Eier (2013)


NOTE: Hints for completing this form can be found in “Directions for the Use of Collaboration Forms” section of the Dashboard.

C = clinician

CI = cochlear implant

G = grad

HL = hearing loss

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

TITR = Tune in™ to Reading


Source: Eier, A. R. (2013). Tune in™ to Reading, an interactive singing program, and children who are deaf or hard of hearing using cochlear implants: Could this program be effective in improving reading fluency. Independent Studies and Capstones. Paper 662. Program in Audiology and Communication Sciences, Washington University School of Medicine (St. Louis, MO.)

Manuscript: http://digitalcommons.wustl.edu/pacs_capstones/662



Reviewer(s): pmh


Date: October 28, 2015


Overall Assigned Grade (because there are no supporting data, the highest grade will be F): F


Level of Evidence: F = Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention.


Take Away: This article explored the feasibility of using Tune in™ to Reading (TITR, a music based interactive software program) to treat children with cochlear implants (CI). Although no effectiveness data were offered, the author indicated that TITR may be useful in improving the reading fluency of children with CI because

  • a review of the literature yielded research supporting its effectiveness with children with normal hearing
  • in many cases, the language used in TITR is appropriate for children with hearing loss
  • there is evidence that the interface of the TITR software and CIs can be successful, although some adjustments will be necessary.


  1. Was there a review of the literature supporting components of the intervention? Yes, a Narrative Review


  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Yes



  1. Was the intervention based on clinically sound clinical procedures? Yes


  1. Did the author(s) provide a rationale for components of the intervention? Yes. The author reviewed the literature pertaining to reading fluency and analyzed the software of “Tune in to Reading” (TITR) with respect to

– language level

– feasibility of using the software with cochlear implants (CI)

– ease of use

  1. Description of outcome measures:


– Are outcome measures suggested? Yes


The outcome measures are.

NOTE: The target behavior of this intervention was improved reading fluency (Outcome #1); the other outcomes are concerned with the author’s analysis of the adequacy of “Tune in to Reading” (TITR.)

  • Outcome #1: Improved reading fluency
  • Outcome #2: Appropriateness of the language level of TITR for children with CI
  • Outcome #3: Feasibility of using TITR software with children with CI
  • Outcome #4: Ease of use of TITR for children with CI


  1. Was generalization addressed? No



  1. Was maintenance addressed? No






PURPOSE: To analyze the potential effectiveness of TITR for improving the reading fluency of children with CI

POPULATION: Hearing Loss, deafness; Children


MODALITY TARGETED: production (reading)


ELEMENTS OF PROSODY USED AS INTERVENTION (list only if prosody is being used as a treatment technique with a nonprosodic outcome):  music (pitch, rate, rhythm)


DOSAGE: not applicable (NA)


ADMINISTRATOR: A variety of professional educators including teachers, deaf educators, Speech-Language Pathologists (SLPs) could also administer TITR


STIMULI: graphic (reading), music (auditory)




  • TITR is an interactive singing-based software program designed to facilitate reading fluency in children who do not have hearing loss (HL) for readers from Grade (G)1 through G8.
  • The major components of TITR are

– The clinician (C, in this case a professional educator) creates an account for the student and assigns a reading level.

– The C assists the student or participant (P) in identifying P’s vocal range.

– P selects a song from the appropriate song-list in the TUNEIN Library. (Appropriateness is determined by reading level and vocal range. The songs from an appropriate song list vary from simple, short or easier, to more complex. The rate of the song as well as the relationship between melody and band components can be adjusted.)

– P listens to the selected song 3 times. The singing and music are accompanied by the lyrics.

– P clicks on each vocabulary word in the lyrics. P then hears the definition of the word and sees a picture.

– P then attempts to sing the song. A red cursor highlights the words to facilitate singing using the appropriate tempo. A blue cursor provides feedback about pitch accuracy.

– Following the completion of each attempted song, P is awarded a star with the color representing an achievement level.

– After singing the song, 5 times the program administers a quiz that assesses:

  • comprehension
  • referential vocabulary
  • inferential vocabulary

– Criteria for at least partial credit for the song is 80% correct on the quiz. Following completion of the quiz, P returns to the song list.

  • The author’s support for TITR for CI users is

– her summarization of research with children without HL who used TITR (or its earlier versions) indicating that TITR was effective.

– most of the lyrics of the songs at the lowest reading level were appropriate for children with HL

– singing using a monotone (frequently observed in children with HL) does not appear to negatively affect progress through the program

– the potential modifications (slowing speed, reducing without instrumental distraction) appeared helpful

– the visual feedback also could help pitch and rhythm of the P.

  • The author’s concerns about TITR for CI users include

– The criteria for awarding the different stars at the end of a song were not clear.

– Less than half of the words in the vocabulary definitions at the lowest level were appropriate for children with HL.

– The phrasing in some of the songs did not represent speech phrasing.

– Although there are 3 options for connecting TITR software with CI, each option is associated with some drawbacks.


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