Sunday, February 17, 2013

Integrated Listening System

Yesterday I traveled to Kansas City, Missouri for a continuing education course on the Integrated Listening System (iLs). I was very fortunate to have several of my colleagues along with me! I wanted to take some time on this post and review the iLs system!

I have to admit I was a bit skeptical going into the continuing education course. Listening based therapy? What is that all about? As a Speech-Language Pathologist I know how important it is for that auditory component but I wanted to dig deeper into this program.

http://www.integratedlistening.com/

In a nutshell:
The iLs program(s) focuses on the brain's neuroplasticy. Neuroplasticity is the brain's ability to create new neural pathways thus increasing various capabilities in cognitive functions. Growth is most  productive when the brain is stimulated in a repetitive manner. So do you remember back in school having to memorize a piece of poetry and then having to present it in front of the class? How did you learn it? Personally, I read it over and over and over and over until I was ready. That is the repetition we are talking about!

The iLs program then targets neuroplasticity by stimulating the reticular activation system (RAS). The RAS is a network of neurons and neural fibers that run through the brainstem. The RAS is responsible for regulating arousal and sleep-wake cycles. Now I want you to focus on the arousal term here. When do we learn best? Obviously when we are awake, when we are aroused. iLs wants to stimulate the RAS system. The RAS is stimulated though a mix of auditory, visual, motor & vestibular tasks.


If you are interested Dr. Ron Minson discusses the program more here.


The auditory component consists of utilizing headphones that go through air conduction and bone conduction. Now the bone conduction is not actually placed on the mastoid bone. The bone conduction component is within the headphone band placed on the top center of the head. Originally I thought that the bone conduction would then be a waist of time being so far from the mastoid bone but I was proven wrong. I was able to hear the stimulus with the air conduction turned off and through only the bone conduction component. Pretty neat!

You can see the bone conduction piece stick out on the center left part of the headphone band.

Throughout the sessions the patient wears the headphones and has soft full spectrum music played. This full spectrum music is one of the ways the RAS is being stimulated. While the full spectrum music is played (soft enough so that patient can still hear their communication partner) they go through at least 15 minutes of a motor task such as bouncing a ball, balancing, walking, etc... Then therapy goes on as typical. I can still target my grammar, articulation, language, memory, etc...

I have a few patient's that I would like to try this with but in the back of my mind I still wonder if my patient's will be able to attend as well with the music playing? Though that in itself is a cognitive task that I would like many of my patient's to be able to do...to be able to attend and process in the presence of background noise.

Originally, I was also nervous about these gross motor tasks being part of my treatment session. I'm not an occupational therapist so how will I bill for this? Well during their gross motor task I can easily add in a language or cognitive task. For instance for a patient that I am working on sentence formulation/completion or turn taking/pragmatics we can pass a ball back and forth, each time ball is passed a new word is added to the story so... once (pass ball), upon (pass ball), a (pass ball) time, (pass ball), there (pass ball), was (pass ball) a... etc.! And I often throw in gross motor tasks anyways when I have a patient that is not wanting to sit still, such as bowling for there target articulation cards.

I tried some of the high level tasks such as balancing on a board with my eye's closed and counting by three's...pretty difficult stuff!





More about that music...
Now the really interesting part within this program is the music design. They have picked full spectrum music meaning the frequencies heard range from below 125 Hz up to 20000 Hz. This range is divided up between three zones.

Zone One - Sensory-Motor
Now think about music that you turn on when you are wanting to relax or go to bed? Or the type of music at a spa! What kind is it? Typically it is a lower frequency song and it is at a slow pace. In zone one the emphasis is on these low frequencies. iLs believes that by having stimulation of these frequencies will then target (stimulate the brain that coincides with) balance, rhythm, coordination, muscle tone, body awareness, laterality and sense of direction.

Zone Two - Communication
This zone focuses on frequencies that are within speech. iLs believes that by having stimulation of these frequencies then improvements will be seen with speech, melody, phonemic decoding, reading, memory, concentration, attention, and reading comprehension.

Zone Three - Integration
Now think about the type of music you turn on when you are wanting to stay awake. I turn on high energy music. The frequencies in Zone three are high frequencies and iLs believes it will increase mental energy, motivation, enthusiasm, organization of ideas, memory, concentration, attention, and reading comprehension.

Out of everything within the iLs course the zones were the most difficult for me to grasp, and to be honest I still feel like I am trying to grasp onto understanding these zones. Since I was struggling I went to the teacher of the course and said "So I can see how Zone two could be measured and is correlated to speech - audiograms show that our speech sounds fall within these frequencies but how did iLs determine that zone one really improves balance? or muscle tone? How was it determined that zone three frequencies stimulated memory and concentration? Was there a functional MRI used while this music was played on test subjects? Our teacher said that most of the evidence was anecdotal though he did encourage me to continue on with my research.

So how do these zones come into play with the music in iLs. Well there are certain programs that each zone participates in or overlaps. There is a Sensory-Motor program (obviously mostly in the realm of zone 1 frequencies for the music), a Concentration & Attention program (mostly zone 2 & 3), Auditory Processing, (mostly zone 2) and Optimal Performance (lots of zone 3).

The zones also have music that can independently focus on grounding a person or alerting a person. So that patient with a traumatic brain injury that is "all over the place" that day (poor attention) may benefit some from zone one music that will calm them. Or that patient that has low motivation? They may benefit from some music that will alert them.

Now I truly believe that just listening to this music alone will not be beneficial. This program does not take the place of a Speech-Language Pathologists goals/intervention or an Occupational Therapists goals/intervention. It is an additional tool that could increase neural stimulation as you are doing your traditional plan. Now this program is not appropriate for everyone - right now I have two or three patient's in mind that I am interested in trying this with.

Here is a video about a pilot program of iLs.

Language specific....yeah!!
Now there is an entire second component to the iLs system that I was really excited about. It is the language program. What the language program offers is again the headphones with air conduction and bone conduction. These headphones are then hooked up to a microphone. I think this in and of itself could greatly benefit so many of my patients for the auditory feedback! There are also other activities that are programmed with the language program such as memory tasks, dichotic listening, etc.

Here is a Speech-Language Pathologist that is currently working with the program.


Lasting thoughts...Pro's
I am very excited that I had the opportunity to go to this course. I have several new ideas for some of my patient's. I am super excited about the language program available and I think this auditory feedback will be amazing for some of my patient's! This course also took me a bit out of my comfort zone, which I think is good to do every so often!

Lasting thoughts...Con's
I still feel like I need to research more into Zone One and Zone Three and the correlation to the aforementioned.

Questions? Comments?
Have you worked with a listening program before?
What are were/are your experiences?
Have you worked with iLs previously? What did you think?

4 comments:

  1. Are you still using Ils? I am thinking of adding it to my practice.

    ReplyDelete
  2. Hi Megan,
    I do use the iLs system. Unfortunately it is not as much as I would like. The most difficult part of this program is finding the time (spaces) in my schedule for a patient to participate. Many families have trouble making it to treatment multiple times per week. Families also find it hard to rent the iLs program. Please let me know if you have any other questions!
    Mallory Mahon M.S. CCC-SLP

    ReplyDelete
  3. Hi, Mallory - Thank you for this in-depth write-up of iLs. We've found you! If you have any case successes or require any information, please reach out to us online: http://integratedlistening.com/contact/ or by telephone: 303-741-4544. - Pattie Kettle, Online Marketing Coordinator, iLs

    ReplyDelete
  4. I thought I would leave my first comment. I don’t know what to say except that I have.
    visit website

    ReplyDelete