People – children and adults – make sounds apparently inadvertently: as a consequence of certain life-processes such as breathing, for example, or through haphazard movements of the limbs, head or trunk. Sounds may be made directly (for example, by knocking against something) or indirectly (for instance, through accidentally tapping a switch). Having made a sound, individuals appear to make no response (except, perhaps, a reflex reaction – see R.1). They do not try to repeat the movement to make the sound again.
Individuals are unable to act consciously on their environment, or are unaware of their capacity to do so; they have no sense of agency.
P.1.A the sounds made by life-processes are enhanced and/or involuntary movements are used to make or control sounds
Auditory feedback does not affect the movements that individuals make
Support children, young people and adults in developing an awareness of the sounds made by life-processes through amplifying, enhancing or otherwise modifying them, intensifying the auditory feedback that would typically be present. This may be achieved electronically, picking the sounds up using a microphone or specialist devices such as an electronic stethoscope, and then, for example, increasing the volume, altering tone colours, adding various types of reverberation, or repeating what is heard (through ‘looping’), using commercially available equipment. It is also possible to use the small movements associated with life that someone may make without being aware of them (such as the rise and fall of the chest in breathing, blinking or the twitches caused by muscle spasms) to cause or control sounds. The necessary interface may take the form of a sensitive electromechanical or pressure switch, or sounds may be triggered with no direct physical contact at all through gesture-recognition technology available on tablets or by using an ultrasonic beam linked to a MIDI device, through which even the tiniest movement can be made to cause or control any sound. You may be able to foster a sense of agency by setting up environments that are particularly conducive to sensorimotor interaction and allowing people to discover for themselves how they can affect the world around them – at first wholly by chance, then through an iterative process of trial and improvement. This is the principle behind Lilli Nielsen’s ‘Little Room’ – https://activelearningspace.org/equipment/purchase-equipment/little-room – a plastic cuboid, open at the base and on one side, large enough for a small child to lie in completely or to accommodate the head and trunk of a teenager or an adult. A number of soundmakers are suspended from the top of the box and others are secured to the sides; all within reach of the supine user. Any gross motor movement is almost guaranteed to make a sound, whose impact will be maximised by the high level of acoustic feedback that the confined environment offers. At the same time, the potential distractions of extraneous sounds are minimised. Further ideas for activities are to be found here. [DOC 28]
Brandon has profound and multiple learning difficulties. Here, he is working with a Soundbeam (an ultrasonic beam that functions as a series of invisible MIDI switches in the air), which is directed towards his right hand so that even the smallest movements will cause a sound to be made. The video excerpt is from the beginning of a 30 minute session.
Brandon occasionally makes short, jerky movements with his right hand that trigger clear, sustained notes via the beam.
The apparently random nature of the movements, which appear to be myoclonic, suggests that they are not intentional. Brandon does not visibly react to them, and there is no evidence that he connects the movement of his fingers to the sound that he causes.
Other video of Brandon
To see how Brandon's movements become larger and observably purposeful later in the session, go to P.2.A (c) (3rd video).
P.1.B sounds are made or controlled through co-active movements
Sounds are produced co-actively, but with no evidence of independent volition, and no reaction beyond reflexes to the sounds that are made.
A widely-held view (or at least, a widely-observed approach) is that people with profound disabilities can be supported to develop an understanding of cause and effect through co-activity: that is, through assisting them to make the movements necessary to effect change in the environment (including creating or controlling sounds). For example, you can place your hand under that of the person you are working with, so that they can potentially sense what is going on proprioceptively, and a cognitive map of the necessary movements may potentially be built up. A further (or alternative) approach is ‘hand-over-hand’. Here, individuals are guided to make the movements that are required to create or control sounds. It is important to be particularly sensitive when adopting this technique, as the person concerned will have little or no control over what is going on. On a larger scale, you can rock children, young people and adults to and fro in a beam such as that produced by the Soundbeam® – https://www.soundbeam.co.uk – for example, in order to create series of sounds. Further ideas for activities are to be found here. [DOC 28]
Rianne has profound and multiple learning difficulties. Here, she is on a summer vacation scheme organised by her school, at which a number of activities are offered, including music. She is being assisted to strum the guitar through co-active movement, hand under hand, which is a new experience for her.
Initially, there is no evidence that Rianne is aware of what she is causing sounds on the guitar – her hand remains closed, and her movements are entirely guided. However, as the interaction progresses, her fingers open up, each plucking the strings separately, and her hand is given less physical support.
It may be that some intentionality is starting to emerge in Rianne’s sound-making on the guitar.
P.1.C activities to promote sound production and/or control occur in a range of contexts
Different contexts appear to have no impact on intentionality in sound production.
Activities to promote sound production or control should occur in a range of contexts. Give individuals the opportunity to experience specialist environments such as Lilli Nielsen’s ‘Little Room’, which enhance the effects of sounds that are made while minimising auditory clutter (see P.1.A and R.1.C). Of course, other environments can potentially be stimulating too, including one-to-one teaching and therapy spaces, classrooms, day rooms, corridors, halls and different locations outside. Bear in mind that a person’s developing willingness and ability to create sounds intentionally may be affected by a range of factors, such as the time of day. Internal influences may also be significant, including fluctuating medical conditions, for instance. Further ideas for activities are to be found here. [DOC 29]
‘E’ has profound and multiple learning difficulties, and has very little voluntary movement, although it is thought that she may have some capacity to turn her head slightly. ‘E’ rarely exhibits behaviours that can be interpreted as observable responses to sound, although she moves her tongue sometimes as an apparent reaction to loud, clear sounds (see P.1.D). It has been noted that she can sometimes appear to be more alert when she is in a vibrant outdoor environment. With all this in mind, in the session shown in the video, ‘E’ is positioned in an outside area near her classroom, with a carousel of bells on her tray, whose movement can be triggered by a head switch.
In the period that is filmed, a teacher operates the switch for her, touching her head at the same time to give a sense of cause and effect. ‘E’s head remains stationary, although her facial expression does change at the time the bells are played.
In the context presented, ‘E’ demonstrates no sense that she can act on her evironment to effect change.
Other video of ‘E’
To see ‘E’ exposed to music and light in a multisensory environment, go to P.1.D.
P.1.D some activities to promote sound production and/or control are multisensory in nature
Multisensory outcomes appear to have no effect on sound production or control.
Almost inevitably, activities that promote an individual’s sound-making or control will involve other potential sensory engagement, whether it is the shimmering of a cymbal, the smell of a shaker made from a gourd, the feel of a vibrating ocean drum or the strings of a guitar, the rough surface of a scraper, the smoothness of a tubular bell, the intriguing shape and changing weight of a rain stick, or the cool feel of the bars on a glockenspiel. Such complex multisensory experiences are part and parcel of everyday life. Feedback can be enhanced through the use of specialist environments such as the Little Room (see P.1.A) or electronic amplification. Individual sensory elements may be controlled with some precision through the use of electromechanical switches or ultrasonic beams linked to lights, fans or vibration. Sound production may be augmented with vibration by using a ‘resonance board’ or vibroacoustic chair. With so many possibilities, you will need to be particularly attentive to any actions that suggest volitional participation, or any attempts to repeat what appeared initially to be an accidental movement, for example. Further ideas for activities are to be found here. [DOC 30]
‘E’ has profound and multiple learning difficulties, with cortical visual impairment (meaning that she has difficulty in processing visual information) and has very little voluntary movement. ‘E’ sometimes moves her tongue as an apparent reaction to loud, clearly defined sounds (see P.1.C). Here, ‘E’ is positioned in a dark room fitted with the ‘Optimusic’ system, which causes sounds to play when a beam of light is broken by a reflective surface. She is with her class, taking it turns to make sounds that form the basis for a simple piece of music that a member of staff improvises on the keyboard
‘E’s teacher guides her hand to move a lightweight ‘paddle’, which breaks the beam and causes short, percussive sounds to be made; there is no independent movement on her part. As the teacher praises her efforts at the end of her turn, she moves her tongue several times.
Initially it is unclear whether ‘E’ can process the sounds and music being made, and whether she can see the beam of light on her hand, and she does not exhibit any voluntary movement that would indiciate that she realises that acting on her evironment can effect change. However, her rapid tongue movements as the teacher praises her (assisted) contribution may indicate some awareness of what has occured and show that she has taken pleasure in the activity.
Other video of ‘E’
To see ‘E’ encountering musical sounds in a different context, go to P.1.C.
Since functioning at Level 1 implies no discernible sense of agency in producing sound or causing or controlling music (through a switch of some kind), assessment at this level necessarily reflects the efforts of teachers, therapists
and other practitioners to support the person concerned in active engagement. The complete Sounds of Intent assessment matrix is to be found here [DOC 60] and downloadable assessment sheets here. [DOCS 61 & 62]
The sounds made by life processes (such as breathing) are amplified and enhanced
Michael is 32 and is in a minimally conscious state following a road traffic accident three years ago. Before the accident he taught the flute. Michael’s music therapist is trying to help him recover some sense of agency by using the rise and fall of his chest as he breathes to operate a Soundbeam, which is set up so that it triggers flute sounds through a Bluetooth speaker placed close to his head.
Veronica, who is 11, has profound and multiple learning difficulties She has little movement in her arms or legs. However, she sometimes makes distinct vocal sounds as she breathes. Her teacher is trying to make her aware of these, and of the variation in the sounds that naturally occurs, by making them louder by using a microphone, amplifier and speakers. The quality of the sounds can also be changed by adjusting the bass and treble.
Involuntary movements are used systematically to make or cause a range of different sounds
Amelia is six years old. She has Rett syndrome of which one symptom is constant wringing movements in her hands. Her mother has found an app on the tablet they have at home which makes different notes when the screen is touched in different places, and, when the tablet is clamped at the appropriate angle next to her fingers, Amelia can be helped to make a constant, but ever-varying stream of bell-like sounds.
Andrei, who is 15, has profound and mutiple learning difficulties and a form of epilepsy that causes myoclonic jerks in his right arm. His music therapist uses a Soundbeam to produce drum sounds when Andrei’s arm moves in the hope that he will come to recognise the impact that he can have on his enivronment.
Co-active movements are used systematically to make or cause a range of different sounds
Hassan is 19, and he has profound and multiple learning difficulties. In music sessions, his teaching assistant helps him to join in by supporting his wrist and moving it towards him so that his fingers pluck the strings of a guitar that is placed on his lap.
Amira is 14, and she has profound and multiple learning difficulties. She is with her class on a trip to explore the gamelan at her local arts centre. Sitting behind her, so their musicle groups align, her teacher helps her to grasp a beater and use it to play the big gong.