The concept of sound therapy is a result of a 17-year-old research project, which led to the creation of an “interactive multisensory environment (iMUSE)” which became possible when the audio, tactile and visual elements combined. [1] This environment was designed to improve the quality of life of the elderly and children with special needs. As the title indicates the sound is emphasised and the therapy and improvement of the wellbeing is achieved through exploring, expressing, playing and responding within the environment of iMUSE by the children or the elderly who receive the therapy.
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The research project which started in 1994, aimed at finding a new way to encourage the elderly or children with special needs who have something to say, to discover new ways of saying it. It is known that these people are often in a position that cannot say what they want and how they feel or they are just not “heard” by the others. [2] The concept of aesthetic resonation was first described by Philip Ellis in 1995 and became a key factor in the idea of sound therapy. [3] It is this factor that encourages creativity in people and motivates those who have something to say to find new ways of saying it. It facilitates personal growth, soothing that results to externalising certain inner moments. Ellis and his colleagues – Lieselotte Van Leeuwen and Kenneth Brown in the article ‘Visual Music Vibrations: Improving quality of life for the elderly and children with special needs’ claimed that the aesthetic resonation results from individual playful, investigative and expressive actions, where playful can be seen as an activity that includes surprising, spontaneous, powerful, stimulating and naive actions.
The project was divided into three phases. The first phase of the research started in 1994 and lasted until 1997/1998 and was concerned in establishing a non-invasive approach in a secure environment with sound and music technologies. This approach would allow for a response within the medium of sound while sonic environment would convert a simple physical movement into an attractive and stimulating sound with expressive possibilities. For example, during the lectures we were showed many videos of people who created beautiful music within that sonic environment, by just using their hands in order to initiate the physical movement needed. Within this environment, the participant patient would make a movement and that movement would be instantly translated into a sound. [4] This could be achieved with the use of soundbeam, a technology that I am going to explain further on. It was hoped that this would result in raising awareness, involvement, activity and pleasure for the participant. The development of physical control and the behavioural changes were also possible.
The second phase of the project began in 1997/1998, lasted until 2004 and became known as “VibroAcoustic Sound Therapy”. During this phase of the research, emphasis was given to the reception of low frequency vibrations to the participant. This was possible through the “Soundbox” and “Soundchair”. [5] As Ellis, Leeuwen and Brown indicate in their article, some previous research contacted by Wigram and Dileo in 1997, Skille and Wigram in 1995 and Williams in 1997 involving mostly the vibroacoustic techniques showed that the combination of low frequency sine tones with calming music improves physical and mental conditions. [6] Consequently, in this part of the research, different tapes of soothing and calming music of a content-free nature were made. [7] This music was often in 3/4 time, slow, calm and between 30-90 kHz. It is a fact that even though the music is determined by the pitch and the timing of the pulse, the environment is focused on the produced effect and not on the technologies used to produce it nor to the heard result. The vibrations are related to the feeling so the music is actually felt and not heard.
The third phase of the research started in 2004 and continues today. In this phase the visual aspect was added, creating a multisensory environment, which I have mentioned at the beginning, the iMUSE, as audio, tactile and visual are now finally all combined. Since 2004, three different approaches to visualisation have been created so far. The first approach uses software that allows colourful visual graphics to be projected on a screen when a physical movement or vocalisation occurs. The second software allows the participant to control the projection of a sequence of different pictures through physical movement, while the third software uses a camera input, which is placed in front of the participant on a stand for a clear and steady result. This creates either a static or a kaleidoscopic image produced by the physical appearance and the movement of the participant. The colours of the clothing of the participant and his or her movements are reflected in the pattern projected.
In general, an iMUSE session would normally have 3 sections: a vocal interaction using a microphone and a sound processor, with or without the involvement of the facilitator, a physical interaction using the Soundbeam alongside with visual effects and finally relaxation and a feeling of comfort and happiness through the experience of vibro-acoustic music accompanied by visual effects. [8]
To analyse the data in order to reveal and illustrate the results of the approach the method of “Layered Analysis” was developed; this aims “to collect a range of indicators that point to the multiple qualitative facets of a potentially significant concept”. [9] This way of analysis involving video recordings of each session which are finally processed, the processing occurs in four stages.
The first stage, the “source” tape, functions as an archive of development of each individual as it is actually a complete recording of each session. The second stage, named as “master” tape, summarises all the significant examples of an individual’s behaviour during the sessions. The third stage, the “layers” tape, is a selection of particular responses of the individual of each of the three sections of the sessions. Finally, the fourth stage is the “summary” tape. It is a 10-minute video that portrays the development of the individual from the beginning of the sessions. This type of analysis mainly focuses on the performed actions, like frequency, variability and content of vocalisation or physical movements. These allow for audio and visual feedback on the way that each individual prefers and chooses to interact. [10]
The study of the data that resulted from the analysis led the researchers to the understanding of the effects of sound therapy with the people who had received it. For example, it was observed that in the elderly there were changes in the mood and in the level of distress, depression, aggression, anxiety and relaxation. The following table was constructed, showing the often movement from the conditions and behaviour that are described in the Depended column towards the Responsive and then to the Independed state.
DEPENDED
RESPONSIVE
INDEPENDED
Isolated
Aware
Contributing
Indifferent
Reactive
Expressive
Frowning
Smiling
Laughing
Crying
Laughing
Expressing
Silent
Content
Receptive
Withdrawn
Thoughtful
Communicative
inward
Poised
interactive
11
Changes were also observed in children with special needs despite the different conditions like cerebral palsy, severe and profound multiple learning difficulties, ADHD and autism, that were presented. The results from the analysis showed that there were changes in their behaviour and these changes could be seen as an indication of progress. The recorded actions indicated a move in their behaviour, from involuntary to voluntary, from accidental to intended, from indifference to interest, from confined to expressive, from gross to fine, from exploratory to preconceived and from solitary to individual.
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All these, as previously mentioned, were and still are achieved with the use of the different music and sound technologies. These technologies include the soundbeam which “translates” the physical movement into sounds, the soundchair and soundbox, that allow the participant to feel the low frequency vibrations that are produced during the different sections of the sessions, the microphone and the different applications that allow for voice feedback and delay, the G-Force programs that enables the visual effects and of course the Arkaos which includes the three softwares mentioned above that allow for different visual effects. There is also a recent innovation, the Wii Painter, which allows the participant to draw on a screen using a remote controller, producing in the same time different sounds and low frequency vibrations.
However, it is important to mention that the improvements in people’s behaviour are not only achieved with the use of the technologies. Intensive interaction has a vital role as well. It was developed during the 80s by a team of staff working at Harperbury Hospital School Herfordshire, a school for people who have severe learning difficulties. It can be defined as “an approach to teaching the pre-speech fundamentals of communication to children and adults who have severe learning difficulties and/or autism and who are still at an early stage of communication development”. [12] When applying intensive interaction the communication partner adjusts his or her interpersonal behaviour. He or she might change his/her voice and body language as this is might be the key to look less threatening and interesting to the eyes of the individual.
The key is to respond to the other person’s actions and not to lead. In this way the communication partner does not create demands on the persons that they might not be able to cope with. In opposition, in this way they show the other persons that they value them and they enjoy being with them, allowing them in the same time to explore with making things happen and take the lead. The communicator uses sensitive observation to judge how well the interaction is going and always treats the thing the person does as if this is communication giving the chance to the person to respond as a communicator and to get to know what this feels like and what it involves.
Even though the technologies and techniques applied are extremely crucial to the outcome and to the betterment of one’s condition, nothing would really matter if the identification of needs is not valid and correct. The therapist/facilitator must know what movement control is possible, the perception and sensory levels, and of course, the motivational and emotional needs. The facilitator is able to find out about all these through published information like books and websites related to the different conditions that he or she might be interested in, through interviews of the caretakers and teachers and observations made at the special school or care home.
Moreover, at this point it feels right to mention the necessary characteristics of a facilitator. It is crucial that the facilitator should keep quiet, watch, listen and leave his or her own prejudices at the door. If the facilitator obeys these four and simple rules and has patience, then he or she is going to be able to discover and get to know the person that he or she is working with. [13]
Sound therapy is a person centred approach and focuses on the insight out. In other words it focused on the insight of the person, to his or her internal world, instead of the outside and as a result it enables the participant to address what is needed to be done and what he or she wants to be done. The facilitator does not guide the participant; in opposition, he or she is guided by him or her. Moreover, a sound therapy session is not only therapeutic. It is also fun and a pleasure for the participant which is a crucial factor during the sessions as this key factor may define whether or not the therapeutic session would be successful. It is known that the best way to achieve something is by having fun and enjoy oneself. Based on that, the facilitator should always focus on what people can do rather on what they cannot do. Their main aim should be the improvement of the quality of life and this is achieved by making the person to feel good and enjoy him or herself. Another important aspect about sound therapy is that the outcome is never predicted. Based on the fact that the participant chooses the content of the session, the facilitator is not able to predict the final result. Even if he or she makes some initial guesses, it is possible that they will be proven false.
Having to deal with such vulnerable people it is inevitable to think about ethics. The facilitators are obliged to have core values, establish set of standards, respect the human rights, promote well being, show highest professionalism, be fully trained and of course to do no harm. [14]
In terms of autism, different projects have been completed in the last two decades and some of them are described in the article ‘Living Sound: human interaction and children with autism’ by Phil Ellis and Lieselotte van Leeuwen. [15] They argue that the iMUSE environment is very effective for autistic people. The multisensory environment meets their needs and makes them to feel comfortable and secure. It is also able to provide each person with the sensory input that is suited to their individual needs. Moreover, it offers an enjoyable and predictable environment that gives the chance to each person to relax and reduce the level of anxiety. Finally it gives the opportunity to the participant to learn new skills.
When working with autistic people, as I have mentioned in a previous chapter, the aims are to develop communication skills managing at the same time to keep the person relaxed. The iMUSE environment meets the sensory needs of each individual making him or her feel secure and comfortable, enabling him or her n that way to find out and experiment with the fundamentals of communication. All these have as a result better concentration and attention.
The North East Autism Society did a project recently, in which four young autistic men took part. The four participants had some common characteristics. All four of them were experiencing high levels of anxiety, had limited communication skills, showed enjoyment when listening to music and had sensory differences that had different impacts on their daily life. They all had a half an hour session per week for four weeks. In that very small time significant changes were identified. Among those changes were the reduction of the level of anxiety, the increased concentration and focus, the decidedness and independence, and vocalisations and confidence. However, it was also observed that after the end of the project the four young men were steadily returning to their previous conditions.
The evidence that sound therapy is beneficial for autistic people is too strong to be ignored. Hence, there are plans for further investigation and for new research in the subject. For example, the North East Autism Society plans to do a project in which there will be an initial assessment of sensory profile and communication skills, then to identify the “Indicators of Wellbeing” and finally to record those indicators in order to give measures within and outside context of iMUSE sessions. [16]
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