Tiszai Luca Preverbal 2019 Net

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Luca Tiszai
PREVERBAL AND NONVERBAL MUSICALITY

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Luca Tiszai
PREVERBAL AND NONVERBAL

MUSICALITY
Musical Interventions
for Nonverbal Children and Adults
with Severe Disabilities
Theory and Practice
Szegedi Egyetemi Kiadó

Juhász Gyula Felsõoktatási Kiadó
Szeged, 2019
Lectors:
dr. Jeska Buhmann
dr. Micheline Lesaffre
dr. Luc Nijs
Prof. Dr. Ir. Leon van Noorden
Language lector:
Eszter Illés
Text management:
Mária Horváthné Szélpál
ISBN 978-615-5946-08-0
© Luca Tiszai, 2019

© JGYF Kiadó, 2019
CONTENTS
REVIEW................................................................................................................................ 9
INTRODUCTION ............................................................................................................ 13
PART I: THEORY ................................................................................................ 15

CHAPTER 1: HOW TO APPROACH INDIVIDUALS
WITH SEVERE DISABILITIES?.......................................................................... 17
HISTORY OF NOMENCLATURE ............................................................................ 17
DEBATES ON MEASURED AND EXPERIENCED SKILLS ................................ 18
Sparks............................................................................................................................ 20
SECONDARY PROBLEMS .......................................................................................... 21
Socialization and social inclusion ............................................................................ 22
WIDER SOCIAL CONTEXT AND THE ‘COLONIAL MODEL’
OF INCLUSION ............................................................................................................ 23
‘Cosmopolitan’ view of inclusion ............................................................................ 24
QUESTIONS .................................................................................................................. 25
CHAPTER 2: QUALITY OF LIFE, COMMUNICATION

AND VITALITY AFFECTS ................................................................................ 27
DANIEL STERN, VITALITY AFFECTS AND AFFECTIVE ATTUNEMENT .... 27
Piaget and Stern about the development of the Self.............................................. 29
Vitality affects in time-based arts ............................................................................ 32
QUESTIONS .................................................................................................................. 32
CHAPTER 3: COMMUNICATIVE MUSICALITY ............................................ 33

PULSE, QUALITY AND NARRATIVE .................................................................... 33
BUILDING UP A COMMON CULTURE ................................................................ 34
Synchrony .................................................................................................................... 34
Sharing the experience: creation of joint meaning ................................................ 35
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CONTENTS
Establishing common codes: theme and variations .............................................. 36

The frame of the interaction – the wider culture .................................................. 37
Balance and improvisational zone .......................................................................... 37
QUESTIONS .................................................................................................................. 38
CHAPTER 4: MUSIC, BODILY EXPERIENCE AND

COGNITIVE DEVELOPMENT .......................................................................... 39
EMBODIED MUSIC COGNITION .......................................................................... 39
Musical engagement: synchronization, embodied attuning and empathy ........ 40
TRADITIONAL VERSUS EMBODIED APPROACHES OF COGNITION
OF NONVERBAL ADULTS ........................................................................................ 40
The developmental theory of Piaget ........................................................................ 41
Vygotsky’s social development theory .................................................................... 41
Language and mental processing ............................................................................ 42
The cost of the verbal shift- developing a false self .............................................. 42
EMBODIED COGNITION AND SEVERE DISABILITIES .................................. 44
Embodied music cognition in the education and therapy of people
with severe disabilities................................................................................................ 44
THEORIES OF NON-LANGUAGE-BASED SYMBOLIC REPRESENTATIONS.... 45
Schema theory ............................................................................................................ 46
Image schemas in music cognition .......................................................................... 47
Narrative intelligence hypothesis ............................................................................ 48
EMBODIED APPROACH AND MUSIC EDUCATION:
DALCROZE AND KOKAS .......................................................................................... 48
QUESTIONS .................................................................................................................. 50
CHAPTER 5: PSYCHOPHYSIOLOGY OF MUSIC.

The effect of music on the human body and nervous system.............................. 51
THE NEUROCHEMISTRY OF MUSICAL REWARD .......................................... 51
MUSIC AS VIBRATION .............................................................................................. 53
MUSIC AND SENSORY INTEGRATION ................................................................ 54
The model of sensory processing by Winnie Dunn .............................................. 54
MUSIC AND THE AUTONOMIC NERVOUS SYSTEM ...................................... 56
Social engagement and Polyvagal Theory .............................................................. 57
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CONTENTS
MIRROR NEURON SYSTEM .................................................................................... 60

QUESTIONS .................................................................................................................. 60
PART II: PRACTICE ............................................................................................ 61

CHAPTER 6: THE ROLE OF ACOUSTIC ENVIRONMENT
IN THE SENSE OF SECURITY............................................................................ 63
NOISE POLLUTION .................................................................................................... 63
FROM LEITMOTIFS TO ACOUSTIC SCHEDULE .............................................. 65
Calendar systems and orientation............................................................................ 65
The idea of Leitmotifs ................................................................................................ 65
The use of Leitmotifs in special education.............................................................. 67
Establishing acoustic schedules based on Leitmotifs ............................................ 67
The advantages of singing ........................................................................................ 69
QUESTIONS .................................................................................................................. 70
CHAPTER 7: ENJOYMENT FOUND IN CLASSICAL MUSIC.

The method of Klára Kokas .................................................................................. 71
THE CONCEPT OF RECREATIONAL MUSIC THERAPY ................................ 71
KLÁRA KOKAS ............................................................................................................ 72
ADAPTATION AND EXPERIENCES ...................................................................... 74
SOCIAL INTERACTIONS .......................................................................................... 75
COGNITIVE BENEFITS .............................................................................................. 76
SOCIAL INTERACTION AND EMBODIED LISTENING .................................. 77
MUSICAL REWARD .................................................................................................... 78
THE ADAPTED KOKAS SESSION............................................................................ 78
Simplified structure .................................................................................................... 78
Ways of supporting .................................................................................................... 80
Reinforcing by mirroring movements and gestures.............................................. 80
QUESTIONS .................................................................................................................. 81
CHAPTER 8: ORCHESTRAL WORK AND COMMUNITY MUSIC THERAPY.

The Consonante method ...................................................................................... 83
THE NATURAL BASICS OF MUSICIANSHIP ...................................................... 83
THE FOUNDING PROCESS OF THE ORCHESTRA ............................................ 85
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CONTENTS
CUSTOM BUILT INSTRUMENTS ............................................................................ 87

BAGPIPE BASS .............................................................................................................. 90
INSTRUMENTATION ................................................................................................ 91
THE ADVANTAGES OF USING FOLK SONGS .................................................... 92
THE PROCESS OF ATTUNING ................................................................................ 92
OPTIMAL ZONE OF ATTUNING ............................................................................ 93
VITALITY AFFECTS AND MUSICAL CHARACTER .......................................... 94
COMMUNITY .............................................................................................................. 95
COMMUNITY MUSIC THERAPY APPROACH .................................................. 96
Workshops and inclusive concerts .......................................................................... 97
Wider social context .................................................................................................. 98
QUESTIONS ................................................................................................................ 100
EPILOQUE ...................................................................................................................... 101
REFERENCES .................................................................................................................. 103
8
PREVERBAL AND NONVERBAL

MUSICALITY
Musical interventions for nonverbal
children and adults with severe disabilities
Reviewed by dr. Jeska Buhmann, dr. Micheline Lesaffre,
dr. Luc Nijs, and Prof. Dr. Ir. Leon van Noorden
GENERAL
From the perspective of music and wellbeing in people with severe disabilities,
this is a valuable and interesting textbook. The author L. Tiszai has integrated
well-established traditional approaches to infant research and innate human musicality
with new work in the expanding fields of music and wellbeing and embodied music
interaction. The book is intended for learners who may have little or no experience
reading professional international journals, but would benefit from a substantial
research base in understanding how these emerging areas can contribute to working
with nonverbal children and adults with severe disabilities.
The book is organized into eight chapters. The first half of the book focuses on
the theoretical background; the second half is dedicated to practice. The subject
matter is accurate and has an appropriate reading level for the students who will
be using the material. The book has been written in a style that will hold the student’s
attention; the end-of-chapter questions will be interesting for the learners.
To conclude her textbook on musical interventions for nonverbal children
and adults with severe disabilities, L. Tiszai pleads for a fair and unbiased treatment
of various groups in society. In doing so she motivates learners to acknowledge
the importance of inclusive communities, where the needs and talents of the most
vulnerable members of society are taken in consideration.
PART I: THEORY
CH1: How to Approach Individuals with Severe Disabilities (Micheline Lesaffre)
In the first chapter an interesting overview is given of approaches and problems
encountered working with individuals with severe disabilities. This is supported
with enriching examples of inadequacy of standard testing and observations
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REVIEW
of people with unexpected reactions in the author’s own practice. Attention is given
to aspects of social context and different models of social inclusion. Thereby, the author
is focusing on the importance of rethinking existing approaches in order to value
and enhance the quality of life of people with severe disabilities.
CH2: Communication, Vitality Affects and Quality of Life (Luc Nijs)

Chapter 2 introduces the concept of ‘vitality affects’ as introduced by Daniel Stern.
This concept is very interesting, because it capture a basic element in human
communication and expressiveness. But this concept is also very useful to the whole
approach that the author presents in her book. It prepares very well the chapter on
communicative musicality. The author gives a good overview of Sterns affect theory.
Moreover, she adds relevant other literature such as the work of Trevarthen,
or Gratier&Magnier. It is also well structured, moving from Stern’s account towards
its application in music therapy time-based arts.
CH3: Communicative Musicality (Luc Nijs)

Building on the previously introduced concept of vitality affects, the author further
elaborates on the expressive non-verbal interaction between individuals and introduces
Malloch’s concept of ‘communicative musicality’. Starting from the basic elements,
the author elaborates on human communication in function of building a common
culture. This chapter elaborates then on the link between musical interaction and
communication, providing the reader with the relevant literature, although there
is dominance by the work of Gratier & Magnier.
CH4: Music, Bodily Experience and Cognitive Development (Leon van Noorden)
This chapter discusses the theories about how a living organism can learn to react
in a meaningful way to sound stimuli at gradually higher levels of involvement
and complexity. In order to describe the link between an external stimulus like
music and a notion of what this means for its being, an organism is said to have
a certain degree of cognition. To express the understanding that this link is to a large
extend determined by the characteristics of the body of the organism one uses the term
“embodied cognition”. Several levels of engagement of the organism with sound
can be distinguished: such as synchronisation of movement to basic pulsation
in the sound, embodied attuning to more complex patterns and empathy to the overall
qualities of the sound stream. All these levels of require from the organism that
it can perceive regularities in the sound and predict the upcoming salient moments
so that it can coordinate its actions with the sound, what would not be possible
if it would only show reactions to some conspicuous events in the sound stream.
10
REVIEW
At a still higher level of cognition an organism can talk about its bodily reactions
and feelings and communicate this to its peers. However words can never describe
fully what ones feels. In the context of the furthering of wellbeing of severely handi-
capped people with only a very little command of language it is very important
to distinguish these two realms of cognition. Several therapies that take this into
considerations are presented.
CH5: Psychophysiology of Music. The Effect of Music on the Human Body
and Nervous System (Leon van Noorden)
This chapter goes deeper into the description of the internal communication
mechanisms and pathways inside the human body and discusses how these mechanisms
can establish a motivation for developing embodied cognition. Music can be considered
as a drug. The body likes, wants and learns to obtain it. In order to get this circuit
started the external stimulus has to “speak” to a manifold of senses and bodily
actuators like ears, eyes, tactile senses, legs, arms, hands, torso, head, voice, etc.
each with its own resonance frequency. In music many of these frequencies are
present simultaneously and in alternation. It will depend upon the disabilities
which signals can be perceived or not. Learning takes place though neurons that
fire at the same moment. The link between external and internal stimuli is discussed
under Sensory Integration. There are some basic pathways in the in the body that
control the overall behaviour of the organism that are important for survival
in adverse environments, the Autonomic Nervous System. It prepares the organism
for action or relaxation. These reactions can be seen in all people, but for severely
handicapped people they can be the starting point for beneficial therapies. Several
of these therapies are presented.
PART II: PRACTICE

CH6: The role of Acoustic Environment Safe on the Sense of Security
(Micheline Lesaffre)
Chapter 6 discusses the challenges people with severe disabilities face in processing
sensory information coming from the acoustic environment (going from noise
to background music). The idea of Leitmotifs, or small structural musical units
processing thematic identities, is introduced and elaborated in context of special
education. Based on that idea an acoustic schedule with different levels of complexity
is established. Acoustic schedule levels start from singing, whistling or playing melodies
of well-known children’s songs. More complex acoustic schedules consist of a variation
of different elements such as natural sounds, short motifs and songs. The advantage
of singing familiar tunes for creating an optimal environment is highlighted.
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REVIEW
CH7: Enjoyment Found in Classical Music: The Method of Klára Kokas

(Jeska Buhmann)
In chapter 7 the importance is stressed for caregivers of persons with severe disability
to be creative in offering recreational activities. Rather than offering passive leisure time,
caregivers are encouraged to involve patients in activities they enjoy to benefit their
social and personal development. The method of Klára Kokas, based on repeated
listening of certain selected pieces of classical music, is described. This method
promotes musical understanding and sharing by means of bodily movements,
thus providing a nonverbal way of communication, which seems to be especially
relevant for nonverbal persons. Some adaptations to the Kokas method are proposed
in order to better suit the needs of (mostly nonverbal) persons with severe disabilities.
Experiences with this adapted approach are discussed and the need to personalize
the approach depending on individual patient’s needs is stressed.
CH8: Orchestral Work and Community Music Therapy. The Consonante Method
(Micheline Lesaffre)
In the last chapter the principles of the Consonante Method are explained. The author
developed the method to meet the need to make musical participation possible
for people with severe disabilities. This method incorporates vitality affects and
automatic synchronization to establish togetherness. Examples are given of how
a search is made for usable instruments, or how existing instruments are adapted
to suit the physical abilities of the musicians. The willingness to give public performances
and even interactive concerts resulted in the formation of an orchestra called
Nádizumzum. The process of becoming an orchestra member is illustrated with
some cases that show the importance of spontaneous movement patterns to music
for choosing appropriate instruments. This approach is supported by a discussion
of the theoretical background on musical gestures. As far as the repertoire is concerned
the author stresses the advantages of using folk songs and typical folk instruments.
Furthermore, the process of attuning is considered with a focus on interpersonal
synchrony and communicative musicality in relation to social isolation as a consequence
of severe disabilities. The chapter concludes with a discussion of the positive
effect of organizing workshops and inclusive concerts not only for the members
of the orchestra but also for the participating audience.
12
INTRODUCTION
“Where words leave off, music begins.” (Heine)
The very first time I met someone with severe disabilities was when I was asked to
play a simple children’s song for a child with Rett-syndrome. The occasion was that
a short film was made about different interventions in Rett-syndrome. I had to sit
on a big ball, and my task was to play and sing a children’s song. An 8-year-old
beautiful girl came into the room and I started to play. A delighted grin lit up her face.
She slowly approached me with a radiant face until her nose almost touched mine.
The situation was so funny that it was hard not to laugh at, but I had to continue
the song because of the filming. We became friends that moment. After that event
we spent a lot of time together. I discovered that we have similar preferences including
swimming, our favorite foods and, of course, music. After this first episode I was
convinced that music is a unique and powerful pathway towards nonverbal people.
I was fortunate enough to be a student of Klára Kokas (1929–2010), a Hungarian
music teacher. She was famous for receiving every child in her classes, with or without
behavioral problems or disabilities. She invented a method to discover the world
of classical music through movement. I have learnt a lot from her. I have been
integrating her method in my teaching experience with children of different ages,
with and without disabilities.
In the past eleven years I have been working in a small Hungarian village, called
Ipolytölgyes, in a nursing home for persons with severe disabilities. I adapted
the Kokas method to nonverbal adults and I set up an orchestra, called Nádizumzum.
The musicians are residents of the house. The methodological foundations of the
orchestral work with these special musicians crystallized in practice. The method
was later named “Consonante”.
Based on this practice, I was encouraged to initiate research with the aim of exploring
the hidden possibilities of music for nonverbal people. Thus, in 2013, I started to
explore the scientific background of my field. I started to ask more and more questions,
filmed Kokas sessions and the rehearsals of my orchestra to discover new possibilities
for this special group, and explored the anatomy of their musicality and their under-
standing of music. The theoretical background of this work is based on the literature
of infant research and innate human musicality, because I found these works
highly helpful not only for preverbal infants but also nonverbal people of all ages.
This book is the fruit of this reflexive practice.
13
PART I: THEORY
CHAPTER 1
HOW TO APPROACH INDIVIDUALS
WITH SEVERE DISABILITIES?
Individuals with severe disabilities form a heterogeneous group. This group

of people has been described from different perspectives using different terms,
describing severe, profound, mental, intellectual or learning disabilities. In order
to refer to additional disabilities, the term multiple is usually added to the original
definition. Terms such as individuals with severe and multiple learning disabilities
distinguish between psychiatric illnesses and severe disability, or deaf-blindness.
There are terms without this specification, for example individuals with severe
and multiple disabilities referring to different additional behavioral or psychiatric
symptoms. From the focus of special care, these people are referred to as individuals
with major support need or ongoing support need. These general terms are used
for describing people with concomitant impairments, for example intellectual
disability and sensory and motor impairments, intellectual disability etc.
Personally, I prefer to use the description ‘people with severe disabilities’, but I will
keep the original terminology in direct quotations.
Generally, these individuals display significant differences in speech or com-
munication, basic physical mobility, sensory awareness and/or behavior. These
individuals require extensive and ongoing support and frequently suffer from
social isolation and stigmatization (TASH, 2011). The particular skill profiles
of the people of this group can be varied depending on the nature or extent of the
different coexisting disabilities a person has, including movement, visual, hearing,
speech or language impairment, serious emotional disability, autism spectrum
disorders, etc. (Márkus, 2005).
HISTORY OF NOMENCLATURE
People with severe disabilities have usually been described with different terms.
In the 1960s the use of ‘mental deficiency’ was the official term describing conditions
as ‘imbecile’ or ‘idiot’ due to ‘subnormal’ intellectual abilities. While mental deficiency
was replaced by ‘learning difficulty’ and ‘learning disability’ this term was rather
associated with literacy and other academic skills. Thus, ‘intellectual disability’ became
the internationally accepted term (Hogg, 1999). The World Health Organization (1992)
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CHAPTER 1
defined this special subgroup as people with profound intellectual disability including
the diagnosis of having an IQ score of less than 20. Nakken and Vlaskamp (2007)
described this group with the term ‘people with profound intellectual and multiple
disabilities’ characterized by both profound motor and intellectual disability. The authors
describe this population as “individuals with such profound cognitive disabilities
that no existing standardized tests are applicable” (cited by Foreman, 2009, p. 66).
DEBATES ON MEASURED AND EXPERIENCED SKILLS

In practice, there are debates going on about the validity of diagnosed intellectual ability.
Being unable to score on any existing formal measure of assessment does not necessarily
mean profound intellectual disability, but could be a result of a highly special skill-profile
(Vlaskamp, 2005). Traditional or standardized assessments are not functional
to measure the skills of these people. According to Crips (2007), the problem is
that intelligence quotient (IQ) scores of different testing methods are not always
informative of the cognitive abilities of children with different conditions such as
physical disabilities, visual impairments, and/or the inability to speak. Most intelligence
measures require a wide range of skills including the ability to answer questions,
reading, writing, pointing or use pencils. In most cases, for example in the case of
athetoid cerebral palsy (CP), it is difficult for the child to point at or even fix their eyes
to the correct answer, draw or copy figures with high accuracy. This inaccuracy
of testing results in the case of special populations, for example the deaf-blindness,
and people with cerebral palsy and other neuromuscular disorders has already been
documented (Crisp, 2007; Fagan, 2000; Klassen et al, 2005; Sattler, 2002).
There is a wide range of examples demonstrating the problems. The case of the
Australian Anne McDonald (1961–2010) is widely known from the book Annie’s
Coming Out (1980) and the film The test of Love (1984). She was born with cerebral
palsy and diagnosed with severe intellectual disability. From the age of three, she was
placed in an institution for children with severe disabilities. These institutions
were established to provide only basic care and safety, but not education. In 1977
Rosemary Crossley, a worker of the institution tried a self-developed communication
technique with Annie. In those days nonverbal people with severe motor impairment
were thought to be incapable of learning (Blatt, 1981; Orelove, 1991; Ferguson, 2008).
Despite commonly held prejudgment, Annie earned a higher education degree
in humanities in 1993. Together with her former teacher she established a training
center, the Anne McDonald Centre, where the technique of facilitated communication
is used. This method is based on the presumption that many nonverbal people,
including people with autism or cerebral palsy, are able to communicate using
an alphabet board, provided that a facilitators amplifies their gestures and helps
18
HOW TO APPROACH INDIVIDUALS WITH SEVERE DISABILITIES?
thems point to the letters properly. However, research did not justify this technique
and it was prohibited. Therefore, Anne McDonald’s case was an important step towards
the development of different augmentative and alternative communication techniques.
Another famous person was Christy Brown (1932–1981), an Irishman born with
cerebral palsy. He could not speak but he learned to write using the toes of one
of his feet. His autobiography entitled My Left Foot (1954) became well-known
thanks to the Academy Award winning film made of it.
Jacob Barnett (1998–) was unable to communicate properly as a three-year-
old child. He was diagnosed with moderate to severe autism and was not expected
to be able to read or do everyday activities without assistance. Jacob has Asperger
Syndrome. Despite the pessimistic prognosis, at the age of twelve, he became a paid
researcher in quantum physics, and in 2014, the fourteen-year-old became a doctoral
student in quantum physics at the Perimeter Institute for Theoretical Physics.
Another example is the case of Carly Fleischmann (1995–), who was diagnosed
with severe autism, oral-motor apraxia and cognitive delay at the age of two.
She could not speak, she repeated bizarre self-aggressive behavioral patterns, and was
labeled to have severe cognitive impairment. At the age of ten Carly reached the laptop
of her therapist and typed “HELP TEETH HURT”. It turned out that she understands
language. She provides reports using a computer which reads out what she types.
The intellectual abilities of nonverbal people are still underestimated, especially
when they act in unusual or even strange ways, such as continually repeating bizarre
automatic hand or whole-body movements. These gestures are frequently associated
with unpredictable and dangerous behavior (Stier & Hinshaw, 2007). There are
many different reasons behind these movements. It is possible that involuntary
movements are the result of dyskinetic forms of cerebral palsy, namely the dystonia,
athetosis or chorea. Another explanation for strange behaviors (like banging one’s
head on the floor or wall) is that only strong, even painful sensory experiences help
individuals with an atypical sensory profile to block the constantly overwhelming
sensory inputs. For example, hyperacusis (amplified hearing) means that everyday
environmental sounds, of which a neurotypical human is unaware, could be
unpleasantly or even painfully loud for the person.
While severe intellectual disability is the most important diagnostic criterion
of this population, in most cases professionals judge the presumed intellectual
capacity from visible reaction within a highly limited timeframe. Other diagnostic
tools worked out for individuals with severe disability are based on reporting by
family members or caretakers. Professionals are requested to answer to different
“does the child understand...” types of questions. However, the subjectivity of the inter-
pretations remains questionable. As external observers are not influenced by their
knowledge about the person, their interpretations about the observable behavior
is more consistent. Observations of caretakers and professionals working with
the person have access to a wide range of complementary sources: in addition to
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CHAPTER 1
the knowledge about personal history and the social context, they understand the highly
individualized signs of communication and provide emotional security in the testing
situation. However, their subjectivity is a threat to the reliability of the results (Guess
et al., 1998; Hogg et. al., 2001; Mudford et al., 1997; Woodyatt et al., 2004). These
multiple reasons lead to a questionable diagnosis about the labeled (usually low)
intellectual capacity of the child, which results in lifelong negative consequences.
Very often, there is no convincing evidence about understanding or about the lack
of understanding the capacities of these people.
Sparks
There are also interesting cases, in which a person reacts in an unexpected way
proving his or her understanding or talent, but it happens only once. I would like
to share two cases from my own practice. All of these people are nonverbal clients
of a nursing home.
K. was diagnosed with cerebral palsy (CP) and profound intellectual disability.
Although she could not speak, she used clear signs of yes and no, and could communicate
with self-invented gestures and vocalization. Once I accompanied her to the hospital.
Because of a potential medical intervention, she had not been allowed to eat.
It was around 3 PM. K. had a fever. The doctor wanted to do an arterial blood test.
As she had a dyskinetic form of CP, it was not an easy procedure. I asked her if she
knew what ‘artery’ meant. She said no. In order to keep her attention away from
the cupping, I started to explain the whole cardiovascular system in a nutshell
including veins, arteries, the heart and lungs. She seemed to understand what
I explained and that made me curious. When the doctor was ready, I asked questions
to check her understanding. She gave me the right answers. I was astonished.
I bet she had no intellectual deficit. In contrary, she could be more intelligent than I.
When I learnt about the blood circulation system, I already had previous knowledge
about the human body and pictures about the process. And, I was not lying in a hospital
starving, neither did I have a fever, but it took me a while to understand blood
circulation. And this young girl seemed to understand it without any help. I told
the whole story to her mother, planning to contact an alternative and augmentative
communication center. Unfortunately, she had died before we could manage it.
R. is a member of my orchestra. She is slightly blind. She used to be able to speak
20–25 words, but since her mother died, she has never spoken a word and she has
almost never changed her facial expression. She does not seem to understand verbal
communication. She used to play my zither, but when it became overwhelming
for her, she threw the pick away, and a second after that my instrument as well.
So, I always had to be alert and catch it. In order to safeguard my instrument,
20
I gave her another one, saying: “it is your own instrument. No one else should play it.
But if you throw it away, I will not catch it anymore.” Since then she has never thrown
it away again, and it happened eight years ago. I could not have been a coincidence.
I don’t know what exactly she could understand of this complex sentence. First,
she knew a lot from her direct experience. As being slightly blind, she could not see
the instrument after throwing it away. At least she understood “I will not catch it”
as well as the possible but unspoken consequence, that the instrument may break.
What is common in these stories is that I have experienced this complex behavior
only once, but it made me think about the real intellectual capacity of my clients.
I would like to suggest that instead of saying that they have “such profound cognitive
disabilities that no existing standardized tests are applicable”, we could humbly
confess that we don’t know much about these people’s intellectual capacity, because
their ways of understanding are not compatible with our measuring tools. We don’t
know much about how they learn, and how this special life situation influences
their coping and learning ability. We have no evidence how their special sensory
functions shape their nervous system, how they process information, how they
perceive, and what they know about the surrounding reality.
Hopefully, the emerging field of assistive technology together with more than
100 years of experience of alternative and augmentative communication techniques
will lead to the development of a wide range of assistive, adaptive, and rehabilitative
devices to discover the real ability of nonverbal people. Nevertheless, these devices
and newly developed techniques are not available for the majority of individuals
with severe disabilities due to lack of professional awareness or financial resources.
The most important thing is that we should not treat these individuals according to
their labeled or measured IQ points. Instead, the cognitive skills of these people
are a part of the mistery of their personalities, which we should approach with
reverence and creativity.
SECONDARY PROBLEMS
Nonverbal adults frequently suffer from secondary emotional and behavioral problems.
The lack of verbal or even nonverbal communication prevents these individuals
from meaningful interactions. While these individuals gradually develop private
codes with their parents or caretakers, this individualized communication system
is based on shared history, thus, is too unique for outsiders to understand. Their
overall participation in any kind of social activity is highly challenging, because
it is not always clear what they could understand from a conversation and it is not easy
to interpret their communicative gestures and respond to them. The frequent
21
CHAPTER 1
experience of being misunderstood leads to anger, anxiety, frustration or even

depression. Not being able to manage these feelings could result in aggression
and/or self-aggression. High rates of mental illnesses and self-injurious behaviors
have been reported among individuals with severe disabilities (Arthur, 2004;
Cooper et al., 2007; Forster, 2011). However, these symptoms are evitable. The preventive
work of parents, family members, better organized care-systems and a more inclusive
society are important factors for improving the quality of their life and preventing
behavioral problems.
Socialization and social inclusion
The definition of The Association for the Severely Handicapped (TASH) (2011)
emphasized that these individuals require extensive ongoing support to participate
in integrated community settings. People with severe disabilities are usually associated
with unpredictable and, thus, dangerous behavior (Stier et al., 2007). Many of these
people repeat bizarre automatic hand movements, or their facial expression changes
involuntary, as a consequence of severe motor impairment. In addition to these
highly stigmatizing features, the behavior of these individuals rarely follows the roles
of the given society. For example, in most of the western cultures, it is strange when
someone approaches and smells the communication partner. Without a mediator,
the communication partner is likely to become more and more frustrated and
finally leaves the embarrassing situation.
The predestinated societal norms, and roles of a given community offer a structured
and safe convention to work within. When these guidelines are absent from the
relationships, people become confused. Because of the social isolation and the lack
of a supportive environment for social learning, they cannot learn socially
acceptable behaviors.
As a result, individuals with severe disabilities experience difficulties in participating
in meaningful interactions. The lack of mutual social relations affects their under-
standing of social-emotional interactions. An inclusive community provides natural
situations of mutual learning and understanding. In contrast, the lack of equal and
mutual interactions prevents these individuals from getting feedback about their own
behavior. Secluded life can lead to childish, socially unacceptable behavioral patterns
and immature coping mechanisms, which increases the danger of marginalization
and exclusion. As a result, socially unacceptable behavior and social exclusion
form a vicious circle.
22
WIDER SOCIAL CONTEXT

AND THE ‘COLONIAL MODEL’ OF INCLUSION
Although the basis of scholarly writing and legislation is the social model of disability,
the everyday personal, interpersonal, family, group and community experiences
of people with disabilities suggest that society at large still considers disability from
the viewpoint of the medical or, rather, the tragedy/charity model. Adlam et al. (2010)
reflect the dynamics of exclusion and inclusion of the welfare state calling the present
model of social care ‘colonial vision of inclusion’. They compare the dominant
sociopolitical structure with the ancient Athenian Democracy, which provides
symbolic citizenship only for those citizens who are already not too far from the norm
and standards of a given society. In the case of disability, I would depict this theory
with three concentric circles. The inner circle represents the so-called ‘normality’.
Here we would find the citizens of a world designed for neurotypical individuals.
The next circle depicts individuals with only few or minor disabilities. With the support
of society they are able to live a “normal” life, they can adapt themselves to the norms
and gain the desired citizenship. The outer circle symbolizes the group of people
with severe disabilities, who are too different from the average population. The social
justice view of disability proclaims the need for social equalization at systemic, social
and political levels, while the identification of these people is based on the medical
model of disability that is focusing on subnormal abilities, impairment or dysfunction.
There are special diagnostic methods to measure the skills of people with disabilities
compared to the ‘average’ population. In the case of individuals with fewer disabilities,
society has established different forms of support to provide participation in daily life.
When the person’s general skill profile is not too below the average, professionals
provide them with support to have access to the whole range of human activities,
or in other words help to gain the citizenship. As Adlam et al. describe the colonial
model whereby ‘we’ invite ‘them’, to join our community and receive its benefits
with different conditions. However, these systems are highly selective with those
who cannot meet these conditions. Society, as they argue, “defensively and [...]
offensively define[s] their boundaries in ways that exclude (or that set unacceptable
terms for the invitation to include)” (Adlam et al., 2010, p. 12).
As it is frequently reported that these people experience direct and indirect forms
of social exclusion that affects their physical and mental health, and day-to-day
life of their family-members as well (Brown, 2004). Regardless of social, economic
and cultural differences, a body of international research reinforced the inter-
relational dynamics of disability, social marginalization and low socioeconomic status
(e.g. Bass, 2004; Contact a Familiy, 2011; Groce et al., 2011; Palmer, 2013; Grut &
23
CHAPTER 1
Ingstad, 2006; MENCAP, 2001; van Kampen, van Zijverden & Emmett, 2008; WHO &
World Bank, 2011). Their perspective and insight is chronically forgotten by policy
makers, social experts, and academics. Reinders (2008) mentions that the aims
of disability rights movements are empowerment, agency or political participation,
and they have a little to say about severe disabilities.
This defensive, or in other cases offensive attitude of the society is enrooted
in our human nature. The social identity theory suggests that establishing strict
categories of in-groups (including the self) and out-groups (different from the self)
strengthens self-esteem and the sense of belonging, which is a basic human need
(Oaten et al., 2011). Moreover, downward comparison enhances self-esteem, thus,
categorizing people as ‘disabled’ reinforces the sense of ‘normality’ of the others
(Kama, 2004; Thomson, 2001).
Oaten et al. (2011, online) state that “perceptions of difference and deviance
are sufficient to arouse existential anxiety; however, it is especially likely to occur
when such differences generate concerns in people about their own vulnerability,
such as when faced with physical disability and disfigurement”. That means that
a person with severe disabilities challenges social norms and structures, value systems
and our overall conceptions about human beings and, thus, about our existence.
Isaksen interprets this encounter as “viewing a person whose symbolic self is over-
shadowed by the physical self” which in turn confronts us with the frightening
life perspective of “inability to impose mind over body” (Isaksen, 2002, p. 802).
The Disease Avoidance Model of disability described by Oaten et al. (2011) proposes
that signs, such as facial lesions, dermatological disorders, abnormal movement
or behavior, changes in the physical structure of the body, etc. trigger our automatic
neurobiological system to avoid contagious diseases. As the aforementioned signs
are primary disease signs, they evoke strong emotional responses such as disgust
and avoidance. This is an evolution based form of protection against infection,
but in the case of disability it produces a false alarm. Individuals with severe disabilities
are stigmatized by more than one false disease signs due to their physical appearance
and social behavior.
‘Cosmopolitan’ view of inclusion
From the viewpoint of Adlam et al. (2010), the presence of individuals with severe
disabilities challenges the ‘city-state’ of society at many different levels, including
physical environment, social and healthcare systems and preconceptions about
humanity or human dignity. Following their metaphor about the metropolitan social
care system, the authors suggest a change of worldview, exemplified with the attitude
of the Greek philosopher Diogenes, the Cynic. When Alexander the Great offered
24
a metropolitan position to Diogenes, he did not accept it, proclaiming that “the world
belongs equally to all its inhabitants, who concomitantly belong to the whole world”
(Adlam et al., 2010, p. 3). Thus, instead of striving for the privileged citizenship,
he established a new concept about equality, mutuality and participation, defining
his position as “cosmopolitan”. The authors interpret this attitude as the “philosophy
of ‘inclusion’ and his hope was the formation of a society [...] within which he could
authentically take up his membership alongside all others” (ibid, p. 4).
As Diogenes challenged and criticized the whole social system of his time,
the existence of people with severe disability reminds us of the inconsistencies
of our social systems and attitudes toward the value of human life. In order to provide
real participation, society must rethink social care system, economics, policy, culture,
and the fundamental questions of human life.
In order to overcome their first subconscious negative reaction, one should reflect
on value systems and identify the contradictions at personal as well as social levels.
This is a challenging process because, instead of providing support to be able to
function as a part of a given structure, these encounters urge individuals and
communities to re-organize their systems and re-define their values and the fundamental
questions of life. This process is an opportunity to build more livable dwelling places
for these individuals and for ourselves as well.
Considering the positive aspects of the outsider position, these individuals
challenge our self-esteem, worldview, social systems and concepts about the value
of human life. Encountering someone with severe disabilities, we should re-think
our relationships, social norms, economics, political decisions, culture, and philosophy,
which requires effort and work. Professionals working with these individuals must
be prepared for these questions and stand up for the value of the life of people
with severe disabilities, and the positive role their social inclusion may play for
the quality of life of the rest of the society.
Questions
What does it mean that people with severe disabilities form a heterogeneous group?
What shall we know about the intellectual capacity of someone diagnosed with severe disabilities?
What are the challenges in mapping their skills?
What kind of secondary problems result from social isolation? How is it possible to prevent them?
What are the most important causes of their social marginalization? What does the concept
‘colonial vision of inclusion’ mean?
25
CHAPTER 2
QUALITY OF LIFE, COMMUNICATION
AND VITALITY AFFECTS
Connectedness, emotional security and intimacy are considered to be among

the most vital aspects of quality of life of individuals with severe disability (Bradshaw,
2001; Caldwell, 2006, 2007; Cascella, 2005; Forster, 2011; Griffiths, 2010, 2013;
Marquis & Jackson, 2000; Petry, Maes & Vlaskamp, 2007; Reinders, 2002). However,
limited verbal communication highly challenges the process of mutual exchange.
While the lack of common system of symbols, codes and signs put a limit on sharing
abstract concepts and ideas, emotional communication, which plays a crucial role
in being understood, is still possible.
Emotional communication through affect attunement is a dynamic interactional
process, a natural form of mutual and reciprocal communication. The theory
of attuning describes the process that allows us to share feelings and emotional states.
The beginning of his process is that one of the dyad may offer a stimulus for the other.
Once the stimulus is offered by the communicator, the condition of mutual engagement
is the attention of the other, who may respond to it with an action. Attuning
could lead to mutual engagement by allowing partners to affect and reflect on how
the other feels and acts (Griffiths, 2013).
Moments of attuning are associated with a positive emotional state of bonding.
It usually occurs in a playful way and helps individuals to develop positive self-esteem.
DANIEL STERN, VITALITY AFFECTS

AND AFFECTIVE ATTUNEMENT
Daniel Stern, psychologist and infant researcher developed the concept of vitality affects.
He explains that vitality affects are common structures or forms of actions, feelings,
derived from the vital processes of life, for example falling asleep, getting hungry,
breathing, etc. He explained this similarity that we can understand rush in many
different modalities, feelings like joy or anger, but the acceleration of music, lights
or thoughts can also be perceived as ‘rushes’ (Stern, 1985). The dynamic contour
of human experience consists of the continuous change in five basic features:
movement, time, force, space, and intention/direction. Stern described vitality affects
27
CHAPTER 2
as holistic amodal experiences coming from different sensations: dynamic changes

in activation contours. These cross-modal matching of intensity contour or “kinetic
qualities of feelings” considered as a basic form of nonverbal communication,
“dynamic micro-momentary shifts in intensity over time that are perceived
as patterned changes within ourselves and others” (Stern, 1985 p. 263). Espan~ ol et al.
(2014) add that the proprioceptive experience of our own movements are the earliest
and primary sense of being alive.
Pavlicevic (2002) exemplified this process. When an infant moves his or her arm
for grabbing an object, the quality of this movement expresses something about
the infant’s internal state. For example, it can be quick and irregular. The mother
detects the dynamic form of the movement by its tempo, rhythm, or other qualities,
which she automatically translates to another modality and accompanies this
movement with vocalization. In addition to the unity of sound and movement,
the mother has a clue about the infant’s internal state by attuning with it, not only
with her voice, but with her emotions as well. The infant also recognizes the matching
contour of his or her movement and the mother’s vocalization. As he or she knows that
the mother senses his or her inner state, the infant starts to play with changing different
elements in her arm movement (for example the speed or length of the movement)
waiting for the corresponding change in the mother’s vocal accompaniment.
Vitality affects appear in the sonic aspects of speech production and in human
communicative gestures. The tempo, rhythm, tone, phrasing, form and intensity
of the verbal expression, in other words the musicality of the communication, is the most
important feature for a newborn baby and holds fundamental information about
the intention and emotional state of the speaker throughout the whole lifespan.
With the words of Stern (1985), this kind of intersubjective exchange, the continual
sharing of feelings and internal states provides the basis of an intimate mother-
infant interaction, the sense of “being with” the other. He described this process
of attuning with the term communion: participating together or sharing one another’s
experience without the intention to alter the other person’s behavior. Stern and
his colleagues observed interactions between infants and their caregivers, using
a frame by frame analysis to measure the subconscious and almost invisible small
signs of affect attunement. They found that this form of communication occurs
in every thirty to ninety seconds during an average interaction.
According to the theoretical framework of Stern, vitality affects play a crucial role
in intersubjectivity and pre-reflective affective communication in early social play.
Stern accentuates that affect attunement is not equivalent to imitation or empathy,
but rather the matching of external conducts of a distinctive and recognizable
inner state (Espan~ ol et al., 2014). Affective attunement is a ‘pre-conscious tuning-
with’ built with an innate base, in other words, vitality affects automatically, allow
28
QUALITY OF LIFE, COMMUNICATION AND VITALITY AFFECTS
us to feel the emotional state of the other. Micro-analysis of nonverbal interactions

between infants and their mothers has shown that young infants are able to observe
highly complex multimodal expression of their parents and respond to it by building
an intimate emotional relationship. Moreover, the process of attuning is highly
informative about the quality of the relationship (Stern, 1985). Different researchers
accentuated the role of affect attunement and vitality affects on social learning
and preverbal communication (Gratier & Magnier, 2012; Papousek, 1995; Pavlicevic,
2002; Stern, 1985; Trevarthen, 1980, 1987, 1993; Trevarthen & Hubley, 1978).
Based on the theoretical framework of Stern, Forster (2011) considered affect
attunement as a key feature of quality interactions between individuals with severe
disabilities and their caretakers. The aim of her paper was to study these interactions
from the perspective of intersubjectivity. The author describes social closeness,
interactive relationships, feelings of togetherness, in other words, intersubjectivity
and affects attunement as the key factors of the well-being of an individual with
severe disabilities. Stern accentuated the role intersubjectivity plays on human
development saying “how we experience ourselves in relation to others provides
a basic organizing perspective for all interpersonal events” (Stern, 1985, p. 6).
Similarly, the theory and practice of music therapy use the power of vitality affects
to develop an intimate emotional relationship, because nonverbal musical improvisation
and early mother-infant interactions are highly resembling processes (Graham, 2004;
Pavlicevic, 2002).
Preverbal communicative interactions are built on the basis of the reciprocal
sharing of sounds, movements and gestures. The main goal of this interplay is
to establish and maintain the reciprocal relationship. From a therapeutic point of view,
subsequent series of sensorimotor attunements could lead to communion and
a feeling of connectedness.
Piaget and Stern about the development of the Self
In order to understand the importance of attunement and connectedness better,

it is important to highlight Daniel Stern’s theory about the layered self. As Piaget’s
well-known theory has a great impact in the fields of psychology and education,
I compare Stern’s and Piaget’s model about human development. According to
Piaget’s developmental psychology, the human cognitive development has four
distinct stages, such as the sensorimotor stage (birth to 2 years), the preoperational stage
(ages 2 to 7) the concrete operational stage (ages 7 to 11) and formal operational stage
(from the age of 12). Piaget proposed different stages of development that children
automatically overcome and step forward to a more mature and more complex
29
CHAPTER 2
way of thinking. In contrast, Stern conceptualized overlapping, coexisting and

interdependent layers or domains of the self that once developed, remain active
throughout the whole lifespan. He distinguished four main senses of self: the emergent self
(from birth to 2 months), a core self (2–6 months), the subjective self (7–14 months),
and the verbal self’ (from 15 months). The aim of Piaget was not only to understand
how children acquire knowledge, but also to understanding the nature of human
intelligence. While his concept has been dominant in the twentieth century, it has
been criticized in the past few decades. From our perspective, the most important
weaknesses of his theory are its action-oriented nature and the underestimation
of the intellectual capacity of young children.
Piaget’s theory is an action-oriented approach based on the observation of the physical
manipulation of external objects. In his view, a physically active role in the learning
process is essential for normal cognitive development. He claims that children develop
Figure 1 Stern, Daniel N. (1998): The Interpersonal World of the Infant:

A View from Psychoanalysis and Developmental Psychology.
London: Karnac Books. Kindle Edition. [p. 32)
Source: http://integral-options.blogspot.com/2012/09/daniel-stern-and-creation-of-self.html
30
QUALITY OF LIFE, COMMUNICATION AND VITALITY AFFECTS
their knowledge by interacting with the world around them with the help of observations
and experiments. They continually reorganize their previous knowledge by assimilation
and accommodation (adding new information to the existing concepts or modifying
them in correspondence to their new experience). His theory has a little to say about
children born without the physical capability to interact with the world in such a way.
Moreover, a body of research supports the idea that Piaget has underestimated
the intellectual ability of young children (e.g. Baillargeon, 1991, 1995; Csibra &
Gergely, 2006; Gopnik, Meltzoff & Kuhl, 2000; Meltzoff & Moor, 1998).
When discovering the cognitive abilities of nonverbal infants or people with
exceptional abilities, the developmental theory of Daniel Stern could provide a more
reasonable starting point.
Stern described the development of the aforementioned senses of self from
relational aspects: according to his theory, human beings born with an emergent
sense of self that means the awareness that a newborn baby can distinguish between
his or her body and the objects around them, and between his or her actions and
movements of things and people, and the self-produced and other sounds of the physical
and social environment. The basis of the sense of self-agency is the ability to interact
with the surrounding world (Fuchs, 2013).
The next layer, which develops when a baby is about two months old, is a sense
of core self, in other words, an experience of being an integrated physical being
with proprioceptive senses, willpower, affectivity and personal history. The key to this
layer is “the sense of being an integrated, distinct, coherent body with control over
his own actions, ownerships of his own affectivity, a sense of continuity, and a sense
of others as distinct and separate interactants” (Stern, 1985, p. 99). Stern describes
four self-invariants: agency, coherence, self-affectivity, and continuity.
The next developmental milestone is the sense of a subjective self and inter-
subjective relatedness at around the age of six months. According to Stern, at around
the 7th month intersubjective relatedness and psychic and physical intimacy are
the most important aspects of the development. The intersubjectivity between the core
self and the other person provides an awareness of separate minds, in other words,
the infant learns that their own self and the other may hold different points of view,
and what is possible to share and communicate. He describes this process of continual
attuning with the term communion: a sense of unity, sharing one another’s experience
without an intention to influence or change his or her behavior (Stern, 1985).
Stern described the development of verbal self around the age of 15 months,
characterized by the ability to understand and construct symbolic representations
and to use language, as qualitatively new realm of interpersonal sharing with almost
infinite new possibilities, for example to be self-reflective, to objectify the self or share
abstract ideas (Stern, 1985).
31
CHAPTER 2
Vitality affects in time-based arts
According to Stern, in addition to pre-linguistic communication vitality affects

as amodal dynamic experiences serve as backbones for artistic expression, especially
in non-figurative temporal arts (Stern, 2010). Thus, methods based on non-verbal
artistic expressions seem to provide unique opportunities of communication for
nonverbal adults. Stern also accentuates that, both in preverbal communicative
play and different forms of art, dynamic expressions of emotions and affective
states are expressed and translated into a different modality (Espan~ ol et al., 2014).
A wide range of art-based nonverbal therapies use vitality affects to express
“dynamic feelings difficult to put into words, which can only be described by means
of dynamic terms” (Espan~ ol et al., 2014, p. 484).
Because of the coexisting and continuously developing layers of the self, affective
attunement is an ever-present component of non-verbal consciousness that constitutes
and develops the sense of self (Stern, 2004). Vitality affects are even more important
when verbal communication lacks. Stern (2010) wrote that, “in the earliest stages of life,
the infant is first or predominantly sensible to vitality forms” (p. 111). In order to
build relationships, nonverbal adults also relay on this form of communication
to build relationships and understand the surrounding social environment.
Thus, they need to develop and master the same sensibility of moment by moment
shifts of activation contour; dynamical, kinematical and rhythmical dimensions
of an emotion or an action. This may lead to increased sensibility of time-based arts,
especially to music.
Questions
How can we describe vitality affects? What is the role of vitality affects in affect attunement?
What does amodal perception mean? Why is it important in affect attunement?
What are the consequences of the verbal shift?
What are the common features of preverbal communication and artistic forms?
32
CHAPTER 3
COMMUNICATIVE MUSICALITY
According to the theoretical framework of communicative musicality, all human

beings with and without a disability possess an innate capacity to understand music
and communicate with musical sounds and gestures. Mother-infant interaction
is also described as a dynamic interplay which is reciprocal, mutual, and musical
(Holck, 2004; Pavlicevic, 2002; Procter, 2002).
Music-like forms of vitality are basic human forms of sharing a meaningful
experience, called proto musicality. These musical interactions, or in other words
protoconversations form a spontaneously occurring, highly dynamic interaction,
a turn-taking exchange with the aim of intersubjectivity and attuning (Pavlicevic,
2002). Other authors described this process as a “flux of experience in inner time”
(Gratier & Trevarthen, 2008, p. 59). This early form of communication involving
vocalization, gesture and eye-contact is present from birth. This is the basic
model of all kind of human interaction including language and other abstract
symbolic communication.
Stern’s concept of vitality affects describes commonalities between time-based arts
and early social play. Andsell (2014) explains this communicative function of vitality
affects as the way “how other people read and recognize us as persons, and are able
and motivated to interact and play with us” (p. 109). Early communication is about sharing
affect, attention, and intention using the temporal changes of movement to express
emotional quality. The very characteristics of a reciprocal inter-subjective relationship
is that, both infant and mother respond to one another, initiate contact or complement
this vivid and fluid interplay. Intimacy, the resonance of inner states, thus, the sense
of being with the other are the core of this dynamic experience (Pavlicevic, 2002).
PULSE, QUALITY AND NARRATIVE
Stephen Malloch introduced the term communicative musicality to describe a special

inborn human behavior, which is considered the biological and psychological basis
of human communication. This early musical communication consists of three
elements: pulse, quality and narrative (Malloch, 1999). In this concept pulse refers
to the temporal and rhythmic qualities and the quality of the temporal changes
33
CHAPTER 3
in intensity, pitch, timbre, and harmony. Narrative is the musical structure

including musical progress, grouping the elements and building up musical
forms such as phrases, questions and answers, a rondo or theme and varations
(Gratier & Trevarthen, 2008).
BUILDING UP A COMMON CULTURE
Music represents the basic forms and also the basic functions of human communication.
Different studies compared this early communicative musicality with the nonverbal
communication of musicians during a musical performance (Goebl & Palmer, 2009;
Gratier, 2008; Keller, 2008; Loehr & Palmer, 2011; Malloch, 1999; Schütz, 1951/1964;
Stern, 1982; 2010; Trevarthen, & Malloch, 2002; Walton et al., 2015). According
to these studies musical-gestural communication is highly similar in both cases:
“pre-communicative, wordless social interaction that is sufficient for establishing
intersubjectivity and mutual understanding” (Gratier & Magnier, 2012, p. 46).
In their study, Gratier and Magnier describe three distinct levels of this conversational
exchange: synchrony, coordination and common culture. They theorize, that
“both infants and improvising musicians achieve a sense of belonging through
the process of getting into a groove, or achieving interpersonal synchrony, which
opens up spaces for co-constructed meaning and the sedimentation of dynamic
cultural forms of interaction” (Gratier & Magnier, 2012, p. 56). In common shared
musical experience, performers use eye-contact, gestures and musical sounds to
establish and keep synchrony. This nonverbal and mutual communication builds
up a continually developing common interactional culture, consists of shared
experience and communicative signs.
Synchrony
The first level, synchrony is an automatically occurring human behavior. Human

beings tend to synchronize their movements even unintentionally (Bargh &
Chartrand, 1999; Issartel, Marin & Cadopi, 2007; Lakens & Stel, 2011; Schmidt &
Richardson, 2008). It is theorized that synchronous movement rhythms and
the subjective experience of togetherness and belonging mutually reinforce each other.
In other words, perceived or experienced social unity is in a close connection
with movement synchrony (Hove & Risen, 2009; Lakens & Stel, 2011; Launay et al.,
34
2014; Lumsden et al., 2012; Lumsden et al., 2014; Stupacher, J., Maes, Witte &
Wood, 2017). Human infants are born with the primary aptitude to achieve synchrony
with competent social partners (Gratier & Magnier, 2012). This unintentional
synchrony occurs when infants coordinate their movements with the prosody
of the adults’ speech, or the pulse of the music they are listening to (Condon &
Sander, 1974). Communicative musicality is based on this innate ability, but it happens
with communicative intention.
Sharing the experience: creation of joint meaning
According to Gratier and Magnier, (2012) interpersonal sharing of inner states,

knowledge and desires is one of the most important attributes of preverbal
communication and also jazz improvisation. In both cases participants become
involved with each other. The authors compare this highly personal interaction
with the concept of participatory sense-making by De Jaegher and Di Paolo (2007).
According to this concept, interactional coordination leads to sharing meanings
and to social understanding; in other words, this interaction creates special joint
meanings. This unique and intimate practice of developing mutual understanding
is a common feature of communicative musicality and joint musical creation.
Gratier and Trevarthen (2008) explain this process with the theory of grounding
as elaborated by Clark and Brennan (1991). Grounding means building mutual
knowledge, mutual beliefs, and mutual assumptions, as a basis of any further
interaction. In other words grounding is a process of building a common culture.
Another important condition of the creation of joint meaning is an emotionally
meaningful experience. Jazz musicians use the expression being in a groove
to describe a peek experience of this mutual understanding, synchrony and attunement.
This is a special shared emotional state, which is more than merely temporal
synchrony. Gratier and Trevarthen (2008) quoted the concept of Monson (1991),
saying that groove can be experienced as a sense of agreement or as euphoria
caused by playing with somebody and enjoying it.
From a therapeutic point of view, Ulla Holck (2004) accentuates the importance
of these meaningful musical interactions, referring to the studies of Klinger and
Dawson (1992), Rogers and Schuler (1988), Prizant and Wetherby (1997). Musical
intervention provides an opportunity to establish reciprocal, meaningful and
enjoyable communication that could ultimately evoke the desire of social interaction
even in the case of socially isolated children.
35
CHAPTER 3
Establishing common codes: theme and variations
Malloch describes communicative musicality as an “expression of our human

desire for cultural learning, our innate skill for moving, remembering and planning
in sympathy with others that makes our appreciation and production of an endless
variety of dramatic temporal narratives possible” (Malloch, 2009, p. 4).
According to Gratier and Magnier (2012) the pattern of interactions is formed
by theme-variation games, which are built on the early vocal and gestural
communication. This is also a culture-producing process, which are fundamental
in all different musical cultures. They describe the process of developing common
codes and building common culture. For example, a mother says to her baby
“that’s rain”. The baby laughs, the mother responds with laughter. During the next
few minutes the mother repeats the sentence “that’s raining” and, just like the first time,
the baby laughs. Musically this is called a rondo. The ‘main theme’ is the expression
linked with the behavior, strengthened by emotional content. The connection
is reinforced by both participants, thus, the pattern becomes part of their common
culture. As these emergent codes are emotionally meaningful, recalling them
creates a sense of intimacy and belonging. This process is highly similar to the
way jazz performers establish their common signs, or communities build their
unique identity by a common shared history. For example, there was a humorous
situation in a group, linked with a unique verbal expression or a quotation.
To repeat these words is enough for the members of the community to recall
the whole event. These events are emotionally meaningful for the participants,
thus, they recall it from time to time, and transmit the story for the next generation
as common shared history.
In short, new forms and meaningful signs emerge during this creative interplay
that gradually get stabilized during the musical game by confirming, repeating,
varying the original theme. It is important to mention, that common culture is
developing with the history of fruitful social interactions. The process called interactive
grounding means that individuals gradually develop mutual understanding.
The content of this joint experience is the so-called common ground. In this process,
the balance between emergent and recurrent forms is crucial. Common codes
help participants to anticipate a common future, while the occurrence of ideas
provide an individual style.
36
The frame of the interaction – the wider culture
Wider culture is important to share identities with other members of the society.
Different musical idioms developed within a particular context including physical
environment, social situation, history, culture, and a wide range of interacting factors
that determines the possible, acceptable, or even plausible variations.
In the early other-infant interaction, wider culture provides a framework for
the communication. It determines the interaction patterns, for example the language
of the mother, the physical distance or body position of the partners. In the case
of musical play, playing music together is supported by pre-existing musical culture,
the score, and the traditional rules of the given musical style. In the case of improvisatory
genres, playing music is supported by rhythmic and melodic harmonic patterns
and by other common musical codes.
In the case of mother-infant interaction, the mother or caregiver can be considered
the teacher, the competent user of the pre-existing cultural codes, who reinforces
the acceptable behaviors of the child, while neglecting socially unacceptable actions.
In contrast, this filter is frequently missing from the interactions with people with
severe disabilities. While parents and immediate family build an intimate communication
and common codes with the nonverbal family member, they not always transmit
the social norms, culture and tradition. The lack of a common cultural code,
often even the basic rules of socially accepted behavior, leads to isolation or social
marginalization. The process of interpersonal grounding is highly important
to provide emotional security, and this first communication serves as a role model
for any further learning and understanding. An infant cannot learn the wider culture
without this previous, unique, and personal communication code, but it should
be developed within the given socio-cultural norms.
Balance and improvisational zone
Both in musical interaction and communicative musicality it is important to establish

a balance between building an intimate, unique communicative style and keeping
the normative rules of the given culture. According to Gratier and Magnier (2012)
playing together over significant periods allows musicians to improvise in a much
more creative and humorous way, than unacquainted musicians, who prefer to play
according to common cultural rules and to play in accordance with the etiquettes.
The same pattern manifests itself in the social context. The jokes, expressions, stories,
in other words, the joint knowledge and history: these are important elements
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CHAPTER 3
of the we-experience and interpersonal engagement in a friendship, family or subgroup.

However, neglecting the wider cultural context and focusing only on the common
codes reduce the possibility of interaction with other members of the same culture.
Similarly, “musical elements or signs, the history of the tradition, is brought into
performance, it becomes an opportunity for individual expression” (Gratier &
Magnier, 2012, p. 60). Without knowing this tradition, musicians cannot master
their instruments. It is highly similar to the process of early cultural learning.
In musical improvisation there is an improvisation zone that provides the balance
between predictability and innovation of the form and content of the play.
The conclusion of Gratier and Magnier (2012) is that “cultural learning cannot
emerge solely as a function of language or protolinguistic behavior; it must be built
into the very fabric of social engagement from the beginning of an individual’s life”
(p. 62). This conclusion is highly important in order to understand the role of music
in the life of individuals with severe disabilities. In addition to emotional regulation,
music can be used in many different ways to transmit wider social culture, norms,
habits, thus help these individuals to learn implicit cultural knowledge. Considering
the wider social context, listening to classical pieces means to be a part of the universal
human culture. As not receiving general education, these people are disadvantaged
in cultural learning including learned behavioral patterns, and other important
elements of the universal and the particular culture, such as customs, traditions,
knowledge, history, science, art, poetry. Becoming a passionate listener of classical
music is a more symbolic, but important aspect of social participation.
Questions
What are the basic elements of communicative musicality?
What are the common processes in musical improvisation and communicative musicality?
What are the most important conditions of building common codes?
Why is it important to build common codes embedded into the wider cultural context?
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CHAPTER 4
MUSIC, BODILY EXPERIENCE
AND COGNITIVE DEVELOPMENT
EMBODIED MUSIC COGNITION
Embodied cognition is an emerging field of cognitive science that offers a new view-
point of understanding the intellectual development of nonverbal individuals.
This theory states that all cognitive processes are based on the body’s interactions
with the environment. This approach models brain-body-environment cognitive
systems and argues that cognition is based on knowledge that comes from the body.
“Activity of the mind is grounded in mechanisms that evolved for interaction with
the environment – that is, mechanisms of sensory processing and motor control.”
(Wilson, 2002, p. 626) Rosch et al. (1991) highlight the essence of this approach
in two main points. “First that cognition depends upon the kinds of experience
that come from having a body with various sensorimotor capacities, and second,
that these individual sensorimotor capacities are themselves embedded in a more
encompassing biological, psychological and cultural context” (p. 172).
Different authors describe music cognition from the perspective of embodiment,
because many features of cognition are embodied in the case of active or receptive
musical experience. The central idea of embodied music cognition is the integration
of action and perception in any kind of musical activity by encoding expressive
gestures into sounds, and decoding sounds into expressive gestures (Greevs &
Sutton et al., 2014). Maes et al. (2013) highlight the characteristics of embodied music
cognition as it is a “dynamical process, including action, perception, introspection,
and social interaction”. Learning to play a musical instrument is a typical example
of associations between sensory and motor representations. In receptive musical
experiences a body of research has proven the reciprocal influence between music
evoked movement and music perception (Phillips-Silver & Trainor, 2005, 2007;
Sedlmeier et al., 2011). Different authors studied the expressive-responding gestures
and movements evoked by music (Amelynck et al., 2014; Bardy et al., 2015;
Leman et al., 2009; Leman & Maes, 2014; Maes et al., 2014 a, b).
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CHAPTER 4
Musical engagement: synchronization, embodied attuning and empathy
Mark Leman (2007) has observed three levels of musical engagement by studying
music-induced movements: synchronization, embodied attuning and empathy.
The first step is engaging with the music described as synchronization of movements
and gestures with the so-called lower or beat-related features of the music. These
responses are highly variable from tapping spontaneously to the beat of the music
to full-body movements responding to the music’s metrical structure. Burger et al
(2014) characterize these spontaneous movements as organized and coordinated.
Leman calls it inductive resonance, emphasizing that these movements imitate
and predict beat and the rhythm patterns.
The next level, embodied attuning describes a wide range of movements responding
to more complex musical features including melody, harmony, rhythm, tonality,
or timbre. The complex musical cues and bodily expression of the listeners depends
on their previous musical experience and actual focus of their attention.
Empathy is the emotional component of the listening experience, the bodily
and gestural expression of emotional experiences evoked by music.
TRADITIONAL VERSUS EMBODIED APPROACHES

OF COGNITION OF NONVERBAL ADULTS
Different concepts of cognition accentuate the pivotal role of physical, bodily

experience in developing a sense of self and any kind of intellectual ability.
Traditional concepts of cognition consider the process of embodied learning
the first developmental stage when the child learns to relate to the world through
continuous interaction of motor expression and sensory feedback. The classical
concepts posited that cognition is about constructing and processing abstract symbols
(Wellsby & Pexman, 2014). In contrast, embodied cognition considers pre-reflective,
non-discursive bodily experiences as implicit ways of learning and developing
cognitive capabilities throughout the entire lifetime. “The concept of embodied
cognition emphasizes the vital role of bodily interactions with the environment
and sensorimotor experience in constructing representing conceptual knowledge”
(Wellsby & Pexman, 2014).
40
MUSIC, BODILY EXPERIENCE AND COGNITIVE DEVELOPMENT
The developmental theory of Piaget
The first systematic study and the most influential model of cognitive development
was worked out by Piaget. As it has already been mentioned, in his understanding
cognitive development is a process of constructing a mental model of the world.
He described four stages of cognitive development, the sensorimotor, the preoperational,
the concrete operational and the formal operational stages. In Piaget’s theoretical
framework, the human mind builds complex mental representation on innate
cognitive structures, so called schemas through two main processes: assimilation
and accommodation. The former means using a previously existing schema to account
for new knowledge, while the latter is changing or altering our existing schemas
by receiving new information.
In this model, cognitive development is considered a constructing concept
independent of the sensorimotor experience (Wellsby & Pexman, 2014). These abstract
concepts are difficult to discover without the use of language or an advanced
communication system. Thinking according to this model, professionals tend
to say that the nonverbal person’s cognition is at the level of a small child. It is not
necessarily true.
Vygotsky’s social development theory
The social development theory was worked out by Vygotsky, a contemporary

of Piaget. According to this theory, the social and cultural context, more precisely
social interaction is the most influential factor of cognitive development. Vygotsky
considered attention, sensation, perception and memory as elementary mental
functions developing into higher mental functions or intellectual strategies depending
on the cultural circumstances. In his understanding the knowledge of a child is a social
and cultural construct, consisting of two main elements: the knowledge and tools
of intellectual adaptation, which is the process of thinking or solving problems.
It is an important theory to keep in mind in understanding children and adults
with severe disabilities, because these individuals usually suffer from social isolation,
and their relationship with their parents is different from typically developed
children. Furthermore, the expectations of the society and the challenges deviate
from the experience of typically developing children.
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CHAPTER 4
Language and mental processing
The relationship between language and mental processing has sparked heated debates.
According to Piaget, there is a reciprocal influence between language and concepts:
they develop together, but thought precedes language. In contrast, Vygotsky considered
language as a primary tool of interaction and cognitive development as an inter-
nalization of language.
Based on the close connection between cognitive functioning and language
acquisition, people without the ability of expressive use of language are disadvantaged
in all aspects of learning. Some of these individuals are able to communicate with
abstract symbols such as BLISS system, hand signs, custom developed communication
board or special assistive techniques but many of them have no access to any kind
of expressive symbolic communication.
While infant research has established methods to study the cognition of preverbal
infants (Aslin & Fiser, 2005; Forssman et al., 2015; Gopnik, Meltzoff & Kuhl, 1999),
still little work has been done to understand the cognitive development of people
without expressive use of language.
The cost of the verbal shift- developing a false self
In Stern’s theoretical framework, the development of the verbal self is characterized

by being able to understand and construct symbolic representation and use language.
While verbal interactions play a decisive role for the intellectual development,
there are negative consequences as well. The use of language disrupts the unity
of lived and shared experience. “Experience in the domains of emergent, core,
and intersubjective relatedness, which continue irrespective of language, can be
embraced only very partially in the domain of verbal relatedness [...] Language,
then, causes a split in the experience of the self” (Stern, 1985, p. 182).
Different psychotherapeutic approaches accentuate the healing power of embodied
experiences proclaiming the unity of emotional and physical expression. Winnicott
(1965) and Stern (1985) pointed out that the development of the verbal self could
overshadow the spontaneity of the core-, and pre-verbal self. Preverbal communication
is based on authentic spontaneous movement expressions in the unity of direct
and felt embodied experience of the present moment. With the aim of verbal
communication, we are able to express abstract mental constructs out of this
unity of sensation, feeling, and expression. However, with the use of language,
42
we determine the wholeness of the personal experience to a general and ‘official

version’ expressed by verbal representational words, which are only fractures.
For example there are a wide range of emotions and various personal experiences
can be expressed as ‘joy’. The process of classifying and isolating specific elements
creates a wedge between the personal experience and its verbal expression (Stern, 1985).
Furthermore, language allows people to name feelings and inner states without
directly experiencing them. In other words, vitality affects help people to experience
the inner state of the other, while naming feelings and emotions verbally could alienate
both the speaker and the listener from the original richness and meaningfulness
of the shared experience.
In accordance with Winnicott’s theory, Stern accentuates that the true sense
of self, which is based on spontaneous authentic experience and a feeling of being
alive can be disavowed with the development of language. The lived and narrated
experience can be very discrepant. Due to these distortions of reality, the child
may establish a false self. The fact that all four layers of the self remains active
throughout the entire lifetime provides an opportunity to work with the preverbal
layers of the self. As the preverbal self is proclaimed to be authentic, focusing on touch,
movement and sensory experiences, it could help the integration of the self,
and connecting the emergent, the core, and its subjective and verbal layers. For example,
the aim of dance-movement therapy is to develop and strengthen the sense of authentic
self with the direct experience of bodily movement, sensation, emotion, as a unique
way of relating with others (Dasgupta, 2013).
This perspective of the development of verbal self could provide an explanation
for the frequently mentioned authenticity and sincerity of people with intellectual
disability. As the developmental theory of Stern pointed out, the use of language
makes a human being able to lie. People with intellectual disability are reported
to be more emotional, or more empathetic than others. It seems that this emotional
resonance is based on their mastery of receiving and responding to vitality affects.
Being in contact with people with intellectual challenges, emotional sharing is more
important than the exchange of cognitive information. Thus, interaction with
people with intellectual disability has a healing potential as well: it promotes this
the aforementioned unity of the self in the interactional partners. Inclusive music
projects help to connect and communicate. The experience of different community
music therapy projects shows that guest musicians notice these benefits: they
enjoy this special interaction and build mutual friendships with my musicians
(see Chapter 8).
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CHAPTER 4
EMBODIED COGNITION AND SEVERE DISABILITIES
Apart from the theoretical question to what extent human cognition is embodied
in general, the theoretical framework of embodied cognition opens an avenue
to approach the intellectual ability of individuals with severe disability. In this case,
the lack of expressive use of language does not necessarily mean the lack of mental
constructs or the ability of higher cognitive functions. The theory of embodied
cognition challenges the traditional concept of unidirectional information processing,
according to which cognition starts with the perception of a sensory input going
through a cognitive process and resulting in an action. The so-called disembodied
theories of cognition conceptualize the mechanics of cognitive processing as creating
internal representations through the process of abstraction. These mental representations
are symbolic structures, autonomous from perceptual systems.
On the contrary, as Wilson and Golonka (2013, online) claim, that embodiment
is a radically new hypothesis according to which “our bodies and their perceptually
guided motions through the world do much of the work required to achieve our goals,
replacing the need for complex internal mental representations”.
Embodied music cognition in the education

and therapy of people with severe disabilities
The approach of embodied music cognition focuses on different features of receptive

musical experience by the bodily gestures of the listener, because we tend to imitate
and predict perceived musical patterns (Leman, 2007). Maes (2016) accentuates
the importance of perceptual-motor interactions, bodily states and reactions
in music cognition. Individuals with severe disabilities produce a wide range of music-
evoked movements synchronized with the music, which holds the potential
to gain a deeper understanding of their cognitive functions. While the previously
quoted definition of Nakken and Vlaskamp (2007) describe this group as “individuals
with such profound cognitive disabilities that no existing standardized tests are
applicable” (cited by Foreman, 2009, p. 66) their receptive experience of music
could be a starting point to study their attention, memory and learning by these
movements. The close observation of movement patterns responding to complex,
hierarchically organized and structured information in music could lead professionals
to deeper understanding of the cognitive ability of nonverbal people.
Individuals with severe disabilities react to more complex musical phenomena
such as a musical period or different musical motifs (Szûcs-Ittzés & Tiszai, 2016).
44
Furthermore, the dynamics of anticipation and satisfaction, which are the results
of highly complex cognitive functions including attention, memory, recognition
of roles and patterns, are observable in their receptive behavior. Thus, it is possible
that they are able to recognize and recall schemas of musical patterns, such
as structural order, harmony or cadence, and this is the way how they are able
to anticipate a wide range of musical resolutions, even in a case of a piece of music
they have never heard before.
Wilson and Golonka open a wider perspective for embodied cognition saying that
“our bodies and their perceptually guided motions through the world do much
of the work required to achieve our goals, replacing the need for complex internal
mental representations. This simple fact utterly changes our idea of what ‘cognition’
involves.” (2013, online) Thus, I would argue that the embodied approach of cognition
is a promising new perspective of discovering cognitive abilities of nonverbal people
with severe disabilities, which may provide new methods of education and therapy.
Regarding the embodied experiences, it is vital to distinguish between the sensori-
motor experiences of early childhood and the embodied experiences of neurotypical
or nonverbal adults. In contrast with children, nonverbal adults have 10-20-30 years
of life experience. They have developed coping skills, behavioral patterns, while
the extent to which these skills and habits are congruent with the given socio-
cultural environment is highly different. Nonverbal adults with severe disabilities
may perceive the environment in a special way. Their nervous system, which may
be slightly different from the average by birth, is shaped by their life experiences,
which can be highly unique.
THEORIES OF NON-LANGUAGE-BASED
SYMBOLIC REPRESENTATIONS
Piaget described special forms of sensorimotor knowledge: repeated intentional

actions and their perceived sensory consequences provide a basic understanding
of the world. A child builds up reliable patterns of actions, the so-called schemas
(Delafield-Butt & Trevarthen, 2015). Self-generated intentional movements even
in primitive pre-conceptual and pre-reflective forms are considered planned, future
and goal oriented actions, the foundations of any goal-oriented, hierarchically
organized human behavior. Early self-generated actions are considered precursors
of intentionality: the anticipation of the desired sensory effects are present before
the conceptual and reflective cognitive functions (Delafield-Butt & Gangopadhyay, 2013).
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CHAPTER 4
Schema theory
The Schema theory was developed by Mark Johnson (1987), which is a more detailed
concept about the role of schemas in human cognition. He described the process
of embodied experience becoming a conceptual structure, the so called image scheme.
According to his concept, a schema is a recurrent pattern based on meaningful,
connected experiences through which human mind is able to process actions,
perceptions, and conceptions. These schemas are dynamic constructions formed
by bodily experiences, such as movement through space, manipulation of objects,
and perceptual interactions.
Image schemas derive from the multi-sensory experiential patterns based
on bodily and social interaction with the environment. Johnson described image
schemas as pervasive organizing structures in human cognition, the foundations
of the conceptual system, special pre-conceptual constructs between specific example
and abstract concepts. They are dynamic analog representations of spatial relations
and movements in space. Image schemas are holistic sensory experiences with
multi-modal conceptual representations across different perceptual modalities including
visual, auditory, kinesthetic, and tactile domains. Although these representations
are learnt knowledge structures, not resulted of from conscious cognitive processes
(Gibbs & Colston, 1995). These complex-schematic concepts are consciously accessible
and guide our sensory-motor coordination, but they are difficult to describe with words
(Mandler, 2004; Mandler & Pagan, 2014).
This concept could offer an explanation for the unexpectedly emerging complex
problem-solving behavior of nonverbal adults. The following example is an interesting
case from a nursing home for individuals with severe disabilities.
D. is an adult woman with Down syndrome. She cannot speak. When someone
approaches her, she gently pushes the person away. Once I served the lunch for
the whole group. She glimpsed the cake on the serving table. I detected her gaze,
so I tried to be cautious, standing in her way to prevent her stealing it. She ate her food,
but in every five minutes she checked the cake. After the meal she threw her full cup
away towards another client. I jumped to wipe it up, and she quickly stood up and
ate the cake. First I became angry, but after that I stared to analyze this situation.
This was a highly complex plan. First she sized situation up and she did not risk
attacking the serving table while I was there. She could delay the gratification
of her desire. As she kept looking at it again and again I was sure that she had not
forgetten about it. And finally, she used a trick. I have learnt a similar pattern
from my coach as a basketball-player at high school. This is a similar schema
46
to drawing the defender out of position by performing a deke. I blocked her way;
thus, she did something to move me out of her way. She threw the tea across the table
that was the perfect position to move me as far as possible. I had to go to the other
side of the table, so I had no chance to stop her. She could wait almost 20 minutes
to complete this action.
Furthermore, there are many different logical steps in this plan: a chain of actions
and consequences. I learnt something similar by long explanation. Nevertheless,
it was the only case I could experience this sophisticated action-planning from
her part, but I presume that she built up at least one highly complex scheme.
Her action fit in the definition of Delafield-Butt (2015, online) about image scheme:
“serial organization of action and accommodation of new possibilities for further
action require more complex cognitive tools of motor planning and associative
and episodic memory of a world of opportunities.”
Image schemas in music cognition
Have (2008, online) describes different image schemas in music as different structures
from the micro-level of music to more complex musical constructs, such as phrases,
cyclical rounds. These schemas derive from bodily experiences based on the translation
of musical experience to the physical world. The movement schema translates and
expresses the changes of music movement in horizontal and vertical space and time.
In western musical culture we tend to describe melody rather in a vertical than
in a horizontal axis talking about ascending or descending melodies, and as high
or low notes. The object schema is the experience music as substance or texture:
such as angular, firm, flowing, heavy, light, slender. The intensity schema refers
to the degree of intensity, temporal density, and tone color, because a degree of intensity
or in other words force of the vector is inherent to describe movement experiences.
The description of movement, object and intensity schemas overlaps with Stern’s
five dimensions of vitality, which he calls the fundamental dynamic pentad (movement,
force, time, space, and directionality or intention), the intermodal correspondences
of vitality affects. Both Stern and Have accentuate that the experience is a whole;
it is illogical to analyze the elements separately from the context, because it is
grasped as a Gestalt.
Image schemas are similar constructs, dynamic multi-modal embodied patterns
and building blocks of abstract concepts.
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CHAPTER 4
Narrative intelligence hypothesis
The theory of narrative intelligence holds that communicating in a narrative format

is an inherent ability of social animals. Narrative is considered a “natural format for
encoding and transmitting meaningful, socially relevant information” (Dautenhahn,
2002, p. 252). The basic narrative form consists of four parts: introduction, development,
climax, and resolution. There are different nonverbal narratives that can be observed
even in non-human primates. Bruner (1990) states that our sensibility of narrative
structures is more ancient than language.
In human culture there are increasingly complex narratives from the simple
reciprocal imitation games to the most complex verbal narratives. According to
Gratier and Trevarthen, (2008) narratives “express preconscious and subconscious
mental contents” (p. 127), providing a “purposeful basis for making practical and
social meaning in a human world of artifacts, techniques and conventions”
(Gratier & Trevarthen, 2008, p. 125). Musical narratives are narratives without words,
because “it is the narrative in music that involves and moves people, their minds
and their bodies, so that their experiences flow in a common musical time
in synchrony with the unfolding energies of the sound of moving in time” (Gratier &
Trevarthen, 2008, p. 127).
Many of the participants of my receptive sessions are sensitive to the overall
structure of the music which is expressed by movements, for example, they slow down,
and stop moving slightly before the end of the musical piece, anticipating the musical
peek and smile or change body position before the subsequent musical phrase,
or release muscles with musical resolution. It is also possible that nonverbal people
are able recognize musical structure, by identifying the narrative of the piece.
EMBODIED APPROACH AND MUSIC EDUCATION:

DALCROZE AND KOKAS
The idea of understanding music through bodily experience is the cornerstone

of the educational concept of Emile Jaques-Dalcroze, Swiss composer and music
educator. Dalcroze developed his method called Eurhythmics in the early 20th century.
Eurhythmics is an approach of music education which teaches music through movement,
because embodied reactions to music reach a deeper level of understanding than
recognizing and naming musical patterns. Dalcroze method is based on the fact that
bodily interaction with music is a powerful way of learning, because students experience
music in a more complex and natural way. According to his concept, students use
48
spontaneous, intuitive physical movement reactions to accompany short pieces of music

improvised by the teacher. Dalcroze introduced kinesthetic, physical experience involving
the whole body to establish a firm basis for musical understanding and further
instrumental training. He set a series of exercises to develop responsive bodily movements
by refining muscular and nervous co-ordination. The aim of his exercises is to develop
a neuromuscular basis for understanding musical timing, articulation, tone quality
and phrasing by free play, imagination and emotions “through the state of satisfaction
and joyful peace that follows” (Jaques-Dalcroze, 1930/1985, p. 6).
In order to understand and refine their movements, students have to develop
the so-called sixth sense, the kinesthetic awareness. This way of listening to music
through body movements requires mental, physical, and emotional consciousness.
While refining nuances of movements to match the music, the student develops
sensitivity to the quality of musical sound.
Similarly to the Dalroze concept, the receptive method of Klára Kokas is based
on the experienced unity of music and movement. Klára Kokas (1929–2010)
was a Hungarian music educator and professor of psychology and pedagogy.
As a young music educator she discovered that children take pleasure in listening
to classical music provided that they are allowed to move with the flow of the music.
She observed through these movements that the whole self of the young participants
is involved in listening to music, providing a deeper understanding of music through
play and joy. She became aware of the fact that young children, even toddlers,
are able to express complex musical phenomena, such as musical forms, dynamics,
harmony that they could not consciously understand in these young ages. Instead
of conscious reflections, she established a complex artistic program, where participants
are encouraged to explore the realm of music through freely improvised body
movements. The core of the method is a repeatedly listening of to classical masterpieces.
Participants are encouraged to express their emotions and inner movements by freely
improvised body movements and dance. The participants of the sessions listen to
music in groups, because individual expression and collective creation are equally
important aspects of this complex artistic experience. After the dance participants
can share their dances with the whole group as solos. After the solos the soloist
is allowed to talk about his or her narratives and imagination evoked by the music.
This kind of musical participation is a complex activity, in which participants
mutually influence each other by sharing their experience through joint creation.
Furthermore, the creation of these dances requires and at the same time develops
attention, musical memory, continuous anticipation and planning. Experience has
shown that even the youngest participants respond to complex musical phenomena.
A possible explanation of for this understanding is that participants build inner
representations of different musical elements and structures.
49
CHAPTER 4
Kokas did not want to establish an educational or therapeutic method; the aim
of these sessions is the development of the whole personality, especially of an ability
to receive music with full attention and to build an emotionally rich foundation for
future music studies. She accentuates social goals as well; these students learn to pay
attention not only to the music but to fellow participants as well. Positive reinforcement
and reverence toward each participant are core elements of Kokas’s pedagogy.
The structure of a Kokas session consists of the following subsequent parts:
introductory singing: calling each of the participants by name; the warm-up section
facilitating improvisation by singing, dramatizing and dancing to well-known songs,
and creating a silent atmosphere for the listening experience. The core of the session
is the repeated listening of classical masterpieces including dances, solos and verbal
storytelling or occasionally other nonverbal artistic expressions, for example painting.
The session closes with farewell rites such as name singing, canons and candle lighting.
The impact of bodily experience on the cognitive abilities of individuals with severe
disabilities is still undiscovered. “The ontogenesis of [narratives and the process
of meaning-making], before the development of words and language remain largely
unknown” (Delafield-Butt & Trevarthen, 2015, online). We have little evidence
how nonverbal and preverbal people process information and how they recall life
events from their own personal history. The close analysis of movements responding
to pieces of classical music could lead professionals to discover patterns and schemas
as basic forms of sensorimotor processing and cognitive abstractions.
Questions
What are the main claims of Embodied Music Cognition?
What is the difference between embodied and traditional approaches of cognition?
What do these concepts hold about the relationship between cognitive processes and language?
What does the image scheme means?
What is the difference between sensorimotor experiences of children and adults with
and without verbal skills?
What kind of new perspectives are offered by embodied approaches in approaching the cognitive
development of nonverbal adults?
50
CHAPTER 5
PSYCHOPHYSIOLOGY OF MUSIC
The effect of music
on the human body and nervous system
The human body responds to music at different levels with physiological reactions:
changes in the heart rate, emotional changes accompanied by physical reactions,
like experiencing chills when music peeks. Music physically moves our body from
semi-conscious music-evoked expressive-responding gestures such as tapping
the feet or shaking the head to the most complex improvised or learnt dances.
There is neurological evidences about the widespread effects of music on psycho-
logical well-being. “Music influences health through neurochemical changes
in the following four domains: reward, motivation and pleasure, stress and arousal,
immunity and social affiliation.” (Chanda & Levithin, 2013, p. 179) For example,
both active and receptive musical experience release oxytocin, “the hormone of social
bonding that has an impact on the experience of social connection in the course
of musical experiences” (Keeler et al., 2015).
THE NEUROCHEMISTRY OF MUSICAL REWARD
An interesting discovery is that the neural processing of musical pleasure is similar

to different addictions, such as food, sex, money or psychoactive drugs. According to
Salimpoor et al (2011), “music, an abstract stimulus, can arouse feelings of euphoria
and craving, similar to tangible rewards that involve the striatal dopaminergic system”
(p. 257). Dopamine is a neurotransmitter that plays a vital role in feeling pleasure
or satisfaction. There are three distinct components of an addiction, liking, wanting
and learning. Liking means that different activities release dopamine, thus, these
activities are perceived as pleasurable. If these activities become desired, the person
anticipates the same reward. This is called incentive salience, or in other words
craving or wanting. If the person repeats the same behavior it causes obsessive
pleasure-seeking behavior or addiction.
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CHAPTER 5
Musical pleasure is an interesting phenomenon. “Musical pleasure cycles are

driven by the dynamic interplay between the listener’s expectations and the statistical
regularities in musical structure. Music is pleasurable when expectations are fulfilled,
but probably even more so when they are slightly violated.” (Gebauer, Kringelbach
& Vuust, 2012, p. 153) This is called positive prediction error: the composer’s
solution is even more interesting than the expectation of the listener. Something
similar happens when the performer’s interpretation is different from the expected,
but the audience enjoys that. The negative prediction error does not lead to pleasure.
That means that the most pleasurable music consists of familiar patterns and
surprises for the listeners. Without any predictability the listener cannot expect
or anticipate certain musical resolutions, thus, cannot take pleasure from chaotic music.
At the same time, on optimal degree of violation leads to the experience of flow,
in other words, if the music is plain and unchanged, the lack of prediction errors
causes less pleasure. It is important to mention that repeated listening of the same
piece of music can be pleasurable because, unless we remember the whole piece,
it can still violate our expectations. Furthermore, expecting and hearing a well-
known part of the music is also rewarding.
Salimpoor et al (2015) describe that due to the complexity of musical experience
and sparse neural representations, listeners are able to familiarize with only some
features of the music even after several listening. It means that after repeated listening
or performing of the same piece of music the human mind is still able to produce
successful predictions as well positive prediction errors.
It is important that there is a wide variety of personal musical tastes, because
the expectations and the optimal level of violation depends on highly personal
factors, such as musical background, cultural influence, personality and favorable
musical style (Salimpoor et al, 2015). It means that musical pleasure is learnable,
musical training, but also repeated listening to quality music could lead to more
musical pleasure. As musical reward is a result of the brain’s dopaminergic reward-
system, it could be a strong motivation to repeat the same activity and memorize
more and more musical patterns.
As repeated listening experience can lead to musical pleasure, the activity
of listening to music can evoke incentive salience signals. In other words, repeatedly
experienced musical rewards could increase the attention, concentration and other
cognitive skills because these functions are linked with the reward circuit of the brain.
The pleasure increases with being able to predict more and more musical patterns.
It means that receptive musical talent is developing through learning. Salimpoor
et al (2015, online) described this process of learning that listening to familiar music
could cause peak experiences and may evoke a sense of anticipation that could lead
to dopamine release. The key of this concept is explicit, or implicit familiarity
52
with the music. The former means that the listener already has known the musical
piece while the latter is the familiarity with the composer, style, structure of the music
based on musical education or previous listening experience. “Musical experiences
and other positive social interactions likewise activate dopaminergic neurons and
are powerful aids to attention and learning” (Altenmüller & Schlaug, 2013, p. 5).
MUSIC AS VIBRATION
Vibration is one of the most effective bodily effects of music that normally helps
to clarify and reinforce listening. Bodily interactions with music, by combining sensing,
feeling, and thinking, reinforce the processing of sensorimotor representations
bounding multisensory connection between body movement and auditory progressing
(Bowman, 2000; Phillips-Silver & Trainor, 2005, 2007; Stubley, 1999; Wigram, 1997).
Vibration is the most direct bodily aspect of music, for example, the felt physical
experience of rhythm and beat with the whole body develops the client’s sense
of structure and internal order (Pellitteri, 2000). Research has shown that vibroacoustic
music therapy can reduce self-injurious, stereotypic, and aggressive destructive
behaviors (Lundqvist, Andersson & Viding, 2009; Wigram, 1997). Vibroacoustic
therapy uses the physical vibration of sound for the deepest, cellular level of body
stimulation with specially designed devices. Vibro-acoustic sensory stimulation
is a commonly used technique for clients with severe disabilities (Breger, 2002;
Hooper & Lindsay, 1997; Wigram, 1997).
Bodily experiences play a decisive role in self-consciousness and identity. Basal
stimulation is an approach worked out by Andreas Frölich, a German special
education teacher, to provide structured and individualized somatic, vestibular
and vibratory sensory inputs for individuals with severe disabilities (Frölich, 1996).
The aim of basal stimulation is to develop their self-consciousness and sense of agency,
experiencing themselves and the surrounding physical and social environment
through assisted physical interactions.
The use of vibration offers somatic, vestibular and vibratory experiences to feel
their own bodies and increases self-cognition as one of the base stones of this concept.
As individuals with severe disabilities frequently struggle with severe sensory
and motor dysfunctions, they need assistance to explore their body, and the surrounding
physical and social environment. Because of the limitation or lack of physiological
movements of the body these individuals have significant deficiency in their body-
perception. This means receiving fewer sensory impulses, in other words less
stimulation of the neuronal structures.
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CHAPTER 5
MUSIC AND SENSORY INTEGRATION
Musical experience is an extremely complex multisensory and motor stimulus

in itself involving acoustic, visual, tactile, proprioceptive domains. Making music
means coordinating a wide range of movements with multisensory feedbacks.
The process of integrating different sensory inputs to a combined sensory impression
involves multisensory integration regions of the brain, namely the parietal lobe
and temporo-occipital regions (Altmüller & Gottfried, 2013). Thus, both active and
receptive musical experience reinforce the processing of sensorimotor representations
(Bowman, 2000; Phillips-Silver et al., 2005, 2007; Stubley, 1999; Wigram, 1997.).
Different techniques of neurologic music therapy use musical stimulation to effect
sensorimotor coordination. For example, the aim of rhythmic auditory stimulation
is to facilitate intrinsically and biologically rhythmical movements, such as gait
with music or other rhythmical auditory stimuli (Oliver, Thaut & Sena, 2005).
Patterned sensory enhancement is another technique, to structure and organize
functional movements providing support with temporal, spatial, and force cues
derived from music with rhythmic, melodic, harmonic and dynamic-acoustical
elements (Oliver, Thaut & Sena, 2005).
The model of sensory processing by Winnie Dunn
The neural processing of people with severe disabilities may develop in a different
way than in the case of average people. Many of these individuals are challenged
with organizing incoming sensory information from the environment. The model
of Winnie Dunn (2001; 1997) describes four different patterns of sensory processing
based on individual differences in neurological sensibility for stimulation and
self-regulation strategies. An individual can be oversensitive or under-sensitive
for a given environmental stimulus, and respond in an active or passive way.
There are two ways of coping with overwhelming information: sensory avoidant
people try to defend themselves form unfamiliar and distressing sensory information.
Avoiding behavior can range from taping the ears and humming to aggression,
self-aggression and impulsivity. Passive behavioral response is the sensory sensitivity,
noticing more sensory events than others.
In the case of low registration and passive behavioral answer, the response
is insensitive or disconnected. These personality types are characterized by slow
and weak reactions, apathy, sleeping or being lost in their own world. The active
behavioral answer to receiving less sensory stimuli from the surrounding world
is sensory seeking (James et al., 2011; Miller et al., 2007).
54
Research has shown that individuals with severe disabilities experience challenges
in vision, hearing, tactile and proprioceptive sense (Bromley, 2000; Evenhuis et al., 2001).
Considering the role the first sensory and motor experiences play on the maturing
of the nervous system, the continuous interaction of atypical sensory experiences
and limited motor expression may cause different neural processing that could
impact cognitive functioning such as attention and memory.
Figure 2 Demopoulos, C., Arroyo, M. S., Dunn, W.,

Strominger, Z., Sherr, E. H., & Marco, E. (2014)
55
CHAPTER 5
MUSIC AND THE AUTONOMIC NERVOUS SYSTEM
The autonomic nervous system regulates key involuntary functions of the body,
such as heart and respiratory rate, body temperature, blood pressure, metabolism,
the production of saliva, sweat and tears, etc. It consists of two branches, the sympathetic
and parasympathetic nervous systems. The former is associated with ‘fight-or-flight’
reaction, while the latter with the ‘rest and digest’ or ‘feed and breed’ functions.
Traditional concepts considered the balance of these two opposite functions
as the key of homeostasis, the balance of the human body.
Hans-Helmut Decker-Voigt (2004) described the connection of music and
autonomic nervous system. Music can be stimulating (ergotropic) or relaxing
(trophotropic). The former affects sympathetic and the latter our parasympathetic
nervous system.
The so called ergotropic music is characterized by rigid rhythms, accelerations,
major key, dissonance and greater sound intensity. This kind of music causes excitation:
increased rate of heart and respiration, elevate blood pressure; higher incidence
of muscular contractions and muscle tone, dilation of the pupils of the eyes and
heightened electrical resistance of the skin. Tropotrophic music is based on minor key,
consonant, floating, with less accentuated rhythms and lower sound intensity. It causes
relaxation, peace, and joy.
Ergotropic Trophotropic
Rhythm rigid rhythms, accelerations less accentuated rhythms
Melody major key, dissonance minor key, consonant, floating
Sound intensity greater sound intensity lower sound intensity
Example march lullaby
Bodily effect excitation: relaxation:
increase heart rate, respiration, decrease heart rate, respiration,
muscular contractions and muscular contractions, muscle
muscle tone, blood pressure, tone, blood pressure;
sympathetic nervous system parasympathetic nervous system
The effect of music is less predictable in a concrete situation for three main reasons.
First, because a piece of music is too complex to easily fit in these categories. Second,
the effect of music depends on musical preference and the previous experience
of the listener. Third, an ergotropic or trophotropic musical piece does not automatically
56
lead to energized or relaxed physical and emotional state. If someone is extremely

stressed, relaxing music can be so far from his or her actual emotional state that
it might make the person even more excited. People prefer listening to music that
correspond to their affective state. Thus, in case of stress, listening to a music that
starts mainly with ergotropic components resonates the listener’s emotional state.
After this kind of ‘musical empathy’ it may be possible to change one’s emotional
state gradually. For example, one of the participants of my sessions is usually self-
aggressive and agitated. He does not like slow and gentle pieces. However, it is possible
to help him to relax choosing pieces like Night on the Bare Mountain from Mussorgsky.
The beginning of this almost ten-minute-long piece is harsh, frightening and chaotic.
After many changes, the last part starts with chimes of bells, slows down and ends
with soft and gentle chords. After moving together with the wide range of vitality
affects of this piece, most of the time he calms down, and relaxes with a peaceful smile.
Regardless of the individual differences, it is important to understand the connection
between certain musical characteristics and their potential effects on the nervous
system. For example, continual ergotropic background music can be an overwhelming
experience, while relaxing music can help to alleviate hypertensive and frequently
painful muscular contractions. Listening to rather ergotropic music during meals
‘turns on’ the sympathetic nervous system, and blocks the parasympathetic branch
responsible for digestive functions.
Social engagement and Polyvagal Theory
The Polyvagal Theory was worked out by of Dr. Stephen Porges (Porges, 2003, 2004,
2007, 2008, 2011). This theory conceptualizes that the autonomic nervous system
plays a crucial role in social behavior. Porges’s theory is based on the discovery
that the vagus nerve in mammals has a third branch as well. The phylogenetically
newer branch, the ‘social nerve’ is associated with social engagement, by calming
the viscera and regulating facial muscles.
Based on the distinct functions of these branches, Porges describes three hierarchically
organized different neural circuits which regulate adaptive behavioral and physiological
responses to safe, dangerous, and life threatening environments. He conceptualizes
a non-cognitive automatic neural judgment, the so called neuroception of danger
or safety. The nervous system responds to the perceived level of danger, with the social,
the mobilization or immobilization systems.
The first or ‘mammalian’neural circuit is associated with social engagement:
according to this theory, our nervous system is designed to seek social support
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CHAPTER 5
to cope with distress. This newer branch of the vagus nerve regulates physiological
state during social interactions associated with variable vocalization pitch, ability
to perceive human voice, changing facial expressivity, eye contact, head turning,
tears and eyelid movement, and facial expression. This system is active from birth,
because human beings are wired to respond to distress first by social engagement.
Environment
outside the body
inside the body
Nervous System
Neuroception
Safety Danger Life threat
Spontaneously engages others Defensive strategies

eye contact, death feigning/shutdown
facial expression, (immobilization)
prosody supporst,
visceral homeostasis
Defensive strategies
fight/flight behaviors
(mobilization)
Figure 3 The Quest for Safety: Emergent Properties of Physiological State
58
In the absence of human support, we react with the mobilized circuitry: fight
or flight or active freeze reaction. This is a hyper arousal ‘reptilian’ response based on
the activation of the sympathetic autonomic neural system, increased heart rate
and sweat, inhibited gastrointestinal function, and limited blood flow to extremities,
which causes a hyper-vigilant, action-orientated, impulsive, emotionally flooded,
reactive state or a sense of frozen body.
Conditions perceived as life threatening cause immobilization (collapse, behavioral
shut down or ‘feign death’), which is the most ancient primitive defense reaction based on
the activity of the parasympathetic system, characterized by collapsed body posture,
loose musculature, weak, defeated, flat affect, a numb, empty, helpless, hopeless
emotional state and difficulty engaging with eye contact or have a calm social manners.
Porges accentuates that neuroception is an open system shaped by the experience
of the child. When children experience danger or less social support, they need to use
philogenetically older defense reactions, thus, their ability to access their social
engagement system gradually decreases. On the other hand, because of the plasticity
of the neural network, social engagement itself can be a threatening experience
increasing the neuroception of safety and the capacity for meaningful social interactions.
This theory holds the potential to understand the behavior of individuals with
severe disabilities. As many of these individuals cannot cope with environmental stress,
they may perceive the surrounding physical and social environment as dangerous.
For example, a blind person in a wheelchair could experience that someone pushes
his or her wheelchair to somewhere, without saying a word. This is likely perceived
as a dangerous situation.
There are other biological or social factors that can result in the neuroception
of danger. Different sensory dysfunctions may cause intolerable perceptions of everyday
sensory environment: extremely loud dog barking, painful physical experience
by a simple touch, etc.
Furthermore, parents and caregivers cannot always provide intimate social
interactions with their children. Many of the parents having a child with a disability
experience traumatic stress that prevents them from providing emotional security
for their children (Bruce, 2000; Kálmán, 2004; O’Neill, 2005). While parents try
to be kind and caring, children detect the hidden emotions in their vocal tone,
attitude and body language. The duality of the situation causes fear, anxiety and
insecurity in the attachment. Finally, children blame themselves for the parental
distress that causes a sense of guilt, helplessness and worthlessness (Kandé-Staehelin &
Lorz-Zitzmann, 2016).
However, common shared active or receptive musical experience, as a meaningful
social interaction, could promote the reparation process increasing the sense of safety
and the overall life-quality of these individuals at all ages.
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CHAPTER 5
MIRROR NEURON SYSTEM
The theory of mirror neurons was worked out by Giacomo Rizzolatti and his colleagues
in the 1980s. Studying the premotor cortex of macaque monkeys, they discovered
neurons that respond during both action and observation of action. Based on this
discovery they conceptualize the theory of the mirror neuron system, the neuronal
basis of learning by imitation, empathy, and social understanding (Rizzolatti &
Craighero, 2004). Mirror neurons let us ‘simulate’ the actions, intentions, and emotions
of other people (Acharya & Shukla, 2012; Bauer, 2005, Gallese & Goldman, 1998a, b;
Gallese, Keysers & Rizzolatti, 2004; Iacoboni et al., 2005).
While there is no direct evidence for the existence of mirror neurons in humans,
researchers discovered that particular brain regions in human beings are active
when the person performs an action and also when the person sees another
individual performing an action.
The Shared Affective Motion Experience (SAME) model of music perception
is based on the theory of mirror neuron systems (Overy & Molnár-Szakács, 2009;
Molnár-Szakács, Green Assuied & Overy, 2011). The SAME model conceptualizes
human beings to understand music as shared social and emotional communication
based on the activity of the mirror neuron system. Musical sounds are created
by intentional and expressive motor acts. Therefore, mirror neurons automatically
detect emotion and intention behind music even when we are listening to music alone
(Molnar-Szakacs, Green Assuied & Overy, 2011). According to Overy, performers
and their audience members are connected through shared emotions through this
human mirror neuron system (Overy & Molnár-Szakács, 2009). The SAME model
is an interpretation of human musical behavior as an extremely complex perceptual
cognitive process with powerful affective responses: a unique mode of communication.
Questions
What do we know about musical reward? Why is it important in different learning processes?
What is vibroacustic therapy? What is it used for?
What is the role of the autonomous nervous system in the perception of safety? Why is
it important to provide predictable environment for the children?
What is the role of music in sensory integration?
How is the theory of the mirror neuron system related to musical experiences?
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PART II: PRACTICE

CHAPTER 6
THE ROLE OF ACOUSTIC ENVIRONMENT
IN THE SENSE OF SECURITY
Individuals with severe disabilities are often challenged in processing the stream
of sensory information coming from the environment. An optimal sensory environment
decreases challenging behavior, increases impulse control. The acoustic environment
is crucial to establish a safe, trustworthy and predictable milieu for all human beings,
but it is vital for individuals with severe disabilities.
NOISE POLLUTION
The needs and sensory awareness of people with severe disabilities can be extremely
different, thus, it is difficult to generalize the optimal conditions. Some of these
individuals have hearing loss or sensory seeking behavior. These people usually hug
megaphones and enjoy such a loud noise that is unbearable or painful for average people.
The other end of the scale is hyperacusis or misophonia, also known as selective
sound sensitivity. For people with these conditions some of the everyday sounds
are unbearably loud. They have two ways of defending themselves from unwanted
sensory flow: acting out or falling asleep (see the model of Winnie Dunn in Chapter 5).
While the neural processing of sound can be highly different, the acoustic
environment of a nursing home or a family can be objectively harmful. Noise pollution
has been defined as disturbing or excessive unwanted noise that affects the physical
and mental health of the individual. Noisy environments could elevate blood pressures
and increase levels of stress-induced hormones. Research has shown that cardiovascular
diseases, hearing loss, nuisance annoyance, hypertension, headache, migraines,
increased stress level, chronic fatigue syndrome and tinnitus are possible consequences
of noise pollution (Basner et al., 2014). They define tinnitus as: “change in sound
perception, such as ringing, that cannot be attributed to an external source often
follows acute and chronic noise exposure, and persists in a high proportion of affected
individuals for extended periods.” (Basner et al., 2014, online)
Nonverbal people and especially those living in nursing homes are proclaimed
to be more endangered by noise pollution than the rest of the society (van Kamp &
Davies, 2013). In different institutional settings such as schools and nursing homes
it is vital to pay attention to the surrounding acoustic environment. The lack of perceived
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CHAPTER 6
control over the noise could cause annoyance or distress that increases negative emotions,
most often dissatisfaction, irritation, anger, helplessness, depression disappointment,
anxiety, agitation, exhaustion or anger (Goines & Hagler, 2007). Negative behavioral
outcomes, such us disengagement, aggression, self-aggression, nonparticipation
are the result of these negative emotions. Consequently, the continual unselected
background music from the radio or television is a possible stressor. While many
of these individuals seem to take pleasure in listening to the radio or watching TV,
the continual use of these electric devices is controversial.
Loud background music interferes with speech communication, decreases the level
of attention, concentration and task performance. Furthermore, in order to be audible,
people, including staff members increase the loudness of their speech. Such high
loudness level decreases intelligibility, because the quality of intonation is poor,
and it would misinform the perceiver about the emotional state or intention
of the speaker. In short, loud speech close to shouting is less intelligible and may be
fearful for the perceiver. It is even more likely to happen in the case of individuals
with sensory loss or other communication difficulties.
Another important disadvantage of background music is that it interferes with
normal environmental sounds. Children are able to recognize events by their sounds,
for example the sound of boiling water is associated with a meal, or the steps of the
mother with her closeness. Individuals with severe disabilities, especially those with
visual impairment use the same ability to predict future events by surrounding noises.
Moreover, continual background music decreases the caretaker’s willingness
of singing, or even communicating with the clients during daily routines. For example,
singing would be a natural part of bath. Decker-Voight (2004) pointed out that
full-body contact with water and the aurally pleasing acoustic environment reminds
human beings on the womb of their mothers. That is the reason why singing
in the bath is a widespread behavior across cultures. Whereas it could be an intimate
calming activity, loud ergotropic background music can alienate this event.
While needs and sensory awareness of people are highly different, all human
beings need peace and quiet. The lack of silence can have serious complications.
Many people, especially young ones grow up surrounded by the continually turned-on
electric source of music. They are endangered in becoming conditioned or even
addictive to sound, and they struggle with silence. For some, constant over-exposure
of our aural nerves makes a quiet environment even unbearable (Sipthorp &
Bittman, 2011). Individuals with severe disabilities are also endangered. Listening
to music is the most widely provided free-time activity for these people. However,
Zijlstra and Vlaskamp (2005) call it ‘passive activity’, because it rather means turning
a device on in the morning and turning it off in the evening. The lack of silence
spoils the capability to enjoy music, because using continual background music
as an acoustic filter decreases the ability of paying full attention to music and sounds.
64
THE ROLE OF ACOUSTIC ENVIRONMENT IN THE SENSE OF SECURITY
FROM LEITMOTIFS TO ACOUSTIC SCHEDULE
Considering the polyvagal theory of porges (see Chapter 5), it is vital to build a safe
and predictable environment, because the neuroception of people with severe
disability is more likely to detect danger in the case of unexpected, unwanted
or unfamiliar sensory inputs.
Calendar systems and orientation
The calendar system is a widely used tool in special education with the aim of orien-
tation and anticipation. In practice, various calendar systems are used. The simplest
form is using calendar boxes with real objects representing different activities.
The order of these boxes represents the timeline of different activities. Other calendars
use small objects, pictures or words with the same purpose.
The first step to establish a more complex calendar system is the anticipation calendar.
In this case, instead of a timeline, we only use one sign at a time which represents
the next event. The acoustic schedule is a sonic anticipation calendar based on the idea
of leitmotifs: musical themes associated with extra musical meaning. It is a powerful
tool for children and nonverbal adults providing orientation or life structure for
its users. As it was described, young infants are able to connect events and people
with different sounds. On this basis professionals can build different signs, and even
complex communication systems. Such an aural communication system can be used
even when other symbolic forms of verbal, gestural or visual communication lack.
The idea of Leitmotifs
Leitmotifs are primarily associated with classical music and Wagner’s Ring Cycle.
The Ring of The Nibelung is a monumental work: a series of four operas, approximately
15 hours of music. The plot is based on German and Scandinavian myths and folk tales,
with three generations of different mortal and immortal characters. In order to help
the audience to orientate in this long and complex story, Wagner used musical motifs
to represent characters and objects in linking elements of the plot.
According to Dahlhaus (1980), the Leitmotif or leading motif is: a recurrent
musical theme, or another coherent idea, to represent or symbolize a person, object,
place, idea, state of mind, supernatural force, etc. The composer retains the musical
theme or slightly modifies on subsequent appearances.
In the Ring Circle, some of the Leitmotifs representing a character suggest something
about his or her overall personality. For example Alberich, the villain is represented
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by a fast and harsh chromatic motif. The giants’ motive is a loud and heavy brass
easily associated with their footsteps. Other motives symbolize objects, for example
the fanfare symbolizes the appearance of gold. In this case, the instrumentation
is important, trills in strings, woodwind in the background, and the percussion
at the end depicts the glitter and glint of gold.
There are many other sound painting motifs, mostly those associated with
nature, such as the rainbow, and the Rhine. Other Leitmotifs express emotions,
for example the minor second down as the expression of pain and woe. There are
more complex concepts such as power of the ring, which are not only heard when
the ring is being used, but also when an event is associated with its power or when
a character desires to own it.
These motifs are developing and changing. Wagner linked together two, three
or more of these signs, used only an identifiable part of a Leitmotif or slightly changed it.
The orchestra plays more than what is seen on stage, reminding the audience
of an important event, or representing a character that is not on stage. Listening
to the orchestra, the audience knows what will happen on the stage, or has a clue
about something that the character on stage does not know (Krauss, 2011).
Wagner developed an extremely complex system of leitmotifs. Different researchers
have identified 60–90 Leitmotifs, and some of them are a modification of another
motif. For example the motif of Sieglinde, Siegmund’s twin sister, is the inversion
of Siegmund’s motif. While people in a concert hall usually know that Wagner
used the leitmotif-system, only a few musicologists can identify more than a few
percent of them. However, the Leitmotifs, in English guiding or leading motifs,
are effective: after a few repetitions we associate the musical element with a character,
object or concept without being able to name or identify the particular theme,
chord progression or rhythm.
Movie makers also use leitmotifs, however, most of the time the audience does
not identify them. For example a two-note motif represents the shark in the movie
Jaws (1975). The most famous example of motifs in film is provided by John Williams
in the Star Wars movies. There is a wide range of motifs: the most identifiable
is the Force motif, but there are several others, such as the theme of Leila, Luke,
Anakin or the Rebel fanfare. John Williams started from the idea of Wagner. Star Wars
is a long and complex ‘space opera’ with strange objects, places and characters.
Thus, Williams was asked to compose traditional music, because the audience needs
something to be familiar with. He exploited the flexibility of Wagner’s Leitmotif
system changing the orchestration, mood or other musical quality of the themes
depicting the development of a certain character. He used the motifs in a simple,
direct and schematic way, for example, diatonic scales represent heroes or heroism,
while motifs based on chromatic scales depict negative objects.
66
This theme-variation form is similar to the process of building and defining

common codes in early communicative musicality. Bergeson and Trehub (2007)
analyzing infant directed speech also described stability and repetition, as critical
characteristics of maternal speech to infants.
Forster (2011) describes the process of developing meaningful pre-symbolic
communication and developing symbols on this basis “by the use of objects as symbols
to express wants and needs”.
The use of Leitmotifs in special education
The use of Leitmotifs in communication is slightly similar to the approach of Symbolic

Communication Training through Music (SYCOM) which is a communication
intervention technique developed under the umbrella of Neurologic Music Therapy.
SYCOM uses a nonverbal ‘language’ system including speech gestures and
emotional communication, musical dialogues, question and answer forms to develop
and stimulate adequate communication behaviors (Oliver, Thaut & Sena, 2005).
What we can learn from these examples is the importance of acoustic cues,
namely that they are effective even without conscious verbal reflection.
Establishing acoustic schedules based on Leitmotifs
The most natural form of an acoustic schedule is based on the use of natural sounds.
In this case, it is important to establish firm connection between the person, event,
place, and the acoustic cue. For example, we can use the same shoes or slippers
to make our footfall more recognizable. The sound of a mixer can be a cue for food.
In order to establish a firm connection between the food and the sound, the mother
should turn the mixer on, even it is not necessary for preparing the food.
The use of Leitmotifs is more complex when we establish acoustic cues to represent
people, activities or places. For example, family members can knock on the client’s
or child’s room with an identifiable personal rhythm. Communicative signs
or Leitmotifs can be established by emergent themes from a meaningful inter-
personal communication, as it happens during the early communicative interplay.
For example, we sing something when playing with building blocks. If it was
an emotionally meaningful moment for the communication partners, the song will
easily be associated with this activity. Another possible use of acoustic sign is when
a tune represents a person. For example, one of my musicians became a friend
of a professional flutist. When he wants to mention this person, he imitates the sound
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of the flute perfectly. First he moved his fingers as well to make this sign clear for me,
but most of the time he only used the acoustic form. When I’m talking about
this person and he realizes it, he makes this sign to emphasize that he knows
who we are talking about.
The most conventional way of working with an acoustic schedule is to choose
melodies or themes and sing (whistle or play) them in the concrete situation. It is possible
to introduce and reinforce a wide range of motifs and themes. As these themes
are well-known in our cultural contexts, other people will be able to use our system
as well. For example, a basic schedule consisting of well-known songs for children
can be used by other people interacting with the child. In early childhood education
it is highly beneficial to use selected musical material associated with the daily routine,
such as wake up songs, dressing up songs, breakfast songs, etc. The use of these
songs creates security, and helps the orientation of the child in space and time.
Furthermore, it provides continuity, for example in an institutional setting where
the person taking care of a child is not always the same staff member. The Leitmotifs
are shorter than a song; they are only one or two beats long, with something that
makes them distinctive. For example a melody consisting of minor thirds is similar
to the majority of the first singing games all around the world, so it is not the best choice,
unless it has a unique rhythm. The use of the motifs should be consistent, to help
the clients recognize them.
A complex acoustic schedule consists of different elements, varying recorded
musical pieces, natural sounds, songs for children and short motifs. Both at home
and in an institutional setting it is beneficial to play the same music associated
with morning, lunch, afternoon sleep and so on. In an institutional setting, it is only
possible for common events or activities. Well-known pieces, such as Morning Mood
from Grieg’s Peer Gynt Suite (Nr. 1 op. 46.), or Vivaldi’s Largo from the Four Seasons
(Concerto No. 4 in F minor, Op. 8, RV 297, Winter) can be chosen because they
are parts of a well-known musical culture. The disadvantage of using popular pieces
is that these classical pieces can be heard frequently, even as background music
or an advertisement on TV, which may cause misunderstanding.
There are opportunities to develop and enrich communication by slightly changing
the Leitmotifs or songs. The first way is the use of so-called flexible songs that consist
of a firm structure and melodic pattern, and a changing part. For example, while
in the bath, we can use a firm song, singing it over and over again, naming different
body parts. The other way of developing the system is simply changing something,
and if the child or the client smiles, similarly as it was written in communicative
musicality, it will be a unique common code. For example, we can slightly modify
the motif of food to establish different variations of the same motif for breakfast,
lunch, and dinner. This is a pre-conscious way of abstraction, expressing the connection
68
between different signs. In addition to cognitive development, the establishment

of new codes strengthens the ‘we-sense’. The last way is abstraction, for example
the shortening of the motif as used in films or in the music of Wagner.
In music, Leitmotifs have narrative, structural and connective functions. They
change and develop with the evolution of characters. All of these functions are
important in establishing an aural communication system. As the example about
the sound of flute has shown, there is a narrative function: my musician can express
his desire to meet his friend. There is a structural function: with the use of different
kinds of music associated with the daily routine, it is possible to predict different
events and understand the structure for the day. The connective function helps
to recognize and associate events, recall memories and develop cognitive functions
in expressing the connection between these signs.
The advantages of singing
The most intimate use of the Leitmotifs is when parents, therapists or caretakers
sing these songs or themes. The human voice is highly sensitive and expresses
intentions and emotional states. Similarly to the small but meaningful changes
of the Leitmotifs in classical music or films, our singing voice is informative
about our inner state, feelings, and intentions. Furthermore, singing for someone
is an intimate activity, providing a certain level of intersubjectivity. The research
of Bergeson and Trehub (2007) has shown that in maternal speech there are
individually distinctive and discernible tunes. Previous research of Bergeson and
Trehub (2002) has revealed the same stability in infant-directed singing in mothers’
pitch level and tempo. These individual and identical features of maternal speech
and singing facilitates voice recognition. The authors assume different other functions
of familiar tunes, such as the recognition of words or phrases and the identification
of the mother’s intentions and emotional states.
Practically, it is difficult to rush someone, to shout or to be harmful when singing:
the song schedule helps the caretaker to slow down and focus his or her attention
better on the child, thus it provides more emotional security. The singing voice of the
caretaker at the same time expresses and tames his or her possible unpleasant feelings,
such as stress, anger, or frustration. ‘Singing out’ these feelings helps both the child
and the caregivers to cope with them. It is important to learn how to cope with these
feelings, and maintain authenticity in the relationship. It is not always successful,
because parents of children with a disability frequently cope with anger, worries,
guilt, and depression. Many of the parents want to hide these negative emotions
from their children. However, they are highly sensitive to the emotional state
of their parents (see Chapter 5).
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Of course, it is not necessary to use certain songs or recorded pieces for the rest
of one’s life. However, it is possible that using motifs with small children, these motifs
become important years later in a summer camp, in hospital or in a new environment.
In adulthood, it is also possible to establish such an audible orientation system, but it is
important to use musical material according to the chronological age of the client.
An optimal and responsive environment increases the sense of agency, opens
new ways for social interaction and autonomy, decreases challenging behaviors,
and increases impulse control and well-being (Cuvo et al., 2001; Kern & Humpal, 2012).
The use of an acoustic schedule, especially with the combination of recorded music,
sung elements and natural sound helps to provide a secure, honest, learnable and
predictable social and physical environment. Another important function of these
motifs is that we can promise the given person something pleasurable, and we can
call to mind events, places or people in their absence.
The introduction of the acoustic schedule system is highly beneficial even
if we cannot establish complex communication systems, or we have no feedback
from the client about his or her understanding.
Oldfield (2006, p. 131) refers to the case of Saperston (1973) with an 8-year-old
boy with autism. The therapist accompanied the child’s movements and gestures
on the piano. As the child understood the play, began to smile at and initiated eye
contact with the therapist. Moreover, he developed the general ability to interact
with other social partners.
As this example shows, the establishment of shared meaning increases the will-
ingness of communication and increases cognitive functions such as the ability
to understand cause and effect.
Questions
What is noise pollution?
What are the disadvantages of continuous background music?
What is a Leitmotif-system? How do Leitmotifs support understanding in Wagner’s Ring Cycle?
What can special education learn from the use of Leitmotifs in music and film?
What are the natural building blocks of an optimal acoustic environment?
What are the steps to establish and develop an acoustic communication system?
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ENJOYMENT FOUND IN CLASSICAL MUSIC
The method of Klára Kokas
The method of Klára Kokas is based on the repeated listening of selected pieces
of classical music. Participants are encouraged to respond to the music with spontaneous
gestures and movements. This method facilitates deep musical understanding and
sharing it with the group through improvised movements. The Kokas method was
simplified and adapted for adults with severe disabilities in Szent Erzsébet nursing
home in Ipolytölgyes, Hungary. The experience of such sessions following the adapted
method of Klára Kokas suggests that it holds many possibilities in social, emotional,
and cognitive fields, even for nonverbal adults.
THE CONCEPT OF RECREATIONAL MUSIC THERAPY
The literature of music therapy describes the concept of recreational music therapy.
According to Bruscia (1998), implementing music or other artistic experience
in institutional settings has a power to enhance the quality of life, thus, increase the
health and well-being of the participants, thus, it is a powerful tool for therapeutic change.
Recreation and hobbies are important parts of human life, because these activities
promote mental and physical health and emotional wellbeing, serving as an intrinsic
source of pleasure. Furthermore, having a hobby means to be engaged in a meaningful
regular occupation, to make conscious efforts to learn something new, or develop
new skills. Thus, recreation and hobbies serve as special and joyful forms of life-
long learning: to discover creativity and hidden talents, to provide opportunities
for socialization, to increase self-knowledge and self-esteem. For people with disabilities
this is even more important, because they provide opportunities for participation
and building relationships, thus, preventing secondary problems stemming from
isolation, such as aggression, self-aggression, decreased self-esteem, and depression.
Hobbies can be considered everyday activities and practices that fill one’s life and
form social identities. Gallagher et al. (2015 online) suggest that any occupation
that can be characterized with the words “meaningful doing, being, belonging and
becoming”, has a positive impact on health and wellbeing. When offering interventions
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to improve health and wellbeing, professionals must consider the social structure,
the individual’s identity and what she or he chooses to do.
Unfortunately, hobbies are still rarely a part of the everyday experiences of people
with severe disabilities; this aspect of life is frequently forgotten, even by professionals.
Zijlstra and Vlaskamp (2005) reported that residential or daily care services are rarely
prepared to offer meaningful and freely chosen leisure activities. Thus, leisure time
often comes down to empty hours rather than meaningful activities (quality time).
Although people with severe disabilities are highly dependent on their relationship
with others in having access to leisure options, professionals working in the field
criticized the concept of planned leisure activities considering it to be contradiction
in terms. They also reported on the ambiguity about the understanding of leisure
activities for persons with severe disabilities. “Is being pushed outside in a wheelchair
during a sunny afternoon ‘leisure’ for the person involved? Is being in the kitchen
while others prepare lunch a leisure activity? Is being in the swimming pool
leisure or therapy?” (Zijlstra & Vlaskamp, 2005, p. 435). The results of their study
have shown that ‘passive activities’ such as watching television or listening to music
on the radio, without any kind of selection or free choice, are the activities that
were offered the most. They conclude that people with severe disabilities are excep-
tionally disadvantaged in accessing leisure activities due to the complexity of their
needs and the attitude of professionals, who rather focus on therapeutic, medical
and educational interventions.
While the lack of verbal communication or damaged sensory and motor systems
makes it challenging to provide artistic participation for individuals with severe disability,
the adapted method of Klára Kokas and the Consonante method (see Chapter 8)
provide examples for professionals wanting to be more creative in designing and
organizing meaningful leisure learning experiences for people with atypical skill-profiles.
KLÁRA KOKAS
Klára Kokas (1929–2010) was a Hungarian music educator and professor of psychology
and pedagogy, who was a student of Zoltán Kodály. Her concept of music education
is based on the playful exploration of music by spontaneous body movements.
The goal of a Kokas session is to introduce children and adults to the realm of classical
music with passion. As she claimed: “I teach musical concentration” (1999, p. 23).
Ansdell (2014) describes the nature of this special attention to music as receptive
‘inner readiness’ to musical forms of vitality that is “complemented by an expressive
competence to characterize and perform ourselves musically through the ‘signature’
of our dynamic forms of vitality.” (2014, p. 109)
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At the 1st Art Therapy World Congress, Kokas (2003, online) presented her program
of music education. She accentuated the importance of the freedom of movement
that was based on the innate connection of music and movement that is predictable
and flexible at the same time and crystallizes in the course of multiple listening
of the same piece. Her experience, according to which improvised movements
provide a deeper reception of music. She has shown commonalities with the theory
of embodied music cognition. She has chosen the words of a nine-year-old participant
as the title of her book (1992): “Music lifts up my hands and plays with them”.
Her observations of the spontaneous body-movements of children responding
to music bear a resemblance to the description of Stern (2010) about five matching
dimensions of movement and music (tempo, rhythm, intensity, stress and accent,
and flow and shape). Kokas described the development of the dances of her students.
“They explore – in freely chosen order but in their indivisibility – rhythm, melodic
cadences, shifts, in consonance, harmony, responses to each other, their dialogues,
their meetings, the entering, the departing, or the harmonious blending of the
different parts.” (Kokas, 2003, online). Leman’s (2007) theoretical framework about
the three levels of musical engagement (synchronization, embodied attuning and
empathy) also holds similarities with the observations of Kokas. Thus, Leman’s theory
may provide a theoretical basis for understanding these music-induced movements
(see Chapter 4.). Kokas wrote that “instrumental sounds address the subconscious,
the preconscious and the conscious, and what is more, the realms of their minds
beyond consciousness – not in the language of factual knowledge but in the language
of emotions” (Kokas, 2003, online). According to Kokas, the full-body engagement
in listening experience does not divide the attention of the dancer but increases
the level of concentration providing a pathway for understanding music.
Even small children feel and express musical phrases, instrumentation and
such complex musical meaning that is possible to teach as abstract concepts when
the child is getting much older.
Klára Kokas invited Zsuzsa Pásztor, who graduated at the Liszt Ferenc Academy
of Music as a piano teacher and earned her PhD with her research of the Kovács-method
“The Care of Musical Work Capacity”. Pásztor analyzed the video recordings
of the sessions. The research reinforced the observations. Pásztor (1980, 1983a,b,
2003, 2016) accentuates that spontaneous bodily response to a sound is phylogenetically
much older than the intellectual concepts, and as such, small children are able to perceive
and respond to complex musical patterns that they would not be able to approach
intellectually. She also accentuates the visibility of the progress of musical under-
standing by comparing the video recordings of beginner and practiced listeners,
the latter being able to move in synchrony with the music and their movements
resembling dances with aesthetical quality. As Pásztor (2003) wrote, improvised
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dances are interpretations of the music in terms of timing, harmony, form, structure
and timbre, integrated with the emotional and personal experience of the dancer,
or as an expression of collective creativity. She accentuates the multidimensional
role of the method on attention, memory, anticipation and the continuous translation
of auditory signals to familiar bodily experiences and movement patterns.
ADAPTATION AND EXPERIENCES
The Kokas method, as a non-language based approach, holds a great educational

and therapeutic potential for nonverbal adults as well. The music-movement program
can be beneficial in promoting sensory integration, increasing cognitive functions
by understanding and anticipating patterns, including attention, memory, and abstract
thinking. The positive ambience of the sessions provides security for social and
emotional learning, strengthens the sense of belonging, and helps to discover
meaningful and enjoyable new pathways of communication. As a joint creative
involvement, where participants are mutually influenced by one another, the sub-
jective sense of well-being, thus, leads to the overall development of the self.
Music can be described as a highly complex and attractive multisensory stimulus.
Vibro-acoustic sensory stimulation is a commonly used therapeutic tool both
in special education and in music therapy (Breger, 2002; Hooper et al., 2004;
Wigram, 1997). In basal stimulation, a concept developed by Andreas Frölich,
vestibular and vibratory experiences play on self-cognition by facilitating the body
awareness and communicative intention of clients with severe and complex needs
(see Chapter 5). People suffering from motor dysfunction may experience their
bodies as a source of continual pain or a domain out of their control. Positive
bodily experiences play a vital role in well-being as well as body awareness and
the overall development of the self.
A body of research has proved the positive role of optimal and responsive sensory
environment in the sense of safety, especially for children and adults with severe
disabilities, cerebral palsy and autism (Carter & Stephenson, 2012; Fornes, 2009;
Hall & Case-Smith, 2007; Kaplan et al., 2006; Lotan & Gold, 2009). Thus, an environment
supporting the process and integratation of sensory information is considered
a necessary condition of a wide range of learning activities. As it was explained
in the previous chapter, music can be an optimal sensory environment. In accordance
with this theory, the experience of both adapted and traditional Kokas sessions
is that repeated listening of classical music increases attention and impulse control
while reducing challenging behavior. As Kokas (2003, online) states, “the body
discovers its laws in joy and devotion, in vitality, safety and love. Everything else,
74
including our revival through self-expression and personal relations, stems from this.
The body is the shell, the place and the means of our capacity to experience joy.”
In order to make the vibration of the music more tangible, I use inflatable furniture
(mattresses and a sofa), a rocking chair, and spring-powered beds for rocking
or jumping. In addition to making a bridge between the audible and tangible
features of the music, this special furniture increases the bodily feedback of small
self-induced movements of the clients fostering their body awareness and sense
of agency. With the words of Kokas, “inspired music can be a physical sensation;
it moves you, perhaps it can even be touched. It resounds in you, below and above you,
all around you.” (1999, p. 11)
SOCIAL INTERACTIONS
Sharing aesthetic experience has a deep impact on social connection. In a Kokas session,
complex and joyful artistic communication or even joint creation is an important
aspect. We have observed many different ways of communication (Szûcs-Ittzés &
Tiszai, 2016). When clients respond to music with movement, they often recognize
the movements of fellow participants as communicative gestures, a way of sharing
their receptive experience. According to the theory of communicative musicality,
the realized matching contour of behaviors increases the willingness of communication.
When participants become aware of the matching aspects of their movements,
they initiate communication via eye contact and smiling. The most frequent commu-
nication forms are facial and gestural interactions, imitation, cross-modal behavioral
changes and direct physical contact.
Rocking on the same mattress is also a special form of communication. I discovered
this game by accident. Some of the participants seemed to be passive during the whole
session, sitting or lying on one of these mattresses. They never initiated contact
with fellow participants. Nevertheless, I saw some of these “passive” clients smile
when someone started jumping on the mattress they were lying on. I realized that this
is a frequent and typical way of communication. Later on, I realized that on many
occasions when participants were using the inflatable furniture, they actually used
it as a communication channel. Furthermore, we observed that most of the clients who
do not normally tolerate the closeness of other people, also enjoyed this rocking game.
In order to gain a deeper understanding of this form of communication,
I established a few sessions with only two participants sitting on an inflatable sofa
designed for two persons. I tested these shorter dyadic sessions with six participants
and most of the possible pairs. I could observe different structures, question-
answer forms, or simultaneous movement. In one of the sessions, a person moved
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while the other one behaved as a receiver: paying attention, but not initiating new
movement. At some point they changed roles, usually after a musical phrase.
In another session I observed ‘polyphonic’ synchronization of slightly different
movements on the same mattress. Both forms of interaction were often reinforced
by smiling, but rarely by eye contact.
Another interesting observation was that one of the participants, who never
interacted with fellow participants or the leader before, seemed to appreciate the music
sessions. After these dyadic sessions, this particular participant even prefers to sit
on that sofa during the regular sessions, most probably seeking for communication.
The polyvagal theory provides a possible explanation for the increased level
of communication. The firm and predictable frames of the sessions and the repeated
listening of the same piece of music could increase the neuroception of safety,
thus increasing the willingness for social interaction.
COGNITIVE BENEFITS
Video analysis has shown that these clients move in synchrony with the music
responding to more or less complex musical phenomena (Szûcs-Ittzés & Tiszai, 2016).
Close observation of the gestures of the listeners shows that participants’ movements
are often synchronized with more than one significant features of the musical piece
they were listening to. For example, a participant followed the meter with the move-
ments of his or her upper body, expressing the changes in tempo, melody, rhythm
or dynamics of the music. In harmony with the progress of the composition,
this person changed the movements according to the form or structure of the piece,
and responded to the orchestration with smaller movements of the hands or arms.
These gestures can be described with Leman’s categories of music-induced movement:
synchronization, embodied attuning and empathy (see Chapter 4). We could
observe different signs of cognitive functioning, for example, smiling or changing
the movements when the musical piece is peaking, or the dynamics of anticipation-
satisfaction. Some of the participants changed their movement seconds before
the musical peak, presumably expecting a certain musical resolution. Synchrony
itself is a sign of anticipation, but simultaneous movements are the result of under-
standing and anticipating different patterns. In another study, two participants
were filmed during the repeated listening of a Chopin piece. Video analysis has
shown anticipation behavior of the repetition of the main theme after the cadence,
and memory functions: the expectation of the listener’s favorite part a few beats
before it started was clearly visible (Bakos & Tiszai, 2018).
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SOCIAL INTERACTION AND EMBODIED LISTENING
The aim of the research of De Bruyn, Leman and Moelants (2008) was to explore
the role of social interaction in the embodied experience of music. According
to their view-point, the human body is seen as a mediator between meaning-
formation activities at the mental level, and musical signals at the physical level.
In this view, corporeal articulations are interpreted as an active personal involvement
of a subject listening to music, including the perceived musical structure and
emotions evoked by music. In this experiment participants were asked to move
in synchrony with the beat of ten different musical excerpts both in an individual
and a social condition. Their hypothesis was that listeners have an impact on each
other’s movements, such as enrich or decline other subjects’ synchronization
or movement intensity (De Bruyn, Leman & Moelants, 2008). The experiment
proved their assumption. They conclude that “there is a social embodiment factor
which can be measured and quantified. The children did not synchronize better
in the social condition, but the social context did stimulate them to move more
intense to the music” (De Bruyn, Leman & Moelants, 2008, p. 666).
Even Ruud considers musical gesture as a basic form of interaction enrooted
in biological behavior that has the power to establish complex social communication.
Even this corresponding nature of movement and sound exists at an unintentional,
pre-linguistic level, without self-conscious attention, and gestures stemming from
one being may be taken as a signal which functions as a stimulus, which initiates
a process of adaptation and signification in the other being. All such responses may
develop into mutual gestures towards the opposite being, which creates a series
of interactions, adaptations and changes in attitude (Ruud, 2008, p. 56).
Something similar happens when participants of Kokas sessions mutually influence
each other, by sharing their experience with visible movements and gestures. Moreover,
in the case of joint creation, participants also use a more complex direct and conscious
artistic communication. Schütz (1951) considered musical experience as a basic form
of any social experience. From this view, meaningful joint musical communication
is a special form of education. It could be even more important when there is
a lack of verbal communication: it could be a prevention of social isolation,
which is frequently reported as a secondary consequence of severe disabilities.
In short, a Kokas session could provide positive models of further relationship
building by facilitating prelinguistic gestural interactions. Even the emergent
synchrony of movements without any conscious communicative intention could
promote a positive emotional experience, and as such it could develop the intention
of communicating and interpersonal sharing.
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MUSICAL REWARD
The musical pleasure linked with the dopamine related reward system could be one
of the key aspects for motivation and learning (see Chapter 5). Many of the indivi-
duals with severe disabilities are disadvantaged to experience other rewards linked
with dopamine: even eating is not always pleasurable, especially for those using
feeding tubes. Thus, musical reward is a unique experience. It means that music
could enhance learning: the anticipation of reward or the state of ‘wanting’ is associated
with the increased functioning of attention and memory. Musical anticipation
is a cognitive function, predicting an already known musical piece based on attention
and memory, while in the case of a new musical piece it is a complex function
of analyzing previously known familiar patterns, while anticipating the progress
of the piece being listened to.
The experience of musical reward could reinforce different educational or therapeutic
uses of music, for example the acoustic schedule, or communication. This concentration
and learning ability may be transferable to other areas of cognitive development.
The anatomy of anticipation is still undiscovered. It may be based on musical image-
schemas as Have (2008 online) theorized (see Chapter 4).
There are different reactions to being captivated by music, ranging from motionless
silence to the decreased level and intensity of challenging and passive behavior
(aggression, self-aggression). The lack of self-stimulation or the synchronization
of usual stereotypical movements with the music are also clear signs of emotional
involvement. In other cases attention and emotional reactions can be discovered
by a gaze or a facial expression.
THE ADAPTED KOKAS SESSION

Simplified structure
The structure of these sessions is easy to recognize. The session consists of three
subsequent parts: the introductory singing, the listening part and the closing song.
The introductory and the closing song provide the frame and the repeated routine
of the session. Like for the acoustic schedule, this is important for the orientation
of the participants. We start the session with singing each participant’s name.
Name-singing functions as a personal invitation to participate, helps clients to prepare
for the music, and may recall memories about the previous sessions. This is an effective
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way to call the attention of the participants, since after a few sessions participants
were waiting for being called by their name. The original structure of the Kokas
Method contains a preparatory part before the listening experience with singing
games and improvisations. However, this was hard to realize with nonverbal adults
with severe disabilities. Furthermore, they do not need more preparation; many
of the participants express their desire to listen to music, for example by looking
at the device that usually played the music. Thus, after the introductory singing,
we start to listen to music. During this part, we listen to one piece of music over and
over again. The selection of the music is crucial. Kokas used the term ‘inspired music’
accentuating the aesthetic dimension of the listening experience. She frequently
quoted the words of Kodály (2007/1929), that “only art of intrinsic value is suitable
for children!” (p. 39), encouraging music teachers to select short and high-quality
classical masterpieces for their classes.
For beginners, Kokas suggested short and expressive baroque pieces such
as Angelo Corelli’s Badinerie (Violin Sonata Op.5, No.11 in E Major, Mov.4).
Short modern pieces with predictable rhythmic features, for example the short
pieces of Bartók: For Children, are also recommended. For participants already
familiar with these Kokas sessions, slower and longer music can be introduced,
and finally, less predictable and longer romantic or modern masterpieces. It is also
possible to listen to more than one piece during a session, but in the case of adapted
sessions usually one piece remains pleasurable during a 30-minute-long session,
even for experienced participants.
Kokas summarized her method of teaching as attention to music: the session
leader should support participants to pay full attention to the music. It is easier with
nonverbal clients, because even if they vocalize sometimes in response to the music,
they are more capable of remaining silent. On the contrary, verbal clients with less
behavior control tend to disturb the listening experience by speaking. According
to my observations most of the nonverbal clients familiarize themselves with the
ambience of the session without any problem. The leader should act on the indivi-
dual needs in a non-intrusive and compassionate way: interact or facilitate interactions
between clients and the music or facilitate communication between group members.
Restraining and being able to recognize and not disturb the intimacy of the com-
munication is also important. The leader has to consider the individual needs
of personal contact, reinforcement or privacy and the balance of the group as a whole,
while managing disturbing behaviors with gentleness and humor.
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Ways of supporting
The leader of the sessions should not enter the personal space of the participants
without permission, thus, it is recommended to use eye contact, facial expressions,
imitation of movements and body positions, or any kind of vitality-affect based
communication. With blind clients, playing with the air as a communication tool
is recommended. For example, using small fans or moving sheets in synchrony
with the pulse of the music can be a gentle invitation for communication. Similarly,
indirect physical contact with soft materials is recommended: pulling a blanket
or a sheet over the body of the client, changing directions with the musical phrase,
or gently initiating the mattress game are ways to offer a secure means of contact,
which can be developed.
The rejection of any communication can be a sign of fear but also a test of their
free will and the reaction of the leader. In both cases, accepting their reaction
reinforces their sense of competence and self-esteem. Furthermore, practice has
shown that by not big forced, the client learns that we value his or her whole personality,
so they become curious and emotionally engaged by the entrainment of fellow
participants and they seek for contact. The patience of the leader usually yields its
fruits and builds trust to develop a deeper relationship.
Reinforcing by mirroring movements and gestures
Mirroring or imitating the movements and body position of the clients enhances
affective attunement and a climate of unconditional acceptance. Participants
recognize when the leader imitates their pre-intentional and intentional movements:
most often they respond to this communication by smiling. Imitation or other
kinds of mirroring games, including mimic and gestural interactions, resemble
the early communicative musicality creating intimacy and trust, developing unique
and personal patterns of communication (Holck, 2004).
The theory of dance therapy uses the term kinaesthetic empathy: the ability to feel
the sensations of the specific movements of another person in one’s own body
(Behrends, Müller & Dziobek, 2012; Dosamantes-Alperson, 1984; Dosamantes, 1992).
The turn-taking games of imitation are also helpful for the leader, because they
provide a deeper understanding of their clients’ bodily sensation, and as such their
intentions and emotions.
In order to evaluate these sessions, it is useful to establish an individual profile
of the participants, describing how the person expresses his or her interest or frustration.
This can be done by observing the most frequent patterns of self-stimulation,
preferred ways of interaction, and other additional information. Some of the participants
80
respond with a movement-pattern to a given musical phenomenon, for example

changing the direction of the movement with a musical structure, shaking the hands
or nodding the head to express the basic beat of the musical piece, jumping in musical
climax, etc. The individual profile is formed by a collection of their affirmative
musical and non-musical responses, patterns of communication, engagement,
and positive or negative emotional states.
When evaluating my sessions I found that visible feedback alone sometimes lacks
information. For example, after not seeing any reaction during a session, I decided
not to include this particular patient in a next session. It was reported later that
she kept crying afterwards. The limitation of their motor and other skills usually leads
to the misinterpretation of their real musical understanding or emotional involvement.
It is almost impossible to evaluate the many possible parallel interactions even
with video analysis. However, strong appreciation, or the so-called receptive musical
talent, a unique skill in full attention and passionate listening to classical music
(Gembris, 2005; Gyarmati, 2002; Kokas, 1999; Révész, 1953) is remarkable during
these sessions. Individual musical taste, for example a clear preference of a musical
instrument, style, or composer is observable during the sessions. It is also important
to mention that observed negative reactions such as aggression, self-aggression,
making disturbing noises, shouting or repeating words, or repeated stereotypical
habits not synchronized with the music, are gradually decreasing with years of listening
experience, which indicates that musical engagement is learnable. Furthermore,
experienced participants function as core members in a group, causing new members
to learn this attention faster than in a group of novice listeners.
Questions
What is a recreational model of music therapy?
How do musical gestures support social interactions?
What are the common elements of Pásztor’s explanation about children’s understanding
of music and the theory of embodied musiccognition?
What are the subsequent parts of the adapted Kokas session?
What are the criteria of the selection of music for a Kokas session?
What does receptive musical talent mean?
Why is it challenging to evaluate a Kokas session?
How can the leader support the participants’ engagement during the session?
What is kinaesthetic empathy?
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ORCHESTRAL WORK
AND COMMUNITY MUSIC THERAPY
The Consonante method
Although numerous methods have been established in the field of community music
therapy as well as special musical education for people with different disabilities,
it seems to be difficult to offer musical participation for those not following verbal
instructions or not able to use even simplified notation. The Consonante Method
was developed in Ipolytölgyes, in Szent Erzsébet Home, a nursing home for 150 people
with severe disabilities. The work started as an optional recreational opportunity
for the residents of this home. During the musical sessions it became obvious that
common shared music gives various opportunities for personal development.
An orchestra called Nádizumzum was formed with a purpose to give public perfor-
mances where these musicians can experience success and appreciation. The orchestra
consists of nine members of the institution. They have rehearsals twice a week
and they give public concerts. In contrast to their everyday experience of dependency
they become aware of their ability to give. Interactive concerts or dance-house events,
where the audience is more involved in the shared music, are even more effective
to create an atmosphere of equality and mutuality.
The Consonante Method is based on three main principles: (1) using vitality
affects and automatic synchronization for providing unity in the group, (2) searching
and adapting musical instruments to suit the physical abilities and movement patterns
of the musicians and (3) using simplified accompaniment called bagpipe bass.
THE NATURAL BASICS OF MUSICIANSHIP
As the extended literature of communicative musicality has shown (see Chapter 3),
all children are born with an innate predisposition to respond to music (Blood &
Zatorre, 2001; Gordon, 1979; Malloch, 1999; Trainor, 1996). In other words, all human
beings possess a certain level of innate musical competency or aptitude. As several
authors have pointed out, musical talent in general terms does not exist, because
musicians, listeners, and composers possess different aspects of musical talent,
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like the ability to improvise, perform, play a musical instrument, sing, compose,
or to receive and own music with emotion (Davidson, Howe & Sloboda, 1999;
Gembris, 2005; Gyarmati, 2002; Hallam & Prince, 2003; Kokas, 1999, Rózsáné-
Szabó, 2007). Therefore, it is more appropriate to talk about a musical skill profile
than a particular ability.
Musical ability, musical talent and musical intelligence are basic concepts of musical
education that have been defined in various ways. Many tests have been developed
to measure the grand variety of identified musical skills. The first research examined
questions relating to aural abilities (rhythm and pitch) or other predictable factors,
as genetic-based basic sensory discrimination or aural skills (Seashore, 1919, Seashore,
Lewis & Saetveit, 1960). Subsequently, different musical ability tests were developed
to predict the future success of musical training (Gordon, 1965, 1979, 1982, 1989).
The validity of these aptitude measures has been criticized because following research
shed light on the fact that musical ability tests usually show high correlation with
previous musical training, thus they are rarely informative about innate abilities
(Ericsson, Krampe & Tesch-Romer, 1993; Gilbert, 1981; Sloboda et al., 1996; Hallam,
1998a, 2004; Williamon & Valentine, 2000). The research of the last decades proved
that in addition to measured musical ability, acquisition of an expert musical
behavior depends also on socio-economic status, self-concept in music, reading
achievement, educational ability, and other factors (Mawbey, 1973; McCarthy, 1980;
Klinedinst, 1991; Hallam, 1998a).
As this short summary exemplifies, the complexity of musical talent makes
it difficult to measure musical ability. It is even more difficult in the case of indivi-
duals with severe disabilities, because of motor and sensory impairments, severe
behavioral problems or the lack of verbal communication. Similarly to intellectual skills
(see Chapter 1) musical skills of individuals with severe disabilities are hardly
measurable with ordinary methods. These people are generally physically unable
to complete the tasks of the different standard musical tests. Aural perception can
be measured by a number of clearly defined characteristics of the sound such us pitch,
loudness, rhythm, time and timbre. New computer based testing procedures
as well as traditional methods for testing aural skills expect some kind of response
to these perceptions. However, all of these tests involve motor skills, verbal
communication, or other abilities (Gilbert, 1981).
However, musical ability is usually associated with the ability to sing properly.
Hüther (2009) pointed out that one of the most precise fine motor activities
in the whole body is the control of the vocal-cords. Individuals with severe motor
impairment usually sing off-key. This is not an obvious sign of the lack of inner hearing,
but rather the result of the incapacity to control the vocal cords. The same problem
manifests itself in the case of producing rhythm. The inability of moving in time
with a rhythm (for example in a drumming or clapping test) is a possible consequence
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ORCHESTRAL WORK AND COMMUNITY MUSIC THERAPY
of delayed motor response. Consequently, the evaluation of the abilities of individuals

with atypical skill profile must be based on close observation of the affirmative
musical responses because the limitations of their motor and other skills usually
lead to misinterpretation of their real musical abilities.
The process of becoming an orchestra member starts with the observation
of the applicants’ musical skills. The receptive musical behavior of the future musician
is the first and most important source of information: the movements they perform
upon hearing music. Many of these individuals follow the changes of music with
their movements, expressing different levels of engagement from simple rhythmic
synchronization to precise and dynamic interpretation of music following small
changes in tempo, rhythm, intensity, stress or accent, flow and shape. As it was
mentioned in previous chapters, spontaneous and rhythmically synchronized body
movements upon hearing music are considered as an innate human behavior
(Eerola, Luck & Toiviainen, 2006; Kirschner &Tomasello, 2009; Toiviainen, Luck &
Thompson, 2009; Styns et al., 2007). Even the simplest form of attunement
is enough to begin community music making for example by playing rhythmic
accompaniment for songs. As these musical movements are rather automatic
than the result of conscious efforts, they are closer to the innate natural musicality.
Clients not being able to keep the meter of a song while clapping are usually able
to move in perfect synchrony with the music they are listening to. In this case
the use of the natural motor patterns to make rhythmical accompaniment of the songs
can be the way to develop their musicianship.
There are other signs of musical engagement. Some of the musically talented
individuals take pleasure in imitating and responding to the surrounding environ-
mental sounds. They are usually singing, whistling or clapping. Others enjoy using
different objects as musical instruments by trying to create new and interesting sounds.
Drumming on different objects or using a comb, a toothbrush as a mallet and seeking
interesting sounds is a natural musical behavior.
THE FOUNDING PROCESS OF THE ORCHESTRA
First, I discovered the musical ability of my instrumental soloist by accident.

She did not speak and spent her day with her accustomed daily routines. Between
two obligations she stayed fixed in an absolutely immobile body position that
she could keep for hours. I was playing a small children’s song to someone else
on xylophone. After more than an hour I put the instrument in front of her. I did not
expect any reaction, because she rarely responds to strangers and she had not had
any contact with me. Unexpectedly, she stretched her arm for the sticker, and played
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the same melody without any mistake. I was astonished. I started to sing melodies
and she played all the songs she already knew. Furthermore, she could play them
in any key. As I started to discover her ability to play, her mother told me that her
daughter used to play the piano. She became the soloist of the orchestra. She plays
with an absolutely uncomfortable technique, and she does not change this position.
But, she follows musical instructions when I show her the character by a recorder
or singing. She is also able to make changes when I describe my intention verbally,
or when I use the technical terms of music as I would do with professional musicians.
In the beginning she did not practice a critical part of the piece; instead she played
the whole piece from the beginning to the end until she played the melody perfectly.
After a few years she started to follow my instructions and to practice only a few
particular beats. As she used to learn to play the piano, she still has a lot of memories
about classical pieces. For example, on one occasion she just started to play the melody
of The Trout [Die Forelle Op. 32, D 550] by Franz Schubert.
The second member of the orchestra was a woman with a good sense or rhythm.
She played accompaniment for any song with simple percussion instruments.
She was able to speak a few words, but since her mother’s death she rarely speaks.
At the beginning she used my Zither to accompany the play of the soloist, but after
five-six minutes se became frustrated, throwing it away. Later on she received her
own Zither. I gave it to her with the following instruction: “This is yours. No one
else will use it. But if you throw it away, I won’t catch it anymore.” Although this
instruction was complex and contained a lot of abstraction such as ‘own property’,
or the possible consequence of throwing the instrument. Nevertheless, it was effective:
she did not throw the instrument away since it is her own.
The third orchestra member was a young woman kicking the drum.
For the summer we prepared folk songs for a concert with a larger group.
For this occasion I started to join the group with my Zither and we extended
the orchestra to 10 musicians.
During the last eleven years there were changes in the orchestra. I could offer
participation for people with different behavioral challenges. A prior condition for
receiving members with behavioral problems is having core members in the orchestra
who follow the given song with joy. They provide the continuity of common creation
of music serving as positive role models and sources of inspiration for the other players.
Behavioral challenges can disrupt the unity of sound, thus, (working alone with
the group without an assistant) the balance between members with behavioral
problems and highly motivated musicians is the most important factor of success.
The participation in the orchestral work is a powerful way of social learning,
could serve as a therapeutic vehicle to overcome aggressive or disturbing habits,
provided that music has become intrinsic motivation for the new member.
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CUSTOM BUILT INSTRUMENTS
Rosenkatz, Williamon and Rothwell accentuate that “playing a musical instrument

is one of the most complex skills a human can achieve” (2007, p. 5200). In contrast
to the traditional way of teaching and automatizing new fine movements, the Consonante
method uses a reverse strategy: searching for special instruments that could be
modified to suit the abilities of individuals with physical limitations. Nijs, Lesaffre
and Leman (2009) describe the process of learning a musical instrument as building
the instrument to the body-scheme of its player, or with their words “prevent
the musical instrument from standing in between what the musician wants and
what he gets” (p. 132). In the case of a traditional musical instrument, the complex
fine movements of the player are far away from the natural gestures evoked by music.
In our case the individual sound-producing movements must be as close to the natural
gestures of the future musicians as it is possible.
Another prerequisite for participation in the orchestra is to persevere in this
activity during a one-hour-long concert the way of using the instrument should
suit their gross and fine motor skills. For example, banging a string instrument
with a stick or mallet is a less complex movement than using picks. Although one
of the musicians is able to use a large plastic card with a spongy handle, this is not
a natural movement. She has to use different fine movements of her wrist to be able
to pick. Consequently, it is more difficult to persevere in the play and less automatic
to attune with the group. Most of the musicians use mallets, because it is possible
to bang the strings by using many different movements of the elbow-, humeral-,
or whist joints. It is also helpful to persevere if the movement of playing automatically
fits with their accustomed body-movements.
The literature of musical gestures (e.g. Cadoz, 1988; Cadoz & Wanderley, 2000;
Jensenius et al., 2009; Wanderley & Depalle, 2004) describes different categories
of music related movements. In my study I use three main categories: (1) sound-
producing gestures, (2) ancillary gestures and (3) communicative gestures.
The movements that make an instrument sound are the sound-producing
gestures, or in other words they are instrumental or effective gestures. Wanderley
and Depalle (2004) suggest the term ancillary movements to describe those gestures
co-occurring with the sound-producing movements but not producing a sound.
According to the study of Wanderley (2002), these movements are stable and
reproducibly essential parts of the instrumentalists’ performance. These movements
“usually not carried out with a specific intention other than being the basis for,
or the result of, the sound-producing gestures” (Jensenius et al., 2009, p. 26).
There are many different types of ancillary gestures. Jensenius et al. (2009) describe
the following subcategories: support, phrasing, entrained and communicative gestures.
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Supporting or sound facilitating movements have an audible component, for example

the movement of the hand, arm, or upper body changes the quality of the sound
produced by the finger of a piano player. Phrasing movements express musical
phrasings, for example the study of Wanderley et al. (2005) has shown that the rhythmic
sway of a clarinetist corresponds to his breathing patterns, thus, expresses the musical
phrases of the melody being played. Tapping a foot, nodding the head or moving
the whole upper body in synchrony with the music are so-called entrained gestures.
These gestures can be different depending on the performers and the style of the
music being played. Regarding to the tempo it is also important to know that
entrained gestures serve as a generator of rhythm and timing while it is also true
that rhythm and timing can be a generator of these movements. Communicative
or semiotic gestures are those observed in performer-performer and performer-
perceiver types of communication.
In the case of special musicians, the main task is to bridge the gap between the natural
movements evoked by music and the sound-producing movements. There are
different solutions for finding the proper instrument for the participant. Some
of the participants are able to perform a specific movement and intentionally make
sound with a musical instrument. In other cases it is possible to use given repetitive
movements, for example tapping with the fingers and turning it to sound-producing
movement to play a rhythmical accompaniment for songs.
Many of these individuals keep repeating sound-producing stereotype movements.
For example, one of the musicians of the Nádizumzum likes playing with fusiform
objects, and uses them for knocking or tapping. I studied her play to know whether
she takes pleasure in the movement or she makes the movement for the sound
it produces. Observing her movements I recognized that she plays in a virtuosic way,
her small performances are not just a monotonic repetition of the same sound:
she keeps changing dynamics, loudness and intensity. Her improvisations could
be described by different musical terms as accelerando or rondo. She likes playing
with the spoon or bread-crust, which means that musical performance with these
objects is more captivating for her than food.
In other cases it is possible to work with different repetitive movements that
originally do not produce any sound. For example, another orchestra member’s
favorite activity is playing with the slider of the zipper or whirl any kind of strings
in her clothes. I wanted to find an instrument to suit these movements. First
I tried out small bells hanging on strings, but she hit her mouth with them until
it started to bleed. As a second try I fixed the same bells into a belt, attached
to her stomach, but she still found a way to hit her lips. Finally a small tambourine
was the solution: she made the metal parts sound with a similar finger-movement
as she plays with the zipper.
88
The last approach is to observe the movement with which the client responds
to the music and find a way to produce sound as part of this movement pattern.
It is possible with small bells attached to the body of the musician, or to make
the accustomed movements (for example finger tapping) audible by giving a drum.
When someone produces full-upper body movements while listening to music,
it is relatively easy to implement sound producing movements that suit this
listening behavior. The hands of the person most often also move in synchrony
with the music, banging an instrument with the hands or a mallet, may make
these movements audible.
It is also possible for clients to participate without being able using a hand
or singing. One of the residents of the institution with cerebral palsy wanted
to join our performance but she couldn’t use her hands. I didn’t know how to find
a solution until I became attentive of her ability to control the movements of her feet.
I offered a big drum for her to kick. She hit it so hard that we had to fix it with stones,
but it was not stable enough. Finally a metal fixture was constructed connecting
her drum with her wheelchair. This way we could establish an unchanged distance
and position for the drum, thus, she could practice her movement precisely.
A harmonica holder could be a solution when musicians can’t use their hands,
but are able to influence their respiration. This kind of playing needs more consciousness
than using the given motor patterns, most often automatically being synchronized
with the music without any effort.
Finding an appropriate instrument can be a long and challenging process.
The instrument should be so captivating for the future musician that playing
it should become a motivation per se. Thus, only well-tuned instruments should
be used with pleasant sounds. Furthermore, the musician must find enjoyment
in the newly found instrument. This is usually a result of research and experimentation,
a step by step creation of instruments or sound-producing techniques that suit
the participants’ personal needs at the highest level.
To become a musician one must learn to enjoy music. According to a famous
phrase of Isaac Stern “the one who learns to enjoy music will become a musician”
(cited by Gyarmati, 2002). I found this approach essential, because learning
to play an instrument always presupposes effort and hard work. In the case of adults
with severe disabilities the only motivation can be the enjoyment of their music.
Musical ability itself is not enough. These people have to overcome the secondary
consequences of isolation, for example, addictive habits of self-stimulation.
They have to leave the security of their closed world; they have to pay attention and
adapt their play to fit the group and delay the gratification of their needs. This is only
possible if the music becomes an intrinsic or, with the term of Csíkszentmihályi (1990),
autotelic experience for these musicians. For example, one of the members was
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aggressive, but she enjoyed listening to music and imitating environmental sounds,
such as a dog barking and the noise of different electric equipments, with singing
or whistling. When I offered her musical instruments she tried them out for a few
minutes, but afterwards she started to destroy these instruments by biting, hitting
or throwing them away. Finally the solution was an instrument, similar to the dulcimer
with hard and strong strings, that she couldn’t destroy it because hitting the string
shove back her stick like a rocket. Repeating it over and over again, her tension
decreased, she started paying attention to the sound she made, and finally she could
pay attention to the music being played by fellow musicians and accompanied
the songs in a gentle and sensitive way.
BAGPIPE BASS
In order to make performing more joyful than simple rhythmic accompaniment,

we use the principle of the bagpipe-bass. The term refers to the drones of the bagpipe
that always produces the same sound, namely a base sound and a perfect fifth.
This is a typical phenomenon in Hungarian folk music, and not only the bagpipe
but different other folk instruments follow this pattern, such as the Hungarian zither
(citera), and the hurdy-gurdy (tekerõlant).
The hurdy-gurdy contains three strings: one is operated by wooden keys,
and the other two, which are called the creaking strings, produce a bourdon accom-
paniment. The Hungarian zither has great variety in form, size, and timbre. The simplest
version called the “trough-zither” resembles an oblong rectangular trough, and its
open side is facing the table. As Sárosi mentions, between the two world wars there
were villages in Hungary where the zither could be found in almost every house.
The reason for the instrument’s popularity is its simplicity: it is easy to make
(usually they were home-made), and easy to play (Sárosi, 1998; Kodály, 1971).
The zither can be diatonic or chromatic. The diatonic zither has a fingerboard
in which the frets are under the strings, while the chromatic version has two pairs
of melody-strings with two different frets. The fret under the outer pair of strings
produces a Mixolydian scale, and the inner pair provides the missing chromatic notes.
Skilled zither-players can show their talent performing rich and various ornaments.
The zither, just like the hurdy-gurdy, also has only a few strings, on which the main
melody is generally played, the remainder strings (4–16) called the accompanying
or “guest” strings, produce the keynote, the perfect fifth, upper fifth and upper
octave of the melody strings. Whichever folk song is played on these instruments,
the accompaniment is a pleasant consonant, but determines the key in which
the melody can be played.
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In addition to the folk songs, the bagpipe-bass can be found in the works of the two
famous Hungarian composers Bartók and Kodály, and it also has been present
in every musical style since the Renaissance. For example, in Haydn’s last symphony,
in the folk dance scene of Beethoven’s Pastoral Symphony, or in Chopin’s works
(Ittzés, 2002). In short, the accompaniment with the base sound and the perfect
fifth could fit with a wide range of musical genres.
The custom built musical instruments must be altered according to this simplified
style of accompaniment of a key note and it’s fifth. In order to suit the accompaniment
for the melody sung, the keynote for each song is given and cannot be changed.
With this simple limitation no one can play false on these instruments. Hence,
I named this method Consonante.
INSTRUMENTATION
Any kind of musical instrument can be used and modified. The possible tone colors
are increasing with the variability of the instruments. The most important factor
is the quality of the instruments. If we intend to experience joy and being involved
in making music, we must use well-tuned and high-caliber musical instruments.
Evidently, it is the quality of sound that should play the most crucial role.
An advantage of using string instruments is the fact that they are easy to tune
to this simplified accompaniment. Percussion instruments, such as the metallo-
phone or the xylophone, could also be used after removing the unnecessary keys
or altering them in other ways. One of the musicians, whose automatic movements
were rather slow and gentle, was only able to sound the kalimba with a small wooden
mallet. The metal slabs were re-tuned with a screwdriver by fastening the anchorage
points on the instrument.
Wind instruments, such as the whistle, are also tuned to C and G. The harmonica
(or mouth organ) can also be used by covering the unnecessary lamellas or re-tune
them with a nail file. The Nádizumzum, after which the orchestra was named,
is a Hungarian folk alteration of the kazoo which also enlarges possibilities, develops
singing-skills, and, what is more, children usually like sounding it. The advantage
of the kazoo is that it is still functional when the singer does not know the text
of the songs. Another observation is that my singer who has difficulties in speech
production, struggles with the tempo of the songs. When she accompanies her
singing with an instrument, the accompaniment follows her rhythmical asynchronies,
while singing in the kazoo without struggling with the pronunciation of words
makes her singing more accurate. However, only a few of Nádizumzum’s musicians
can speak or sing, and not every singer understands that they have to sing into
the nádizumzum instead of blowing it.
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THE ADVANTAGES OF USING FOLK SONGS

The use of folk songs was not only the consequence of following the pattern of the
bagpipe bass. In Hungary, folk songs are still part of national culture. The repertoire
of the Nádizumzum Orchestra consists of over 250 Hungarian folk songs, which
are captivating for participation. The audience easily recognizes them and sings
along with us, especially when they are encouraged to do so. In addition to the practical
benefits, these songs are ancient national and cultural forms of music, a possible way
to make a connection with our culture and heritage that is even more important
for individuals endangered by social isolation. Furthermore, recognizing common
cultural roots can build strong ties within the community, where people with and
without disabilities can form a common social identity through music. Kodály
considers folk songs to be a child’s own cultural constitute or, in other words,
“musical mother-tongue” (1941/2007, p. 192). He said: “Music is a manifestation
of the human spirit, similar to language. Its greatest practitioners have conveyed
to mankind things not possible to say in any other language. If we do not want
these things to remain dead treasures, we must do our utmost to make the greatest
possible number of people understand their idiom.” (Kodály, 1953/2007b, p. 295)
As we perform and sometimes teach new folk songs in our concerts, the orchestra
is also a transmitter of culture.
Regarding the international perspective, the described model can be used by other
nations. Hungarian folk music applies and uses melodies based on the pentatonic
scale that is widely used in folk-music around the globe (Faragó, 2011).
It is also recommended to involve the typical folk instruments of the nation
or region where the method is used. I have intended to teach other nations’
pentatonic songs to our orchestra-members. Making it clearly differentiable from
the Hungarian cultural heritage, I replace the zither with guitar for these songs.
The sound of the zither is unique and loud, (it was used to accompany dances),
and therefore, replacing it with something else causes distinctive changes in the sound.
THE PROCESS OF ATTUNING

In order to play together, the musicians should be engaged to the common
creation of music.
Responding to music with synchronized body-movements is an innate human
musical behavior (Aigen, 2005; Leman, 2007; Malloch, 1999; Nordoff & Robins, 1977).
The synchronization of these movements with the music happens almost automatically.
However, there are different conditions of the unity of the sound produced by the
orchestra members.
92
To become a member of the orchestra can be a long learning process. The new
members have to make connection with the surrounding reality, they have to be present.
This is challenging in itself, because many of these individuals live in their own worlds
protecting themselves from overwhelming or environments. Some of these people
disconnect with the present moment from time to time due to different medical
conditions such as painful or disturbing sensory inputs or small epileptic episodes
(called simple or complex focal seizures). Furthermore, these individuals are rarely
conditioned to focus their attention for a longer time, thus, they are more sensitive
to different distractors, such as doors, windows, or any kind of discomfort.
To make an instrument sound and insist on playing for hours is a difficult task.
But as many of these people easily engage with music, the orchestral work is a highly
motivating activity. Some of the musicians first enjoy the music in a receptive way,
and play the instrument just for a few moments. Others can be very preoccupied
with their instruments and play without paying attention to the main melody.
But later on they can enjoy both. Dynamical theories of rhythm coordination
describe that interpersonal synchrony arises naturally in different social situations
(Richardson, Marsh & Schmidt, 2005; Richardson et al., 2007; Schmidt et al., 1998).
OPTIMAL ZONE OF ATTUNING
At the beginning of the orchestral work we accompanied the playing of our instrumental
soloist. While she could play the melodies with a limited tempo, we all started to
follow her performance. After a year we were asked to play folk songs for a one-hour-
long dance-house, and our tempo were not suitable for dancing. As we started to
play faster and faster, I was surprised that my instrumental soloist could keep up
with the group. She skipped some of the musical notes, but she played the rest
of the melody with high accuracy. The rest of the musicians seemed to enjoy fast
tempos more and we could play in better synchrony.
There is an interesting explanation for that. Cyclic motor patterns, such as walking,
finger-tapping, or even speaking is associated with a stable personal rate an endogenous
(internal) rhythm (McAuley et al., 2006; Moelants, 2002; Murray, Drought, &
Kory, 1964). The optimal efficiency of different motor systems depends on individual
differences in anatomical and biomechanical constraints. Endogenous rhythms
are natural motor resonances, to minimize the effort and energy expenditure.
Temporal coordination and interpersonal synchrony depend on two main components:
the endogenous rhythm and the external influence.
According to Van Noorden et al. (2017), being able to synchronize with different
tempi is a learnt skill, infants and young children are able to synchronize with
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a very narrow range of frequencies, approximately around 120 BPM (Drake et al., 2000;
Van Noorden et al., 2014).
The research of Zamm et al. (2016) has revealed that the endogenous rhythms are
an important component of interpersonal synchrony, even in common shared music.
Individuals, even musicians with close endogen rhythms are able to synchronize
their movement better than those with different rates. The experience of the orchestral
work suggests that the natural sound-producing movements of the musicians are
relatively fast, therefore, they can synchronize better with fast tempos. According
to my experience, the optimal zone of attuning seems to be approximately 90–120 BPM,
but temporarily the orchestra is able to play in synchrony for a short time even
much faster (140–190 BPM). In slower tempos, some of the musicians tend to double
their movements (e.g. playing 160 BPM instead of 80), but this double tempo
does not disrupt the unity of the music.
The most important consequence of this observation is that we can produce
folk songs in original tempos, thus, the audience can sing or dance with us. When
the orchestra members simply start to play together (for example before or after
the official rehearsal) they frequently synchronize their play spontaneously. I try
to choose the speed of our songs close to the tempo where this spontaneous
synchrony frequently occurs.
VITALITY AFFECTS AND MUSICAL CHARACTER
As it was described in the previous chapter, the movements responding to music

are more than stereotypical or repetitive patterns. Even with a highly limited movement
repertoire participants appeared to make dynamic responses to the music, matching
in force, time, space or intention with the music (see Chapter 2, 3). I used these
movements as a basis for future orchestral work. As Pásztor (2003, 2016) and the
theoretical framework of Leman (e.g. 2007) also accentuate, human beings tend to
synchronize their movements with the beat and the meter first, and later with other
characteristics of the music. In addition to synchronizing, the goal of the rehearsals
is to practice different musical characters and making the participants sensitive
to follow bigger or smaller changes. Naturally, with increasing emotional involvement,
it is easier to play accelerando and crescendo than diminuendo or decrescendo.
It is more difficult to react to sudden changes, thus, we practice these changes
together with the particular piece. With years of practice the orchestra members can
find the proper fine movements to express different musical characters, and they
learn to pay attention to these changes.
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COMMUNITY
Music is originally a social activity, thus musical participation plays crucial role
in socialization. The experience that regardless of the way of using these instruments,
their sound is always consonant with the ‘whole’ promotes the sense of belonging.
The cross-modal matching of perceived musical behaviors of fellow musicians,
even if it is only semi-conscious at the beginning of the play, helps the participants
to synchronize their movements with the beat of the performed piece and the move-
ments of fellow musicians. Furthermore, it is an important therapeutic experience
of emotional sharing and belonging to the community. According to the theoretical
framework of communicative musicality, musical communication and affect attunement
provide a firm basis for intersubjectivity and interpersonal sharing.
Social isolation is reported as a secondary consequence of severe disabilities
(Brown, 2004; Favire et al., 2000; Groce et al., 2011; Palmer, 2013; Schädler,
Rohrmann & Schür, 2008; WHO & World Bank, 2011). Many of these individuals
are deprived of the opportunity of learning the basic social roles of a given community.
The lack of social experiences and the occurrence of socially unacceptable behaviors
form a vicious circle (see Chapter 1). Thus, the expectations coming along with being
part of a performing group, prepare these individuals for participation in different
communities. They have to learn not to expect the full attention of the leader but
adjust their personal expression to the common-shared music. Musicians must learn
to pay attention to one another, and follow different social rules: delay the gratification
of their needs, focus their attention to the leader and keep doing their tasks even
if they are not motivated to persevere. Being a part of a musical community plays
an important role in community building. Musicians experience positive aspects
of fellowship such as equality, mutuality and having quality time with others.
The musical performance is a common creation of each participants, the quality
depends on each musician. This interdependency is a completely new perspective
in their lives. As they play a subordinated role in all of their relationships deprived
of responsibilities and obligations, they learn the importance of their part and
the respect towards the other members of the orchestra. They also learn working
on a particular musical piece and tolerating the stress of a public performance,
including travel, disturbing noises during the performance, and a new environment.
As a reward of their perseverance, they experience success, applause and other
forms of appreciation. They become aware of their ability to give and these experiences
increase their self-confidence, self-esteem and sense of agency. Furthermore,
the membership has a positive impact on the life of the whole family: parents can be
proud of their children, invite their friends to the concerts, make new relationships,
and share their experiences with others.
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COMMUNITY MUSIC THERAPY APPROACH
Community music therapy considers musical performance as a unique pathway

of social inclusion, and a vehicle for social changes. Common shared music is a unique
way to reframe social interactions and provide equal and mutual relationships
(Kaufman & Source, 2011; Pavlicevic & Ansdell, 2004; Stige, 2010; Welch et al., 2014).
From this perspective, a musical performance challenges the prejudgment
of the society. A successful concert promotes social recognition and empowerment.
People with severe disabilities are often described as people without voice
(e.g. MENCAP, 2001). As Stige and Aaro (2011) claimed “we cannot give people
a voice, but we can contribute to the construction of conditions that allow for previously
unheard voices to be heard [...] It also opens a space for visions of a better world.” (p. 5)
Successful concerts help to hear the unheard voices of this minority group.
With the words of Ruud: performance provides “a way to gain access to symbolic
resources often highly regarded within a society” (2008, p. 58).
Stige and Aaro (2011) summarize, “Community music therapy encourages musical
participation and social inclusion, equitable access to resources, and collaborative
efforts for health and wellbeing in contemporary societies. It could be characterized
as solidarity in practice” (p. 5).
Petra Kuppers (2004) reflects to the challenge of being a performing artist
with disability. As she is a professor and also a performer with physical disability,
let me provide a longer quote of her thoughts:
The disabled performer is both marginalized and invisible relegated to
borderlands, far outside the central area of cultural activity, by the discourses
of medicine. At the same time, people with physical impairments are also
hypervisible, instantly defined by their physicality. The physically disabled
performer has therefore to negotiate two areas of cultural meaning: invisibility
as an active member in the public sphere and hypervisibility and instant
categorization as passive customer and victim in much of the popular imagination.
Disabled performers have successfully and visibly taken up the medium
of performance to expand the possibilities of images spaces and positions
for their bodies. In their work in public spheres, they attempt to break through
stereotypes of passive disability (p. 49).
It is important to keep in mind this aspect of public performances of people

with severe disabilities and visible facial and bodily disfigurement (see Chapter 1).
The quality of the performance is essential to help the audience to overcome their
prejudgments.
96
There are many different ways to promote this attitudinal change. I became
aware of this aspect of our concerts after one of the first public performances of the
Nádizumzum. It was a long process to prepare everything on the stage because
of lack of experience. I felt the tension of the audience. Our group was highly
different from previous performers with fewer or no visible signs of disabilities.
As I stood in front of the orchestra, I could not see the audience, but I saw
the faces of my musicians. As they are really sensitive to the attitudes towards them,
they seemed really discouraged. Then we started to play. Slowly I saw a smile
appearing on their faces, and I knew that they react to the change of the audience.
I realized during the concerts that more or less seven minutes of playing is enough
for this change to happen.
At the second level, we started to involve the audience, giving them percussion
instruments, encouraging them to sing along with us, or asking someone to lead
simple dances. These interactive concerts are even more successful, provided that
we can impress the audience. If they enjoy the performance and feel that they
have received something valuable from people belonging to an undervalued and
marginalized minority group, such concerts can promote attitudinal changes.
As one of the participants of a workshop in which she played together with
my orchestra shared when talking about her experience: “I enjoyed it so much,
it was a lot of fun. But if I had met with these people on the tram, I wouldn’t have
known what to do.”
Workshops and inclusive concerts
In 2013 we started new projects: workshops for professionals and inclusive concerts
with amateur and professional musicians, and music students.
The first workshop was planned for a national art therapy congress in 2013
(Tiszai, 2016.). The main goal of the workshop was to prepare a musical encounter
between musicians of the Nádizumzum, and participants of the workshop.
The workshop had three subsequent parts. First, as an introduction I demonstrated
the method and presented a general overview about people with severe disability.
Second, the participants could try the instruments out, and we made music together.
The instruments are captivating and easy to use, thus, people were able to make
music without any previous musical training. The third and most important part
of the workshop was, when the Nádizumzum members arrived, and they played
together with the participants. The appearance of the musicians enhanced the quality
of the play. Considering that the Nádizumzum rehearse two hours weekly and it was
97
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the first trial of the participants, this is not surprising. However, with the commonly
held prejudgment that people with severe disabilities are passive customers,
or subjects to charity, this was an unexpected experience for the participants.
In addition to better synchrony, the joy they bring to common music making
encouraged the participants to be more creative. This is a reverse form of inclusion:
the Nádizumzum, as an experienced musical community shares their goods with
the participants who need their help in this newly learnt activity. This situation,
as a metaphor of social inclusion, challenges the traditional ‘cosmopolitan’ concept
of social care, which considers social inclusion as a unilateral act of charity,
without any benefit for the majority of the community (see Chapter 1).
Preparing a concert together with other musicians is also propagation of inclusion.
Musicians, music students, and Nádizumzum members are similar in the common
shared passion for music. When we rehearse together, music becomes a basis
of mutual understanding and fruitful cooperation: the participants experience joy,
togetherness, equality and mutuality. Working on common shared musical goals
is a common experience of the participants regardless of the level of musical training
and intellectual capacity. This situation naturally leads to focusing on the abilities
and talent of fellow musicians. Guest musicians understand and appreciate
the musicianship of the Nádizumzum members, while they carefully adapt their
abilities and talents to the common performance. This situation leads to a natural
balance between accepting the limitations, appreciating the talents and expecting
effort and work from fellow musicians with severe disabilities. The balance
of these factors is the key of building an inclusive community, with mutual respect
and shared responsibility. The common performance is also a common shared
meaningful activity for both parties. Social bonding, interpersonal exchange and
the sharing of emotions facilitate deeper human relationships: guest musicians
and Nádizumzum members usually develop friendship.
Wider social context
The ecological model of social bonding offers a wider perspective for understanding
the importance of the experience of a musical community. According to this model,
the human person is a part of different interacting levels of micro- and macro-systems
(Bronfenbrenner, 1979, 1994; Richard, Gauvin & Raine, 2011). All human beings cause
important systematic changes through their existence. Considering the inclusion from
a utilitarian perspective, judging the value of the person only by his or her material
productivity cannot count with the positive role these people play in the different
98
systems. While denial and rejection are natural human reactions to defend our
identities, inclusion needs effort and work such as radical changes of the personal
value-system, our concepts about the value of human life, the role of material
productivity, well-being and human fulfillment. Similarly, these individuals challenge
our “cosmopolitan” social systems. However, the inclusion of these vulnerable members
is a foundation of new and more human systems and communities. Participants
of the common projects report joy, freedom, and quality time as the most important
experience. Fellow musicians often talk about a common performance, as a unique
and meaningful experience resembling the description of flow (Csíkszentmihályi, 1990).
According to his research flow or optimal experience occurs when someone is being
fully immersed in an activity with a sense of control caused by a challenge which
is adequate to the skills of the agent, and the immediate feedback about the performance.
This state of complete absorption in the present moment is gratifying, and the
activity is experienced as intrinsically rewarding. The author mentions that making
music is associated with flow by its nature, because many of these components
are given in a musical performance. Playful activities also become a source of pleasure.
In the case of inclusive concerts, the musicians of the Nádizumzum not always
behave and react as expected in certain social situation; which easily becomes
a source of humor. Playing with new people or having a new situation during
the concert, the members of the Nádizumzum may react and play in a different
way than during the rehearsal. Thus, fellow musicians must be aware of this fact
and be ready to improvise. This uncertainty leads to more focused attention and
brings playfulness to common artistic creation.
Furthermore, the visible disability of the orchestra members reduces the
performance anxiety of fellow musicians, thus, they are able to focus better and
be ready for risk-taking. During performance, this results in an increased level
of creativity, more focused attention, reduced level of stress, and more sensitive
attunement. As a consequence, the presence of vulnerable members fosters the
quality of the performance.
The inclusive concert experience is an example of the effectiveness of inclusive
communities. When the needs and talent of the most vulnerable members are taken
into consideration, we can build more human social systems and communities,
which are more effective and powerful than a competitive community. Furthermore,
the inclusive community is a testimony about the unconditional value of human
life and dignity. The high-quality inclusive performance carries out this message
for the audience by the visible joy and unity of the performers, regardless of any
difference in their abilities.
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CHAPTER 8
Questions
Why is the method named Consonante?
What are the basic principles of this method?
How to adapt the instruments to the movements of the musicians?
What is bagpipe bass?
What are the basics of the unity in the orchestra?
What can we learn from the community music therapy approach?
How can a common musical performance promote social inclusion?
100
EPILOQUE
This work is based on almost twenty years of experience with children and adults with
severe disabilities. While many of these people are not able to speak, music allowed
me to build deep and mutual friendship with many people who I could not approach
verbally. During these years I could see that professional musicians are amazed
by the musicality of these friends of mine when playing together with my musicians
or simply watching how they are able to enjoy classical music. For example, after
the first encounter with adults with severe disabilities a professional musician concluded:
“nothing works properly in these guys but music”.
However, for non-musicians it is difficult to discover these reactions. Once,
we had guest students in our institution. One of the residents of the home started to cry.
The student wanted to comfort her, but she could not. “What shall I do?” She asked me.
As this young woman is a passionate participant of a classical music listening group,
I said “Quality classical music”. “Oh well, music is not my cup of tea” responded
the student. I turned my cell phone on, choosing an adagio for her. My friend stopped
crying, turned her attention to the music, and started to tap the hand of the student
in synchrony with the piece. The student did not pay attention to that, instead,
started to talk to someone else. “Now, she is drawing the musical structure in your arm”
– I told her, because my friend started to draw lines to the forearm of the student:
one line for 8 beat, and back for the next 8. The student stopped talking. Instead
she closed her eye. They were like that until the end of the piece. The student slowly
opened her eyes. Realizing that I’m still there, she told to me: “You know what?
I understand this music, because she explained it to me.”
This was the aim of this work: to draw the attention of different professionals
to the signs of innate musicality and explain experience-based methods and their
theoretical background built on this capacity.
101
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PREVERBAL AND NONVERBAL MUSICALITY

PREVERBAL AND NONVERBAL

Szegedi Egyetemi Kiadó

© Luca Tiszai, 2019

PART I: THEORY ................................................................................................ 15

CHAPTER 2: QUALITY OF LIFE, COMMUNICATION

CHAPTER 3: COMMUNICATIVE MUSICALITY ............................................ 33

Establishing common codes: theme and variations .............................................. 36

CHAPTER 4: MUSIC, BODILY EXPERIENCE AND

CHAPTER 5: PSYCHOPHYSIOLOGY OF MUSIC.

MIRROR NEURON SYSTEM .................................................................................... 60

PART II: PRACTICE ............................................................................................ 61

CHAPTER 7: ENJOYMENT FOUND IN CLASSICAL MUSIC.

CHAPTER 8: ORCHESTRAL WORK AND COMMUNITY MUSIC THERAPY.

CUSTOM BUILT INSTRUMENTS ............................................................................ 87

EPILOQUE ...................................................................................................................... 101

REFERENCES .................................................................................................................. 103

PREVERBAL AND NONVERBAL

CH2: Communication, Vitality Affects and Quality of Life (Luc Nijs)

CH3: Communicative Musicality (Luc Nijs)

PART II: PRACTICE

CH7: Enjoyment Found in Classical Music: The Method of Klára Kokas

“Where words leave off, music begins.” (Heine)

Individuals with severe disabilities form a heterogeneous group. This group

DEBATES ON MEASURED AND EXPERIENCED SKILLS

HOW TO APPROACH INDIVIDUALS WITH SEVERE DISABILITIES?

HOW TO APPROACH INDIVIDUALS WITH SEVERE DISABILITIES?

experience of being misunderstood leads to anger, anxiety, frustration or even

Socialization and social inclusion

HOW TO APPROACH INDIVIDUALS WITH SEVERE DISABILITIES?

WIDER SOCIAL CONTEXT

‘Cosmopolitan’ view of inclusion

HOW TO APPROACH INDIVIDUALS WITH SEVERE DISABILITIES?

Connectedness, emotional security and intimacy are considered to be among

DANIEL STERN, VITALITY AFFECTS

as holistic amodal experiences coming from different sensations: dynamic changes

QUALITY OF LIFE, COMMUNICATION AND VITALITY AFFECTS

us to feel the emotional state of the other. Micro-analysis of nonverbal interactions

Piaget and Stern about the development of the Self

In order to understand the importance of attunement and connectedness better,

way of thinking. In contrast, Stern conceptualized overlapping, coexisting and

Figure 1 Stern, Daniel N. (1998): The Interpersonal World of the Infant:

QUALITY OF LIFE, COMMUNICATION AND VITALITY AFFECTS

Vitality affects in time-based arts

According to Stern, in addition to pre-linguistic communication vitality affects

According to the theoretical framework of communicative musicality, all human

PULSE, QUALITY AND NARRATIVE

Stephen Malloch introduced the term communicative musicality to describe a special

in intensity, pitch, timbre, and harmony. Narrative is the musical structure

BUILDING UP A COMMON CULTURE

The first level, synchrony is an automatically occurring human behavior. Human

Sharing the experience: creation of joint meaning

According to Gratier and Magnier, (2012) interpersonal sharing of inner states,

Establishing common codes: theme and variations

Malloch describes communicative musicality as an “expression of our human

The frame of the interaction – the wider culture

Balance and improvisational zone

Both in musical interaction and communicative musicality it is important to establish

of the we-experience and interpersonal engagement in a friendship, family or subgroup.

Musical engagement: synchronization, embodied attuning and empathy

TRADITIONAL VERSUS EMBODIED APPROACHES

Different concepts of cognition accentuate the pivotal role of physical, bodily