Volume 2, Chapter 03: Music Therapy as specific and complementary training in the early rehabilitation of adult CI users – Insights from the “Heidelberg Model”.



Hearing disorders are among the most common diseases. One treatment option for severe hearing loss is cochlear implantation.


Music has evolved in all cultures around the world. Music is no discursive form of communication and does not contain semantic meaning but is much more precise than speech when it comes to expressing emotions. Music supports human well-being, helps us to regulate the mood and fosters social cohesion.


Post-lingually deaf adult CI users usually achieve good speech comprehension in silent surroundings but CI users often are unable to appreciate music. In auditory segregation, CI users rely on loudness cues rather than on pitch. This strategy works quite well with linguistic features but has clear limits when processing musical sounds which are based on fine-grained spectral changes. Consequently, the ability to perceive music is viewed as a pinnacle of achievement that may be possible through cochlear implants. This chapter will illustrate the differences in spectral and temporal resolution for speech and music and take a look behind the scenes of technical and psychophysiological challenges and restrictions in CI processing strategies.


Improving access to rehabilitation services and augmented rehabilitative strategies will help CI users to get the most out of their device. Aural rehabilitation is not standardized for adults after cochlear implantation. Comprehensive individual music trainings for adult in the early stages of rehabilitation are sparse. Most approaches use pre-recorded or electronically produced (MIDI) files and often focus on single music aspects, such as timbre, pitch or contours. Interactive music-based rehabilitation programs are a promising innovation. They can enhance musical pattern perception, stimulate the hearing performance of CI users and possibly extend to prompt better speech intelligibility.


As one example, the Heidelberg music therapy for post-lingually deaf adult CI recipients will be presented. Apart from accuracy, the musical appraisal is of utmost importance for the Heidelberg music therapy. CI users attend 5 to 10 individualized 50-minutes sessions during their first year of rehabilitation. The treatment is subdivided into five modules, each pursuing a specific therapeutic goal, taking into account the individual needs and problems of the CI users. Study results indicate a significant increase in hearing quality, in musical hearing performance as well as prosodic elements in speech. Further lines of research will be sketched out.


Speech recognition performance is no predictor of music perception but advances in hearing abilities of musical elements after a cochlear implantation tend to improve linguistic features. Music based trainings not only are “nice to have” but they have profound consequences not only on speech comprehension and vocal expression but also on improvements in quality of life and social engagement. We advocate, that multidimensional, person-centered music based trainings seems to be a fruitful and far-reaching completion and should become a cornerstone of CI rehabilitation.



Multimedia Elements


Spectral vs. temporal organization of acoustic stimuli: Animated graphical score

Stephen Malinowski. The first movement of Vivaldi's Concerto in E major (RV 269), "Spring" (from The Four Seasons) performed by the American Baroque. Retrieved from https://www.youtube.com/watch?v=CcrrXHnN5uU

  1. 1.     Basic music elements

a)     Pitch

b)     Beat and Rhythm

c)     Timbre

  1. 2.     Speech sound samples – normal hearing vs. cochlea implant simulation

a)     Unprocessed sentence : http://www.rle.mit.edu/apc/sounddemos/snd_demo1_unproc.wav

b)     Processed with a 24-channel noise-excited vocoder :http://www.rle.mit.edu/apc/sounddemos/snd_demo2_24ch.wav

c)     Unprocessed sentence in background speech: http://www.rle.mit.edu/apc/sounddemos/snd_demo3_uproc_int.wav

d)     Processed with a 24-channel vocoderProcessed with a 24-channel noise-excited vocoder:

  1. 3.     Music sound samples – normal hearing vs. cochlea implant simulation

Institut für Schallforschung (ISF). Acoustic CI simulations: Music 11. Retrieved from https://www.kfs.oeaw.ac.at/index.php?option=com_content&view=article&id=496&Itemid=765&lang=de


Film documents

  • Film 1: Music perception – a patient‘s perspective
    Narration of a bilateral CI user concerning his music perception before music therapy (German with English subtitles)
  • Film 2: Variability of voice and speech I – Kazoo-Imitation of melodic contours
    Female patient (Instructions in German language only)
  • Film 3: Variability of voice and speech II – Vocal improvisation using simple words (“hallo”, “saxophone”)
    Male patient (Instructions in German language only)
  • Film 4: Basic components of music I – Kazoo imitation of tones played on the piano
    Male patient – two parts: 1) at the start of therapy, 2) after 5 sessions music therapy (Instructions in German language only)
  • Film 5: Basic components of music II – Timbre identification
    Female patient (German with English subtitles)
  • Film 6: Results from a patient‘s perspective
    Narration of the bilateral CI user from film 1 concerning his music perception after music therapy (German with English subtitles)



 Chapter Contributors


Dr. Heike Argstatter


Dr. Heike Argstatter is chairwoman and research CEO at the German Center for Music Therapy Research (Deutsches Zentrum für Musiktherapieforschung DZM e.V.). The DZM e.V. is one of Europe’s leading music therapy research centers. Dr. Argstatter holds a diploma in psychology and a master's degree in musicology and completed her doctors degree at the ENT-department of the university hospital Heidelberg (Prof. Plinkert). In recent years, her main focus of research has been with music therapy in the field of hearing disorders. Since 2010 she has been significantly involved in establishing music therapy as specific and complementary training for adults after cochlear implantation – both in the context of research and as part of the routine rehabilitation procedure the ENT-department of the Heidelberg University hospital.



Elisabeth Hutter


Elisabeth Hutter holds a degree as psychologist from the University Regensburg and the Université Aix-Marseille I in France. From 2011 to 2016 she was the research associate at the German Center for Music Therapy Research (Deutsches Zentrum für Musiktherapieforschung, DZM e.V.) in Heidelberg. From 2014-2016 she was head of the cochlear implant outpatient center at the DZM and also worked for the CI rehabilitation center of the ENT clinic Heidelberg. Since 2016 she has been a permanent employee of the CI-team at the ENT clinic Heidelberg. Her key activities are research and development of music therapy in the early rehabilitation for adult CI recipients.