Tuesday, October 14, 2008

Auditory interventions - a trip down the rabbit hole

I posted two and a half years ago about problems with a lack of evidence for the Wilbarger intervention methods. In that post I included a link to http://www.sensorydefensiveness.com/ which at the time was allegedly sponsored by Pat Wilbarger. Now that website curiously redirects and links to a mirror page for Valerie Dejean and The Spectrum Center, which is now located in New York. Apparently they used to have a center in Maryland, but according to documents from the Maryland Board of Occupational Therapy Practice, it is a matter of public record that a Valerie Dejean surrendered her license to practice for several reasons including:
  • use of the Tomatis Electronic Ear which has been banned by the FDA
  • use of unlicensed persons to practice occupational therapy
  • fraudulent billing practices

I previously wrote about concerns with the Tomatis program and the FDA ban here.

So in summary this Tomatis progam is not generally accepted but some occupational therapists continue to flirt with these programs. I don't understand why.

I called The Spectrum Center today to get more information and they told me that they do not practice occupational therapy in New York state. They are still using the Tomatis device and they told me that they use a combined approach that includes sensory integration techniques and Tomatis. But it is not OT. On their website they call it "vestibular re integration" and claim "80 percent success in improving if not curing these 4000 autistic children."

This is just conjecture - but based on the current prices they reported to me ($400 for an evaluation and $7440 for the 'therapy') that is a windfall of over $30,000,000.00 dollars. That's not a bad days work, especially for someone who had to surrender their license to practice occupational therapy.

The rabbit hole continues - a Dr. Ron Minson owns Integrated Listening Systems. His work is based largely off of Tomatis as stated on his website - but rather than using the banned FDA device his system relies on music recorded on an IPod. They also have a 'device' that they sell (the iLs 1000) but I don't know if this is related to the banned FDA device.

Interestingly, in a fascinating document available online that references the Dejean case, the FDA is asked to evaluate the Tomatis version of the device. Referenced in the petition is that manipulation of the Freedom of Speech principle would allow filtered music to be streamed online or distributed on compact disc. The CDs or online streamed filtered music would presumably be protected as 'Free Speech.'

There are a plethora of 'filtered music' CDs and programs, like Dr. Minson's, that are being marketed and distributed in an apparent loophole around the FDA ban. So with all this filtered music - where are the devices located that MADE the filtered music?

So why mention Dr. Minson specifically? Well he is directly associated with Dr. Lucy Miller and together they co-founded the Sensory Therapies and Research (STAR) facility. The SPD Foundation (formerly the KID Foundation) is a Colorado public charity sponsored in part by STAR Center. According to this page, iLs makes donations and training discounts for the benefit of The SPD Foundation.

The SPD Foundation, from my perspective, has contributed significantly to the knowledge base of sensory processing disorders. But why be entangled with Tomatis and similar programs that are under such heavy criticism. At a time when people are trying to determine if SPD is eligible for inclusion in the DSM, how can alignment with Tomatis help the cause?

A bottom line issue remains - and I am still waiting for someone to stand up and explain this - but I believe that this auditory intervention is only tenuously related to occupational therapy practice. Occupational therapists don't typically intervene with direct auditory stimulation in any other interventions - so how did some practitioners come to think that this is within the OT scope of practice?

When most people think of auditory evaluations or auditory interventions they obviously think that is within the scope of practice of an audiologist or perhaps a speech pathologist. If you search the American Academy of Audiology website for 'Tomatis' there are no results returned. Anyone out there beside me wonder why? Here is the most recent document on the subject from the American Speech Language and Hearing Association. Do OTs know something that the speech therapy professionals don't?

I think that OT as a profession needs to come to grips with this issue. Here is my attempt to start a conversation.

edit 4/21/11 - fixed a few broken links that were moved/redirected.

edit 3/27/12 - again! fixed broken links that were moved/redirected. Does someone not like this post? Also, the sensorydefensiveness.com website now lists a page in (apparent) Japanese (according to Google Translation) about sushi. TOO FUNNY.

5 comments:

Liz Ditz said...

I thought of you and this post when I read this manifesto by Dr. Val, urging her fellow physicians to combat anti-science thinking in the medical field, posted at Science-Based Medicine:

Oct 07 2008: A “Shruggie” Awakening – One Doctor’s Journey Toward Scientific Enlightenment

The post ends:


The infiltration and whole cloth acceptance of pseudoscience (often being marketed as health and wellness practices) is misleading the public, fleecing our patients, and putting our children at risk. All the shruggies out there should soberly consider whether or not it’s ethical to remain indifferent and/or silent on the matter. Perhaps you don’t realize how high the stakes are (the very foundations of the scientific method and the integrity of our profession are indeed being attacked), or perhaps it will take a personal experience (as it did for me) for you to have an awakening. I sure hope that you’ll join the pro-science movement before lies seep deeper into the public consciousness through an Internet teeming with for-profit fake cures.

Marla said...

There are some very interesting posts here.

I would be very hesitant as a parent to try something that has so little research behind it.

Brian Riter said...

I always look forward to these posts. It's good to see that some in our community realize that the survival of our field depends upon science and valid research in order to ensure efficacy. Keep up the good work!

tlmurray said...

If you search for Tomatis at FDA.gov, you find that in 11/2008 the FDA said "it" was a medical device, but I am unclear what "it" is or was; then in 09/2009 the Miracle Ear was banned from import. The FDA response talks about the use of audio, and . . . well, you should read for yourself and see if it's clear as to exactly what is medical device. I have not found other FDA-related material than that.
And then I wonder: What do the practitioners do or use for the Tomatis method?

Christopher Alterio said...

Hi tlmurray,

Clinicians are using recordings of filtered music and some are also using the audiokinetron itself - there are some who are saying they are using it for 'education' and not for 'medical' purposes and that theoretically removes them from the clutches of the FDA. I don't know if this is a large issue or if enough of it is going on for there to be an enforcement effort to tamp it down.

Bottom line: highly controversial, not evidence-based, not supported by mainstream professionals, caveat emptor.