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How does music impact students with CVI?

Explore our music showcase, find research about music and the brain, and learn the benefits of adding music therapy to your CVI toolkit.

Zach smiles in front of a microphone, wearing The Spinrockers hat and shirt.

To Zachary LaViola, music has been transformational. 

“At 12-14 months, he only responded to us with music,” says his mother, Mara LaViola. “If we sang to him, we got engagement. Otherwise, nothing.”

By 16 months old, he was “plucking out melodies on a xylophone,” and by two years old, he was harmonizing with his older sister. “People told us he had perfect pitch at that age. We thought, ‘That’s really nice, but he doesn’t speak and he’s walking into walls,’” she recalls.

Zach has CVI, autism, cerebral palsy, and severe central auditory processing disorder (CAPD). LaViola, who works as a special education advocate, says she didn’t realize the extent of his musical talents at first because the family was so occupied with the trappings of his many diagnoses. 

For many people with CVI, music is an integral part of life. Research demonstrates the neurological benefits of music, which can be an extremely worthwhile activity for people with CVI, whose visual impairment stems from damage to the visual pathways or visual processing areas of the brain.

Music facilitates movement in our brains. Music speeds brain waves and synchronizes networks of neurons. Music is a catalyst for neuroplasticity. (Viskontas, I., 2022) 

Neurologist and acclaimed author Oliver Sacks evangelizes the power of music to heal the brain. Throughout his work, Dr. Sacks uses real-world examples of people who can’t talk or move but, when accompanied by music, find they can sing and dance. 

While research on music and the brain does not focus on participants with CVI, we can learn a lot from the data that show the transformational power of music for the brain and, therefore, cognition, physical skills, and emotional well-being. (Kobus et al., 2022)

Many professionals agree that music interventions have great potential for people with CVI. Neurologic music therapist Marie Miller, who works with children who have CVI, calls music “a global experience in the brain, activating many regions and priming the brain for learning.” She adds that “music-based intervention promotes the creation of alternate pathways and alternate routes for processing,” which paves the way for communication, literacy, and social interaction. (Crozier-Fitzgerald & Miller, 2020)

As an added benefit, it’s fun! Children with CVI often have many appointments—therapeutic, medical, or otherwise—that take time away from leisure activities. “In music therapy, children can engage in meaningful opportunities that incorporate their needs and practice their skills, but that are delivered in a motivating and enjoyable setting where they are free to be creative.” (Music Therapy Handbook, 2015)

Parents of kids with CVI report that music has a calming and focusing effect on their children, allowing them to use their functional vision more effectively and to build physical and emotional resilience.

My son “just started music therapy and the techniques to help him find calm and focus are incredible!” -Rachel Bennett

“My daughter does everything better with music. Physical, educational, emotional, all of it.” -Jennifer Thoreson.

Music therapy

Though she didn’t know Zach was a budding musician, LaViola recognized music as her son’s “greatest zone of confidence” and “his first form of communication.” She placed him in music therapy at an early age, which turned out to be the most powerful form of intervention for him.

Cleveland Clinic describes music therapy as the work of a credentialed music therapist and the participant to reach goals through music or musical elements. The therapist may coordinate care with other healthcare providers or educators in a school setting. Music therapists must meet certain requirements for licensure and use evidence-based methodologies, which sets their sessions apart from music lessons.

LaViola says music is the bridge to the things that Zach finds most challenging. He could sing lyrics before he could speak a single word. Music also facilitated motor planning abilities, supported academics, and nurtured relationship skills.

Without music therapy, “I don’t think he’d have speech or the level of coordination” he has now. LaViola explains, “There was no motor planning or use of his left side unless there was music” due to cerebral palsy. 

Kristi Faby, Director of Community Engagement at South Shore Conservatory says, “I think the more music the better because it builds different neural pathways. The more we experiment and try these different musical techniques with children with CVI, the more effectively we can work on a variety of neurological goals.”

case study

From the Music Therapy Handbook edited by Barbara L. Wheeler 

A child with CVI and cerebral palsy who had little use of his hands and refused to touch the instruments during music intervention was uncomfortable during sessions, screaming the entire time. He did not receive vision services at school and people had described him as having “little to no vision at all.” His parents were told he was blind and would never see.

But the music therapist saw a different child. “I tried my best to provide time during our individual sessions to work on vision goals, such as using the light box to reach and touch an instrument. I still remember the joy that his mother and I felt the first time we observed him using his vision to look at a chime tree while illuminated on the light box.” Over two years, he gradually became more comfortable and ended up participating in a music recital. (Wheeler, 2015, p. 320)

This is just one example of how a relationship with a music therapist can unlock a world of potential.

Benefits of music intervention to students with CVI

Under the Individuals with Disabilities Education Act (IDEA), IEP teams can identify music therapy as a related service for students with disabilities, including those with blindness/visual impairment. Though not explicitly listed in the related services section of IDEA (Sec. 300.34), music therapy may be used to address an area of educational need. 

“Research supports connections between speech and singing, rhythm and motor behavior, memory for recall and retention of academic material, and overall ability of preferred music to enhance mood, attention, and behavior to optimize the student’s ability to learn and interact.” (American Music Therapy Association, 2021)

Individualized music therapy is a versatile tool that can aid the development of a wide range of skills, including those that fall under the Expanded Core Curriculum (ECC), like self-determination, communication and social interaction, orientation and mobility (O&M), recreation and leisure, and sensory efficiency skills.

Faby also emphasizes the importance of individualized approaches because “a lot of students will respond and be highly motivated by it. Some may not. So it’s not like music therapy is this magical thing. It’s like every other thing, it’s a lot of trial and error and seeing what sticks.” 

case study

From Kristi Faby, Director of Community Engagement, South Shore Conservatory

Faby recalls working with a student in the Perkins School for the Blind Lower School while conducting a pilot study for her thesis work. She explored whether preferred music could be used to support sustained visual attention.

“It didn’t really work because we found that it was hard for him to focus on the object visually and listen to the music,” Faby says.

Nevertheless, he loved music and—with appropriate adaptations and accommodations—Faby used music therapy to help him reach his goals related to communication, self-determination, and mobility. For example:

  • Taking turns mimicking each other’s cooing sounds as a form of dialogue
  • Vocally improvising songs to instrumentation
  • Choosing an instrument from a selection of tactile object choices (e.g., a tiny tambourine presented on a black background in his preferred visual field)
  • Singing movement songs to teach body parts and spatial awareness (e.g., assisting him with tapping his feet or clapping his hands to a song)

These are a few ways music therapy can help students meet a range of goals. Many examples come from an evidence-based curriculum guide to music therapy for children with CVI, Faby’s master’s thesis work at Perkins School for the Blind.

Explore the CVI music therapy curriculum guide. 

Social skills and emotional well-being

Music therapy offers essential practice in social situations.

It is important to provide structured opportunities for children with visual impairments to build social skills because they miss the opportunities for incidental learning about social norms and cues that their sighted peers absorb through vision. 

Faby’s proposed music therapy curriculum guide outlines social engagement activities for students of all ages. For example, the “I Like It” song encourages students to take turns sharing what they like about a given topic (e.g., the weather, food, an upcoming holiday) and then turn to ask a peer to share his or her preference too.

People with visual impairments can feel socially isolated, which can lead to depression and other mental health concerns. Faby (2016) notes that singing in a choir can decrease feelings of isolation. In terms of music therapy, she suggests iterations on the “Feelings Song” that grow more nuanced as the student matures. 

Movement and motor skills

One group of researchers found that children with neurological diseases who received live music therapy during physical therapy sessions had “decreased heart and respiratory rates and increased oxygen saturation during and after sessions.” They postulate that the improved vital signs help these children achieve their physical therapy goals more quickly. (Kobus, 2022) Others note that music therapy integrated with repetitive rehab exercises can enhance motivation and improve patient outcomes. (Street, 2015) 

Students can exercise fine motor skills by playing instruments or using equipment or apps to make music, like GarageBand. (Faby, 2016) However, fine motor coordination is not required for making music. Programs like Soundbeam convert physical movements into sound using sensors, empowering people of all abilities to make music. Eye gaze software is another entry point, offering the chance to play music with the tiniest movements and eye tracking. (Kantor et. al, 2021)

O&M

Music enhances orientation and mobility lessons (O&M) too. “I have found that students with traumatic head injury and other brain-related issues often learn best through songs or chants,” says Diane Brauner, Certified Orientation and Mobility Specialist and Paths to Technology manager. “The brain will create new pathways through songs and chants, helping students to learn and remember routes.” 

O&M instructors and music therapists can work together to teach positional concepts, sensory skills, movement skills, cognitive concepts, and body parts through song. For example, in Cody: Learning life skills through technology, a high school student used a modified version of “Old McDonald Had a Farm” to remember the building order in his high school.

A song with a steady beat can improve cane-tapping skills. Sapp (2011) suggests finding natural rhythms, repetition, and word patterns. 

Here are a two collections of O&M songs:

Before using music during O&M, the instructor should consider whether the student can handle the mulitsensory input and if it’s safe to use music in the current environment. For example, student safety could be compromised if music was incorporated into a lesson focused on listening and watching for traffic.

Communication

“Honestly, I do not think my son would have language without music therapy,” says LaViola. “My son had lost all vocalizations and music helped bring out his voice. He could sing lyrics before he could ever speak a single word. His brain seems to have retained the ability to process music but not language.”

According to Sacks, “music therapy, for some patients, can succeed where conventional speech therapy has failed…it may be that cortical areas previously inhibited but not destroyed can be de-inhibited, kick-started into action, by reexperiencing language, even if it is of a wholly automatic sort, language embedded in music.” (Sacks, 2008)

For people who use augmentative and alternative communication (AAC), musical expression can support language expression. (Kantor et al., 2021) Citing others, Kantor et al. write, “research has shown that music has an effect on supporting and promoting communication for people who use AAC, especially in case of people limited to severe and profound levels of functioning.” (Elefant, 2010; Lee & Ferran, 2012; Thompson & Ferran, 2015). 

In her CVI-focused music curriculum guide, Faby (2016) explains how to use a “Hello Song” to elicit greetings verbally or through a communication device. She also indicates that music improvisation, theme songs, drum circles, and jams can act as a conduit for communication and self-expression. 

Boosting attentive behavior 

“In regard to functional vision, music has been used to help students with visual impairments sustain and enhance attention, which are important skills for learning.” (Faby 2016) 

Music can also boost auditory attention. One study compared the attentive behavior of visually impaired preschoolers during music- and play-based interventions. It can be more challenging for people with visual impairments to sustain attention in a traditional group setting, which is heavily reliant on visual references. The study found that the participants’ attentive behavior was significantly higher in the music-based sessions. (Robb, 2003)

The author also recognizes the “monumental importance” of being able to “exercise selective attention” for children with visual impairments so that auditory clutter does not become prohibitively distracting. In the study “participants were able to physically orient to a central stimulus more readily in the music condition,” though the study had no way of confirming the participant’s cognitive engagement. (Robb, 2003)

Sample accommodations

What can I do to secure music therapy for my child?

  1. Make sure the music therapist is certified. Though musicians and music teachers have much to offer, music therapists must attend an accredited university, complete clinical hours, and undergo board certification. Find a certified music therapist
  1. Interview the potential therapists to assess their patience, flexibility, and willingness to learn about CVI and other diagnoses your child may have.
  1. If your child is enrolled in early intervention, the agency may have music therapists on staff or under contract. To make your case, note that music therapy in early intervention has significant effects on language acquisition, peer interaction, attention span, following directions, and motor coordination and strength. (Harmony Music Therapy)
  1. If your child is enrolled in the public school system, you can advocate for musical therapy services as a related service in the IEP as a research-based method for helping the student achieve non-musical goals. 
  1. IEP and IFSP teams must first conduct evaluations to determine if the service is appropriate. While you may not dictate the evaluation instrument, it is appropriate to ask which one will be used. 

For example, the Special Education Music Therapy Assessment Process (SEMTAP) compares discrete skills demonstrated with and without the support of music therapy. Know which goals will be used during the assessment and provide your input. You want to be sure the goals selected for your child’s assessment are compatible with music (e.g., it may or may not be distracting for your child to use music during math). Students who have trouble with the complexity of music may need more than one session with the music therapist to authentically determine their level of responsiveness.

If the team is conducting the SEMTAP, it is within your rights to request the Music Therapy Special Education Assessment Scale (MT-SEAS), a supplement to SEMTAP that evaluates developmental achievement in major domains, like communication, cognitive, social/emotional, and motor skills. The MT-SEAS may demonstrate the need for music therapy by showing that the student is more engaged and available to learn with music as a component. 

CVI music showcase

One morning LaViola woke up to someone playing Beethoven’s “Pathetique” on a keyboard downstairs. At first, it didn’t occur to her that it could be her son Zach, who was 14 years old at the time and had not received any formal piano training. 

But it was. Zach was playing a piece he had heard his brother practice 10 years earlier.

In the CVI Now Parents Facebook group, people have shared some of the remarkable musical gifts possessed by people they know with CVI. Because we lack research on CVI and music, we don’t know the prevalence of absolute pitch, synesthesia, or other musical strengths among the CVI population. However, we can extrapolate from other studies about people with neurological issues or visual impairments to begin to understand why many people with CVI are drawn to and excel at music.

Whatever the underpinnings, there’s no doubt many people with CVI love music. Experience their joy and talents for yourself!

Dagbjört Andrésdóttir, opera singer 

“My pianist creates two recordings for me: one is my part and the other is the accompaniment. When I learn new songs or roles, I use YouTube or Spotify. For the opera I am playing the lead role in, I listened to the entire score on Spotify a bazillion times. And apart from learning my solos and parts, I have to learn everyone else’s solos, so I know what to do at every second in the show. I have my music in my ears at least one to five times a day.” (Read an interview with Dagbjört, Why Music is My Vision.)

Anna-Ray, community entertainer

Anna has an incredible ability to memorize melodies and play them on the keyboard after hearing them only once or twice. She performs regularly at coffee shops, nursing homes, hospitals, and events. (Follow Anna-Ray’s Facebook page)

Drake, fiddler

Drake’s goal is to play his fiddle in a slow country style.

Hannah, pianist

Hannah is performing a piece she taught herself after listening to it on YouTube. Hannah has high tone CP affecting her left hand but her love of music encourages her to use her left hand to play the piano.

Jasmine on the auto harp

Jasmine is a part of her school ukulele club and has performed a concert on stage with them on her auto harp. She was also cast in the school musical “Finding Nemo Kids” as the scuba mask dancer! 

Molly Field, YouTube’s VI drummer

“Since I was 20, I have realised how important music is in my life and wanted to channel this in some way, to see where it will lead. I have been collecting records since I was 20 and mainly listen to rock & pop music. My favourite bands are; Nickelback, Within Temptation and Disturbed. My favourite solo artists are Adele and Kylie Minogue. I began taking drumming lessons for the Silver Duke of Edinburgh’s Award back in 2022 and have continued ever since. I really think that learning an instrument can help you understand music in more depth and in a different way, and it can open up a whole new world of opportunities for your future.” (Subscribe to Molly’s YouTube channel.)

Tina on the ukelele

“This was a hobby of mine before I got diagnosed with CVI at 19. I never knew why I could never sing and play it. I realize now my CVI played a role in why it was hard for me to sing, look at the music sheet and play.”

Zach, classical pianist

A relaxed Zach noodles on the piano, playing a rock/jazzy tune although he is really a classical pianist.

Jimmy on the bead drum

Jimmy is playing his favorite instrument, the bead drum. Jimmy also loves to play the piano, steel tongue drum and strum the guitar. 

Savannah on keyboards

Savannah enjoys playing her light purple keyboard while standing in her stander. She loves music and instruments. The xylophone was a staple in the early years.

Justin with maracas

Last Christmas Eve, Justin joined a street performance with a group of musicians. Music is his favorite activity. He loves to listen and dance to the beat.

Grace, choir member

Grace’s youth choir sings at festivals, with the NC Symphony, and in churches throughout the region. This song is about embracing who you are and recognizing the light and love you bring to the world.

Ben, pianist and composer

Ben is learning how to play piano using a system of colored stickers, instead of reading music the traditional way. He also likes to make up his own songs that represent how things sound to him, including his feelings, the rain, and his little sister. 


References

American Music Therapy Association. (2021). Music Therapy with Acquired Brain Injury (ABI). [Fact Sheet]. https://www.musictherapy.org/assets/1/7/FactSheet_Music_Therapy_with_Acquired_Brain_Injury_2021.pdf 

American Music Therapy Association. (2021). Music Therapy and the Neonatal Intensive Care Unit (NICU). [Fact Sheet]. https://www.musictherapy.org/assets/1/7/FactSheet_Music_Therapy_and_the_Neonatal_Intensive_Care_Unit__2021.pdf 

American Music Therapy Association. (2021). Music Therapy in Special Education. [Fact Sheet]. https://www.musictherapy.org/assets/1/7/FactSheet_Music_Therapy_in_Special_Education_2021.pdf  

Crozier-Fitzgerald, F., & Miller, M. (2020, Nov. 9). Music Therapy: A Vehicle for Driving Communication, Literacy, and Social Interaction Skills in Students with CVI. Salient Features: The PCVIS Blog. https://pcvis.vision/music-therapy-a-vehicle-for-driving-communication-literacy-and-social-interaction-skills-in-students-with-cvi/ 

Faby, K. (2016). Music Therapy for Children with Cerebral Visual Impairment. Retrieved from http://purl.flvc.org/fsu/fd/FSU_2016SU_Faby_fsu_0071N_13353 

François, C., Grau-Sánchez, J., Duarte, E., & Rodriguez-Fornells, A. (2015). Musical training as an alternative and effective method for neuro-education and neuro-rehabilitation. Frontiers in psychology, 6, 475. https://doi.org/10.3389/fpsyg.2015.00475

Kantor, J., Kupferstein, H., Skogdal, S., Anderson, T., Olsen, E.B., Skogdal, E., Častulíková, N., Kantorová, L. (2021). Potential of music experiences for augmentative and alternative communication users and their effect on communication training: a scoping review protocol. Journal of Exceptional People. 10(18), 51.

Kobus, S., Bologna, F., Maucher, I., Gruenen, D., Brandt, R., Dercks, M., Debus, O., & Jouini, E. (2022). Music Therapy Supports Children with Neurological Diseases during Physical Therapy Interventions. International journal of environmental research and public health, 19(3), 1492. https://doi.org/10.3390/ijerph19031492

Magwati , P., & Manatsa , P. (2023). The musical development of visually impaired learners: A case study of a special needs secondary school. African Musicology Online, 12(1), 1–10. https://doi.org/10.58721/amo.v12i1.208 

Metell, M., & Stige, B. (2016). Blind spots in music therapy. Toward a critical notion of participation in context of children with visual impairment. Nordic Journal of Music Therapy. 

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Sacks, O. (2008). Musicophilia: tales of music and the brain. New York, Alfred A. Knopf.

Music Therapy Handbook. (2015). United Kingdom: Guilford Publications.

Robb, S.L.. (2003). Music Interventions and Group Participation Skills of Preschoolers with Visual Impairments: Raising Questions about Music, Arousal, and Attention. Journal of Music Therapy, XL(4), 266.

Sacks, O. (2008). Musicophilia: tales of music and the brain. Revised and expanded, first Vintage books edition. New York, Vintage Books.

Sapp, W. (2011). Somebody’s jumping on the floor: Incorporating music into orientation and mobility for preschoolers with visual impairments. Journal of Visual Impairment & Blindness, 105(10), 715-719. Retrieved from https://login.proxy187.nclive.org/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fscholarly-journals%2Fsomebodys-jumping-on-floor-incorporating-music%2Fdocview%2F902630628%2Fse-2%3Faccountid%3D14867 

Street, A. J., Magee, W. L., Odell-Miller, H., Bateman, A., & Fachner, J. C. (2015). Home-based neurologic music therapy for upper limb rehabilitation with stroke patients at community rehabilitation stage-a feasibility study protocol. Frontiers in human neuroscience, 9, 480. https://doi.org/10.3389/fnhum.2015.00480 

Sykes, J., & Rosenbloom, A. (2023, July 28). Taylor Swift fans ‘Shake It Off,’ causing record-breaking seismic activity during Seattle shows. CNN. https://www.cnn.com/2023/07/27/entertainment/taylor-swift-seismic-activity/index.html 

Viskontas, I. (Host) 2022, April 14. Music as Medicine (No. 6) [Audio Podcast Episode]. In Radiant Minds: The World of Oliver Sacks. Audible Original Podcast. https://www.audible.com/pd/Music-as-Medicine-Podcast/B09WJMZ4WN?action_code=ASSGB149080119000H&share_location=pdp

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