Document Type


Date of Degree

Fall 2016

Access Restrictions

Access restricted until 02/23/2021

Degree Name

PhD (Doctor of Philosophy)

Degree In


First Advisor

Gfeller, Kate

Second Advisor

Bentler, Ruth

First Committee Member

Gfeller, Kate

Second Committee Member

Bentler, Ruth

Third Committee Member

Adamek, Mary

Fourth Committee Member

Oleson, Jacob

Fifth Committee Member

Manternach, Jeremy


The overarching purpose of the study was to explore how music interventions, including spoken communication can be effectively facilitated with older adults with hearing loss. Specifically, aspects of the listener, auditory input, environmental factors, and non-auditory information that could be modified within the context of music therapy sessions to enhance music and speech perception were explored. A modified sequential exploratory mixed methods design (Qual->Quan+Quan) was used to address the research questions.

The first phase of the study consisted of a one-time large group interview with audiologists to elicit an open discussion related to three questions: (a) What do music therapists need to know about hearing loss and assistive listening devices to effectively design and implement music therapy interventions for older adults with hearing loss? (b) What environmental considerations and modifications can be used to enhance successful communication and music listening in individual and group settings? and, (c) Are there strategies for supporting effective hearing and listening by older adults that could be applied to the context of music therapy? Data were gathered through written responses from the interview participants as well as notes taken by the moderator and a non-participant observer. Thematic analysis revealed the general categories of “areas of therapist knowledge,” “maximizing individual interactions,” and “improving access to communication.” From the initial phase of the study, a conceptual framework was identified to guide the parallel second and third phases to specifically investigate two forms of music stimuli.

Phase II of the study included the creation of standardized recordings of 24 musical instruments to answer the question, How do musical instruments commonly used by music therapists with older adults interface with common configurations of hearing loss? The spectral analysis from each instrument was then applied to a series of audiograms to facilitate the comparison of each instrument’s spectral properties with common hearing loss profiles to determine potential audibility.

Phase III consisted of a single-group, repeated measures design to investigate sung sentence recognition and the potential benefit derived from the inclusion of non-auditory information to facilitate top-down processing. For the purposes of this study, the Sung Sentence Recognition Test was developed to measure sentence recognition under three presentation conditions: sung with guitar accompaniment (SU-G), sung with guitar accompaniment and contextual cues (SU-G+C), and sung with guitar accompaniment and visual cues (SU-G+V). A total of 24 bilateral hearing aid users between the ages of 60 and 79 participated in Phase III. Results indicated that the presence of non-auditory information, in the form of contextual or visual cues, was beneficial for all listeners with a greater degree of benefit derived from visual cues. In addition, Phase III affirmed that listener characteristics such as music training also play a role in determining success. Clinical implications in the form of general strategies as well as recommendations matched with the auditory perceptual requirements of specific music interventions are proposed integrating the results from each of the three phases in this study.

Public Abstract

Hearing loss is an incurable condition affecting two-thirds of older adults in the United States. This condition results in significant negative impact on quality of life such as increased social isolation and depression, decreased physical functioning, and accelerated cognitive decline. Hearing loss creates barriers to effective therapeutic interactions across healthcare disciplines, and the disproportionate size of the aging baby-boom generation suggests that demands on healthcare workers to overcome such barriers will only increase.

Music therapy is an effective approach to maintain and improve the quality of life of older adults. However, even with the use of hearing aids, hearing loss may render music an ineffective therapeutic tool. This study examined the potential impact that age-related hearing loss may have on the practice of music therapy and sought specific strategies to improve effective communication. Areas of importance included characteristics of the listener, the auditory sound whether music or speech, the listening environment, and supplemental contextual and visual information.

Results from this study show that strategic decisions made by music therapists and other healthcare professionals can enhance music perception for those with hearing loss. Specifically, musical instruments vary in audibility given the listener’s hearing profile, and ensuring the presence of visual cues to supplement song lyrics improves perception. Attention to decisions related to the listening environment, how music and speech are presented, and the accessibility of contextual and visual cues is essential for successful implementation of music interventions with individuals with hearing loss.


Aging, Hearing Loss, Music, Music Therapy, Older Adults


xiv, 348 pages


Includes bibliographical references (pages 329-348).


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Copyright © 2016 Lindsey Anne Wilhelm

Available for download on Tuesday, February 23, 2021

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