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Auditory, Visual, and Vestibular Influences in Sensory Integration Disorders and Cognition, and new Perspective on Noise Pollution

Originally Published 2002    Revised: November, 2006

BY: Stephen Dolle, Ph.D. (Unofficial)

STUDY SUMMARY: This study was undertaken to evaluate vestibular and sensory integration (neuro-hypersensitivity) responses in individuals with hydrocephalus and developmental disorders to a set of auditory, visual, and motion stimuli, and to determine whether new THERAPIES might help de-sensitize or compensate deficits in persons with such disorders. We measured sensory integration responses (in complaint assessment) from unsyncopated (repetitive) audible rhythms and syncopated (melodic) rhythm patterns, i.e. the Mozart Effect, using a 50-patern metronome device. We documented a causal relationship between vestibular deficit and chronic neurological complaints, as defined by headache, nausea, disorientation, eye pain, decreased cognition and attention, and malaise, which we and others have termed " sensory overload." We found similar sensory integration ( overload) symptoms to be caused by momentary exposure to "repetitive" or "unsyncopated" audible rhythms from our metronome device. 

We are very familiar with the increasing prevalence of sensory integration disorders like autism in young children, the rapid increase in audio visual devices in common use, and increased noise and general congestion in urban areas (i.e. noise pollution). We felt that sensory strengthening therapies could well be helpful in treating these growing complaints. In our study, we observed some momentary relief in sensory overload complaints when the participants were exposed to "syncopated" rhythms using the metronome. This suggests that a combination audiotape or CD of the two very different rhythm patterns might be effective in treating sensory overload complaints on a longer term basis, and we created an audiotape for this purpose. Even more so, we believe participation and moderate exposure to live drumming could strengthen an individual's threshold to sensory overload complaints. These therapies could be employed in the classroom and work setting to improve tolerance to room noise (unsyncopated sound) in those with neurological or sensory integration disorders. We postulate these therapies would also enhance cognition, concentration, and productivity.

STUDY HYPOTHESIS: Vestibular deficits and increased neuro-hypersensitivities (sensory overload disorder) follow a variety of neuro-pathological changes in the brain, including, migraine, autism, ADHD, post TBI, hydrocephalus, PTSD, and others. There is a known association between chronic neurological complaints and sensory integration disorders and decreased tolerance to light and sound, with an associated decrease in cognitive function. We postulate this sequela is due in great part to fatigue on the brain’s hippocampal processing functions, where related deficits require specific compensatory relief. Affected individuals are thought to be more visually dependant in maintaining "vestibular" orientation, as well as seem more susceptible to sensory integration complaints. Neuro-compensatory actions can best be " explained" by simple acknowledgment of those who can easily adjust to the vestibular disruptions of being in a small boat out at sea, without developing any sea-sickness effects. New research has revealed these individuals are helped to compensate with specifically tailored vestibular, auditory, and visual therapies. 

A second issue we studied was in evaluating responses to various syncopated and unsyncopated auditory rhythm patterns using a metronome. We postulated that when auditory hypersensitivities are present, the critical causative element seemed to be more in the "rhythmic pattern" of the stimuli, versus the volume and tempo (speed) of the rhythm pattern. So we attempted to draw a correlation between specific rhythm patterns and increased neuro-hypersensitivity responses. We further hoped we could then establish some "parameters" to define "normal" and "abnormal" response ranges, or tolerance, to auditory stimuli. In today's Western culture and lifestyle, children of all ages and adults are continually exposed (bombarded) by a variety of auditory stimuli through the sounds of household and work site machinery, music and television, electronic games, and public gatherings, including public education in classrooms, and in public places. A metronome, producing (50) different rhythmic auditory patterns, with volume and tempo adjustments, was employed to emulate the variety of rhythmic patterns found in everyday life.

Our study interest was initially triggered due to new favorable reports with EMDR Therapy in treating Post Traumatic Stress Disorder, or PTSD. In PTSD, chronic neurological complaints and neuro-hypersensitivities are believed to impair the function of the hippocampus, which lies just beneath the brain’s primary vestibular control center. The hippocampus, located in the same mid-brain region, is a common origin of seizure activity and is actively involved in chronic neurological and neuro-cognitive complaints. PTSD has been observed in solders returning from combat operations, eliciting the typical triad of hippocampus related complaints: headache, neuro-cognitive, and neuro-hypersensitivity. We theorized that because of the favorable results reported with EMDR Therapy in persons with PTSD, which incorporates structured visual and auditory movements, that similar sensory deficits in persons with hydrocephalus, migraine, ADHD, autism, etc. might well respond favorably to audio visual therapies.

Our Three-Fold Study Goal Encompassed:

1. To determine whether there is an association between chronic complaints (commonly observed in hydrocephalus) to that of central vestibular deficits with subsequent visual dependency; and

2. To determine if there was an association between auditory rhythmic patterns, and exacerbated neuro-hypersensitivities;

3. To observe whether vestibular, auditory, and visual therapies might prove effective in strengthening the neuro-compensatory mechanism, and reduce the levels of headache, neuro-hypersensitivity, and/or neuro-cognitive complaints, also hypothesized as related to the hippocampus.

MATERIALS: 1. Airex balance mat; 2. Standardized vestibular test and therapeutic protocol; 3. Standard business card attached to an 18 inch wooden bar. 4. Boss 64 track recording system with built in "metronome," having "50" selectable rhythm patterns, volume, and tempo controls; 5. Pen and paper used to identify each of the "50" rhythms, and note study subject responses to each, with volume and tempo variations; 6. Audio-cassette recorder and (2) blank cassette tapes; 7. Several cassette tapes containing soft music; and 8. Yamaha keyboard.

METHODS: Using the Airex balance mat, vestibular testing was undertaken on a group of (16) persons: (8) patients with shunted hydrocephalus (N=8), and (8) persons as normal control subjects. The study group was screened for visual dependency, and then interviewed briefly regarding specific nature and frequency of common hydrocephalus complaints (HA, neuro-hypersensitivity, vestibular changes). Each study subject’s vestibular system was challenged while on the Airex mat, first with eyes open, then with eyes closed. A third test then employed a moving business card, moving laterally to and fro, where the subjects were asked to focus on the moving target and maintain their balance.

The auditory protocol exposed three (3) study subjects to our protocol. One had a diagnosis of hydrocephalus, and the other two had diagnoses of developmental disorders. All three (3) reported complaints consistent with neuro-hypersensitivities. We used a Boss recorder to generate a total of fifty (50) metronome patterns, where tempo and volume level were both varied on each rhythm. We painstakingly evaluated and categorized specific rhythms prior to the study, so we could better introduce them later in the study. Initially, we randomly picked rhythms until we began to see a pattern emerge with the type, complexity, and tempo of the rhythms while we asked the study subjects to describe their "degree" of both adverse or favorable responses via sensations of neuro hypersensitivity complaints. We then varied the volume and tempo. We identified (12) twelve rhythms which produced the strongest increase in complaints, and a few that were found to produce a therapeutic "relief" in complaints. We wanted to identify a select group of most problematic rhythms so as to create a "therapeutic audio- tape" of patterns, to play at small intervals to minimize hypersensitivity. We felt we could increase the study subjects tolerance and compensatory adjustment to these patterns. We then evaluated the study subjects responses to a full range of tones/notes using a Yamaha keyboard, and additionally evaluated their responses when these tones were combined with the previously selected rhythms from the metronome.

RESULTS AND DISCUSSION: Sensory integration disorders are often associated with vestibular deficit, hearing and/or processing difficulties, headaches, visual deficits, neuro-hypersensitivities, and neuro-cognitive deficits. Some of these deficits can be associated with changes in ICP and CBF. Multiple Sclerosis, Parkinson's Disease, and dementia can also exhibit many of these same features. Developmental disorders and autism that involve cognitive deficits tend to be associated with neuro hypersensitivities as well.

In this study, participant with hydrocephalus who were unable to maintain balance on the Airex mat with their eyes closed, or follow a moving visual target without loosing balance, also reported an increase in the triad of chronic hydrocephalus complaints. Those who failed the eyes closed test, also failed the moving target test. Those who tested normal in the vestibular challenge tests interestingly reported a lesser degree of chronic triad complaints, especially headache. This latter group's "normal" vestibular findings were roughly identical to the control (normal) group. Our findings were age independent, rather, there were no significant differences in results with age, though no participants were older than 50 years of age. Those in the study ranged between the age of 7 and 50 years of age, and were equally divided in the respective visual-dependant vestibular, normal vestibular, and control subjects. 

For the auditory stimuli segment of our study, we first evaluated (50) auditory tones of the Boss metronome machine to identify and group rhythm patterns. We postulated that we might be able to use selected rhythms to create a therapeutic audiotape, that could gradually de-sensitize study subjects, increase compensatory action, and reduce auditory neuro-hypersensitivities.

We identified (12) metronome patterns which produced complaints in the study subjects. The complaints appeared to be less related to volume, and more related to an increase in tempo. This response varied slightly with the selected rhythms, where some produced a more intense response when the tempo was sped up. We then narrowed the rhythms down to (6) rhythm patterns, which produced intolerable complaints in all three (3) study subjects within a 10 second interval. This response was also related to the status of the study subject prior to initiating the auditory test exposure: the more rested the study subject, the more he/she could tolerate. The most critical discovery was that (6) patterns consistently produced an adverse response, while a number of others seemed to provide relief in their complaints.

We observed that (8) to (10) of the rhythms appeared to relax the subjects. From here, we identified (3) three that were the most pleasing. We postulate that the increased response to the most offensive (repetitive) metronome patterns, and faster tempos, was due to the abundance of these auditory sounds in everyday machinery and crowded room noise, and are rhythm patterns to which these study subjects have been over-exposed. Such repetitive rhythms create a more difficult possibility for an affected person to assimilate and compensate. We postulate that the study subjects cannot "syncopate" these rhythms and tempos within their cognition, as the patterns are locked (syncopated) and uncontrollable. There may also be a correlation of these repetitive patterns to low frequency and volume tones, which we may be consciously unaware, but which emulate and magnify certain rhythm sequences of cognitive thought, and surface as deficits.

We next created an audiotape combining the identified pleasing and offensive rhythms, with keyboard tones, and some soft music as a known reference or comparison. We evaluated three (3) study subjects known to experience neuro-hypersensitivities with the auditory therapy tape of offensive and pleasing metronome rhythms, various keyboard tones, and both together. The tape also included some music as a reference. All three (3) reported a 30% or more decrease in severity of neurological complaints.

We also informally interviewed between 10 and 20 individuals, with varying etiologies of neurological disorder and injury, and were consistently informed by all that each suffered the most offensive response to "repetitive" rhythms from a variety of sources, notably, jackhammer guns, truck and diesel engines, and the beeping sound of forklifts and trucks when moving in reverse.

It is unclear which portion of the tape therapy contributed most to the reduction in chronic complaints in the 4 week trial, as the study did not allow for separate measurements. What was of importance, was that it did help de-sensitize the study subjects response to auditory stimuli. We postulate these chronic neurological complaints are involving deficits within the hippocampus, where neuro hypersensitivities are felt to originate. It would be useful to have corroboration with fMRI or PET imaging for assessment of hippocampus dysfunction.

In closing, it would appear this study demonstrated sufficient favorable findings to pursue a larger formalized study, including corroboration using fMRI or PET imaging. We also believe vestibular and audible rhythm therapies are helpful in reducing mild to moderate sensory overload complaints in children and adults from a variety of etiologies, plus improve concentration, cognition, and learning in noisy classroom and industrial settings. Auditory and vestibular therapies would seem to aid chronic complaints and possibly "seizure activity" related to dysfunction of the hippocampus.

Here is a general information Group Drumming slide show by Stephen Dolle for a keynote presentation, "Team Building & Communications thru Group Drumming: Engaging the Rhythms of your Brain:"

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