Effects of the Tomatis® Method on physically and mentally impaired adults

EFFECTS OF THE TOMATIS® METHOD ON PHYSICALLY AND MENTALLY IMPAIRED ADULTS Hilde Tinkl, Barbara Thima, Nafeesah Mayet Tomatis® Institut Thima, Serravagasse 6, 1140 Vienna.

Correspondence Author: Barbara Thima, E-mail: barbara.thima@tomatis.at

Objective The effect of the Tomatis® Method on physically and mentally impaired adults was studied.

Method 24 adults were selected from a rehabilitation center and a protected workshop of the Lebenshilfe in Austria. They were then assigned randomly to two groups; an experimental group and a control group. The experimental group received the Tomatis® Training over a period of 40 weeks, consisting of 4 blocks with 40 minutes a day over the course of 10 days per block (40 minutes x10 days x4 blocks). A questionnaire (Disability Rating Scale) and a Biofeedback Measurement Instrument was employed as a pre- and post-test, before, during and after the Tomatis® Training.

Results The Biofeedback Measurements show significant differences in heart rate variability (HRV), muscle tension, respiration (RESP) and skin temperature between the experimental group and the control group. In addition, statistical analysis displayed a significant difference between the scoring of the two groups.

Introduction The Tomatis® Method is a natural approach to neurosensory stimulation. Its listening programs change the music or voice in real time in order to capture the brain’s attention and to develop motor, emotional and cognitive skills. Developed by the French Doctor and Researcher, Alfred Tomatis, the Tomatis® Method relies on an advanced technology and the excellence of its trained professionals on how to use it.

Alfred Tomatis, founder of this method, verified that listening to some filtered sounds, especially Mozart’s music, has a practical effect on the brain, so that it enhances listening and speaking skills as well as emotional and mental awareness. According to this theory, the sounds that are produced by the Tomatis® Electronic Ear provide a stimulus which affects the ear muscles. By using the Tomatis® Method emotional (sensory) data processing may change.

This method is valuable because it can affect social interaction, stereotypical behavior, and provide a method to improve heart rate variability, motor response and various other physiological parameters.

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Subjects and Measures Subjects The study cohort consists of individuals 1) who are mentally and/or physically impaired, however dietary intake is performed independently; 2) diagnosed with various mental and/or physical disorders, making the participants reliant to twenty-four-hour care; 3) who were needed as a control group whereas food intake is performed by themselves.

A random method was used to divide the 24 mentally and /or physically impaired adults living at a Lebenshilfe Center in Styria in Austria. The subjects were divided and then designated either to the control group or the experimental group. All subjects participating in the study were diagnosed by psychiatrists and neurologists with both psychiatric as well as neurological health problems. The participants have been living at the center for at least a year. It is significant to mention that the case study concentrated on subjects aged between 25 and 70 years.

Measures

The selection of the tests was influenced by the primary aim of the study, i.e. the Effects of the Tomatis® Method on Physically and Mentally Impaired Adults on behavioral as well as on various physiological parameters.

The following tests were administered before the Tomatis® Training had begun and again after auditory training was completed.

• The Disability Rating Scale (M. Rappaport, 1982) was applied as an indication of the severity of impairment as well as the changes before and after auditory training.

• The Disability Rating Scale (DRS) was developed as a measure of disability that would be applicable to individuals with moderate to severe traumatic brain injury at a wide range of functional levels from coma through community living. The DRS has been recommended as a primary outcome measure for clinical trials involving individuals with brain injury causing impairment.

• The DRS is an 8-item measure (each rated on a maximum of 3–5-point scale) that is summed to give a total score. The DRS addresses all three categories of functioning proposed by the World Health Organization (body function, activity and participation). The first three items of the DRS (eye opening, communication ability, and motor response) reflect body function. The next three items (cognitive ability for feeding, toileting, and grooming) relate to

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activity. The last two items (level of functioning and employability) reflect participation.

• The maximum score a patient can obtain on the DRS is 29 (extreme vegetative state). A person without disability would score zero. The DRS rating must be reliable, i.e., obtained while the individual is not under the influence of anesthesia, recent seizure, or recovering from surgical anesthesia.

• Biofeedback Measurement Instrument as a pre- and post-test used to determine various physiological parameters. Biofeedback has been described as a ‘psychophysiological mirror’ by which clients monitor and learn from psychological signals produced by their bodies (Peper et al.

2008). Biofeedback procedures utilize electronic sensors to measure the physiological signals.

• The Biofeedback sensors come in a variety of sizes and shapes and almost every type of sensor is non-invasive. Specialized electrodes are used to monitor specific respiration patterns, skin conductance level (SCL), heart rate variability (HRV) etc. Irrespective of the type of sensors used all Biofeedback procedures include a training component that supports developing self-awareness and control over a person’s physiology.

• However, at this point it must be pointed out, that the Biofeedback Measurement Instrument was only applied as a measurement component and not as a training measure during the study.

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Procedures Tomatis® Training as well as Biofeedback Measurements were performed at the Rehabilitation Center and were preceded by a consent form conducted at the participants homes. Trained interviewers administered a structured questionnaire based on the Disability Rating Scale which included changes before, during and after using the Tomatis® Training. In addition, data on dietary intakes, mood, health and functional status has been collected.

Before the Tomatis® Training started, a Biofeedback Measurement Instrument was applied, measuring respiration patterns, skin conductance level (SCL) and heart rate variability (HRV), blood volume pressure and scalene-to-trapezius surface electromyograph.

Subjects: The Pre and Post-Testing results of the subjects were analysed for determining the effects of the Tomatis® Method on physically and mentally impaired adults. All subjects received the Tomatis® Training during a period of 40 weeks.

Evaluation: Each subject received a series of standardized measures prior to begin of the Tomatis® Training.

I. A questionnaire based on the Disability Rating Scale II. Biofeedback Measurement determining pulse rate (HRV), skin conductance level (SCL), blood volume pressure (BVP), breath (RESP) and scalene-totrapezius surface electromyograph signal (SEMG).

Treatment Procedures: After each subject underwent a Biofeedback Measurement and a questionnaire (based on the DRS and filled out by trained interviewers) the Tomatis® Training was administered. The auditory stimulation was divided into four blocks. Each block included 10 days with 40 minutes Tomatis® Training. Between the 1st and 2nd block there was a break of 6 weeks, between the 2nd and 3rd block an 8-week break and between the 3rd and 4th block a 12-week break.

It must be emphasized that the series of standardized tests were applied both during and after auditory training.

At the end of 26,67 hours auditory training, a final Biofeedback Measurement was applied.

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Statistical Methods The statistical design for the interpretation of the results was focused towards testing the significance of the difference between the two methods (means) applied before and after auditory training.

Statistical Software SPSS was applied to normal distribution and homogeneity of variance based on the collected data and thereafter to conduct the t-test on measurement data (x ± s) and x2-test on enumeration data. P < 0.01 was set as the standard to determine whether the difference was statistically significant.

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Results Changes in Disability Rating scores of the Experimental Group and the Control Group After the Tomatis® Training, progress in the experimental group evaluated by the Disability Rating Scores of each tested item was statistically significant (P < 0.01).

The control group did not show any statistically significant changes based on the Disability Rating Scale.

Table 1: Comparison of Experimental Group and Control Group based on Disability Rating Scale after Tomatis® Training.

Eye opening Communication ability Motor response Cognitive Ability of Feeding Cognitive Ability of Toileting Cognitive Ability Grooming Level of Functioning Level of Employability

Experimental Group (n=20) Before After P

Control Group (n=20) Before After

± 3 ± 4 ± 5 ± 3

± 2 ± 2 ± 2 ± 3

0.000 0.000 0.000 0.000

± 3 ± 4 ± 5 ± 3

± 3 ± 4 ± 5 ± 3

± 3

± 3

0.000

± 3

± 3

± 3

± 2

0.000

± 3

± 3

± 4 ± 3

± 2 ± 3

0.000 0.000

± 4 ± 3

± 4 ± 3

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Figure 1: Mean Disability Rating Scale during the 40-week assessment period. Disability Rating Scale scores range from 0 to 29; higher scores indicate more severe impairment. Disability Rating Scale scores improved rapidly up to block 4 of Tomatis® Training.

40 35 30 25 20 15 10 5 0 Pre-Test (Before Tomatis® Training)

Block 1

Block 2

Block 3

Block 4

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Figure 2: Mean Improvements after Tomatis® Training.

DISABILTY RATING SCORES IN PERCENT

80% 70%

68%

65% 65% 60% 56%

60% 50%

57%

45%

44%

40%

43% 41%

37%

36%

32% 30% 22% 20%

15%

13%

13% 8%

10% 0% Body Funtion

Activity

Postural Balance

Before Tomatis® Training

Communication

While Tomatis® Training Programm

Motor Response

Cognitive Ability

After Tomatis® Training

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Figure 3: Physiological stressor profile showing how thinking about a stressor increases respiration rate and heart rate and decreased peripheral blood flow as measured by blood volume pulse amplitude.

(Tomatis® Training)

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Figure 4: Physiological profile showing how thinking about a stressor increases respiration rate and heart rate and decreased peripheral blood flow as measure by blood volume pulse amplitude.

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Figure 5: Physiological recording during Tomatis® Training. When breathing slower during the relax condition (Tomatis® Training), increased scalene-to- trapezius (SEMG) with every inhalation and an initial increase in skin conductance level (SCL) can be seen.

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Discussion and Conclusion All subjects demonstrated a certain change after the Tomatis® Training. The largest area of change based on the Disability Rating Scale was evidenced by communication ability and motor response. According to Figure 1 subjects show a rapid development from a DRS of 26,5 to 14 after having the Tomatis® Training.

After Block 1 a value of 20,5 DRS was reached. Subsequent a slight decrease at Block 2, followed by a stable DRS of 14 during Block 3 and 4. As a result, it can be assumed that a continual use of the Tomatis® Training may help improving various physiological parameters.

Figure 5, based on the Biofeedback Measurement, shows that subjects began to breath slower during the Tomatis® Training with an increase in heart rate variability (HRV). In addition, skin conductance level increased at the beginning of the training and scalene-to-trapezius surface electromyograph signal (SEMG) increased with each inhalation. The above mentioned are all signs of a healthy response.

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