Keywords
music - deafness - cochlear implantation - social skills
Introduction
A growing number of experimental studies use music as an intervention procedure to
analyze its benefits in cochlear implant (CI) users. The results have demonstrated
that musical interventions can be an effective strategy to help develop auditory skills
for the perception of speech and oral language. However, the length of sensory deprivation
and the absence of binaurality can hinder such development. Binaural sound information
processing is essential for individuals without hearing loss and for CI users,[5] and it is related to more complex auditory abilities such as speech perception in
noisy environments and music perception.
The specific literature shows that CI users exposed to music training experience an
improvement on their linguistic skills, auditory perception,[2] and speech production.[1]
[6]
[7] Moreover, studies have demonstrated a tendency toward an increase in the habit of
listening, enjoying, and engaging with music after CI surgery,[8]
[9] associating these practices with their self-perceived quality of life.[10]
The similar hierarchical structures in the process of learning music and language
suggest a connection between them in terms of higher cognitive functions and subsystems,
such as memory, attention, and categorization.[11] This assumption has been reinforced by studies that demonstrated[12]
[13]
[14] that musical learning favored brain plasticity and expanded connections among neurons,
including mirror neurons, which are recruited through imitation in both action and
observation of activity. These are neurons responsible for building productive and
healthy interpersonal relationships[12]
[13] and learning,[14] which are essential to child neurodevelopment.
Additionally, attention has been given to understanding emotional processing in CI
users, since important acoustic cues are missed not only by artificial electrical
stimulation but also due to auditory neural changes resulting from the period of sensory
deprivation. Ascribing meaning, whether to a song or the speaker's voice, reflects
the emotion that the individual experiences through hearing and, consequently, their
emotional response to the situation.[15]
[16]
Children with severe or profound hearing loss have limited or no access to spoken
language, which hinders their development of socioemotional skills[17]
[18] and increases their likelihood of developing behavioral problems,[19]
[20] as language enables emotional self-regulation and sociocognitive skills.[21] Thus, social skills are essential for full child development.[22]
Social skills are essential social behaviors to build healthy and productive interpersonal
relationships.[23] They encompass academic competence and behavioral problems,[24]
[25]
[26] divided into externalizing behaviors (such as inattention, aggressiveness, and hyperactivity),[27] and internalizing ones, such as depression and anxiety.[28] Said and Abramides[23] and Said et al.[29] pointed out that aspects of the musical learning process were responsible for promoting
social skills, academic competence, and behavioral problems in typically-developing
children.
Music training can enhance children's social skills by engaging them in active, structured
learning experiences that include musical activities such as playing instruments and
singing. These experiences not only foster the development of musical abilities but
also activate physiological, cognitive, and emotional processes that influence non-musical
outcomes, such as social skills.[30] Thus, research suggests that active music training[23]
[29]
[31]
[32] promotes interpersonal communication, empathy, and collaboration. These benefits
are linked to the way music taps into both cognitive and emotional processes that
are essential for social functioning.
Building on these connections, the seven social functions of music proposed by Koelsch[33] provide a framework to understand how music contributes to social and emotional
development. These functions—social contact, social cognition, copathy (empathy),
communication, coordination of actions, cooperation, and social cohesion—highlight
music's integral role in fostering interpersonal relationships and group cohesion.
For children, engaging in music can serve as a medium for emotional expression and
social interaction,[31]
[32] supporting the development of key socioemotional skills, including those using CIs.
Literature reviews[8]
[9]
[34]
[35] have shown that when CI-using children with severe or profound sensorineural hearing
loss are exposed to early intervention combined with musical activities, they experience
an improvement on their development of auditory, social, speech, and language skills.
However, there were few studies[10]
[36]
[37] in the researched literature that evaluated or merely reported the effects of music
training on socioemotional skills, and no studies were found on academic skills or
behavioral problems in children using bilateral CIs.
The present study hypothesized that music training based on the Music Learning Theory
(MLT)[38] in children using bilateral CIs will influence their development of social, behavioral,
and academic skills, positively reflecting on academic classroom activities.
In this sense, the objective of the current study was to investigate the effect of
music training on the set of social, behavioral, and academic skills in children with
hearing loss who use bilateral CIs, from the perspective of regular schoolteachers.
Methods
This controlled, longitudinal, non-randomized, blind clinical study is an integral
part of the research group named “Centro de Pesquisas Audiológicas - CNPq”, linked
to the Speech-Language-Hearing Postgraduate Program of the Dental School of Bauru,
University of São Paulo (FOB/USP), Bauru campus, in partnership with the Hospital
for Rehabilitation of Craniofacial Anomalies (HRAC) and the Bravo Music Academy, based
in Bauru.
This study was approved by the Research Ethics Committee of the Dental School of Bauru
FOB/USP, protocol no. 2.820.891.
Selection of the Sample
Children enrolled in the Specialized Center for Hearing Development (CEDAU) of the
Hospital for Craniofacial Anomalies (HRAC/USP) were invited to participate in this
study, according to the following inclusion criteria: 1) age from 6 to 10 years, as
it is pointed out as an excellent stage of life to acquire and develop academic skills
and consolidate the set of social skills. Socially, children transition from family-centered
interactions to forming peer relationships and engaging in group dynamics. Academically,
foundational skills like literacy and numeracy are consolidated, along with higher-order
cognitive skills, such as reasoning. Academic skills refer to abilities such as attention,
task persistence, self-regulation, and communication, while consolidating social skills
involve refining behaviors like cooperation, empathy, and conflict resolution. These
milestones make this age group ideal to study interventions such as music training,
which may enhance these skills;[23] 2) both sexes; 3) bilateral severe or profound sensorineural hearing loss; 4) bilateral
CI users; 5) no complaints related to neurological and psychiatric problems; and 6)
intellectual level within normal parameters, assessed through the Raven's Colored
Progressive Matrices (CPM)[39] applied by a psychologist external to the research. This instrument is a nonverbal
test that assesses general intelligence regarding analogical reasoning aptitude, that
is, the child's ability to deduce relationships involving objects or elements, which
is one of the main components of general intelligence (g factor).
The exclusion criteria were as follows: children with bilateral severe or profound
postlingual sensorineural hearing loss; unilateral CI users; non-residents of the
city where the study was performed; children who had already had music classes; and
those who did not attend the proposed music training effectively.
Participants
Twenty randomly divided children who met the inclusion criteria were divided into
the experimental group (EG) and the control group (CG). During data collection, 70%
of the children in the CG dropped out, because they were waiting for the intervention
and due to factors external to the study, such as the beginning of the coronavirus
disease 2019 (COVID-19) pandemic. The remaining 30% of the CG participants were reallocated
to another study due to the small number of participants left in the group.
Thus, the sample consisted of 10 children with profound hearing loss, users of bilateral
CI, oralized, with mean time of CI use of 3.7 years, and enrolled in elementary school.
There were 6 girls and 4 boys, with a mean age of 6.9 years, with a mean age at implantation
of 3.2 years, with low (n = 7; 70%) and very low socioeconomic status (n = 3; 30%), public school students (n = 8; 80%) and with congenital hearing loss (n = 10; 100%) . All participants attended all music training sessions.
Instruments
The current study used the teacher form of the Social Skills Rating System–Brazilian
version (SSRS-BR). This scale was originally produced in the United States,[40] and it was validated for the Brazilian context by Freitas and Del Prette,[41] with psychometric qualities verified in terms of internal consistency and temporal
stability for preschoolers and children in the first to fourth grades. It contains
three subscales – social skills, behavior problems, and academic competence –, totaling
38 items for analysis. The factors in the social skills subscale are Global score,
F1–responsibility, F2–self-control, F3–assertiveness/social resourcefulness, and F4–affection/cooperation.
The factors in the behavioral problems subscale are Global score, F1–externalizing,
F2–hyperactivity, and F3–internalizing. And the academic competence subscale is composed
of the Global Score. The results are based on the scores correlated with the percentile
scale provided in the application manual, which classifies social skills as below
the lower average, within the lower average, good, elaborate, and highly-elaborate;
behavior problems as very low, low, average, upper-average, and above upper average;
and academic competence as below the lower average, within the lower average, in the
median, high, and very high. No other studies have used the SSRS with pediatric CI
users.
Procedures
The teachers answered the self-administered teacher form of the SSRS-BR.[41] The data were investigated and interpreted by a psychologist external to the research
with experience in using the questionnaire.
The teacher form of the SSRS-BR was presented to teachers at 4 different moments:
M1–2 months before the beginning of music training; M2–at the beginning of music training
(first week of class); M3–during music training (3 months after the beginning); and
M4–at the end of music training (6 months after the beginning).
Intervention Procedure
The MLT, a musical learning approach for children,[38] was performed by a music educator specializing in the method who was external to
the research.
The MLT is a music teaching and learning theory that focuses not only on the teaching
of music but also on the process through which it is learned, aiming to achieve musical
understanding, which the author Edwin Gordon[38] terms audiation. The use of the MLT as an intervention procedure is justified by the fact that this
teaching and learning theory is structured through sequenced learning activities.
These activities use musical patterns, which are basic units with musical meaning
that can be compared with words, making music learning similar to speech learning,
with emphasis on body movement associated with musical practice.
The MLT activities start with sound material familiar to the child, and the classes
are structured around the use of the singing voice. The music training lasted 60 minutes,
and it was divided into playful and dynamic musical activities. Weekly classes were
held throughout the semester, totaling 20 classes. The classes had a collective format,
with the 10 children in the EG doing the activities together belonging to the same
class. [Fig. 1] presents musical training details.
Fig. 1 Details of the music training.
In the MLT framework, each stage serves a specific purpose to support the child's
musical development:
Welcoming – this stage focuses on creating a welcoming and supportive environment. It helps
develop affinities among participants and establishes clear rules and expectations
for the session, fostering a sense of belonging and structure.
Tonal and Rhythmic Musical Activities – this is the core of the session, involving auditory-perceptual activities designed
to enhance listening skills and musical understanding. It includes learning sequence
activities, in which children are introduced to tonal and rhythmic patterns, as well
as memorization, in which they internalize musical material, and improvisation, which
enables them to explore and apply their musical knowledge creatively. The use of group
singing is emphasized as a central activity, enabling children to engage with tonal
and rhythmic patterns collectively, reinforcing their musical perception and fostering
group cohesion.
Relaxation and Farewell – this stage emphasizes musical appreciation, giving children the opportunity to
reflect on the musical experiences of the session in a calm and enjoyable way. It
helps close the session on a positive note, reinforcing the learning and emotional
connection with music.
Appendix 1 presents a lesson example.
Metehod Used or Result Analysis
The data were analyzed descriptively and inferentially, using the IBM SPSS Statistics
for Windows (IBM Corp.), version 25.0, and the Sigmaplot (Grafiti LLC) software, version
12.0. Ordinal quantitative and qualitative variables were expressed using measures
of variability (standard deviation), central tendency (mean and median), and position
(minimum, maximum, and quartiles one and three) of the scores in each factor evaluated.
Preliminarily, the normality of the data was determined using the Shapiro-Wilk test,
with p ≤ 0.05. To compare the multiple analyses of the EG, we used repeated measures analysis
of variance (ANOVA) and the Tukey test (post hoc), which indicates at which moment
there was a statistical difference (M1, M2, M3, and M4). The significance level was
set at 5% (p ≤ 0.05) in all inferential analyses.
The qualitative analysis used the percentile scale as proposed in the instrument,
with social skills scored as follows: 1 to 25–below the lower average; 26 to 35–within
the lower average; 36 to 65–good; 66 to 75–elaborate; and 76 to 100–highly elaborate.
The behavior problems were scored as: 1 to 25–very low; 26 to 35–low; 36 to 65–average;
66 to 75–upper average; and 76 to 100–above the upper average. Finally, academic competence
was scored as: 1 to 25–below the lower average; 26 to 35–within the lower average;
36 to 65–in the median; 66 to 75–high; and 76 to 100–very high.
Results
[Table 1] shows the performance on the SSRS-BR in factors that encompass social skills in
M1, M2, M3, and M4, as well as a comparative score analysis. The results indicated
that the global score increased from 29.80 (M1) to 38.00 (M4) (p = 0.001; post hoc: M1 > M4; M1 > M3); the percentiles improved from 35 (M1) to 75
(M4). Responsibility (F1) increased from 9.00 (M1) to 10.90 (M4), but this was not
significant (p = 0.071). The percentiles remained stable (from 30 in M1 to 40 in M4). Self-Control
(F2) increased from 9.20 (M1) to 12.40 (M4) (p = 0.001; post hoc: M1 > M4; M2 > M4; and M3 > M4); The percentiles increased from
25 (M1) to 55 (M4). Assertiveness/Social resourcefulness (F3) increased from 7.30
(M1) to 9.10 (M4) (p = 0.026; post hoc: M1 > M4); The percentiles increased from 55 (M1) to 85 (M4). And
affection/cooperation (F4) increased from 4.40 (M1) to 5.70 (M4) (p = 0.003; post hoc: M1 > M4); the percentiles rose from 40 (M1) to 65 (M4).
Table 1
Performance in the factors that encompass social skills in the four assessment moments
(M1, M2, M3, and M4) and comparative analysis of the scores per assessment moment
|
SSRS-BR
(teacher form)
|
M1
|
M2
|
M3
|
M4
|
p
|
Post hoc
|
|
Mean
|
Standard deviation
|
Mean
|
Standard deviation
|
Mean
|
Standard deviation
|
Mean
|
Standard deviation
|
|
Global score
|
29.80
|
± 10.76
|
32.80
|
± 11.75
|
35.00
|
± 12.49
|
38.00
|
± 11.82
|
0.001*
|
M1 > M4 = 0.001;*
M1 > M3 = 0.010;*
M2 > M4 = 0.001*
|
|
Percentile
|
35
|
45
|
60
|
75
|
|
F1–responsibility
|
9.00
|
± 2.75
|
10.20
|
± 2.39
|
10.00
|
± 2.94
|
10.90
|
± 2.28
|
0.071
|
|
|
Percentile
|
30
|
35
|
40
|
40
|
|
F2–self-control
|
9.20
|
± 2.94
|
10.60
|
± 3.10
|
10.60
|
± 3.37
|
12.40
|
± 2.76
|
0.001*
|
M1 > M4 = 0.001;*
M2 > M4 = 0.025;*
M3 > M4 = 0.025*
|
|
Percentile
|
25
|
35
|
40
|
55
|
|
F3–assertiveness/social resourcefulness
|
7.30
|
± 2.11
|
7.90
|
± 1.97
|
8.40
|
± 2.22
|
9.10
|
± 1.60
|
0.026*
|
M1 > M4 = 0.019*
|
|
Percentile
|
55
|
60
|
75
|
85
|
|
F4–affection/ cooperation
|
4.40
|
± 1.58
|
4.40
|
± 1.58
|
5.40
|
± 1.58
|
5.70
|
± 1.58
|
0.003*
|
M1 > M4 = 0.013*
|
|
Percentile
|
40
|
40
|
60
|
65
|
Abbreviation: SSRS-BR, Social Skills Rating System–Brazilian version.
Note: *Statistically significant.
[Table 2] shows the performance in factors that encompass the frequency of problematic behaviors
in M1, M2, M3, and M4, as well as a comparative score analysis. The results indicated
that the global score decreased from 4.30 (M1) to 1.50 (M4) (p = 0.003; post hoc: M1 > M3; M1 > M4); the percentiles dropped from 50 (M1) to 20
(M4). Externalizing behaviors (F1) decreased from 1.30 (M1) to 0.50 (M1), which was
not significant (p = 0.280); the percentiles dropped from 45 (M1) to 20 (M4). Hyperactivity (F2) decreased
from 2.70 (M1) to 1.20 (M4) (p = 0.046; post hoc: M1 > M4); the percentiles decreased from 65 (M1) to 10 (M4). And
internalizing behaviors (F3) increased from 0.64 (M1) to 0.91 (M4), which was not
significant (p = 0.770); the percentiles remained stable (from 25 in M1 to 35 in M4).
Table 2
Frequency of factors that encompass problematic behaviors in the four assessment moments
(M1, M2, M3, and M4) and comparative analysis of the scores per assessment moment
|
SSRS-BR
(teacher form)
|
M1
|
M2
|
M3
|
M4
|
p
|
Post hoc
|
|
Mean
|
Standard deviation
|
Mean
|
Standard deviation
|
Mean
|
Standard deviation
|
Mean
|
Standard deviation
|
|
Global score
|
4.30
|
± 2.98
|
3.30
|
± 2.26
|
2.30
|
± 1.70
|
1.50
|
± 1.43
|
0.003*
|
M1 > M3 = 0.038;*
M1 > M4 = 0.002*
|
|
Percentile
|
50
|
40
|
30
|
20
|
|
F1–externalizing
|
1.30
|
± 1.70
|
0.90
|
± 0.99
|
0.60
|
± 1.08
|
0.50
|
± 1.27
|
0.280
|
|
|
Percentile
|
45
|
40
|
30
|
20
|
|
F2–hyperactivity
|
2.70
|
± 1.77
|
1.90
|
± 1.52
|
1.60
|
± 1.43
|
1.20
|
± 1.40
|
0.046*
|
M1 > M4 = 0.034*
|
|
Percentile
|
65
|
50
|
25
|
10
|
|
F3–internalizing
|
0.64
|
± 0.67
|
1.00
|
± 1.10
|
0.91
|
± 0.38
|
0.91
|
± 0.58
|
0.770
|
|
|
Percentile
|
25
|
40
|
35
|
35
|
Abbreviation: SSRS-BR, Social Skills Rating System–Brazilian version.
Note: *Statistically significant.
[Table 3] shows the performance in factors that encompass academic skills in M1, M2, M3, and
M4, as well as a score analysis. The results indicated that the global score increased
from 27.46 (M1) to 32.55 (M4) (p = 0.001; post hoc: M1 > M4; M1 > M3; and M2 > M4); the percentiles improved from
20 (M1) to 40 (M4).
Table 3
Academic competence in the four assessment moments (M1, M2, M3, and M4) and comparative
analysis of the scores obtained per assessment moment
|
SSRS-BR
(teacher form)
|
M1
|
M2
|
M3
|
M4
|
p
|
Post hoc
|
|
Mean
|
Standard deviation
|
Mean
|
Standard deviation
|
Mean
|
Standard deviation
|
Mean
|
Standard deviation
|
|
Global score
|
27.46
|
± 14.25
|
28.36
|
± 14.13
|
30.73
|
± 14.18
|
32.55
|
± 14.37
|
0.001*
|
M1 > M3 = 0.017;*
M1 > M4 = 0.001;*
M2 > M4 = 0.002*
|
|
Percentile
|
20
|
30
|
35
|
40
|
Abbreviation: SSRS-BR, Social Skills Rating System–Brazilian version.
Note: *Statistically significant.
Discussion
The development of musical perception in CI-using children has been studied in recent
years, as it is directly linked to auditory processing and auditory skills acquired
throughout a person's life.
Musical aptitude is an innate competence, but it is affected by the quality of the
environment to which the child belongs, the richer it is musically, the more favorable
it is for improving more specific auditory skills.[38]
The data found in the present study demonstrated that, in the teacher's view, music
training promoted significant changes in the attitudes of CI-using children in the
classroom. This finding is in line with the MLT, which, as an intervention procedure,
covers the basic elements of music, but also playfully addresses sensory, cognitive,
perceptual, motor, social, and language factors.
[Table 1] points out significant differences in the teachers' views regarding the improvement
in the set of social skills, in terms of the global score, self-control, assertiveness/social
resourcefulness, and affection/cooperation at the end of the music training – except
for F1 (responsibility). Thus, the analysis of the instrument's percentile in the
four assessment moments demonstrates that CI-using children started the study with
a set of assertiveness/resourcefulness and affection/cooperation expected for their
age – that is, with balanced interpersonal behaviors for coexistence in society. At
the end of the training, there was significant improvement in these factors, as they
began to demonstrate highly satisfactory and skillful behaviors, according to the
teacher. In this context, this draws attention to the impact of music training on
self-control, in which the behavior of CI-using children was below average, with an
index considered critical for social and academic adjustment, and, at the end, they
began to behave as expected for the age group ([Table 1]). Such an evolution in the set of social skills is justified by the learning process
resulting from the active music training structure, which establishes their interaction
and communication with the teacher and peers and requires discipline, attentional
focus, and the ability to follow rules.[23]
[29]
[30]
[31]
[32]
Music training is described as an activity that triggers higher cognitive functions,
such as the attention control subsystem, which helps develop self-control, responsibility,
affection, and cooperation. Consequently, the child maintains concentration on a given
task and ignores distracting factors, favoring the classes of social skills investigated,[11] additionally improving their quality of life.[10]
In the analysis of behavior problems, we compared assessment moments ([Table 2]) and found a result similar to that described previously, with a significant decrease
in the frequency of hyperactive behavior problems and global score after music training
– except for externalizing behaviors. As for internalizing behaviors, the results
did not have a consistent pattern, which may reflect the teacher's difficulty in analyzing
their aspects, such as anxiety, depression, and social phobia. The analysis of the
percentiles shows that, for the global score and hyperactivity, CI-using children
started with behaviors within the average, with a balance between interpersonal resources
and deficits, and later achieved a very low set of behavior problems, indicative of
highly satisfactory interpersonal resources ([Table 2]).
The results are consistent with those of studies[24]
[25] that show that social skills prevent the development of problematic behaviors. Group
practices in music training have a high socialization power and predispose the individual
to lose selfishness and individualism[23] and interact with the teacher, considered in the literature as the main MLT conduction
axis.[38]
The learning process, including musical learning, stimulates the child's multiple
connections, reasoning, and intelligence in the short term, and it favors children's
academic performance in the long term.[42] In line with this statement, in the current study, a significant difference was
found in the academic competence of CI-using children ([Table 3]), who went from a level below the lower average (which indicates the need for intervention
in academic performance and the conditions that favor it) to average competence, with
results within the average.
In this context, the development of social skills, behavior problems, and academic
competence can be significantly correlated with the seven social functions of music
proposed by Koelsch.[33] These functions play a central role in shaping children's ability to interact and
collaborate effectively in various contexts. Music training, as a social tool, facilitates
emotional and cognitive processes that contribute to the regulation of social behavior
and interactions. Engaging in music training can improve communication and empathy,
for example, which are essential to establish positive peer relationships and enhance
cooperation within group settings. Furthermore, music training's ability to synchronize
actions and foster social cohesion can lead to improved behavior, reducing disruptive
tendencies by promoting shared experiences and mutual understanding. These positive
outcomes, in turn, can create a conducive environment for academic success, as children
develop the skills necessary to manage emotions, work collaboratively, and remain
engaged in learning activities. Thus, incorporating music training into educational
and therapeutic interventions may not only address behavioral challenges but also
foster academic competence and emotional well-being and quality of life.[10]
It is important to highlight that the learning process used in the music training
of the current study is defined as a knowledge-building process. Hence, the longer
the exposure to structured and sequenced musical activities, the more expressive the
results.[38] In the present study, the music training lasted 6 months, with significant changes
in most of the factors assessed, which enables us to deduce that there could be a
continuity in the evolution of social skills, behavioral problems, and academic competence.
First, one may question whether the improvement in these factors would not be due
to the development process expected for the age. This hypothesis is nullified by previous
studies[23]
[29] in which the authors performed structured and sequenced music training with the
same duration as in the current study, in children of the same age group, and found
significant differences in social skills, behavior problems, and academic competence
only in those submitted to music training, whereas the control children presented
results without significant differences throughout 6 months. Moreover, differences
in these factors started to occur after the beginning of auditory training, as no
significant difference was observed between the reference values—M1 (2 months before
the beginning of auditory training) and M2 (immediately before its beginning)—with
2 months between them ([Tables 1]
[2]
[3]).
The lack of a control group in the current study is not a weakness when considering
the study design. The longitudinal analysis with controlled sample heterogeneity,
as individuals controlled themselves, eliminates variables such as quality of stimulation,
social level, and so forth, which generally hinders conclusive discussions. However,
it is important to note that the teachers were not blinded to the intervention, which
can be considered a bias.
The results are promising and lead to further studies that can be conducted with methodological
replication and larger samples, enabling for a more in-depth analysis of the data
and a broader understanding of the effect of music training as an integrative health
practice.[43]
Conclusion
The scientific evidence obtained in the current study demonstrates that CI-using children
submitted to music training experienced improvement in their social, behavioral, and
academic skills from their schoolteacher's perspective.
Appendix 1 Lesson Example
Intervention: Music Learning Theory (MLT)
Objectives
To promote immersion in a variety of tonalities and in binary, ternary, odd irregular,
and even irregular meters by activating learning channels through activities that
combine body movement, breathing, tonal and rhythmic patterns (acculturation and imitation),
harmony, and improvisation.
Musical material
Children's songs suitable and adapted for the 6-to-10-year-old age group, specifically
composed to emphasize musical aspects (harmonic function, tonality, pulse, rhythmic
or tonal pattern) by music educators specializing in MLT. Songs include those with
and without lyrics, sung with the neutral syllable “PAM” or recited with the neutral
syllable “PA,” performed in a natural a-cappella voice, and occasionally with simple
instrumental accompaniment (example: a single instrument like the ukulele).
Play materials
Fabrics of various textures and sizes, toys, balls, and soap bubbles to explore movement
aspects related to fluidity, weight, and speed. Percussion instruments include claves,
egg shakers, castanets, wooden shakers, jingles, bells, metallophones, hand drums,
and tambourines.
Welcome Activity
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Song: “Music class” (Lydian tonality/duple meter).
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Material: None.
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A song to welcome the students—accompanied by the teacher playing the ukulele and
singing. The students join with a percussion instrument and sing along.
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All sit in a circle on a mat.
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Tonal and Rhythmic Musical Activities
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Song: “Little balloon” (Major tonality/duple meter).
Acculturation tonal pattern/Tonal pattern V-I/Emphasize the tonic note of the song.
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Song: “Vestidos de lunares” (Phrygian tonality/triple meter).
Emphasize the tonic note and tonal pattern V-I.
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Song: “Owl” (Lydian tonalit /duple meter).
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Material: Satin rings.
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Students sit in a circle with the teacher. They hold satin rings and make fluid pulse
movements as the teacher sings.
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On the sound “u,” they raise and lower the fabric.
Tonal pattern V-I/Emphasize the tonic note. Students repeat the tonal pattern.
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Song: “Scooter” (Dorian tonality/duple meter).
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Material: None.
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Students and teacher stand. Explore locomotor and stationary movements through the
song.
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○ As the teacher sings, students walk around the room without a set path.
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○ When the teacher stops singing, students stop walking and emphasize the tonic by
singing “PAM.”
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After a few repetitions, the teacher explains that when the singing stops, students
will sing “PAM” and interact with a classmate.
Emphasize the tonic note and tonal pattern V-I.
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Song: “Dinosaur” (triple meter).
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○ They walk to the macropulse and later the micropulse played on the drum by the teacher.
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○ Students then accompany the song on the drum and with their singing, imitating the
teacher.
Acculturation rhythmic pattern.
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Song: “Seahorse” (Aeolian tonality/duple meter).
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Material: Helanca fabric.
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Students sit in a circle with the teacher. As the teacher sings, students make wave
movements in the micropulse with the fabric.
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After a few repetitions, students switch to wave movements in the macropulse.
Emphasize the tonic note/Tonal pattern V-I.
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Song: “Guacamole” (odd irregular meter).
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Material: None.
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Students stand.
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Song: “El baile de las nubes” (Mixolydian tonality/even irregular meter).
Emphasize the tonic note/Tonal pattern V-I.
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Song: “The sled” (Harmonic minor tonality/duple meter).
Acculturation tonal pattern/Tonal pattern V-I/Emphasize the tonic note.
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Song: “Gymnopédie – Satie”.
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Song: “Bye” (same as “Music class”).
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Material: None.
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A farewell song accompanied by the teacher playing the ukulele and singing.
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Students join with a wooden shaker and sing along.
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All sit in a circle on a mat.
Bibliographical Record
Paula Martins-Said, Kátia de Freitas Alvarenga, Dagma Venturini Marques Abramides.
Effects of Music Training on Social, Behavioral, and Academic Skills of Children with
Cochlear Implants from the School Teacher's Perspective. Int Arch Otorhinolaryngol
2025; 29: s00451809646.
DOI: 10.1055/s-0045-1809646
