Charles Limb: Building the musical muscle

譯者: Meg Lee 審譯者: Yen-chung Nora Huang

Now when we think of our senses,

現在當我們想到知覺時

we don't usually think of the reasons

我們通常並不會特別去想

why they probably evolved, from a biological perspective.

從生物演化的觀點，他們是怎麼發展而成的

We don't really think of the evolutionary need

我們並不會特別去想在演化上有什麼需要

to be protected by our senses,

讓我們被這些知覺保護著

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

但這大概正是這些知覺得以演化的真正原因--

to keep us safe, to allow us to live.

保護我們安全，讓我們繼續存活

Really when we think of our senses,

當我們真的開始思考我們的知覺

or when we think of the loss of the sense,

或是思考失去某些知覺的可能時

we really think about something more like this:

我們其實是這樣子思考的：

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

可以去觸摸些高級用品，去品嘗些美食的能力

to smell something fragrant,

聞到香氣

to see something beautiful.

或看見美麗事物的能力

This is what we want out of our senses.

這是我們希望知覺可以帶給我們的

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

我們想要美好的事物；而不單只是物理功能而已

And when it comes to sensory restoration,

所以當我們講到知覺重建的時候

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

其實我們離可以提供美好的感受這階段還很遠

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

而這就是我今天想要談論的內容

Likewise for hearing.

好比說聽力

When we think about why we hear,

當你想到為什麼我們要聽

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

我們並不會想到是聽到警報的能力

although clearly that's an important thing.

雖然那當然是一件很重要的事

Really what we want to hear is music.

我們真正想要聽到的是音樂

(Music)

(音樂)

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

很多人都知道那是貝多芬的第七交響曲

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

也很多人知道在他寫這曲子的時候

when he wrote that.

他耳聾了，或接近全聾

Now I'd like to impress upon you

現在我想要強調的是

how unusual it is that we can hear music.

我們可以聽見音樂是一件多麼不尋常的事

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

音樂只是眾多奇怪事情的其中之一

It's acoustic vibrations in the air,

那是空氣中的聲波震動

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

微小的能量波動，搔動著我們的耳膜

Somehow in tickling our eardrum

基於某些原因，當耳膜被搔動的時候

that transmits energy down our hearing bones,

這些能量就會傳到我們的聽小骨

which get converted to a fluid impulse inside the cochlea

接著轉換成耳蝸內的流態神經衝動

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

接著便在我們的聽覺神經轉換成電子訊號

that somehow wind up in our brains

然後神奇的抵達我們的大腦

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

接收成一首歌或是一段美好的音樂

That process is entirely abstract and very, very unusual.

這個過程是完全抽象，和非常、非常不尋常的

And we could discuss that topic alone for days

單就這個主題我們就可以討論好幾天

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

去真的了解，當它們的起源都不過是空氣中的震動時

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

我們到底是怎麼去聽見這些充滿情緒的聲響的呢？

Turns out that if you have hearing loss,

結果發現當我們失去聽覺時

most people that lose their hearing

許多失去聽覺的人

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

都是失去所謂的耳蝸，內耳。

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

失去的是毛細胞的部分

Now if you had to pick a sense to lose,

現在如果讓你挑個知覺失去

I have to be very honest with you

我會非常誠實的跟你說

and say, we're better at restoring hearing

相較於其他知覺

than we are at restoring any sense that there is.

我們比較擅長重建聽力

In fact, nothing even actually comes close

事實上，沒有任何其他知覺的重建

to our ability to restore hearing.

和重建聽力的能力有得比

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

身為一個物理學家和外科醫師，我可以自信地告訴我的病人

that if you had to pick a sense to lose,

如果你非得挑個知覺失去

we are the furthest along medically and surgically with hearing.

聽覺重建是醫學上和手術上發展最進步的

As a musician, I can tell you

而身為一個音樂家，我可以告訴你

that if I had to have a cochlear implant,

如果我做了人工內蝸移植術

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

我將會心碎，徹底的心碎

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

因為我知道音樂聽起來再也不會像從前一樣了

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

現在我要播放一段影片給你們看

of a girl who's born deaf.

一個出生就失去聽覺的女孩

She's in a very supportive environment.

有個非常支持她的環境

Her mother's doing everything she can.

她的母親竭盡所能照顧她

Okay, play that video please.

好，請撥放影片

(Video) Mother: That's an owl.

(影片) 母親: 那是一隻貓頭鷹

Owl, yeah.

貓頭鷹，對

Owl. Owl.

貓頭鷹。貓頭鷹。

Yeah.

對

Baby. Baby.

寶貝。寶貝。

You want it?

你要這個嗎？

(Kiss)

(親吻)

Charles Limb: Now despite everything going for this child

Charles Limb：除了這些

in terms of family support

家庭給這孩子的支持

and simple infused learning,

和簡單的灌輸學習

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

對這些聽障的孩子，或出生就失去聽覺的嬰兒來說

has in this world

在這世界上，總是有些限制

in terms of social, educational, vocational opportunities.

不論是社會、教育、就業的機會

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

我不是指他們無法擁有美好的生命

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

我是說他們將會面對諸多阻礙

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

是聽力正常的人所不需要面對的

Now hearing loss and the treatment for hearing loss

到目前為止，聽力損失和治療聽障的技術

has really evolved in the past 200 years.

已經發展了將近200年

I mean literally,

我說真的

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

人們曾經試過將耳朵形狀的物體貼到耳朵上

and stick funnels in.

插根漏斗進去

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

那曾經是治療聽障的唯一可做的

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

當時我們甚至還沒辦法看到耳膜

So it's not too surprising

所以當時無法就聽障提供良好的治療

that there were no good treatments for hearing loss.

其實並不讓人驚訝

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

而今天我們有現代的多頻道內蝸植入手術

which is an outpatient procedure.

這是一個門診手術

It's surgically placed inside the inner ear.

要將這人工耳蝸手術放至在內耳

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

依據醫院的不同，手術約需一個半小時到兩個小時

under general anesthesia.

手術需要全身麻醉

And in the end, you achieve something like this

末了，你會得到類似這樣的結果

where an electrode array is inserted inside the cochlea.

一個電極陣列會插入你的耳蝸

Now actually, this is quite crude

事實上，相較於正常的內耳

in comparison to our regular inner ear.

這有點粗

But here is that same girl who is implanted now.

而這是和稍早影片中的同一個女孩，她現在做了植入手術

This is her 10 years later.

這是十年之後的她

And this is a video that was taken

而這個影片是由

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

我的手術導師John Niparko醫師主刀、錄製的

If we could play this video please.

麻煩播放這個影片

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

(影片) John Niparko: 所以妳寫了兩本書？

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

女孩: 我寫了兩本書 (母親:另外一本是書還是日記?)

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

女孩:不是，另一本也是書 (母親:喔,好)

JN: Well this book has seven chapters,

JN:這本書有七個章節

and the last chapter

而最後一個章節

is entitled "The Good Things About Being Deaf."

標題是「耳聾的好處」

Do you remember writing that chapter?

你還記得你寫過這個章節嗎?

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

女孩: 我記得。我記得寫了每一個章節。

JN: Yeah.

JN: 好。

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

女孩:有時候我妹妹會有點煩人

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

所以耳聾還滿方便的，讓我不要被她煩

JN: I see. And who is that?

JN: 我了解。那這是誰?

Girl: Holly. (JN: Okay.)

女孩: Holly。 (JN:好。)

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

母親: 這是她妹妹。(JN:她妹妹。) 女孩: 我的妹妹。

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

JN: 那你是怎麼避免被她煩的呢?

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

女孩: 我就把我的植入拿下來，然後我就什麼都聽不到了

(Laughter)

(笑聲)

It comes in handy.

很方便的

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

JN:所以妳不想要什麼聲響都聽得到嗎?

Girl: No.

女孩: 不想

CL: And so she's phenomenal.

CL: 她非常厲害

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

這絕對會被視為非常成功的案例

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

這正是。在現代醫學的角度說，這的確是個成功的故事

However, despite this incredible facility

但是，除了這些非常好的輔助設備

that some cochlear implant users display with language,

讓一些耳蝸植入者可以用語言表達之外

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

當你把收音機打開，他們突然就都聽不到音樂了

In fact, most implant users really struggle

事實上，幾乎所有的植入者都非常掙扎

and dislike music because it sounds so bad.

而且不喜歡音樂，因為聽起來很糟

And so when it comes to this idea

因此，當我們談到

of restoring beauty to somebody's life,

"重建美麗到這些人的生命裡"這點子時

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

關於聽覺，我們還有好長一段路要走

Now there are a lot of reasons for that.

這有很多原因

I mentioned earlier the fact

我稍早提到

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

音樂和語言不同，因為那很抽象

Language is very different. Language is very precise.

語言是非常精準的

In fact, the whole reason we use it

事實上，我們使用它的原因

is because it has semantic-specificity.

就是因為語言是有語意特異性

When you say a word,

當你說一個字

what you care is that word was perceived correctly.

你在意的是這個字有沒有被正確的解讀

You don't care that the word sounded pretty

當它被念出來的時候

when it was spoken.

你並不在意這個字好不好聽

Music is entirely different.

而音樂是截然不同的

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

當你聽到音樂，如果它不好聽，那又何必聽呢?

There's really very little point in listening to music

如果音樂對你來說不好聽的話

when it doesn't sound good to you.

聽音樂就沒有什麼意義

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

音樂聲學比語言更難

And you can see on this figure,

就像你從這個圖表可以看到的

that the frequency range

頻率的幅度、

and the decibel range, the dynamic range of music

分貝範圍、音樂的動態範圍

is far more heterogeneous.

差異度都遠高於語言

So if we had to design a perfect cochlear implant,

所以當我們要設計一個完美的耳蝸植入器時

what we would try to do

我們會嘗試的目標

is target it to be able to allow music transmission.

是能夠傳輸音樂

Because I always view music as the pinnacle of hearing.

因為我始終認為，音樂是聽覺的頂峰

If you can hear music,

如果你可以聽得到音樂

you should be able to hear anything.

那你應該什麼都可以聽得到

Now the problems begin first with pitch perception.

現在問題從音準開始

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

我的意思是，我們大部分人都知道，音準是建立音樂的基礎

And without the ability to perceive pitch well,

若沒有辨識音準的能力

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

音樂和旋律都是非常困難的

forget about a harmony and things like that.

更別提和諧度或是其他類似的事情

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

現在這是 拉赫曼尼諾夫 的<前奏曲>MIDI版本

Now if we could just play this.

現在我們播放這個

(Music)

(音樂)

Okay, now if we consider

好，現在我們考慮

that in a cochlear implant patient

對耳蝸植入患者

pitch perception could be off as much as two octaves,

音準的感知可以大到兩個八度

let's see what happens here

那我們來看看會發生什麼事

when we randomize this to within one semitone.

我們將這些隨機變換在半音的幅度裡

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

如果能在患者身上發現對一個半音音準的辨識能力的話，我們會很高興

Go ahead and play this one.

好，開始播放

(Music)

(音樂)

Now my goal in showing you that

我播放這個的目的

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

是想要讓你知道音樂不能這樣隨意的更換

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

你換了一點點，尤其是音準，整個曲子就不一樣了

And it might be that you kind of like that.

當然你可能有點喜歡新的版本

That's kind of hypnotic.

有點催眠的功效

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

但那很顯然不是音樂本來想要表現的

And you're not hearing the same thing

而且你現在並不是在聽

that most people who have normal hearing are hearing.

那個多數聽力正常的人可以聽到的版本

Now the other issue comes with,

另外一個隨之而來的問題是

not just the ability to tell pitches apart,

不單只是分辨音準的能力

but the ability to tell sounds apart.

還有分辨各種聲音的能力

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

多數耳蝸植入手術的患者無法分辨不同的樂器

If we could play these two sound clips in succession.

如果我們連續撥放這兩段聲音

(Trumpet)

(小喇叭)

The trumpet.

那是小喇叭

And the second one.

接著第二個

(Violin)

(小提琴)

That's a violin.

那是小提琴

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

它們有類似的聲波，但是截然不同的樂器

Cochlear implant users cannot tell the difference

耳蝸植入的患者無法分辨

between these instruments.

這兩個樂器之間的差異

The sound quality, or the sound of the sound

聲音的品質，或是聲音的聲音

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

是我用來形容音色，色調

they cannot tell these things whatsoever.

但他們怎麼都無法分辨這些的不同

This implant is not transmitting

這些植入並無法傳遞

the quality of music that usually provides things like warmth.

這些音質，好比溫暖的音色

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

現在如果你看這些植入手術患者的腦部

and you have them listen to speech,

然後讓他們聽一段演講

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

讓他們聽一段節奏，聽一段旋律

what you find is that the auditory cortex

你會發現，聽覺皮層

is the most active during speech.

在聽演講的時候最為活躍

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

你會以為這些植入對於演說有加分的效果、

they were designed for speech.

本來就是設計來聽話的

But actually if you look at melody,

然而，事實上你如果看看旋律

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

你會發現，相較於正常聽力者

in implant users compared with normal hearing controls.

在植入患者身上，皮質活動非常少

So for whatever reason,

不論原因為何

this implant is not successfully stimulating auditory cortices

當在接收旋律的時候

during melody perception.

這些植入無法成功刺激聽覺皮層

Now the next question is,

所以下一個問題是

well how does it really sound?

那旋律到底聽起來像什麼?

Now we've been doing some studies

現在我們做了一些研究

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

去了解這些音質對植入患者來說，到底像什麼

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

我要撥放兩段亞瑟小子（Usher）的影片

one which is normal

一段是正常的

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

一段幾乎沒有高頻和低頻

and not even that many mid frequencies.

也幾乎沒有中頻

Go ahead and play that.

現在我們播放

(Music)

(音樂)

(Limited Frequency Music)

(音頻限制的音樂)

I had patients tell me that those sound the same.

我有患者告訴我這兩段聽起來一樣

They cannot differentiate sound quality differences

在這兩段不同的音樂片段中

between those two clips.

他們沒有辦法分辨音質的差異

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

再強調一次，我們離想要達成的目標還非常非常遠

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

所以現在的問題是，有希望嗎?

And yes, there is hope.

有的，是有希望的

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

我不知道有沒有任何人知道這是誰

This is ... does somebody know?

這是....有人知道嗎?

This is Beethoven.

這是貝多芬

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

我們怎麼知道貝多芬的頭骨長這樣?

Because his grave was exhumed.

因為他的墳墓被挖掘出來

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

結果發現他死的時候，顳骨被取走(顳骨位於顱骨兩側，又稱為內耳門的開口)

to try to look at the cause of his deafness,

想辨別他失去聽覺的原因

which is why he has molding clay

這就是為什麼上面有一些模型用的陶土

and his skull is bulging out on the side there.

然後他的頭骨側面有些鼓鼓的

But Beethoven composed music

但是貝多芬即使在失去聽覺很久之後

long after he lost his hearing.

他依舊作曲

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

這顯示即使失去聽覺

the capacity for music remains.

音樂的能力還是保存下來

The brains remain hardwired for music.

大腦還是可以接受音樂

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

我非常幸運的可以和David Ryugo醫生一起工作

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

我們研究一些失聰的白貓

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

試著給它們做人工耳蝸植入

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

這是一隻被訓練會對小喇叭反應以換取食物的貓

(Music)

(音樂)

Text: Beethoven doesn't excite her.

文字:貝多芬並不讓她興奮

(Music)

(音樂)

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

柴可夫斯基的1812序曲也不值得她起床

(Trumpet)

(小喇叭)

But she jumps to action when called to duty!

但她聽到這個訊號立刻採取行動!

(Trumpet)

(小喇叭)

CL: Now I'm not suggesting

CL:我現在不是說

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

貓聽到這個小喇叭的聲音和我們聽到的是一樣的

I'm suggesting that with training

我是想說經過訓練

you can imbue a musical sound with significance,

你可以灌輸音樂聲的意義

even in a cat.

即使對象是一隻貓

If we were to direct efforts

如果我們現在把這些努力

towards training cochlear implant users to hear music --

用來訓練耳蝸植入者聽音樂--

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

因為現在基本上是完全沒有、

no rehabilitative strategies,

沒有任何康復的策略

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

很少真正使用先進技術提高音樂品質的努力--

we would come a long way.

我們有很長的路要走

Now I want to show you one last video.

我現在要播放最後一段影片

And this is of a student of mine named Joseph

這是我的一個學生叫作約瑟

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

我有幸和他在我的實驗室裡共事三年

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

他是聽障，在他接受人工耳蝸植入後

after he received the cochlear implant.

他學會彈鋼琴

And here's a video of Joseph.

這是一段約瑟的影片

(Music)

(音樂)

(Video) Joseph: I was born in 1986.

(影片) 約瑟: 我出生於1986年

And at about four months old,

大概四個月大的時候

I was diagnosed with profoundly severe hearing loss.

我被診斷有嚴重的聽覺障礙

Not long after,

在那不久之後

I was fitted with hearing aids.

我就裝了聽力輔助器

But although these hearing aids

但即使是當時市場上

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

最好的輔助器

they weren't very helpful.

也都不太有用

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

基於這個原因，我得學習讀唇語

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

我也其實聽不太到別人在說什麼

When I was 12 years old,

而當我十二歲的時候

I was one of the first few people in Singapore

我是新加坡頭少數幾個

who underwent cochlear implantation.

接受人工耳蝸植入手術的病人

And not long after I got my cochlear implant,

接受手術之後不久

I started learning how to play piano.

我就開始學琴

And it was absolutely wonderful.

而那真是太美好了

Since then, I've never looked back.

自從那之後，我再也不回頭看

CL: Joseph is phenomenal. He's brilliant.

CL:約瑟非常驚人，他太棒了

He is now a medical student at Yale University,

他現在是耶魯大學醫學系的學生

and he's contemplating a surgical career --

他目標成為外科手術醫生

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

是少數聽障者得以考慮擁有這樣的職業

There are almost no deaf surgeons anywhere.

這世界上幾乎沒有聽障的醫生

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

這基本上是前所未聞的，都拜科技所賜

And the fact that he can play the piano like that

而他可以彈琴這個事實

is a testament to his brain.

就是他大腦的最好證明

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

事實上，就算沒有植入你也可以學會彈琴

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

因為你只需要在適當的時機按下正確的按鍵

You don't actually have to hear it.

你其實不真的需要聽到聲音

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

我知道他聽得不好，因為我聽他唱過歌

(Laughter)

(笑聲)

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

而那是世界上最糟糕的事情之一

heartwarming, but awful.

非常溫暖人心，但是非常糟糕

(Laughter)

(笑聲)

And so there is certainly a lot of hope,

所以這世界的確有希望

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

但我們還有很多需要做的

So I just want to conclude with the following words.

所以我想要用下面這段話做為今天的結論

When it comes to restoration of hearing,

關於聽覺重建

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

我們確實已經走了一段很長的路

And we have a much longer way to go

然而關於重建完美聽力的想法

when it comes to the idea of restoring perfect hearing.

我們還有一段更長的路要走

And let me tell you right now,

現在，讓我告訴你

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

我們當然可以對聽得到說話感到滿意

But I tell you, if we lost our hearing,

但是我告訴你，如果我們失去聽力

if anyone here suddenly lost your hearing,

如果現在這裡任何一個人突然失去聽力

you would want perfect hearing back.

你會想要重拾完美的聽覺

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

你不會想要一個"還可以"的聽覺，你會想要完美的聽覺

Restoration of basic sensory function is critical.

重建這個基礎感知是非常重要的

And I don't mean to understate

我並不想低估

how important it is to restore basic function.

重建基礎功能的重要性

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

但是重建對於美的感知

where we can get inspiring.

是我們可以得到啟發的關鍵

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

而我想我們不應該放棄美好的事物

And I want to thank you for your time.

謝謝各位的時間

(Applause)

(鼓掌)