MONOGRAPH NUMBE R TH IRTEEN

Verbo-Tonal Method for

Rehabilitating People with
Communication Problems

Carl W. Asp, Ph.D.

Professor of Audiology
University of Tennessee
Knoxville, Tennessee
and
Petar Guberina, Ph.D .
Professor of Psycholinguistics
University of Zagreb
Zagreb, Yugoslavia

Contributor: Mihovil Pansini, M.D.

Professor of Audiology, Faculty of Medicine
Zagreb. Yugoslavia

International Exchange of Information in Rehabilitation

World Rehabilitation Fund. Inc.
400 East 34th Street
New York, New York 10016
This monograph series is sponsored by the World Rehabilitation Fund, Inc.
under Grant #22-P-S9037/2-03 from the National Institute of Handicapped
Research, U.s. Department of Education, Washington, D.C. 20201, United
States of America.

ISBN 0-939·986-25-6

Copyright © 1981 World Rehabilitation Fund, Inc. Portions of this publication may be
reprinted provided permission to do so is obtained in writing from the World
Rehabilitation Fund, Inc. or from the National Institute of Handicapped Research,
Office of Human Development, U.S. Department of Education with whose support
the project resulting in this publication wa s conducted.
 2012, VERBOTONAL BOOKS, PUBLICATIONS, UNITS AND TRAINERS

Book 1: Verbotonal Speech Treatment, by Professor Carl Asp, PhD, CCC-A/SL. Plural
Publishing, San Diego, CA, 2006, revised, 2012. The book explains the Verbotonal Strategy and
the global application for training both children and adults with various communication
disabilities. Theory, terminology and specific training tools are described to provide the reader a
basic understanding of the Verbotonal Strategy which is successfully implemented and
acclaimed worldwide. This book is free on the Verbotonal UT Website (Verbotonal.utk.edu), or
directly at (casp@utk.edu).

Book 2: The Verbotonal Method for Rehabilitating People with Communication Problems,
by Professors Carl Asp, PhD, Professor Petar Guberina, PhD, and Dr. Mihovil Pansini,
MD, published in 1981 by The World Rehabilitation Fund, NY, NY and revised, 2012. The book
emphasizes theory, space perception, diagnosis, Suvag units, habilitation and rehabilitation of
hearing impaired children and adults, speech listening-therapy for normal hearing clients,
summarizes results, and includes research references. The book is available on the Verbotonal
UT Website (Verbotonal.utk.edu), or directly at (casp@utk.edu).

Recent 2012 Verbotonal Publications:

1) Verbotonal University of Tennessee (UT) Website (verbotonal.utk.edu): has strategy,
photos, video therapy, publications, the two free books above, glossary, references,
testimony, etc. Links are available for other Verbotonal Websites Worldwide.
2) The Two Books above are available free through at the Verbotonal UT Website above
(Verbotonal.utk.edu) or directly at (casp@utk.edu).
3) The 2012 Book 1 (first edition 2006) has been translated into Chinese, Arabic, Russian
and, in the near future other languages. These translations are available through the
Chinese publisher in Mainland China with the simple Chinese translation. The
comprehensive Chinese translation is available from Hong Kong, and Taiwan publishers.
Saudi Arabia publishers have the Arabic Translation available in most Arab countries.
Russian publishers have the Russian translation available. Other translations are in
progress. Most translations are sold by the publishers. Email Dr. Asp at (casp@utk.edu)
for more information.
4) The Verbotonal Society Worldwide (registered since 1979 in the State of Tennessee
through the University of Tennessee). The Society offers consulting, training and
certification by Verbotonal Trainer listed herein and others worldwide.
5) Verbotonal Listen Auditory Training Units with microphones, vibrators, and headsets
are available through Listen Incorporated, 602 South Gay Street, Unit 902, Knoxville,
TN, 37902 (casp@utk.edu). These Listen units are a digital update of the Suvag units.
Also, the Tennessee Optimum Speech Amplifier (TOFA) that uses octave filters to
correct speech errors of normal-hearing children.
6) Recent Publications in 2012:
a) Verbotonal History in the USA, by Dr. Carl Asp and Ms. Madeline Kline, available
from Zagreb, Croatia (simpozij2011@suvag.hr) or on the Verbotonal UT Website
(Verbotonal.utk.edu).
 b) Timeless Verbotonal Body Movements by Dr. Carl Asp and Ms. Madeline Kline,
available from Zagreb, Croatia (simpozij2011@suvag.hr), or the Verbotonal UT
Website (Verbotonal.utk.edu).
c) Verbotonal Worldwide by Dr. Carl Asp, Dr. Kaz Koike and Ms. Madeline Kline,
available in a book titled “Translational Speech-Language Pathology and Audiology”
,2012, by Plural Publishing, San Diego, CA, (angiesingh@pluralpublishing.com) or
the Verbotonal Website (Verbotonal.utk.edu).
d) Verbotonal Body Movements by Dr. Carl Asp, Dr. Kaz Koike and Ms. Madeline
Kline, available in a book titled “Translational Speech-Language Pathology and
Audiology”, 2012, by Plural Publishing San Diego, CA (angiesingh@plural
publishing.com) or the Verbotonal UT Website (Verbotonal.utk.edu).
e) Verbotonal Rehabilitation: Are We Doing Enough by Dr. Carl Asp, Dr. Kaz
Koike, and Ms. Madeline Kline. Obtain this article by googling
(thehearingjournal.com) under the January 2012, Vol., 65, No 1, p 28-34, or from
the Verbotonal UT Website (Verbotonal.utk.edu).
f) Ten Monthly Verbotonal Articles by Dr. Robert Martin and Dr. Carl Asp, in The
Hearing Journal, are in progress. Obtain these articles by googling
(thehearingjournal.com). These articles start in January 2012 and continue under the
Nuts and Bolts Section on Verbotonal, or from the Verbotonal Website
(Verbotonal.utk.edu).
Verbotonal Trainers Worldwide: Email Directly or use (casp@utk.edu).
1) Professor Carl Asp, PhD in Speech and Hearing Science, MA Audiology, BS
Speech Pathology, CCC-S/L, Master Trainer, Consultant and Director of the
Verbotonal Research Lab, University of Tennessee, Knoxville, TN, (casp@utk.edu) .
2) Professor Kaz Koike, PhD in Speech and Hearing Science, MA Speech Pathology
and Audiology, CCC-A, Master Trainer, Consultant and Director of Audiology at
the West Virginia Medical School, Morgantown, WV. In 1982, published the
Tennessee Test of Rhythm and Intonation Patterns (T-TRIP) (fluent in Japanese and
English) (kkoike@wvu.edu).
3) Ms. Madeline Kline, MS in Deaf Ed., BS in Dance, Master Trainer in Verbotonal
Body Movements approved personally by Professor Petar Guberina, certified in Deaf
Ed, English and Language Arts, Private Practice Consultant with specialty in Public
Schools and Private Clinics, Knoxville, TN (movetohear@aol.com).
4) Mr. Wayne Kline, MS in Deaf Ed, University of Tennessee Law Degree, Master
Trainer, PreK-Teacher, Consultant and Attorney, Knoxville, TN.
(wkline@hdclaw.com).
5) Dr. Mary Koike, AuD in Audiology, MA in Audiology, BS Speech Pathology,
CCC-A, Master Trainer, Specializes in diagnosis of Hearing Impaired Infants and
placement of Hearing Aids and/or Cochlear Implants, Consultant and Audiologist at
the West Virginia Medical School, Morgantown, WV,
(archerma@wvuhealthcare.com).
6) Mr. John Berry, MS in Deaf Ed, BS in Deaf Ed, Certified Hearing Aid Dispenser,
Master Trainer, Owner of the Blount hearing and Speech Center, Maryville, TN, and
founder of the Hearing and Speech Foundation. The Center and Foundation provide
diagnosis, Verbotonal training and services to hearing impaired children and adults.
Mr. Berry specializes in hearing aid fitting. Most of the Center’s staff are certified
 Verbotonal Trainers; contact Mr. Berry for their names and qualifications
(www.bhssinc.com).
7) Dr. Mihovil Pansini, MD, ENT specialists, co-author of Book 2, Vestibular-
Cochlea hearing and the role of Space Perception in the Verbotonal Strategy (fluent
in French, Croatian, and English) (mihovil.pansini@zg.t-com.hr) Zagreb, Croatia.
8) Professor Youngsun Kim, PhD in Speech and Hearing Science, MA in Speech
Pathology, CCC-S/L, Master Trainer, Consultant and Professor at the Ohio
University, Athens, Ohio, Published the Rhythm and Intonation Speech Test
(kimy2@ohio.edu) (fluent in English and Korean).
9) Professor Carole Johnson, PhD in Speech and Hearing Science, MA Audiology,
CCC-A, Master Trainer, Consultant and Professor at Auburn, University, Auburn,
Alabama (johns19@auburn.utk).
10) Professor Hsiaochuan Chen, PhD, in Speech and Hearing Science, MA in
Audiology, Master Trainer, Taiwan University, Taiwan (fluent in English and
Chinese, editor of the Chinese translation of Verbotonal Book 1).
11) Professor Claude Roberge, PhD in Linguist, Master Trainer, Consultant and
Professor at Sophia University, Tokyo, Japan, (fluent in English, Japanese and
French; author of Verbotonal publications in French, Japanese and English) (see Dr.
Koike for contact information).
12) Drs. Dennis and Patti Earl, PhD’s in Speech and Hearing Science, CCC-A,
Trainers in Audiology and services in the clinical practice of Verbotonal Strategies,
Knoxville, TN.
13) Dr. Doris Shelton, PHD in Speech and Hearing Science, MA and BS in Speech
Pathology, CCC-S/L.
14) Ms. Ljerka Guberina, MS in Foreign Languages, Master Trainer, Paris, France,
specializes in teaching foreign languages (fluent in English, French and Croatian) (
ljegu@yahoo.com) (daughter of Professor Petar Guberina, founder of the Verbotonal
Strategy).
15) Dr. Maya Guberina, PhD, Master Trainer and Psychologist, Paris, France (fluent
in English, French and Croatian) (maja.guberina@gmail.com) (daughter of Professor
Petar Guberina, founder of the Verbotonal Strategy.
16) Ms. Cathy Davis, MA, Master Trainer, Consultant and Audiologist in Knox County
School System, Knoxville, TN. Specializes in Verbotonal diagnosis and treatment of
pre-k and elementary school hearing impaired children using body movements to
develop listening skills and spoken language.
17) Ms. Julie McCallie, BS, Deaf Ed, Trainer, Consultant and Special Education
Teacher in the application of the Verbotonal Strategy with the emphasis on
developing listening skills and spoken language in hearing impaired children, Knox
County School System, Knoxville, TN.
18) Ms. Marie Mazara, BS, Trainer, Consultant and Speech Pathologists using the
Verbotonal Strategy of body movements and acoustic filters to develop listening
skills and spoken language in hearing impaired children in the Miami Dade School
System, Miami, FL, (mmazz@bellsouth.net).
19) Ms. Janet Thurman, BS, Deaf Ed, Trainer, Consultant and Supervising Teacher in
the Verbotonal Strategy to develop listening skills and spoken language in hearing
impaired children in Knox County School System, Knoxville, TN.
20) Ms. Barbara Leseur, BS, Parent Trainer in the Verbotonal Strategy, Miami, FL,
(fluent in Spanish and English). Barbara’s son Michael, who is hearing impaired,
received Verbotonal training in Miami-Dade County Schools (Beleseur@aol.com).
21) Mr. Michael Leseur, BS, Trainer, who is hearing impaired, received Verbotonal
training from preschool through high school at UT and in the Miami-Dade School
System, Miami, Fl., college graduate and will discuss his developing skills in
listening and spoken language (Beleseur@aol.com) .
22) Ms. Kile Aguero, BS, Parent Trainer in the Verbotonal Strategy, Miami, FL. Kile’s
son Larry, who is hearing impaired, received Verbotonal training in Miami-Dade
County Schools, (LSGEURO@miamidade.gov).
23) Mr. Larry Ageuro, BS, Trainer, who is hearing impaired, received Verbotonal
training from preschool through high school in the Miami-Dade School System,
Miami, Fl., college graduate and currently enrolled in graduate school and will
discuss his development of listening and spoken language skills
(LSGEURO@miamidade.gov).
24) Ms. Sandra Smith, BS, Parent Trainer in the Verbotonal Strategy. Sandra’s
daughter Aaron and Lane received Verbotonal training from preschool through high
school in the Knox County Schools, Knoxville, TN and are enrolled in college
(SansSurprise@aol.com).
25) Dr. Audi Smith, MD, Parent Trainer in the Medical Applications, daughter Aaron
and Lane, who are hearing impaired, received Verbotonal treatment from preschool
through high school in Knox County School System.
26) Professor Lina Obs, PhD, Trainer, Saudi Arabia University, Saudi Arabia (fluent
in Arabic and English), and was the Arabic translator and the editor of the
Verbotonal book 1.
27) Dr. Olga Victorona, PhD, Trainer, Russia University (fluent in Russian and
English), and translator and editor of the Russian translation of Verbotonal Book 1.
Russia has 29 Verbotonal Centers.
28) Ms. Barbara Spletzer, MA, CCC-S/L, Master Trainer and skilled in using
acoustic filters and body movements to improve the listening skills of normal-
hearing children to correct speech/language errors, Speech Pathologists, Toledo,
Ohio.
29) Dr. Sue Hume, PhD, CCC-S/L, Trainer, University of Tennessee.
30) Ms. Ruth Lawarre, MA, CCC-A, Trainer, Hendersonville, North Carolina.
31) Dr. Vivian Kirpatrick, PhD, CCC-S/L, Master Trainer, Atlanta, Georgia.
32) Dr. Charotte Hubbard, PhD., CCC-S/L, Trainer, East Kentucky University,
Kentucky.
33) Ms. Ann Browning, MA, CCC-S/P, Trainer, Knoxville, Tennessee.
34) Mr. Larry Boyd, BS, Trainer, Engineer and Designer of Listen Auditory Training
Units. The units have an amplifier, acoustic filters, speech vibrators, and headsets to
develop listening skills for improving spoken language in children and adults.
35) Email Additional Verbotonal Trainers through the University of Tennessee,
Verbotonal Website (verbotonal.utk.edu), the Links, or email the trainers above to
locate other trainers throughout the USA and Worldwide in a variety of languages.
36) Zagreb, Verbotonal Suvag Center, (Zagreb@suvag.hr), in Zagreb, Croatia is the
Parent Program where Professor Peter Guberina, along with Dr. Pansini, MD,
 developed the Verbotonal Strategy for all communication problems. The Center
provides Verbotonal training in English, Croatian, French, Spanish, Russian, and
other languages (ititl@suvag.hr) .

We The Above, Honor The Late Professor Petar Guberina, PhD. He laid the
foundation for Verbotonal Worldwide, including the certification of Trainers and
Consultants to train teachers and clinicians to develop good listening and speaking skills
for successful mainstreaming into the spoken language of their society and other
societies worldwide.
INTERNATIONAL EXCHANGE OF INFORMATION
IN REHABILITATION

This monograph is the last in the International Exchange of Information in

Rehabilitation series published by the World Rehabilitation Fund, Inc. under a
grant from the National Institute of Handicapped Research. Under this project
the world Rehabil itation Fund, Inc. commissions foreign authors to prepare
brief monographs in topic areas in rehabititation where there are information
gaps in the U.s.
Under a companion grant, the International Exchange of Experts in
Rehabilitation, U.s. experts have been selected to receive fellowships from
WRF, Inc. to investigate exemplary rehabilitation programs, practices and
policies in other countries with the agreement that these "fellows" will transmit
the knowledge from abroad to the US
Monograph #13 verba-Tonal Method for Rehabilitating People with Com-
munication Problems is the product of the collaboration of a WRF expert Carl
Asp, Ph.D., who enhanced his knowledge of the Verba-Tonal method by study-
ing with the individual who developed the method in Zagreb, Yugoslavia, and
Professor Petar Cuberina who is that individual.
In addition to the Asp-Cuberina collaboration, a highly skilled editor, Ms.
Pat Kramer. contributed significantly with her expert manuscript revisions.
The WRF, Inc. is extremely pleased to have had the opportunity to coor-
dinate and sponsor this effort
It is our hope that this "product" w ill be useful to those in the rehabil ita-
tion community who are concerned about the communication needs of indi-
viduals with hearing impairments.

Howard A. Rusk, M.D.

President

New York, New York

June, 1981
CO NTENTS

ACKNOWLEDGMENTS
PREFACE
, INTRODUCTIONTOTHECENERAl THEORY 1
2 SPACE PERCEPTION 4

3 EVALUATION PROCEDURES 7
4 SUVAC AUDITORY TRAIN INC UNITS 13
5 HABILITATION FOR HEARINC-IMPAIREDCHILDREN 14
6 REHABILITATION FOR HEARING-IMPAIRED ADULTS 20
7 SPEECH AND LISTENING REHABILITATION FOR NORMAL·
HEARING PEOPLE 21

8 RESULTS 23
9 TRAINING ATTHE INSTITUTE OF AURAL REHABILITATION 27

10 REFERENCES 29
ACKNOWLEDGMENTS

The authors extend their appreciation to Dr. Mihevil Pansini, Professor of Audi-
ology, Faculty of Medicine, Zagreb, Yugoslavia, for his contribution of Chapter
2, Space Perception; to the World Rehabilitation Fund, Inc. for funding our
projects and publishing this monograph; to Dr. O. Lipscomb, Professor of
Audiology. University of Tennessee, for his editorial assistance; to Patricia Ann
Kramer for her advice and manuscript revisions; to Kaz Koike, Ph.D., student at
the University of Tennessee, for his work on the references; and many others for
helping to prepare this manuscript for publication.
We wish to recognize the interest the co-operation and the encourage-
ment of the Verbo-Tonal teacher-clinicians, the researchers, the young and
some not-50-young patients and their parents. We thank all of you who have
contributed so much to developing this method.

Petar Guberina
Carl Asp
PR EFACE

The task of presenting an introduction to the Verba-Tonal Method has been

difficult because the method is complex and can be applied to various
commun ication problems or situations. Therefore, we have limited our i ntr~
duction to discussing the rehabilitation procedures for people wno have com-
munication problems, primarily those who need speech and listening
rehabilitation; we only briefly mention those who have speech and language
disorders. Other aspects of this program, such as re habilitating the speech of
children who are socially and culturally handicapped, modifying dialectical
speech, and teaching foreign languages, have not been mentioned,
We have attempted to introduce the general theory, to expla in some
diagnostic procedures. to describe the techniques for speech and listening
rehabilitation, and to present some results from the programs in North America
and Europe. We have supplied references to verify certain aspects of the
theory Of method and to direct the reader to supplementary information.
It is not possible to identify objectively one method as being superior to
others. It is possible to determine if the goals have been achieved. If this
method is applied by a competent Verba-Tonal clinician, patients can develop
good oral communication skills and can be successfully integrated into soci-
ety. The goals have been and can be realized
If this monograph helps clinicians to understand that the patient bears
within himself the means for his rehabilitation. and if it stimulates research to
improve rehabilitation, we will have achieved our purpose.
1. INTRODUCTION TO THE GENERAL THEORY

The Verbo-Tona l method of rehabi litation for people who have severe
commu nication problems was developed in the 1950s by Professor Petar
Guberina. a linguist who was particularly interested in speech perception.
Underlying the method is the conviction that language evolved from
spoken language and that speech (which is used interchangeably with
spoken language) is a social event We speak (i.e., we use spoken
language) when we want to express something or when we react to an
event In this sense, the "meani ng" of speech is transmitted not only by
linguistic elements but also by the auditory and visual information pres-
ent in the rhythm, the intonation, the loudness, the tempo. the pauses, the
tension, and the gestures of the speaker. Thus the individual speaker is
bath a producer and a perceiver of speech. Most important, the auditory
and visual information in his production reflects hov\! he perceives
speech. If his perception changes, his speech wi ll also change. If we have
corrected his speech, we have corrected his perception.
The Verba"Tonal procedures follow the pattern of language deve~
opment observed in babies who have normal hearing. Before a baby
learns to speak, he cries, babbles, and coos- he produces sounds. His
whole body participates in producing and receiving sounds. This vocal
activity is not a response to his sense of hea ring; rather, it is a response to
his proprioceptive sense.
As the baby matures. his vocal play becomes more sophistica ted.
During this time. rhythm and intonation patterns and rhythmic motor ac-
tivities, as well as his vestibular, tactile, and proprioceptive senses, contri-
bute to his speechJlanguage development By the time he utters his first
meaningfu l word at 9 to12 months of age. he has already learned how to
manipulate rhythm and intonation to assign different meanings to the
word. For example. when he says " Mama" he may mean " Mama. come
here" or " Mama. don' t go" or " Mama, I'm getting impatient If you don' t
hurry with my food, I'm going to scream." And Mama learns quickly to
understand these patterns.
Rhythm and intonation transmit meaning not only in infant speech
but in adu lt spoken language as well. If we say " Mary came home yester"
day," and emphasize the first word, no more words are needed to convey
the meaning that Mary came, as opposed to anyone else. If we empha-
size the last word, we mean that she came yesterday and not on another
day.
As early as1938 Cuberina stressed the importance of rhythm and in-
tonation in producing and perceiving speech; moreover, as a result of his
research and experience. he proposed that the low frequencies transmit
the rhythm and intonation patterns of language. In the early 1950s he
began to apply these two principles to the habilitation of deaf children
who have hearing only in the low frequencies (Guberina 1954). He rea-
soned that the brain would function best if it were to receive the auditory
stimuli for which the ear is most sensitive; moreover, it would be enriched
(in Piaget's terms) by these optimal stimuli; and with time and training. it
would be prepared to respond to more difficult tasks. i.e" less favorable
sti muli.
It wasn' t until the late 1950s and early 60s that other researchers
began to use low-frequency amplification with deaf children. Henk, Huiz-
ing, and Taselaar(1958) concluded that the main contribution to intelligt--
bility is given by that part of the " tone scale" where the hearing is most
sensitive. later they said, " These results correspond closely to the expert--
ments of Cuberina" (Huizing & Taselaar 1959).
In North America, Daniel Ling(1963, 64,65) was one of the early ad-
vocates of using the child's residual hearing in the low frequencies. After
he visited the Center for the Verbo-Tonal Method in Marseil les in1960. he
reported that deaf children had excellent speech because the Verba-
Tonal instruments transmitted the low frequencies without distortion. As
a resu lt of Ling's research, Zenith developed the first commercial hearing
aid that had an extended low-frequency response. Since that time many
other manufacturers have developed similar hearing aids. Despite the
wide availability of low-frequency and/or " high gain" hearing aids, the
goal of intelligible. rhythmical. spoken language for most deaf children
has not been realized.
Amplification alone will not guarantee good speech. Amplification
must be accompanied by " appropriate auditory training" (Rosenthal,
lang. & levitt 1975). During Verba-Tonal training. deaf children are taught
to speak and to perceive speech simultaneously. The speech stimulation
procedures follow the developmental patterns which have been ob.
served in normal-hearing chi ldren. The hearing-impaired chi ldren receive
speech through vibrators that sti mul ate their vestibular. tactile, and pro-
prioceptive senses and through headphones. The chi ldren learn to
produce normal rhythm and intonation patterns (suprasegmentals) and
normal voice quality by imitating bodily movements and rhythmic pat-
terns. They learn to develop meaningful speech by participating in simu-
lated communication situations.
Our goals are to help them develop good communication skills and
to integrate them into a normal educational system. Thus the Verbo-Tonal
method stresses the importance of simu ltaneously developing all the

2
senses; it does not advocate isolating any sense, exaggerating any stimuli,
or substituting an alternative linguistic code. In short. it is not a "Total
Communication" approach to rehabilitating hearing impaired individu-
als; if it is anything. it is a " unified sensory" approach which emphasizes
the importance of spoken language.
Although we receive information from the low frequencies, we must
also discriminate speech sounds. Normal listeners can discriminate low-
pitched words and sounds through a low-frequency band. but they do not
comprehe nd higll-pitched words. They can comprehend higll-pitched
phonemes (e.g. IiI), however, if we pass one low-frequency band (0.5 Hz to
300, 6((), or 10Cl0 Hz} and one high band (320) to 6400 Hz). The intensity
level for the low band can be at the person's threshold level or slightly
above (0 to 20 dB S.L), while the high band need be only near the person's
threshold level. This Guberina calls "discontinuous hearing."
Other researchers have confirmed that we can perceive speech
through discontinuous frequency bands. Paiva's results (1965) show that
listeners comprehend 18% of the words when speech is passed through
480-660 Hz; they comprehend 25% when it is passed through 1800-2400
Hz; but when sound is passed through both bands simultaneously. they
comprehend 70% of the words. For other results see Matzker (1956),
linden (1964), Ticinovic & Sonic (1971).
When Rosenthal. l ang. and levitt {1975} discussed the importance
of low frequencies for hearing-impaired individuals, they also mentioned
that the addition of one band of high frequencies improves comprehen-
sion significantly. Barbara Franklin's results (1969, 1973, 1975, 1979) con-
firmed that both normal and hearing-impaired listeners comprehend
speech better through discontinuous transmission than through a broad
frequency band. Furthermore, the previous studies support our own in-
vestigations and observations that speech discrimination percentages are
greater during discontinuous transmission than the sum of the percent-
ages for the individual bands.
Thus far we have discussed the significance of speech production.
of the low frequencies, and of discontinuous frequency-band transmis-
sion in speech perception. The hearing-impaired individual has yet
another perceptual process which helps him discriminate and acquire
speech. When he is given the opportunity to practice listening through his
most perceptive frequency bands{his optimal field of hearing}, he percep-
tua lly discovers in the speech signa l the clues he needs to distinguish one
sound from another. In other words, when he receives speech through his
optimal field of hearing. he can learn to discriminate all speech sounds
even though some acoustic information is diminished.

3
 The central nervous system receives information from all the senses.
It is responsible for organizing this information by eliminating those stim-
uli which create cybernetic noise (von 8ekesy's sensory inhibition, 1967)
and by selecting those stimu li which are optimal for it to function. Ac-
cording to Verbo-Tonal theory, sensory information is subordinate to the
function of language. The brain can be taught to structure the informa-
tion through functional rehabilitation.

2. SPACE PERCEPTION

Through motor activity and vibro-tactile stimulation, children learn to

develop good motor control and good oral communication sk ills. The
movements an infant makes while on his back or stomach help his me--
tabolism and increase the activity of the vestibular nuclei. Mothers can
stimulate their infants by walk ing them, rocking them, and genera lly mov-
ing them from room to room. Infants who are given the opportunity to ex-
plore their environments develop better co-ordination than those who are
restricted. The body, its movement, and the vestibular sense play an im-
portant role in rehabilitating chi ldren who are profoundly deaf.

The Veslibular Sense

Embryologically; the vestibular organ fi rst began as a thickening of the

ectoderm and then developed specific sensory cells (mechano-receptors).
The sense organ includes the otolith and the cupu la. The sensory cells of
the otolith have four essentia l functions : (1) perception of the gravita-
tiona l fields, (2) perception of linear acceleration, (3) perception of angu-
lar acceleration, and (4) some response to sound. The cupu la enhances
perception of angular acceleration.
Phylogenetically; the vestibu lar sense is older than the vestibular
sensory organ. During the paleozoic period, the lagena evolved in the
fish. This sm all growth, anterior to the saccu lus, expanded to become the
cochlea for audition. However; the primitive auditory function of the oto-
lith was not lost along the way. Neu rophysiological investigation has
established that the otolith responds to tones as high as 1CXXl Hz to sup-
plement cochlear activity. The capacity of the vestibular organ for hear-
ing is yet to be explored fully. Perhaps the lim its are greater than we
suspect
Since the vestibule and the cochlea comprise the inner ear. one
cou ld refer to vestibulo-cochlear hearing rather than merely to cochlear
hearing. Vestibular and auditory reception overlap for frequencies be-
tween 16 and 1(0) Hz. Frequencies below 16 Hz are perceived only by the
vestibu lar organ. The thresholds of the vestibular response are not known
because it is difficult to separate vestibular and auditory reception.
Sensory input to the vestibular nudei also goes to the reticular for-
mation, the cerebellum, and t he collateral auditory pathways. This input
influences the role of the macular structures (utricle and sacculae).
A spatial stimulus activates the mechanism of spatial perception.
One must recall that every healthy sensory organ supplies redundant in-
formation and that perception occurs even under unsuitable conditions.
W hen hearing is defective and redundancy is limited, perception depends
on other biological mechanisms such as the spatial sense. These mecha-
nisms are more primitive and thus are more resistant to damage. For
example, if a patient is aphasic from a vascular insult, he may lose his
capacity to comprehend speech; yet he may retain the more prim itive
function of singing. If both functions are impaired, singing will be re-
established before speech.

Vestibular Exercises
The patient's vestibular sense shou ld be evaluated prior to rehabi litation.
Since these tests are well known, they will not be discussed here. To reha-
bilitate deaf children who do or do not have peripheral vestibular func-
tion, their central vestibular sense is essential for perceiving the rhythm
and intonation of speech (Guberina et al. 1972). Resu lts of Frequency
Following Response Audiometry at the Zagreb Suvag Center indicate no
differences in the early neu rophysiological responses to low frequencies
by the cochlear and vestibular portions of the inner ear and the stato-
acoustic nerve [VII I] (R ibaric et a!. 1975). The differences appear later. and
they depend on where the bioelectric potentials go, how they are struc-
tured, and what role individual organs play within the whole sense of spa-
tial perception.
In. 1944, Cawthorne and Cooksey first introduced exercises to
rehabilitate people who have peripheral vestibular damage. In France,

5
Portmann expanded these exercises to correct centrally caused defects of
balance; Briand and his colleagues developed other exercises.
Damage to the peripheral vestibular organ inhibits the flow of bio-
electric potentials to the vestibular nuclei. Vestibular function depends
on a fine balance of bioelectric potentials in the vestibular nudei from
both sides. Any imbalance distorts information about the movement of
the body through space. If the vestibule is damaged, the central informa-
tion is incorrect; consequently, the body's position or balance is lost or
disrupted and the patient appears to be dizzy. There are several ways,
however, that the central system can compensate for this imbalance:
1. If the vestibular nucleus on one side lacks bioelectric potentials, the
patient could have symptoms of strong ataxia, dizziness, and neurovege-
tative disturbances such as nausea and vomiting. These symptoms can be
suppressed if the cerebellum decreases the bioelectric potentials from
the healthy side, thereby correcting the imbalance.
2. If the vestibular nucleus is healthy, it will gradually produce a steady
number of bioelectric potentials by receiving inputs from other areas, and
not only from the damaged vestibule. These bioelectric potentials even-
tually equal the number on the opposite side. Then balance is restored
and can be observed when the rotator vestibular test gives a nystagmus of
equal strength on bath sides, and the turning test of caloric stimulation
does not provoke nystagmus. This is known as Ruttin's phenomenon.
Although the bioelectric potentials in the vestibular nucleus of the
damaged side probably come from that site. they may also come from
other areas for space perception. We do not know what relation one
sense has to the others. Nor do we know how the number of bioelectric
potentials equalizes.
3, If one vestibule receives imperfect information, it will send fewer bio-
electric potentials to the central mechanism. The central mechanism can
compensate for the difference between the vestibular inputs by constru-
ing a state of balance.
4. When a person doses his eyes or turns out the light. his balance can be
threa tened because the visual input to his vestibule has been disrupted.
The central mechanism can maintain balance by using information from
the other sensory organs for space perception.

In the Verba-Tonal method, we use vestibular exercises to rehabi~

itate balance, to develop an input to the central monitoring system, and
to increase the vestibular input for space perception. For children, these

,
exercises are games that are within their physical potential: jumping rope,
changing positions or directions while swinging. walking on a balance
beam with eyes open or closed, turning around in each direction, turning
on a cross bar, rolling forward and backward on the ground, and jumping
and completing a circle in two to four jumps.
We present the vestibu lar exercises in three ways, proceeding gradu-
ally from the analytic to the global-structural approach. Even when the
patient advances to a higher level, we repeat the earlier procedures:
Level 1. In the analytic approach, we select space exercises that use each
of the five senses. We introduce new movements gradua lly until the child
is unable to perform them. later, these movements are re-introduced as
his performance improves. A lthough we use exercises for vision, hearing.
proprioception, and touch, the exercises for the vestibular sense are the
most important for hearing-impaired children.
Level 2. In the synthetic approach, we attempt to stimu late all the senses.
Ini tially. we integrate only a few senses; more are added as the child
progresses.
l evel 3. In the global-structural approach, we use exercises that develop
automatic motor behavior which is used in daily life. Since Verbo-Tonal
rehabilitation attempts to unify the sensory inputs, these vestibular exer-
cises enhance the child's ability to restructure behavior (see Chapter 8).

3. EVALUATION PR OC ED URES

Initially all chi ldren and adu lts are examined by an otolaryngologist and
are tested using standard audiometry. If the patient has a hearing loss he
is given the appropriate Verba-Tonal tests. Some young, congenitally deaf
children may not be able to respond to the Verbo-Tonal tests until after
they have received some therapy. Therefore, they wou ld enter therapy
having had only standard audiometry; and they would be given Verbo-
Tonal tests when possible. The purpose of the tests is to determine the pa-
tient's sensitivity for speech and to evaluate his ability to understand
speech. Furthermore, the patient's responses help us to plan the therapy
and evaluate his progress.

7
Threshold Evaluations

VERBO-TONAL SPEECH DETECTION THRESHOLDS,

Guberina developed the stimu li for his tests from his early investigations
of speech perception. He passed vowels and consonants through octave.
band filters and asked normal-hearing listeners to identify them. He ob-
served that certain consonants and vowels were easily identified in spe-
cific octave bands(Guberina 1964, 1972; McKenney & Asp 1972; Asp 1975;
Miner & Danhauer 1977}. When the C-V (consonant vowel) syllable is fil-
tered through a frequency band other than its "optimal" band, it is per-
ceived as some other consonant-vowel combination. Therefore. he
selected those consonant-vowel combinations which were identified con-
sistently for each octave-band and used them for the stimuli in the speech
detection test (see Table 1).
Each two-syllable. frequency specific stimulus is called a logotome.
We recorded the logotomes unfiltered and fittered through their respec-
tive " optimal" octave bands, and the patients respond at hearing thresh-
old levels(dB HTL) relative to the average threshold responses of normal-
hearing listeners.
Because the logotome is " optima l" for its frequency band, the pa-
tient's threshold responses to these stimuli indicate his sensi tivity not only
for the logotome but also for the frequency band. In other words. we use
speech stimu li (Verba) to evaluate sensitivity for various frequencies
(Tonal).

TABLE 1
Verbo-Tonal Audiogram: Pure Tone Audiogram:
Detection Thresholds Detection Thresholds

Logoto mes Optimal Octave Comparable Pure Tone

of Logotome (Hz) (Hz)

Ibru brul 50-100 75

Imu mul 75-150 125
Ibu bul 150-300 250
Ivo vol 300-600 SOO
/Ia lal 600-1200 1()()()
Ike kel 1200-2400 2000
I i il 2400-4800 3000
lsi sil 4000-9600 6000
lsi sil 6400-12,800 8000

•
 We compare the patient's detection thresholds for the filtered and
unfiltered logotomes to his thresholds for pure-tones (see Table 1), If his
threshold for a filtered logotome is significantly better than his threshold
for the comparable pure-tone, he has the potential to understand speech
through his "optimal" frequency area. Conversely, if his threshold for the
logotome is poorer than his pure-tone threshold, he may have difficulty
using this frequency region to discriminate speech.

TRANSFER TESTS

In Chapter 1 we said that hearing-impaired people can learn to perceive

phonemes which are outside their pure-tone sensitivity range. Guberina
designed "Transfer Tests" to assess the patient's potential to perceptually
transform speech sounds and to evaluate his progress in therapy. In these
tests, the patient's thresholds for logotomes which are filtered through
their respective optimal bands are compared to his thresholds for logo-
tomes which are filtered through (Guberina's "transferred to") non-
optimal bands.
In the test of Low Transfer; a high-frequency logotome, e.g. l si sil, is
filtered through a low-frequency band, e.g. 200-400 Hz. If the patient is
more sensitive for lsi sil in the non-optimal, low-frequency band than in its
optimal band (4800-96CXJ Hz), he has the potential to perceptually trans-
form speech in the low frequencies. This is not to be confused with "fre-
quency transposition," in which computers transpose acoustic informa-
tion into the low frequencies- a physical process. We are speaking here
about the patient's potential to transform the stimulus-a perceptual
process.
For the test of High Transfer; a low-frequency logotome is passed
through a high-frequency band. If the patient detects the stimulus better
in the high frequencies, he may be able to use the high frequencies for
discrimination.
We discussed discontinuous transmission and speech perception in
the first chapter. To test the patient's potential to use a discontinuous fre-
quency band, we pass a high-frequency logotome simultaneously
through its optimal-octave band and through a low-frequency band. The
patient's discontinuous threshold is compared to his optimal-octave
threshold. If his discontinuous threshold is better; he has the potential to
combine low and high frequencies to enhance his perception of the high
frequencies.

9
Speech Discrimination Evaluation

We are concerned not only with speech detection but also with speech
discrimination. How well does the patient discriminate words that are
presented at levels above his detection thresholds? At what intensity and
in what frequency regions does he discriminate the words best? To explain
the development of the stimuli for these supra-threshold tests. we must
discuss the idea of " tonality" in speech sounds.
Earlier studies in psychoacoustics (Fairbanks 1940.1950; Black 1949)
related the vowel's pitch to the physical measurement of fundamental
frequency(Fo ). Some of the studies used listener's judgments. while others
did not In most studies, the physical measurement of Fo and "pitch" were
used interchangeably. However. whispered vowels, which do not have
normal phonation, can be recorded in pairs and judged for pitch(Harbold
1954). Moreover, when two different vowels lal and Iii are produced with
the same Fo' most listeners will choose Iii as being higher in "pitch." This
choice cannot now be related to the Fo; rather, it is related to the higher
formant structure of /i/. These are the same formants that help us distin-
guish one vowel from another.
To differentiate between the judgment of " pitch" that is related to
the vocal qualities (Fo) and the judgment of spectral " pitch" that may be
involved in phoneme discrimination, the authors use the term "tonal ity"
for the latter.
Norma ~hearing subjects judged the tonality of consonants as well
as vowels (Peterson 1971; Peterson & Asp 1972; Boring 1942). After all of
the phonemes have been judged, we can arrange them on a perceptual
continuum and divide the continuum into five tonality categories: low.
low-middle. middle. midd le-high, high. Thus. consonants and vowels that
fall into anyone of the categories are homogeneous and can be COfl}
bined to form a syllable having the same tonality. For example, luI, Ip/.
and /bl all have low tonality, and the syll ables /pul and /bul have the same
tonality. These five tona lity categories represent a progression on the
sa me frequency continuum as the logotomes. I n other words. low ton-
ality stimu li are low-frequency stimuli. When a patient responds to low
tonality syllables, he responds to low-frequency stimu li.

SPEECH DISCRIMINATION CURVE

To develop the stimu li for the speech discrimination tests, we selected

English words that contained homogeneous-tonality phonemes. Then.
normal--hearing listeners were asked to judge the tonalities of the words.

10
The results indicated that the words can be arranged in the same order on
the frequency continuum as the logotomes. That is, the unfiltered ton-
ality words correspond to the frequency regions of the logotomes when
the latter are filtered into their optima l bands (Asp, Berry, & Bessel 1978;
Bessel & Asp 1980). For example, "cease" is a high tonality word, and its
tonality is the same high frequency as the optimal-octave as lsi si/ -
480)..9600 Hz. Furthermore, because the words were distributed along the
frequency continuum, they can be grouped into the f ive tona lity cate-
gories mentioned previously.
For the discrimination tests, two words from each tonality category
were recorded to form discrimination lists of 10 words each. We use these
lists to eva luate the patient's discrimination (% correct) at each 10 dB in-
crement above his detection threshold. We continue to increase the in-
tensity until we have reached the patient's tolerance level or the audio-
meter's output limit For the speech discrim ination curve, we plot the dis-
crimination score as a fu nction of intensity. In previous years this display
was called the articulation curve; recently it has been called the PI func-
tion (performance vs. intensity).

TONALITY TESTS

Although the speech discrimination score gives us some information

about the patient's performance as a function of intensity, it does not tell
us what perceptual errors he is making or what these errors mean. Which
sounds are easy for him? How has he progressed from one training session
to another? Which hearing aid is the best for him? The tonality tests were
designed to supply this information.
The stimuli for the tests are five words from each of the five
categories. Using these twenty-five words, we can establish the patient's
"performance vs. frequency" (PF) function because each tonality group
represents a portion of the frequency continuum.
In the first tonality test the stimuli are presented in "free f ield," un-
aided, at normal conversational level if possible, to obtain a baseline
measurement for each category.
After we have established the baseline, we use the tonality words
and a SUVAG I I instrument to determine the patient's optimal f ield of
hearing (OFH) for training. The SUVAG II is a multt.channel filter which
allows the examiner to transmit speech at various intensity levels through
different f requency responses (see Chapter 4). The O FH is the frequency
response that elicits the patient's best discrimination score. W hen the to-

"
nality words are presented through the patient's optimal field of hearing.
we gain valuable information about his listening abi lity.
Earl ier we said that we evaluate the patient's potential to discover
acoustic clues (perceptual transformation) when we cbtain threshold re-
sponses to the logotomes in the Transfer Tests. However, the optimal oc-
taves of the logotomes are linked to the tonality categories on the fre-
quency continuum. Therefore, if the patient's responses to the logotomes
at threshold levels represent his potential to transform the stimuli, then his
responses to the tonality words at supra-threshold levels shou ld indicate
his ability to transform the stimuli. Furthermore, if we can measure this
abil ity as a function of frequency(PF), we can also monitor his progress in
therapy.
As the patient progresses in therapy; he may be able to understand
speech through a wider frequency response than his initial OFH, with no
deterioration in his performance. We continue to enlarge his field of hear-
ing until he no longer improves. At this point, the tonality lists are again
used to evaluate the patient's performance with hearing aids.

Additional Evaluations
Even after a child or adult has started a therapy program, his program
may continue to be " diagnostic-therapy./I We may need up to six months
to present a detailed diagnosis and therapy plan for some patients,
especially for those who have severe communication disorders.
We are thankful for other professionals who help us evaluate the
patients. An otolaryngologist or audiologist administers the vestibular
tests. Previous studies at the Zagreb Center have shown a close relation-
ship between the vestibular function and the child's motor and speech
ability. If the vestibular response is normal. the prognosis for the chi ld is
good. Occasionally, the child's vestibular response improves during regu-
lar therapy.
A speech pathologist eva luates normal-hearing patients w ho have
speech and language disorders, and a psychologist evaluates the child ren
who have learning problems.

12
4. SUVAG AUDITORY TRAINING UNITS

The instruments used in the Verbo·Tonal Method are SUVAC J, SUVAG II,
SUVAC lingua for classroom, SUVAC lingua for individual therapy, and
Mini-SUVAG hearing aid. The operation and characteristics of each unit
are described below.
The SUVAG I aduditory training unit is used daily for individual
therapy a nd for classroom activities with six to ten hearing-impaired chj~
dren. The teacher selects the output condition which can be either a flat
frequency response{O.5 to 2O,0X) Hz) or a low-frequency band pass(O.5 to
300,600, 1cxx), 2(XX) Hz), The teacher's microphone is positioned near her
mouth to provide a good signa~tc~noise ratio. The children wear a bone
vibrator (SUVAG Vibar) strapped to their wrists, andio r circumau ral head-
sets (Koss K-6). The equipment is designed to allow the teacher and the
chi ldren to move f reely,
The SUVAC II is a multiple fi lter unit that is used duri ng individual
therapy for hearing-impaired people. It has five independent channels: (a)
a flat f requency response (0.5 to 2O,<XX) Hz); (b) low-pass filters; (c) low-
peaking filters; (d) high-pass filters; and (e) high-peaking filters. The f ilters
have variable cut-off frequencies and slopes and independent dB level
controls for each channel. Thus the SUVAC II can be adjusted to produce
almost any frequency response. The clinician selects the frequency
response where the patient achieves the best understanding of speech
(optimal field of hearing). During training sessions, she adjusts the fre-
quency response to correct the patient's perceptu al errors.
The SUVAG Lingua for classroom is an instrument that f aci litates
teaching a foreign language to groups of 10 to 30 pupi ls. This unit can be
set for a flat frequency response (0.5 to 2O,<XX) Hz), a 320 Hz low-pass fi~
ter, a 3200 Hz high-pass filter, or a miG-frequency response with emphasis
at 500 Hz and at 4<XX> Hz. The SUVAC Lingua modifies the prerecOf"ded
foreign language lessons which are presented to the class through a high
quality loudspeaker. With the low-pass setting. the people hear the
rhythm and intonation of the language they are trying to learn. The high-
pass filter is added to obtain more tension in t he production and percep-
tion. O nce the pupi ls learn the correct rhythm and intonation. the teacher
switches to the mid-frequency response to develop the correct produc-
tion and perception of the phonemes (speech sounds) of that language.
Then the flat frequency response is used to prepare the student for every-
day listening situations.
 The SUVAG lingua which we use for individual therapy is a multiple
filter unit sim ilar to SUVAG 11. It has seven independent channels, which
include the following: (a) a flat frequency response (0.5 to 2O,(X)) Hz); (b)
a low-pass filter of 320 Hz and lower frequencies; (c) high-pass filters of
3200 Hz and higher; and (d) fou r band-pass fi lters, each of which is
capable of 'Il-, 'fl-, and l-octave settings and a wide range of center fre-
quencies (8 to 8()(X) Hz). The low-pass and high-pass filters are used as
described above in the SUVAG lingua classroom application. The band-
pass fi lters emphasize the phoneme the pupi l is trying to perceive, With
this unit, the pupil can learn to produce and perceive the correct rhythm
and intonation as well as the phonemes of the target language. It is used
in foreign language training and in rehabilitating normal-hearing patients
who have speech disorders.
The Mini-SUVAG hearing aid is a wea rable, " body" hearing aid that
can be used as an auditory tra ining unit when the chi ld is away f rom the
center or school. It has a frequency response that is similar to the SUVAG
I (8 Hz t020,0CM) Hz) and can be set for a Jow-pass condition. This portable
aid is capable of driving a vibrator (SUVAG Vibar) and a pair of head-
phones(Koss K-6) or hearing aid receivers, simu ltaneously. It is especially
useful for people who cannot understand speech through the air conduc-
t ion channel. For these people, the vibrator can be strapped to their wrist
to develop their sensitivity for speech; the air conduction mode is added
later.
Information on these units is available from Dr. H ilton Smith, Presi-
dent, University of Tennessee Research Corp., 404 Andy Holt Tower.
University of Tennessee, Knoxville, Tennessee 37916; (615) 974-3466.

5. HABILITATION FOR HEARING·IMPAIRED CHILDREN

Diagnostic-Therapy Program

W hen a child's responses to standard audiometry suggest or confi rm that

he has a hearing loss, he is enrolled in a Verbo-Tonal diagnostiNherapy
program. The pu rpose of this program is to evaluate his ability to imitate
rhythm and intonation patterns, to assess his muscular co-ordination, and
to observe his reaction to amplification. We discuss the results and thei r
implications with the parents, and we explain the therapy program. The
child is then enrolled in therapy with a group of children who have similar
diagnostic results.

Pre-School Program
Croups of six to ten hearing-impaired chi ldren receive three to five hours
of training daily. The children usually begin this program when they are
three years old and they stay for a minimum of three years. The percent-
age of children who can be integrated increases if they start therapy
earlier or if they continue in therapy for a feo.v years beyond the first grade
(see Chapter 8).
The classroom teacher and the individual therapist are responsible
for the child's training. The parents do not have to become special
educators. They are encouraged to treat their hearing-impaired child in
the same way that they would treat a normal-hearing child. However; if
the parents prefer to become more directly involved. they are not dis-
couraged from doing so.
The format of the pre-school program has advantages for parents
who work: (1) the children are occupied for an extended period of time
each day so the parents don't have to make special arrangements for
transportation and baby-sitting as they would if the child attended a 1 hr.
session 3 days/week; (2) the cost is reduced because we can train the chil-
dren in group sessions rather than privately; (3) the parents can use their
time at home to fulfill their obligations as parents. however they under-
stand this role.

Procedures

The SUVAG I auditory training unit is set for a wide frequency response
(0.5 to 2O,OCO Hz) or for a low-pass response (0.5 to 300, 600, lOCO, or 200)
Hz), depending on the requirements of the children in the group.
The teacher'S microphone is positioned near her mouth to prOVide a
good signai-to-noise ratio. During the group sessions, the children receive
visual clues naturally; however. they don't receive any lipreading in-
structions.
When the young children begin therapy they sit on a sounding
board that is driven by bone vibrators (SUVAG Vibar) from the output of
the SUVAG I unit During this stage, the children use the upper half of
their bodies for " movement activities." As the child adapts to the situa-
tion and responds to the activities, a bone vibrator is strapped to his wrist

15
so that he can move about freely. If the child responds to speech that is
transmitted by air conduction, he is given Koss K~6 ci rcumau ral head-
phones in addition to the vibrator.
When the child has acquired some rhythm and intonation patterns,
the clinician attempts to evaluate his optimal field of hearing (see Chap-
ter 3) and correct his perceptual errors through a SUVAG II. Eventually.
the SUVAG II can be used for the individual therapy in the same way that
it is used for hearing~impaired adults (see Chapter 6).
Young profoundly deaf children use a Mini-SUVAG hearing aid
when they are away from the Center. This body hearing aid has a f r~
quency response similar to SUVAG I. and can be worn with a vibrator a nd
headphones or hearing aid receivers.
For chi ldren who have a moderate-to-severe hearing loss, a com-
mercial hearing aid is recommended in the ea rly stages of therapy if they
can listen and respond to spoken language.

Therapy Me thods
Group lessons occupy 80% of the child's time in the first stage of therapy.
During these lessons we concentrate on helping the chi ldren develop the
rhythm and intonation patterns of spoken language with a normal voice
quality. They receive continuous, but informal, speech stimu lation.
The children learn the social aspect of speech through structured
play si tuations which promote spontaneous physical and emotional reac-
tions. They learn to play with one another and as a group. They become
so involved in the activities that even three-year-olds will "work" for three
hou rs with only a few short breaks. Consequently; the chi ldren have fun
learning to speak because they have something they want to say. They
learn how to say it through "phonetic rhythm" games which include
movement activities and nursery rhythms.
In Chapter 2 we discussed the importance of the vestibular sense in
developing the rhythm and intonation patterns of language. Movement
activi ties stimulate this sense of space perception. They help develop the
c hild's memory for motor patterns. These activities promote muscu lar
gene ralization: by manipulating and controll ing the muscle tension
throughout his body; the chi ld learns to control the tension in his speech
muscula ture.
The tension in the movement activities corresponds either to the
tension in the intonation pattern or to the relative tension of the pho-
nemes. For example, when the intonation pattern rises in the game the
chi ldre n are playing. the movement activity is more tense and is di rected
away from the body's state of rest If the intonation pattern falls, the terr
sion decreases in the movements and the activity is directed toward a
state of rest
As the child develops natural motor patterns, he feels (SUVAG
Vibar) and hears (low frequencies from SUVAG 10 the associated speech
patterns. To facilitate the child's correct perception, the clinician initially
uses low- and mid-tonality sounds in the syllables (see Chapter 3). If high-
tonality sounds are introduced too early in the training. the child will
incorrectly perceive them as a low-tonality sound and will receive confus-
ing information from the movement activity.
We must stress here that the clinician controls the speech stimula-
tion in these activities, and she corrects the child's production indirectly. If
the child's intonation pattern is incorrect. the clinician can change the
tension in the movement activity, alter the duration, or substitute another
phoneme-one that is different in tonality and/or tension. If the child
produces incorrect phonemes, the clinician can modify the rhythm and
intonation pattern, alter the duration, or change the tension in the move-
ment activity. During this time the child is unaware that the clinician is
correcting his speech. He continues to have fun with the different
"games."
The movement activities are taught not only in games but also in
meaningful play situations. These situations are designed to elicit emo-
tional expressions (happy, sad, surprise, etc.) and the appropriate physical
reactions from the children and the teacher. Initially, the teacher supplies
the verbal response. Thus the children learn to associate the rhythm and
intonation that they produce, feel. and hear with the meaning. They learn
that the same utterance (e.g., "ohn) can be modified to express different
meanings. They learn that the intonation patterns not only are fun but
also convey information.
When the child can produce some simple repetitive syllables using
the correct intonation patterns, the clinician introduces the nursery
rhythms. Initially the chi ldren learn simple rhythms that have low-tonality
sounds, e.g. "ah boo bah boo boo boo bah" and they progress to com-
plex rhythms that contain high-tonality words. e.g. "Shower. shower, take
a shower, wash your shoulders, take a shower." The children memorize
the motor and auditory patterns, and they enjoy performing these
rhythms alone or in groups.
A small amount of time is allotted to " unaided" listening practice
daily. The group teacher takes each child aside for five minutes to assess
his ability to imitate some basic rhythm patterns when he receives the
auditory stimuli "unaided," i.e. without amplification, vibrations, or vis-

17
ual clues. To do this, she speaks very close to the chi ld's ear; gradually she
increases the distance. This practice prepares the child to use the rhythm
and intonation information when he receives a commercial hearing aid.
Each child also has individual therapy for 15 to 30 minutes daily.
During this session the teacher-clinician gives him ' the attention that the
classroom teacher could not give him in the group. When the child is
ready for a body hearing aid, she introduces him to the Mini-SUVAG hear-
ing aid, teaches him how to use it. and monitors his progress.
Initially, the child uses the SUVAG I and the SUVAG Viba r for the if")-
dividual therapy session just as he does for the group session. After he has
control over the rhythm and intonation and has acquired some language
and listening sk ills, the clinician attempts to evaluate his optimal field of
hearing on the SUVAG II (see Chapter 3). When the clinician is able to use
the SUVAG II for the individual therapy session, the profoundly deaf
child is then fu nctioning as a hearing-impaired person, and the therapy is
structured accordingly (see Chapter 6).
The children are taught to read and to write in the final stages of
therapy, after they have acquired reasonably intelligible oral communica-
tion. This is si milar to the developmenta l sequence that norma~hearing
children follow.
The results of these extensive training procedu res are that most of
the children have voice quality and suprasegmental patterns that are
close to normal (Sanatore 1980; Asp 1981). Their oral language skills are
good, often similar to the average of their norma~hearing peers, because
they have perceived and learned spoken language in meaningful
situations.

Integration Programs
The goal of the Verbo-Tonal Program is to integrate hearing-impaired chi~
dren into regular educational and socia l situations. Integration can be ac-
complished in a number of different ways. The most common way is to
enroll those preschool children who have developed normal oral and
social skills into kindergarten or the first grade either part-time or ful~
time. All of these children should continue to have 20-30 minutes of if")-
dividual therapy daily from a Verba-Tonal clinician to preserve the chi ld's
skills and to increase his ability to fu nction in a classroom where the sig-
na~to-noise ratio is usually very poc;oAs the children progress, these ses-
sions can be less frequent and scheduled when necessa ry.
For those chi ldren who cannot be integrated at six or seven years of
age, a specialized elementary school program should be available as part

18
of the Verbo-Tonal Program. At the SUVAC Center in Zagreb the children
continue with the basic Verbo-Tonal procedures described earlier, and
they follow the academic program for norma~hearing chi ldren in public
schools. Having had this extended Verbo-Tonal Training. many of the chi~
dren can be integrated bet\.veen seven and twelve years of age (see
Chapter 8).
Another way to integrate the children is to structure the pre-school
program so that the hearing-impaired children receive 1 Yz to 2 hours of
specialized training each day, and then they spend the rest of the day in a
class with norma~hearing children. This class wou ld follow a standard
nursery school program that has many activities and opportunities to use
oral commun ication skills. To obtain the best result, one or two hearing-
impaired children should be enrolled with 20 normal-hearing children.
With this approach, the hearing-impaired chi ldren have more time to
communicate with normal-hea ring chi ldren. Sometimes the norma~
hearing chi ldren can participate in the Verbo-Tonal training session.
The most difficult children to integrate are those who have multiple
handicaps in add ition to hearing impairments. These children usually
have neurological damage which affects their gross motor control as well
as their speech articulation. They need intensive training in motor pat-
terning to develop rhythm and intonation. Their training period is usually
longer and their integration with normal-hearing children may not be pos-
sible. Success depends on the structure of the program and on the availa-
bility of intensive training.
In summary, the Verbo-Tonal method stresses intensive intervention
strategies using both group and individual therapy sessions. Hearing-
impaired children develop good voice quality and rhythm and intonation
patterns because they use wide-band amplification and vibro-tactile stim-
ulation when they are developing these ski lls. Thus they develop intellig-
ible speech and language which enable them to commu nicate with
others. Once they have developed spontaneous oral skills, they learn to
read and to write normally. Most of these chi ldren adapt easily to amplifi-
cation and use their listening ski ll s to participate in a "hea ring" society.

19
6. REHABILITATION FOR HEARING·IMPAIRED ADULTS

After we have evaluated the patient's hearing. using both standard and
Verbo-Tonal procedures, and after we have identified 'the optimal field of
hearing. we schedule the hearing-impaired adults for auditory training on
SUVAG II. The training sessions are 30 to 60 minutes, two to five times per
week. The training perioo is one to three months for adults who acqu ired
a hearing loss after they had developed normal speech. OUf task is to help
them improve their listening ability, even though their sensitivity (hearing
loss) may remain the same.
The listening exercises are filtered through the patient's optimal
field of hearing (OFH). The OFH is explained in Chapter 3; briefly, it is a
limited frequency band, usually two or more octaves wide, having slopes
and"Cut-off frequencies that can be changed by the clinician. We begin
therapy using the patient's OFH because he perceives speech best in this
frequency region, and he needs less intensity here than in the frequency
areas where he is least sensitive. Thus he is less likely to be bothered by re-
cruitment or injured by intense sounds.
The patient receives speech through the vibrator (SUVAC Vibar)
andl or circumaural headsets (Koss K·6). The vibrator is placed on differ·
ent parts of the head or body to enhance the perception of intonation
and rhythm. Hence, the patient learns to extend his listening skills to in-
clude the information available in the rhythmic patterns of speech. The
headsets are used simultaneously with the vibro-tactile input or separ·
ately. When the patient can use the auditory system for rhythm and in-
tonation, the vibrator is no longer necessary.
The clinician helps the patient to correct his perceptual errors by
changin.; the frequency response on SUVAC II or by altering her voice
and rhythm patterns temporarily. If the clinician uses a rising inflection,
her voice will have more tension, making it easier for the patient to per-
ceive a higher pitched sound. Also, speaking more slowly or increasing or
decreasing the duration of a phoneme or a syllable will alter perception.
When the patient perceives the word or words correctly; the clinician en-
sures that he can then perceive the words correctly through his OFH with-
out her having to alter her voice.
During each session, the patient practices perceiving speech with-
out any amplification. The clinician finds the distance from the patient at
which he can perceive speech and delivers the practice words or sen-
tences. For one patient this distance might be five inches from his ear; for

2Q
another it might be three feet Speaking at normal conversational level.
the clinician attempts to increase the distance during each session. At the
end of V-T training. a patient who could perceive unaided speech at a
distance of three feet at the beginning of therapy, usually perceives it at
six feet
After we have corrected his perception through his OFH, we at-
tempt to broaden the patient's OFH without increasing his errors. During
the last few weeks of therapy, we recommend a hearing aid that has a fre-
quency response corresponding to his final optimal field of hearing.
The schedule of the SUVAC Center in Zagreb demonstrates how ill-
tense and organized this training can be. Each clinician works one shift
and has ten, one-half hour sessions per day(10 patients). There are a total
of ten clinicians on the two shifts, so 100 patients receive regular training
each day. Observers for the World Rehabilitation Fund were impressed to
see such intense training for listen ing skills prior to ca reful hearing aid
selection (Santore 1980; Asp 1981).
Although we discuss results in Chapter 8, we think one study is
worth noting here. In 1975c Asp and Berry reported that adults who re-
ceived regular Verbo-Tonal training improved their speech discrimination
by 20% . They also observed that the patients were able to transfer these
ski lls to daily listening situations and were able to function better with or
without amplification. The patients were able to use amplification better
in noisy situations than those patients who had not received training.
In summary, Verbo-Tonal training has a positive influence on the
communication ability of people who have acquired hearing losses. They
ca n be prepared to use amplification by being taught to use limited fre-
quency bands in which they have the best speech discrimination.

7. SPEEC H AN D LI STEN ING REHAB ILI TAT ION

FOR NORMAL-HEA RI NG PEOPLE

Normal-hearing people who have mild-to-severe speech and/or language

disorders use a SUVAC Lingua auditory training unit, with circumaural
headsets and vibrator (SUVAC Vibar). We present the speech stimuli at
nomlal conversational level and we modify the frequency response to
present a clear signal without the interference of background noise.

21
 By passing the speech through one-third, one-half, or one-octave
filters, we alter the acoustic characteristics of the stimuli. For example,
the 300 Hz low-pass filter enhances the rhythm and intonation patterns,
whereas adding the 3000 Hz high-pass filter enhances intelligibility and in-
creases the tension of the sounds; the octave band 200-400 Hz enhances
the perception of the vowel /u/, and the band 6400-12800 Hz emphasizes
the consonant /s/. The band is adjusted higher or lower in frequency
and/or intensity according to the response given by the client We adjust
the filters to correct perceptual errors while we help the client develop
the correct motor patterns of speech. After the error is corrected, the pa-
tient should be able to produce the correct speech sound when speech is
transmitted through a wide-band frequency response or when it is trans-
mitted naturally without the SUVAG.
The speech departments at the SUVAG Center in Zagreb and the
Gent Center in Belgium provide services for people who have speech, lan-
guage, and learning disorders. In September 1980. the University of Telr
nessee received a grant to develop these procedures for norma~hearing
children who have misarticulations (Asp 1981). At the University of Ten-
nessee, we also see children who have severe expressive language dis-
orders. These chi ldren have normal receptive language and intelligence.
but highly unintelligible speech. They improve significantly when they are
given group and individual therapy similar to that which is given to the
hearing-impai red children.
At the Zagreb Center; Mrs. M. Stajnko. a speech pathologist, and Dr.
M. Upovesk, a neurologist, have demonstrated that neurologically im-
paired individuals who have normal hearing benefit from Verbo-Tonal
therapy. The majority of the patients are elderly people who have had
strokes, tumors. or other neurological trauma caused by severe ac6-
dents. As a key member of the neurological diagnostic team, Mrs. Stajnko
observes each patient's surgery to better understand and plan the
rehabilitation process.
The rehabilitation program includes early, intensive intervention,
simultaneous speech and physical rehabilitation, and frequent consulta-
tion between the clinician and the surgeon. Rehabilitation can begin
immediately after the trauma, and it continues for at least 2 hours daily,
including weekends (Asp 1981).
The Zagreb Center provides group and individual training daily for
norma~hearing pre-schoolers who have severe motor and visual prob-
lems in addition to severe speech and language disorders. A specialist
works with these children to develop motor patterning and to improve
gross motor skills through rhythm and body movement exercises. These

12
exercises help them to produce normal rhythm and intonation patterns
and intelligible speech (Asp 1981). Recently Bennett (1980) demonstrated
a relationship between motor; suprasegmental, and language skills.
Workers at the Zagreb Center do not wait to see if maturation will
correct speech and language problems in very young chi ldren. When they
identify a problem, they begin therapy. Furthermore, Mrs. Stajnko has
devised a program for babies who are likely to have problems, i.e. " high-
risk" babies, and their families (Santore 1980).
In summary' results suggest that using SUVAG instruments and
movement therapy may lead to a shorter and more effective rehabilita-
t ion process for those people who have speech-language disorders.

8. RESULTS

For hearing-impaired children and adults, the goal of Verbo-Tonal therapy

is to help them develop good oral communication skills which will allow
them to freely interact with normal-hearing people. Young hearing-
impaired children should be integrated into regular classrooms as soon as
possible. In this chapter. we will attempt to assess how Verbo-Tonal Cen-
ters in North America and in Europe achieve this goal by reviewing the
evaluations of their patients' communication skills and integration rates.
The University of Tennessee Verbo-Tonal program provides regular
training for young hearing-impaired children. Evaluators of this program
have reported that the children showed significant improvement in oral
communication skills as a function of therapy (Asp 1969; Bradbury 1970;
Asp, French, & Lawson 1970; Asp 1973a; Asp, Archer. & Kline 1979; Asp
1981). Pre-school children who had the most therapy talked more fre-
quently with normal-hearing pre-schoolers than those who had less VT
therapy (Shirley 1972).
When the Verbo-Tonal program was compared to other programs,
our children had better listening and speaking skills than those who were
enrolled in a comparable oral day program (Woodfin 1971; Woodfin &
Asp 1971), and they had better articulation and oral reading skills than
children who were in a signed English(Total Communication) program at
a residential school for the deaf (Duncan 1976).

2J
 Between 1972 and 1978, 53% of the hearing-impaired children at
the University (average loss 90 dB in the better ear) were integrated into
public school classrooms{Asp, Archer, & Kline 1979). For the years 1976 to
1978, the percentages were 60, 62, and 71% respectively. More of these
children could have been integrated if they could have continued in ther-
apy beyond six years of age (Asp, Archer, & Kline 1979).
If the frequency response for the auditory training and the hearing
aid is carefully chosen, the rehabi litation time for adults and chi ldren
who developed hearing losses after they had developed language will be
shorter than for young congenitally deaf children (Asp & Berry 1975c). To
ensure that the test scores agree with the patient's personal evaluation of
his " handicap," it is necessary to include a noise and reverberation back-
ground with the speech stimulus (Mason 1977). When tested appropri-
ately, most patients show a 20% improvement in discrimination within 3
months of regular training (Asp & Berry 1975c). Some patients improve
their speech reception thresholds even though pure-tone thresholds re-
main the same (Vertes et at 1972). Generally, Verbo-Tonal training helps
the patients adjust to amplification and it improves their communication
ability in everyday listening situations.
The New York league for the Hard-of-Hearing provides aural reha-
bilitation for hearing-impaired adults and some children. Santore re-
ported that the Verbo-Tonal method satisfied the diagnostic and thera-
peutic needs of the hearing-impaired population better than other
auditory training programs previously used at the league. The pro-
cedures identified auditory functions that are not ordinarily diagnosed
with standard audiometric procedu res. Therefore, the therapy was partic-
ularly beneficial for people who did not function well in daily situations
even though they had good speech discrimination scores or for people
who were not able to adjust to amplification. In a five-year study of 80
adults, 71% of the patients had a significant improvement in auditory
perception (Santore 1978b).
Eisenberg & Santore (1976) presented a case study of a 12-year-old
child who had a congenital, profound bilateral sensori-neural hearing
loss. Despite substantial auditory training. he was unable to comprehend
any speech material through his binaural amplification or through the
audiometer prior to Verbo-Tonal therapy. Following two and one-half
yea rs of VT therapy. he was able to use his residual hearing to perceive
speech. His aided speech discrimination scores improved from 0% (prior
to therapy) to 56% . The authors suggested that this method should be
tried with other children who have not benefitted from standard
procedures.
 The Western Pennsylvania School for the Deaf. a residentia l school.
has adopted the Verba-Tonal Method for all grades. All of the chi ldren,
from those in the nursery school to those in the upper school, improved in
receptive and expressive communication ski lls. The prof essionals have
developed an interesting integration program in which the deaf children
and normal-hearing children are brought together either in the regular
public school classroom or at the residential school. Generally; the results
have been positive; however; the investigators have cautioned that such a
program must be carefully organized and frequently reviewed if it is to be
successful (Craig. Douglas, & Burke 1979).
Over the years a number of other programs in North America have
reported results. Investigators who evaluated the program at the Alex-
ander Graham Belt School for the Deaf in Columbus, Ohio, reported that
the method had advantages that traditional systems lacked (Black 1971).
The chi ldren improved their speech intelligibility and their rhythm and in-
tonation patterns{Card, Jones, Prillerman 1972). The Metropol itan School
for the Deaf in Toronto, Ontario, reported that the deaf children in all the
Verbo-Tonal classes progressed at least as much as the children in the reg-
ular program, and in some cases their progress was exceptional (Roberts
1%9).
Through two independent fellowships from the World Rehabilita-
tion Fund, Santore (1980) and Asp (1981) were able to observe and
evaluate major Verbo-Tonal Centers in Europe where the method is used
in different languages and cultures. In the following review, we will com-
bine information from the fellowship reports with results of studies which
were completed at the various centers.
The SUVAG Center in Zagreb, Yugoslavia, has grown over the past
25 years, and currently is the most comprehensive Verbo-Tonal Center in
the world. It provides services for people who have many kinds of com-
munication problems. In an early study sponsored by the United States
Government., the SUVAG Center evaluated the progress of 100 hearing-
impaired chi ldren over a five-year period (Guberina et a!. 1972). The
results showed that 44% of the children were integrated into regu lar
publ ic school classrooms, where they performed at the appropriate grade
level. {The number increased after the reporting period, December 1966,
because some of the child ren were sti ll in training at that time}. Thirty per
cent of the children improved significa ntly in speech discrim ination; 97%
improved when speech was presented through their op timal field of hea r-
ing; 92% improved in their ability to understand speech in a free field
presentation; and 23% achieved 100% intell igibility through a hearing
aid at a distance of ten feet More recent stat istics showed that 75 to 90%

25
of the hearing-impaired children from this center are integrated (Asp
1981).
Santore (1980) reported that the Zagreb pre-school children who
had moderate-to-severe hearing losses had uniformly excellent speech,
language, auditory sk ills, voice qual ities, rhythm and intonation patterns.
She attributed this result to the fact that they used body movement ac-
tivities and musical rhythm exercises to develop the auditory system for
speech and language acqu isition. The children who had profound hearing
losses had good voice quality, rhythm and speech patterns, and they were
able to communicate orally, In general, she was impressed with the
speech intelligibility and the spontaneous language skills of these
children.
Researchers at the Zagreb Center have studied the vestibu lar func-
tion and motor skills of the hearing-impaired children. These studies
showed that the children who had greater hearing losses also had more
vestibular impairment The chi ldren who had better peripheral vestibular
fu nction benefitted more from training. During the period of rehabilita-
tion, the majority of the children showed an improvement in central ves-
tibular responses which correlated with their improvement in motor and
oral communication skills (Cuberina et al. 1972).
The researchers also compared the sleep patterns of deaf chi ldren
from the V-T program, deaf children who had not received ¥T training.
and norma l-hearing children. The children from the V-T program had
rapid eye-movement patterns (REMs) sim ilar to those of the norma l-
hearing chi ldren. The REMs of the deaf chi ldren who had not received V-T
training were different from those of the normal-hearing children{Stojan-
ovic & Cuberina 1975).
Dr. Busquest is the director of the Verba-Tonal center in Argenteuil.
France; L'Ecole tntree Casanova. The center is fortunate to have a school
for normal-hearing children next door where they can integrate the deaf
children. Eight other elementary schools also participate in the integra-
tion program. During the 1979-80 school year, there were 134 hearing-
impaired children enrol led at l ' Ecole tntree Casanova. Although all of the
chi ldren use speech in class and in social situations, their speech was bet-
ter in structured situations than in spontaneous ones (Santore 1980). Fifty-
six per cent of the chi ldren between 3 and 14 years of age were integrated
on a partial or a full-time basis (Asp 1981).
The Verbo-Tona l Center in Paris, France, is co-ord inated by Professor
Cospodnetic. Over the past few years, 68% of the hearing-impa ired chit-
dren were integrated into the public schools. Those who cou ld not be
integrated were chi ldren who had a hearing loss greater than 100 dB (Asp
1981).
The Verbo~Tonal Center in Gent, Belgium, with Co-ordinator Ma-
dame l ayon, has over one thousand patients who have all types of com~
munication problems. The Gent Center has a comprehensive program for
infants (0 to 3 yrs.) and their parents which prepares the infants for the
p re~school program (3 to 6 yrs.). The overall o rganization and quality of
therapy in this Center is truly impressive. The Center integrates 99% of
the hearing-impaired chi ldren into regu lar classrooms by the sixth grade.
Of these, 40% are in tegrated by the second grade (Asp 1981),
In summary, the European Centers had the following integration
rates: (1) 75 to 90% at the Suvag Center in Zagreb; (2) 99% at the Gent
Center in Belgium; (3) 56% at the Argenteuil Center; and (4) 57% for the
Paris Center. These results indicate that the Verbo~Tona l programs have
been extremely successful in integrating the deaf chi ldren who begin
therapy at 2 or 3 yea rs of age, even if the parents lack the time, the
finances, or the education to become involved. Moreover; the results
from those centers that have an Infant/Parent program or from those
where the children can continue in therapy beyond the first grade suggest
that the children who are integrated are not the E'xception- they are the
rule. Most deaf children can develop good oral communication ski lls,
and they can enter a "hearing society."

9. TRAINING AT THE INSTITUTE OF AURAL REHABILITATION

The Institute of Aura l Rehabilitation (lAR) at the University of Tennessee

has been established to train and certify Verba-Tonal clinicians. The I....
stitute provides the follOWing: (1) certified instructors who supervise the
training; (2) information about educat ional and therapy materials (video
tapes, books, slides, curricula, etc.); and (3) information about the SUVAC
Auditory Training Units.
The IAR offers regular15-day workshops on the U.T. campus and in
other locations. The successfu l trainee is certified in one of the following
areas: (1) rehabilitating hea ri ng-impai red chi ldren and adult s; (2)

27
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10
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l7
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INTERNATIONAL EXCHANGE
OF INFORMATION IN REHABILITATION

WORLD REHABILITATION FU ND, INC.

Howa rd A. Rusk, M.D., President

James F. Garrett. Ph.D., Vice President

Diane E. Woods, C. R.C., Project Coordinator
Leonard Diller. Ph.D., Program Evaluation Consultant
John E. Muthard. Ph.D., Research Utilization Consultant
Adele Youdin, Project Secretary
Sylvia Wackstein, Secretary-Treasurer; WRF
Judith Maleter. Project Assistant
Project Officer. George Engstrom, Director of Utilization and
Trainin& National Institute of Handicapped Research

COOPERATING INTERNATIONAL ORGANIZATIONS

(US. Based)

University Centers for International Rehabilitation

Don Galvin, Director
Michigan State University, Michigan

Rehabil itation International U.SA

New York

Rehabilitation International
Norman Acton, Secretary General
New York

Partners of the Americas

Cregg Dixon, Director
Washington, D,C

People-to-People
Washington, D.C
ADVISORY COUNCIL
(Project Year 1980-81)

Diane de Castellane
Camite National Francais de liaison pour la Readaptation
des Handicapes, Paris

Mr. Fred Hill, Executive Director

Volu ntary Health Insurance Association of Australia

Professor aUe Hook, M.D.. Professor

Universitetet i Gotebor&. Sweden

Kurt-Alfons Jochheim
University of Cologne, Federal Republic of Germany

Aufikki Kananoja
R.I. Finnish Committee (RIFI), Helsinki

Barbara Keller
Pro Infirm is, Zurich

Yoke Kojima, Ph.D., Professor

Japan Women's University, Japan

Sulejman Masovic
Zagreb, Yugoslavia

cw. de Ruijter
lucasklinieken voor de Mijnstreek, Hoensbroek, Netherlands

Teresa Sell; Serra

Rome

Marian Weiss
5toleczne Centru m Rehabil itcji. Konstancin, Poland

George Wilson, Executive Director

Royal Association for Disability and Rehabilitation, England
American Coalition for Citizens with Disabilities, Washington, D.C.

Dr. Richard E. Desmond

Dept. of Special Education and Rehabilitation Counseling,
University of Pittsburgh, Pa.

D[ Martin McCavitt
International Activities Office, Rehabilitation Services
Administration, Washington, D.C.

Claude A. Myer, Director

Division of Vocational Rehabilitation Services, North Carolina
MONOGRAPHS
Project Years 1978·80

TITlE AUTHOR

1 Readaptation After Harald Sanne, M.D.

Myocardial Infarction Department of Rehabilitation
Medicine 1
Sahlgren's Hospital
University of Goteborg
Gotebor& Sweden
2 Hospital Based Community Sven-Jonas Dencker, M .D.
Support Services for Department II
Recovering Chronic LiJlhagen Hospital
Schizophrenics: The 5422 03 Hising Backa
Experience at lillhagen Sweden
Hospital. Gotebor& Sweden
3 Vocational Training for Trevor R. Parmenter, B.A.
Independent Living M.A.C. E.
Senior Lecturer in Special
Education
Macquarie University
North Ryde, Australia

4 The Value of Independent Jean Simkins

Living: Looking at Cost The Economist Intelligence Unit
Effectiveness in the U.K. 27 St James Place
(Issues for Discussion in the London, England
U.S.)
5 Attitudes and Disabled Vic Finkelstein, B.A.
People: Issues for Discussion (Hons) M.A., P.C.C.E .,
A.B.Ps.$; Lectu rer, Post·
Experience Course Unit
The Open University
Milton Keynes, MK7 6AA
Great Britain
6 Early Rehabi litation at the Aila larvikoski
Work Place Rehabilitation Foundation
Helsinki
7 The Role of Special Education Birgit Dyssegaard
in an Overall Rehabil itation Head, Department of Special
Program Education
County of Copenhagen
Denmark
Project Year 1980·81

TITLE AUTHO R

8 Justice, liberty. Compassion: Ruth Purtilo, Ph.D.

Analysis of and Implications Health Care Ethics and
for " Humane" Health Care Humanistic Studies
and Rehabilitation in the U.S. Massachusetts Ceneral Hospital
(Some lessons from Sweden) Institute of Health Professions
Boston, Massachusetts

9 Rehabilitation Medicine; The Alex Chantraine, MO.

State of the Art Hopital Cantonal
Universitaire de Ceneve
Switzerland
and
Q lle Hook, M.D.
Universitetet I Coteborg
Sweden

10 Interchange of American Gini laurie

and European Concepts of Editor, Rehabilitation Cazette
I ndependent living and and
Consumer I nvolvement of lex and Joyce Frieden
and by Disabled People Houston, Texas

11 The Prevention of Pressure Philip C. Noble

Sores for Persons with Bioengineering Division
Spinal Cord Injuries Royal Perth Hospital
Australia

12 People with Disabilities- Or. Philip N.H. Wood

Toward Acquiring Information ARC Epidemiology
Which Reflects More Sensitively Research Unit
Their Problems and Needs

13 Verbo-Tonal Method for People Carl W. Asp, Ph.D.

with Communication Problems University of Tennessee
Knoxville, TN
and
Petar Cuberina, Ph.D.
Yugoslavia