Charles Limb: Building the musical muscle

翻译人员: Jing Gao 校对人员: Angelia King

Now when we think of our senses,

当我们想到我们的感官时，

we don't usually think of the reasons

我们一般不会从生物学的角度来考虑

why they probably evolved, from a biological perspective.

为什么我们会进化出感官。

We don't really think of the evolutionary need

我们并不会想到，因为进化需求，

to be protected by our senses,

我们需要得到感官的保护。

but that's probably why our senses really evolved --

但那也许才是我们的感官进化的真正原因——

to keep us safe, to allow us to live.

保护我们的安全，让我们得以存活。

Really when we think of our senses,

当我们想到我们的感官时，

or when we think of the loss of the sense,

或想到失去感官时，

we really think about something more like this:

我们更多想到的是：

the ability to touch something luxurious, to taste something delicious,

触摸奢华物品的能力，品尝美味食物的能力，

to smell something fragrant,

嗅到芬芳气息的能力，

to see something beautiful.

看见美丽事物的能力。

This is what we want out of our senses.

这些正是我们希望通过感官得到的东西。

We want beauty; we don't just want function.

我们追求美；我们不只是追求实用。

And when it comes to sensory restoration,

当我们帮患者恢复感官时，

we're still very far away from being able to provide beauty.

我们离帮助他们恢复赏美能力还差得远。

And that's what I'd like to talk to you a little bit about today.

这就是我今天想要和大家讲的。

Likewise for hearing.

听力亦如此。

When we think about why we hear,

当我们想到我们为什么要听时，

we don't often think about the ability to hear an alarm or a siren,

我们一般不会想到能听见警报或者警笛，

although clearly that's an important thing.

虽然毫无疑问这也是很重要的。

Really what we want to hear is music.

但我们真正想要听的是音乐。

(Music)

（音乐）

So many of you know that that's Beethoven's Seventh Symphony.

在座的许多都知道这是贝多芬的第七交响曲。

Many of you know that he was deaf, or near profoundly deaf,

在座的许多都知道当他谱写这首曲子时，

when he wrote that.

他已失聪，或近乎完全失聪。

Now I'd like to impress upon you

我想向诸位强调，

how unusual it is that we can hear music.

我们能够听到音乐， 是多么的不寻常。

Music is just one of the strangest things that there is.

音乐真是所有事物中最奇特的事物之一。

It's acoustic vibrations in the air,

它是空气中的声波震动，

little waves of energy in the air that tickle our eardrum.

空气中的微小的能量波敲击我们的耳膜。

Somehow in tickling our eardrum

在声波敲击我们的耳膜时，

that transmits energy down our hearing bones,

能量被传送入我们的听骨，

which get converted to a fluid impulse inside the cochlea

在耳蜗里被转化为流体性冲力，

and then somehow converted into an electrical signal in our auditory nerves

然后在我们的听觉神经中被转变成电信号，

that somehow wind up in our brains

最后传入我们的脑中，

as a perception of a song or a beautiful piece of music.

被大脑接收为一首歌或者一首美丽的乐曲。

That process is entirely abstract and very, very unusual.

这个过程是完全抽象的，而且非常、非常得不寻常。

And we could discuss that topic alone for days

我们光讨论这个话题就可以讨论上好多天，

to really try to figure out, how is it that we hear something that's emotional

来试着弄清楚，我们从最开始的空气中的震动，

from something that starts out as a vibration in the air?

到最后听到充满感情的音乐，到底是怎么一回事。

Turns out that if you have hearing loss,

事实上如果你失去了听力，

most people that lose their hearing

大多数人失去听力是

lose it at what's called the cochlea, the inner ear.

因为失去了耳蜗，就是内耳。

And it's at the hair cell level that they do this.

这种失聪发生在毛细胞水平。

Now if you had to pick a sense to lose,

如果你不得不失去一项感官的话，

I have to be very honest with you

我必须实话告诉你，

and say, we're better at restoring hearing

我们恢复听力的能力

than we are at restoring any sense that there is.

比我们恢复其他感官的能力都要好。

In fact, nothing even actually comes close

事实上，我们恢复其他感官的能力

to our ability to restore hearing.

跟我们恢复听力的能力根本没法比。

And as a physician and a surgeon, I can confidently tell my patients

作为一位内外科医生，我可以很自信地告诉我的病人，

that if you had to pick a sense to lose,

如果你不得不失去一项感官的话，

we are the furthest along medically and surgically with hearing.

从医学和手术角度上讲，我们更容易帮助你恢复听力。

As a musician, I can tell you

作为一个音乐家，我可以告诉你，

that if I had to have a cochlear implant,

如果我不得不做耳蜗植入的话，

I'd be heartbroken. I'd just be plainly heartbroken,

我会伤心欲绝的。我真的会伤心欲绝，

because I know that music would never sound the same to me.

因为我知道音乐听起来决不会和以前一样了。

Now this is a video that I'm going to show you

现在我想展示一段录像。

of a girl who's born deaf.

这段录像是关于一个失聪的女孩的。

She's in a very supportive environment.

她周围的环境给予了她很大的支持。

Her mother's doing everything she can.

她的妈妈做了一切她能做的事来支持她。

Okay, play that video please.

好，请播放这段录像。

(Video) Mother: That's an owl.

（录像）母亲：这是个猫头鹰。

Owl, yeah.

猫头鹰，对！

Owl. Owl.

猫头鹰。猫头鹰。

Yeah.

对！

Baby. Baby.

宝宝。宝宝。

You want it?

你想要宝宝么？

(Kiss)

（亲吻）

Charles Limb: Now despite everything going for this child

Charles Limb: 尽管这个孩子得到了许多帮助，

in terms of family support

有家庭支持，

and simple infused learning,

和简单的灌输式学习，

there is a limitation to what a child who's deaf, an infant who was born deaf,

但一个失聪的孩子，一个生来就失聪的孩子，

has in this world

在这个世界上能得到的东西还是有限的，

in terms of social, educational, vocational opportunities.

不管是社交方面、教育方面，还是职业方面。

I'm not saying that they can't live a beautiful, wonderful life.

我并不是说他们就不会有幸福美好的生活，

I'm saying that they're going to face obstacles

我只是说，他们要面对许多大多数听力正常的人

that most people who have normal hearing will not have to face.

不会遇到的困难。

Now hearing loss and the treatment for hearing loss

失聪和治疗失聪

has really evolved in the past 200 years.

在过去的200年有了很大的发展。

I mean literally,

过去人们会把耳朵形的东西插进你的耳朵里，

they used to do things like stick ear-shaped objects onto your ears

把漏斗插进你的耳朵里，

and stick funnels in.

是真的把这些东西插进耳朵里。

And that was the best you could do for hearing loss.

那就是当时我们能做的最好的失聪治疗了。

Back then you couldn't even look at the eardrum.

那时我们甚至不会看耳鼓。

So it's not too surprising

因此当时没有好的失聪治疗，

that there were no good treatments for hearing loss.

这一点也不吃惊。

And now today we have the modern multi-channel cochlear implant,

现在我们有现代的多通道人工耳蜗植入，

which is an outpatient procedure.

这是个门诊治疗。

It's surgically placed inside the inner ear.

人工耳蜗通过手术，被放置入内耳。

It takes about an hour and a half to two hours, depending on where it's done,

在全身麻醉下，根据手术地点，

under general anesthesia.

整个手术需要一个半到两个小时。

And in the end, you achieve something like this

手术最后就是这个效果，

where an electrode array is inserted inside the cochlea.

一个电极阵列被放入在耳蜗内部。

Now actually, this is quite crude

事实上，这个和我们正常的内耳比，

in comparison to our regular inner ear.

太粗糙了。

But here is that same girl who is implanted now.

但是这是刚才同一个女孩，她植入了人工耳蜗。

This is her 10 years later.

这是她10年后的录像。

And this is a video that was taken

这段录像是我的手术导师，John Niparko医生，拍摄的。

by my surgical mentor, Dr. John Niparko, who implanted her.

他为她做了人工耳蜗植入手术。

If we could play this video please.

请播放这段录像。

(Video) John Niparko: So you've written two books?

（录像）John Niparko：你写了两本书？

Girl: I have written two books. (Mother: Was the other one a book or a journal entry?)

女孩：我写了两本书。（母亲：另一本是书还是日记？）

Girl: No, the other one was a book. (Mother: Oh, okay.)

女孩：不，另一本是本书。（母亲：好吧。）

JN: Well this book has seven chapters,

JN：这本书有7个章节，

and the last chapter

最后一章

is entitled "The Good Things About Being Deaf."

叫做“失聪的美妙”。

Do you remember writing that chapter?

你还记得你写了这个章节么？

Girl: Yes I do. I remember writing every chapter.

女孩：记得。我记得我写过的每个章节。

JN: Yeah.

JN：好。

Girl: Well sometimes my sister can be kind of annoying.

女孩：有时候我妹妹很烦人。

So it comes in handy to not be annoyed by her.

失聪就不会被她烦到了。

JN: I see. And who is that?

JN：明白了。她是谁？

Girl: Holly. (JN: Okay.)

女孩：Holly。（JN：好吧。）

Mother: Her sister. (JN: Her sister.) Girl: My sister.

母亲：她的妹妹。（JN：她的妹妹。）女孩：我妹妹。

JN: And how can you avoid being annoyed by her?

JN：你怎么避免被她烦到？

Girl: I just take off my CI, and I don't hear anything.

女孩：我把我的人工耳蜗取下来，我就什么都听不到了。

(Laughter)

（笑声）

It comes in handy.

很方便的。

JN: So you don't want to hear everything that's out there?

JN：你不想听到所有的声音？

Girl: No.

女孩：不想。

CL: And so she's phenomenal.

CL：她的例子令人惊叹。

And there's no way that you can't look at that as an overwhelming success.

我们不能不承认人工耳蜗是个巨大的成功。

It is. It's a huge success story in modern medicine.

它是的。它是现代医学的巨大成功。

However, despite this incredible facility

然而，尽管这个设备如此奇特，

that some cochlear implant users display with language,

一些人工耳蜗的使用者甚至都写了书，

you turn on the radio and all of a sudden they can't hear music almost at all.

你打开收音机，他们却几乎完全听不到音乐。

In fact, most implant users really struggle

事实上，大部分人工耳蜗使用者听到音乐时一点也不喜欢，

and dislike music because it sounds so bad.

感到痛苦极了，因为音乐听起来太糟糕了。

And so when it comes to this idea

我们距离

of restoring beauty to somebody's life,

帮助病人恢复审美能力

we have a long way to go when it comes to audition.

还差的远得很。

Now there are a lot of reasons for that.

导致这个的原因有许多。

I mentioned earlier the fact

之前我提到过

that music is a different capacity because it's abstract.

音乐是不一样的，因为它是抽象的。

Language is very different. Language is very precise.

语言就不同了。语言非常的具体。

In fact, the whole reason we use it

事实上，我们使用语言，

is because it has semantic-specificity.

就是因为它具有特定的语义。

When you say a word,

当我们说到一个词时，

what you care is that word was perceived correctly.

我们在乎的是这个词是否被准确得理解了。

You don't care that the word sounded pretty

我们不在乎这个词说起来

when it was spoken.

好不好听。

Music is entirely different.

音乐完全不一样。

When you hear music, if it doesn't sound good, what's the point?

当我们听到音乐时，如果它不好听，我们还听什么？

There's really very little point in listening to music

如果音乐听起来不好听，

when it doesn't sound good to you.

我们就不会再听下去了。

The acoustics of music are much harder than those of language.

音乐的音质比语言的音质要高多了。

And you can see on this figure,

从这幅图中我们可以看到，

that the frequency range

音乐的频率范围，

and the decibel range, the dynamic range of music

分贝范围，和能动范围

is far more heterogeneous.

比起语言要复杂多了。

So if we had to design a perfect cochlear implant,

因此如果我们必须要设计出一个完美的人工耳蜗的话，

what we would try to do

我们必须要让它能够

is target it to be able to allow music transmission.

传输音乐。

Because I always view music as the pinnacle of hearing.

我一直把音乐视为听力的巅峰。

If you can hear music,

如果你能听见音乐，

you should be able to hear anything.

你就应该可以听见任何东西。

Now the problems begin first with pitch perception.

问题首先起于音高接收。

I mean, most of us know that pitch is a fundamental building block of music.

我们大部分人都知道音高是音乐的一个基本组成部分。

And without the ability to perceive pitch well,

如果不能很好地接收音高，

music and melody is a very difficult thing to do --

音乐和旋律听起来就会非常困难。

forget about a harmony and things like that.

更别说和弦之类的了。

Now this is a MIDI arrangement of Rachmaninoff's Prelude.

这是拉赫玛尼诺夫的序曲的MIDI版本。

Now if we could just play this.

我们来播放一下。

(Music)

（音乐）

Okay, now if we consider

好的，现在我们假设

that in a cochlear implant patient

有一个植入了人工耳蜗的病人，

pitch perception could be off as much as two octaves,

他的音高接收也许能差上两个八度，

let's see what happens here

我们来看看当我们随机地把这些音符升高或降低半个音调时

when we randomize this to within one semitone.

会发生什么。

We would be thrilled if we had one semitone pitch perception in cochlear implant users.

如果人工耳蜗的使用者能接收到半个音调的不同，那会好极了。

Go ahead and play this one.

播放一下这段音乐。

(Music)

（音乐）

Now my goal in showing you that

我向各位展示这段音乐的目的

is to show you that music is not robust to degradation.

是想展示音乐经不起损伤。

You distort it a little bit, especially in terms of pitch, and you've changed it.

你只是篡改了一点点，特别是从音高角度来讲，但你已经改变整个音乐。

And it might be that you kind of like that.

也许你有点喜欢这么做。

That's kind of hypnotic.

这有点儿像催眠。

But it certainly wasn't the way the music was intended.

但毫无疑问，音乐听起来不应该是这样的。

And you're not hearing the same thing

你听到的和大多数听力正常的人听到的

that most people who have normal hearing are hearing.

是不一样的。

Now the other issue comes with,

另一个问题不仅是因为病人

not just the ability to tell pitches apart,

缺乏区分音高的能力，

but the ability to tell sounds apart.

还因为他们无法区分声音。

Most cochlear implant users cannot tell the difference between an instrument.

大多数人工耳蜗使用者不能区分不同的乐器。

If we could play these two sound clips in succession.

我们来连续播放一下这两段音频。

(Trumpet)

（喇叭）

The trumpet.

喇叭。

And the second one.

第二段。

(Violin)

（小提琴）

That's a violin.

是小提琴。

These have similar wave forms. They're both sustained instruments.

这两段音频的声波波形很相似。它们都来自持续演奏的乐器。

Cochlear implant users cannot tell the difference

人工耳蜗使用者无法辨别

between these instruments.

乐器间的差异。

The sound quality, or the sound of the sound

我喜欢用音质，或是说声音的声音

is how I like to describe timbre, tone color --

来描述音色，音调——

they cannot tell these things whatsoever.

但人工耳蜗使用者无法辨别这些区别。

This implant is not transmitting

人工耳蜗没法传递

the quality of music that usually provides things like warmth.

音乐的质感，这种质感带给我们，比如说，温暖的感觉。

Now if you look at the brain of an individual who has a cochlear implant

我们来观察一下一位人工耳蜗使用者的大脑，

and you have them listen to speech,

让他听人讲话，

have them listen to rhythm and have them listen to melody,

或者听节奏，听旋律，

what you find is that the auditory cortex

我们会发现他的听觉皮层

is the most active during speech.

在他听别人讲话时最活跃。

You would think that because these implants are optimized for speech,

你也许会认为这是因为这些人工耳蜗是专为听讲话设计，

they were designed for speech.

会优化话语。

But actually if you look at melody,

但事实上我们来看一下人工耳蜗使用者听旋律时的反应，

what you find is that there's very little cortical activity

我们会发现，和听力正常的人比起来，

in implant users compared with normal hearing controls.

他们的皮质活动非常少。

So for whatever reason,

不管是基于什么原因，

this implant is not successfully stimulating auditory cortices

耳蜗的植入没能在病人听旋律时

during melody perception.

成功地刺激他的听觉皮层。

Now the next question is,

下一个问题就是，

well how does it really sound?

对于耳蜗植入者来说，音乐听起来到底是什么样的？

Now we've been doing some studies

我们一直在研究，

to really get a sense of what sound quality is like for these implant users.

对于这些人工耳蜗使用者，音质到底是什么样的。

I'm going to play you two clips of Usher,

我会给大家播放两段Usher的音乐，

one which is normal

一段是正常的，

and one which has almost no high frequencies, almost no low frequencies

另一断几乎没有高频音，没有低频音，

and not even that many mid frequencies.

甚至中频率音也没有多少。

Go ahead and play that.

来播放一下。

(Music)

（音乐）

(Limited Frequency Music)

（限频音乐）

I had patients tell me that those sound the same.

病人告诉我，这两段音乐听起来是一样的。

They cannot differentiate sound quality differences

他们不能区分

between those two clips.

这两段音频的音质。

Again, we are very, very far away in just getting to where we want to get to.

再一次强调，我们距离我们的目标还差得非常、非常远。

Now the question comes to mind: Is there any hope?

现在问题变成了：有希望么？

And yes, there is hope.

有的，希望是有的。

Now I don't know if anybody knows who this is.

我不知道有没有人知道这是谁。

This is ... does somebody know?

有人知道么？

This is Beethoven.

这是贝多芬。

Now why would we know what Beethoven's skull looks like?

我们为什么会知道贝多芬的头骨是什么样的？

Because his grave was exhumed.

因为他的坟墓被挖掘了。

And it turns out that his temporal bones were harvested when he died

事实上在他辞世时，他的颞骨被取走

to try to look at the cause of his deafness,

以研究他失聪的原因，

which is why he has molding clay

这就是为什么在他的头骨里有黏土，

and his skull is bulging out on the side there.

头骨的侧面是鼓出来的。

But Beethoven composed music

但是贝多芬在他失聪后很长时间

long after he lost his hearing.

还在作曲。

What that suggests is that, even in the case of hearing loss,

这意味着，即使在失去听力的情况下，

the capacity for music remains.

欣赏音乐的能力还是能保留下来。

The brains remain hardwired for music.

大脑还对音乐有感觉。

I've been very lucky to work with Dr. David Ryugo

我曾有幸和David Ryugo医生一同工作。

where I've been working on deaf cats that are white

在他那儿我研究，如果我们给失聪的白猫

and trying to figure out what happens when we give them cochlear implants.

植入人工耳蜗，会发生什么。

This is a cat that's been trained to respond to a trumpet for food.

这只猫受训后，知道喇叭声就是发食物的信号。

(Music)

（音乐）

Text: Beethoven doesn't excite her.

文字：她对贝多芬不感冒。

(Music)

（音乐）

The "1812 Overture" isn't worth waking for.

“1812序曲”也不管用。

(Trumpet)

（喇叭）

But she jumps to action when called to duty!

但是一听到喇叭，她就跳了起来！

(Trumpet)

（喇叭）

CL: Now I'm not suggesting

CL：我不是说

that the cat is hearing that trumpet the way we're hearing it.

这只猫听喇叭就跟我们听到喇叭一样。

I'm suggesting that with training

我是说，通过训练，

you can imbue a musical sound with significance,

你甚至可以给一只猫灌输

even in a cat.

一种特别的音乐。

If we were to direct efforts

如果我们花些功夫，

towards training cochlear implant users to hear music --

来训练人工耳蜗植入者听音乐——

because right now there's virtually no effort put towards that,

目前我们还从来没有在这方面上下过功夫，

no rehabilitative strategies,

我们没有什么康复策略，

very little in the way of technological advances to actually improve music --

我们也没什么能改进音乐的技术上的进步——

we would come a long way.

我们将取得很大的成就。

Now I want to show you one last video.

现在我想给大家播放最后一段录像。

And this is of a student of mine named Joseph

这是关于我的一个学生，他叫Joseph，

who I had the good fortune to work with for three years in my lab.

三年前我有幸和他在我的实验室里一同工作。

He's deaf, and he learned to play the piano

他失聪了，在他植入人工耳蜗后，

after he received the cochlear implant.

他学会了弹钢琴。

And here's a video of Joseph.

这是Joseph的录像。

(Music)

（音乐）

(Video) Joseph: I was born in 1986.

（录像）Joseph：我出生于1986年。

And at about four months old,

大概在我4个月大的时候，

I was diagnosed with profoundly severe hearing loss.

我被诊断患有严重的失聪。

Not long after,

之后没过多久，

I was fitted with hearing aids.

我开始使用助听器。

But although these hearing aids

尽管那些助听器

were the most powerful hearing aids on the market at the time,

是当时市场上最好的助听器，

they weren't very helpful.

它们没怎么帮到我。

So as a result, I had to rely on lip reading a lot,

因此，我不得不经常依靠唇读。

and I couldn't really hear what people were saying.

我没法真的听见人们在说什么。

When I was 12 years old,

在我12岁时，

I was one of the first few people in Singapore

我成了新加坡为数不多的、

who underwent cochlear implantation.

接受人工耳蜗植入的人。

And not long after I got my cochlear implant,

之后不久，

I started learning how to play piano.

我开始学习演奏钢琴。

And it was absolutely wonderful.

钢琴真是太美妙了。

Since then, I've never looked back.

从此之后，我一直在演奏。

CL: Joseph is phenomenal. He's brilliant.

CL： Joseph真是令人赞叹。他卓越杰出。

He is now a medical student at Yale University,

他现在是耶鲁大学的医学院学生，

and he's contemplating a surgical career --

他想作一位外科医生——

one of the first deaf individuals to consider a career in surgery.

他是最早考虑作外科医生的失聪患者之一。

There are almost no deaf surgeons anywhere.

失聪的外科医生几乎哪儿也没有。

And this is really unheard of stuff, and this is all because of this technology.

这前所未闻，这是人工耳蜗技术的功劳。

And the fact that he can play the piano like that

他能够那样演奏钢琴

is a testament to his brain.

是对他大脑的证明。

Truth of the matter is you can play the piano without a cochlear implant,

事实是，你没有人工耳蜗也可以弹钢琴，

because all you have to do is press the keys at the right time.

因为你只需要在适当的时间按琴键就是了。

You don't actually have to hear it.

你不需要真的能听见。

I know he doesn't hear well, because I've heard him do Karaoke.

我知道Joseph的听力不是很好，因为我听过他唱卡拉OK。

(Laughter)

（笑声）

And it's one of the most awful things --

那真是最糟糕的事情之一——

heartwarming, but awful.

他的心意我领了，但是还是很糟糕。

(Laughter)

（笑声）

And so there is certainly a lot of hope,

因此毫无疑问我们有希望帮患者恢复审美，

but there's a lot more that needs to be done.

但我们需要做的还有很多。

So I just want to conclude with the following words.

我想用以下的话来结束我的演讲。

When it comes to restoration of hearing,

说到帮患者恢复听力，

we have certainly come a long way, a remarkably long way.

我们毫无疑问已经走了一段很长、非常长的路。

And we have a much longer way to go

我们前方的路会更长，

when it comes to the idea of restoring perfect hearing.

如果我们想帮助患者恢复完美的听力。

And let me tell you right now,

我现在就告诉大家，

it's fine that we would all be very happy with speech.

我们为能听见别人讲话而满意，这没什么不好。

But I tell you, if we lost our hearing,

但我想告诉大家，如果我们失去了听力，

if anyone here suddenly lost your hearing,

如果在座的某位突然失去了听力，

you would want perfect hearing back.

我们会想要恢复完美的听力的。

You wouldn't want decent hearing, you would want perfect hearing.

我们不会想要不错的听力，我们想要完美的听力。

Restoration of basic sensory function is critical.

恢复基本的感官功能是极其重要的。

And I don't mean to understate

我不是在低估，

how important it is to restore basic function.

恢复基本功能的重要性。

But it's really restoration of the ability to perceive beauty

但我们真正会从中得到启发的，

where we can get inspiring.

是恢复欣赏美的能力。

And I don't think that we should give up on beauty.

我想我们不会放弃美的。

And I want to thank you for your time.

谢谢大家。

(Applause)

（掌声）