 Cochlea implanted <strong>children</strong> <strong>in</strong> this study showed a chang<strong>in</strong>g<br />
concern<strong>in</strong>g <strong>the</strong> modes <strong>of</strong> <strong>in</strong>teraction.<br />
In <strong>the</strong> 10 th session we secondly see that both players give <strong>in</strong>itiatives and<br />
react on <strong>the</strong> <strong>in</strong>itiatives <strong>of</strong> <strong>the</strong> partner as well. An equal partnership has<br />
developed.<br />
This development I wan t to show you with <strong>the</strong> help <strong>of</strong> an o<strong>the</strong>r graph: .<br />
Here we can see <strong>the</strong> number <strong>of</strong> <strong>in</strong>itiatives, <strong>of</strong>fered by Niklas and by <strong>the</strong><br />
<strong>the</strong>rapist, that br<strong>in</strong>gs <strong>the</strong> o<strong>the</strong>r player <strong>in</strong>to communication
Radbruch, K. (2001) <strong>Music</strong> <strong><strong>the</strong>rapy</strong> <strong>in</strong> <strong>the</strong> <strong>rehabilitation</strong> <strong>of</strong> <strong>children</strong> with<br />
cochlear implant (CI). <strong>Music</strong> Therapy Today (onl<strong>in</strong>e), November, available at<br />
www.music<strong><strong>the</strong>rapy</strong>world.<strong>in</strong>fo<br />
Transparency 5<br />
Number <strong>of</strong> <strong>in</strong>itiatives<br />
20<br />
15<br />
10<br />
5<br />
0<br />
1<br />
Niklas: "Initiatives"<br />
2<br />
2<br />
Niklas Therapeut<strong>in</strong><br />
3<br />
3<br />
1<br />
1 2 3 4 5 6<br />
Episodes:1+2 from Session 1; 3+4 fromSession 5; 5+6 from Session 10.<br />
In <strong>the</strong> work with hear<strong>in</strong>g impaired <strong>children</strong> I <strong>of</strong>ten observe an imbalance<br />
between <strong>the</strong> two communication partners: some <strong>of</strong> <strong>the</strong>m dom<strong>in</strong>ate <strong>the</strong><br />
<strong>in</strong>teraction completely <strong>in</strong> <strong>the</strong> beg<strong>in</strong>n<strong>in</strong>g, o<strong>the</strong>rs only react or imitate for a long<br />
time what I play.<br />
8 <strong>of</strong> 9 cochlea implanted <strong>children</strong> <strong>in</strong> this study showed a chang<strong>in</strong>g concern<strong>in</strong>g<br />
<strong>the</strong> relationship between <strong>the</strong> <strong>in</strong>itiatives <strong>of</strong> child and <strong>the</strong>rapist.<br />
A “healthy” <strong>in</strong>teraction requires that <strong>the</strong>re is a sense <strong>of</strong> action and reaction<br />
from all participants <strong>in</strong>volved. For <strong>children</strong> who have just received <strong>the</strong> CI,<br />
<strong>in</strong>teraction on a verbal level is almost impossible – but via <strong>the</strong> medium <strong>of</strong><br />
music it is easier to connect and f<strong>in</strong>d an appropriate level <strong>of</strong> communication.<br />
Children experience active parts <strong>of</strong> <strong>in</strong>teraction; <strong>the</strong>y feel how to react and to<br />
lead. They make <strong>the</strong> experience <strong>of</strong> autonomy <strong>in</strong> an <strong>in</strong>teraction.<br />
Communication is never static. Strict exercises with fixed rules would never<br />
come close to what is typical <strong>of</strong> an <strong>in</strong>teraction, namely that someth<strong>in</strong>g<br />
develops <strong>in</strong> an unexpected way and permanently changes. This is <strong>the</strong> reason<br />
why I mostly avoid hear<strong>in</strong>g exercises. It must be observed, however, that a<br />
completely spontaneous unstructured activity might be too much for some <strong>of</strong><br />
<strong>the</strong> <strong>children</strong>, without at least some guidance and rules.<br />
14<br />
4<br />
4<br />
5<br />
5<br />
6
Radbruch, K. (2001) <strong>Music</strong> <strong><strong>the</strong>rapy</strong> <strong>in</strong> <strong>the</strong> <strong>rehabilitation</strong> <strong>of</strong> <strong>children</strong> with<br />
cochlear implant (CI). <strong>Music</strong> Therapy Today (onl<strong>in</strong>e), November, available at<br />
www.music<strong><strong>the</strong>rapy</strong>world.<strong>in</strong>fo<br />
Th<strong>in</strong>k<strong>in</strong>g <strong>of</strong> <strong>the</strong> results <strong>of</strong> <strong>the</strong> research study and th<strong>in</strong>k<strong>in</strong>g <strong>of</strong> all <strong>the</strong> my<br />
experiences <strong>in</strong> <strong>the</strong> work with <strong>the</strong> <strong>children</strong> I know for sure that music <strong><strong>the</strong>rapy</strong><br />
can be a useful and <strong>in</strong>creas<strong>in</strong>g supplementation <strong>in</strong> <strong>the</strong> <strong>rehabilitation</strong> <strong>of</strong><br />
cochlea implanted <strong>children</strong>.<br />
We will never replace nei<strong>the</strong>r <strong>the</strong> speech <strong><strong>the</strong>rapy</strong> nor any o<strong>the</strong>r pr<strong>of</strong>ession <strong>in</strong><br />
<strong>the</strong> program, but we can give <strong>the</strong> <strong>children</strong> useful and essential experiences<br />
on <strong>the</strong>ir way to <strong>the</strong> world <strong>of</strong> sound and voices and to <strong>the</strong> world <strong>of</strong> verbal<br />
<strong>in</strong>teraction and communication.<br />
ALDRIDGE, David. <strong>Music</strong> Therapy<br />
Research and Practice <strong>in</strong> Medic<strong>in</strong>e:<br />
FromOut <strong>of</strong> <strong>the</strong> Silence. Jessica<br />
K<strong>in</strong>gsley, London 1996.<br />
BREINER, Herbert. Erarbeitung der<br />
äußeren Seite der Sprache und<br />
kommunikativer Hilfsmittel. <strong>in</strong>:<br />
Handbuch Sonderpädagogik. S. 141 –<br />
163.<br />
DILLER, Gottfried. Hören mit e<strong>in</strong>em<br />
Cochlear-Implant: e<strong>in</strong>e E<strong>in</strong>führung.<br />
Heidelberg, 1997.<br />
DILLER, Gottfried (Hrsg.) Hörgerichte<strong>the</strong>it<br />
<strong>in</strong> der Praxis. Heidelberg, 1998.<br />
GÄNGLER, Elisabeth. Neue Wege, neue<br />
Ziele – Leben mit e<strong>in</strong>em<br />
hörgeschädigten K<strong>in</strong>d. Frankfurt,<br />
1995.<br />
HILDMANN, Agnes. Frühk<strong>in</strong>dliche<br />
Audiometrie und<br />
Hörgeräteversorgung. <strong>in</strong>: Siemens<br />
Audiologische Technik GmbH (Hrsg.):<br />
Früh erkannt, Gefahr gebannt – e<strong>in</strong>e<br />
Chance für schwerhörige K<strong>in</strong>der.<br />
Tagungsband der<br />
Beethovengespräche 1999 <strong>in</strong> Bonn..<br />
S. 31 – 38.<br />
KLINKE, Ra<strong>in</strong>er. Hören als zentralnervöser<br />
Verarbeitungsprozeß. <strong>in</strong>: HÖRPÄD<br />
6/1997. S. 355 – 369.<br />
LEDERBERG, Everhardt. Communication<br />
between Deaf Children and <strong>the</strong>ir<br />
Hear<strong>in</strong>g Mo<strong>the</strong>rs: <strong>the</strong> Role <strong>of</strong> Language,<br />
Gesture and Vocalisation, 1998.<br />
LEONHARDT, Annette. E<strong>in</strong>führung <strong>in</strong> die<br />
Hörgeschädigtenpädagogik. München,<br />
1999.<br />
NICHOLAS, GEERS, KOZAK. Development<br />
<strong>of</strong> Communication Function <strong>in</strong> young<br />
Hear<strong>in</strong>g-Impaired and Normally Hear<strong>in</strong>g<br />
Children, 1994.<br />
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