Interview with Richard Reed, HOPE Notes Developer, Musician, and Cochlear Implant User

Richard Reed

SMAKA: This is Carolyn Smaka from AudiologyOnline and today I'm speaking with Richard Reed who has developed a software program to help cochlear implant (CI) recipients enjoy music.

Richard, how did the idea to develop this program come about?

REED: I should begin by mentioning that I'm a cochlear implant recipient. At conferences and online, other CI users always ask about music. My project began as a way to address some of those questions. For a lot of CI users, once they do relatively well with speech comprehension, improved music is next on their wish list.

At its most basic, my CI music project pulls together some of the kinds of practice materials I wish I'd had early on in my own CI process.

SMAKA: Perhaps you could fill us in on your hearing history?

REED: I had great hearing growing up, was a lifelong musician, and played nightclubs in and around Providence, RI at the age of 13! My brother Tom plays bass. Our parents used to drop us off at gigs and pick us up afterward. I played all through high school and college;then went out on the road, mostly with Blues and R&B bands. I became a late-deafened adult due to an ototoxic antibiotic in the early 1990s. I used hearing aids for 10 years but hearing aids just couldn't do enough. For a long time, I was scared to get a cochlear implant, way too long in fact. I should've gotten one sooner. In 2002, after meeting some implant users who didn't have to speechread anymore, I made an appointment to have CI surgery. As for expectations, I mostly just wanted to hear my niece, Grace, as she learned to talk. She sings to me sometimes now, and even though I don't always like her song choices, I never ask her to stop. It's amazing to be able to tell whether or not I like a particular song again.

SMAKA: It's hard to imagine a life without a soundtrack. What was that like?

REED: One of the saddest things about hearing loss was how music went from being a source of solace and joy to being a horrible background noise that interfered with my ability to hold a so-called "normal" conversation. For anyone who loses their hearing- but perhaps especially late-deafened adults who know what they're missing- "music loss" is particularly heartbreaking. As someone who made a living playing in bands, and was passionate about music, it's hard to describe the experience without sounding melodramatic. When you lose your hearing, every attempt at conversation reminds you of the loss and every crowded room is a lonely place. See what I mean? If I'd been able to hear some of my favorite songs, the loss might've felt a bit less disheartening.

I wish I'd taken more of my audiologist's advice in the early days. He told me everything I needed to know, but it was hard to put his guidance into practice. I didn't want to feel foolish or different, so I'd try to bluff, which, of course, only made me appear foolish and/or different! Some of my pre-CI social gaffes are hilarious in retrospect, but in real-time, well, without subjecting your kind readers to any Rock & Roll vernacular, suffice to say it was a drag.

SMAKA: What's music like using your cochlear implant?

REED: After receiving my implant, music sounded stranger than ever, really distorted and surprisingly loud. I'd forgotten that anything could be that loud. My brain had grown used to aural dullness. When the CI got activated, thousands of rusty synapses snapped to attention, wow! But they didn't, or couldn't, make sense of all they were being asked to process. I heard a lot of things that didn't make sense at first.

For quite a while, distinguishing between any two musical instruments seemed impossible. Well, I might've been able to tell the difference between a bass and a flute, sure;but even that might've had a lot to do with the tactile thump of the bass and the flute's lack thereof. As pure sounds, they'd be separate but indistinct noises. After practicing and listening to friends play, little by little, over a period of weeks and months, music slowly became more tolerable. It wasn't how I remembered it, but it was becoming a little less strange anyway. Eventually I was able to hear, not just feel, the difference between instruments, and finally, between various notes and intervals. Now I can play again. I played a gig last night.

SMAKA: What instrument do you play?



Richard makes his living as a professional musician again, after years of missing music and then working to hear it, appreciate it, and play it again with his cochlear implant. He developed HOPE Notes to help other cochlear implant recipients with music listening.

REED: I play organ and piano in Rock & Roll and Blues bands, rootsy stuff. My favorite gigs lately are with the singer/songwriter Mark Cutler. Mark was nice enough to sing and play on my music project, as did a lot of other talented pals. I play squeezebox on a couple of songs on Mark's latest CD, called "Red".

These days I use a digital sampler unless a real piano or Hammond organ is provided by a concert promoter or nightclub. I played a real Hammond with a songwriter from Cape Verde named Ilo Ferreira a few weeks ago. The old buttons, sliders and knobs- not to mention the swirling tone- took some getting used to. After a few songs, it felt like driving a beautiful old car.

SMAKA: Do you do covers, write your own material, or both?

REED: Except for Blues bands, it's almost always original music, with an obscure or favorite cover tune or two tossed in when we feel like it. If someone in the audience yells out a song title and two or three guys know it, we'll usually give it a shot. Before I lost my hearing, I could do that without thinking. Now I have to concentrate, maybe for a verse and a chorus, but then I can usually relax and stop thinking completely!

While I've always been a happy sideman, I put on a different hat, writing most of the music for my CI music project, called "HOPE Notes".

SMAKA: When I talk to people who have cochlear implants, they tell me speech initially sounds distorted and strange and it takes time to make sense of it. Would you say that speech came sooner than music for you?

REED: Yes. My ability to understand speech returned quickly, but it definitely sounded strange at first, like cartoon chipmunk robots. Fortunately, my CI mentor, Janice Taylor, had explained that the whacky tone of human voices (even my own!) was temporary. Instead of scaring me, I actually enjoyed people sounding as if they were speaking through helium balloons for a few weeks. Plus, I could understand them! It was an amazing time, an aural rebirth. Speech perception improved with auditory-verbal therapy, books-on-tape, and conversing with family and friends. Spoken words now sound crisp and clear, as if everyone's an FM radio disc jokey. I can hear the /s/ and /t/ sounds more clearly than I remember them.

Music still doesn't sound like it used to but I've learned to really enjoy the sound of it- not every kind of music, but a lot, more than I dared hope- through my cochlear implant.

Some songs are gone forever, but that doesn't make me the least bit wistful anymore. It is what it is. Besides, no one can listen to every kind of music.



HOPE Notes is available through Cochlear Americas. To order, please visit: www.cochlearamericas.com/store

SMAKA: Tell me about "HOPE Notes".

REED: For CI users, anytime there are three or four instruments playing, music can seem like a messy audio lasagna;it's very difficult to discern the separate musical ingredients. Some pieces on the DVD version of HOPE Notes use song introductions, snippets of an individual instrument's most basic part, before the whole song begins. "Here's what the acoustic guitar will be doing, here's the singer, the bass, the drums, etc."

The DVD also uses very simple animations and text to help explain what we're trying to hear. Once we're more familiar with the DVD material, we can listen to the CD versions- maybe download a few onto an iPod. Obviously, the CD has fewer cues, which makes listeners rely more on their new aural memories, and, of course, their electric ears.

The project evolved and expanded in unexpected ways over time. Initially, I booked a few hours of studio time with the recording engineer and guitarist Emerson Torrey, an old friend. We recorded a few simple scales and chords. Fast forward three years, and I'd written, arranged and recorded many hundreds of audio tracks from which we built ten different listening exercises. Each piece has its own little mysteries and solutions. Like all music, it's up to the individual to figure out what it all means. Most of the pieces take the form of songs, while others are pretty straightforward music exercises.

SMAKA: Can this program be used for anyone that has a cochlear implant regardless of how long they've had it or what type they have?

REED: Yes. While no one can provide all the pieces to someone else's aural puzzle, it can take just one short musical phrase, one sung line or guitar riff, perhaps even just one note that sounds okay compared to the others, and you're on your way up, so don't look down! Everybody's CI experience is unique and that's especially true when it comes to music. And there are so many factors that influence musical taste: what your friends listen to, what you grew up listening to, the subliminal soundtrack of your first love, a soul-stirring concert, etc. But anybody can certainly try HOPE Notes. It's mostly Blues, Folk and Country: simple forms that might be familiar to some late-deafened listeners. There's not a lot of classical music included because I'm not a classical musician. There is a Beethoven piece, but it's done like a surf-rock instrumental. Some CI users might use HOPE Notes merely to build-up a tolerance for music, which might then lead to improved tonal perception. Eventually, they could have an easier time finding some songs online, in record stores or friend's libraries that speak more clearly to their own heart. That's the aim.

SMAKA: Music is so personal.

REED: That's right, and that's why, really, you have to work at this. These materials will seem oversimplified to people with two working biological ears. But for CI users, and many hearing aid users too, the complexity of the simplest musical tones will override the lack of adornment. There's no way around the noise, so embrace it! There aren't too many simple sounds once you can hear them again. Ask any CI user who's winced at the sound of a crinkled paper bag.

SMAKA: You mentioned other implant wearers said the program helped them. What kind of feedback have you gotten?

REED: The most gratifying reaction was someone who got so excited to hear and understand just a few notes that they broke down in tears. I had to gently make light of it, or I would've started crying too! But that's not the usual reaction. Many if not most listeners will find the exercises very noisy and confusing at first, and a bit easier to take with repeated listening.

One other thrilling reaction was a woman at a conference who asked the meaning of the word "pitch". Trick question, right? But no, she'd been born with a severe hearing loss and received her cochlear implant in her teens. She's in her twenties now and heard people talking about pitch, but she'd never experienced it. I showed her a piece from the HOPE Notes program that demonstrates a simple scale and a visual icon lights up, ascending and descending along with the melody. She saw where one note was higher or lower than the next. I explained that, melodically, pitches rise, fall or repeat. We focused on higher and lower frequencies. It was an epiphany for her, and a profoundly humbling thing to witness. I can't take credit. She did the work by asking the right questions, and by not giving up. I just happened to be there when a big piece of her individual puzzle fell into place.

Not everyone will have a musical "CI moment" from HOPE Notes. I wish! For most people it will take repeated listening, perhaps even way beyond boredom. Repetition is the key, I think. CI music success is as much about neuroplasticity as it is about the device. After speech comprehension has improved, what's between your ears has more to do with improving music perception than what you wear on them.

Just a few years ago, researchers were surprised when some CI users reported liking music. It didn't make sense on paper. The data doesn't support our being able to perceive enough useful musical information. But while music perception is in the mind, music appreciation is in the heart. Never mind words, sometimes statistics fail!

That said, I certainly can't speak highly enough about all the great underappreciated researchers and clinicians working on new devices and strategies. They've got it down, but are intent on making it better still. I've upgraded my external device three times, and am happier with each one.

SMAKA: I was so amazed when I talked to someone with an implant recently who told me that she still feels she's making improvements using her cochlear implant after having it for many years.

REED: Improved music seems a much more incremental process than augmented speech skills. That's an anecdotal generality of course. Individual results vary widely. Cochlear implant recipients will, on average, show the greatest communication improvement over the first year post-activation. They reach a plateau, but from that plateau, there are still some hard-scrabble hills to climb and a nicer view if you do climb them.

I find a lot of CI users give up on music. They get improved speech perception, and they're satisfied with that. Perhaps I would have been happy with just that too because, let's face it, being able to converse is more important than music. But music is much more than a mere luxury. I wouldn't be surprised if some form of proto tune pre-dated human speech: a caveman mom imitates her child's laughter, adds a mimicked bird call, then repeats them in a pattern: the first hit song! Seriously, music accompanies almost every human ritual, from our first birthday, school graduation, wedding, celebrations and funerals: it's not something we should choose to live without unless and until we've exhausted every possible option.

On the practical side for CI users, improved music appreciation has been tied to improved hearing-in-noise. Background noise is one of the biggest complaints from all hard of hearing persons. And music can help us more easily tune-in to the rhythms of everyday life, feel less awkward or isolated. It brings people together in positive ways.

It helps just to be able to recognize the sound of an instrument, let's say an acoustic guitar. Someone with two biologic ears hears an acoustic guitar in a restaurant, and can recognize that string-y tone immediately. Their ears and brains can better ignore it while they converse. When we listen through any device that uses a microphone- so less attuned to aural nuance than natural hearing- it's more difficult for your brain to ignore that background sound. However, if you can recognize an acoustic guitar, really differentiate it from the clatter of silverware, the chattering diners, etc. it's a little easier to process, to ignore, if you will. It'll still be a challenge, but recognition helps. I still fall back on speech reading and all the things I learned (so reluctantly at the time) while I was deaf. But speech reading and all the other hard-learned lessons of late-deafened adulthood are side strategies now. Hearing itself is once again the main method of interpretation. That's all thanks to the CI. There's a lot less stress now, too. Having music back in my life played a large role in that.

SMAKA: Who are some of your favorite blues musicians or your musical inspirations?

REED: I actually include some of them on a Blues song on HOPE Notes. "Blues Downtown" sung by Dave Howard of Roomful of Blues is about a guy whose girlfriend throws away all of his wonderful old vinyl records. I have friends who would have a breakdown if it ever happened to them! The storyline provided a light-hearted excuse to list some of my favorite Blues artists, like Howling Wolf, B.B. King, and Memphis Slim.

When it comes to old favorites, I think it's sometimes easier for CI users to embrace familiar styles wherever possible, but perhaps using unfamiliar material or arrangements. That way, listeners can't have expectations of how it's supposed to sound. They can't compare my songs to what they remember beyond thinking "It's supposed to be a little twangy if it's Country." That's helpful because our deepest musical memories can be so heartfelt that it's hard to get past the tonal contrast of before-and-after the CI. I suspect that the handful of CI users who claim music sounds completely natural post-activation, didn't have a full tonal spectrum to draw upon pre-surgery.

If I can bend CI users' ideas of what's good and bad, make it seem just "different", then hopefully some of them can get used to those differences and then someday retry an old favorite or two, and perhaps re-gain an appreciation of how it sounds now. The melodies and instrumentation will likely never sound the way they once did, but that's okay.

With unfamiliar music, CI users don't have any choice but to be open minded about it a little bit, because it can't dash their expectations. For instance, on HOPE Notes, I took "Twinkle Twinkle Little Star" and played the melody at Middle C on the piano, then higher up, and down low. Then, I changed the rhythm a little, adding a bit of a swing feel to it. Finally, I added a full-blown blues band in a minor key, so it's like taking "Twinkle, Twinkle", adding B.B. King's "The Thrill is Gone", and dividing by two. The goal is for anyone who remembers the melody of "Twinkle, Twinkle" to stretch their abilities some by trying to get into this blues tune. Being able to watch the notes of Thom Enright's guitar solo dance all over the screen might hopefully give folks a visual and aural glimpse of improvisation. I could understand only one or two notes of his slinky riffs when we recorded them, but now I could hum the whole solo. It's my new "Stairway to Heaven"!

Alas, it takes a lot of work, a lot of practice. There are some folks too, who won't ever be able to hear "real" music regardless of device, therapy, attitude or determination. For them, the rhythms, tone and poetry of nature, relationships, work and the arts will hopefully suffice. While I was deaf, reading Toni Morrison novels provided the feel of Blues, Thomas Hardy conveyed English folk songs in prose form, and Larry Brown's gritty stories were like American roots music on the page.

SMAKA: So many of us were introduced to blues through rock and roll. We heard the Stones or Zeppelin or the Doors do something, and then come to find out it was really an old blues number, like "Back Door Man" or "Little Red Rooster".

REED: Exactly. I found out about Otis Redding through the Young Rascals, and Thelonious Monk from Terry Adams of NRBQ. Roots musicians take the same three chords and reinvent them every time. There's a simplicity there, and even if implant users can't initially embrace it, I'm hoping they might at least put up with it for a while. From there, I'm hoping they get to the point where it sounds less odd. And then- and it's a leap, but why not take the jump?- from "less odd" to "not bad," all the way up to "that's better or even that's okay."

SMAKA: Tell me about some of the other tracks on HOPE Notes.

REED: Sure. The first piece on HOPE Notes, "The Thing with Scales", uses 12 different instruments, each one playing a major scale up and down, one at a time. Before and after each scale there's a plain drumbeat, so that it might be less boring. The piece was written to help people hear the difference between instruments, an acoustic guitar and a trombone, or an electric piano and an organ. I chose 12 instruments that are used elsewhere on the program, so that when someone tries listening to a song and is having problems, they might go back and try listening to the solo instrument on the Scales piece again. Along with recognition through practicing the Scales piece, I'm hoping for improvement of the tonal perception of those instruments within the context of the other exercises.

On vocal songs I asked the singers to sing very plainly, almost using their everyday speaking voices rather than "belting" or using vibrato or melisma (stretching one syllable over many notes). We then mixed the songs so that the vocals are up-front in the arrangement. With the exception of a hi hat and occasional cymbal tap, it's less noisy for having no cymbal crashes. We kept everything relatively soft compared to modern pop recordings, which are mixed very loud. Producers mix everything on "11" these days. Digital technology allows them to turn it way up without distorting. A lot of movies are mixed too loudly, too. And TV commercials - don't get me started!

As for other HOPE Notes songs, there's one called "Waltzing Miranda," a country waltz. I was trying for a Johnny Cash kind of feel, and I had the singer kind of speak the verses and sing the choruses. When you're watching the program, it shows each syllable of every word he sings as he sings it. I also threw in a short little trombone solo, because it's in a good frequency range for implant users, and I thought it sounded kind of comical and sad at the same time. No one expects a trombone in the middle of a country song. Good!

I co-wrote a song with Mark, using just acoustic guitar, cello, his voice and a mandolin solo. It's sung in Spanish, called "Canción en Español" about a guy who wishes that he could sing in Spanish. Simple enough theme, right? It's our variation on Paul McCartney's "Michele," where the narrator wanted to be able to sing in French. For people who speak Spanish, it's a nice simple story song. And people who don't speak Spanish aren't pressured to understand the words, but just try listening for speech sounds, Mark's pleading tone of voice in the chorus and the strumming of the guitar. There's a translation on-screen, similar to foreign movie subtitles. Even though it's very simple, you'd have to watch it more than once, probably more than four or five times, to begin getting all the various pieces of the audio puzzle. And I'll say it again, repetition is key.

Another song is called "Bayou Boys," which uses the melody of the traditional song "Buffalo Gals," set to a New Orleans rhythm. A piece called "The Man Upstairs," is all different drum sounds over which I tell a story. I give some clues as to which percussion sound is playing as the story unfolds. It's designed to help listeners to practice listening to the spoken word in background noise. It's like someone telling you a very corny joke at a noisy party.

Another song is called "Someone Else's Heartache." I wrote it on guitar, which imposed simplicity since I can't really play the guitar! The song's narrator has a melody stuck in his head, and he keeps singing that same melody over and over. It's a relatively uncomplicated folk song. We tried to avoid tedium by inserting a brief break in the middle. I'm hoping listeners might get the redundancy and build off of it.

SMAKA: To me, part of the beauty of HOPE Notes is that it's developed by a musician.

REED: Thanks. It was challenging, but it was fun. The biggest challenge was keeping it simple. I think Ray Charles said that writing a simple song is incredibly difficult. And he was a genius. It was much harder for me!

SMAKA: Does HOPE Notes walk the listener through different steps or is it more free flowing?

REED: With the exception of the first piece, it's more free flowing. I would recommend everyone start with the Scales piece. In it I introduce each instrument aloud, saying, for example, "Piano in C," and then, starting at middle C, the piano plays a rising scale. The listener can then decide which instrument they want to focus on. I would suggest repeated listening to the instrument that sounds the least strange. After that, they might skip around and see which pieces sound best (or the least odd!).

SMAKA: Are there plans for a follow-up to HOPE Notes?

REED: Yes, based on the feedback we get from the current version so that we can meet a wider range of individual needs and perhaps even requests. Hopefully, we'll receive a lot of constructive critiques and suggestions. I've got some new ideas sketched out. We're doing one verse of "Amazing Grace" with a barbershop quartet, showing each individual singer alone, then as a duo and trio, before we all four together. Harmony is one of the biggest musical challenges for CI users. I'd like to be able to let listeners mix the songs themselves somehow, maybe with an app for portable devices. We'll have to see what's feasible.

SMAKA: Have you met other cochlear implant recipients who are musicians?

REED: Only a few. But no matter what we listen to or play, we share a sincere gratitude for the return of music despite the difference in tone. Fortunately, a lot of children with implants are getting into music early. A lot of parents now are having their kids with CIs take music lessons, which is great.

SMAKA: How do people go about getting HOPE Notes, Richard?

REED: HOPE Notes is $19.99 and can be ordered through Cochlear. To place an order folks can visit: www.cochlearamericas.com/store, or call 1-(800)-523-5798.

SMAKA: What are your future plans?

REED: I'm playing gigs, traveling, recording and writing. This summer I'll visit England, Belgium and then attend the CI 2010 convention in Stockholm Sweden. I'll be talking to recipients and researchers about HOPE Notes and my CI music experiences. When I return, there are recording sessions with Bill Harley, a Grammy-award winning children's musician. I'll be playing accordion on his sessions, adding that Zydeco or Cajun feel to an acoustic tune or two. August is mostly live dates and lectures around New England, then some CI music workshops out west in the fall.

It's amazing to be able to play with people whose music I'm not familiar with. I ask for the chords and lyrics rather than just a recording of the songs, so I can better orient myself to the various parts;but after that my brain makes sense of it, and I can hear it pretty much ear it the way it's meant to be heard.

When I started doing gigs again, some of my old pals would jokingly introduce me as "Miracle Boy" because I'd been out of the scene for so long, and was back thanks to the CI. And occasionally, I'd play a wrong note or chord, which might happen still, but not as often. And I can laugh off mistakes now, rather than feeling completely lost.

SMAKA: Instead of "I can't do that anymore," it sounds like you take an "I can't do that yet" approach to life.

REED: That's a good way of putting it, but I wasn't always that way. Hearing loss had a seriously detrimental effect on my self-confidence. It reached into places I didn't know had anything to do with hearing. Low expectations are a key to success for cochlear implant users, but high hopes should always be in there too. It's not always an easy line to draw.

SMAKA: I wish you much success with HOPE Notes. Music is such an important part of my life, and I hope it helps others get that joy back.

REED: Thanks, Carolyn. People without hearing loss can't imagine the void of a life without music. For me, it was especially tough because all my friends are music fanatics or musicians. When I lost music, I couldn't believe how much my friends talked about music and how much it enriched our lives. Aside from listening and playing, it's really great to be able to converse about it again.

I talk to a lot of audiologists who are sad that they can't do more for their clients who ask about music. If HOPE Notes helps CI users with even just a few notes or instruments, then the sting of diminished hearing might be lessened a bit. I sure hope that happens. Any improvement in music perception or appreciation could lead to further growth. It sounds like a simple enough goal but it can take a lot of work on the listener's part. But the payoff is well worth it.

SMAKA: Richard, it has been a pleasure.

REED: Thanks again, Carolyn.

For More Information

Richard is working on a website;in the meantime, please visit his Facebook page about CIs, hearing aids, hearing loss & "music loss": www.facebook.com/reedsongs

For More Information - HOPE Notes



HOPE Notes is offered through HOPE, a Cochlear Americas program designed to support the cochlear implant community and the professionals who serve them. The HOPE program provides free online training as well as products and services on (re)habilitation for children and adults with implants and educational issues for children with hearing loss. For more information, please visit the HOPE area of the Cochlear Americas website at www.cochlearamericas.com/HOPE.